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Antibiotics Revision > Micro and Antibiotic man > Flashcards

Micro and Antibiotic man Flashcards

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1
Q

what are gram -ve coliforms sensitive to

A

gentamicin and aztreonam

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2
Q

what is 47% of e. coli resistent to

A

amoxicillin

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3
Q

what covers 65% of e coli

A

co-trimoxazole

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4
Q

what are ESBL resistant to

A

most penicillins- co- amoxiclav, piperacillin/tazobactam and aztreonam

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5
Q

what covers ESBLs

A

temocillin, pivmecillinam

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6
Q

would you give metronidazole with pip-tazobactam/ co-amoxiclav

A

no as they both have anaerobic cover

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7
Q

do temocillin and ertapenem cover pseudomonas

A

no

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8
Q

do temocillin and aztreonam have aerobic or gram +ve cover

A

no have neither

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9
Q

what aee CPEs resistant to

A

pencillins, cephalosporins, pip-tazobactam, aztreonam, temocillin, carbapenems & often
other classes of antibiotics – gentamicin, ciprofloxacin, co-trimoxazole

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10
Q

what are anaerobes sesnitive to

A

metronidazole

also- co-amoxiclav, clindamycin, pip-tazobactam and meropenem

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11
Q

gram +ves like staph aureus (MSSA, MRSA), streps and enterococci are sensitive to what when there is a penicillin allergy

A

vancomycin (except VREs)

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12
Q

what is MRSA resistant to

A

all beta lactams (penicillins, flucloxacillin, piptazobactam, cephalosporins, meropenam)

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13
Q

what is VRE resistant to

A

vancomycin and meropenam

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14
Q

what are beta haemolytic streps (groups A, C and G) sensitive to

A

penicillin and flucloxacillin

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15
Q

what causes meningitis

A

pneumococcus, meningococcus

if >/= to 60 y/o then listeria

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16
Q

what causes encephalitis

A

herpes simplex

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17
Q

what are pneumococci and meningococci sensitive to

A

penicillin

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18
Q

what are the indications for IV anitbiotics

A

Specif ic inf ections e.g. endocarditis, septic arthritis, abscess, meningitis, osteomy elitis
• 2 or more criteria as abov e out with range (temperature, respiratory rate, pulse, WCC)
• Febrile with neutropenia or immunosuppression
• Oral route compromised
• Post surgery – unable to tolerate 1 litre of oral f luids
• No oral f ormulation av ailable

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19
Q

what must you consider in clarithromycin

A

interactions (e.g. with statins)

risk of OT interval prolongation

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20
Q

what should you do if IV therapy is still indicated after 72 hrs of gentamicin (or 24hrs with poor renal function)

A
  1. CHECK MICROBIOLOGY RESULTS & SENSITIVITIES
  2. CONSIDER SWITCH TO AZTREONAM
  3. IF REQUIRED ASK ID OR MICRO FOR ADVICE
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21
Q

when should aztreonam be used

A

only for certain patients as alternative to gentamicin

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22
Q

Tx for meningitis

A

ceftriaxone IV + dexamethasone IV

aciclovir IV if encephalitis suspected
add amoxicillin IV if >/= 60 / immunocompromised (to cover listeria)

