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Antimicrobial chemotherapy Flashcards

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1
Q

Where can antibiotics act on bacteria?

A 
Cell wall synthesis
Folic acid metabolism
Cytoplasmic membrane structure
DNA gyrase
RNA elongation
DNA-directed RNA polymerase
Protein synthesis
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2
Q

What are examples of penicillins?

A 
Benzylpenicilin
Amoxicillin
Flucloxacillin
Co-amoxiclav
Piperacillin/tazobactam
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3
Q

What bacteria do benzylpenicillin act on?

A

Streptococci
Neisseria
Spirochetes

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4
Q

What infections are benzylpenicillin used for?

A 
Soft tissue infection
Pneumococcal infection
Meningococcal infection
Gonorrhoea
Syphillis
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5
Q

What is the activity of amoxicillin?

A

Broad spectrum but resistance is common

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6
Q

What is amoxicillin generally used for?

A

UTI

Resp tract infection

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7
Q

What is the activity of flucloxacillin?

A

Staphylococci

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8
Q

What is the main use for flucloxacillin?

A

Staph aureus

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9
Q

What is the activity of co-amoxiclav?

A

Broad spectrum including anaerobes

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10
Q

What is co-amoxiclav used for?

A

UTI
Resp tract infection
Soft tissue infection
Surgical wound infection

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11
Q

What is the activity of piperacillin?

A

Broad spectrum including pseudomonas and anaerobes

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12
Q

What is the main use for piperacillin?

A

Neutropenic sepsis

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13
Q

What are different cephalosporin generations?

A

First to fourth generation = narrow to broad spectrum

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14
Q

What are examples of cephalosporins?

A 
Cefradine - 1st gen
Cefuroxime - 2nd gen
Ceftriaxone - 3rd gen
Ceftazidime - 3rd gen
Ceftaroline - 4th gen
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15
Q

What is the activity of ceftradine?

A

Broad spectrum - resistance is more common

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16
Q

What is the main use for ceftradine?

A

UTI

Soft tissue infection

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17
Q

What is the activity of cefuroxime?

A

Broad spectrum

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18
Q

What are the main uses for cefuroxime?

A

UTI
Resp tract infection
Surgical prophylaxis

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19
Q

What is the activity of ceftriaxone?

A

Broad spectrum especially good against gram negative bacilli

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20
Q

What is the main use of ceftriaxone?

A

Hospital infections ie bacteraemia

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21
Q

What is the activity of ceftrazidime?

A

Broad spectrum and effective against pseudomonas

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22
Q

What is the main use of ceftrazidime?

A

Pseudomonal infections in hospital

Cystic fibrosis

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23
Q

What is the activity of ceftaroline?

A

Broad spectrum, less gram negative cover, anti MRSA

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24
Q

What is the use of ceftaroline?

