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Microbiology and Immunology > Antibiotics Overview and stewardship > Flashcards

Antibiotics Overview and stewardship Flashcards

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1
Q

Antibiotic Def

A

Antibacterial agent. Can be synthetic, semi synthetic and natural

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2
Q

Antiviral Def

A

Treats viral infections

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3
Q

Antifungal Def

A

Treats fungal infections

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4
Q

Antimicrobial Def

A

General term used to encompass drugs that target pathogens whether they be bacterial, viral or fungi

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5
Q

Selective Toxicity Outline

A

Drug administered targets pathogens. Only interacts with components in pathogen cells and have limited to no interactions with host (avoid damage and death in hosts)

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6
Q

Examples of things unique to pathogenic organisms (not present in hosts)

A

Cell walls, specific membrane antigens and certain DNA replication components

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7
Q

Empiric Treatment Outline

A

Treatment of an infection before data from the lab is obtained. General antimicrobials administered (Smart Start). Only factor taken into consideration is patient history

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8
Q

Targeted Therapy Outline

A

Treatment after lab reports are back. Treatment administered is specific to the pathogen and it’s particular susceptibilities

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9
Q

Prophylactic Therapy Outline

A

Administration of antimicrobials to prevent infection. Eg 30 minutes before surgery

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10
Q

Antibiotics Classifications

A

Antibiotic family, bactericidal vs bacteriostatic, narrow vs broad-spectrum and action mechanisms

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11
Q

Antibiotic Families

A

Beta-lactam, glycopeptide, aminoglycoside, quinolone, macrolide and tetracycline

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12
Q

Bacteriostatic Antibiotics Outline

A

Inhibits bacterial growth (doesn’t immediately kill - might kill as biproduct). Healthy patient immune defences kill pathogen

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13
Q

Bactericidal Outline

A

Kills bacteria, eliminating them from body. Used in immunocompromised individuals or for specific infections eg meningitis, endocartitis and blood infections

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14
Q

B-Lactams and glycopeptides Mechanism of Action

A

Bactericidal. Inhibits cell wall synthesis

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15
Q

Fluoroquinolones Mechanism of action

A

bactericidal. Inhibits DNA replication

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16
Q

Aminoglycosides Mechanisms Of Action

A

Bactericidal. Protein synthesis inhibition

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17
Q

Macrolides, lincosamides, streptogramins, chloramphenicol and oxazildilones Mecahnsism of action

A

Bacteriostatic. Protein synthesis inhibition

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18
Q

Polymyxins and lipoproteins Mechanisms of Action

A

Bactericidal. Binds to cell wall

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19
Q

Rifamycin’s Mechanisms of Action

A

Sometimes bactericidal, sometimes bacteriostatic. Inhibition of RNA polymerase (DNA dependent)

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20
Q

Tetracyclins Mechanism of action

A

Bacteriostatic. Protin synthesis inhibition

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21
Q

Trimethoprim and sulfonamides Mechanism of action

A

bacteriostatic. Folate synthesis inhibition

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22
Q

Narrow Spectrum Antibiotics Outline

A

Targets a specific type of organism. Can’t be used for empirical therapy but doesn’t damage human tissue. Eg penicillin G against gram positive cocci

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23
Q

Broad Spectrum Antibiotics Outline

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A

Active against most types of bacteria. Can cause superinfection by overexposure but can be used in empirical therapy. Eg piperacillin-tazobactam treats gram positive cocci, gram negative bacillus, pseudomonas and anaerobic bacteria

