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Year 3 - Infection > Antimicrobials - Bacteria and Fungi > Flashcards

Antimicrobials - Bacteria and Fungi Flashcards

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1
Q

What are the principles of prescribing antimicrobials?

A
  1. Indications for antimicrobials
  2. Making a clinical diagnosis
  3. Patient characteristics
  4. Antimicrobial selection
  5. Regimen selection
  6. Liaison with laboratory
  7. Antimicrobial Stewardship
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2
Q

What are the principles of prescribing - Indications for antimicrobials?

A

Therapy:
> Empiric - Without microbiology results
> Directed - Based on microbiology results

Prophylaxis:
> Primary:
- Anti-malarial; immunosuppressed patients
- Pre-operative surgical 
- Post-exposure e.g. HIV, meningitis

> Secondary:
- To prevent a second episode e.g. PJP

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3
Q

What are the principles of prescribing - Diagnosis?

A

Diagnosis of infection:

  • Clinical
  • Laboratory
  • None (No treatment)

Severity assessment:

  • Sepsis?
  • Septic shock?
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4
Q

What are the principles of prescribing - Patient characteristics?

A 
> Age
> Renal function
> Liver function
> Immunocompromised
> Pregnancy
> Known allergies
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5
Q

What are the principles of prescribing - Antimicrobial selection?

A 
> Guideline or “individualised” therapy
> Likely organism(s)
> Empirical therapy or result-based therapy
> Bactericidal vs. bacteriostatic drug
> Single agent or combination
> Potential adverse effects
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6
Q

What should antibiotic selection be based on?

A

The known or likely causative organism(s)

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7
Q

What are the most likely causative bacteria in soft tissue infection?

A 
> Streptococcus pyogenes
> Staphylococcus aureus
> Streptococcus group C or G
> E coli
> Pseudomonas aeruginosa
> Clostridium species
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8
Q

What are the most likely causative bacteria pneumonia?

A 
> Streptococcus pneumonia 
> Haemophilus influenza
> Staphylococcus aureus 
> Klebsiella pneumonia 
> Moraxella catarrhalis 
> Mycoplasma pneumonia 
> Legionella pneumonia 
> Chlamydia pneumonia
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9
Q

Bactericidal?

A

> Eg Beta-lactams
Act on the cell wall
Kill organisms
Indications: neutropenia, meningitis and endocarditis

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10
Q

Bacteriostatic?

A 
> Eg Macrolides
> Inhibit protein synthesis
> Prevent colony growth 
> Require host immune system to "mop up" residual infection 
> Useful in toxin-mediated illness
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11
Q

When would combination antimicrobial therapy be used?

A

> HIV and TB therapy
Severe sepsis (febrile neutropenia)
Mixed organisms (faecal peritonitis)

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12
Q

What is the advantage of single over combination antimicrobial therapy?

A

> Simpler
Fewer side effects
Fewer drug interactions

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13
Q

What are the principles of prescribing - regimen selection?

A

> Route of administration
Dose
Adverse effects (side effects/toxicity)
Duration
Intravenous to oral SWITCH therapy
Inpatient or Outpatient therapy: - Outpatient parenteral antimicrobial therapy (OPAT)
Therapeutic drug monitoring

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14
Q

When would the oral route for antimicrobials be selected?

A

> No vomiting
Normal GI function
No shock
No organ dysfunction

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15
Q

When would the intravenous route for antimicrobials be selected?

A

> Severe or deep-seated infection

> Oral route is not available

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16
Q

What is oral bioavailability?

A

> Ratio of drug level when given orally compared with level when given IV
Varies widely, E.g:
- Flucloxacillin 50-70%
- Linezolid 100%

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17
Q

Types of adverse effects of antimicrobials?

A 
> Allergic reactions
> Gastrointestinal
> Candida (Thrush)
> Liver
> Renal
> Neurological
> Haematological
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18
Q

Types of adverse effects of antimicrobials - Allergic reactions?

A

> Immediate hypersensitivity:
- Anaphylactic shock

> Delayed hypersensitivity:

  • Rash
  • Drug fever
  • Serum sickness
  • Erythema nodosum
  • Stevens-Johnson syndrome

Most likely caused by penicillins and cephalosporins

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19
Q

Types of adverse effects of antimicrobials - Gastrointestinal?

