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Critical Care I > ABX specific > Flashcards

ABX specific Flashcards

1
Q

1st gen cephalosporins
name 2 of them

A

Cephalexin
Cephazolin

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2
Q

what class
Cephalexin
Cephazolin

A

1st gen cephalosporins

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3
Q

what are 1st gen cephalosporins used in
Cephalexin
Cephazolin

A

Skin and UTI

Prophylaxis to prevent infections from surgical repair

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4
Q

specific organisms 1st gen cephalosporins treat

A

Gram + (skin)
-Streptococci
-Staphylococci that are not B lactamase

Gram - (UTI)
-Proteus Mirabelis
-E.Coli
-Klebsiella pneumoniae

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5
Q

Name 4 of the 2nd gen cephalosporins

A

Cefuroxime
Cefotetan
Cefoxitin
Cefaclor

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6
Q

what drug class?
Cefuroxime
Cefotetan
Cefoxitin
Cefaclor

A

2nd gen cephalosporins

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7
Q

What do 2nd gen Cephalosporins treat

A

Increased resistance to B lactamase as opposed to 1st gen

These have better gram - coverage than 1st gen
Also 2 in this class have anaerobic coverage
Cefotetan and Cefoxitin

Gram -
H. Influenzae
Serratia Marcescens
Enterobacter aerogenes
Some Neisseria

Only Cefotetan and Cefoxitin can treat anaerobic (Bacteroides Fragilis ->Peritonitis)

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8
Q

what 2nd gen Cephalosporins can treat the anaerobic bacteria seen in Peritonitis (Bacteroides Fragilis)

A

Cefotetan
Cefoxitin

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9
Q

what 3 generations of cephalosporins are considered Broad Spectrum

A

3rd generation
-Cefixime
-Ceftriaxone
-Cefaxime
-Ceftazidime

4th Gen
-Cefepime

5th gen
Ceftaroline

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10
Q

what 2 generations of cephalosporins can cross the BBB

A

3rd generation
-Cefixime
-Ceftriaxone
-Cefaxime
-Ceftazidime

4th Gen
-Cefepime

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11
Q

what antibiotics are 3rd gen cephalosporins

A

-Cefixime
-Ceftriaxone
-Cefaxime
-Ceftazidime

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12
Q

what med class
-Cefixime
-Ceftriaxone
-Cefaxime
-Ceftazidime

A

3rd gen cephalosporins

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13
Q

As you get further into the generations of cephalosporins, how does the coverage change

A

1st gen has the most gram + coverage
least amount of gram -

3rd and 4th are broad spectrum, however 4th has less coverage against gram + and increased coverage for gram -

however 4th gen is broader than 3rd gen

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14
Q

What does 3 rd gen cephalosporins treat and organisms
-Cefixime
-Ceftriaxone
-Cefaxime
-Ceftazidime

A

Less gram + and better gram - coverage
Also Ceftazidime covers Pseudomonas

Bacterial Meningitis
-H.Influenzae
-Pneumococci
-Meningococci
-Neisseria

PCN resistant Neisseria Gonorrhoeae

Ceftazidime - covers Pseudomonas Aeruginosa
Ceftriaxone - covers Borrelia Burdorferi - Lyme disease

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15
Q

what 3rd gen cephalosporin covers for Pseudomonas Aeruginosa

A

Ceftazidime

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16
Q

What 3rd gen cephalosporin covers for Borrelia Burdorferi seen in Lyme disease

A

Ceftriaxone

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17
Q

what is the 4th generation cephalosporin

A

Cefepime

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18
Q

what class is Cefepime

A

4th gen cephalosporin

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19
Q

What is 4th gen Cephalosporin (cefepime) affective against

A

Gram + and - and pseudomonas

-Pseudomonas aeruginosa
-Bacterial meningitis
-Nosocomial infections - does not treat MRSA

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20
Q

What class
Ceftaroline

A

5th gen cephalosporin

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21
Q

what is the 5th gen cephalosporin

A

Ceftaroline

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22
Q

what medications are effective against MRSA

A

Vancomycin
Ceftaroline

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23
Q

If a pt has a _____ allergy, they cannot have cephalosporins

A

PCN - cross reactivity

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24
Q

Adverse reactions for Cephalosporins

A

Diarrhea
Nausea
Rash
Disulfiram like reaction
-mixing with alcohol causes
-nausea
-Flushing
-rapid heartbeat

