Dr. Cluck Treatment

Question 1

S. aureus

Answer 1

-most virulent Gram (+)
-Staph. -> produces β-lactamase

-Only coagulase-positive Staphylococci -> Abscess
-causes bacteremia, skin soft tissue infections, endocarditis, pneumonia, abscesses, osteomyelitis, food-borne illness, toxic shock syndrome

NEVER a contaminant

Question 2

Treat S. aureus (MSSA)

Answer 2

If severe (in the blood) > IV

MSSA: Antistaph. bc they are ß-lactamase resistant
-> C D M N O OR 1st Gen Cephalosporin

IV: Nafcillin, Cefazolin
PO: Dicloxacillin, Cephalexin

Question 3

Treat S. aureus (MRSA)

Answer 3

MRSA:
IV: Vancomycin OR Linezolid, Tigecycline Daptomycin, Ceftaroline

PO: Doxycycline, Clindamycin, TMP-SMX

Question 4

Staphylococcus epidermidis

Answer 4

-CoNS: coagulase negative
-can cause disease. but is often a contaminant
-bloodstream infections, endocarditis, and prosthetic device infections -> BIOFILM

Question 5

Treat Staphylococcus epidermidis

Answer 5

-MRSA
I-f truly infected: Vancomycin

Question 6

Staphylococcus saprophyticus

Answer 6

-often UTI in young females
-does NOT produce ß-lactamase (EXCEPTION)

-> So treat with PNC, TMP-SMX or FQ

Question 7

Streptococcus pyogenes - Gr A

Answer 7

-do not produce a β-lactamase
-strep throat and cellulitis
-can cause necrotizing fasciitis (emergency - dead tissue) and toxic shock

-post-infection sequelae: glomerulonephritis and rheumatic fever

Question 8

Treat Streptococcus pyogenes - Gr A
NO ß-L

Answer 8

-no resistance
-Penicillin
-In case of necrotizing fasciitis PNC and Clindamycin (against toxins, decrease inflammation)
-PNC allergic: Clindamycin, TMP-SMX

Question 9

Streptococcus agalactiae Gr B

Answer 9

-Normal inhabitant of the GI tract and lower GU tract
-neonatal infections (eg meningitis)
-colonizer of the vagina

Question 10

Treat Streptococcus agalactiae Gr B
No ß-L

Answer 10

Penicillin

Question 11

Streptococcus bovis/S. gallolyticus
Gr D

Answer 11

-Normal in GI
-marker of colonic neoplasia if found in the blood
-can cause infective endocarditis

Question 12

Treat Streptococcus bovis/S. gallolyticus
No ß-L

Answer 12

-Penicillin

Question 13

Streptococcus pneumoniae

Answer 13

-Captain of the men of death
-AUT Syndrome: meningitis, endocarditis, and pneumonia
-Virulence increased by capsule

Question 14

Treat Streptococcus pneumoniae
No-ß-L

Answer 14

-Penicillin resistance at 30%
-β-lactam or FQ

Question 15

Viridans streptococci

Answer 15

-normal GI flora (including oral cavity)
-endocarditis, poor dentition, damaged heart valves
-Streptococcus anginosus belongs to this group (causes abscesses)

Question 16

Treat Viridans streptococci

Answer 16

Penicillin
-ß-lactam resistance is rising

Question 17

Enterococcus

Answer 17

-Normal bowel flora
-wound infections, endocarditis, and UTIs (NOT pneumonia)

-E. faecalis is often more drug-susceptible
-E. faecium is more drug-resistant

Question 18

Treat Enterococcus faecalis

Answer 18

ß-lactams are only static against Enterococcus

-Amino penicillins plus an aminoglycoside (Ampicillin + Gentamycin - SYNERGY)
OR linezolid, daptomycin

Question 19

Treat Enterococcus faecium

Answer 19

ß-lactams are only static against Enterococcus

-Vancomycin OR linezolid, daptomycin

Question 20

Mycobacteria

Answer 20

-causes (tuberculosis, leprosy - lepra -skin, nerves)
-it has a lipid-rich cell wall causing it to stain poorly -> “acid-fast”

Question 21

Treat Mycobacteria

Answer 21

-M. tuberculosis requires 4 drug therapy
-Non-tuberculosis Mycobacteria (NTM) have variable susceptibilities -> may be resistant to anti-tuberculosis agents

-NTM: M. chelonae, M. abscessus, M. fortuitum, M. marinum

Question 22

Bacillus

Answer 22

-known are B. anthracis, B. cereus
-B. cereus produces an enterotoxin (Chinese food)

Question 23

Treat Bacillus

Answer 23

only supportive, antibiotics are not necessary
(for B. cereus foodborne illness)

B. anthrax: Ciprofloxacin?

Question 24

Listeria monocytogenes

Answer 24

-found in soil, water, and the GI tract of animals, home-made cheese, unpasteurized milk
-cause meningitis

