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IDMM > Antibacterial Therapy > Flashcards

Antibacterial Therapy Flashcards

0
Q

Penicillins

V (PO), G (IV)

A

Spectrum: streptococci

Common indications: bacterial pharyngitis, endocarditis (IV)

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1
Q

Beta-lactams:
Penicilins
Cephalosporins
Carbapenems

A

MOA: inhibition of bacterial cell wall synthesis

  • bind and inactivate penicillin binding protein (PBPs) in the bacterial cell wall membrane
  • prevent cross-linking of peptide chains
  • activate’s bacterial cell’s autolytic system
  • clavulanic acid can be added to inhibit beta-lactamase
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3
Q

Amocicillin PO and Ampicillin IV

A 
Spectrum: streptococci and Enterococcus faecalis 
Common indications: 
- otitis media
- community acquired pneumonia (CAP) 
- enterococal infections
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4
Q

Cloxacillin PO/IV

A

Spectrum: Methacillin susceptible staph. aureus (MSSA)
Common indications:
IV: bacteremia, endocarditis, bone/joint infections
PO: skin/soft tissue

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5
Q

Amoxacillin/clavunate PO

A

Spectrum: Gram +/-, anaerobes
Common indications:
poly microbial infections - bite wounds, diabetic foot ulcer

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6
Q

Piperacillin/tazobactam IV

A

Spectrum: Gram +/-, Pesudomonas aeruginosa, anaerobes
Common indications:
febrile neutropenia, intraabdominal, polymicrobial infections, sepsis unknown source

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7
Q

Ticarcillin/clavunate IV

A

Similar to piperacillin/tazobactam

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8
Q 
Cephalosporins:
Cephalexin, cefazolin 
Cefuroxime, Cefprozil 
Cefotaxime, Ceffixime, Ceftazidime
Cefepime
A

Spectrum: Gm +, Gm- for some newer gens, no activity against enterococci, no activity vs MRSA
Common indications:
1st gen - skin/soft tissue, bone/joint
2nd gen - CA resp infections (not first line)
3rd gen - urosepsis, endocarditis, meningitis, UTI, gonorrhea
4th gen - combo with amino glycosides for Pseudomonas, febrile neutropenia, polymicrobial infections

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9
Q

Carbapenems:
Ertapenem IV
Meropenem IV
Imipenem IV

A

Spectrum: Gm +/-, ESBL/AmpC producers, pseudomonas, anaerobes
Common indications:
- not first line for CA infections
- reserve for serious infix with known multi-drug resistance
-activity vs ampC cephalosporinase and ESBL-producing organisms
- no activity vs MRSA

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10
Q

Type I allergy - Immediate

IgE mediated

A

Anaphylaxis, hypotension, bronchoconstriction, urticaria, laryngeal edema, angioedema
- onset within 1 hr up to 72 hrs

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11
Q

Type II allergy - Cytotoxic

IgG/IgM mediated

A

Hemolytic anemia, neutropenia, thrombocytopenia

- onset > 72 hrs

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12
Q

Type III allergy - Immune Complex

A

Serum sickness, drug-induced fever, interstitial nephritis

- onset 7-14 days

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13
Q

Type IV allergy - T-cell mediated

A

Contact dermatitis, exfoliative dermatitis, maculoapular or morbiliform rash, Stevens Johnson syndrome
- onset >72 hours

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14
Q

Penicillin Allergy

A
  • < 10% reported are IgE mediated
  • risk of anaphylaxis with parenteral penicillin: 0.01-0.02%, risk of mortality: 0.0015-0.02%
  • 50% patients will lose sensitivity to penicillin after 5 years
  • 80% lose sensitivity after 10 years
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15
Q

Penicillin Allergy Cross-Reactivity

A

Related to R-side chain of antibacterial (not the beta-lactam ring)

  • ~1% risk with cephalosporins or carbapenems with known penicillin allergy
  • if IgE mediated rxn to penicillin, consider 3rd/4th gen cephalosporins/carbapenems via graded challenge or desensitization
  • if life-threatening non-IgE mediated rxn, AVOID ALL beta-lactams
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16
Q