24
Q

Consequences of Incorrect Antibiotic Choices

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A

Infection progression, resistance development and host cell damage

25
C difficile infection Outline
Spore forming bacteria in bowel. Infects colon resulting in diahorrea and fever and in extreme cases sepsis and death. Infection can be result of healthy microbiome disruption due to antibiotic course
26
4 main groups of bacteria according to antibiotic treatment
Gram positive, gram negative, anaerobes and atypical (small bacteria that lack a cell wall). Bacteria can be ultiple of these groups
27
Atypical Bacteria Outline
Chlamidya (intracellular pathogen (hard to culture)) and mycoplasma + ureaplasma (small bacteria with no cell wall
28
Narrow spectrum anti-gram positive agents
Penicillin and clindamycin
29
Broad Spectrum anti-gram positive agents
Cefalexin (beta-lactam), minocycline (tetracyclines) and erythromycin (macrolides)
30
Anti-Anaerobe Agents
Metronidazole
31
Anti-Atypical Agents
Tetracyclines, macrolides and quinolones.
32
Antibiotic attack outline
Disrupt bacterial essential structures/ processes; cell wall breach, gene expression interfrence and protein synthesis disruption
33
Cell wall breach Outline
Bactericidal. Denatures/destroys active agents of cell wall
34
Gene Expression Interference Outline
Rifamipicin inhibits RNA synthesis and ciproflaxin inbitis DNA replication
35
Susceptibility Testing Outline
In vitro tests predicting success/failure antibiotic in vivo. Test on both pathogen (antibiotic susceptibility and min inhibitory conc) and host (therapeutic effectiveness, allergies, ect) cells. Aids targeted therapy
36
2 Methods of Susceptibility Testing
Disk diffusion (semiquantative ~ qualative and Minimum Inhibitory Concentrations (MICs)
37
Disk Diffusion Outline
Whether pathogen is susceptible/ressistant. Inoculate agar plate with test organism, apply cellulose disks with standard amount of antibiotic (antibiotic diffuses into agar). Bigger the zone on the plate = the more resistant the pathogen
38
Minimum Inhibitory Concentration Outline
Lowest antibiotic conc required to stop bacterial growth (minimize toxic effects). Grow fixed quantity of bacteria in different concentrations of antibiotics (only 1 antibiotic tested at a time). Measure growth after 24 hrs (cloudier = more growth)
39
MIC Etest
Quantative, diffusion. 2 fold dilutions of highly concentrated antibiotic. Antibiotic concentrations are spread linearly along a strip determines efficacy of treatment. MIC = conc at point of lune where eclipse zone intersects
40
How does MIC help patients
If patient pathogen sample shows to respond to doses lower then standard dose we know that treatment will be effective. If a patient pathogen sample shows to respond only to doses higher then standard then different treatment is necessary (toxicity risk)
41
What uses a penicillin MIC
Viridans streptococcus
42
What uses a Gemiticin MIC
Kalesia pneumonia
43
Ideal Antibiotic Characteristics
Selective toxicity, bactericidal/static, spectrum, favourable pharmacokinetics (good bioavailability) , high TI and little/no resistance dev
44
Antimicrobial Stewardship Def
Timely and optimal selection of dose and duration of antimicrobial for the best clinical outcome (minimise toxicity and resistance dev). Careful monitoring of bacterial use
45
Antimicrobial Stewardship Outline
Patient outcome improvement (reduce morbidity and mortality), patient safety outcome (reduce antimicrobrial consumption), minimise ressistance risk and reduce cost (without reducing quality)
46
Empirical Treatment steps
Prescribe broad spectrum antibiotics (once bacterial infection is confirmed), take patient samples before treatment is administered (send to lab), document name, dosage and treatment duration and ensure antibiotics are taken 4 hrs (or 1 hr in severe sepsis) after prescription
47
Target Therapy Steps and Considerations
24-48 hrs after stopping, review lab results. Choice: stop antibiotics (no bacterial infection)/change route of admin/go on narrower range antibiotics/stay on current
48
Factors to consider moving from oral to IV
Clinical improvement (improving symptoms eg decreasing temp), oral route not compromised (GIT absorption), blood pressure + heart rate + breathing rate remain stable and if there's no need for high drug conc in body tissues
49
Antibiotic Prophylaxis
2 types: surgical and medical. Prevent infections
50
Antibiotics Adverse Effects
Hypersensitivity (allergy), altered normal flora (eg C Diff), drug interactions, specific organ toxicity and antibiotic ressistan
50
Allergy Types Outline
Anaphylaxis (IgE, regulated), Urticaria (itchy raised skin, IgE regulated), Angioedema (rapid swelling, IgE regulated) and maculopapular rash
51
Is GIT irritation in response to penicillin an allergy
No
52
Altered Normal Flora Outline
Caused by use of broad spectrum antibiotics. Due to disruptions in normal flora opportunistic/super infections may arise. Eg C Diff (diahorrea)
53
Drug interactions outline
Drugs react to reduce the efficacy of eachother ( eg rifampicin and oral contraceptives). Others have negative consequences on patient health (eg vomiting) (eg ciprofloxacin and aminophylline)
54
Examples of tissue toxicities
rifampicin -> liver hepatitis, aminoglycasides -> nephrotoxicity and ototoxicity (auditory nerve)

Microbiology and Immunology (22 decks)

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