[05.45a] Antimicrobials for Respiratory Infections (Part 1) V2.pdf

More than 90%

What is the proportion of initial infections that leads to containment of M. tuberculosis?

Reactivation

What may occur in less than 10% of those who initially contained the M. tuberculosis disease?

Microbiologic factors

What category of factors addresses the fundamental question, "What am I treating?"

Host-related or patient-related factors

What category of factors addresses the fundamental question, "Who am I treating?"

Drug-related factors

What category of factors addresses the fundamental question, "Which antimicrobial (or antibiotic combination) is most appropriate?"

Dosing regimen

What category of factors addresses the fundamental question, "How do I administer the proper antimicrobials?"

Site of infection

What factor in choosing antimicrobials addresses whether the antibiotic can reach the target area?

Bacterial load, virulence, regrowth pattern, and susceptibility of the pathogen

Name a pathogen-related factor to consider in antimicrobial choice.

Pus, Devitalized tissue, Foreign body

Name two local factors that can impair antibiotic penetration.

Glucose-6-phosphate dehydrogenase (G6PD)

What genetic factor is mentioned that can affect antibiotic metabolism?

Gray baby syndrome, hepatotoxic, nephrotoxic, ototoxicity

Name two infamous toxicities related to drug adverse effects.

Provide Broad-Spectrum In Therapy Of Critically Ill Patients

Name one rationale for antibiotic combination therapy related to critical illness.

Prevent/Delay Emergence Of Resistance

Name a rationale for combination therapy particularly important in mycobacteria infections.

Decrease Dose-Related Toxicity

What rationale for combination therapy is achieved by lowering individual drug dosages, such as with Flucytosine + amphotericin B?

Obtain Synergism

What rationale is achieved when Penicillin + aminoglycosides are used for enterococcal endocarditis?

M. tuberculosis, M. leprae, and P. aeruginosa

Infections caused by which three microbes often require combination therapy to prevent resistance emergence?

Toxicity reactions

What type of general adverse reaction to antibiotics is dose-related?

Idiosyncratic reaction

What type of general adverse reaction to antibiotics is not dose-related and may be genetic?

Alteration of normal microflora / superinfections

What are examples of biologic and metabolic reactions caused by antimicrobials?

Formulate a clinical diagnosis of microbial infection

What is the first step in appropriate antimicrobial therapy?

Obtain appropriate specimen for lab exam

What is the second step in appropriate antimicrobial therapy, following clinical diagnosis?

Microbiological diagnosis is a must (via ordering culture and sensitivity)

What must be done if empiric drugs are no longer working?

Mucolytics and expectorants, antipyretics, oxygen, intubation

Name two examples of adjunctive and non-pharmacologic therapy for respiratory infections.

Wrong choice of drug

Name one drug factor causing failure in antimicrobial therapy.

Poor host defense

Name one host factor causing failure in antimicrobial therapy.

Drug resistance

Name one microbial factor causing failure in antimicrobial therapy.

Use in untreatable (viral) infection

What is a common misuse of antimicrobials that usually only prevents complications (e.g., superimposed bacterial infection)?

Complete reliance on chemotherapy (omission of surgical drainage and non-pharmacological therapy)

What misuse of antimicrobials is exemplified by treating an abscess only with antibiotics?

Antibiotic alone will not reach the bacteria inside an abscess

Why is surgical drainage often necessary for an abscess alongside antibiotic therapy?

Lack of appropriate bacteriologic information when indicated

What should be requested if multiple drugs have already been given without success?

Over-the-counter sale of antibiotics

What factor contributing to misuse involves retail accessibility?

Recycling antibiotic prescription or self-medication

What misuse occurs when patients use previously prescribed antibiotics for similar symptoms without consulting a physician?

Use of antimicrobials as growth promoters in farm animals

What misuse occurs outside of human health, such as giving antibiotics to roosters for cockfights?

Pressure from patients/parents

What social factor in the Philippines leads to the inappropriate expectation of receiving medication?

Emergence of drug-resistant organisms

What unwanted consequence of misuse leads to using next-line antimicrobials?

Staphylococcus aureus

Which gram-positive bacteria causes pneumonia, abscess, endocarditis, gastroenteritis, skin infections, and Toxic Shock Syndrome (TSS)?

Penicillinase-resistant Antibiotics, Vancomycin, Linezolid

Name two drugs used to treat S. aureus infections.

Streptococcus pneumoniae

Which gram-positive bacteria causes pneumonia, Otitis Media, Sinusitis, and Meningitis?

Penicillins, 3rd Gen. Cephalosporins

Name two drugs used to treat S. pneumoniae infections.

Streptococcus pyogenes (GAS)

What is the species name for Group A Streptococcus?

Penicillins

What is the drug group of choice for S. pyogenes?

Partial hemolysis, Optochin sensitive, Encapsulated

Name two characteristics of S. pneumoniae.

Clindamycin, Vancomycin, Linezolid

Name two drugs commonly used to cover MRSA.

Cell wall synthesis

What is the target of Penicillins, Cephalosporins, and Carbapenems?

DNA gyrase

What is the target of Ciprofloxacin and Novobiocin?

RNA elongation

What is the target of Actinomycin?

DNA-directed RNA polymerase

What is the target of Rifampin?

