Infectious and antimicrobial stew

Question 1

What is antimicrobial stewardship

Answer 1

Promoting appropriate use of antibiotics and combatting antibiotic resistance.

Question 2

What is “start smart antimicrobial stew” ?

Answer 2

1) Evidence of infection: history, symptoms, physcial exam, test results.

2) Asses: evidence of infection, patient risk

3) Investigate: cultures. lab tests, imaging

4) Taking into consideration: Allergies etc

5) Document: treatment regimen and plan and review dates.
should be done within 48-72 hrs

evidence, asses, investigate, prescribe, document.

Question 3

What is “cares” antimicrobial steward ship ?

Answer 3

cease
amend
refer
extend
switch

this is for prescription reviews

Question 4

When should surgical prophylaxis be done before starting surgery procedure ?

Answer 4

within 1 hour before the start of the procedure

normally one dose
but can be more for longer porcedures.

Question 5

common interactions

Answer 5

Ciprofloxacin and NSAIDS: seizures

ciprofloxacin and methotrexate: toxicity

methotrexate and penicillin: toxicity

warfarin and ciprofloxacin: anticoag effect

macrolides and diuretics: hypokalaemia

Question 6

sepsis signs adults:

Answer 6

Slurred speech
Extreme shivering
Passed no urine in a day
Severe breathlessness
Illness
Skin discolour

Question 7

sepsis signs children:

Answer 7

-breathing fast
-convulsions
-bluish pale looking
- rash
-lethargic
- cold

Question 8

General symptoms of infection

Answer 8

fever
chills and sweats
cough
sore throat
shortness of breath
nasal congestion
diarrhoea
vomit
headache
temperature

Question 9

local symptoms of infection

Answer 9

uti: pain/burning when urinating

copd, pneumoia, congestive heart failure, pulmonary embolism: coughing and chest pain

infected cut: redness/pus.

Question 10

example of broad spectrum antibiotics

Answer 10

doxycycline
Amoxicillin/clavulanic acid
azithromycin
piperacillin/tazobactam

Question 11

what type of bacteria causes skin infection

Answer 11

staphylococcus aureus

• so can be treated with flucloxacillin

Question 12

what type of bacteria causes GI infection

Answer 12

anaerobic bacteria

• metronidazole can be used in combo with other broad spectrum antibiotics.

Question 13

What is the “then focus” bit

Answer 13

1) take samples for culture

2) give appropriate empirical treatment

3) receive culture results

4) change treatment as per culture and sensitivity report (focus)

Question 14

what are the 5 antimicrobial prescribing decisions

Answer 14

1) stop- if no longer signs or symptoms

2) switch- IV to oral

3)change- ideally change to narrow spectrum

4) continue- document next review or stop date

5)OPAT (outpatient parenteral antibiotic therapy)

Question 15

what does “I” mean in a S/R sensitivity report

Answer 15

Intermediate

falls between sensitive and resistance

Question 16

what is used to treat endocarditis

Answer 16

penicillin and gentamicin

• penicillin induces cell wall damage, causing permeability of enterococci to aminoglycosides to increase, facilitating gentamicin to get to the target site.

Question 17

example of an antagonistic combo that should not be given together

Answer 17

erythromycin and clindamycin

• as they both bind to the same sub unit of bacterial ribosome
• so will compete for binding site, and will have no effect.

Question 18

what are examples of drugs that require therapeutic monitoring

Answer 18

Vancomycin
gentamicin
teicoplanin

• to make sure levels of drug is maintained within the therapeutic window.

Question 19

antimicrobial prescribing considerations

Answer 19

1) is an antimicrobial indicated

2) what is the most appropriate antimicrobial or combo for the INFECTION

3) which drugs can penetrate to the site of infection

4) what is the most appropriate antimicrobial or combo for the SPECIFIC PATIENT

5) what is the most appropriate route

6) what is the most appropriate dose and freq

7) What is the most appropriate course length

Question 20

minimum inhibitory concentration (MICs)

Answer 20

lowest conc of an antimicrobial that is needed to inhibit visible growth of a microorganism

Question 21

Minimum bactericidal concentration (MBCs)

Answer 21

lowest conc of antimicrobial needed to prevent growth of an organism

Question 22

what are the 3 types of antimicrobial classifications (MIC and MBC)

Answer 22

1) concentration dependent/killing

2) time dependent

3) Hybrid

Question 23

conc dependent

Answer 23

The higher the drug concentration relative to pathogen minimum inhibitory concentration, the greater the rate and extent of antimicrobial activity.

for conc dependent killing, best response is when the drug conc used is more than x10 higher than MIC.

