Introduction To Abx Flashcards by Alice Kra

Penicillins are used to treat which bugs? (5)

Strep pyogenes: GAS, erysipelas, glomerulonephritis, pharyngitis
Strep viridans: found in mouth, causes endocarditis
Oral anaerobes: but less efficient than Clindamycin
Syphillis
Leptospirosis: kidney and liver disease
[P.VALS]

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Ampicillin and amoxicillin both cover the same organisms than penicillin plus …

E.Coli: they can be used for UTI in pregnancy as they are safe for the foetus

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Penicillin exists in 3 forms

Penicillin G: IV
Penicillin VK: oral
Benzothine: long acting IM used for syphillis

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Which gram negative bacterias are covered by amoxicillin?

H.Influenza
E.coli
Listeria
Proteus
Salmonella
[HELPS]

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Amoxicillin is the best initial tx for (6)

Otitis media
Dental infection, endocarditis prophylaxis
Lyme limited to 7th CN, rash, joint
UTI in pregnancy
Listeria
Enterococci

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Oxacillin, cloxacillin, nafcillin, dicloxacillin can be used for tx of

Skin infections: cellulitis (bc it is staph)
Endocarditis, meningitis and bacteremia from staph
Osteo and septic arthritis when proven sensitive
NOT against MRSA or enterococcus

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Piperacillin and Ticacillin cover which organisms?

Gram neg bacilli (E.coli and proteus)
Enterobacteriae
Pseudomonas

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Piperacillin and Ticacillin are the best therapy for (6)

Cholecystitis
Ascending cholangitis
Pyelonephritis
Bacteremia
Hospital acquired or ventilator assoc. pneumo
Neutropenia (absolute neutrophil count

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Piperacillin, ticacillin, azlocillin, mezlocillin are generally combined with?

A beta-lactamase inhibitor such as taxobactam or clavulonic acid

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Taxobactam and clavulonic acid add …. coverage to piperacillin and ticacillin

Staph

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Cross reaction between penicillin and cephalosporins is

3-5%

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Can you use cephalosporin in a penicillin allergic patient?

If pt only has a rash: yes

If anaphylaxis: no beta lactams

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Which organisms are covered by any class of cephalosporins?

Group A, B and C strep
Strep viridans
E.coli
Klebsiella
Proteus

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Which organisms are resistant to all forms of cephalosporins? (3)

Listeria
MRSA
Enterococcus

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Name 4 first generation cephalosporins

Cefazolin, cephalexin, cephradrine, cefadroxyl

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First generation cephalosporins are used to treat

Staph (methicillin sensitive)
Strep (but not enterococcus)
Some gram neg like E.coli but not pseudomonas
Osteomyelitis, septic arthritis, endocarditis, cellulitis

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Name 6 second generation cephalosporins

Cefotetan, cefoxitin, cefaclor, cefprozil, cefuroxime, loracarbef

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Second generation cephalosporins cover

Cover the same organisms than first generation (staph and strep if methicillin sensitive) but a little more anaerobes (specially cefotetan and cefoxitin) and gram neg bacilli

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Cefotetan and cefoxitin (2nd generation cephalosporins) are the best initial therapy for …. But increase risk of … and …

PID combined with doxy

Bleedind and disulfiram like reaction with alcohol

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Cefotetan and cefoxitin should not be taken with… ; why?

Alcohol

Disulfiram like reaction

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Cefuroxime, loracarbef, cefprozil, cefaclor (2nd gen cephalosporins) are used for which conditions?

Respiratory infections (NOT PNEUMO)
bronchitis, otitis media, sinusitis

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Name three third generations cephalosporins

Ceftriaxone, cefotaxime, ceftazidime

Ceftriaxone (3rd generation ceph)is first line tx for (5)

Pneumococcus, including partially insensitive organisms: meningitis, CAP (combine with macrolide), gonorrhea, lyme involving heart or brain

In whom ceftriaxone should be avoided?

Neonates, anaphylaxis to penicillin

Cefotaxime (3rd generation ceph) is better than ceftriaxone in which population? In which disease? Has better ... Coverage

Impaired hepatic metabolism (cefotaxime does not require metabolism by liver): Neonates Spontaneous bacterial peritonitis Pseudomonal

Cefepime (4th gen ceph) has better ... Coverage than third generation and is used for...

