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BOK 380 > Antibiotics in surgery > Flashcards

Antibiotics in surgery Flashcards

1
Q

What are the definitions of the following:
- Antibiotic
- Prophylaxis
- Emperic therapy

A

Antibiotic:
- Type of antimicrobial agent active against bacteria

Prophylaxis:
- Prevention of infection complications using antimicrobial therapy

Emperic therapy:
- Therapy begun on the basis of a clinical educated guess

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2
Q

Which classes of bacteria are pencillins active against

A

Gram + cocci
Gram + bacilli
Gram - cocci
Anaerobic organisms
Spirochetes

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3
Q

What are first generation cephalosporins active against

A

First generation:
* GPCs – staph and strep
* Not effective for x Enterococcus
* does not penetrate CNS
* cefazolin has the longest half-life → best for prophylaxis

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4
Q

What are second generation cephalosporins active against

A
  • GPCs
  • GNRs
  • ± anaerobic coverage
  • lose some staph activity

Not effective for
* Enterococcus
* Pseudomonas
* Acinetobacter
* Serratia

Effective only for community-acquired GNRs
* Cefotetan has longest half-life → best for prophylaxis

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5
Q

What are third generation cephalosporins active against

A
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6
Q

What are carbapenems active against

A

Broad spectrum
* GPCs
* GNRs
* anaerobes

Not effective
* MRSA
* Enterococcus
* Proteus

Cilastatin – given with carbapenems
* prevents renal hydrolysis of the drug
* increases half-life

Side effects:
* Seizures with imipenem

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7
Q

What are monobactam active against

A

GNRs:
* Pseudomonas
* Acinetobacter
* Serratia

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8
Q

Which antibiotic classes are cell wall synthesis inhibitors

A
  • penicillins
  • cephalosporins
  • carbapenems
  • monobactams
  • vancomycin
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9
Q

What is vancomycin active against

A
  • GPCs
  • Enterococcus
  • Clostridium dificile (with PO intake)
  • MRSA
  • Binds cell wall proteins
  • Resistance: develops from a change in cell wall–binding protein

Side effects:
* HTN
* Redman syndrome (histamine release)
* nephrotoxicity
* ototoxicity

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10
Q

Which antibiotics classes inhibit 30s ribosome and protein synthesis

A
  • tetracycline,
  • aminoglycosides (tobramycin,
    gentamicin),
  • linezolid
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11
Q

What are aminoglycosides active against

A

Gentamicin, tobramycin, amikacin

  • GNRs
  • Good for
  • Pseudomonas
  • Acinetobacter
  • Serratia

Not effective
* anaerobes (need O2 )

Synergistic with ampicillin
* Enterococcus

Beta-lactams (ampicillin, amoxicillin)
* facilitate aminoglycoside penetration

Side effects:
* reversible nephrotoxicity * irreversible ototoxicity

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12
Q

What are tetracyclines active against

A
  • GNRs
  • syphilis

Side effects:
* tooth discoloration in children

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13
Q

Which antibiotics inhibit 50s ribosome and protein synthesis

A
  • Clindamicin
  • Erythromycin
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14
Q

What is clindamycin effective against

A
  • Anaerobes
  • some GPCs
  • Good for aspiration pneumonia
  • Can be used to treat C. perfringens

Side effects:
* pseudomembranous colitis

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15
Q

What are linezolid active against

A
  • GPCs
  • includes MRSA, VRE
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16
Q

What are macrolides active against

A
  • GPCs

Best for
* community-acquired pneumonia
* atypical pneumonias

Side effects:
* nausea (PO)
* cholestasis (IV)

Also binds motilin receptor and is prokinetic for bowel

17
Q

What are Sulphonamides and
trimethoprim active against

A
  • GNRs, ± GPCs

Not effective for
* Enterococcus
* Pseudomonas
* Acinetobacter
* Serratia

Side effects (numerous):
* teratogenic
* allergicreactions
* renal damage
* Stevens–Johnson syndrome (erythema multiforme)
* hemolysis in G6PD-deficient patients

18
Q

What are the MOA of quinolones

A

Inhibitor of DNA helicase

19
Q

What are Quinolones active against

A

Ciprofloxacin, levofloxacin, norfloxacin

  • Some GPCs
    Mostly GNRs
  • Pseudomonas
  • Acinetobacter
  • Serratia

Not effective for Enterococcus
* 40% of MRSA sensitive
* same efficacy PO and IV
* Ciprofloxacin has BID dosing
* levofloxacin has QD dosing

Side effects:
* tendon ruptures

20
Q

What is metronidazole’s MOA

A

Produces oxygen radicals that breakup DNA

21
Q

What is metronidazole active against

A
  • Anaerobes
  • Side effects:
  • disulfiram-like reaction
  • peripheral neuropathy (long-term use)
22
Q

What are the indications of prophylactic antibotics

A
  • Implantation of foreign bodies
  • Amputation
  • Immunosuppressed patients
  • Compound fractures and penetrating wounds
  • Surgical incisions
23
Q

Explain Clostridium difficile colitis in terms of:
- Symptoms
- Diagnosis
- Treatment

A

Symptoms:
* foul-smellingdiarrhea
* nursinghome
* ICU patients

Diagnosis:
* ELISA for toxin A
* elevated WBCs (often in 30–40’s)

Treatment:
* oral – vancomycin or Flagyl
* IV – Flagyl

24
Q

What are the risk factors for wound infection

A
  • long operations
  • hematoma or seroma formation
  • advanced age
  • chronic disease
  • (eg COPD, renal failure, liver failure, diabetes mellitus)
  • malnutrition
  • immunosuppressive drugs
25
Q

How is necrotizing fasciitis treated

A

Early debridement
High-dose penicillin
Broad spectrum if polymicrobial

26
Q

What is the treatment for Fourniers gangrene

A

Early debridement
Antibiotics

27
Q

What is the treatment for secondary bacterial peritonitis

A

Laparotomy
Antibiotics

BOK 380 (91 decks)

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