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Y2 infection > antimicrobial chemotherapy 2 - optional > Flashcards

antimicrobial chemotherapy 2 - optional Flashcards

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1
Q

which antibiotics inhibit cell wall synthesis

A 
cycloserine 
vancomycin 
bacitracin 
penicillins 
cephalosporins 
monobactams 
carbapenems
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2
Q

which abx act on folic acid metabolism

A

trimethoprim

sulfonamides

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3
Q

which abx act on the cytoplasmic membrane structure

A

polymyxins

daptomycin

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4
Q

which abx act on DNA gyrase

A

quinolones: nalidixic acid, ciprofloxacin,, novobiocin

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5
Q

which abx act on RNA elongation

A

actinomycin

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6
Q

which abx act on DNA directed RNA polymerase

A

rifampicin

streptovaricins

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7
Q

which abx are protein synthesis 50S inhibitors

A

erythromycin (macrolides)
chloramphenicol
clindamycin
lincomycin

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8
Q

which abx are protein synthesis 30S inhibitors

A 
tetracyclines
spectinomycin 
streptomycin 
gentamycin 
kanamycin 
amikacin 
nitrofurans
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9
Q

which abx act on protein synthesis (tRNA)

A

mupirocin

puromycin

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10
Q

6 examples of penicillin abx

A 
benzylpenicillin 
penicillin V
amoxicillin 
flucloxacillin 
co-amoxiclav 
piperacillin/tazobactam
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11
Q

activity of benzylpenicillin, penicillin V

A

streptococci
Neisseria
spirochetes

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12
Q

main uses of benzylpenicillin, penicillin V

A 
soft tissue 
pneumococcal 
meningococcal 
gonorrhoea
syphilis
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13
Q