30S inhibitors

Tetracyclines, Streptomycin, and Amikacin target which ribosomal subunit?

50S inhibitors

Erythromycin (macrolides), Chloramphenicol, and Clindamycin target which ribosomal subunit?

Trimethoprim, Sulfonamides

What two drugs target folic acid metabolism?

Polymyxins, Daptomycin

What two drugs target cytoplasmic membrane structure?

Decrease Peptidoglycan Synthesis

What specific action do Vancomycin, Teicoplanin, and Fosfomycin perform?

Pen G, Pen V

Name the two Natural Penicillins.

Oxacillin, Nafcillin, Dicloxacillin

Name two Antistaph Penicillins.

Amoxicillin, Ampicillin

Name the two Amino-penicillins.

Piperacillin, Ticarcillin, Carbenicillin

Name two Anti-pseudomonal penicillins.

β-lactamase inhibitors

What drug class is used in combination with aminopenicillins and antipseudomonal penicillins?

Cefazolin, Cephalexin

Name two 1st Generation Cephalosporins.

Cefaclor, Cefuroxime

Name two 2nd Generation Cephalosporins.

Cefepime, Cefpirome

Name the two 4th Generation Cephalosporins.

Ceftobiprole, Ceftaroline

Name the two 5th Generation Cephalosporins.

2nd and 3rd gen

Which generation cephalosporins are commonly used for respiratory infections?

4th and 5th gen

Which generation cephalosporins are used for more severe respiratory infections?

Doripenem, Imipenem, Meropenem, Ertapenem

Name the four Carbapenems (DIME mnemonic).

Ertapenem

Which Carbapenem does not cover Pseudomonas?

Aztreonam

What is the Monobactam listed?

Streptococcus pneumoniae

What is the most common Gram (+) bacterial cause of respiratory infections?

Moraxella catarrhalis and H. influenzae

What are the two most common Gram (-) bacterial causes of respiratory infections?

E. coli, Klebsiella, Enterobacter

Name three Gram-negative bacilli that are fast lactose fermenters.

Pseudomonas

Which Gram-negative bacteria is oxidase-positive and non-lactose fermenting?

Aspiration pneumonia

In what specific type of pneumonia might E. coli, Klebsiella, and Enterobacter be particularly relevant?

E. coli

Which Gram-negative bacteria causes Diarrhea, Sepsis, Cystitis, Pyelonephritis, and Pneumonia?

Third generation cephalosporins

What drug class treats K. pneumoniae for Pneumonia, UTI, and Sepsis?

Cefotaxime

What drug treats Serratia for UTI, wound infections, pneumonia, and septicemia?

P. aeruginosa

Which Gram-negative bacteria causes Burn infections, Otitis externa, Meningitis, and Pneumonia?

Ceftriaxone, Rifampin

Name two drugs used to treat H. influenzae.

L. pneumophila

Which bacteria causes Legionnaire disease (atypical pneumonia)?

Erythromycin

What is the drug of choice for Legionnaire disease caused by L. pneumophila?

B. pertussis

Which bacteria causes Whooping cough?

Chlamydia

Which bacteria causes atypical pneumonia, treated with Doxycycline and Ceftriaxone?

M. pneumoniae

Which bacteria causes Walking pneumonia?

Macrolides

What drug class is often used for respiratory tract infections and includes Erythromycin, Azithromycin, and Clarithromycin?

Clindamycin

Which Lincosamide is used for anaerobes?

Linezolid

Which Oxazolidinone targets the 23s rRNA component of the 50s subunit and is used for MRSA?

Doxycycline and Tetracycline

Name two Tetracyclines commonly used for respiratory tract infections (RTIs).

Aminoglycosides

What 30S inhibitor class includes Streptomycin, Gentamicin, and Amikacin?

Nucleic Acid Synthesis

What target mechanism includes Fluoroquinolones and Folic acid metabolism inhibitors?

Sulfamethoxazole (SMX)

Which Folic acid pathway inhibitor converts PABA to DHF?

Trimethoprim (TMP)

Which Folic acid pathway inhibitor converts DHF to THF?

DNA Gyrase

What enzyme do Fluoroquinolones inhibit?

Levofloxacin and Moxifloxacin

Which two FQs are also known as respiratory quinolones?

Rifampicin

Which antibiotic inhibits mRNA synthesis (DNA-directed RNA polymerase)?

Very Finely PPRoficient At Murder

What mnemonic helps recall bactericidal drugs?

Oxazolidinones, Erythromycin, Clindamycin, Sulfamethoxazole, Trimethoprim, Tetracycline, Chloramphenicol

Name three bacteriostatic drugs (ECSTaTiC mnemonic).

Penicillins (PCNs), Cephalosporins, Carbapenems, Polymyxin, Linezolid

Name three antimicrobials associated with neurotoxicity.

Linezolid

Which neurotoxic drug can cause serotonin syndrome and peripheral neuropathy?

PCNs, Cephalosporins, TMP-SMX, Chloramphenicol, Linezolid

Name three antimicrobials associated with pancytopenia.

Polymyxins, Nitrofurantoin

Name two antimicrobials associated with respiratory failure.

Pulmonary fibrosis

What specific respiratory failure concern is caused by Nitrofurantoin?

Aminoglycosides, Vancomycin

Name two antimicrobials associated with ototoxicity.