Glycopeptides/lipopeptides:

  • Vancomycin (glyco)
  • Daptomycin (lipo)
A

MOA: inhibit bacterial cell wall synthesis, bactericidal
glycopeptides: bind to terminal D-ala-D-ala residues
lipopeptides: Ca2+ dep cel memb depol/ disrupts RNA/DNA protein synthesis
Spectrum: Gm+ including MRSA
Special considerations:
- vancomycin slowly tidal
- PO vancomycin not systemically absorbed (good for C. difficile)
- daptommycin inactivated by lung surfactant - not effective for pneumonia

17
Q

Vancomycin IV

A 
Spectrum: Gm+ including 
- enterococci
- penicillin-resistant streptococci 
- MRSA
- coagulas(-) staphylococcus 
Common indications: 
- bacteremia, pneumonia, endocarditis, bone/joint, skin/soft tissue, surgical prophylaxis
18
Q

Daptomycin IV

A

Spectrum: Gm+
- as for vancomycin IV
- vancomycin resistant organisms (eg. VRE)
Common indications: bacteria, endocarditis, bone/joint, skin/soft tissue

19
Q

Aminoglycosides:

  • Gentamicin
  • Tobramycin
A

MOA: Bind to 30S ribosomal subunit, inhibit protein synthesis, Bactericidal
Special considerations
- renal eliminated
- may cause nephrotoxicity, ototoxicity
- gentamicin synergy vs Enterococci with beta-lactams (facilitates uptake of gentamicin)

20
Q

Gentamicin IV

A

Spectrum: Gm -
- pseudomonas
- syngergy vs Streptococci and Enterococci with beta-lactam or vancomycin
Common indications:
- drug resistant UTI
- combo therapy for Gm - spesis
- synergy for Gm+ bacteremia and endocarditis

21
Q

Tobramycin IV

A 
Spectrum: Gm - 
- pseudomonas (better than gentamicin) 
Common indications:
- drug-resistant UTI
- combo therappy for serious Pseudomonas infx
22
Q

Macrolides

- azithromycin

A

MOA: bind to 23S rRNA of 50S subunit, inhibit protein synthesis, Bacteriostatic
Special considerations:
- active vs intracellular organisms
- long half-life (3 day = 10 day course)

23
Q

Azithromycin IV/PO

A 
Spectrum: 
- Chlalmydophila
- Legionella
- Moraxella catarrhalis
- Chlamydia trachomatis 
- Neisseria gonorrhea 
- Mycobacterium avium complex (MAC) 
Common indications: 
- combo for MAC tx
- MAC prophylaxis in HIV pts
- 2nd line for STIs
- combo with beta-lactam for CAP
  • preferred macrolide over erythormycin and clarithromycin b/c broader spectrum, fewer drug interactions, once daily dosing, tolerability, IV option
24
Q

Lincosamides

- Clindamycin

A

MOA - binds to 50S ribosomal subunit, inhibit protein synthesis, Bacteriostatic

Special Considerations:

  • Excellent bioavailability
  • possibly inhibits toxin production form GAS, active vs bacteria in resting phase
  • used in combo with penicillin for necrotizing fasciitis
  • high risk of C. difficile
25
Q

Clindamycin PO/IV

A 
Spectrum: 
- Streptococci
- S. aureus
- MRSA 
- Anaerobes 
Common indications: 
- skin/soft tissue 
- bone/joint 
- abscesses
- alternative for dental infections 
- poly microbial infections in combo with Gm- agent
- combination vs necrotizing fascitis
26
Q

Tetracyclines and Glycycyclines

  • Doxycycline (PO)
  • Tigecycline (IV)
A

MOA: Bind 30S and 50S ribosomal subunits, inhibit protein synthesis, Bacteriostatic
Special considerations:
- active vs intracellular pathogens