benefits of benzylpenicillin, penicillin V

A

IV/IM usage

cheap

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14
Q

activity of amoxicillin

A

broad spectrum but resistance is common

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15
Q

main uses of amoxicillin

A

UTI

RTI

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16
Q

benefits of amoxicillin

A

cheap

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17
Q

activity of flucloxacillin

A

staphylococci

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18
Q

main uses of flucloxacillin and benefits

A

S. aureus

cheap

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19
Q

activity of co-amoxiclav

A

broad spectrum

incl. anaerobes

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20
Q

main uses of co-amoxiclav

A

UTI
RTI
soft tissue infections
surgical wound infections

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21
Q

disadvantages of co-amoxiclav

A

C. difficile infection

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22
Q

action of piperacillin/tazobactam

A

broad spectrum incl. pseudomonas and anaerobes

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23
Q

main uses of piperacillin/tazobactam

A

neutropenic sepsis

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24
Q

route of administration of piperacillin/tazobactam

A

IV only

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25
5 examples of cephalosporin abx and their generation
1st - cefradine 2nd - cefuroxime 3rd - ceftriaxone/cefotaxime, ceftazidime 4th - ceftaroline/ceftobiprole - anti-MRSA
26
cefradine activity
broad spectrum | resistance +
27
main uses of cefradine
UTI | soft tissue infection
28
advantages of cefradine
oral | cheap
29
activity of cefuroxime
broad spectrum
30
main uses of cefuroxime
UTI TRI surgical prophylaxis
31
activity of ceftriaxone/cefotaxime
broad spectrum esp good against gram -ve bacilli
32
main uses of ceftriaxone/cefotaxime
hospital infections e.g. bacteraemia pneumonia, abdo sepsis
33
disadvantages of ceftriaxone/cefotaxime
risk factor for MRSA, C diff | IV/IM only
34
activity of ceftazidime
like ceftriaxone but also active against pseudomonas
35
main uses of ceftazidime
pseudomonal infections in hospital and in CF
36
disadvantages of ceftazidime
risk factor for MRSA, C diff | IV only
37
ceftaroline/ceftobiprole activity
broad spectrum less gram -ve cover MRSA
38
main uses of ceftaroline/ceftobiprole
skin and soft tissue infection | endocarditis resistant to other treatment
39
disadvantages of ceftaroline/ceftobiprole
risk factor for development of C diff expensive IV only
40
2 examples of aminoglycoside abx
gentamicin | amikacin
41
activity of gentamicin and | amikacin
gram -ve bacilli
42
main uses of gentamicin and | amikacin
serious gram -ve infections e.g. bacteraemia, endocarditis, neutropenic sepsis
43
disadvantages of gentamicin and amikacin
IV? and IM only renal and ototoxicity measuring levels is essential
44
3 examples of macrolide abx
clarithromycin erythromycin azithromycin
45
activity of clarithromycin
``` streptococci staphylococci mycoplasma chlamydia legionella ```
46
main uses of clarithromycin
resp infection soft tissue infection (if penicillin allergic) STD
47
activity of erythromycin
``` streptococci staphylococci mycoplasma chlamydia legionella ```
48
main uses of erythromycin
resp infection soft tissue infection (if penicillin allergic) STD
49
disadvantages of erythromycin
GI intolerance
50
advantages of clarithromycin
better tolerated
51
activity of azithromycin
better for gram -ve e.g. haemophilus | chlamydia
52
main uses of azithromycin
chlamydia
53
2 examples of quinolones
ciprofloxacin | levofloxacin/moxifloxacin
54
activity of ciprofloxacin
gram -ve bacilli pseudomonas some activity against staphylococci and streptococci
55
main uses of ciprofloxacin
complicated UTI complicated hospital acquired pneumonia some GI infections
56
disadvantages of ciprofloxacin
C. diff | may affect growing cartilage
57
activity of levofloxacin/moxifloxacin
``` enhanced activity against staphylococci/streptococci less against pseudomonas active against pneumococcus mycoplasma chlamydia legionella ```
58
main uses of levofloxacin/moxifloxacin
2nd/3rd line agent for pneumonia
59
disadvantages of levofloxacin/moxifloxacin
C. diff | may affect growing cartilage
60
2 examples of glycopeptide abx
vancomycin | teicoplanin
61
activity of vancomycin and teicoplanin
gram +ve bacteria only (streptococci and staphylococci)
62
main uses of vancomycin and teicoplanin
MRSA pts allergic to penicillin C. difficile (oral vanc)
63
disadvantages of vancomycin and teicoplanin
IV/IM only (except for C. diff) regular levels required nephrotoxicity
64
activity of trimethoprim
gram -ve bacilli | some activity against streptococci and staphylococci
65
main uses of trimethoprim
UTI resp infection MRSA
66
advantages of trimethoprim
cheap
67
what 2 drugs make up co-trimoxazole
trimethoprim | sulphamethoxazole
68
uses of co-trimoxazole
broad spectrum | pnemocysititis jiroveci
69
main uses of co-trimoxazole
resp infection | PCP
70
disadvantages of co-trimoxazole
rashes
71
activity of clindamycin
streptococci staphylococci anaerobes