Staph | Used for : neutropenia and fever, ventilator associated pneumonia

What cephalosporin covers MRSA?

Ceftaroline

Carbapenems cover

``` Gram negative bacilli Anaerobes Staph and strep Neutropenia and fever Pseudomonas (except ertapenem) ```

Ertapenem is different than other carabapenems because

It does not cover pseudomonas

Axtreonam is used exclusively for

Gram negative bacilli, like E.coli, enterobacter, citrobacter, pseudomonas

Can you use aztreonam in a penicillin allergic patient?

Yes, there is no cross reaction

Name 4 fluoroquinolones

Ciprofloxacon Gemifloxavin Levofloxacin Moxifloxacin

Fluoroquinolones are first line treatment for...

CAP: including penicillin resistant pneumococcus (except cipro!) Gram negative bacilli including pseudomonas

Ciprofloxacin is number one drug for

Cystitis and pyelonephritis

Mocifloxacin is used for | It is the only quinolone covering

Lungs infections, diverticulitis and GI infections (no need to be combined with metronidazole) It covers anaerobes

Quinolones adverse effects

Bone growth abnormalities in children and pregnant woman (do not use them in kids and preg) Tendonitis and achilles tendon rupture

Gentamicin, tobramycin, amikacin (aminoglycosides) cover

Gram negative bacilli (bowel, urine, bacteremia): e.coli, enterobacter, citrobacter, pseudomonas, morganella, ceressia + synergistic with beta lactams for enterococci and staph

Aminoglycoside are synergistic with ... For ... And ... Infections

Beta lactams | Enterococci and staph

Aminoglycoside no not cover

Anaerobes: they need oxygen to work

Aminoglycoside side effects

Nephrotoxic : acute tubular necrosis | Ototoxic

Doxycycline is a drug of choice for

Chlamydia Lyme disease rash, joint, 7th CN palsy MRSA of the skin Rickettsia (rocky mountain spotted fever) Syphillis primary and secondary but ONLY if allergic to penicillin Borrelia (lyme), ehrlichia (also tick borne) and mycoplasma

Adverse effects of doxy

Tooth discoloration (children) Fanconi syndrome (type II RTA proximal) Photosensitivity Esophagitis (sit and drink a lot of water)

TMP/SMX is used for

Cystitis (3d if uncomplicated) Pneumocystis pneumonia tx and prophylaxis MRSA of skin and soft tissue (not heart and brain!)

TMP/SMX S.E

rash (sulfa drug) Hemolysis, specially in G6PD deficiency Bone marrow suppression (folate antagonist)

Nitrofurantoin is used for

Cystitis in pregnancy

Amoxicillin clavulonate Ticacillin/clavulonate Add what coverage?

Staph, covers only sensitive staph though

Best initial tx for sensitive staph or strep?

Oxacillin, cloxacillin, nafcillin, dicloxacillin (Ox and naf IV) 1st gen cephalo Fluoroquinolones Macrolides (axithromycin, claithro, erythro): less efficacy than ox or cephalo and erythro is more toxic

Methicillin resistant staph first line tx?

``` Vancomycin Linezolid (careful, reversible BM tox) Daptomycin (NOT for lung) Tigecycline (does not cover pseudomonas) Ceftaroline ```

S.E of linezolid?

Reversible bone marrow toxicity (platelets!)

Tx for minor MRSA infections of the skin (not for blood, brain or heart)

TMP/SMX Clindamycin Doxycycline

Tx for anaerobes infections

Oral (above diaphragm) : penicillin (G, VK, ampi, amoxi), clindamycin Under diaphragm: metronidazole (safe in pregnancy) Piperacillin, carbapenems, second gen ceph also cover anaerobes

Diseases caused and tx for gram neg bacilli (e.coli, enterobacter, pseudomonas, klebsiella, proteus, citrobacter)

Bowel (peritonitis, diverticulitis) Urinary tract (pyelonephritis) Cholecystitis or cholangitis Quinolones, aminoglycosides, carbapenems, piperacillin, tocacillin, aztreonam, cephalosporins (not pseudomonas in first gen)

Name beta lactams group of drugs (4)

Penicillins Cephalosporins Carbapenems Aztreonams