How are ESBL producing MDRO's treated? ESBL = Extended spectrum beta-lactamase producing organisms MDRO's = Multi drug resistant organisms

Carbapenems An ESBL resistant to Carbapenem is treated with: - Ceftolozane/Tazobactam - Ceftazidime/Avibactam - Polymyxin

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What are the risks of using medications for a resistant organism on a sensitive organism?

High treatment failure rate.

Particularly with vancomycin use for sensitive staphylococci in the blood.

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First agents in sensitive Staphylococcal isolates

IV: Oxacillin, Nafcillin, Cefazolin (1st gen.)

Oral: Dicloxacillin, Cephalexin, Cefadroxil (1st gen.)

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Additional agents in sensitive Staphylococcal isolates

IV: any cephalosporin, any carbapenem, beta-lactam/beta lactamasae combinations

Oral: Amoxicillin/Clavulanate, any oral cephalosporin

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MRSA Drugs

Dalbavancin
Oritavancin
Telavancin
Tedizolid
Linezolid
Vancomycin
Daptomycin

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First agents in resistant Staphylococcal isolates

IV: Vancomycin, Linezolid, Daptomycin, Ceftaroline, Oritavancin, Telavancin, Dalbavancin

Oral: Linezolid, TMP/SMX, Doxycycline

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Additional agents in resistant Staphylococcal isolates

IV: Oritavancin, Dalbavancin, Telavancin

Oral: Tedizolid

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What is the best empiric therapy for gram positive cocci growing from blood cultures?

Vancomycin (to cover resistance until sensitivity testing results are available)

If intolerant or allergic to Vancomycin, use Linezolid, Daptomycin or Ceftaroline.

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Adverse effects of MRSA drugs

Linezolid, Daptomycin, Tigecycline

Linezolid - Thrombocytopenia, interaction with MAO inhibitors
Daptomycin - CPK elevation; not effective in the lung
Tigecycline - Not used for MRSA in the blood

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Treatment for minor MRSA infections of the skin

TMP/SMX
Clindamycin
Doxycycline
Linezolid

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Penicillin G, VK, Benzathine treats

Viridans group streptococci, Streptococcus pyogenes, Oral anaerobes, Syphilis, Leptospira

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Ampicillin and Amoxicillin treats

E.coli, Lyme disease, other gram negative bacilli and same organisms covered with Penicillin.

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What is the most accurate diagnostic test for infectious diseases

Culture

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Amoxicillin is the best initial therapy for …?

Otitis media
Dental infections
Endocarditis prophylaxis
Lyme disease limited to rash, joint or 7th CN involvement
UTI in pregnant woman (or nitrofurantoin)
Listeria monocytogenes
Enterococcal infections

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What are the penicillinase resistant penicillins (PRP’s)

Oxacillin
Cloxacilin
Dicloxacillin
Nafcillin

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PRP’s are used to treat:

Skin infections: Cellulitis, Impetigo, Erysipelas.

Endocarditis, meningitis and bacteria from staphylococci

Osteomyelitis and septic arthritis with proven sensitive organism.

Not active against MRSA or Enterococcus

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Piperacillin, Ticarcillin, Azlocillin, Mezlocillin cover which organisms?

Gram negative bacilli (E.coli, Proteus)

Pseudomonads

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Cephalosporins, Piperacillin, Ticarcillin, and Mezlocillin are the best initial therapy for?

Nearly always used in combination with a beta-lactamase inhibitor such as Tazobactam or Clavulanic acid

Cholecystitis and ascending cholangitis
Pyelonephritis
Bacteremia
Hospital acquired and ventilator associated pneumonia
Neutropenia and fever

If these are caused by single organisms such as streptococci or anaerobes, treat using a narrower agent

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All cephalosporins treat …?

Group A, B and C streptococci
Viridans group streptococci
E. coli
Klebsiella
Proteus mirabilis

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How are ESBL producing MDRO’s treated?

ESBL = Extended spectrum beta-lactamase producing organisms
MDRO’s = Multi drug resistant organisms

Carbapenems

An ESBL resistant to Carbapenem is treated with:

Ceftolozane/Tazobactam
Ceftazidime/Avibactam
Polymyxin

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What organisms are resistant to all forms of Cephalosporins?

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MRSA
Listeria (Tx: Amoxi)
Enterococcus (Tx: Amoxi)

Delafloxacin (fluoroquinolone) is used to treat …?

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MRSA of skin/soft tissue
Gram negative rods

Only quinolone that does not prolong QT interval

First Generation Cephalosporins (Cefazolin, Cephalexin, Cephradine, Cefadroxil) are usted to treat …?

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Staphylococci (MSSA)
Streptococci (except Enterococcus)
Gram negative bacilli like E.coli, not Pseudomonas
Osteomyelitis, septic arthritis, endocarditis, cellulitis

Second Generation Cephalosporins (Cefotetan, Cefoxitin, Cefaclor, Cefprozil, Cefuroxime, Loracarbef) can cover … ?

