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Antibiotics Flashcards

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1
Q

Different targets of antibiotics

A 
Cell wall
DNA/RNA synthesis
Folate synthesis
Cell membrane
Protein synthesis
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2
Q

Categories of cell wall antibiotics

A 
Beta lactams
Glycopeptides
Bacitracin
Fosfomycin
D-cycloserine
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3
Q

Examples of B-lactams

A

Penicillins
Cephalosporins
Carbapenems
Monobactams

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4
Q

Categories of antibiotics that prevent DNA/RNA synthesis

A

Quinolones
Nitromidazoles
Rifamycins

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5
Q

Examples of antibiotics that interfer with folate synthesis

A

Trimethoprim

Sulfonamides

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6
Q

Examples of antibiotics that prevent cell membrane formation

A

Daptomycin

Polymixins

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7
Q

Groups of antibiotics that interfer with protein synthesis

A 
30s: 
Tetracyclines
Aminoglycosides
50s:
Lincosamides
Oxazolidinones
Chloramphenicol
Macrolides
(Ta locum!)
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8
Q

Penicillins

A 
Penicillin G
Penicillin V
Piperacillin
Ampicillin
Amoxicillin
Nafcillin
Dicloxacillin
Ticarcillin
Oxacillin
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9
Q

Cephalosporins (10)

A 
Cefazolin
Cephalexin
Cefuroxime
Ceftriaxone
Cefotaxime
Cefixime
Ceftaxidime
Cefepime
Cefoxitin
Cefotetan
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10
Q

Carbapenems

A 
Meropenem
Ertapenem
Doripenem
Imipenem
Aztreonam
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11
Q

Quinolones/fluoroquinolones

A

Ciprofloxacin
Levofloxacin
Gatifloxacin
Moxifloxacin

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12
Q

Nitromidazoles

A

Tinidazole
Nitrofurantoin
Metronidazole

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13
Q

Rifamycins

A

Rifampin
Rifabutin
Rifapentine

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14
Q

Examples of tetracyclines

A

Tetracycline
Doxycycline
Minocycline
Tigecycline

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15
Q

Examples of macrolides

A

Erythromycin
Clarithromycin
Azithromycin
Telithromycin

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16
Q

Examples of aminoglycosides

A

Streptomycin
Tobramycin
Amikacin
Gentamicin

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17
Q

Examples of lincosamides

A

Clindamycin

lincomycin

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18
Q

Examples of glycopeptides

A 
Vancomycin
Teichoplanin
Telavancin
Ramoplanin
Dalbavancin
Oritavancin
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19
Q

What does MALDI-TOF stand for?

A

Matrix Assisted Laser Desorption Ionisation- Time of Flight

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20
Q

Draw the flow chart for gram negative rod identification

A

Obligate anaerobes (Bacteroides)
Micro-aerophilic (oxidase positive Campylobacter)
Aerobic

MacConkey agar:
no: Parvobacteria (chocolate agar, requires X, V H.influenza)
yes:

Lactose fermentation:
yes: Chrome agar (pink e.coli)
no:

Oxidase
positive: Pseudomonas
No: Enterobacteriaceae (salmonella, shigella)

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21
Q

Draw the flow chart for gram positive cocci identification

A

Catalase test
+ve: Staphylococcus
-ve: Streptococcus

Coagulase
+ve Staph aures

MacConkey agar:
+ve Enterococcus (lancefield group D)
-ve

Blood agar
alpha (optochin s: Strep pneumoniae r: Strep viridans)
beta (bacitracin s: Strep pyogenes/group A r: Strep agalactiae/group B)
gamma: enterococcus

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22
Q

Treatment for community acquired pneumonia

A

Septic?