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25
Q

Vancomycin treats what?
is this gram + or gram -

A

MRSA
gram +

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26
Q

On the antibiotic ladder,
what is the top gun for gram + and for gram -

A

gram + - Linezolid (Zyvox)
gram - - Carbopenems - merapenem

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27
Q

Gram - coverage - lowest on abx ladder
IV and PO option

A

IV - Ampicillin
PO - Amoxicillin

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28
Q

Broad spectrum on abx ladder that covers for B lactamase bacteria …..just above Amp and amox

A

IV - Ampicillin/sulbactam - Unasyn
PO - Amoxicillin/Clavulanate - Augmentin

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29
Q

up the Antibiotic ladder on the Gram - side above Unasyn and augmentin
Covers for Pseudomonas
Broad spectrum
+ and -
and anaerobes
does not cover for MRSA or fungals

A

Pipercillin/Tazo (Zosyn)

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30
Q

-floxacin

A

fluoroquinolones

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31
Q

what routes do fluoroquinolones come in

A

Broad spectrum
They all come PO and IV,

Ciprofloxacin and Ofloxacin come in otic solutions

Moxifloxacin comes in ophthalmic

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32
Q

what are fluoroquinolones effective against

A

Gram negative bacteria
-Enterobacteriaceae
-Haemophilus
-Legionella
-Neisseria
-Moraxella
-Pseudomonas
Effective against certain mycobacteria
-used to treat TB
Bacterial resistance starting to see for Ciprofloxacin

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33
Q

fluoroquinolone base analogy on abx ladder

A

1st base - Ciprofloxacin
2nd base - Levofloxacin
3rd base - Moxifloxacin

1st base and 2nd base are gram neg coverage.
3rd base is both

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34
Q

Avoid Clarithromycin and Erythromycin in neonates due to what potential complication

A

Hypertrophic pyloric stenosis

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35
Q

Antibiotics for Community acquired pneumonia

A

Azithromycin PO
or
Ceftriaxone and Azithromycin IV
or
Moxifloxacin IV or PO

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36
Q

Antibiotics for Hospital acquired pneumonia

A

Vancomycin
and
Zosyn

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37
Q

Abx for Meningitis

A

Ceftriaxone
Vancomycin
+/- steroids
+/- Ampicillin - for immune compromised

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38
Q

ABX for UTI

A

Amoxicillin - pregnant
or
Nitrofurantoin - women
or
Bactrim - if no renal failure
or
Ceftriaxone - IV inpatient for pylo
or
Cipro - Outpatient for Pylo

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39
Q

abx for Cellulitis

A

Vancomycin - covers MRSA
or
Clindamycin
or
Bactrim

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40
Q

is e.coli gram neg or gram pos

A

gram neg

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41
Q

is PJP gram neg or pos

A

gram neg

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42
Q

Macrolides can cause what big side effect?

