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Flashcards in Antibiotics Deck (51):
1

who should receive antibiotic prophylaxis?

certain surgical patients (cardiac, peripheral vascular, ortho, GI, hysterectomy), severely neutropenic patients, the patient at risk for bacterial endocarditis, the patient with recurrent UTIs, severe rheumatic endocarditis

2

PCN: Narrow- spectrum penicillinase sensitive

Pen G, Pen V- Useful for strep spa, Neisseria spa, many anaerobes, spirochete

3

PCN: Narrow- spectrum penicillinase resistant

Nafcillin, oxacillin, cloxacilin, dicoxacillin- useful for staph aureus

4

PCN: Broad- spectrum

Ampicillin, amoxillin, bicampicillin- Useful for H. influenzae, E.Coli, P.mirabilis, N. gonorrhoeae, entercocci

5

PCN- Extended- Spectrum pencillins

carbenicillin indanyl, ticarcillci, mezlocillin, piperacillin- useful for H. Influenzae, E.Coli, P.Mirabilis, N. Gonorrhoeae, entercocci, plus, Pseudomonas, enterobacter spp., bacterioides fragilis, many klebsiella

6

PCN- Side effects and toxicities

Pain at IM inn site, rare neurotoxicity, reactions to procaine and potassium, allergy in 2-30min is immediate, accelerated is 1-72 hours, late is days to weeks, anaphylactic retains more common than other drugs

7

Cephalosporins

are beta-lactam antibiotics that bind to PBPs, resistance to cephalosporins occurs due to beta-lactamases which cleave open the drugs. Groups into generations which take into account spectrum of activity, susceptibility, to beta-lactamases, and increasing ability to penetrate the CSF

8

First generation cephalosporins

Good gram positive coverage

9

second generation cephalosporins

gram positive coverage and some gram negative coverage

10

third generation cephalosporins

gram negative aerobes, ceftazidime is effective against pseudomonas

11

fourth generation cephalosporin

cefipime- broadesr spectrum, good penetration

12

Side effects and toxicities of cephalosporins

allergy- micropapular rash after several days is the most common manifestation
Increased bleeding tendencies (cefmetazole, cefoperazone, cefotetan), alcohol intolerance

13

Carbapenems

broad spectrum beta-lactam anx. Include imipenem (most broad), meropenem, ertapenem

14

Vancomycin

reserved for serious infections- AAPMC (second choice to metronidazole) MRSA, serious infections in the PCN allergic patients. Binds to cell wall synthesis but is not a beta lactam, ototoxicilty at high levels. Other rxn include rashes, thrombophlebilits, no cross- reactivity in the PCN allergic patient

15

Tetracyclines

tertracycline, oxytetracyline, demeclocycline, methacycline, doxycycline, and minocycline

16

Therapeutic uses of tetracycline

infection diseases: rickettsia, chlamydia trachomitis, brucellosis, cholera, mycoplasma pneumonia, lyme disease, anthrax, H Pylori. TX of acne- topical and PO. PUD, periodontal disease

17

Side effects and toxicities of tetracyclines

GI irritation; NVD, esophageal ulceration, Staining of teeth- avoid during pregnancy, avoid form ages 4mos to 8yrs, supra infection; AAPMC, candida, hepatoxicity, renal toxicity, photosensitivity

18

Macrolides

Erythromycin, clarithromyscin, azithromycin and dirithromycin

19

erythromycin- Activity, SE, drug interactions

macrolide. has activity against most gram + and some gram -, drug of choice for the PCN allergic for whooping cough and legionnaires disease.
SE: NVD, cholestatic hepatitis (10-20 days after, reversed with d/c of drug) and supra infection
Drug interaction- Cyp450 inhibitor; theophylline, carbamezepine, warfarin- monitor closely. Do not combine with clinda or chloramphenicol

20

clarithromycin

for soft tissue and skin infections, H pylorim respiratory tract infections in PCN allergic patients

21

azithromycin

for skin and soft tissue infections, H pylori, respiratory tract infections, and drug of choice for chlamydia trachoma tis

22

sulfonamides uses and side effects

UTIs, nocardiosis, burns, superficial eye infections. Hypersensitivity reactions: rash, drug fever, photosensitivity, stevens-johnson syndrome. Hemolytc anemia- seen in patients with G6PD deficiency. Kernicterus- do not give in preggo, breastfeeding, or infants, 2 months. Renal damage from cystalluria

23

Trimethoprim uses and side effects

rarely used alone for uncomplicated UTIs

24

Fluoroquinolones uses and side effects

borad spectrum antibiotics used for bone and soft tissue infections, UTIs, respiratory tract infections, GI infections and prevention of anthrax. Mild GI side effects, CNS s/e include dizziness, headache, restlessness, seizures rare. TENDON RUPTURE (usually achilles tendon) rare but d/c at first sign of tendon pain, do not use in children ,18yo, may elevate warfarin and theophylline

25

metronidazole uses

used to treat anaerobic bacterial infections of CNS , abdominal organs, skin, joints, soft tissues, and GU and protozoal infections. Also prophylactic antibiotic for colorectal surgery, abdominal surgery, vaginal surgery. May be used in combo for H pylori.

