Antimicrobial Deck 3 Flashcards by Nathan Koranda

Gram + Cocci

SSE

staph, strep, enterococcus

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Gram - Cocci

H.Flu
Neisseria
Moxaxella

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Gram - Bacilli

EKP
ESP

Escherichia coli
Klebsiella pnemonaie, Klebsiella oxytoca
Proteus mirabilis

Enterobacter sp.
Serratia marcescens
Providencia stuartii
Salmonella enteritis
Shigella sp.

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Psudomonas

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Anaerobes

Bacteroides

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Mycoplasms

– Mycoplasma: CAP
– Ureaplasma: GU

community acquired pneumona

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Chlamydia

– GU
– Respiratory
– Eye

dies when outside of the cell

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Ricketssias

• Ricketssias
– Ricketssia: Rocky Mountain Spotted fever
– Ehrlichia: tick‐borne

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• Acid‐fast

– Mycobacterium tuberculosis

– Nocardia

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• Fungal‐like

– Actinomyces

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Spirochetes

Borrelia burgdorferie (Lyme Disease)
Treponema P llid a um (S hili ) (Syphilis)

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• Borrelia burgdorferie (Lyme Disease) treatment

– Doxycycline, Amoxicillin

– Cephalosporin 3rd/4th Gen

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Treponema P llid a um (S hili ) (Syphilis) treatment

– Pen G 2.4 million units
– PCN Allergy: Doxy/Tetracycline
– Azithromycin but multiple resistant strains

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Gram Positive

thick peptidoglycan layer in the cell - purple

thicker cell wall
no porin channels
simpler organism

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Gram negative

does not have a peptidoglycan layer - pink

thinner cell wall
lipopoysaccharide outer membrane
porin channels
more complex

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Staph clinical associations

skin, soft tissue

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Strep clincial associations

respiratory

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enterococcus clinical manifications

GI/GU

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H.Flu Clinical Associations

AOM, sinusitis, bronchitis

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Neisseria clinical associations

Meningitis

Morxella clinical associations

AOM, sinusitis, bronchitis

EKP clinical associations

Infection: UTI, GI

ESP clinical associations

Salmonella, shigella clinical associations

Pseudomonas clinical associations

pneumonia, various

Bacteroides clinical associations

GI, Aspiration pneumonia

Goal of Using the Simplified Pathogen | List

Match the drug to the bug • Identify the most likely pathogen • Describe the spectrum of activity of an antibiotic (or antibiotic class) • Develop a simplified “drugs of choice” list

• Gram + activity

Staph, Strep

• Some Gr‐ activity

EKP(E. coli, Klebsiella, Proteus)

• Good Gr – activity

ESP (Enterobacter Enterobacter, Serratia Serratia, Providencia Providencia) • +/‐ pseudomonas

Anaerobic activity

Bacteroides

Factors to Consider When Prescribing | Antimicrobials

* Site of Infection * Pathogen * Extent of Infection * Purpose * Host

Host Criteria

``` – Immune status – Comorbidities – Age – Genetic Factors – Allergies – Pregnancy and Lactation ```

Systematic Approach for Selecting | Antimicrobial Agents

Confirm the presence of infection Identification of the likely pathogen Selection of presumptive therapy Monitor therapeutic response

Broad Spectrum

• Broad activity against Gram + and Gram – Organisms

Examples of broad

``` • Tetracyclines, phenicols, fluoroquinolones, “third‐generation” and “fourth‐ generation” cephalosporins ```

Narrow Spectrum

• Limited activity and are primarily only useful against particular species of microorganisms

Narrow Glycopeptides PCNs are mainly affective

against Gram+ bacteria

Narrow polymixins are usually only effective against

Gram‐ bacteria

Narrow aminoglycosides and sulfonamides are mainly effective against

aerobic organisms

Narrow nitroimidazoles are generally only effective

for anaerobes

``` Penicillin Ampicillin Amoxicillin Penicillin G Treats ```

Gram + (SSE) Strep, Staph, Enterococcus Skin, soft tissue, respiratory

Penicillin Extended Spectrum Treats

Less Gr+, more Gr‐ (EKP, ESP) E‐coli, Shigella, Salmonella, Proteus β lactamase Gr + GU G Skin/soft tissue, resp y iratory

Tetracyclines Doxycycline Minocycline Treats

``` Gr – Atypicals, MRSA chlamydiae, mycoplasmas, and rickettsiae, and protozoan parasites Propionibacterium acnes Gr+ Strep pneumonaie Skin GU/GI Respiratory Sulfonamide TMP‐SMX Gr‐ E coli, Proteus, Klebsiel ```

Cephalosporins 1st Generation cephadroxil Cephalexin Treats

Gram + Staph, Strep, Enterococcus (SSE) Resp, skin/soft tissue

``` Cephalosporins 2nd Generation cefprozil cefaclor cefuroxime ``` Treats

Gr+, weak Gr‐ Staph, Strep, Enterococcus (SSE) Resp

``` 3rd Generation cefotaxime cefpodoxime cefdinir ceftazidime ceftriazone ``` Treats

``` Weak Gr+, Gr‐ β lactamase H‐Flu, E‐coli, Klebsiella, Proteus (EKP) ESP ``` Resp, GU, GI

4th Generation Cefepime Treats

β lactamase Enhanced Gr‐, polymicrobial infections (ESP, EKP, SSE) Resp, GI, GU

5th Generation Ceftaroline Treats

Gr+, Gr‐ MRSA , DRSP GI, GU, Skin, Resp