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PT3: L1+4
Antibiotics
| Question | Answer |
|---|---|
| Guiding Principles of Antibiotic Tx [5] | -Right dx -Eliminate source -Correct abx -Do no harm -Antibiotic use promotes bacterial resistance |
| Signs and Sx of Infection [3 + 12] | -Fever (Normal: 98.6F or 37C) -Leucocytosis (Normal WBC: 4000-11000) -Inflammation Markers: ESR (slow) and CRP (fast) -Altered mental status, tachycardia, lactic acidosis, rigors, pain, swelling, purulent drainage, sputum, cough, tachypnea, dysuria |
| Recommendations for Blood Cultures | -Always 2 sets of 2 bottles -1:4 might mean contaminate -1+ is bacteremia |
| Recommendations for Sputum Cultures | -BAL is the best -Quantitative testing is important. |
| Host Factors for Antimicrobials [10] | -Where acquired -Site/Severity -Previous exposure to abx -Previous cultures -Recent environment exposure -Drug allergy -Age -Pregnancy/Lactation -Renal/Hepatic Dysfx -Concomitant therapy and comorbidities |
| Organisms ALWAYS Pathogenic in Sputum Cultures [12] | -Chlamydia -Legionella -Tuberculosis -Influenza -RSV -Parainfluenza -Toxoplasma gondii -P. jiroveci -Histoplasma capsulatum -Coccidiodis immitis -Blastomyces dermatitdis -Cryptococcus neoformans |
| What is stool culture most sensitive for? | Clostridium difficile |
| Gram Positive Organisms [3] | -Staphylcoccus aureus -Enterococcus sp -Streptococcus pneumoniae |
| Gram Negative Organisms [7] | -E. coli -Pseudomonas aeruginosa -Enterobacter sp. -Acinetobacter sp. -Stenotrophomonas maltophilia -Serretia sp. -Klebsiella sp. |
| Anerobic Organisms [3] | -Clostridium sp. -Bacteroides fragilis -Peptostreptococcus |
| Atypical Organisms [3] | -Mycoplasma -Legionella pneumophilia -Chlamydia sp. |
| Resistance Mechanisms [4] | -Alter the target (MRSA) -Produce inactivating enzymes (Beta-lactams) -Develop efflux pumps (Pseudomonas aeruginosa) -Resistance plasmids |
| Superbugs [5] | -Staphylcoccus aureus -Pseudomonas aeruginosa -Acinetobacter baumanii -Enterococcus faecium -Clostridum difficile |
| Staphylcoccus aureus | -Gram + -Alters PBP -> MRSA -50% prevalence in US -Community-acquired/Hospital-acquired different -hVISA, VISA, VRSA |
| Pseudomonas aeruginosa | -gram - -Pseudomonas can become resistant to everything |
| Enterococcus faecium | -gram + -High incidence in KUH due to bone marrow transplant population |
| Clostridum difficile | -Spore producing -Requires special cleaning procedures |
| Cell Wall Synthesis Abx | -D-cycloserine -Vancomycin -Bacitracin -Penicillins -Cephalosporins -Cephamycins |
| DNA Synthesis Abx | -Metronidazole |
| DNA Gyrase Abx | -Quinolones |
| RNA Polymerase Abx | -Rifampin |
| Protein Synthesis (50s) Abx | -Erythomycin -Choramphenicol -Clindamycin -Lincomycin |
| Protein Synthesis (30s) Abx | -Tetracycline -Streptomycin -Spectinomycin -Kanamycin |
| Bactericidal | -Penicillins -Cephalosporins -Carbapenems -Monobactams -Glycopeptides (like vanco) |
| Time-Dependent Killing | -Penicillins -Cephalosporins |
| Drug of choice for Listeria? | -Ampicillin |
| Anti-Pseudomonal Abx | -Ticarcillin -Piperacillin -Ceftazidime -Cefepime -Aztreonam (Monobactam) -Fluoroquinolones |
| Which cephalosporin does NOT need dose adjustments for renal dysfunction? | -Ceftriaxone |
| Cephalosporine with best CNS penetration? | -Ceftriaxone and cefepime |
| Only 4th gen Cephalosporin? | -Cefepime |
| Just approved cephalosporin? | -Ceftaroline -New generation -Skin infections and CA-pneumonia -Covers gram + INCLUDING MRSA |
| Drug of choice for ESBL-producing pathogens? | -Carbapenums |
| Concentration Dependent Killing | -Fluoroquinolones |
| Adjust dose for renal dysfunction for quinolones EXCEPT? | -Moxifloxacin |
| Fluoroquinolones Adverse Effects [5] | -Tendon rupture -Prolonged QT interval -CNS effects -Phototoxicity -Not recommended for children |
| Active against Atypicals | -Fluoroquinolones |
| Active against penicillin resistant S. pneumoniae? | -Fluorquinolones |
