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Clinical pharmacology and therapeutics > Antibiotics > Flashcards

Antibiotics Flashcards

1
Q

What percentage of hospital in patients are on antibiotics?

A

25%

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2
Q

What proportion of the NHS drug budget is spent on antibiotics?

A

30%

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3
Q

What proportion of antibiotic use is inappropriate?

A

50%

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4
Q

Give some examples of the relationship between inappropriate drug use and resistance

A

MRSA
Clostridium difficile
VRE
Resistant enterobacteriaceae

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5
Q

Give some examples of resistant enterobacteriaceae

A

E.coli
K. pneumoniae
Extended spectrum beta lactamase (ESBL) producers
Carbapenemase producing enterobacteriaceae
Klebsiella producing carbapenemases (KPC)

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6
Q

What can reduce the risk of antibiotic resistance?

A

Giving less antibiotics

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7
Q

What is the most common antibiotic resistant bacteria at the moment?

A

E.coli

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8
Q

Which antibiotics is E.coli currently resistant to?

A

Gentamicin
Ciprofloxacin
Piperacillin - tazobactam
Co-amoxiclav

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9
Q

In what ways are some antibiotics not appropriate?

A

Indication

Duration

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10
Q

What type of bacteria is E.coli?

A

Gram negative

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11
Q

What factors affect antibiotic choice?

A

Patient factors - severity and predisposition (eg. splenectomy)
Antimicrobial resistance - exposure and epidemiology
Microbial aetiology - exposure and focus
Antibiotic knowledge

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12
Q

In clinical practice what do you use to inform your knowledge of antibiotics?

A

Microguide

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13
Q

What is antimicrobial stewardship?

A

A set of strategies used to reduce antibiotic resistance, avoid unnecessary cost and improve patient outcomes

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14
Q

Give the 2 antimicrobial stewardship strategies

A

Primary care - Target

Secondary care - Start smart then focus

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15
Q

What percentage of review and revise decisions are to continue antibiotics?

A

95%

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16
Q

How can we review and revise antibiotics better?

A

Recognize that in hospitals antibiotics are usually started empirically

Think about what evidence you would want to have at review

When you review

  • Remember antibiotics are harmful
  • Did they ever have an infection?
  • Are they better now?
  • Do the risks of continuing outweigh the benefits?
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17
Q

At what point should you review antibiotics?

A

48 to 72 hours after starting

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18
Q

What are the two moments when making ood antimicrobial choices?

A

Initial prescription - microbial aetiology, patient factors, antimicrobial resistance issues, monitoring, guidelines, knowledge

Monitoring and test results - review and revise

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19
Q

What type of antibiotic is amoxicillin?

A

Penicillin

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20
Q

How does amoxicillin differ from other penicillins?

A

Longer half life than penicillin 5
Better activity against gram negative bacteria
Good oral bioavailability

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21
Q

Where is amoxicillin used?

A

Treatment of S.pyogenes infections, pneumococcal infection and coliform infections

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22
Q

Describe the mechanism of action of amoxicillin

A

Inhibition of bacterial wall synthesis

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23
Q

What is the standard dose of amoxicillin?

A

250-1000mg 8 hourly

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24
Q

Give the adverse effects of amoxicillin

A

Allergy

Damage to commensals

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25
Q

Give an interaction of amoxicillin

A

Can increase the levels of other protein bound drugs

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26
Q

Give the half life of amoxicillin

A

1 hour

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27
Q

How is amoxicillin excreted?

A

Urine

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28
Q

List the beta lactam antibiotics

A 
Penicillin G and V
Amoxicillin and co amoxiclav
Flucloxacillin
Piperacillin 
Cephalexin
Cefuroxine 
Meropenem
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29
Q

Which antibiotic is used for staph aureus infections?

A

Flucloxacillin

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30
Q

Which antibiotic is regarded the easy oral penicillin?

A

Amoxicillin

31
Q

What is co amoxiclav?

A

Amoxicillin protected against beta lactamases

32
Q

What is the penicillin used to treat pseudomonas?

A

Piperacillin

33
Q

What is another word for a penicillin allergy?

A

Beta lactam allergy (class effect)

34
Q

Name the two classes of penicillin allergy

A

Immediate/Accelerated (Type 1)

Delayed (Type 2)

35
Q

What percentage of courses result in a type 1 immediate/accelerated penicilin allery?

