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Y4 - Prudent Antimicrobial Prescribing Flashcards

1
Q

Which antibiotics inhibit cell wall synthesis?

A 
Penicillins
Cephalosporins
Carbapenems
Daptomycin 
Glycopeptides
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2
Q

What antibiotic inhibits DNA synthesis?

A

Fluoroquinolones

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3
Q

What antibiotic inhibits RNA synthesis?

A

Rifampicin

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4
Q

What antibiotics inhibit protein synthesis?

A 
Macrolides
Chloramphenicol
Tetracycline
Aminoglycosides
Oxazolidonones
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5
Q

What antibiotics inhibit folic acid synthesis?

A

Sulfonamides

Trimethoprim

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6
Q

True or false:

Bactericidals work faster than bacteriostatics

A

True

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7
Q

Which antibiotics are bactericidal?

A 
Beta-lactams
Glycopeptides
Fluoroquinolones
Cephalopsorins
Daptomycin
Aminoglycosides
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8
Q

Which drugs are bacteriostatic?

A 
Tetracyclines
Clindamycin
Sulfonamides
Chloramphenicol
Linezolid
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9
Q

Which drugs are intermediate (can be bactericidal or bacteriostatic)?

A

Macrolides

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10
Q

What antibiotics are beta-lactams?

A

Penicillins, carbapenems, cephalosporins

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11
Q

What is the structure of beta-lactams and how do they work?

A

Contain a beta-lactam ring which inhibits formation of peptidoglycan cross links in the bacterial cell wall

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12
Q

What must you do before using carbapenems?

A

Seek microbiology advise

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13
Q

Give examples of antibiotics which are glycopeptides

A

Vancomycin and teicoplanin

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14
Q

Bactericidals should always be used for what group of patients?

A

Immunocompromised patients

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15
Q

What are the mechanisms of bacterial resistance to antibiotics?

A
  1. Bacteria acquire genes encoding enzymes to inactivate antibiotics, e.g. B-lactamases
  2. Bacteria finds alternative metabolic pathway, e.g. trimethoprim
  3. Alteration of the target site so antibiotic is no longer able to bind
  4. Decreased permeability via porin channels in the cell wall
  5. Antibiotic is removed from the bacteria via an efflux pump, e.g. tetracyclines
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16
Q

What is the difference between penicillin V (phenoxymethylpenicillin) and penicillin G (benzylpenicillin)?

A

Penicillin G is IV only

Penicillin V is oral only

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17
Q

What is the coverage with penicillin V/benzylpenicillin?

A

Streptococci
Enterococci (faecalis & faecium)

Moderate coverage of anaerobes

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18
Q

What are coliforms?

A

Gut bacteria, e.g. E. coli

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19
Q

Give examples of atypical bacteria

A

Legionella
Chlamydia
Mycoplasma pneumoniae
Myobacterium tuberculosis

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20
Q

Why are bacteria classed as atypical?

A

They don’t gram stain

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21
Q

What is coagulase negative staph?

A

Any staph that is not staph aureus

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22
Q

What is the coverage of flucloxacillin?

A

Staph, strep

Best for staph aureus

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23
Q

What is the coverage of amoxicillin?

A

Strep
Enterococcus faecalis

Moderate anaerobe, coliform and respiratory (e.g. H. influenzae, Moraxella catarrhalis) cover

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24
Q

What is the coverage of co-amoxiclav?

