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Pharmacology > Antibiotics and Infectious Diseases > Flashcards

Antibiotics and Infectious Diseases Flashcards

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1
Q

What are the 3 most common bacteria (outside the neonatal period) which cause meningitis? How do you differentiate them?

A

Neisseria meningitidis
Haemophilus influenzae
Streptococcus pneumoniae

Differentiate on gram staining

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2
Q

What are the 3 most common bacteria which cause meningitis in a neonate?

A

Group B streptococci
E. Coli - and other coliforms
Listeria monocytogenes

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3
Q

What are the common groups of viruses which cause meningitis?

A

Enteroviruses - Echoviruses, Coxsackie viruses A & B, poliovirus

Herpes viruses - Herpes simplex I and II

Paramyxoviruses - As a complication of mumps

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4
Q

What is the one key fungal cause of meningitis to be aware of?

A

Cryptococcal meningitis

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5
Q

What would you expect a CSF sample of a patient with bacterial meningitis to be like?…Give appearance, gram stain, cells, protein, glucose

A

Appearance = May be clear, may be turbid
Gram stain = May be negative, depending on how severe the infection is
Cells = Very high polymorphs
Protein = High due to the presence of bacterial proteins
Glucose = Low due to bacteria consuming glucose for energy

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6
Q

What would you expect a CSF sample of a patient with viral meningitis to be like?…Give appearance, gram stain, cells, protein, glucose

A 
Appearance = Clear
Gram stain = Negative
Cells = Lymphocytes high
Protein = Only slightly raised
Glucose = Normal
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7
Q

A 5 month old baby presents with a 12 hr h/o vomiting, incessant crying and irritability. Immunisations are up‐to‐date. O/E she is listless, pyrexial, cries when her head is moved, fontanelles are full; there is a small conjunctival haemorrhage. Chest and abdomen clear, there is a suggestion of a rash over shoulder. What is the most likely diagnosis, and what is the organism causing this?

A

Meningitis - most common cause at this age is meningococcal meningitis.

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8
Q

What antibiotic would you immediately start in A+E for a patient with suspected meningitis?

A

IV ceftriaxone (2g / 12hr over 3 minutes)

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9
Q

Which antibiotic would you administer in a community setting for a patient with suspected meningitis?

A

IM benzylpenicillin 1.2g stat

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10
Q

Is meningitis a notifiable disease?

A

YES

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11
Q

What would you give as prophylaxis for close contacts of a patient with meningitis?

A

Adults - Flucloxacillin 500mg single dose
Children - Rifampicin (per kg of body weight) twice a day for 2 days
Pregnancy - IM ceftriaxone

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12
Q

Give 4 risk factors for the development of pneumococcal meningitis

A

Age
Splenectomy
Smoking
Alcohol excess

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13
Q

What type of organisms (based on staining patterns) are normally responsible for skin and soft tissue infections?

A

Gram positives

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14
Q

Streptococci - what is the staining pattern, shape and arrangement of these bacteria?

A

Staining pattern = Gram positive
Shape = Cocci
Arrangement = Chains

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15
Q

What types of bacteria are gram positive cocci arranged in chains?

A

Streptococci

Enterococci

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16
Q

What is the difference between streptococci organisms and enterococci organisms?

A

The haemolysis pattern:
Alpha and beta haemolysis = streptococci
‘Non’-haemolytic pattern = enterococci

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17
Q

Which 2 types of infection are normally caused by viridans group streptococci?

A

Native valve endocarditis

Aspiration pneumonia

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18
Q

What is the main virulence factor of streptococcus pneumoniae?

A

Anti-phagocytic due to the capsule

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19
Q

Which 2 types of infection are normally caused by streptococcus pneumoniae?

A

Community acquired pneumonia

Pneumococcal meningitis

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20
Q

What is the drug of choice for streptococcal sore throat?

A

Penicillin V

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21
Q

Why would you NOT give amoxicillin for streptococcal sore throat?

A

In case diagnosis is actually glandular fever - Epstein Barr Virus interacts with amoxicillin and causes a non-allergic reaction including sore throat, lymphadenopathy, rash

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22
Q

What types of infection are caused by Group A streptococci?

A

Pyogenic infections: Streptococcus sore throat, Impetigo, Cellulitis, Necrotising fasciitis, Post partum sepsis

Toxin associated infections: Erysipelas, toxic shock syndrome, Scarlet Fever

Streptococcal Sequelae: Rheumatic Fever, Immune Complex Mediated Disease

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23
Q

How would you treat impetigo?

A

Flucloxacillin and amoxicillin - allowing for good cover of the staph and strep infection respectively (impetigo is a dual infection)

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24
Q

Why is amoxicillin not a good drug for staphylococcal infections?