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23
Q

what is herpes simplex sensitive to

A

IV aciclovir

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24
Q

what causes epiglotitis

A

H. influenzae, streptococci

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25
what are all beta haemolytic strep (groups A, B, C and G) sensitive to
penicillin
26
what causes tonsilitis
group A strep
27
what causes sinusitis
pneumococcus
28
what cause AOM
pneumococcus, H. influenzae
29
what is the Tx for epiglottitis/ supraglottitis
ceftriaxone IV
30
what is h influenza sensitive to
amoxillin, doxycycline,
31
what are pneumococci and meningococci sensitive to
penicillin but amoxicillin better oral absorption
32
what causes mild/ mod CAP
pneumococcus (strep pneumonae), H influenzae
33
what causes mild/mod CAP
pneumococcus (strep pneumonae), H influenzae coliforms and atypicals: legionella, mycoplasma, chlamydia pneumoniae, coxiella S. aureus post influenza (PVL producing forms V severe in children/ YA)
34
what causes an acute exacerbation of COPD
pneumococcus, H. influenzae
35
Tx for mild/mod CAP
amoxicillin IV/PO (5 days) | if penicillin allergic doxycycline PO or clarithromycin IV
36
Tx for severe CAP
co-amoxiclav IV + doxycyline PO if penicillin allergic IV levofloxacin if ICU/HDU/NBM then Co-amoxiclav IV + clarithromycin IV step down to doxycycline for all (total 7 days)
37
what is H influenza sensitive to
amoxicillin | doxycycline
38
why do you give co-amoxiclav in severe CAP
as covers both H influenae and coliforms
39
why do you give doxycycline in severe CAP
atypical cover | pneumococci sensitive to it
40
what does levofloxacin cover in CAP
legionella | aslo covers MSSA, h infleunzae, pneumococci and coliforms
41
what has better atypical cover in severe CAP: clarithromycin or doxycyline
doxycycline | clarithromycin used in penicillin allergies
42
what causes HAP
pneumococcus, H influenzae and coliforms | legionella
43
what tests should you do in pneumonia
if mild/ mod can rely on clinical picture bood cultures, clotted blood for atyptical bacteria, throat swab in viral transport medium, sputum for bacterial culture, BAL or tracheal aspirates as indicated clinically (suitable for PCR for Legionella and PCR for PCP if induced sputum cannot be done), urine (white topped sterile universal) for Legionella antigen serogroup 1
44
Tx for non severe hospital acquired pneumonia
PO amoxicillin (doxycyline if penicillin allergic) (5 days)
45
Tx for severe HAP
IV amoxicillin + gentamicin (if penicillin allergic IV co trimoxazole + gentamicin) step down PO co-trimoxazole (total 7 days)
46
Tx for non severe aspiration pneumonia
PO amoxicillin + metronidazole (if penicillin allergic PO doxycyline and metronidazole) (total 5 days)
47
Tx for severe aspiration pneumonia
IV amox + met + gent (if penicillin allergic replace amox with PO doxycycline or IV clarithromycin) step down PO amoxicillin + metronidazole (allergic replace amox with doxycycline) total 7 days
48
Tx for exacerbation of COPD
only antibiotics in increased sputum purulence/ consolidation on CXR/ signs of pneumonia 1st line amoxicillin 2nd line doxycycline 5 days
49
Tx for acute cough/ acute bronchitis
only in frail elderly 1st line amoxicillin 2nd line doxycycline 5 days
50
what causes acute native valve endocarditis
s aureus
51
what should you do in acute native valve endocarditis
2 sets of blood cultures and start antibiotics within the hour
52
what causes native valve subacute endocarditis
viridans strep, enterococci
53
what should you do in native valve subacute endocarditis
take 3 sets of blood cultures | 6 hours apart if patient stable
54
what causes prosthetic valve endocarditis
MRSA, coagulase negative strep
55
Tx for native valve indolent (subacute) endocarditis
IV amoxicillin + gentamicin
56
Tx for native valve severe sepsis (acute)
IV flucloxacillin
57
Tx for prosthetic valve/ suspected MRSA endocarditis
IV vancomycin + IV gentamicin (can add rifampicin)
58
how you you need to give antibiotics to treat endocarditis
high doses, prolonged duration (4-6 weeks), bacteriocidal, IV, to eliminate bacteraemia, penetrate vegetations and reduce septic emboli risk
59
where should you take samples from CVC related infection
blood cultures from peripheral and line site, swab exit site
60
what causes peritonitis/ biliary tract sepsis/ intraabdominal infections
