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Pharmacology > Antibiotics and Infectious Diseases > Flashcards

Antibiotics and Infectious Diseases Flashcards

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
Q

What is the primary management for necrotising fasciitis?

A

Extensive surgical debridement plus antibiotics

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26
Q

What is the most common diarrhoea causing salmonella in the UK?

A

Salmonella enteritidis

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27
Q

What are the two broad groups of salmonellae?

A

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)

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28
Q

What is the bacteria responsible for Lyme Disease?

A

Borrelia burgdorferi

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29
Q

Give 4 circumstances which might give rise to infective endocarditis.

A
  • 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
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30
Q

What is the most common bacterial cause of native valve infective endocarditis?

A

Viridans group of streptococci

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31
Q

What is the most common bacterial cause of prosthetic valve infective endocarditis?

A

Staph. aureus

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32
Q

What criteria is used to diagnose infective endocarditis?

A

Duke’s criteria

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33
Q

How is the Duke’s criteria used to diagnosis infective endocarditis?

A

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
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34
Q

What is the treatment for a streptococcal native valve infective endocarditis?

A

Amoxicillin 2mg/4hrs IV
Gentamicin 1mg/kg/12hrs IV
(Vancomycin 1mg/12hrs IV if penicillin allergic)

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35
Q

What is the treatment for a streptococcal prosthetic valve infective endocarditis?

A

Gentamicin 1mg/kg/12hrs IV
Vancomycin 1mg/12hrs IV
Rifampicin 300-600mg/12hrs PO or IV

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36
Q

Group B is normal flora of which part of the body?

A

Vagina

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37
Q

What infection does group B streptococcus cause?

A

Most important cause of neonatal sepsis - the baby is infected as it travels down the birth canal

38
Q

What is an example of a Group F streptococcus?

A

Streptococcus milleri

39
Q

What is the empirical treatment for an infection caused by Group F streptococcus? Why?

A

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
Q

What is the treatment of choice for a non-haemolytic gram positive organism i.e. enterococcus? What about if there is resistance?

A

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
Q

What might be the underlying problem in a patient with recurrent folliculitis infections? Why?

A

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
Q

List some examples of where staphylococcus may infect once it enters the bloodstream i.e. a deep-seated staphylococcal infection

A

Heart valves i.e. endocarditis
Bone i.e. osteomyelitis - especially vertebral bodies due to the particular blood supply
Joints i.e. septic arthritis

43
Q

What is the main treatment for a staphylococcus aureus infection?

A

Flucloxacillin - or clarythromycin / doxycycline if penicillin allergy

44
Q

What is the treatment for MRSA?

A

Vancomycin or teicoplanin

45
Q

What is the most common coagulase negative staphylococcus?

A

Staphylococcus epidermidis

46
Q

What type of drug is flucloxacillin?

A

Beta lactamase stable penicillin

47
Q

What is the spectrum of cover for penicillin?

A

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
Q

What is the oral form of penicillin?

A

Penicillin V

49
Q

Give 2 uses for Penicillin V

A
  • Streptococcal sore throat

- Prophylaxis in asplenic patients

50
Q

Give 3 side effects of linezolide

A
  • Bone marrow suppression so can’t give to thrombocytopenic or anaemic patients
  • Peripheral neuropathy including optic neuritis
  • Interaction with monoamine oxidase inhibitors
51
Q

List some broad spectrum beta lactams

A

Ampicillin, amoxicillin, co-amoxiclav, piptazobactam, carbopenems

52
Q

Why would you avoid using co-amoxiclav for a single-organism streptococcal infection?

A

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
Q

Is co-amoxiclav effective against pseudomonas?

A

No

54
Q

Which broad spectrum beta lactam antibiotic(s) are effective against pseudomonas?

A

Piptazobactam

Carbopenems

55
Q

List 6 ‘problem’ gram negative organisms

A

Pseudomonas, klebsiella, enterobacter, serratia, acinectobacter, proteus

56
Q

Can you use a cephalosporin against an ESBL (extended spectrum beta lactamase)?

A

No - they will cleave the cephalosporin.

For ESBLs use carbapenems

57
Q

Give 2 examples of carbopenems

A

Meropenem

Ertapenem

58
Q

Which carbapenem has activity against pseudomonas?