A

80% of staphs produce beta-lactamases

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25
What is the primary management for necrotising fasciitis?
Extensive surgical debridement plus antibiotics
26
What is the most common diarrhoea causing salmonella in the UK?
Salmonella enteritidis
27
What are the two broad groups of salmonellae?
Typhoid / Enteric fever causing salmonella (includes salmonella typhi and salmonella paratyphi - these do not cause food poisoning) Diarrhoea causing salmonella (includes salmonella enteritidis and salmonella typhimurium - these do cause food poisoning i.e. gastroenteritis)
28
What is the bacteria responsible for Lyme Disease?
Borrelia burgdorferi
29
Give 4 circumstances which might give rise to infective endocarditis.
- Congenital or acquired defects of the heart valves - Normal valves with virulent organisms e.g. streptococcus pneumoniae - Prosthetic valves - In association with ventricular septal defects or persistent ductus arteriosus
30
What is the most common bacterial cause of native valve infective endocarditis?
Viridans group of streptococci
31
What is the most common bacterial cause of prosthetic valve infective endocarditis?
Staph. aureus
32
What criteria is used to diagnose infective endocarditis?
Duke's criteria
33
How is the Duke's criteria used to diagnosis infective endocarditis?
Diagnose if 2 major, or 1 major and 3 minor, or all 5 minor: MAJOR: - Positive blood cultures i.e. 2 cultures positive for likely organism, or 3 cultures positive >12 hours apart - Evidence of endocardium involvement i.e. on ECHO or by detection of new cardiac murmur MINOR - Predisposition or IV drug use - Fever >38 degrees - Vascular / immunological signs - Positive blood cultures that do not meet major criteria - Evidence of cardiac involvement that does not meet major criteria
34
What is the treatment for a streptococcal native valve infective endocarditis?
Amoxicillin 2mg/4hrs IV Gentamicin 1mg/kg/12hrs IV (Vancomycin 1mg/12hrs IV if penicillin allergic)
35
What is the treatment for a streptococcal prosthetic valve infective endocarditis?
Gentamicin 1mg/kg/12hrs IV Vancomycin 1mg/12hrs IV Rifampicin 300-600mg/12hrs PO or IV
36
Group B is normal flora of which part of the body?
Vagina
37
What infection does group B streptococcus cause?
Most important cause of neonatal sepsis - the baby is infected as it travels down the birth canal
38
What is an example of a Group F streptococcus?
Streptococcus milleri
39
What is the empirical treatment for an infection caused by Group F streptococcus? Why?
Penicillin based antimicrobial PLUS metronidazole - gives good ANAEROBIC cover as well as covering the gram positive strep. because Group F strep usually causes infection at mucosal surfaces where there are lots of anaerobes.
40
What is the treatment of choice for a non-haemolytic gram positive organism i.e. enterococcus? What about if there is resistance?
Penicillin + gentamicin although beware most E. faecium are resistant to amoxicillin Use vancomycin or teicoplanin if there is resistance but beware VREs (Vancomycin Resistant Enterococci) - can use linezolid for VREs
41
What might be the underlying problem in a patient with recurrent folliculitis infections? Why?
Diabetes - Patients with diabetes have dysfunctional neutrophils and are particularly prone to staphylococcal infections. So in someone with recurrent folliculitis, investigate for underlying diabetes.
42
List some examples of where staphylococcus may infect once it enters the bloodstream i.e. a deep-seated staphylococcal infection
Heart valves i.e. endocarditis Bone i.e. osteomyelitis - especially vertebral bodies due to the particular blood supply Joints i.e. septic arthritis
43
What is the main treatment for a staphylococcus aureus infection?
Flucloxacillin - or clarythromycin / doxycycline if penicillin allergy
44
What is the treatment for MRSA?
Vancomycin or teicoplanin
45
What is the most common coagulase negative staphylococcus?
Staphylococcus epidermidis
46
What type of drug is flucloxacillin?
Beta lactamase stable penicillin
47
What is the spectrum of cover for penicillin?
Narrow spectrum - gram positives only and even within this group only streptococci because the staphylococci have beta lactamase so are resistant. Also Neisseria (particularly Neisseria meningitidis) have susceptibility to penicillin.
48
What is the oral form of penicillin?
Penicillin V
49
Give 2 uses for Penicillin V
- Streptococcal sore throat | - Prophylaxis in asplenic patients
50
Give 3 side effects of linezolide
- Bone marrow suppression so can't give to thrombocytopenic or anaemic patients - Peripheral neuropathy including optic neuritis - Interaction with monoamine oxidase inhibitors
51
List some broad spectrum beta lactams
Ampicillin, amoxicillin, co-amoxiclav, piptazobactam, carbopenems
52
Why would you avoid using co-amoxiclav for a single-organism streptococcal infection?