26

metronidazole side effects

GI: nausea, dry mouth, metallic taste, urine may turn darker color, avoid using in first trimester pregnancy, causes disulfiram-like reaction with alcohol, lower doses of warfarin when used with metronidazole

27

What do you use to treat empirically for PCN resistant strep for pneumococcal disease?

ceftriaxone/ cefotaxime or quinolones (levo or moxifloxin)

28

General antibiotic classes

BETA-LACTAMS- Penicillins= ampicillin, amoxicillin, nafcillin, diclocillin, piperacillin, ticarcillin. Cephalosporins= Cefazolin, cephalexin, cefoxitin, cefotetan,ceftriaxone, ceftazidime, cefepime) Monobactam (aztreonam) Carbapenem (imppenem, meropenem)
COMBINATIONS- Amoxicillin/clavulanate, ampicilin/sulbactam, piperacillin/tazobactam
GLYCOPEPTIDES- vancomycin, teicoplanin
MACROLIDES- erythromycin, clarithromycin, azithromycin
LINCOSAMIDES- clindamycin
AMINOGLYCOSIDES- gentamycin, tobramycin
QUINOLONES- norfloxacin, ciprofloxacin, oflaxacin, levofloxacin, gemifloxacin, moxifloxacin
SULFONAMIDES- trimethoprim + sulfamethoxazole
TETRACYCLINE- tetracycline, doxycyline, minocyline
NITROIMIDAXZOLE- metronidazole

29

ANTIBIOTIC SIDE EFFECTS: PCN, CEPHALOSPORINS, CARBAPENEMS, VANCOMYCIN

PCN: Allergic reactions (1-5%), anaphylaxis (rare), cross reactions (3-7% with ceph), prolonged high dose- granulocytopenia, interstitial nephritis
CEPHALOSPORINS- Allergic reactions (1-3%), cerfotetan- disulfiram-like reaction and hemostasis (hypoprothrombinemia)
CARBAPENEMS (allergic reactions with PCN, SZ in high doses)
VANCOMYCIN- red man syndrome, nephrotoxicity when used with amino glycosides

30

ANTIOBIOTIC SIDE EFFECTS: MACROLIDES, AMINOGLYCOSIDES, QUINOLONES, SULFONAMIDES, TETRACYLCINES, METRONIDAZOLE

Macrolides- GI COMPLAINTS, Cramping, diarrhea, drug interactions
Aminoglycosides- nephrotoxicity, ototoxicity,
QUINOLONES- GI and CNS complaints, SZ with high doses
SULFONAMIDES- Allergic reactions, stevens johnson
TETRACYCLINES- photosensitity
METRONIDAZOLE- Disulfiram-like reactions with ETOH, CNS( SZ) and neuropathy

31

Treatment of skin and soft tissue infections (not bite wounds)

staph aureus, strep pyogenas (impetigo, erysipelas, lymphangitis, cellulitis, surgical wound infections, pyomyositis, necrotizing fasciitis).
Cefazolin, cephalexin, nafcillin, dicloxacillin, clindamycin, vancomycin, amox/ clav. ampicillin/ sulbactam. DURATION; 10 days

32

Treatment of skin and soft tissue infection: Bite wounds

staph and strep (including microaerophilic), Eikenella (animal bites: pasturella), bactericides, prevotella, fusobacterium, peptostreptococcus. Treatment: clean, deride and tetanus shot. Amox/clavulanate, ampicillin, sulbactam

33

Upper Respiratory Tract infections: Pharangitis, otitis media, sinusitis/ bronchitis

Pharangitis: Group A strep, PCN x10days
Otitis media: Pneumococcus, H influenze, moraxella catarrhalis- amocillin (augmentin) Macrolides, Cephalosporins
Sinusitis/ bronchitis: Pneumococcus, Hinfluenze, Klebsiella, moraxella, staph aureus, anaerobes. TMP/SMX. Second choice amoxicillin, augmentin, macrolides, cephalosporins, quinolones

34

Community acquired pneumonia: Typical

Acute once, symptoms ,1week, productive cough, SOB, Chest X-ray shows lobar infiltrates. bugs: Streptococcus pneumoniae, H. influenzae, Moraxella catarhalis, klebsiella pneumoniae, staph aureus, aspiration or naerobic lung abscess. empiric treatment with ceftriaxone or cefotaxime; alternatives are vanco, clindamycin, or quinolone (levo, gemi, moxi)

35

Community acquired pneumonia: Atypical/walking

insidious onset, symptoms >1week (2-3 weeks usually), nonproductive cough, dyspnea on exertion (then SOB), chest X-ray shows interstitial infiltrates. Bugs: mycoplasma pneumonia, chlamydia pneumoniae, legionella pneumophila, influenza A 7B (parainfluenze, adenovirus) TB, miliary, fungal, pneumocystis carinii. Treatment with erythromycin (clarithromycin, azithromycin). Alternative is quinolones

