HIPSHER Antibiotics Q1-18 Flashcards
(32 cards)
List the factors that should be considered when choosing an antimicrobial regimen
- Consider the Site, severity, organisms suspected, does it require a bactericidal agent
- Consider the pt: Allergies*, age, renal function, co-morbids
- Avoid redundancy
- Cost effective
- Convenience: (Use PO agents ASAP when able) Home infusions that require infrequent dosing
What are common colonizers/contaminants in cultures that are not ultimately the true culprit/problem in the infection?
Coag Negative staph and diphtheroids
How do you get the most reliable diabetic foot ulcer, lung and urine culture/samples?
Diabetic Ulcer - surgical culture that is deep
Lung - bronchoscopy to avoid mouth flora
Urine - mid stream
When should and should you not hold antibiotics until a specimen is obtained?
DO NOT WAIT TO START ABX IF SEPTIC/UNSTABLE
infections requiring surgery & long-term abx therapy, abx should be withheld in stable pts until accurate surgical samples can be obtained
○ = Example: prosthetic joint, post-op infections after spinal surgery w/ hardware replacement, osteomyelitis
What infections require empiric anaerobe coverage?
Intra-abdominal, DM foot ulcers, Gas gangrene, aspiration pneumonia, dental infection, pelvic, inflammatory dz
What agents empirically cover anaerobes?
ampicillin-sulbactam
pip-tazo
all carbapenems
clindamycin
metronidazole
moxifloxacin
What infections need to be empirically covered for pseudomonas?
Nosocomial pneumonia,
nosocomial UTI
post-op meningitis (following neuro sx)
severe DM foot ulcer
puncture wound through the shoe
burns
What agents empirically covers pseudomonas?
pip-tazo
ceftazidime
cefepime
cipro,
levaquin
all carbapenems except ertapenem
What infections require empiric MRSA coverage?
purulent cellulitis
post-op wound infx
nosocomial pneumonia
nosocomial meningitis
What agents empirically cover MRSA?
clindamycin
bactrim doxycycline
linezolid vancomycin
What infections require empiric enterococcus coverage?
Intra-abdominal infx (especially bilary tract)
UTI
CLABSI - central line associated blood stream infection
What agents empirically cover enterococcus?
o PCN o augmentin o pip-tazo o ampicillin-sulbactam o vanco o daptomycin o linezolid o ciprofloxacin, levofloxacin, nitrofurantoin for UTI
What MOA are beta lactams and what are their ADRs?
MOA: bactericidal to cell wall
ADR: rash, drug fever, thrombocytopenia, sz
What is a contraindication of PCN?
previous allergic rx or anaphylaxis to other beta-lactam classes
What is a contraindication of Aminopenicillins + B-lactamase inhibitors?
empiric intra-abdominal infections due to increasing Bacteriodes resistance
What is a CI to Cephalosporin (3rd gen) Cefazidime?
: empiric coverage of GN infections (increasing resistance
What is a CI to Carbapenems?
lowers the sz threshold, avoid in head trauma or seizure history
What is a CI to monobactams?
overall costly, assoc. with phlebitis and increased LFTS… try to not use if really needed
What drugs are in the drug class of PCN?
• Penicillin: potent bactericidal
o Pencillin G IV
o PenVK PO
o Benzathine penicillin IM
What drugs are in the drug class anti-staph PCN?
• Anti-staphylococcal PCN
o Nafcillin
o Oxacillin
o Dicloxacillin
What drugs are in the drug class aminopenicillins?
o Ampicillin
o Amoxicillin
What is the extended spectrum PCN?
Pip-Taz (Zosyn)
What are the B-lactam/Beta lactamase Inhibitors?
o Ampicillin-Sulbactam [Unasyn]
o Amoxicillin-Clavulanate [Augmentin]
What species does cephalosporins not cover?
enterococcus and anarobes