A 
Staph 
Strep 
Enterococcus faecalis
Anaerobes
Coliforms
Respiratory
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25
What is co-amoxiclav?
Amoxicillin + clavulanic acid (Beta-lactamase inhibitor) Helps overcome beta-lactam resistance
26
What are the broad spectrum penicillins?
Piperacillin/tazobactam Cover staph, strep, enterococcus faecalis, anaerobes, coliforms, respiratory pathogens and pseudomonas aeruginosa
27
What are the two carbapenems?
Ertapenem and meropenem
28
What is the coverage of the carbapenems?
Ertapenem and meropenem cover staph, strep, Ef, anaerobes, coliforms, respiratory, ESBL Meropenem also covers pseudomonas aeruginosa
29
What are the cephalosporins?
``` Cefalaxine (1st gen) Cefuroxime (2nd gen) Cefotaxime & ceftriaxone (3rd gen) Ceftaroline (5th gen) Ceftazidime/avibactam ```
30
What is the coverage of 1st to 5th generation cephalosporins and what trend does coverage follow as the generations become later?
All cover staph, strep and coliforms, After 2nd generation, all moderately cover anaerobes and cover respiratory well 3rd and 5th generation moderately cover ESBL 5th generation covers MRSA
31
What are the tetracyclines?
Tetracycline | Doxycycline
32
What is the coverage of doxycycline?
``` MRSA Staph Respiratory Atypicals Moderately covers ESBL, strep, anaerobes ```
33
What is the coverage of trimethoprim?
Moderately covers MRSA, staph, strep, Ef, coliforms, respiratory
34
What is the coverage of co-trimoxazole?
MRSA, staph, coliforms | Moderately covers strep, Ef, respiratory
35
What is co-trimoxazole?
Sulfamethoxazole & trimethoprim
36
What are the macrolides?
Azithromycin Clarithromycin Erythromycin
37
What is the coverage of erythromycin?
Atypicals Moderately staph, strep, anaerobes, resp
38
What is the coverage of azithromycin & clarithromycin?
Staph, respiratory, atypicals Moderately strep, anaerobes
39
What is the coverage of clindamycin?
Staph, strep, anaerobes
40
What antibiotics are used for gram negative cover?
``` Ciprofloxacin/ofloxacin Levofloxacin/moxifloxacin Gentamicin/tobramycin/amikacin Aztreonam Fosfomycin ```
41
What is the coverage of ciprofloxacin/ofloxacin?
Coliforms, respiratory, pseudomonas, atypicals Moderately staph, strep, Ef, ESBL
42
What is the coverage of levofloxacin/moxifloxacin?
Staph, strep, coliforms, resp, pseudomonas, atypicals Moderately Ef, ESBL
43
What is the coverage of the aminoglycosides?
MRSA, staph, coliforms, resp, pseudomonas | Moderately ESBL
44
What is the coverage of aztreonam?
Coliforms, resp, pseudomonas
45
What is the coverage of fosfomycin?
MRSA, staph, coliforms, ESBL Moderately strep
46
What antibiotics are good for gram positive cover?
Vancomycin and teicoplanin | Sodium fusidate
47
What is the coverage of the glycopeptides?
All gram positives (MRSA, staph, strep, Ef, anaerobes)
48
What is the coverage of sodium fusidate?
All gram positives (MRSA, staph, Ef, anaerobes, only moderately strep)
49
What is the coverage of metronidazole?
Anaerobes
50
What is the coverage of nitrofurantoin?
MRSA, staph, strep, Ef, coliforms, ESBL
51
What is the issue with nitrofurantoin?
Poor tissue penetration results in treatment failure in anything other than a lower UTI NOT suitable for urosepsis/pyelonephritis
52
What is the coverage of rifampicin?
MRSA, staph, strep, resp, atypicals | Moderately Ef
53
What is the coverage of chloramphenicol?
Everything apart from pseudomonas
54
Which antibiotics are known for their nephrotoxicity?
Vancomycin, teicoplanin, gentamicin
55
How do you treat community acquired pneumonia (CURB 0-1)?
Admission to hospital probably unnecessary Amoxicillin or Doxycycline
56
How do you treat community acquired pneumonia (CURB 2)?
Amoxicillin PLUS doxycycline | Consider admission to hospital
57
How do you treat community acquired pneumonia (CURB 3-5)?
Admit to hospital Amoxicillin PLUS doxycycline OR levofloxacin Vancomycin if MRSA suspected
58
What is trimethoprim used for mostly?
1st line for UTIs
59
What is co-trimoxazole used for?
Treating staph skin infections
60
What is often used as an alternative for those with penicillin allergy?
Clarithromycin
61
What are the issues with the macrolides?
Prolong QT interval DDIs common Prolonged use can cause sudden cardiac death
62
What are the ADRs assoc with quinolones?
Inhibit liver enzymes, DDIs, Achilles tendinitis, prolong QT interval and reduce seizure threshold - therefore must be avoided in those with epilepsy, alcoholics, recent head injury
63
How can quinolones affect older people?
May cause them to become drowsy and disorientated
64
What sort of toxicity can gentamicin cause?
Ototoxicity and renal toxicity | Ototoxicity often manifests as balance issues
65
What are vancomycin/teicoplanin useful for?
Orally only covers stuff in bowel (e.g. C. diff) | IV covers staph and strep
66
What are the issues with linezolid?
Supresses bone marrow Cannot be used in conjunction with antidepressants Can cause optic neuritis Do not use for more the 28d
67
What is sodium fusidate used for and what is the issue with it?
Impetigo | Do not use on own for long periods of time as staph become v. resistant to it
68
What antibiotic must not be taken with alcohol?
Metronidazole | Can cause facial flushing and hypotension
69
What can rifampicin be used for?
TB | Also aids penetration of other antibiotics in prosthetic infection by interrupting bacteria biofilm
70
What are the issues with rifampicin?
Interacts with rivaroxaban and warfarin etc. | Induces hepatic enzymes
71
What is chloramphenicol used for?
Meningitis (crosses BBB when meninges inflamed)
72
What is the issue with chloramphenicol?
Can cause aplastic anaemia
73
What is community acquired pneumonia?
Pneumonia acquired outside the hospital
74
What scoring system is used to assess the prognosis associated with pneumonia?
``` CURB 65 Confusion RR 30+ Urea >7mmol/L BP diastolic of 60 or less, or systolic of 90 or less 65y+ ```
75
What mortalities are associated with: 1. CURB65 0/1 2. CURB65 2 3. CURB65 3-5
0-1: <3% 2: 3-15% 3-5: >15%
76
What CURB65 scores should be admitted to hospital?
0-1 - home based care 2 or more consider hospital care 3 or more may consider ITU care
77
When should you offer microbiological tests for community acquired pneumonia?
Moderate/high severity CAP only
78
What tests should be done for community acquired pneumonia?
Blood and sputum cultures Consider pneumococcal and legionella urinary antigen tests XRay to diagnose
79
What two organisms cause most skin and soft tissue infections?
Staph or strep
80
What is the mainstay antibiotic for skin and soft tissue infections?
Flucloxacillin Clarithromycin if allergic Vancomycin if MRSA
81
What antibiotic is best to cover bites?
Co-amoxiclav (as it covers anaerobic gram negatives as transferred from saliva)
82
How do you treat uncomplicated UTI?
Trimethoprim 200mg BD 3 days for women 7 days for men
83
How do you treat uncomplicated UTI in pregnancy?
Nitrofurantoin (avoid in 3rd trimester) | 7 days
84
How do you treat urosepsis?
Gentamicin | Aztreonam if kidney problems

Infection (22 decks)

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