Question 25

Treat Listeria monocytogenes

Answer 25

if invasive: Ampicillin or TMP-SMX VNC or Meropenem NO Cephalosporin is active against Listeria

Question 26

Clostridium

Answer 26

Anaerob Garam (+) rod -C. perfringens: food-borne illness and gas gangrene -C. difficile: pseudomembranous colitis -C. tetani and C. botulinum: different typed paralysis

Question 27

Treat C. diff

Answer 27

ORAL VNC - the only one to treat with PO VNC!! mild to moderate: PO VNC or fidaxomicin severe: PO VNC + IV metronidazole

Question 28

Moraxella catarrhalis

Answer 28

-colonizer of the upper respiratory tract -may cause many diseases: Comm. ac. pneumonia, otitis media, sinusitis -produce ß-lactamase inconsistently

Question 29

Haemophilus influenzae

Answer 29

-similar to Moraxella -colonizer of the upper respiratory tract -Type B capsule versus non-typeable strain -Vaccination available

Question 29

Treat Moraxella catarrhalis

Answer 29

-Amoxicillin typically doesn't produce ß-lactamase

Question 30

Acinetobacter spp.

Answer 30

-Essentially ubiquitous (isolated from food, hospitals, soil, skin) -highly resistant and deadly -ß-lactamase doesn't work -sulbactam (protects the ß-lactam drug - usually has no activity) here: has microbial activity

Question 31

Treat Acinetobacter spp.

Answer 31

-multiple ways to treat -Carbapenems

Question 32

Neisseria

Answer 32

-N. gonorrhea and N. meningitidis -N. meningitidis causes meningitis -N. gonorrhoeae causes gonorrhea (STI) and PID (pelvic inflammatory disease) -Both encapsulated

Question 33

Treat Neisseria

Answer 33

-N. meningitidis with 3rd Gen Cephalosporin/sometimes with Pen G bc some do not produce ß-lactamase -N. gonorrhoeae with Cephalosporins Alternative: FQ, Macrolides (high dose)

Question 34

Enterics

Answer 34

-belong to the family of Enterobacterales -Salmonella and Shigella are NOT part of normal human flora -Ecoli and Klebsiella produce ESBL (ESBLs hydrolyze 3rd GEN cephalosporins) -Enterobacter is the prototype organism for AmpC (ß-lactamases cutting many ß-lactams)

Question 35

Treatment Enterics (E.coli, Enterobacter, Citrobacter)

Answer 35

-Treatment depends on the characteristics of the drug, the context of the patient -Therapy should be broad -piperacillin-tazobactam, cefepime, or a carbapenem -> depends on the case

Question 35

Treat E. coli and Klebsiella

Answer 35

Carbapenem

Question 36

Pseudomonas aeruginosa

Answer 36

-aerobic gram (-) rod -multidrug-resistant

Question 37

Anaerobes

Answer 37

-often in a harmless commensal relationship with the host -Trauma or immunocompromised can cause infection

Question 38

Treating Anaerobes

Answer 38

Metronidazole, Clindamycin, Carbapenem

Question 39

Zoonotics

Question 40

Treat Zoonotics

Answer 40

-Doxycycline 100mg BID for 7 days - NOT in pregnancy -In pregnancy: chloramphenicol

Question 41

Borrelia burgdorferi

Answer 41

causes Lyme disease -transmission via an arthropod vector – ticks -Treat with doxycycline or a β-lactam

Question 42

Chlamydophila

Answer 42

causes atypical pneumonia (Chlamydophila pneumoniae) treat with Doxycycline

Question 43

Chlamydia

Answer 43

-STD Treat with high intracellular concentrations such as macrolides or tetracycline

Question 44

Which drug class is excreted via glomerular filtration (kidney)

Answer 44

Aminoglycosides and Tetracyclines

Question 45

Which drug is associated with Disulfiram reaction as an adverse effect?

Answer 45

Metronidazole

Question 46

Which drug class is appropriate for respiratory infections?

Answer 46

Macrolides

Question 47

Which drug class is associated with Nephrotoxicity - Ototoxicity - Neuromuscular blockade (N-O-N)

Answer 47

Aminoglycosides

Question 48

Which drug lacks activity to Acinetobacter - Pseudomonas - Enterococcus

Answer 48

Ertapenem

Question 49

Which drug can result in Falconi syndrome, when taken after expiration date?

Answer 49

Tetracyclines

Question 50

Which organisms are NOT covered by tigecycline?

Answer 50

-Pseudomonas -Proteus -Providencia -Morgonella

Question 51

Which drug is associated with an increase in potassium level?

Answer 51

-Trimethoprim-sulfamethoxazole -Trimethoprim structure is similar to triamterene = potassium-sparing diuretic)