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Infectious Disease 2 > Anti-Infectives for Gram-Negative Pathogens in Health Systems > Flashcards

Anti-Infectives for Gram-Negative Pathogens in Health Systems Flashcards

1
Q

What are the beta-lactam anti-infectives?

A
  • Penicillins
  • Cephalosporin (Cephamycins)
  • Carbapenems
  • Monobactams
  • Sulbactam-Durlobactam
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2
Q

Of the fluoroquinolones, which of them have Pseudomonas activity?

A
  • Ciprofloxacin
  • Levofloxacin
  • Delafloxacin
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3
Q

What are the aminoglycosides?

A
  • Gentamicin
  • Tobramycin
  • Amikacin
  • Plazomicin
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4
Q

What gram-positive activity do aminopenicillins have?

A
  • Streptococci
  • Enterococcus (especially faecalis species)
  • PCN-susceptible Staphylococci
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5
Q

What is the spectrum of activity of gram-negatives for aminopenicillins?

A
  • Limited Enterobacterales
  • NO Pseudomonas
  • NO Acinetobacter
  • NO Stenotrophomonas
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6
Q

What is the DOC for Acinetobacter baumannii including CRAB?

A

Ampicillin/Sulbactam

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7
Q

What are the beta-lactamase inhibitors?

A
  • Sulbactam & Clavulanate
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8
Q

What is the spectrum of activity of aminopenicillin/beta-lactamase inhibitors?

A
  • SOME Enterobacterales
  • Acinetobacter
  • NO Pseudomonas
  • NO Stentrophomona
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9
Q

What is the spectrum of action of Sulbactam and Clavulante?

A

Class A beta-lactamase and some ESBL (clavulante only); but not including KPCs

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10
Q

What SOA does piperacillin/tazobactam have?

A
  • Many Enterobacterales
  • Pseudomonas
  • H. influenzae
  • N. meningitis
  • Limited for Acinetobacter
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11
Q

What SOA does piperacillin/tazobactam NOT have?

A

NO Stenotrophomonas

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12
Q

What are the 1st generation cephalosporin?

A

Cefazolin, Cephalexin, Cefadroxil

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13
Q

What SOA does 1st Gen Cephs organisms do have?

A
  • Staphylococcus aureus/MSSA
  • Streptococci (GAS, GBS)
  • Some Enterobacterales (E.coli, Klebsiella pneumoniae, Proteus mirabilis)
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14
Q

What SOA do 1st Gen Cephs NOT have?

A

S. pneumoniae and anaerobic activity

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15
Q

What are the 2nd generation cephalosporin?

A

Cefuroxime, Cefaclor, and Cefprozil

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16
Q

What SOA do 2nd Gen Cephs have?

A
  • Some Enterobacterales
  • H. influenzae
  • N. meningitis
  • Narrow simple BLs
  • S. pneumoniae (more reliable)
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17
Q

What SOA do 2nd Gen Cephs NOT have?

A

MSSA and no anaerobic activity

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18
Q

What are the 2nd generation cephamycins (cephalosporins) and why are they a rule-breaker of the second generation?

A
  • Cefotetan and Cefoxitin
  • Because their SOA are H. influenzae, N. meningitidis, some Enterobacterales, and Anaerobes, and are stable to ESBL
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19
Q

What are the 3rd generation cephalosporin?

A
  • Ceftriaxone, Cefotaxime, Cefpodoxime, and Cefixime
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20
Q

What SOA do 3rd Gen Cephs have?

A
  • H. influenzae
  • N. meningitis
  • many Enterobacterales (=some Enterobacterales + Citrobacter and Serratia)
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21
Q

What is the rule breaker of the 3rd generation of cephalosporin and what are their SOA?

A
  • Ceftazidme
  • SOA: H. influenzae, N. meningitis, many Enterobacterales, and Pseudomonas
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22
Q

What SOA does Ceftazidme NOT have?

A

Staphlycoccus and streptococcal activity

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23
Q

What is the 4th generation cephalosporin?

A
  • Cefepime
24
Q

What SOA does Cefepime have?

A
  • H. influenzae
  • N. meningitis
  • most Enterobacterales (Enterobacter, K. aerogenes including AmpC)
  • Pseudomonas
  • MSSA, streptococcal activity, S. pneumoniae
25
Q

What is the 5th generation of Cephalosporin and why is it a rule-breaker?

A
  • Ceftaroline
  • Because it has activity against MRSA, H. influenzae, some-many Enterobacterales
26
Q

What SOA does Ceftolozane/tazobactam have?

A
  • H. influenzae
  • Most Enterobacterales
  • Pseudomonas (+ including DTR)
27
Q

What SOA does Ceftolozone/tazobactam NOT have?

A
  • ESBL
  • N. meningitidis
28
Q

What is the SOA of ceftolozone?

A

Can go against Pseudomonas Amp C cepholosporinase
* Not affected by porin loss (OprD) and efflux pump activity

29
Q

What is the SOA of Ceftazidime/Avibactam?

A
  • H. influenzae
  • N. meningitis
  • Most Enterobacterales (+ including ESBL, CRE-KPC, CRE-OXA-48, AmpC)
  • Pseudomonas (including DTR)
30
Q

What is the SOA of Cefiderocol?