36

UTI: bugs, DX, and TX

Ecoli, enterococcus, s.saprophyticus, proteus klebsiella, pseudomonas. DX: Clean catch. Pyuria, leuocyte esterase, hemturia, >100,000 bacterial colonies. TX: Empiric TMP/SMX, quinolone for 5-7 days. Pyelonephritis: 14 days

37

GI bugs and treatments

GASTEROENTERITIS: Shigella, salmonella, enterotoxic E coli, campylobacter- Hydration, TMP/SMX, quinolones.
C DIFF COLITIS- Metronidazole, Vanco
HEPATOBILIARY- enteric gram neg, enterococcis, anaerobes- Ceftriaxone, ampicillin/ sulbactam, cefoxiten
CATASTROPHIC GI- polymicrobial- cefoxiten, amp/sulbactam, amp+gent+metronidazole

38

Urethritis/ Cervicits, nongonnococcal urethritis (NGU), bugs and tx

Chlamydia trachomatis, ureaplasm urealyticum, mycoplasma genitalium, HSV and trichomonas vaginalis. Tx Doxycyline 100mg BID x7days or Azithromycin 1 gram single dose. Other alternatives are erythromycin 500mg QIDx7dys, ofloxacin 300mg BID x7days, refractory metronidazole 2 gram in single dose

39

Urethritis/cervicitis: Gonoccal urethritis bugs and tx

Mucopurulent, n gonorrhoeae, cefixime 400mg or cirpfloxin 500mg or ofloxacin 400mg orally in single dose or ceftriaxone 125mg IM in a single dose PLUS doxycyline 100mg BID x 7days or azithromycin 1 gram unless using ofloxacin BD x7day regime. GC pharyngitis is same but cefixime is not effective. Disseminated GC needs IV

40

Vaginal discharge: Bacterial Vaginosis. S/SX, DX, and TX

White, noninflammatory discharge, clue cells, Ph.4.5, fishy odor, (+/- KOH 10%). Metronidazole 500mg BID x7days. Alternative Clindamycin cream 2% or metronidazole gel 0.75% intravaginally QHS x7days

41

Vaginal discharge: Trichomoniasis. S/SX and TX

Malodorous, yellow-green with irritation, trichomonad vaginalis protozoan. Metronidazole 2 grams orally in single dose or 500mg BID x 7days

42

Vaginal discahrge: Vulvovaginal candidiasis

White discharge with parities +/- or burning. Candida albicans or others. Topical azole antifungals 3-14 days or fluconazole 150mg orally in a single dose

43

PID- S/Sx, bugs and tx

upper genital tract: endometriosis, salpingitis, tubo-ovarian abscess, pelvic peritonitis. Lower abdominal pain, adenexal, cervial motion tenderness +/- temp, discharge, ESR, CRP pr histopath/ US/ Laparoscopic N. gonorrhoeae, C. Trach, anaerobes, G. Vaginalis, Hinfluenze. oral regimen: ofloxacin BIDx14days plus metronidazole 500mg BID x14days

44

Syphilis

Primary and Secondary- Benzathine Penicillin G 2.4Mill IM x1 week. If PCN allergy: Doxycyline 100mg PO BID x2 weeks
Latent syphilis-> tertiary syphilis- Benzathine PCN G 7.2 million IM weekly x3 days. Neuro syphilis needs IV

45

Chancroid

multiple painful ulcers, no syphilis, adenopathy, H ducreyi
TX: Azithromycin 1 gram x1 or ceftriaxone 250 IM or ciprofloxacin 500mg BIDx3 days or erythromycin 500mg QID x7days

46

Herpes Simplex

Painful ulcers, positive culture for HSV. Acyclovir 400mg TID or famciclocie 250mg TID or Valacyclovir 1 gram BID for 7-10days

47

Tips for COMMON INFECTION: OTITIS MEDIA

1/3 cases are viral, antibiotics can be deferred for 48h in mild cases, Amoxicillin, TMP/SULFA are most appropriate,. If no clinical improvement in 48-72 hours, change ANX

48

Tips for COMMON INFECTION: ACUTE BRONCHITIS

most are self-limiting and viral. Consider ANX for COPD, suggestive of PNA, or symptoms lasting longer than 10days

49

tips for common infection: PHARYNGITIS

MOst are self limiting, only 12% caused by group a strep. Determine that strep is the causative agentPCN drug of choice

50

Tips for the common infection: COLD AND ACUTE SINUSITIS

most are viral. Green or yellow discharge is not indicative of bacterial infection. Defer tx unless temp is >39C, facial pain or swelling, or cough with purulent rhinorrhea for .7-10 days

51

Guidelines for prevention of spread of antibiotic resistance

Do not use broad spectrum as freebies, use local epidemiological data, educate patient about taking full course of and, shorter courses when possible