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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
Q

What is co-amoxiclav?

A

Amoxicillin + clavulanic acid (Beta-lactamase inhibitor)

Helps overcome beta-lactam resistance

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26
Q

What are the broad spectrum penicillins?

A

Piperacillin/tazobactam

Cover staph, strep, enterococcus faecalis, anaerobes, coliforms, respiratory pathogens and pseudomonas aeruginosa

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27
Q

What are the two carbapenems?

A

Ertapenem and meropenem

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28
Q

What is the coverage of the carbapenems?

A

Ertapenem and meropenem cover staph, strep, Ef, anaerobes, coliforms, respiratory, ESBL

Meropenem also covers pseudomonas aeruginosa

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29
Q

What are the cephalosporins?

A 
Cefalaxine (1st gen) 
Cefuroxime (2nd gen) 
Cefotaxime & ceftriaxone (3rd gen) 
Ceftaroline (5th gen) 
Ceftazidime/avibactam
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30
Q

What is the coverage of 1st to 5th generation cephalosporins and what trend does coverage follow as the generations become later?

A

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

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31
Q

What are the tetracyclines?

A

Tetracycline

Doxycycline

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32
Q

What is the coverage of doxycycline?

A 
MRSA
Staph
Respiratory 
Atypicals 
Moderately covers ESBL, strep, anaerobes
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33
Q

What is the coverage of trimethoprim?

A

Moderately covers MRSA, staph, strep, Ef, coliforms, respiratory

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34
Q

What is the coverage of co-trimoxazole?

A

MRSA, staph, coliforms

Moderately covers strep, Ef, respiratory

35
Q

What is co-trimoxazole?

A

Sulfamethoxazole & trimethoprim

36
Q

What are the macrolides?

A

Azithromycin
Clarithromycin
Erythromycin

37
Q

What is the coverage of erythromycin?

A

Atypicals

Moderately staph, strep, anaerobes, resp

38
Q

What is the coverage of azithromycin & clarithromycin?

A

Staph, respiratory, atypicals

Moderately strep, anaerobes

39
Q

What is the coverage of clindamycin?

A

Staph, strep, anaerobes

40
Q

What antibiotics are used for gram negative cover?

A 
Ciprofloxacin/ofloxacin
Levofloxacin/moxifloxacin
Gentamicin/tobramycin/amikacin 
Aztreonam
Fosfomycin
41
Q

What is the coverage of ciprofloxacin/ofloxacin?

A

Coliforms, respiratory, pseudomonas, atypicals

Moderately staph, strep, Ef, ESBL

42
Q

What is the coverage of levofloxacin/moxifloxacin?

A

Staph, strep, coliforms, resp, pseudomonas, atypicals

Moderately Ef, ESBL

43
Q

What is the coverage of the aminoglycosides?

A

MRSA, staph, coliforms, resp, pseudomonas

Moderately ESBL

44
Q

What is the coverage of aztreonam?

A

Coliforms, resp, pseudomonas

45
Q

What is the coverage of fosfomycin?

A

MRSA, staph, coliforms, ESBL

Moderately strep

46
Q

What antibiotics are good for gram positive cover?

A

Vancomycin and teicoplanin

Sodium fusidate

47
Q

What is the coverage of the glycopeptides?

A

All gram positives (MRSA, staph, strep, Ef, anaerobes)

48
Q

What is the coverage of sodium fusidate?

A

All gram positives (MRSA, staph, Ef, anaerobes, only moderately strep)

49
Q

What is the coverage of metronidazole?

50
Q

What is the coverage of nitrofurantoin?

A

MRSA, staph, strep, Ef, coliforms, ESBL

51
Q

What is the issue with nitrofurantoin?

A

Poor tissue penetration results in treatment failure in anything other than a lower UTI

NOT suitable for urosepsis/pyelonephritis

52
Q

What is the coverage of rifampicin?

A

MRSA, staph, strep, resp, atypicals

Moderately Ef

53
Q

What is the coverage of chloramphenicol?

A

Everything apart from pseudomonas

54
Q

Which antibiotics are known for their nephrotoxicity?