A
  • Most Enterobacterales (including ESBL, CRE, AmpC)
  • Pseudomonas (DTR)
  • Acinetobacter (+CRAB)
  • Stenotrophomonas
31
Q

Does Ceftriaxone require renal dosing?

A

Does NOT require renal dosing

32
Q

Ceftazidme

A
  • 3rd gen rule breaker
  • 1st antipseudomonal cephalosporin
  • Induces AmpC
33
Q

What are the adverse effects of ceftriaxone?

A
  • Calcium drug crystallization (fatal lung, kidney precipitates) in neonates
  • Biliary sludge
34
Q

What are the five cephalosporins that have anti-pseudomonal activity?

A
  • 3rd gen: Ceftazidme
  • 4th gen: Cefepime
  • Ceftolozane/tazobactam
  • Ceftazidme/avibactam
  • Cefiderocol
35
Q

Cefepime

A
  • 4th gen
  • Neurotoxicity potential prominent-careful dosing adjustment with kidney impairment required
  • Has a high “dose-dependent susceptibility” definition (SDD)-need higher doses with certain MIC
36
Q

Avibactam

A

Non-beta BLI with broader spectrum compared to tazobactam, sulbactam or clavulanate due to unique bridged bicyclic urea core structure

37
Q

What is Avibactam’s susceptibility?

A
  • Class A beta-lactamases, including ESBLs and KPCs
  • Class C beta-lactamases (AmpC)
  • Some class D beta-lactamases (notably OXA-48 carbapenemases)
  • Does NOT inhibit MBLs
38
Q

Cefiderocol

A
  • Unique MOA: “Trojan horse”
  • Catechol side chain at R2 function as a siderophore–> binds free host iron enabling outer membrane passage via iron transport systems along with the attached cephalosporin moiety–> gains access to PBP site of action
  • Requires iron supplemented growth media for susceptibility testing
39
Q

What are the carbapenems?

A
  • Ertapenem
  • Imipenem/cilastatin
  • Meropenem
  • Meropenem/vaborbactam
  • Imipenem/cilastatin/relebactam
40
Q

T/F: ALL carbapenems are parenteral, also have activity against Anaerobes, are neurotoxic and interact with valproic acid

A

T

41
Q

What SOA does Ertapenem have?

A
  • MSSA, Penicillin-susceptible Streptococci,
  • Enterobacterales (+ESBL, AmpC)
  • H. influenzae
  • N. meningitis
42
Q

What SOA does Ertapenem NOT have?

A
  • Enterococcus
    * Pseudomonas
  • Acinetobacter,
  • Stenotrophomonas
43
Q

Imipenem/Cilastatin

A
  • Considered to be more epileptogenic (induce seizures) than others in class
  • Imipenem is metabolized in the kidneys to a nephrotoxin
  • Dose: based on imipenem; careful adjustment required with renal impairment
44
Q

What SOA does imipenem/cilastatin have?

A
  • MSSA, Penicillin-susceptible streptococci, some Enterococci
  • Enterobacterales (+ESBL, AmpC)
  • Pseudomonas
  • Acinetobacter
  • H. influenzae
  • N. meningitis
45
Q

What SOA does Imipenem/Cilastatin NOT have?

A
  • Stenotrophomonas
  • Unreliable for Proteus, Providencia, and Morganella
46
Q

What SOA does Meropenem have?

A
  • MSSA, penicillin-susceptible streptococci, some Enterococci
  • Enterobacterales (+ESBL, AmpC)
  • Pseudomonas
  • Acinetobacter
  • H. influenzae
  • N. meningitis
47
Q

What SOA does meropenem NOT have?

A

Stenotrophomonas

48
Q

Vaborbactam

A
  • Broad spectrum non-beta lactam BLI
49
Q

What is the SOA of vaborbactam?

A
  • Class A beta-lactamases, including ESBLs and KPC carbapenemase
  • Class C beta-lactamases
  • Does NOT inhibit MBLs or Class D carbapenemases, including OXA-48
50
Q

What SOA does Meropenem/vaborbactam have?

A
  • Enterobacterales (+ESBLs, AmpC, CRE-KPC)
  • Pseudomonas
  • Acinteobacter
51
Q

What SOA does meropenem/vaborbactam NOT have?

A
  • P. aeruoginosa-DTR
  • A. baumannii-CRAB
52
Q

Relebactam

A

Broad spectrum non-beta-lactam BLI

53
Q

What is Relebactam’s SOA?

A
  • Class A beta-lactamases including ESBLs and KPC carbapenemase
  • Class C beta-lactamases
  • Some class D beta-lactamases (NOT OXA-48)
    * Does NOT inhibit MBLs
54
Q

What is Imipenem/cilastatin/relebactam’s SOA?

A
  • Enterobacterales (+ESBL, AmpC, CRE)
  • Pseudomonas (+DTR)
  • Acinetobacter
55
Q

What SOA does Aztreonam have?

A
  • Enterobacterales (+CRE-MBL)
  • Pseudomonas
56
Q

What SOA does Aztreonam NOT have?

A
  • Acinetobacter
  • Stenotrophomonas
  • Gram-pos activity

Infectious Disease 2 (7 decks)

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