A

> Nausea, vomiting, diarrhoea

> Clostridium infection

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20
Q

Types of adverse effects of antimicrobials - Candida (thrush)?

A

Caused by broad spectrum penicillins, cephalosporins

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21
Q

Types of adverse effects of antimicrobials - Liver?

A

> All drugs, particularly tetracyclines, TB drugs

> More likely if pre-existing liver disease

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22
Q

Types of adverse effects of antimicrobials - Renal?

A

> Gentamicin, Vancomycin

> More like if pre-existing renal disease or on nephrotoxic meds

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23
Q

Types of adverse effects of antimicrobials - Neurological?

A

> Ototoxicity - Gentamicin, Vancomycin

> Optic neuropathy - Ethambutol (TB)

> Convulsions, encephalopathy - Penicillins, cephalosporins

> Peripheral neuropathy - Isoniazid (TB), Metronidazole

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24
Q

Types of adverse effects of antimicrobials - Neurological caused by gentamicin?

A

Ototoxicity

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25
Types of adverse effects of antimicrobials - Neurological caused by vancomycin?
Ototoxicity
26
Types of adverse effects of antimicrobials - Neurological caused by Ethambutol (TB)?
Optic neuropathy
27
Types of adverse effects of antimicrobials - Neurological caused by penicillins?
Convulsions, encephalopathy
28
Types of adverse effects of antimicrobials - Neurological caused by cephalosporins?
Convulsions, encephalopathy
29
Types of adverse effects of antimicrobials - Neurological caused by Isoniazid (TB)?
Peripheral neuropathy
30
Types of adverse effects of antimicrobials - Neurological caused by metronidazole?
Peripheral neuropathy
31
Types of adverse effects of antimicrobials - Heamatological?
> Marrow toxicity | > Megaloblastic anaemia (folate metabolism) - Co-trimoxazole
32
Types of adverse effects of antimicrobials - Penicillins?
> Allergic reactions > Candida > Convulsions, encephalopathy
33
Types of adverse effects of antimicrobials - cephalosporins?
> Allergic reactions > Candida > Convulsions, encephalopathy
34
Types of adverse effects of antimicrobials - gentamicin and vancomycin?
> Renal | > Ototoxicity
35
What are the principles of prescribing - liaison with laboratory?
> Sending appropriate specimens: - culture - direct detection - serology > Receiving results - preliminary culture results - sensitivity results - final results > Monitoring - disease activity - therapeutic drug monitoring
36
What are the principles of prescribing - antimicrobial stewardship?
> Antimicrobial Guidelines & Policies > Audit of quality of antimicrobial prescribing > Education
37
Who is involved in the antimicrobial management team?
``` > Pharmacists > Infectious diseases > Acute medicine > Medical microbiology > Infection prevention and control > General practice > Public partner ```
38
Outbreaks of Clostridium difficile infections often occurs due to what?
Broad spectrum antibiotics
39
What are the 4 C's that are linked to C difficile?
``` 4 antibiotics: > Ceftriaxone (and other cephalosporins) > Clindamycin > Co-amoxiclav > Ciprofloxacin (and other quinolones) ```
40
The antimicrobial classes?
``` > Penicillins (β-lactams) > Cephalosporins (β-lactams) > Aminoglycosides > Macrolides > Quinolones > Glycopeptides > Others > Antifungals > Antivirals ```
41
Mechanism of action - Inhibition of cell wall synthesis?
> Beta-lactams: - Penicillins - Cephalosporins > Glycopeptides: - Vancomycin - Teicoplanin
