Infectious Diseases (Antibiotics)

Question 1

What is the most accurate diagnostic test for infectious diseases?

Answer 1

Culture

Question 2

What bacteria are covered by amoxicillin?

Answer 2

HELPS: H. Influenzae, E. Coli, Listeria, Proteus, and Salmonella

Question 3

For which illnesses are penicillins the “best initial therapy”

Answer 3

Otitis media
Dental infection and endocarditis prophylaxis
Lyme disease limited to rash, joint, or CNVII involvement
UTI in pregnant women
Listeria Monocytogenes
Enterococcal infections

Question 4

What are the penicillinase-resistant penicillins

Answer 4

Oxacillin
Cloxacillin
Dicloxacillin
Nafcillin

Question 5

What are the penicillinase-resistant penicillins used to treat?

Answer 5

Skin infections (cellulitis, impetigo, erysipelas)
Endocarditis, meningitis, and staphylococcal bacteremia
Osteomyelitis and septic arthritis when organism is sensitive

Question 6

Which penicillins cover gram negative bacilli?

Answer 6

Piperacillin, ticarcillin, azlocillin, mezlocillin

Question 7

Piperacillin, ticarcillin, azlocillin, mezlocillin are the best initial therapies for…

Answer 7

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

Question 8

The only cephalosporin that will cover MRSA is…

Answer 8

Ceftaroline

Question 9

______, ______, and ______ are resistant to all forms of cephalosporins

Answer 9

Listeria, MRSA, Enterococcus

Question 10

What are the first generation cephalosporins?

Answer 10

Cefazolin, Cephalexin, Cephadrine, Cefadroxyl

Question 11

What are first generation cephalosporins used to treat?

Answer 11

Staphylococci (methicillin sensitive)
Streptococci (except enterococcus)
E. Coli (but not Pseudomonas)
Osteomyelitis, septic arthritis, endocarditis, cellulitis

Question 12

What are the second generation cephalosporins?

Answer 12

Cefotetan, Cefoxitin, Cefaclor, Cefprozil, Cefuroxime, Loracarbef

Question 13

Second generation cephalosporins cover all the same organisms as 1st generation cephalosporins and add coverage for…

Answer 13

anaerobes and more gram-negative bacilli

Question 14

Which are the only cephalosporins that cover anaerobes?

Answer 14

Cefoxitin and Cefotetan

Question 15

What is the best initial therapy for pelvic inflammatory disease when combined with doxycycline?

Answer 15

Cefoxitin or Cefotetan

Question 16

What are the risks of Cefotetan and Cefoxitin?

Answer 16

Increase risk of bleeding (deplete prothrombin) and give a disulfiram like reaction with alcohol

Question 17

What are the third generation cephalosporins?

Answer 17

Ceftriaxone, Cefotaxime, Ceftazidime

Question 18

Ceftriaxone is first line for…

Answer 18

Pneumococcus, Meningitis, CAP (in combination with macrolides), Gonorrhea, Lyme disease involving brain or heart

Question 19

Why should you avoid ceftriaxone in neonates? What should you use instead?

Answer 19

Because of impaired biliary metabolism; Cefotaxime

Question 20

Which third generation cephalosporin has pseudomonal coverage?

Answer 20

Ceftazidime

Question 21

What is the fourth gen cephalosporin? What is its advantage over the 3rd generation?

Answer 21

Cefepime; has better staphylococcal coverage compared with the 3rd gen cephalosporins

Question 22

What is the 5th gen cephalosporin? What does it treat?

Answer 22

Ceftaroline; Treats gram-negative bacilli and MRSA

Question 23

What are the Carbapenems? What are they used to treat?

Answer 23

Imipenem, Meropenem, Ertapenem, Doripenem; Used to treat neutropenia and fever

Question 24

What is the only monobactam drug?

Answer 24

Aztreonam

Question 25

Aztreonam is exclusively for...

Answer 25

Gram-negative bacilli (including pseudomonas)

Question 26

What is the best therapy for community acquired pneumonia (CAP)?

Answer 26

Fluoroquinolones

Question 27

What fluoroquinolone is used for cystitis and pyelonephritis?

Answer 27

Ciprofloxacin

Question 28

What is covered by fluorquinolones?

Answer 28

Gram negative bacilli including most psuedomonads

Question 29

Which Fluoroquinolone is the only one that can be used as a single agent for diverticulitis

Answer 29

Moxifloxacin (all others require metronidazole)

Question 30

Risks of quinolones?

Answer 30

Bone growth abnormalities in children and pregnant women | Tendonitis and achilles tendon rupture

Question 31

What are the aminoglycosides?

Answer 31

Gentamicin, Tobramicin, Amikacin

Question 32

What do aminoglycosides cover?

Answer 32

Gram negative bacilli

Question 33

Why do aminoglycosides have NO EFFECT against anaerobes?

Answer 33

They need oxygen to work

Question 34

Aminoglycosides have what types of toxicity?

Answer 34

Nephrotoxicity and ototoxicity

Question 35

What can Doxycycline be used to treat?

Answer 35

Chlamydia Lyme disease (limited to rash, joint of CNVII palsy) Rickettsia MRSA of skin and soft tissue Primary and secondary syphilis (if allergic to penicillin) Borrelia, Ehrlichia, and Mycoplasma

Question 36

What are the adverse effects of doxycycline?

Answer 36

Tooth discoloration, Fanconi syndrome (type II RTA proximal), Photosensitivity, Esophagitis/ulcer

Question 37

What is TMP/SMX used to treat?

Answer 37

Cystitis Pneumocystitis pneumonia (tx and prophylaxis) MRSA of skin and soft tissue (cellulitis)

Question 38

What are some adverse effects of TMP/SMX?

Answer 38

Rash, Hemolysis with G6PD deficiency, bone marrow suppression (folate antagonist)

Question 39

What are the beta lactam/beta lactamase combinations?

Answer 39

Amoxicillin/Clavulanate Ticarcillin/Clavulanate Ampicillin/Sulbactam Piperacillin/Tazobactam

Question 40

Beta lactam/beta lactamase combinations are the first choice for...

Answer 40

Mouth and GI abscess

Question 41

Gram positive cocci (Staph and Strep) are best treated with...(4)

Answer 41

Penicillins: Oxacillin, Cloxacillin, Dicloxacillin, Nafcillin 1st Gen Cephalosporins Fluorquinolones Macrolides (3rd line agents)

Question 42

MRSA is best treated with... (6)

Answer 42

``` Vancomycin Linezolid Daptomycin Tigecycline Ceftaroline Telvancin ```

Question 43

All the beta lactam/beta lactamase combinations cover _____ with equal efficacy to metronidazole

Answer 43

Anaerobes

Question 44

How are anaerobes treated when... Above the diaphragm (oral): Abdominal/GI:

Answer 44

Above the diaphragm (oral): Penicillin; Clindamycin | Abdominal/GI: Metronidazole or beta lactam/beta lactamase combination

Question 45

What are the gram negative bacilli?

Answer 45

E. Coli, Klebsiella, Proteus, Pseudomonas, Enterobacter, Citrobacter

Question 46

Which antibiotics cover gram negative bacilli? (6)

Answer 46

``` Quinolones Aminoglycosides Carbapenems Piperacillin, ticarcillin Aztreonam Cephalosporins ```

Question 47

What is the one indication for Nitrofurantoin?

Answer 47

Cystitis