Question 24

time dependent

Answer 24

dependent on duration of pathogen exposure to antibiotic.

e.g. B- lactams and clindamycin bind for long periods of time

• so their pharmacodynamics can be modified to bind for less amount of time, where drug conc still remains above the MIC

Question 25

hybrid

Answer 25

mix of conc dependent and time dependent - and has persistent post antibiotic effect so works even after the antibiotic has been completely cleared out.

Question 26

why are tetracyclines not recommended for kids

Answer 26

could cause discolouration and deformity of growing bones and teeth

Question 27

can ciprofloaxacin be used in kids

Answer 27

no causes arthropathy (joint disease)

Question 28

examples of drugs that are avoided or dose reduced with impaired renal or hepatic function

Answer 28

RENAL Aminoglycosides vancomycin HEPATIC isoniazid rifampicin clindamycin

Question 29

what is the general course length of antimicrobials ?

Answer 29

5 days

Question 30

When is antimicrobial prophylaxis considered

Answer 30

1) surgery 2) post-splenectomy/dysfunctional spleen 3) Bacterial meningitis 4) TB 5) Immunocompromised 6) HIV 7) Bite wounds 8) malaria

Question 31

what causes 50% of sepsis cases

Answer 31

pneumonia

Question 32

what are the 6 parameters for the NEWS scoring system

Answer 32

respiration rate oxygen saturation systolic blood pressure pulse rate level of consciousness or confusion temperature

Question 33

Ciprofloxacin

Answer 33

Drug Class: Fluoroquinolone antibiotic Indication: Used for a wide range of bacterial infections, including urinary tract infections, respiratory infections, and skin infections. Mechanism of Action: Inhibits bacterial DNA gyrase and topoisomerase IV, enzymes involved in DNA replication, transcription, and repair, leading to bacterial cell death. Side Effects: Nausea, diarrhea, dizziness, tendonitis/tendon rupture, photosensitivity, QT prolongation, CNS effects (confusion, seizures), and risk of C. difficile infection.

Question 34

Doxycycline

Answer 34

Drug Class: Tetracycline antibiotic Indication: Treatment of various bacterial infections such as respiratory tract infections, Lyme disease, acne, and sexually transmitted infections. Mechanism of Action: Inhibits bacterial protein synthesis by binding to the 30S ribosomal subunit, preventing tRNA from attaching to the ribosome. Side Effects: Nausea, vomiting, photosensitivity, gastrointestinal discomfort, esophageal irritation, and tooth discoloration in children.

Question 35

Amoxicillin

Answer 35

Drug Class: Beta-lactam antibiotic (Penicillin class) Indication: Used to treat a variety of bacterial infections, including ear infections, sinusitis, bronchitis, and urinary tract infections. Mechanism of Action: Inhibits bacterial cell wall synthesis by binding to penicillin-binding proteins, leading to cell lysis. Side Effects: Diarrhea, rash, allergic reactions (hives, anaphylaxis), and gastrointestinal upset.

Question 36

Azithromycin

Answer 36

Drug Class: Macrolide antibiotic Indication: Treatment of respiratory infections, sexually transmitted infections, and skin infections. Mechanism of Action: Binds to the 50S ribosomal subunit, inhibiting bacterial protein synthesis. Side Effects: Diarrhea, nausea, abdominal pain, QT prolongation, and risk of C. difficile infection.

Question 37

Piperacillin/Tazobactam

Answer 37

Drug Class: Beta-lactam antibiotic (Piperacillin is a penicillin derivative, and Tazobactam is a beta-lactamase inhibitor) Indication: Treatment of serious infections, including intra-abdominal, skin, soft tissue, and urinary tract infections. Mechanism of Action: Piperacillin inhibits bacterial cell wall synthesis, while Tazobactam inhibits beta-lactamases, protecting piperacillin from being broken down Side Effects: Diarrhea, rash, liver enzyme elevations, allergic reactions, and risk of superinfection.

Question 38

Flucloxacillin

Answer 38

Drug Class: Beta-lactam antibiotic (Penicillin class) Indication: Primarily used for infections caused by penicillin-resistant staphylococci, such as skin infections and endocarditis. Mechanism of Action: Inhibits bacterial cell wall synthesis by binding to penicillin-binding proteins, leading to cell lysis. Side Effects: Rash, diarrhea, nausea, allergic reactions, and liver toxicity (rare).