A

Long QT syndrome
azithromycin -infants
clarithromycin
Erythromycin - Everyone

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43
Q

PCN covers gram ___

A

+

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44
Q

Amox and Amp covers gram

A

+ and -

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45
Q

Augmentin and Unasyn cover

A

+ - and anaerobes

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46
Q

Methicillin and Oxacillin cover gram

A

+

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47
Q

Zosyn (piperacillin-tazobactam) and Timentin (Ticarcillin/Clavulanate) cover

A

Pseudomonas
Anaerobes

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48
Q

5th generation cephalosporin (Ceftaroline) covers for ____ but not _____

A

Covers for MRSA
Does not cover for Pseudomonas

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49
Q

Carbapenems cover

A

Gram +, -, pseudomonas, Anaerobes

*except ertapenem will not cover pseudomonas

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50
Q

Aztreonam covers

A

Gram - and pseudomonas

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51
Q

Quinolones cover

A

some gram +
gram -
Pseudomonas

Also Moxifloxacin will cover Anaerobes and Atypicals

52
Q

Aminoglycosides cover

A

Gram -
Pseudomonas

53
Q

Bactrim covers

A

MRSA
Gram +
Gram -

54
Q

Macrolides cover

A

Gram +
Gram -
Atypicals

55
Q

Tetracyclines (Doxycycline) cover

A

Gram +
Gram -
MRSA
Atypicals

56
Q

Tigecycline covers

A

Everything except Pseudomonas

57
Q

Clindamycin covers

A

MRSA
Gram +
Anaerobes

58
Q

Vancomycin covers

A

MRSA
Gram +

59
Q

Daptomycin covers

A

MRSA
Gram +

60
Q

Daptomycin covers

A

MRSA
Gram +

61
Q

Linezolid covers

A

MRSA
Gram +

62
Q

How is CNS penetration with Cefazolin

A

poor

63
Q

How is CNS penetration with Clindamycin

A

Poor

64
Q

How is CNS penetration with Gentamicin

A

only 10-30% penetration with inflamed meninges

65
Q

which drugs concentrate high in the urine

A

Penicillin
Cephalosporins
Aminoglycosides

66
Q

Gram + or -
E. Coli

A

Gram -

67
Q

Gram + or -
Staphylococcus
-MRSA
-MSSA
-Staph Epidermidis

A

Gram+

68
Q

Most common organisms in CLABSI

A

Coagulase-negative Staphylococcus (CoNS)
S. aureus
GNR
Candida

69
Q

After diagnosing a CLABSI, when would you considering removing the central line?

A

-Severe Sepsis
-Endocarditis
-Persistently + cultures after 72 hours of therapy
-S. aureus, GNR including Pseudomonas, Bacillus, Enterococcus
-Mycobacteria/fungi
-Tunnel site infection
-Suppurative thrombophlebitis

70
Q

Gram + or -
Streptococcus
-Agalactiae (Group B Strep)
-Anginosus
- Constellatus
-Intermedius
-Pneumoniae
-Pyogenes (Group A strep)

A

Gram +

71
Q

Gram positive cocci in clusters

A

Staph

72
Q

Vancomycin covers

A

All Staph aureus including MRSA

73
Q

You have a pt who you start on Vancomycin for MRSA coverage.
After your culture comes back, continue only if MRSA AND ???

What if the culture shows MSSA

A

CNS infection OR
Endovascular infection (ie: endocarditis)

otherwise switch to another agent like clindamycin - like for a bone infection

for MSSA
-for parenteral therapy: can use nafcillin or cefazolin

74
Q

Gram + or -
Enterococcus
-Faecalis
-Faecium

A

Gram +

75
Q

Gram + or -
Enterobacter
-Aerogenes
-Cloacae

A

Gram -

76
Q

Drugs that offer MRSA coverage (can be limited by resistance)

A

-Vancomycin
-Clindamycin
-Bactrim
-Doxycycline
-Linezolid
-Ceftaroline

77
Q

Gram + or -
Klebsiella
-Oxytoca
-Pneumoniae

A

Gram -

78
Q

Gram + or -
Morganella Morganii

A

Gram -

79
Q

In treating MRSA
What would be a smaller gun for treating MRSA rather than Vancomycin

A

Bactrim - In 2020 only 5% of cases were resistant
Clindamycin - 25% MRSA and 16% MSSA were resistant

Vancomycin - 100% susceptible - so best choice for initial therapy…

80
Q

CoNS is frequently a blood culture contaminate but can be a real pathogen in what settings

A

-Preterm neonates
-CLABSI
-VP Shunt infections
-Hardware infections
-S. saprophyticus can cause UTIs in adolescents

81
Q

Gram + or -
Proteus Mirabilis

A

Gram -

82
Q

Gram + or -
Pseudomonas Aeruginosa

A

Gram -

83
Q

Gram + or -
Salmonella species Not Typhi

A

Gram -

84
Q

Enterococcus are inherently resistant to what drugs

A

Cephalosporins

85
Q

Drug options for Enterococcus

A

Depends on susceptibility
-Ampicillin
-Zosyn
-Vancomycin

In abdominal infections:
-Carbapenems (Meropenem) will cover Ampicillin susceptible Enterococci

In VRE (Vancomycin resistant Enterococcus)
-Linezolid
-Daptomycin

86
Q

Treatment for VRE (Vancomycin resistant Enterococcus)