72
main uses of clindamycin
soft tissue infection | gangrene
73
disadvantages of clindamycin
associated w/ C. diff
74
activity of tetracycline and doxycycline
``` streptococci staphylococci chlamydia rickettsiae brucella ```
75
main uses of tetracycline and doxycycline
``` Q fever brucellosis chlamydia atypical pneumonia MRSA ```
76
disadvantages of tetracycline and doxycycline
CI in pregnancy and childhood (effects on teeth and bones)
77
activity of rifampicin
mycobacteria meningococcus staphylococci
78
main uses of rifampicin
TB MRSA meningococcal prophylaxis complicated staphylococcal infections
79
disadvantages of rifampicin
drug interactions -enzyme inducer
80
activity of meropenem
broad spectrum incl. anaerobes | pseudomonas
81
main uses of meropenem
2nd or 3rd line for hospital infections
82
advantages of meropenem
good CNS penetration | but IV only
83
activity of metronidazole
anaerobes | protozoa e.g. giardia
84
main uses of metronidazole
surgical infections giardiasis amoebiasis trichomonal infections
85
disadvantages of metronidazole
antabuse - reaction w/ alcohol
86
activity of linezolid
gram +ve bacteria only: streptococci, staphylococci, enterococci
87
main uses of linezolid
2nd line agent for MSSA, MRSA, VRE
88
route of administration for linezolid
oral and iV
89
disadvantages of linezolid
blood and optic neuropathy | S/Es
90
activity of daptomycin
gram +ve bacteria only (streptococci, staphylococci, enterococci)
91
main uses of daptomycin
2nd line agent for MSSA, MRSA, VRE
92
disadvantages of daptomycin
IV only inactive in lung myositis S/E
93
activity of tigecycline
very broad spectrum incl. MRSA, ESBL, anaerobes
94
main uses of tigecycline
3rd line intra-abdo sepsis | soft tissue infections
95
disadvantages of tigecycline
IV only | ineffective against pseudomonas
96
indications for antimicrobials
therapy | prophylaxis
97
what is empirical therapy
w/o microbiology results
98
what is directed therapy
based on microbiology results
99
what is 1y prophylaxis
anti-malarial, immunosuppressed pts pre-operative surgical post-exposure e.g. HIV, meningitis
100
what is 2y prophylaxis
prevent a 2nd episode e.g. PJP
101
how is a diagnosis of infection made
clinical laboratory none - no treatment
102
severity assessment of infection
? sepsis (qSOFA) | Septic shock
103
qSOFA criteria
syst BP <100 altered mental state RR >22
104
patient characteristics to consider when prescribing
``` age renal function liver function immunocompromised pregnancy known allergies ```
105
things to consider when making antimicrobial selection
``` guideline or individualised therapy likely organism empirical therapy or result based bactericidal vs bacteriostatic drug single agent or combination potential adverse effects ```
106
30% rule of prescribing abx
30% of all hospitalised inpatients at any given time recieve abx >30% of abx are prescribed inappropiately in the community up to 30% of all surgical prophylaxis is inappropriate 10-30% of pharmacy costs can be saved by antimicrobial stewardship programmes
107
how does abx resistance occur
natural phenomenon bacteria adapt to survive bacteria rapidly multiply and can generate resistance very quickly
108
4 main mechanisms of resistance
enzymatic inactivation of drug modified targets for drugs reduced permeability to drug efflux of drug
109
genetics of resistance
chromosomally mediated | plasmid mediated
110
chromosomally mediated resistance
mutation in gene coding for drug target or membrane transport system frequency of spontaneous mutations 10^-7 to 10^-9 much lower than frequency of acquisition to plasmids less of a problem clinically basis for multi drug therapy e.g. TB
111
what is binary fission
DNA replicates cell elongates divides in 2 2 identical bacteria
112
plasmid mediated resistance
plasmid = extra-chromosomal strand of DNA replicate independent of cell chromosome carry genes for enzymes which degrade abx and modify membrane transport systems may carry 1 or more resistance gene
113
how is plasmid mediated resistance passed on
bacteria have ability to conjugate can transfer resistance genes to other species of bacteria certain bacteria can take up plasmids by transformation
114
5 medically important resistant organisms
``` MRSA VRE ESBL CPE Clostridium difficile ```
115
methicillin
methicillin is a penicillinase resistant penicillin (e.g. similar to flucloxacillin) used in lab to determine whether organisms are sensitive to flucloxacillin
116
MRSA
methicillin resistant staphylococcus aureus MRSA has an altered binding protein compared w/ MSSA resistant to flucloxacillin
117
clinical effects of MRSA
most often colonisation w/o infection can cause severe invasive infections e.g. osteomyelitis, endocarditis mortality in pts w/ MRSA bacteraemia = 2x that of MSSA bacteraemia carriage of MRSA is promoted by use of abx
118
VRE
vancomycin resistant enterococci enterococci are intrinsically only sensitive to a limited number of abx VRE are only sensitive to 1 or 2 abx VRE colonise GI tract in pts exposed to multiple abx can cause invasive disease (e.g. endocarditis) esp in pts w/ prosthetic devices
119
ESBL producing enterobacteraciae
