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Infection & Immunity > Clinical Uses of Antibiotics > Flashcards

Clinical Uses of Antibiotics Flashcards

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1
Q

how are most penicillins administered

A

IM or IV

not very soluble or stable in stomach acid

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2
Q

what does the R-group of a penicillin determine

A

selectivity, solubility, stability, bioavailability, beta-lactamase resistance

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3
Q

what penicillins are beta-lactamase sensitive

A

benzylpenicillin, phenoxymethylpenicillin

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4
Q

what penicillins are beta-lactamase resistant

A

flucloxacillin, temocillin

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5
Q

what are some broad spectrum penicillins

A

ampicillin, amoxicillin, co-amoxiclav

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6
Q

what penicillins are anti-pseudomonal

A

piperacillin

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7
Q

what are the pharmacokinetics of benzylpenicillin

A

IM or IV slow infusion, high blood conc achieved rapidly, non-toxic, good diffusion into body and tissues, low CSF levels, long post-antibiotic effect, rapid excretion in urine

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8
Q

how to maintain benzylpenicillin blood levels

A

administer large doses

frequent dosing

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9
Q

what is benzylpenicillin used for

A

mild to moderate throat infections, otitis media, cellulitis, pneumonia, endocarditis, meningitis

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10
Q

what causes meningitis

A

neisseria meningitis, stapholococcus pneumoniae, haemophilus influenzae

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11
Q

what are the pharmacokinetics of amoxicillin

A

70-90% absorption, peak blood conc after 90 min, good CSF levels in meningitis, mainly excreted in urine

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12
Q

what are the clinical uses of amoxicillin

A

RTIs, oral infections, otitis media, sinusitis, UTIs, GI, listerial meningitis

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13
Q

what are the side effects of amoxicillin

A

hypersensitivity, neurotoxicity, renal failure, diarrhoes and pseudomembranous colitis (c. diff)

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14
Q

what is the origin of cephalosporins

A

isolated from cephalosporium acremonium

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15
Q

what are the properties of cephalosporins

A

resistant to beta lactamases, originally active against gram positive bacteria, risk of c.diff

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16
Q

what is the cephalosporin activity aainst gram positive bacteria

A

affinity for PBPs, resistant to beta lactamases

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17
Q

what is the cephalosporin activity against gram negative bacteria

A

penetration through outer membrane

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18
Q

what are second generation cephalosporins

A

active against gram positive and some gram negatives
more resistance to beta lactams
used for severe infections

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19
Q

what are third generation cephalosporins

A

broad spectrum, increased activity and increased resistance to beta lactamases
active against pseudonomas

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20
Q

what are carbapenems

A

inhibitors of cell wall synthesis

highly resistant to beta lactamases, broad spectrum activity

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21
Q

what are glycopeptides

A

inhibitors of cell wall synthesis

only active against gram positive (too large to pass through membrane of gram negative)

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22
Q

what are some examples of glycopeptides

A

vancomycin, teicoplanin

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23
Q

what is vancomycin used for

A 
systemic infections (IV)
orally (c.diff)
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24
Q

what is teicoplanin used for

A

IM or IV injection for systemic infections

also for infection from b-lactam resistant organisms (MRSA)