A

Meropenem

NOT Ertapenem

59
Q

Give an example of a 1st generation cephalosporin

A

Cefadroxil

60
Q

Give an indication for use of a 1st generation cephalosporin (e.g. cefadroxil)

A

UTI in pregnancy, especially when organism resistant to amoxicillin (or patient allergic)

61
Q

Give an example of a 2nd generation cephalosporin

A

Cefuroxime

62
Q

Is Cefuroxime effective against pseudomonas?

A

No - it is a 2nd generation cephalosporin and these are not effective against pseudomonas

63
Q

Give an example of a 3rd generation cephalosporin

A

Ceftazidime, ceftriaxone, cefotaxime

64
Q

Is Ceftazidime effective against pseudomonas?

A

Yes

65
Q

Is Ceftazidime effective against ESBL organisms?

A

No

66
Q

Give 3 examples of macrolide antibiotics

A

Erythromycin
Clarythromycin
Azithromycin

67
Q

What is erythromycin the drug of choice to treat?

A

Atypicals - Mycoplasma pneumoniae, chlamydia pneumoniae, legionella pneumoniae

68
Q

Which antibiotic could you use for a septic arthritis in a patient who is allergic to penicillin?

A

Clindamycin

This is a lincosamide antibiotic and has good penetration into the bones and joints

69
Q

Give 3 uses for clindamycin based on it’s useful spectrum of cover.

A

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
Q

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.

A

Quinolones e.g. ciprofloxacin

71
Q

Is ciprofloxacin effective against streptococcal organisms?

A

No, only staphylococcal

72
Q

Give an example of an aminoglycoside antibiotic

A

Gentamicin

73
Q

Why is it important to measure the levels of someone taking gentamicin?

A

It is nephrotoxic and ototoxic

74
Q

Side effects of rifampicin

A 
Turns secretions pink
Induces liver enzymes
Raises liver aminotransferases
Hepatitis
Thrombocytopenia
75
Q

Side effects of isoniazid

A

Peripheral neuropathy
Hepatitis
Allergy (skin rash and fever)

76
Q

Side effects of pyrazinamide

A 
Hepatitis
Hyperuricaemia
Gout
Rash
Arthralgia
77
Q

Side effects of ethambutol

A

Optic neuritis

78
Q

Give 4 uses of benzylpenicillin

A

Infective endocarditis
Meningitis (IM injection)
Cellulitis
Necrotising fasciitis

79
Q

What is a pharmacokinetic disadvantage of IV benzylpenicillin?

A

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
Q

Give 2 uses for oral penicillin V

A

Prophylaxis in splenectomised patients

Streptococcal sore throat

81
Q

If a patient is on IV benzylpenicillin and you want to switch them to an oral regime, which drug would you choose and why?

A

Amoxicillin - better bioavailability when taken orally than penicillin V

82
Q

List 4 uses for amoxicillin / ampicillin

A

UTI in pregnancy, mild-moderate pneumonia, native valve endocarditis, Listeria infections (e.g. meningitis in immunocompromised patients)

83
Q

True / False: Amoxicillin can be used to treat staphylococcal infections

A

False - Amoxicillins are not beta-lactamase stable so they cannot be used to treat staphylococcal infections

84
Q

How is co-amoxiclav protected against beta-lactamase

A

Clavunate acts as a ‘suicide beta lactam’ and reacts with the beta-lactamase thus releasing the amoxicillin to exert its antimicrobial effect

85
Q

Give 8 uses for co-amoxiclav

A 
Severe CAP
Aspiration pneumonia
IECOPD
Diverticulitis
Cholecystitis
Cholangitis
Appendicitis
Bites
86
Q

Give 2 examples of glycopeptide antibiotic

A

Teicoplanin

Vancomycin

87
Q

What is Red Man Syndrome?

A

Side effect of vancomycin - it is an anaphylactoid reaction caused by histamine release characterised by an erythematous rash

88
Q

Give 2 uses of cefuroxime

A

Abdominal infections e.g. peritonitis

Pyelonephritis

89
Q

Give 1 cephalosporin which is affective against pseudomonas

A

Ceftazidime

90
Q

List 5 drugs which are effective against pseudomonas

A 
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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