Empiric antibiotic treatment of infectious disease syndromes Flashcards Preview

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Flashcards in Empiric antibiotic treatment of infectious disease syndromes Deck (30):
1

Respiratory tract cluster of 'bugs'

-Pneumococcus
-Hemophilus influenzae
-Moraxella catarrhalis
-Meningococcus
-Chlamydophila pneumoniae
-Mycoplasma pneumonaie
-Group A streptococcus

2

What are the common respiratory tract syndromes?

-Otitis media
-sinusitis
-pharyngitis
-pneumonia
-meningitis

3

Intra-abdominal cluster of 'bugs':

-Gram negative aerobic bacill
-anaerobes
-enterococci

4

What are the common intra-abdominal syndromes?

-diverticulitis
-intra-abdominal abscess/peritonitis
-cholecytitis
-pylonephritis
-pelvic inflammatory disease
-diabetic foot infection

5

What are the skin 'bugs'?

-Group A streptococcus
-Staphylococcus aureus

6

What are the common skin syndromes?

-cellulitis
-erysipelas
-abscess

7

What are the major antibiotic 'families' and individual antibiotics that you need to know?

FAMILIES:
-Penicillins (BL)-C
-Cephalosporins (BL)-C
-Fluoroquinolones-C
-Macrolides-S
-Tetracyclines
-Aminoglycosides- C
-Carbapenems (BL)-C

INDIVIDUAL AGENTS:
-Trimethoprim-sulfamethoxazole C
-Nitrofurantoin - C or S
-Metronidazole- C
-Clindamycin- s
-Vancomycin (C), Linezolid (S)

8

What are the main 2 families for inpatients and 2 main families for outpatients?

-outpatients: macrolides, tetracyclines

-inpatients: carbapenems, aminoglycosides

9

Match the AB to the bacteria:
Penecillins:
1. Pen
2. Amp/Amox
3. Clox

1. Pen: Strepto, pneumo-cocci

2. Amp/Amox: enterococci

3. Clox: Staph aureus

10

Match the AB to the bacteria:

1. Cephalosporins (1)

2. Ceph (2)

3. Ceph (3)

by generation:

1. Ceph (1): Staph aureus

2. H flu or pneumococcus (resp)

3. Pneumococcus and GN (GC, meningococcus, H flu)

11

Match AB to bacteria:

Fluoroquinolones

GN (cipro) and resp tract (Levo, moxi).

12

Match AB to bacteria:

macrolides (azithromycin, clarithromycin):

-Group A strep, pneumococcus, Staph aureus (if penicillin allergy)

-Resp tract infx

-Traveler's diarrhea or Chlamydia (Azithro)

13

What ABs are used on really sick patients with resistant organisms?

- Vancomycin (GP: MRSA, Enterococcus)

-Aminoglycosides (GN aerobes)

-Carbapenems or Pip-Tazo (v. broad spectrum)

14

What AB is used for anaerobes (esp intra-abdominal)?

metronidazole

15

What AB is used for anaerobes for above the DIA and some GP?

Clindamycin

16

What ABs are used for cystitis?

Trimethoprim-sulfamethoxazole or nitrofurantoin

17

What AB is used for Clamydia (urethritis/PID) and respiratory tract infections?

Doxycline

18

What do you need to consider when choosing an empiric AB?

-Local resistance patterns
-Recent use of ABs
-Co-morbidities
-If the px is very sick (broad spectrum, IV)
-Cost
-Safety issues (allergy/toxicity, drug interactions)
-Tissue penetration by antibiotic
-Bactericidal vs bacteriostatic - cidal if host defense challenged: Meningitis, endocarditis, neutropenia
-Evidence from randomized trials

19

What drugs would you use for purulent tonsillitis?

think: Strep Pyogenes (versus: viruses like EBV)

RX:
Penicillin, Cephalosporin (1st gen), Macrolide

20

What drugs would you use for cellulitis?

Think: streptococcus pyogenes (Group A) or Staphylococcus aureaus

Rx:
1st Gen Cephalosporin
Cloxacillin
Clindamycin, Macrolide, Respiratory fluoroquinalone

21

What drugs would you use to rx septic monoarthritis?

think: staphylococcus aureus (esp if older px), Group A strep, Strep pneumoniae , gonococci (if STI risk fx's)

rx:
Cloxacillin, 1st gen Cephalosporin , Vancomycin...if gonococci-> ceftriaxone/3rd gen ceph

22

Rx for acute otitis media?

think: strep pneumoniae, hemophilus influenzae, moraxella catarrhalis , viruses

Rx:
amoxicillin, cephalosporin (2nd/3rd), clarithromycin, azithromycin

23

Rx for cyctitis (lower, uncomplicated UTI)?

think: E. coli, GN aerobic bacilli, staph saprophyticus

rx: trimethoprim-sulfamethoxazole, nitrofurantoin, ciprofloxacin (if severe)

24

Rx for intra-abdominal sepsis?

think: GN aerobic bacilli, anaerobes (esp B. fragilis)

rx:
GN aerobic:
-source control
-cephalosporin, aminoglycosides, ciprofloxacin

GN anaerobic:
metronidazole

meropanem, piperacillin-tazobactam

25

Rx for meningitis?

think: Spneumoniae, H influenzae, meningococcus, listeria

rx:
ceftriaxone (3rd gen ceph), vancomycin, ampicillin

26

What score is used to assess the severity of pneumonia?

CURB-65
c=confusion
u=urea >7mmol/L
r= RR.30/min
b=BP <90/60
65= age over 65

score:
0-1 outpatient rx
2: in-patient rx, general ward
3/4/5: in patient, ICU

27

Rx for CAP (pneumonia, CURB-65 =0 )?

think: S. pneumoniae, H. influenzae , mycoplasma pneumonaie, chlamydophila pneumoniae, legionella

rx:
macrolide+beta-lactam, doxycycline, RFQ (levofloxacin, moxifloxacin)

28

Why should you avoid a respiratory fluoroquinalone (RFQ) with mild disease (pneumonia)?

-it is broad spectrum--> C diff high risk
-overuse may lead to resistance

29

If macrolide-resistance to pneumococcus is >25%, what should you add to macrolide rx?

beta-lactam

note: macrolide-resistance in Toronto: 28%

30

Rx for traveler's diarrhea?

think: GN aerobic bacteria: salmonella, shigella, campylobacter, yersinia entrocolitica, e.coli

rx:
-fluoroquinolone (or azithromycin)