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Clinical pharmacology and therapeutics > Antibiotics > Flashcards

Antibiotics Flashcards

(74 cards)

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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
Give an interaction of amoxicillin
Can increase the levels of other protein bound drugs
26
Give the half life of amoxicillin
1 hour
27
How is amoxicillin excreted?
Urine
28
List the beta lactam antibiotics
``` Penicillin G and V Amoxicillin and co amoxiclav Flucloxacillin Piperacillin Cephalexin Cefuroxine Meropenem ```
29
Which antibiotic is used for staph aureus infections?
Flucloxacillin
30
Which antibiotic is regarded the easy oral penicillin?
Amoxicillin
31
What is co amoxiclav?
Amoxicillin protected against beta lactamases
32
What is the penicillin used to treat pseudomonas?
Piperacillin
33
What is another word for a penicillin allergy?
Beta lactam allergy (class effect)
34
Name the two classes of penicillin allergy
Immediate/Accelerated (Type 1) | Delayed (Type 2)
35
What percentage of courses result in a type 1 immediate/accelerated penicilin allery?
0.02%
36
Describe a type 1 immediate/accelerated penicillin allergy
0-72hrs after exposure IgE and mast cell mediated Urticaria, wheeze and life threatening
37
Describe a type 2 delayed penicillin allergy
> 72 hours after exposure Will worsen with repeated exposure Does not become the immediate type
38
What percentage of antibiotic courses result in an delayed penicillin allergy?
2-3%
39
Describe cephalosporin allergy
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
Describe a history of beta lactam allergy and the outcome of the history
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
What drug class is clarythromycin?
Macrolide
42
What is clarythromycin used to treat?
S.pyogenes infections Pneumococcal infections Coliform infections Cell wall deficient bacteria (chlamydia) so used to also treat genitourinary infection
43
Give the mechanism of action of clarythromycin
Inhibition of protein synthesis in the bacterial ribosome (50S subunit)
44
What is the standard dose of clarythromycin?
500mg 12hrly
45
Describe the drug interactions of clarythromycin
Inhibits enzymes (cytochrome p450) involved in metabolism of other drugs
46
Give the half life of clarythromycin
1-6hrs
47
How is clarythromycin excreted?
Bile
48
How is clarythromycin metabolised?
Hepatic
49
What are the adverse effects of clarythromycin?
Nausea and diarrhoea | May alter cardiac conduction - arrhythmia
50
What class of antibiotic is vancomycin?
Glycopeptide
51
What is vancomycin active against?
Gram positive bacteria | Methicillin resistant staph aureus (MRSA)
52
Describe the oral bioavailability of vancomycin
Low as it is a big molecule
53
What is the half life of vancomycin?
4-8 hours
54
How is vancomycin excreted?
Urine
55
Give the mechanism of action of vancomycin
Inhibits bacterial cell wall (peptidoglycan) formation by a different target to beta lactams
56
What is the dose of vancomycin
Dosed according to drug level in blood - narrow therapeutic index. 500-1500mg 12 hourly
57
What does narrow therapeutic index mean?
Levels needed to kill the patient are close to the levels that are toxic to the patient
58
What are the adverse effects of vancomycin?
Nephrotoxic and ototoxic
59
What interactions are there with vancomycin?
Other nephrotoxic and ototoxic drugs
60
What class of antibiotic is doxycycline?
Antibiotic
61
What is doxycycline used to treat
Skin, genitourinary and respiratory infections Gram positive - staph and strep Gram negative - haemophilus Cell wall deficient - chlamydia
62
What interactions does doxycycline have?
Competes for protein binding with digoxin and warfarin
63
Describe the mechanism of action of doxycycline
Inhibits protein synthesis in bacterial ribosomes (30S subunit)
64
What is the standard dose of doxycycline?
100-200mg daily
65
What are the adverse effects of doxycylcine?
Dyspepsia | Photosensitivity
66
In which patients must doxycycline be avoided?
Pregnant | Children(teeth)
67
What drug class does nitrofurantoin belong to?
Nitrofuran
68
What does nitrofuratoin treat?
``` Wide spectrum E.coli and enterobacteriaceae Staphs Streps Enterococci ``` Only indicated for UTI treatment
69
What is the half life of nitrofurantoin?
1 hour
70
What is the dose of nitrofurantoin?
50mg qds
71
How does nitrofurantoin work?
Damages bacterial DNA High resistance threshold Complex mechanism of action
72
Describe the use of nitrofurantoin in pregnancy
Safe in early pregnancy | Avoid in late
73
Is nitrofurantoin safe in renal impairment?
No - doesnt penetrate urine if GFR is low
74
Which antibiotics seem to have a low C.diff risk?
Nitrofurantoin and doxycycline

Clinical pharmacology and therapeutics (27 decks)

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