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25
what are some features of vancomycin and teicoplanin
penetrate CSF, excreted by kidney, cannot be absorbed through the gut, can be used orally for c.diff
26
what are the side effects of vancomycin and teicoplanin
pain at injection site, renal toxicity, ototoxicity, blood disorders, anaphylactoid reactions
27
what antimicrobials affect bacterial membranes
polymyxin (colistin) - active on gram negative bacteria (disrupt membrane and cause leakage of cytoplasm)
28
what are polymyxins used for
IV for resistant gram negative infections, nebulised or DPI for p.aeruginosa in GF patients
29
what are the side effects of polymyxins
highly neurotoxic and nephrotxic
30
what antimicrobials affect bacterial membranes
lipopeptides like daptomycin
31
how does daptomycin (lipopeptide) work
active on gram positive bacteria rapid depolarisation of cytoplasmic membrane resulting in loss of function due to leakage of ions and depolarisation of cell
32
what are the uses of lipopeptides
IV for skin and soft tissue infections, endocarditis caused by resistant gram positives (MRSA)
33
what are some side effects of lipopeptides
nephrotoxicity, myopathy, peripheral neuropathy, colitis
34
what are examples of metabolic inhibitors of nucleic acid synthesis
sulphonamides, trimethoprim | sulfonamides more selective than trimethoprim
35
where do sulphonamides act
on para-amino benzoic acid conversion to dihydropteroic acid in nucleic acid synthesis
36
where does trimethoprim work
on dihydrofolic acid in nucleic acid synthesis
37
what are the uses of sulphonamides
limited uses
38
what are the uses for trimethoprim
UTI and acne
39
what are the side effects of trimethoprim
(rare) GI tract, allergy, myelosuppression | avoid in 1st trimester pregnancy
40
what are examples of fluoroquinolones
ciprofloxacin, levofloxacin, moxifloxacin, ofloxacin
41
what is ciprofloxacin
flouroquinolone | synthetic, broad spectrum, bacterialcidal, inhibit DNA gyrase and IV topisomerase
42
what are the uses of ciprofloxacin
active against gram negative bacteria and intracellular pathogens like chlamydia, myobacteria limited use with streptococci and enterococci
43
what are the side effects of ciprofloxacin
GI, CNS, tendon damage, photosensitiviy, renal impairment | interacts with a lot of CYP enzymes
44
what is a dietary caution with ciprofloxacin
avoid dairy as they contain a lot of cations | avoid iron tablets as they can affect absorption
45
what is an example of a RNA polymerase inhibitor
rifamycin | e.g.rifampicin
46
what is rifampicin
semi-synthetic bactericidal antibiotic | penetrates deep into bone
47
what are the uses for rifampicin
TB, meningitis prophylaxis, infections of joints, endocarditis
48
what are dietary cautions for rifampicin
avoid dairy or taking iron tablets at the same time | can turn urine red
49
what are the side effects of rifampicin
hepatotoxicity, fever/rash, GI, orange-red colour to secretions can increase metabolism of other drugs
50
what is an example of a DNA inhibitor
nitromidazoles | e.g. metronidazole
51
what are the uses of metronidazole
anaerobic infections, genital tract infections, SSTIs where anaerobes are suspected, abdominal and dental infections
52
what are the side effects of metronidazole
GIT, candida infections, CNS, hypersensitivity, red/brown urine
53
how does nitrofurantoin work
its active metabolites target DNA synthesis, RNA synthesis, protein synthesis, aerobic energyy metabolism, cell wall synthesis it accumulates in the bladder and cannot be used on patients with a catheter
54
what are the uses for nitrofurantoin
treating non-catheterised UTI caused by gram positive and gram negative aerobic bacteria
55
summary of agents for cell wall synthesis
glycopeptides
56
summary for agents for cell membrane
polymyxin | daptomycin
57
summary of agents for nucleic acids
sulphonamides/trimethorpim, fluoroquinolones, rifamycin, metronidazole, nitrofurantoin
58
what are some examples of aminoglycosides
gentamicin, amikacin, tobramycin, streptomycin
59
what is gentamicin used for
serious infections caused by aerobic bacteria active against gram negatives like pseudonomas active against gram positives like staphylococci
60
what are the pharmacokinetics of aminoglycosides
Iv, IM or topically for wounds, oral for gut contamination as it is not absorbed, short half life, crosses placenta, prro penetration, renal excretion
61
what are the side effects of aminoglycosides
nephrotoxicity (reversible, caused by the drug accumulating in proximal tubule) ototoxicity (irriversible, drug accumulates in fluid-filled inner ear and damages hair cells)