42
Mechanism of action - Beta-lactams?
Inhibition of cell wall synthesis
43
Mechanism of action - Penicillins?
A beta lactam - Inhibition of cell wall synthesis
44
Mechanism of action - Cephalosporins?
A beta lactam - Inhibition of cell wall synthesis
45
Mechanism of action - Glycopeptides
Inhibition of cell wall synthesis
46
Mechanism of action - Vancomycin?
A Glycopeptides - Inhibition of cell wall synthesis
47
Mechanism of action - Teicoplanin?
A Glycopeptides - Inhibition of cell wall synthesis
48
Mechanism of action - Inhibition of Protein Synthesis?
> Aminoglycosides: gentamicin > Macrolides: clarithromycin > Tetracyclines: doxycycline > Oxazolidinones: linezolid
49
Mechanism of action - Aminoglycosides
Inhibition of Protein Synthesis
50
Mechanism of action - gentamicin?
An aminoglycoside - Inhibition of Protein Synthesis
51
Mechanism of action - Macrolides?
Inhibition of Protein Synthesis
52
Mechanism of action - clarithromycin?
A macrolide - Inhibition of Protein Synthesis
53
Mechanism of action - Tetracyclines?
Inhibition of Protein Synthesis
54
Mechanism of action - doxycycline?
A tetracycline - Inhibition of Protein Synthesis
55
Mechanism of action - Oxazolidinones?
Inhibition of Protein Synthesis
56
Mechanism of action - linezolid?
An oxazolidinones - Inhibition of Protein Synthesis
57
Mechanism of action - Inhibition of Nucleic acid synthesis?
> Trimethoprim > Sulfonamides: sulfamethoxazole > Quinolones: ciprofloxacin
58
Mechanism of action - Trimethoprim
Inhibition of Nucleic acid synthesis
59
Mechanism of action -Sulfonamides
Inhibition of Nucleic acid synthesis
60
Mechanism of action - sulfamethoxazole?
A Sulfonamide - Inhibition of Nucleic acid synthesis
61
Mechanism of action - Quinolones?
Inhibition of Nucleic acid synthesis
62
Mechanism of action - ciprofloxacin?
A Quinolone - Inhibition of Nucleic acid synthesis
63
Use of benzylpenicillin?
``` > Soft tissue > pneumococcal > meningococcal > gonorrhoea > syphilis infections ```
64
Use of penicillin V?
``` > Soft tissue > pneumococcal > meningococcal > gonorrhoea > syphilis infections ```
65
Pathogens targeted by benzylpenicillin?
> Streptococci, > Neisseria > Spirochetes
66
Pathogens targeted by penicillin V?
> Streptococci, > Neisseria > Spirochetes
67
Use of amoxicillin?
> UTI | > RTI
68
Pathogens targeted by amoxicillin?
Broad spectrum but resistance is common
69
Pathogens targeted by flucloxacillin?
Staphylococci (S aureus)
70
Pathogens targeted by co-amoxiclav?
> Broad spectrum | > Anaerobes
71
Use of Co-amoxiclav?
> UTI > RTI > Soft tissue infections > Surgical wounds
72
Risk of using co-amoxiclav?
C difficile
73
An example of a 1st generation cephalosporin?
Cefradine
74
Pathogenic activity of a 1st generation cephalosporin (Cefradine)?
> Broad spectrum | > Resistance
75
Uses of a 1st generation cephalosporin (Cefradine)?
> UTI | > Soft Tissue infection
76
An example of a 2nd generation cephalosporin?
Cefuroxime
77
Pathogenic activity of a 2nd generation cephalosporin (cefuroxime)?
Broad spectrum
78
Uses of a 2nd generation cephalosporin (cefuroxime)?
> UTI > RTI > Surgical prophylaxis
79
An example of a 3rd generation cephalosporin?
> Ceftriaxone > Cefotaxime > Ceftazidime
80
Pathogenic activity of a 3rd generation cephalosporin (ceftriaxone/ cefotaxime)?
> Broad spectrum esp good against Gram-neg bacilli > Ceftazidime for Pseudomonas
81
Uses of a 3rd generation cephalosporin (ceftriaxone/ | cefotaxime)?
Hospital infections eg bacteraemia, pneumonia, abdo sepsis
82
Uses of a 3rd generation cephalosporin (Ceftazidime)?
