4 Antibiotics Flashcards by Susan Johnston

Gram positive bugs

Staphylococcus
Streptococcus
Enterococcus

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If PCN allergic give a

Not a

Macrolide( like zithromax)

Not a cephalosporin!

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Gram neg bugs

Everything besides a staph strep or enterococcus

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E. Coli stands for

Escherichia coli. NOT enterococcus

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Staphylococcus are usually

Skin bugs
Gram +
Staph aureus. Skin
MRSA. Nl abx for staph won't work
Staph saprophyticus- UTI, vagina
Staph epidermis

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Streptococcus

Gram pos

Strep pyogenes. Throat
Strep pneumoniae. Lungs
Strep viridans. Dental access, endocarditis
Strap agalactiae. Group B strep. Preg moms check bc babies inc mortality

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Enterococcus

Gram pos
Enterococcus faecalis. Urinary tract
Enterococcus faecium. Urinary tract

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Gram neg bugs

Everything else!

Neisseria gonorrhoeae
Neisseria meningitis

Diarrhea: e. Coli, shigella, campylobacter, salmonella
Pasturella
Mycoplasma
H. Flu
M. Cat
Proteus
Pseudomonas 
Legionella

Atypical pathogens:
Mycoplasma, H. Flu, M. Cat
Legionella

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Atypical pathogens: of gram neg

Mycoplasma, H. Flu, M. Cat

Legionella

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If you r allergic to PCN, what abx should be used w precaution

Cephalosporin

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% of people allergic to PCN are also allergic to cephalosporin

Never give cephalosporin had these rxns
Give PCN if had this rxn

2-10% of peeps are allergic to PCN and also cephalosporin allergic

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GIVE a cephalosporin if PCN rxn was a

Mobilliform rash

A drug rash is papular all over. Never red raised or itchy (allergic rashes are IgG mediated)

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Mobilliform rash

Macular or maculopapular. Lesions are fixed expand slowly over several days
May itch
This is T cell mediated NOT IgG mediated like allergic/anaphylactic rash
Mobilliform rash happens more commonly with aminopcns- amox and ampicillin
Concurrent viral infxn can predispose a pt to mobiliform rashes

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Never give suspected mono pt

PCN! If u give PCN to mono pt they will get an ampicillin rash, even up to a year later.

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Be aware of beta lactam ring for two reasons

Allergies (bc both PCN and cephalosporins share beta lactam ring)
Beta lactamase: an enzyme that smart bacteria learn to produce
That destroys the beta lactam ring

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Augmentin is

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PCN that has a cover over the beta lactam ring

Name 4 penicillins

What are they good for?

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Ampicillin
Amoxicillin
Penicillin k
Penicillin G

Good for gram pos strep and enterococcus but NOT for staph!!!!

Extended spectrum PCN are

NOT good for
:

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Augmentin and all its generics
Covers gram +, gram -, and beta lactamase( so give if pt had abx in last 90 days,)

Augmentin NOT for MRSA

But good for gram pos:
Strep ABCG
Enterococcus
Strep pneumoniae
DRSP 
MSSA

AND gram neg:
H flu. M. Cattaralis
E. Coli. Neisseria

Why would a provider think the bug is a beta lactamase producer?

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Bc pt had abx in last 90 d

What 2 abx are good for Gram negs?

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Tetracyclines:

Doxycycline (get for atypical pathogens- h flu, E. coli, legionella, mycoplasma, chlamydiaphilia, ricksetta)
Minocycline best choice for MSSA and CA-MSSA

Sulfonamides:
-PTMP/SMX(Bactrim, Sentra)
MRSA!!!!

Best abx choice for MSSA and CA-MSSA?

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Minocycline

Best choice for MRSA? (For gram neg- MRSA behaves differently than other gram + so treat like gram neg)

Best 2nd line for MRSA?