62
what are examples of tetracyclines
coxycycline, minocycline, oxytetracycline
63
what are tetracyclines used for
acne, RTIs, chlamydia, SSTIs
64
what are the pharmacokinetics of tetracyclines
high absorption but decreased by cations, well distributed (inclusing foetus), accumulation and excretion in bile
65
what are the side effects of tetracyclines
GI, deposition in forming bone/teeth, lover damage, vertigo, photosensitivity
66
what are the side effects of doxycycline
incorporation into tissues that are calcifying at time of administration (staining of teeth) photosensitivity from aromatic rings absorbing light energy, producing reactive O2 intermediates which can damage cell membranes
67
what are macrolides
alternatives to penicillin for trating infections caused by streptococci
68
what are examples of macrolides
erythromycin, azithromycin, clarithromycin
69
what is the mode of action of erythromycin
bind 23S rNA in 50S subunit, decreasing translocation and release of tRNA
70
what are the pharmacokinetics of erythromycin
oral or IV, acid labile, rapidly absorbed and well distributed, metabolised in liver and excreted in bile
71
what are the side effects of erythromycin
GI, cholestatic jaundice, reversible ototoxicity, allergic reactions, cardiac arrhythmia
72
what is am example of a lincosamide
clindamycin
73
what is clindamycin used for
staphylococcal bone and joint infections, RTs, peritonitis, scepticaemia
74
what is an example of oxazolidinones
linezolid
75
how is linezolid used
infection cause by resistant gram positive bacteria (MRSA) and vancomycin resistant enterococci no major side effects - rarely used
76
what is fusidic acid
narrow spectrum for staphylococcal infections
77
how does fusidic acid work
affects EF-G which supplies energy for translocation stage of protein synthesis
78
what is fusidic acid used for
topical for skin and eye infections | oral or IV for osteomyelitis and endocarditis
79
what is the mode of action for chloramphenicol
binds to 50s subunit and prevents peptide bond formation
80
what are the pharmacokinetics of chloramphenicol
topical/oral/IV, penetrates all tissues including the brain, metabolised in the liver and renally excreted
81
what are the side effects of chloramphenicol
bone marrow suppression, GI, peripheral or optic neuritis, aplastic anaemia
82
what is aplastic anaemia
bone marrow stem cells die - normal haemopoietic cells are absent and the space is filled by adipose tissue rare but fatal caused by chloramphenicol
83
summary of antibacterials which inhibit protein synthesis
aminoglycosides/oxazolidinones, tetracyclines, macrolides/lincosamides, fusidic acid, chloramphenicol
84
what is the definition of surgical site infection (superficial)
occurs 30 days postoperatively and involves skin or subcutaneous tissue of the the incision and drainage/symptom of infection/culture
85
what is the definition of surgical site infection (deep)
30 days postoperatively or within one year if an implant is left in place, infection involves deep soft tissues and pt has drainage/fever/localised pain and tenderness/abcess
86
what is the definition of surgical site infection (organ)
part of the body opened during operative procedure, pt has drainage/infective organisms/abcess
87
what are the meausres that can prevent surgical site infection
theatre airflow and workflow, skin prep, bowel prep, implants/foreign meterials containing antimicrobials, screening, prophylaxis
88
what is a clean degree of contamination
no inflammation, respiratory/GI tract not entered
89
what is clean-contaminated degree of contamination
respiratory/GI tracts entered without spillage
90
what is contaminated degree of contamination
accute inflammation without pus, visible wound contamination
91
what is dirty degree of contamination
presence of pus, compound/open injuries more than four hours old
92
what is the duration of antibiotic prophylaxis recommended for a clean-contaminated proceedure
one dose
93
what is the duration of antibiotic prophylaxis recommended for a contaminated proceedure
5-7 days of treatment
94
when is non-surgical prophylaxis given
recurrent infections, endocarditis, high risk contacts (HIV, meningitis, influenza), immunosuppressed (chemotherapy)
95
what is asplenia
removal of spleen after it ruptures spleen stores white blood cells so pts now have higher risk of infection prophylaxis recommended

Infection & Immunity (22 decks)

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