polymicrobial coliforms, anaerobes and eneterococci
61
tx for peritonitis/ biliary tract/ intra-abdominal infections
IV am + met + gent step down PO co-trimoxazole + met (if penicillin allergic IV vanc + met + gent- step down PO co-tri + met) (total days)
62
Tx for non severe C diff
metronidazole PO 10 days
63
Tx for severe C diff
vancomycin PO/NG 10 days
64
what defines recurrent c diff
positive CDI in previous 8 weeks
65
Tx for acute gastroenteritis
none
66
Tx for acute pancreatitis
none
67
what causes spontaneous bacterial peritonitis
coliforms +/- anaerobes, sometimes strep pneumoniae
68
what should you do for an intra abdominal infection
send blood cultures, pus/ other intra abdominal samples
69
who gets HUS
people with ecoli 0157 infection aged <5 or >65 most develop 6-8 days post onset of symptoms more common in those with bloody diarrhoea/ who are unwell
70
why do you not give antibiotics for e coli 0157
might precipitate HUS
71
what should you do in e coli 0157
notify public heath faeces fro culture heamotolofy: FBC, film for HUS/ confimed 0157 biochem: U&E, LDH, CRP
72
what are coliforms sensitive to
getamicin and aztreonam
73
Tx for a mild proven spontaneous bacterial peritonitis
co-trimoxazole PO (5-7 days)
74
Tx for a severe proven spontaneous bacterial peritonitis
piperacillin/tazobactam IV | step down PO co-trimoxazole (5-7 days)
75
cause of female uncomplicated lower UTI
coliforms, enterococci
76
what causes a male UTI
coliforms, enterococci
77
what causes (complicated UTI) pyelonephritis, urosepsis
coliforms, pseudomonas aeruginosa, enterococci
78
what should you do for UTIs
blood cultures and urine cultures if complicated or male females no culture unless recurrent do not send catheter urine samples unless you thin this is a source of infection and they have signs of infection
79
Tx for catheterised UTI
do not treat unless signs/ symptoms of infection same as complicated UTI IV amox + gent (if penicillin allergic IV com-trimoxazole + gent) strep down PO co-trimoxazole (total 7 days)
80
Tx for UTI in older patients
do not treat unless signs/ symptoms of infection | treat same as male/female Tx
81
Tx for complicated UTI/pyelonephritis/ urosepsis
IV amox + gent (if penicillin allergic IV com-trimoxazole + gent) strep down PO co-trimoxazole (total 7 days)
82
Tx for uncomplicated female lower UTI
nitroflurantoin or trimethoprim (3 days)
83
Tx for uncatheterised male lower UTI
nitroflurantoin or trimethoprim (7 days)
84
when is nitrofurantion not excreted in the urine
in renal impairment (also has no kidney penetration so only ever used for uncomplicated lower UTIs in females and uncatheterised males)
85
cause of cellulitis
s aureus, group A strep and other beta haemolytic strep
86
Tx for cellulitis
flucloxacillin (in penicillin allergic doxycycline PO) total 7 days
87
cause of diabetic foot acute
staph aureus
88
cause of diabetic foot on acute on chronic polymicrobial
s aureus, coliforms and anaerobes
89
Tx for mild diabetic foot infection
flucloxacillin or doxycycline 7 days
90
Tx for moderate diabetic foot infection
flucloxacillin + metronidazole or doxycycline + met 7 days
91
what should you do in skin or soft tissue infection
if severe/ systemic take blood cultures swab wounds- these will not be able to distinguish infection for colonisation previous antibiotics will select out coliforms and pseudomonas
92
does flucloxacillin cover beta haemolytic strep
yes
93
does co-trimoxazole cover MRSA
yes
94
Tx for open fracture prophylaxis
IV co-amoxiclav (or IC co-trimoxazole) + metronidazole | start within 3 hours for max 72 hours
95
Tx for acute septic arthritis/ osteomyelitis
IV flucloxacillin
96
Tx for severe systemic infection source unkown
Iv amox met and gent (if PWID add IV flucloxacillin for s aureus) if penicillin allergy Iv vanc + met + gent
97
cause of septic arthritis/ osteomyelitis
s aureus
98
what should you do in septic arthritis/ osteomyelitis
blood cultures before antibiotics, joint aspirates/ washouts and bone samples consider distant focci of infection
99
how do you need to give antibiotics in septic arthritis/ ostepmyelitis
high doses IV, prolonged duration (4-6 weeks), bactericidal to penetrate joint and tissue, elimante bacteraemia and reduce septic emboli risk

Antibiotics Revision (2 decks)

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