A

-Linezolid
-Daptomycin

87
Q

Gram + or -
Serratia Marcescens

A

Gram -

88
Q

Gram + or -
Stenotrophomonas Maltophilia

A

Gram -

89
Q

Cystic fibrosis isolates in Gram neg

A

Pseudomonas Aeruginosa (CF)
Pseudomonas Aeruginosa, Mucoid (CF)
Stenotrophomonas Maltophilia (CF)

90
Q

Cystic fibrosis isolates in Gram Pos

A

MRSA (CF)
MSSA (CF)

91
Q

treatment for Strep. pneumoniae

A

1st line
-PCN
-Ampicillin
-Amoxicillin (high dose so overcome resistance)

2nd line
-3rd gen cephalosporins
-Ceftriaxone and cefotaxime
-oral: Cefdinir, cefixime, Cefpodoxime
-Clindamycin

Do not use
-Azithromycin
-Bactrim

For multi-drug resistant:
-Vancomycin
-Levofloxacin
-Linezolid

92
Q

Gram neg rod
pink stain

A

E. coli

93
Q

Gram neg drugs

A

-Beta-Lactams

-Aminoglycosides (Gentamicin, tobramycin)
(Nephrotoxic, Ototoxic)

-Bactrim

-Fluoroquinolones (Levofloxacin, Ciprofloxacin)
(Black box warning: damage cartilage in growing children)

-Carbapenems (meropenem, imipenem)

-Others (Tigecycline, colistin)

94
Q

When do you consider pseudomonas?

A

-Fever and neutropenia
-Ventilator Associated pneumonia
-Cystic Fibrosis
-Burns
-Chronic otitis/mastoiditis
-Osteomyelitis after nail puncture through tennis shoes

95
Q

Anti-pseudomonal drugs

A

Beta-lactams
-Piperacillin, Ticarcillin
-Cefepime, Ceftazidime
-Carbapenems

Aminoglycosides

Fluoroquinolones

Aztreonam

96
Q

When do you consider anaerobes

A

-Dental infections
-Deep neck infections
-Bran abscesses
-Abdominal process

97
Q

Drugs with anaerobic coverage

A

-PCN (unless Beta lactamase positive)

-Augmentin, Bactrim

-Clindamycin

-Flagyl

-Ticarcillin-Clavulanate, Zosyn

-Meropenem/Carbapenems

98
Q

What antibiotics cover osteomyelitis from S. Aureus

A

-Nafcillin
-Cefazolin
-Clindamycin
-Vancomycin

*4 week min
* if uncomplicated, can transition to oral therapy

99
Q

What antibiotics cover osteomyelitis from Streptococci?

A

PCN
Ceftriaxone

*4 weeks min

100
Q

What antibiotics cover osteomyelitis from Pseudomonas

A

Ceftazidime
Zosyn
Fluoroquinolones

-Shorter course usually okay if proper debridement

101
Q

What antibiotics cover osteomyelitis from Kingella

A

Ceftriaxone

102
Q

What antibiotics cover osteomyelitis from Salmonella

A

Ceftriaxone (ampicillin if susceptible)

  • 4 weeks min
103
Q

For Osteomyelitis what would you cover with while waiting on Culture

A

Vancomycin - staph
Ceftriaxone -strep, kingella, salmonella

doesn’t cover for pseudomonas

104
Q

CSF analysis
OP < 20
WBC <5
Protein 15-45
Glucose 45-80
Stain/Cx Neg/Neg

A

Normal CSF

105
Q

CSF analysis
OP elevated
WBC >1000
Protein >100
Glucose <40
Stain/Cx Pos/Pos

A

Bacterial

106
Q

CSF analysis
OP WNL
WBC <300
Protein <150
Glucose WNL
Stain/Cx Neg/Pos

A

Viral

107
Q

CSF analysis
OP Very elevated
WBC <500
Protein >100
Glucose <50
Stain/Cx Pos/Pos

A

TB

108
Q

CSF analysis
OP elevated
WBC <200
Protein Elevated
Glucose WNL
Stain/Cx Neg/Neg

A

Abscess

109
Q

meningitis etiology by age

A

< 1 mos
-GBS
-E.coli
-Listeria Monocytogenes

1-3 mo
-Neonatal pathogens
-S pneumoniae
-N. meningitis
-Hib

3-6 mos
-S. pneumoniae
-N. meningitis
-Hib

> 7 mo - 21 yrs
-S. pneumoniae
-N. meningitis

110
Q

abx to cover meningits

A

usually
Vancomycin + Ceftriaxone if > 1 month

Vanc (just in case strep pneumo that is resistant to Rocephin)
Ceftriaxone (strep pnemo and N. meningitis)