extended spectrum beta lactamase confer a range of resistance mechanisms, enzymatic degradation of antibiotic, reduced porins, increased efflux resistant to beta-lactam abx, often cephalosporins may be associated w/ further resistance mechanisms such as resistance to aminoglycosides and carbapenems
120
CPE
``` carbapenem producing enterobacteriacae multiple resistant bacteria typically only sensitive to a few abx of last resort can colonise gut of healthy individuals associated w/ high mortality can colonise healthcare environment ```
121
factors influencing abx resistance
widespread abx use encouraging selective pressure abx use by medical professions, veterinary practices, farming pts surviving longer w/ more medical conditions and hospital contact more invasive procedures and prosthetic devices increased bed pressure in UK encourages spread of resistant organisms
122
quinolones - example and resistance
ciprofloxacin levofloxacin associated w/ C diff overuse associated w/ increased MRSA rates
123
macrolides - example and resistance
clarithromycin erythromycin limited spectrum of activity not for severe infections
124
licosamides - example and resistance
clindamycin only gram +ve and anaerobic activity high risk of C diff resistance reasonably common in staph and strep
125
co-trimoxazole
limited IV supply good spectrum of coverage less active against strep pneumoniae caution in renal dysfunction, marrow toxicity
126
aminoglycosides
gentamicin potent antimicrobial use limited by renal and ototoxicity not used as single agent in gram +ve infection
127
glycopeptides
``` vancomycin teicoplanin need monitoring to achieve therapeutic agents less active against staph aureus no gram -ve cover ```
128
daptomycin
only gram +ve activity toxicities include eosinophilic pneumonia and myositis can't be used in pneumonia
129
tetracycline
doxycycline GI intolerance common not used in bacteraemic infection
130
tigecycline
broad spectrum of coverage | not used in bacteraemic illness
131
oxazolidinones
restricted antibiotic | marrow toxicities
132
types of hypersensitivity reactions
``` type I anaphylaxis type II type III type IV ```
133
type I hypersensitivity reactions
IgE mediated stimulates pro-inflammatory release uritcaria, laryngeal oedema, bronchospasm, circulatory collapse
134
anaphylaxis and penicillin
occurs in 4-15/100 000 penicillin treatment courses
135
type II hypersensitivity reactions
beta lactam specific IgG or IgM antibodies bind to circulating blood cell haematological reactions or interstitial nephritis
136
type III hypersensitivity reactions
circulating beta lactam specific IgG or IgM bind to beta lactam antigens fixing compliment lodge in tissues serum sickness and drug related fever
137
type IV hypersensitivity reactions
not antibody mediated | T cell recognises antigen leading to localised inflammation e.g. contact dermatitis
138
management of a pt w/ beta lactam allergy
5-20% of pts give hx of beta lactam allergy less that 1% of those will have type 1 penicillin allergy difficult to confirm - lack of available testing good hx is important
139
define resistance
inability of antibiotic to kill bacteria can be detected in the lab by measuring MIC levels - minimum inhibitory conc clinical failure may occur despite lab reports of sensitivity
140
reasons for failure of therapy
inadequate dose of antibiotic inappropriate route non-compliance bacteria walled off in abscess cavity foreign bodies e.g. surgical implants, prosthesis poor penetration of drug to site of action
141
name 3 abx w/ good biofilm availability
rifampicin daptomycin ceftobiprole
142
what is antibiotic stewardship
using the right antibiotic for the right indication for the right duration of time
143
how to achieve antibiotic stewardship
use an antibiotic only if suspected or proven bacterial infection use abx as per guidelines and review w/ results of microbiology review antibiotic prescriptions regularly and stop ASAP limit use of broad spectrum blind antibiotic therapy to seriously ill patients
144
when to consider switching patients from IV to oral abx
``` after 48hrs provided that: pt is improving clinically and is able to tolerate an oral formulation i.e. all of the following: able to swallow and tolerate fluids temp 36-38C for at least 48hrs HR <100bpm for prev 12hrs WCC between 4 and 12x10^9L ```
145
when would you not switch to oral abx
``` yes to any of the following: oral route compromised - vomiting, nil by mouth, steatorrhoea, swallowing disorder, unconscious continuing sepsis special indication febrile neutropenia hypotension/shock ```
146
special indications for not switching to oral abx
``` endocarditis meningitis staph. aureus bacteraemia immunosuppression bone/joint infection deep abscess CF prosthetic infection ```
147
alert microbials
restricted use only under the authorisation of a microbiologist or infectious disease specialist and/or according to approved indications within local guidelines/policies
148
how to help prevent antibiotic resistance
use abx only when prescribe prescribe abx only when neccesary and appropriate complete the full course never share abx or use leftover prescriptions

Y2 infection (15 decks)

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