Yes: Co-amoxiclav 1.2g iv tds + clarithromycin 500 mg po/iv bd (if severe add single dose gentamicin 5 mg/kg iv)

No:
CURB65 0-1 amoxicillin 500 mg po tds
CURB65 2-5 amoxicillin 1 g iv tds + clarithromycin 500 mg po bd

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23
Q

CURB65

A 
Confusion (AMT abbreviated mental test <=8)
Urea (>7 mmol/L)
Resp rate (>30 brpm)
BP (<90 systolic, <=60 diastolic)
Age (>=65 years)
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24
Q

First line treatment for Staph aures

A

Flucloxacillin (Vancomycin if resistant)

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25
Tazocin
piperacillin + tazobactam
26
Co-amoxiclav
amoxicillin (beta lactam) + clavulanic acid (B-lactamase inhibitor)
27
Mechanisms for antibiotic resistance
Efflux pumps Alteration in outer membrane permeability (e.g loss of porin channel) Target modification Inactivating enzymes Genetic mutation Vertical/horizontal gene transfer (pilus)
28
Incidence
Rate of occurance of new cases (useful for short lived conditions)
29
Prevalence
How many people have it. Frequency of existing cases in a defined population. Useful for chronic conditions
30
Incubation period
Time between exposure to an infection and appearance of first symptoms.
31
A vector
An agent that carries/transmits an infectious patogen into another living organism.
32
Treatment for c.tetani
ITU Human tetanus Ig (IM at multiple sites to neutralise toxin) Metronidazole. Vaccine available
33
Treatment for haemophilus influenza
First choice for life threatening: 3rd generation cephalosporin (ceftriaxone as it penetrates CSF) Less serious: oral ampicillin
34
Gram negative structure
LPS in outer membrane (lipid A, O polysaccharides) Outermembrane Peptidoglycan cell wall Inner membrane Contains aqueous transmembrane channels (porins) which allows entry of some antibiotics.
35
Symptoms of Neisseria gonorrhoea
``` Men: Urethral pus Tenesmus (wanting to poo) Proctitis (inflammation of rectum and anus) Discharge PR (especially if gay) ``` Women: Often asymptomatic Baby: Blind
36
Latent period
Time from exposure to becoming infectious
37
Mycobacterium pathogenesis
Mycobacteria ligate TLR2 as they infect macrophages. Ligation of TLR2 leads to production of NO and secretion of IL12. Presentation of mycobacteria antigens to T cells with IL12 causes macrophage stimulation and division. T cells release IFNgamma. More macrophages recruited and granuloma formation.
38
Reactivation of TB
10% risk in lifetime. Risk greatest within first 2 years. Risk factors include HIV (10%/year). Immunocompromised (corticosteroids, TNFalpha antagonists).
39
Treatment for N. gonorrhoea
Ceftriaxone
40
Mechanism of beta lactam antibiotics
Bind penicillin binding proteins (PBPs). Inhibit peptidoglycan cross-linking. Bactericidal if cells are actively dividing.
41
What is penicillin G?
benzylpenicillin
42
What is penicillin V?
Oral version of penicillin G
43
Spectrum of activity for penicillin G/V
Used to be wide: syphilis, anaerobes, gram +ves, a few gram -ves. Now resistance (not that useful against other gram -ves/anaerobes). Still the best antibiotic for penicillin-sensitive Streptococci, Neisseria, and spirochaetes.
44
Examples of extended spectrum penicillins (ESPs)
Ampicillin | Amoxicillin
45
Spectrum of activity of ESPs
Improved activity against some gram -ves. e.g H.influenza and E.coli (useful in RTI/UTIs). Less activity agains gram +ves than penicillin G but still useful.
46
Which has better oral bioavailability? Amoxicillin or Ampicillin
Amoxicillin
47
Examples of antistaphylococcal penicillins
Flucloxacillin | Methicillin
48
Spectrum of activity of flucloxacillin