> Hospital infections eg bacteraemia, pneumonia, abdo sepsis | > Pseudomonal infections in hospital and in cystic fibrosis
83
Pathogenic activity of a 3rd generation cephalosporin (Ceftazidime)?
> Broad spectrum esp good against Gram-neg bacilli | > Pseudomonas
84
What are the risks of using 3rd generation cephalosporins?
Risk factor for MRSA, C. diff, VRE;
85
An example of an aminoglycoside?
> gentamicin | > amikacin
86
Pathogenic activity of an aminoglycoside?
Gram-neg bacilli
87
Pathogenic activity of an aminoglycoside?
Serious Gram-negative infections eg bacteraemia, endocarditis, neutropenic sepsis
88
What are the risks of using an aminoglycoside?
Renal and ototoxicity; measuring levels essential
89
What are the risks of using gentamicin?
Renal and ototoxicity; measuring levels essential
90
What are the risks of using amikacin?
Renal and ototoxicity; measuring levels essential
91
Pathogenic activity of gentamicin?
Serious Gram-negative infections eg bacteraemia, endocarditis, neutropenic sepsis
92
Pathogenic activity of amikacin?
Serious Gram-negative infections eg bacteraemia, endocarditis, neutropenic sepsis
93
Pathogenic activity of gentamicin?
Gram-neg bacilli
94
Pathogenic activity of amikacin?
Gram-neg bacilli
95
"...romycin"
Macrolide
96
"...acillin"
Penicillin
97
"...floxacin"
Quinolones
98
Examples of macrolides
> Clarithromycin > Erythromycin > Azithromycin
99
Pathogenic activity of clarithromycin?
``` > Streptococci > Staphylococci > Mycoplasma > Chlamydia > Legionella ```
100
Main uses of clarithromycin?
> Respiratory infection > Soft tissue infection (if penicillin allergic) > STD
101
Pathogenic activity of erythromycin?
``` > Streptococci > Staphylococci > Mycoplasma > Chlamydia > Legionella ```
102
Main uses of erythromycin?
> Respiratory infection > Soft tissue infection (if penicillin allergic) > STD
103
Pathogenic activity of azithromycin?
Rel better for Gram-neg e.g. Haemophilus; Chlamydia
104
Main uses of azithromycin?
Chlamydia
105
Risk of erythromycin?
GI intolerance
106
Is erythromycin or clarithromycin better tolerated?
Clarithromycin
107
Pathogenic activity of ciprofloxacin?
Gram-negative bacilli: > Pseudomonas > some activity against staphylococci and streptococci
108
Pathogenic activity of levofloxacin/ | moxifloxacin?
``` > Enhanced activity against staphylococci/ streptococci > Pneumococcus, > Mycoplasma > Chlamydia > Legionella > Less against Pseudomonas ```
109
Main uses of ciprofloxacin?
> Complicated UTI > Complicated hospital acquired Pneumonia > GI infections
110
Main uses of levofloxacin/ | moxifloxacin?
2nd or 3rd line agent for pneumonia
111
Risk of Quinolones?
> Associated with C. difficile | > May affect growing cartilage
112
Examples of quinolones?
> ciprofloxacin > levofloxacin > moxifloxacin
113
Examples of glycopeptides?
> vancomycin | > teicoplanin
114
Pathogenic activity of vancomycin and teicoplanin?
Gram-positive bacteria only (streptococci, staphylococci)
115
Main uses of vancomycin and teicoplanin?
> MRSA - patients allergic to penicillin (IV Vanc) | > C.difficile (oral vanc)
116
Risk involved with glycopeptides?
Regular drug levels required; nephrotoxicity
117
Examples of glycopeptides?
> Vancomycin | > Teicoplanin
118
Pathogenic activity of trimethoprim?
> Gram-neg bacilli; | > Some activity against Streptococci and staphylococci
119
Main uses of trimethoprim?
> UTI > Resp infection > MRSA
120
Pathogenic activity of Co-trimoxazole | (trimethoprim-sulphamethoxazole)?
> Broad spectrum | > Pneumocystis jiroveci
121
Main uses of Co-trimoxazole | (trimethoprim-sulphamethoxazole)?
> Respiratory infection | > PCP
122
Risk involved with Co-trimoxazole | (trimethoprim-sulphamethoxazole)?