The spectrum is too broad - it covers gram positives, gram negatives and anaerobes and so it not necessary to use for simple infections. It's reserved for multi-organism infections
53
Is co-amoxiclav effective against pseudomonas?
No
54
Which broad spectrum beta lactam antibiotic(s) are effective against pseudomonas?
Piptazobactam | Carbopenems
55
List 6 'problem' gram negative organisms
Pseudomonas, klebsiella, enterobacter, serratia, acinectobacter, proteus
56
Can you use a cephalosporin against an ESBL (extended spectrum beta lactamase)?
No - they will cleave the cephalosporin. For ESBLs use carbapenems
57
Give 2 examples of carbopenems
Meropenem | Ertapenem
58
Which carbapenem has activity against pseudomonas?
Meropenem NOT Ertapenem
59
Give an example of a 1st generation cephalosporin
Cefadroxil
60
Give an indication for use of a 1st generation cephalosporin (e.g. cefadroxil)
UTI in pregnancy, especially when organism resistant to amoxicillin (or patient allergic)
61
Give an example of a 2nd generation cephalosporin
Cefuroxime
62
Is Cefuroxime effective against pseudomonas?
No - it is a 2nd generation cephalosporin and these are not effective against pseudomonas
63
Give an example of a 3rd generation cephalosporin
Ceftazidime, ceftriaxone, cefotaxime
64
Is Ceftazidime effective against pseudomonas?
Yes
65
Is Ceftazidime effective against ESBL organisms?
No
66
Give 3 examples of macrolide antibiotics
Erythromycin Clarythromycin Azithromycin
67
What is erythromycin the drug of choice to treat?
Atypicals - Mycoplasma pneumoniae, chlamydia pneumoniae, legionella pneumoniae
68
Which antibiotic could you use for a septic arthritis in a patient who is allergic to penicillin?
Clindamycin This is a lincosamide antibiotic and has good penetration into the bones and joints
69
Give 3 uses for clindamycin based on it's useful spectrum of cover.
Aspiration pneumonia - Due to good gram positive (streptococcal) and anaerobe cover Necrotising fasciitis - Due to action on the ribosome to switch off toxin producing components within the cell Osteomyelitis - Due to good penetration of bone and joints
70
What class of antibiotic would you use for a pseudomonas infection in a patient who is penicillin allergic? Give an example of a drug in this class.
Quinolones e.g. ciprofloxacin
71
Is ciprofloxacin effective against streptococcal organisms?
No, only staphylococcal
72
Give an example of an aminoglycoside antibiotic
Gentamicin
73
Why is it important to measure the levels of someone taking gentamicin?
It is nephrotoxic and ototoxic
74
Side effects of rifampicin
``` Turns secretions pink Induces liver enzymes Raises liver aminotransferases Hepatitis Thrombocytopenia ```
75
Side effects of isoniazid
Peripheral neuropathy Hepatitis Allergy (skin rash and fever)
76
Side effects of pyrazinamide
``` Hepatitis Hyperuricaemia Gout Rash Arthralgia ```
77
Side effects of ethambutol
Optic neuritis
78
Give 4 uses of benzylpenicillin
Infective endocarditis Meningitis (IM injection) Cellulitis Necrotising fasciitis
79
What is a pharmacokinetic disadvantage of IV benzylpenicillin?
Degraded quickly via excretion from the kidneys so need to administer several times per day - this is not very practical especially when administering IV
80
Give 2 uses for oral penicillin V
Prophylaxis in splenectomised patients | Streptococcal sore throat
81
If a patient is on IV benzylpenicillin and you want to switch them to an oral regime, which drug would you choose and why?
Amoxicillin - better bioavailability when taken orally than penicillin V
82
List 4 uses for amoxicillin / ampicillin
UTI in pregnancy, mild-moderate pneumonia, native valve endocarditis, Listeria infections (e.g. meningitis in immunocompromised patients)
83
True / False: Amoxicillin can be used to treat staphylococcal infections
False - Amoxicillins are not beta-lactamase stable so they cannot be used to treat staphylococcal infections
84
How is co-amoxiclav protected against beta-lactamase
Clavunate acts as a 'suicide beta lactam' and reacts with the beta-lactamase thus releasing the amoxicillin to exert its antimicrobial effect
85
Give 8 uses for co-amoxiclav
``` Severe CAP Aspiration pneumonia IECOPD Diverticulitis Cholecystitis Cholangitis Appendicitis Bites ```
86
Give 2 examples of glycopeptide antibiotic
Teicoplanin | Vancomycin
87
What is Red Man Syndrome?
Side effect of vancomycin - it is an anaphylactoid reaction caused by histamine release characterised by an erythematous rash
88
Give 2 uses of cefuroxime
Abdominal infections e.g. peritonitis | Pyelonephritis
89
Give 1 cephalosporin which is affective against pseudomonas
Ceftazidime
90
List 5 drugs which are effective against pseudomonas
``` Piperocillin-tazobactam Ciprofloxacin (only one available orally but there is emerging resistance) Ceftazidime Meropenem Gentamycin ``` (Pneumonic - Pseudomonas can cause me grief)

Pharmacology (7 decks)

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