Neonates - Ampicillin and Ceftazidime (or gentamicin)

Infants and children: Vancomycin and 3rd gen cephalosporin (Ceftriaxone)

111
Q

Most likely pathogens causing sepsis in normal infants and children with no other factors

Treat?

A

S. pneumoniae,
N. meningitidis,
Group A streptococcus

Vancomycin + Rocephin

112
Q

Most likely pathogens causing sepsis in normal infants and children with
Skin lesion, bone or joint focus, trauma

Treat?

A

S. aureus
Group A streptococcus

Vancomycin +/- Rocephin
Add Nafcillin if suspecting Staph

113
Q

Most likely pathogens causing sepsis in normal infants and children with burns

A

Pseudomonas

114
Q

Most likely pathogens causing sepsis in normal infants and children with uropathy or UTI

Treat?

A

Gram - enterics

-Rocephin (if differential does not include pseudomonas)
-Zosyn

115
Q

Most likely pathogens causing sepsis in normal infants and children with Gastrointestinal source

A

Gram - enterics
Anaerobes

-Zosyn
-Ampicillin or Rocephin + Clindamycin or Flagyl + aminoglycoside

116
Q

Acute community-acquired pneumonia in normal children: infectious etiologies​

Treatment:

A

Birth to 3 wks​

-GBS, GNR, CMV, Listeria, HSV, syphilis​

3 wks to 3 months​

-Viruses, GBS, S. pneumoniae, pertussis, C. trachomatis (2 wks – 4 mo)​

3 mo to 5 yrs​

-Viruses, S. pneumoniae, Hib, NT H. flu, Moraxella, S. aureus, S. pyogenes, Mycoplasma, think about TB too!​

Children > 5 yrs​

-Mycoplasma pneumoniae​

-S. pneumonia, S. aureus, S. pyogenes​

Treatment:
-Ampicillin for fully immunized infant or school aged
-Ceftriaxone if not fully immunized
-Local epidemiology with PCN resistance
-Life threatening infection
-empyema

Add Vanc or clindamycin if you are concerned about S. Aureus

Add azithromycin if concerned for atypical

117
Q

Outpatient pneumonia management

A

Amoxicillin (high dose)
-Add azithromycin if need atypical coverage

oral cephalosporins not recommended

118
Q

parenteral treatment for UTI

A

Rocephin
Cefotaxime
Ceftazidime
Gentamicin
Tobramycin
Piperacillin

119
Q

most common organism for Purulent/fluctuant lesions (abscess, furuncle, folliculitis)

A

Staph aureus

120
Q

Most common organism for cellulitis, erysipelas

A

GAS and other beta-hemolytic strep or S. Aureus

121
Q

Most common organism for impetigo

A

S. Aureus or GAS

122
Q

Abx for skin and soft tissue

A

Bactrim
Clindamycin
or Doxycycline

123
Q

Most common organisms for acute otitis media

Treatment?

A

Streptococcus pneumoniae, nontypeable H. influenzae, and Moraxella catarrhalis​

If > 2 years and uncomplicated/ non-toxic – could observe x 48-72 hours after risk/ benefit discussion with family​

Antibiotics: ​

Amoxicillin (90 mg/kg/DAY divided into 2 doses)​

Amoxicillin-clavulanate if recent betalactam use or if no response to amoxcillin​

124
Q

Most common organism for sinusitis and treatment

A

Haemophilus influenzae (nontypeable)​

Streptococcus pneumoniae​

Moraxella catarrhalis ​

Treatment: ​

Amoxicillin-clavulanate

125
Q

GAS pharyngitis treatment

A

Penicillin x 10 days​

Amoxicillin x 10 days is a reasonable alternative​

Cephalosporins, clindamycin, and macrolides are alternatives for patients who are allergic to penicillin or who cannot otherwise tolerate penicillin​

Critical Care I (27 decks)

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