Rashes
123
Risk involved with clindamycin?
Associated with C. difficile
124
Main uses of clindamycin?
> Soft tissue infection | > gangrene
125
Pathogenic activity of clindamycin?
> Streptococci > Staphylococci > anaerobes
126
Pathogenic activity of tetracycline and | doxycycline?
``` > Streptococci > Staphylococci > Chlamydia > rickettsiae > brucella ```
127
Main uses of tetracycline and | doxycycline?
``` > Q fever > Brucellosis > chlamydia > atypical pneumonia > MRSA ```
128
Risk involved with tetracycline and | doxycycline?
Contraindicated in pregnancy and childhood (effects on teeth/bones)
129
Main uses of linezolid?
2nd line agent for MSSA, MRSA, VRE
130
Pathogenic activity of linezolid?
Gram-positive bacteria only: > Streptococci > Staphylococci > Enterococci
131
Risk involved linezolid?
Blood and optic neuropathy S/Es
132
Risk involved daptomycin?
Inactive in lung | Myositis S/E.
133
Pathogenic activity of daptomycin?
Gram-positive bacteria only: > Streptococci > Staphylococci > Enterococci
134
Main uses of daptomycin?
2nd line agent for MSSA, MRSA, VRE
135
Main uses of tigecycline?
3nd line, | Intra-abdominal sepsis, soft tissue infections
136
Pathogenic activity of tigecycline?
Very broad spectrum: > MRSA > ESBL > anaerobes
137
Pathogenic activity of Metronidazole?
> Anaerobes | > protozoa (eg giardia)
138
Main uses of Metronidazole?
> Surgical infections; > giardiasis > amoebiasis > trichomonal infections
139
Risk involved Metronidazole?
“Antabuse” reaction with alcohol
140
Risk involved meropenem?
Iv only; goof CNS penetrations
141
Risk involved rifampicin?
Drug interaction – enzyme inducer
142
Main uses of meropenem?
2nd and 2rd line for hospital infections
143
Main uses of rifampicin?
``` > TB > MRSA > meningococcal >prophylaxis > complicated staphylococcal infections ```
144
Pathogenic activity of meropenem
Broad spectrum: > anaerobes > pseudomonas
145
Pathogenic activity of rifampicin
> Mycobacteria > Meningococcus > Staphylococci
146
Pathogenic activity of linezolid?
Gram-positive bacteria only: > Streptococci > Staphylococci > Enterococci
147
Pathogenic activity of daptomycin?
Gram-positive bacteria only: > Streptococci > Staphylococci > Enterococci
148
Pathogenic activity of tigecycline?
Very broad spectrum, including: > MRSA > ESBL > anaerobes
149
Main uses of linezolid?
2nd line agent for MSSA, MRSA, VRE
150
Main uses of daptomycin?
2nd line agent for MSSA, MRSA, VRE
151
Main uses of tigecycline?
3nd line, | Intra-abdominal sepsis, soft tissue infections
152
Risk involved linezolid?
Blood and optic neuropathy S/Es
153
Risk involved daptomycin?
Inactive in lung | Myositis S/E
154
Risk involved tigecycline?
Ineffective against | Pseudomonas.
155
Examples of azoles (antifungal)?
> Fluconazole > Itraconazole > Voriconazole
156
Main uses of azoles?
Candida and aspergillus
157
Main uses of fluconazole?
Candida, some resistance
158
Main uses of itraconazole?
Candida and aspergillus
159
Main uses of voriconazole
Candida and aspergillus
160
Examples of polyenes (Antifungals)?
> Amphotericin | > Nystatin
161
Main uses of amphotericin?
Candida and aspergillus
162
Main uses of nystatin?
Candida
163
Examples of Echinocandin (Antifungals)?
> Caspofungin > Anidulafungin > Micafungin
164
Main uses of Echinocandin?
Candida and Aspergillus
165
Main uses of Caspofungin?
Candida and Aspergillus
166
Main uses of Anidulafungin?
Candida and Aspergillus
167
Main uses of Micafungin?
Candida and Aspergillus
168
Main uses of terbinafine?
Tinea, nails

Year 3 - Infection (16 decks)

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