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Antimicrobials
| Question | Answer |
|---|---|
| two categories of abx with highest incidence of resistance | 3rd gen. cephalosporins and fluorquinolones |
| Coagulase +/- used for: | Staph species (+ is usually staph aureus) |
| Hemolysis is used for: | Strep |
| Rod/Bacilli are usually: | Gram negative |
| Cocci are usually | Gram positive |
| Common gram positive organisms | Staph, Strep, Enterococccus |
| Common Gram negative organisms | E.coli, Psudomonas Aeruginosa, Kelbsiella |
| Common Anaerobic organisms | Clostridium Difficile (+) bacteroides Fragillis (-) |
| common atypical organisms | Mycoplasma pneumoniae, legionella pneumoniae, chlamydia pneumonia |
| What medications do you give for atypical pneumonias | Macrolides (ex: Zpak) or Fluoroquinolones (do not give Cipro) |
| Common fungal pathogens | Candida (yeast) and Aspergillus species (mould) |
| Three stages of abx therapy | Empiric, Therapeutic, Prophylactic |
| primary indicators of infection | fever and leukocytosis |
| Left Shift: | (segs are mature neutrophils and bands are immature neutrophils), infection causes cirulating segs to leave blood and bone marrow produces more bands. result--> decrease in %segs vs. bands in circulation. |
| Cross reactivity with penicillin and cephalosporins | If PCN allergy, low prob of cephalosporin allergy. If Ceph or Carbapenem allergy, high probability of PCN allergy |
| To cover gram + and gram -, initially what abx would you give? | Vancomycin and Piperacillin-tazobactam |
| TEE vs. TTE | TTE is not as sensitive as TEE |
| Signs and Symptoms of infective endocarditis | Janeway lesions, roth spots, osler's nodes, splinter hemorrhages |
| organisms that cause infective endocarditis | Viridans Group Strep (lives in mouth), Staph Auereus, Enterococcus (ampicillin), and HACEK (cultures are negative) |
| Community acquired MRSA | close quarters, lower socioeconomic status, poor hygiene. skin and soft tissue. skin to skin. mortality rate is low. fast growing, resistant to b-lactams. susceptible to: CLINDAMYCIN, TMP-SMX, TETRACYCLINES |
| Hospital acquired MRSA | heterogenous infections, mortality is 20%, slow growing, Multi-drug resistant. Susceptible to VANCOMYCIN |
| D-test | If D-test is positive, the organisms is resistant to Clindamycin |
| When would you give Abx to patient with abscess | Significant cellulitis or toxic appearing (hypotensive, tachycardic, diaphoretic, febrile) |
| What do you give to a dirty bite wound | Amoxacillin-clvulanic acid (augmentin). Cover for Eikenella corrodens and Prevotella sp (beta lactamase producing bugs) |
| C. Diff treatment | Metronidazole, oral vancomycin, Fidaxomicin, Nirazoxanide (cryptosperidium), Rifaxamin (hepatic encephalopathy) |
| These cultures do not require treatment | MRSA nasal swab, VRE rectal swab, Acinetobacter sputum sample, Enteroccoccus urine, Enterococcus in respiratory, candida in urine, cancida in respiratory |
| CONDOM drugs | for anti-staph pencillin. Cloxacillin, oxacillin, nafcillin, dicloxacillin, oxacillin, methicillin. no need for renal adjustment. |
| Cephamycins | Anaerobic coverage. Cefotetan and cefoxatin (tanning fox) |
| Carbapenems | Ertapenem lacks coverage for enterococcus, acinetobacter and pseudomonas. Meropenem covers Enterococcus, acinetobacter and pseudomonas |
| Abacavir | never challenge a pt. with allergy to abacavir |