Stable to staphylococcal beta-lactamase so active against penicillin resistant S.aures. Mainstay of treatment for S.aures infections. Also active against some other gram +ves e.g streptococci so good for skin infections. NOT useful against gram -ves.
49
How does S.aures develop resistance to methicillin/flucloxacillin?
Modification of PBP target.
50
Treatment against pseudomonas
``` Piperacillin Tazocin Ceftazidime Meropenem Gentamicin Ciprofloxacin ```
51
Cephalosporins specrum of activity
Broader spectrum than penicillins. Most are active agains Staph aures and Strep. Unlike penicillins, NOT active against enterococci or listeria (add ampicillin if risk of listeria). Veriable activity against gram -ves. Inactive against anaerobes (combine with metronidazole if anaerobic cover needed).
52
Group 2 cephalosporins cover
Good activity against common gram +ve (S.aures and Strep). Limited activity against gram -ve (NOT for H.influenza). Uses: outpatient treatment for upper resp, urinary, soft tissue infections.
53
Group 3 cephalosporins cover
Active agains wide range of gram +ve and -ve but NOT pseudomonas. Uses: severe sepsis (urinary, resp and soft tissue infections).
54
Group 4 cephalosporins cover
Active agains wide range of gram +ve and more gram -ve but NOT pseudomonas. Long half life allows administration once per day. Can get into CSF. Uses: severe infections including bacterial meningitis.
55
Group 6 cephalosporins cover
Similar to group 4 but also ACTIVE against pseudomonas. Uses: wide range of severe infections.
56
Carbapenems (cover and usage)
Broadest spectrum beta-lactam antibiotics. Stable to most beta-lactamase and ESBL producing gram negatives. Active against most (but not all) gram +ve and -ve bacteria.
57
Glycopeptides (examples and cover)
e.g vancomycin, teichoplanin Active against gram +ves including enterococci and MRSA. NOT active against gram -ves: large molecules cannot penetrate outer membrane. Poor oral availability. Give IV.
58
Group 2 cephalosporins examples
e.g cefalexin, cefradine (first generation oral)
59
Group 6 cephalosporins examples
e.g ceftazidime (3rd generation, parenteral)
60
Group 3 cephalosporins example
e.g cefuroxime (second gen, parenteral)
61
Group 4 cephalosporins examples
e.g ceftriaxone, cefotaxime (3rd generation, parenteral)
62
Spectrum of aminoglycosides
Active transport into cell. Potentially bactericidal against staphylococci and most gram -ves including pseudomonas. Poor oral availability. Give IV. Risk of ototoxicity and nephrotoxicity so monitor levels.
63
Tetracyclines (spectrum and uses)
Broad spectrum but bacteriostatic. Good oral availability. Active against wide range of gram +ve and -ve but increasing resistance. Uses: Rickettsia, lyme disease. Prophylaxis malaria. Causes discolouration of bones and teeth (avoid in young children).
64
Agent that causes lyme disease
Borelia burgdorferi
65
Use of trimethoprim
Uncomplicated UTIs.
66
Folate antagonist that you use in combination with other things
Sulphonamides Co-trimoxazole (septrin)= sulfamethoxazole + trimethoprim: synergism. Used against a range of gram +ve, gram -ve and some protozoa (e.g PCP)
67
What is PCP?
Pneumocyctis pneumonia
68
Causative agent of PCP
Pneumocystis jirovecii (yeast)
69
Spectrum of activity of nitromidazoles
Active against most anaerobes. | Used to treat some protozoa (Entamoeba histolytica, Giardia).
70
Capsulated bacteria
Gosh Some Nasty Killers Have Serious Capsule Protection ``` Group B strep Strep pneumoniae Neisseria meningitides Klebsiella pneumoniae Haemophilus influenza type B Salmonella typhi Cryptococcus neoformans (fungi) Pseudomonas aeruginosa ```
71
Catalase Positive Organisms
Catalase Positive: Notoriously Bubbling HASSLE ``` Candida Pseudomonas Nocardia B. cepacia H. pylori Aspergillus Staphylococci Serratia Listeria E.coli ```

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