A

0.02%

36
Q

Describe a type 1 immediate/accelerated penicillin allergy

A

0-72hrs after exposure
IgE and mast cell mediated
Urticaria, wheeze and life threatening

37
Q

Describe a type 2 delayed penicillin allergy

A

> 72 hours after exposure
Will worsen with repeated exposure
Does not become the immediate type

38
Q

What percentage of antibiotic courses result in an delayed penicillin allergy?

A

2-3%

39
Q

Describe cephalosporin allergy

A

Very complicated – lots of potential haptens involved
Not a class effect
Penicillin X-reactivity more with 1st & 2nd generations
Risk ~8% if previous penicillin allergy
Less with 3rd Generation

40
Q

Describe a history of beta lactam allergy and the outcome of the history

A

When was it?
What happened – time course and severity?
What was the drug?
Might they have had glandular fever?
Have they had a (different) beta-lactam since?

Good history of anaphylaxis – avoid all beta-lactams
Weak history or of delayed reaction – consider re-challenge.

41
Q

What drug class is clarythromycin?

A

Macrolide

42
Q

What is clarythromycin used to treat?

A

S.pyogenes infections
Pneumococcal infections
Coliform infections
Cell wall deficient bacteria (chlamydia) so used to also treat genitourinary infection

43
Q

Give the mechanism of action of clarythromycin

A

Inhibition of protein synthesis in the bacterial ribosome (50S subunit)

44
Q

What is the standard dose of clarythromycin?

A

500mg 12hrly

45
Q

Describe the drug interactions of clarythromycin

A

Inhibits enzymes (cytochrome p450) involved in metabolism of other drugs

46
Q

Give the half life of clarythromycin

A

1-6hrs

47
Q

How is clarythromycin excreted?

A

Bile

48
Q

How is clarythromycin metabolised?

A

Hepatic

49
Q

What are the adverse effects of clarythromycin?

A

Nausea and diarrhoea

May alter cardiac conduction - arrhythmia

50
Q

What class of antibiotic is vancomycin?

A

Glycopeptide

51
Q

What is vancomycin active against?

A

Gram positive bacteria

Methicillin resistant staph aureus (MRSA)

52
Q

Describe the oral bioavailability of vancomycin

A

Low as it is a big molecule

53
Q

What is the half life of vancomycin?

A

4-8 hours

54
Q

How is vancomycin excreted?

A

Urine

55
Q

Give the mechanism of action of vancomycin

A

Inhibits bacterial cell wall (peptidoglycan) formation by a different target to beta lactams

56
Q

What is the dose of vancomycin

A

Dosed according to drug level in blood - narrow therapeutic index. 500-1500mg 12 hourly

57
Q

What does narrow therapeutic index mean?

A

Levels needed to kill the patient are close to the levels that are toxic to the patient

58
Q

What are the adverse effects of vancomycin?

A

Nephrotoxic and ototoxic

59
Q

What interactions are there with vancomycin?

A

Other nephrotoxic and ototoxic drugs

60
Q

What class of antibiotic is doxycycline?

A

Antibiotic

61
Q

What is doxycycline used to treat

A

Skin, genitourinary and respiratory infections
Gram positive - staph and strep
Gram negative - haemophilus
Cell wall deficient - chlamydia

62
Q

What interactions does doxycycline have?

A

Competes for protein binding with digoxin and warfarin

63
Q

Describe the mechanism of action of doxycycline

A

Inhibits protein synthesis in bacterial ribosomes (30S subunit)

64
Q

What is the standard dose of doxycycline?

A

100-200mg daily

65
Q

What are the adverse effects of doxycylcine?

A

Dyspepsia

Photosensitivity

66
Q

In which patients must doxycycline be avoided?

A

Pregnant

Children(teeth)

67
Q

What drug class does nitrofurantoin belong to?

A

Nitrofuran

68
Q

What does nitrofuratoin treat?

A 
Wide spectrum
E.coli and enterobacteriaceae
Staphs
Streps
Enterococci

Only indicated for UTI treatment

69
Q

What is the half life of nitrofurantoin?

A

1 hour

70
Q

What is the dose of nitrofurantoin?

A

50mg qds

71
Q

How does nitrofurantoin work?

A

Damages bacterial DNA
High resistance threshold
Complex mechanism of action

72
Q

Describe the use of nitrofurantoin in pregnancy

A

Safe in early pregnancy

Avoid in late

73
Q

Is nitrofurantoin safe in renal impairment?

A

No - doesnt penetrate urine if GFR is low

74
Q

Which antibiotics seem to have a low C.diff risk?

A

Nitrofurantoin and doxycycline

Clinical pharmacology and therapeutics (27 decks)

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