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Same organisms as 1st gen cephalosporins

Add coverage for anaerobes and more gram negative bacilli.

What is the best initial therapy for PID?

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Cefotetan or Cefoxitin (2nd gen.) combined with doxycycline.

Cefotetan and Cefoxitin increase the risk of bleeding and give a disulfiramlike reaction with alcohol.

Cefuroxime, Loracarbet, Cefproxil, and Cefaclor (2nd gen.) are usted to treat?

Respiratory infections: Bronchitis, Otitis media and Sinusitis.

Ceftriaxone (3rd gen.) is used to treat?

First line for pneumococcus, including partially insensitive organisms: - Meningitis - Community acquired pneumonia (combined with macrolides) - Gonorrhea - Lyme involving heart or brain

Why is Ceftriaxone (3rd gen.) avoided in neonates?

Impaired biliary metabolism

Cefotaxime (3rd gen.) is used to treat?

Spontaneous bacterial peritonitis (SBP)

Cefepime (4th gen.) is used to treat?

Neutropenia and fever Ventilator associated pneumonia *Better Staphylococcal coverage compared with 3rd gen.*

Ceftaroline (5th gen.) is used to treat?

Gram negative bacilli MRSA *NOT Pseudomonas*

Which Cephalosporin has pseudomonal coverage?

Ceftazidime (3rd gen.)

Which are the only Cephalosporins that cover anaerobes?

Cefotetan and Cefoxitin (2nd gen.) *Both deplete prothrombin and increase risk of bleeding*

Carbapenems (Imipenem, Meropenem, Ertapenem, Doripenem) cover and treat?

``` Gram negative bacilli (including Pseudomonas) Resistant Anaerobes Streptococci Staphylococci ``` Treat neutropenia and fever

How is Ertapenem different to other Carbapenems?

Does not cover Pseudomonas

What is Aztreonam used for?

Exclusively for gram negative bacilli including Pseudomonas. *NO cross reaction with penicillin*

Fluoroquinolones (Ciprofloxacin, Gemifloxacin, Levofloxacin, Moxifloxacin) can be used to treat?

- Ventilator associated pneumonia (VAP), Community acquired pneumonia (CAP), including penicillin resistant pneumococcus (except Cipro) - Gram negative bacilli including most pseudomonas - Cystitis, pyelonephritis - Diverticulitis and GI infections

Ciprofloxacin is mostly used to treat for?

Cystitis Pyelonephritis Ventilator associated pneumonia (VAP)

How are diverticulitis and GI infections treated?

Ciprofloxacin, Gemifloxacin and Levofloxacin combined with Metronidazole (to cover anaerobes) Moxifloxacin as single agent for diverticulitis

What are some side effects of Quinolones?

- Bone growth abnormalities in children and pregnant women. | - Tendonitis and Achilles tendon rupture.

Aminoglycosides (Gentamycin, Tobramycin, Amikamicin) are mostly used to treat?

Gram negative bacilli (bowel, urine, bacteremia) | Synergistic with beta lactic abx for enterococci and staphylococci

What are negative effects of Aminoglycosides?

Nephrotoxic Ototoxic No effect on anaerobes (need O2 to work)

Doxycycline treats?

Bronchitis Lyme disease limited to rash, joint, or 7th CN palsy Rickettsia MRSA of skin and soft tissue (cellulitis) Primary and secondary syphilis (allergic to penicillin) Borrelia, Ehrlichia and Mycoplasma Chlamydia

What adverse effects are associated to Doxycycline use?

Tooth discoloration (children) Fanconi syndrome (Type II RTA proximal) Photosensitivity Esophagitis/Ulcers

Trimethoprim/Sulfamethoxazole (TMP/SMX) is used to treat?

Cystitis Pneumocystis pneumonia treatment and prophylaxis MRSA of skin and soft tissue (cellulitis)

What side effects can TMP/SMX have?

Rash Hemolysis in G6PD deficiency Bone marrow suppression (folate antagonist)

Beta-lactam/Beta-Lactamase Combinations are used to treat?

Anaerobes First choice for mouth and GI abscess

How are anaerobes treated?

Oral (above diaphragm) - Penicillin (G, VK, ampicillin, amoxicillin)) - Clindamycin Abdominal/Gastrointestinal: - Metronidazole - Beta-lactam/lactamase combinations - Carbapenems Others: - Piperacillin - Cephalosporin (2nd gen.)

What infections are caused by Gram Negative Bacilli (E.coli, Klebsiella, Proteus, Pseudomonas, Enterobacter, Citrobacter)?

- Bowel (Peritonitis, Diverticulitis) - Urinary Tract (Pyelonephritis) - Liver (Cholecystitis, Cholangitis)

What agents cover Gram Negative Bacilli?

``` Quinolones Aminoglycosides Carbapenems Piperacillin, Ticarcillin Aztreonam Cephalosporin Polymyxin (last resource due to nephrotoxicity) ```

Infectious Diseases Flashcards

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