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Bactrim first for MRSA

If Bactrim- allergic use Minocycline (first line for MSSA)

Cephalosporins have —– generations

Gen 1 is for
Gen two is for
Etc

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Four!
1st gen. Skin. GRAM + only. -staph
Ex. Cephalexin (Keflex)
Cefadroxil (Duricef)

2nd generation.
GRAM + and -

If not positive if Pt has Strep or H. Flu use this! But won’t cover beta lactamase producers
Cefuroxime (cerftin)
Cefaclor (Ceclor). Got when I was little but now not good for sinus!
Cefprozil (Cefzil)

3rd gen. Twisted ring again to get beta lactamase producers but now weak gram + coverage
Weak gram +, Gram -, and beta lactamase producers

Ceftibutin(Cedax)
Cefixime(Suprax)

**Extended spectrum 3rd gen. Covers everything!!- twisted ring again and got back gram +. Give when not sure what bug it is

Gram +, gram -, and beta lactamase producers
(Not MRSA)
Ceftriaxone (Rocephin) IM
3 orals great for Peda bc taste delicious!:
-Cefdinir (Omnicef)
-Cefpodoxime (Vantin)
-Cefditoran (Spectracef)

Cephalosporin. 1gen

What bugs and give ex

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Gram +

Staph

Cephalexin(Keflex)
Cefadroxil (Duracef)

What class are Cefuroxime (Ceftin) and Cefaclor (Ceclor)?

Cephalosporins | 2nd gen- Gram + and - No beta lactamase

If u r not sure if pt has Strep or H. Flu- what Cephalosporin to give?

Give (Cefuroximine)Ceftin or (Cefaclor)Ceclor 2nd gen Cephalosporin Gram + and -

If pt has sinus infxn and was txd 2 wks ago w Amox what Cephalosporin to give?

3rd gen. Bc covers beta lactamase producers | Weak gram +, gram - and beta l producers

What Cephalosporin to give for a kid when u r not sure what bug is? Give examples

Extended spectrum 3rd gen cephalosporins Gram +, gram - and beta lactamase producers Cefdinir (Omnicef) Cefpodoximie (Vantin) Cefditoran(Spectracef) All oral and taste delicious for peds!

If PCN allergic use----- Not -------

If PCN allergic use Macrolides (Erythromycin, Azithromycin, Clarithromycin) Not Cephalosporin bc share beta lactam ring

List 3 Macrolides Which one doesnt work anymore? Which 2 are good for atypicals?

Early gen:Erythromycin SUCKS. Wont cover much anymore Later gen: azithromycin(Zithromax) and Clarithromycin (Biaxin) Both very easy to consume. Z pack Cover Atypicals - MSSA and Listeria (NOT Strept or Enterococcus)

A 'thromycin is a

Macrolide Azithromycin Clarithromycin

'Floxacin is what class?

Fluroquinolones

Fluoroquinolones 2nd generation

Ciprofloxacin. Gram - Atypical pathogens Hits below the belt! Not respiratory bc doesnt kill strep or DRSP

Fluoroquinolones 3rd generation

Respiratory And below belt. If wiggles levofloxicin will kill it! WOW!! The idiot's antibiotic bc it covers everything- save for peeps that can't afford a tx failure ``` Only one: Levofloxacin. (Levoquin) Gram -/+ Atypical pathogens DRSP ```

Respiratory Fluoroquinolones 4th gen

Three- give for above belt, gram +, beta lactamase producers Moxifloxacin (Avelox) Gemifloxacin (Factive) Gatifloxacin (Zymat opth) -gram +, atypical pathogens, DRSP

Fluoroquinolones summary. 2nd, 3rd, and 4th gen

2nd: Ciprofloxacin gram neg atypicals below belt 3rd Levofloxacin (Levoquin) everything! Gram -/+ respiratory 4th. Respiratory quinolones -moxifloxacin (Avelox) -Gemifloxacin (factive) -Gatifloxacin (Zymar opth) Gram +, atypicals, !!!!!!DRSP!!!!!, beta lactamase producers

Remember fluoroquinolones

2nd. Below belt. Cipro gram - below belt 3rd. Levofloxacin (Levoquin) all! Gram -/+ respiratory 4th. Moxi, Gemi, and Gatifloxacin. Gram +, beta lactamase producers and DRSP!! Respiratory Remember Quin= s "ox". Good mornin!

Pt with UTI. Which gen Quinolone to avoid?

4th everyday of the week! (Resp )

With UTI. Would u rather give a 2nd or 3rd gen quinolone and why?

Give 2nd- Cipro Save Levofloxacin 3rd for bug resistant organismas

4 Antibiotics Flashcards

(39 cards)