A

Skin and soft tissue infection

Endocarditis resistant to other treatment

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25
What is the main example of an aminoglycoside?
Gentamicin
26
What is the activity of gentamicin?
Gram negative bacilli
27
What is the use of gentamicin?
Serious gram-negative infections
28
What are examples of macrolides?
Clarithromycin Erythromycin Axithromycin
29
What is the activity of clarithromycin and erythromycin?
``` Streptococci Staphylococci Mycoplasma Chlamydia Legionella ```
30
What are the main uses for clarithromycin and erythromycin?
Resp infection Soft tissue infection if penicillin allergic STD
31
What is activity of azithromycin?
Good for gram negative
32
What is the main use of azithromycin?
Chlamydia
33
What are examples of quinolones?
Ciprofloxacin | Levofloxacin
34
What is the activity of ciprofloxacin?
Gram negative bacilli Pseudomonas Some activity against strep and staph
35
What are the main uses of ciprofloxacin?
Complicated UTI Complicated hospital acquired infection Some GI infections
36
What is the activity of levofloxacin?
``` Enhanced activity againts staph and strep Less effective against pseudomonas Effective against pneumococcus Mycoplasma Chlamydia Legionella ```
37
What is the main use for levofloxacin?
2nd or 3rd line agent for pneumonia
38
What is the main example of a glycopeptide?
Vancomycin
39
What is the activity of vancomycin?
Gram-positive only
40
What is the main use for vancomycin?
MRSA Penicillin allergy C. Diff
41
What is trimethoprim used for?
UTI | MRSA
42
What is co-trimoxazole used for?
Resp infection
43
What is clindamycin used for?
Soft tissue infection | Gangrene
44
What is tetracycline and doxycycline used for?
Brucellosis | Atypical pneumonia
45
What is rifampicin used for?
TB
46
What is meropenem used for?
2nd or 3rd line for hospital infections
47
What is metronidazole used for?
Surgical infections
48
What is linezolid used for?
2nd line for MRSA
49
What is daptomycin used for?
2nd line for MRSA
50
What is tigecycline used for?
3rd line for intra-abdominal sepsis
51
What is empiric antimicrobial therapy?
Given without microbiology results
52
What is directed antimicrobial therapy?
Given based on microbiology results
53
What is primary prophylaxis?
Prevent infection
54
What is secondary prophylaxis?
Prevent a second episode
55
What are patient characteristics which will impact prescription?
``` Age Renal function Liver function Immunocompromised Pregnancy Known allergies ```
56
How do we choose antimicrobials?
``` Guidelines Consider likely organisms Empirical or result based? Bactericidal vs bacteriostatic Single agent or combination Potential adverse effects ```
57
How can antibiotic resistance be tested?
Disk defusion method
58
What are the 4 main mechanisms of antibiotic resistance?
Enzymatic inactivation of drug Modified targets for drugs Reduced permeability to drug Efflux of drug
59
What us chromosomally mediated resistance?
Mutation in gene coding for drug target or membrane transport system
60
What is plasmid mediated resistance?
Bacteria transfer resistance genes to other species of bacteria horizontally
61
What are medically important resistant organisms?
Methicillin resistant staph aureus (MRSA) Vancomycin resistant enterococci (VRE) Extended spectrum beta lactamase (ESBL) producing enterobacteriaciae Carbapenem producing enterobacteriacae (CPE) C diff
62
What makes MRSA resistant?
Change in binding site
63
Why is VRE so dangerous?
Only susceptible to 1 or 2 antibiotics since enterococci are intrinsically only sensitive to limited number of antibiotics
64
What factors influence antibiotic resistance?
Antibiotic use by medical professions, veterinary practice, farming Patients surviving longer with more medical conditions and hospital contact More invasive procedures and prosthetic devices Increased bed pressure
65
What antibiotics can be given for penicillin resistant organisms?
``` Quinolones Macrolides Licosamides Co-trimoxazole Aminoglycosides Glycopeptides Daptomycin Tetracycline Tigecycline Oxazolidinones ```
66
What is type I hypersensitivity reaction?
IgE mediated specific immunoglobulin, stimulates pro-inflammatory release resulting in urticarial, laryngeal oedema, bronchospasm
67
What is type II hypersensitivity reaction?
Beta lactam specific IgG or IgM antibodies bind to circulating blood cell resulting in haematological reactions or interstitial nephritis
68
What is type III hypersensitivity reaction?
Circulating beta-lactam specific IgG or IgM bind to beta-lactam antigens fixing complement and lodging in tissues resulting in serum sickness and drug related fever
69
What is type IV hypersensitivity reaction?
Not antibody mediated, T-cell recognises antigen leading to localised inflammation
70
What is the difference between resistance and failure of therapy?
Resistance is inability of antibiotic to kill bacteria, failure is clinical error
71
What can cause failure of therapy?
``` Inadequate dose of antibiotic Inappropriate route Non-compliance with antibiotic Bacteria walled off in abscess cavity Foreign bodies Poor penetration of drug to site of infection ```
72
What antibiotics are effective against biofilms?
Rifampicin Daptomycin Ceftobiprole
73
When can a patient be considered for switching from IV to oral antibiotics?
``` If all of the criteria are met: Able to swallow and tolerate fluids Temp 36-38 for at least 48 hours Heart rate <100 for previous 12 hours WCC between 4 and 12 ```
74
When should a patient not be switched from IV to oral?
Oral route is compromised Continuing sepsis Febrile neutropenia Hypotension/shock

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