A

Vancomycin, teicoplanin, gentamicin

55
Q

How do you treat community acquired pneumonia (CURB 0-1)?

A

Admission to hospital probably unnecessary

Amoxicillin

or

Doxycycline

56
Q

How do you treat community acquired pneumonia (CURB 2)?

A

Amoxicillin PLUS doxycycline

Consider admission to hospital

57
Q

How do you treat community acquired pneumonia (CURB 3-5)?

A

Admit to hospital
Amoxicillin PLUS doxycycline OR levofloxacin

Vancomycin if MRSA suspected

58
Q

What is trimethoprim used for mostly?

A

1st line for UTIs

59
Q

What is co-trimoxazole used for?

A

Treating staph skin infections

60
Q

What is often used as an alternative for those with penicillin allergy?

A

Clarithromycin

61
Q

What are the issues with the macrolides?

A

Prolong QT interval
DDIs common
Prolonged use can cause sudden cardiac death

62
Q

What are the ADRs assoc with quinolones?

A

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
Q

How can quinolones affect older people?

A

May cause them to become drowsy and disorientated

64
Q

What sort of toxicity can gentamicin cause?

A

Ototoxicity and renal toxicity

Ototoxicity often manifests as balance issues

65
Q

What are vancomycin/teicoplanin useful for?

A

Orally only covers stuff in bowel (e.g. C. diff)

IV covers staph and strep

66
Q

What are the issues with linezolid?

A

Supresses bone marrow
Cannot be used in conjunction with antidepressants
Can cause optic neuritis

Do not use for more the 28d

67
Q

What is sodium fusidate used for and what is the issue with it?

A

Impetigo

Do not use on own for long periods of time as staph become v. resistant to it

68
Q

What antibiotic must not be taken with alcohol?

A

Metronidazole

Can cause facial flushing and hypotension

69
Q

What can rifampicin be used for?

A

TB

Also aids penetration of other antibiotics in prosthetic infection by interrupting bacteria biofilm

70
Q

What are the issues with rifampicin?

A

Interacts with rivaroxaban and warfarin etc.

Induces hepatic enzymes

71
Q

What is chloramphenicol used for?

A

Meningitis (crosses BBB when meninges inflamed)

72
Q

What is the issue with chloramphenicol?

A

Can cause aplastic anaemia

73
Q

What is community acquired pneumonia?

A

Pneumonia acquired outside the hospital

74
Q

What scoring system is used to assess the prognosis associated with pneumonia?

A 
CURB 65
Confusion 
RR 30+
Urea >7mmol/L
BP diastolic of 60 or less, or systolic of 90 or less
65y+
75
Q

What mortalities are associated with:

  1. CURB65 0/1
  2. CURB65 2
  3. CURB65 3-5
A

0-1: <3%
2: 3-15%
3-5: >15%

76
Q

What CURB65 scores should be admitted to hospital?

A

0-1 - home based care
2 or more consider hospital care
3 or more may consider ITU care

77
Q

When should you offer microbiological tests for community acquired pneumonia?

A

Moderate/high severity CAP only

78
Q

What tests should be done for community acquired pneumonia?

A

Blood and sputum cultures
Consider pneumococcal and legionella urinary antigen tests

XRay to diagnose

79
Q

What two organisms cause most skin and soft tissue infections?

A

Staph or strep

80
Q

What is the mainstay antibiotic for skin and soft tissue infections?

A

Flucloxacillin
Clarithromycin if allergic
Vancomycin if MRSA

81
Q

What antibiotic is best to cover bites?

A

Co-amoxiclav (as it covers anaerobic gram negatives as transferred from saliva)

82
Q

How do you treat uncomplicated UTI?

A

Trimethoprim
200mg BD
3 days for women
7 days for men

83
Q

How do you treat uncomplicated UTI in pregnancy?

A

Nitrofurantoin (avoid in 3rd trimester)

7 days

84
Q

How do you treat urosepsis?

A

Gentamicin

Aztreonam if kidney problems

Infection (22 decks)

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