Question 39

Metronidazole

Answer 39

Drug Class: Nitroimidazole antibiotic/antiprotozoal Indication: Treatment of infections caused by anaerobes, such as bacterial vaginosis, Clostridium difficile infections, and infections from Giardia and Entamoeba histolytica. Mechanism of Action: Enters bacterial and protozoal cells, where it is reduced to toxic metabolites that bind to DNA and inhibit nucleic acid synthesis, leading to cell death. Side Effects: Nausea, metallic taste, neurotoxicity (seizures, peripheral neuropathy), and disulfiram-like reaction with alcohol.

Question 40

Penicillin

Answer 40

Drug Class: Beta-lactam antibiotic (Penicillin class) Indication: Treats a variety of bacterial infections, including strep throat, syphilis, and pneumonia. Mechanism of Action: Inhibits bacterial cell wall synthesis by binding to penicillin-binding proteins, leading to bacterial cell lysis. preventing peptidoglycan synthesis and cross linking of peptidoglycans, causing cell lysis. inhibits transpetidase enzyme Side Effects: Allergic reactions (rash, anaphylaxis), gastrointestinal upset, and superinfections. diarrhoea nausea vomit

Question 41

Gentamicin

Answer 41

Drug Class: Aminoglycoside antibiotic Indication: Treatment of severe infections caused by Gram-negative bacteria, including sepsis, pneumonia, and urinary tract infections. Mechanism of Action: Inhibits bacterial protein synthesis by binding to the 30S ribosomal subunit, leading to misreading of mRNA and impaired protein production. Side Effects: Abdominal or stomach cramps or pain. agitation. back pain. black, tarry stools. blood in the urine. blurred or double vision.

Question 42

Erythromycin

Answer 42

Drug Class: Macrolide antibiotic Indication: Treatment of respiratory infections, acne, and sexually transmitted infections. Mechanism of Action: Inhibits bacterial protein synthesis by binding to the 50S ribosomal subunit. Side Effects: Gastrointestinal upset, nausea, diarrhea, QT prolongation, and potential drug interactions due to CYP450 inhibition.

Question 43

Clindamycin

Answer 43

Drug Class: Lincosamide antibiotic Indication: Treatment of infections caused by anaerobic bacteria, including skin and soft tissue infections, and certain bone infections. Mechanism of Action: Inhibits bacterial protein synthesis by binding to the 50S ribosomal subunit. Side Effects: Diarrhea, nausea, potential for Clostridium difficile-associated colitis, and skin rashes.

Question 44

Vancomycin

Answer 44

Drug Class: Glycopeptide antibiotic Indication: Used to treat serious infections caused by Gram-positive bacteria, including methicillin-resistant Staphylococcus aureus (MRSA). Mechanism of Action: Inhibits bacterial cell wall synthesis by binding to the D-alanyl-D-alanine portion of peptidoglycan precursors. Side Effects: Red man syndrome (flushing, hypotension), nephrotoxicity, ototoxicity, and phlebitis.

Question 45

Teicoplanin

Answer 45

Drug Class: Glycopeptide antibiotic Indication: Similar to vancomycin, used for severe Gram-positive bacterial infections, including MRSA. Mechanism of Action: nhibits bacterial cell wall synthesis by binding to D-alanyl-D-alanine residues on the peptidoglycan precursor, preventing its polymerisation and preventing cell wall formation Side Effects: Rash, fever, phlebitis, nephrotoxicity (rare), and ototoxicity (rare).

Question 46

Isoniazid

Answer 46

Drug Class: Antitubercular agent Indication: Primary treatment for active tuberculosis (TB) and prophylaxis for TB exposure. Mechanism of Action: Inhibits the synthesis of mycolic acids, which are essential components of the bacterial cell wall of Mycobacterium tuberculosis. Side Effects: Hepatotoxicity, rash, and elevation in liver enzymes. loss of appetite. nausea or vomiting. numbness, tingling, burning, or pain in hands and feet. unusual tiredness or weakness.

Question 47

Rifamipicin

Answer 47

Drug Class: Rifamycin antibiotic Indication: Primarily used for the treatment of tuberculosis and other mycobacterial infections, as well as for prophylaxis in cases of meningococcal exposure. Mechanism of Action: Inhibits bacterial RNA polymerase, preventing transcription and bacterial RNA synthesis. Side Effects: Hepatotoxicity, orange-red discoloration of bodily fluids (urine, tears, sweat), and potential drug interactions due to liver enzyme induction.