| Vancomycin works against? (4 important) | -C. difficile (oral only) -MRSA -Ampicillin resistant enterococcus (VSE) -Coagulase-negative Staphylcoccus (CoNS) |
| Cell Wall Synthesis Abx | -D-cycloserine -Vancomycin -Bacitracin -Penicillins -Cephalosporins -Cephamycins |
| DNA Synthesis Abx | -Metronidazole |
| DNA Gyrase Abx | -Quinolones |
| RNA Polymerase Abx | -Rifampin |
| Protein Synthesis (50s) Abx | -Erythomycin -Choramphenicol -Clindamycin -Lincomycin |
| Protein Synthesis (30s) Abx | -Tetracycline -Streptomycin -Spectinomycin -Kanamycin |
| Bactericidal | -Penicillins -Cephalosporins -Bactrim -Aminoglycosides (Tobramycin) -Carbapenems -Monobactams -Glycopeptides (like vanco) |
| Time-Dependent Killing | -Penicillins -Cephalosporins |
| Drug of choice for Listeria? | -Ampicillin |
| Anti-Pseudomonal Abx | -Ticarcillin -Piperacillin -Tobramycin/Gentamicin (Aminoglycosides) -Ceftazidime -Cefepime -Aztreonam (Monobactam) -Fluoroquinolones |
| Which cephalosporin does NOT need dose adjustments for renal dysfunction? | -Ceftriaxone |
| Cephalosporine with best CNS penetration? | -Ceftriaxone and cefepime |
| Only 4th gen Cephalosporin? | -Cefepime |
| Just approved cephalosporin? | -Ceftaroline -New generation -Skin infections and CA-pneumonia -Covers gram + INCLUDING MRSA |
| Drug of choice for ESBL-producing pathogens? | -Carbapenums |
| Concentration Dependent Killing | -Fluoroquinolones -Aminoglycosides (Gentamicin) |
| Adjust dose for renal dysfunction for quinolones EXCEPT? | -Moxifloxacin |
| Fluoroquinolones Adverse Effects [5] | -Tendon rupture -Prolonged QT interval -CNS effects -Phototoxicity -Not recommended for children |
| Active against Atypicals | -Fluoroquinolones -Macrolides -Tetracyclines |
| Active against penicillin resistant S. pneumoniae? | -Fluorquinolones -Macrolides (-thromycins) |
| Important organisms that Vancomycin works against? [4] | -C. difficile (oral only) -MRSA -Ampicillin resistant enterococcus (VSE) -Coagulase-negative Staphylcoccus (CoNS) |
| Vancomycin Adverse Effects [2] | -Potentially nephrotoxic -Red Man Syndrome |
| Aminoglycoside dosing [3] | -Traditional -Extended (Hartford Nomogram) -Zaske |
| Aminoglycoside Adverse Effects [2] | -Nephrotoxic -Potentially ototoxic |
| Abx for Serretia sp? | -Gentamycin/Tobramycin (Aminoglycosides) |
| What macrolide is used to stimulate GI motility? | -Erythromycin |
| Drug of choice for Rickettsia, Borrelia, Ehrlichia? (Tickbourne diseases) | -Tetracyclines |
| Bacteriostatic | -Tetracyclines -Linezolid |
| Adverse effects of Tetracyclines | -Photosensitivity -Bone/Enamel deformity and discoloration (Don't use in kids or pregnancy!) |
| ABx for VRE [3] | -Linezolid -Daptomycin -Tigecycline |
| ABx for MRSA [4] | -Vancomycin -Linezolid -Daptomycin -Ceftaroline |
| ABx for CA-MRSA [4] | -Tetracyclines -Bactrim -Clindamycin -Linezolid |
| ABx with good CNS Penetration [3] | -Ceftriaxone -Cefepime -Metronidazole |
| ABx with poor CNS Penetration [2] | -Vancomycin -Aminoglycosides |
| ABx with good Lung Penetration [2] | -Quinolones -Macrolides |
| ABx with poor Lung Penetration [1] | -AVOID DAPTOMYCIN |
| ABx to avoid with UTI [2] | -Moxifloxacin -Tigecycline |
| ABx with Hep Dsyfx dose changes [8] | -Ceftriaxone -Nafcillin -Clindamycin -Metronidazole -Macrolides -TCNs -Rifampin -Isoniazid |
| Abx with Renal Dfx dose changes [7] | -B-lactams (except ceftriaxone) -Aminoglycosides -Vancomycin -Bactrim -Nitrofurantoin -Daptomycin -Fluoroquinolones |
| ADE Rifampin | -Stains body secretions orange |
| ADE Chloramphenicol | -Gray baby syndrome -Nephrotoxic |
| ADE Bactrim | -Photosensitivity |
| ADE Metronidazole | -Disulfiram reaction with alcohol -Urine discoloration -Metallic taste |
| ADE Daptomycin | -Rhabdomyolysis |
| ADE Linezolid | -Myelosuppression -Irreversible peripheral neuropathy (>4wks use) |
| ADE Tigecycline | -Nausea and Vomiting Hardcore |
| Drug choice for stenotrophomonas maltophilia? | -Bactrim |
| What carbapenum does NOT treat Pseudomonas sp? | -Ertapenum |
Created by:
Nami01
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