| Inhibitors of CYP-450 (clearly cool ken's vehicle is equally quick) | Chloramphenicol, cimetidine, ketoconazole, valproic acid, isoniazid, erythromycin, quinolones |
| Inducers of CYP-450 (barbie's race car goes phast) | barbituates, rifampin, carbamazepine, griseofulvin, phenytoin |
| DO NOT USE: | Linezolid for MRSA< Daptomycin for pneumonia, Tigecyclinfor bacteremia or Pseudomonas, Cipro for strep pneumonia |
| Beta hemolytic strep | penicillin |
| alpha hemolytic strep | deftriaxone, moxifloxacin, levofloxacin (NO CIPRO) |
| MSSA | Oxacillin, defaxolin, dicloxacillin, cephalexin (NO PCN, AMINOPCN, 3RD GEN CEPH) |
| MRSA | bactrim, doxy, clindamycin, vancomycin, daptomycin(NOT FOR PNEUMONIA) linesolid (NOT FOR MRSA BACTEREMIA) and ceftaroline |
| Enterococcus | Ampicillin, vancomycin |
| VRE | daptomycin, linezolid, dalfo/uinu, tigecycline |
| Listeria | Ampicillin |
| Corynebacterium | Vancomycin |
| Nocardia | Bactrim |
| Stenotrophamonas | Bactrim, levofloxacin (2nd) |
| Pseudomonas | defepime, pip/tax, levo, cipro (NOT CEFTRIAXONE) |
| atypicals | fluoroquinolones and macrolides |
| anaerobes | Metronidazole, clidamycin, pcn + beta lactam inhibitor |
| c diff | metronidazole, oral vanc, fidaxomicin |
| ESBL | carbapenem |
| KPC | Colistin |
| Candida allbicans | fluconazole |
| candida krusei | Echinocandin (micafungin, caspofungin, anidulafungin) |
| Aspergillus | Voriconazole (DOC), amphotericin B |
| Zygomycetes | amphotericin-B and posaconazole |
| Endemic Fungi | Itraconazole |
| Cryptococcus | Amphotericin B (2 weeks), then fluconazole |
| Adverse effects of B-lactams | Neutropenia, seizures, thrombocytopenia, hypersensitivity, (ceftriaxone causes sluddging of gallbladder in neonates) (oxacillin, nafcillin, ceftriaxone causes hepatotoxicity) |
| Adverse effects of Vancomycin | Red man's syndrome, nephrotoxicity, thrombophlebitis, neutropenia |
| Adverse effects of Daptomycin | myalgias, arthralgias, rhabdomyolysis, watch CPK |
| AE of Linezolid | peripheral neuopathies and optic neuritis (irreversible) and thormbocytopenia (at day 10) |
| AE of Tigecycline | Nausea and Vomiting |
| AE of Tetracyclines | esophagitis, photosensitivity, avoid in <8yo |
| AE of Fluorquinolones | QT prolongation, tendone rupture, photosensitivity, hepatotoxicity, never co-administer with cations |
| AE of Macrolides | QT prolongation, Diarrhea |
| AE of Aminoglycosides | Nephrotoxicity, neurotoxicity |
| AE of Polymyxin E (Colistin) | Nephrotoxicity and neurotoxicity |
| AE of Bactrim | bone marrow suppression, nephrotoxicity, hyperkalemia, hyerpsensitivity, photosensitivity |
| AE of Rifampin | color secretions red, hepatotoxicity |
| AE of Clindamycin | GI upset, C diff, Hepatotoxicity |
| AE of Flagyl | Disulfiram like reaction (no alcohol), peripheral neuropathies, metallic taste |
| AE of Fluconozole | hepatotoxicity, QT prolongation |
| AE of Itraconazole | Hepatotoxicity, CHF exacerbation |
| AE of voriconazole | auditory and visual halluciations, visual changes, nephro and hepatotoxicity |
| AE of Posaconazole | hepatotoxicity, QT prolongation |
| AE of ampohtericin B | nephrotoxicity, infusion reactions, anaphylaxis, hyomagnesium and hypokalemia |
| AE of Acyclovir | nephrotoxicity, thrombophelbitis |
| AE of Ganciclovir and Valganciclovir | Granulocytopenia, thrombocytopenia, teratogenic/aspermatogeneis, hypertension and headache. |
Created by:
ehoward2014