27
Q

Doxycycline PO

A

Spectrum:
- mycoplasma, chlamydophila, Legionella, Chlamydia thrachomatic, S.penumoniae, Haemophilus, Moraxella, S aureus (incl MRSA)
Common indications:
- COPD, CAP, chlamydial STIs, purulent cellulitis (Suspected MRSA)

28
Q

Tigecycline IV

A 
Spectrum: 
- broad Gm+/- (incl E. faecalis, MRSA) 
- anaerobes 
Common Indications:
- last line option of polymicrobial, multi drug resistant organisms if susceptibility confirmed
29
Q

Fluoroquinolones

  • ciprofloxacin
  • levofloxacin
A

MOA: inhibition of DNA gyrase and topoisomerase, Bactericidal
Special considerations:
- excellent bioavailability
- levofloxacin and moxifloxacin active vs. intracellular pathogens
- High risk of C. difficile
- widespread use leading to Gm - resistance

30
Q

Ciprofloxacin IV/PO

A

Spectrum:
- Gram-, Pseudomonas
Common indications:
- usu not 1st line due to increasing Gm - resistance
- UTI
- in combo with metronidazole or clindamycin for polymicrobial infections

31
Q

Levofloxacin IV/PO

A 
Spectrum: 
- Streptococci
- Mycoplasma
- Chlamydophila 
- Legionella 
- Gm neg 
Common indications: 
- not 1st line 
- reserve for suspected drug-resistant respiratory infection or allergy to 1st line agents
32
Q

Anti-folates

  • Trimethroprim-sulfamethoxazole (TMP-SMX)
  • Nitrofurantoin
A

MOA:
TMP-SMX: inhibit DHFR and DHPS [Bacteriostatic]
- excellent oral bioavailability
- increasing resistance for S. pneumoniae
and E.coli

Nitrofurantoin: reduced to reactive intermediates that damage ribosomal proteins, DNA etc. [Bactericidal]

  • effective for cystitis, not pyelonephritis
  • may not be effective if CrCl <40-60ml/min
33
Q

Trimethoprim/Sulfamethoxazole IV and PO

A 
Spectrum:
- Gm-
- S. aureus (incl MRSA)
- S pneumoniae 
- Nocardia, Pneumocystis jiroveci 
Common indications:
- UTI (not first line) 
- purulent cellulitis 
- nocardia infections 
- PCP treatment and prophylaxis
34
Q

Nitrofurantoin PO

A 
Spectrum:
- E. Coli
- Klebsilela 
- E. faecalis 
Common indications: 
- first line for cystitis
35
Q

Nitroimidazoles

- Metronidazole

A 
MOA: inhibits DNA synthesis, bactericidal
Special considerations: 
- excellent bioavailability 
- excellent CNS penetration 
- avoid alcohol (disulfiram rxn)
36
Q

Metronidazole PO/IV

A 
Spectrum: 
- anaerobes, including C. difficile 
- protozoa (eg. Giardia) 
Common indications: 
- C. difficile 
- used in combo for polymicrobial infections/abscesses 
- Trichomoniasis
37
Q

Oxazolidinones

- Linezolid

A

MOA - inhibition of protein synthesis by binding to 23S rRNA in 50S ribosomal subunit (prevent 70S formation); Bacteriostatic

Special considerations:

  • activity vs beta-lactam resistant and vancomycin resistant organisms
  • excellent bioavailability
  • cytopenias with prolonged therapy (>2 weeks)
38
Q

Linezolid IV/PO

A 
Spectrum: 
- Streptococi 
- Enterococci
- Staphylococci 
- anaerobes 
Common indications: 
- resistance, allergy or failure with vancomycin therapy
39
Q

Anti-tuberculous Drugs

  • Rifampin
  • Isoniazid
  • Pyrazinamide
  • Ethambutol
A

Special considerations:

  • four drug combo for TB empirically due to increasing resistance
  • bactericidal
  • well absorbed
  • drug interactions due to induction of Cyp3A4 by rifampin
  • monitor for hepatotoxicity

IDMM (8 decks)

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