Drugs for Bacterial Infections Parts 1&2

What method is a means of identifying two broad classes of bacteria by their ability to uptake crystal violet to stain cell walls?

gram stain

antibiotics used to treat MRSA

clindamycin, bactrim, doxycycline, minocycline, linezolid, rifampin

parental antibiotics for institutional use

vancomycin, clindamycin, daptomycin, tigecycline, linezolid

first line treatment for C. diff

oral Vancomycin

treatment options for strep pneumo

penicillin G, amoxicillin, or a first or second gen cephalosporin

If a patient is allergic to to penicillin or cephalosporin, what abx can they get to tx strep pneumo?

macrolide (if infxn isnt that serious)

tx for life threatening strep pneumo

vancomycin

For a patient who has strep pneumo and is resistant to usual med options, you should use

fluoroquinolones (levo, moxifloxacin) or doxycycline

what is a common gram-negative pathogen

E. coli

tx for acute uncomplicated cystitis in females

bactrim or nitrofuratonin

tx for UTI in men, either sex with pyelonephritis, or upper UTI outpatient

fluoroquinolones (levo or cipro)

tx for UTI in men, either sex with pyelonephritis, or upper UTI inpatient

ceftriaxone or pip-tazo

what is the duration of antibiotics given for upper urinary tract infections?

5-14 days (longer courses)

which class of medication is less effective in treating gram-negative infections?

beta lactams

what meds are fairly effective against E. coli, P. mirabilis, K. pneumo?

first and second gen cephalosporins

if the organism is resistant to cephalosporin, it will likely respond to

aminoglycosides (gentamicin, tobramycin, amikacin)

bacteriocidal

Kills bacteria directly

bacteriostatic

inhibits bacterial growth

minimum inhibitory concentration (MIC)

lowest concentration of an antibiotic that stops visible growth of bacteria.

think of it as a "target concentration"

time dependent killing

bactericidal activity continues as long as plasma concentration is greater than the MIC

-It's not how high the drug level gets, but how long the drug stays above the MIC.

time dependent antibiotics

beta lactams

concentration dependent killing

the rate and extent of killing increases as the peak drug concentration increases (higher concentration = greater killing)

concentration dependent antibiotics

aminoglycosides and fluoroquinolones

concentration dependent has ______ dosing intervals and _______ doses per day

longer, fewer

cell wall synthesis inhibitors

beta lactams

vancomycin

cycloserine

DNA gyrase inhibitor

Fluoroquinolones

DNA-directed RNA polymerase inhibitor

Rifampin

Protein synthesis inhibitors (30S)

Aminoglycosides

Tetracyclines

Protein synthesis inhibitors (50S)

Chloramphenicol

Macrolides

lincosamides

folic acid metabolism inhibitors

Trimethoprim

Sulfonamides

when etiology is know, what 3 criteria of antibiotics is recommended (in terms of resistance)

most cost effective

least toxic

most narrow in spectrum

Bactericidal antibiotics that affect cell wall synthesis

penicillins and cephalosporins

which penicillin IS effective against gram negative bacteria?

ampicillin

which penicillin is more reliably absorbed when given by mouth?

penicillin V

which penicillin was created to develop and sustain high tissue levels? (will maintain therapeutic levels for up to a week)

Bicillin

natural penicillins

penicillin G and V

natural penicillins clinical uses

pneumo. PNA, strep, STDS (gonorrhea)

natural penicillins adverse reactions

rash, urticaria, mild diarrhea, nausea, vomiting, oral or vaginal candidiasis

natural penicillins interactions

oral contraceptives

what is a contraindication to taking penicillins?

a person with mono- likely to develop a rash

patient education for women taking penicillins

women taking oral contraceptives should use another form of non hormonal method of contraception

extended spectrum penicillins are also known as the

cephalosporins

as the designation increases from first to third generation, there is _________ activity against gram-negative organisms

increased

first gen cephalosporins

cefazolin (IV or IM)

cephalexin (PO)

second gen cephalosporins

cefprozil (PO)

cefuroxime (IV and IM)

cefaclor (PO)

what is the most commonly used 2nd gen cephalosporin?

cefuroxime

3rd gen cephalosporins

ceftriaxone (IM or IV)

cefixime (PO)

cefdinir (PO)

3rd gen cephalosporins are the most useful in treating

gram negative bacteria

3rd gen cephalosporins penetrates the CSF, meaning they can treat

meningitis

which 3rd gen cephalosporin covers pseudomonas?

Ceftazidime

4th gen cephalosporin

cefepime (IV or IM)

4th gen cephalosporins (cefepime) are active against

pseudomonas aeruginosa

5th gen cephalosporins

Ceftaroline (IV)

5th gen cephalosporin (ceftaroline) are active/not active against pseudomonas/MRSA?

active against MRSA

not active against pseudomonas

Cephalosporins adverse effects

nausea, mild diarrhea, mild abdominal cramping, antibiotic associated colitis

ceftriaxone adverse effect

pain at injection site

to minimize pain at the injection site with ceftriaxone, you can dilute it with

lidocaine

what 2 medications can increase nephrotoxicity if taken with cephalosporins?

aminoglycosides and loop diuretics

beta-lactamase-resistant penicillins

cloxacillin

oxacillin

piperacillin

piperacillin and tazobactam

what 2 meds are usually combined to treat sepsis?

vancomycin + pip tazo

what 2 beta-lactamase-resistant penicillins cover pseudomonas infections?

pip-tazo and ticarcillin-clavulanate

beta-lactamase-resistant penicillins adverse reactions

urticaria, rashes, pseudomembranous colitis, nausea, vomiting, diarrhea, interstitial nephritis

Which beta-lactamase resistant penicillin can cause thrombocytopenia?

pip-tazo

extended spectrum penicillins

amoxicillin

amox-clauvulanate

ampicillin

ampicillin-sulbactam

extended spectrum penicillins can pass through the outer membrane and can reach

penicillin-binding proteins (PBPs)

which extended spectrum penicillin is preferred due to its lower incidence of diarrhea?

amoxicillin

extended spectrum penicillins is/is not indicated for pseudomonal infections

is not

extended spectrum penicillins adverse reactions

nausea, vomiting, diarrhea, abd upset, pain at injection site, skin rash, vulvovaginal infection

macrolides

erythromycin, clarithromycin, azithromycin

when giving a macrolide, you should observe for signs and symptoms of

anaphylaxis

which topical medication is flammable?

clindamycin

macrolides are known for treating ________ pathogens

atypical (mycoplasm, legionella, chlamydia)

Azithromycin is used first line in the treatment of (hint: STD)

chlamydia and gonorrhea (azithro 1 gram PO once)

Azithromycin is commonly used to treat __________ due to its anti-inflammatory properties

bacterial exacerbations in COPD

Azithromycin adverse reactions

QTc prolongation, photosensitivity, GI upset

may also increase overall mortality in elderly

erythromycin is typically used before

colonoscopies

clinical uses of erythromycin/clarithromycin

Legionnaires disease

diphtheria

atypical pneumonias

endoscopy procedures

erythromycin adverse reactions

QTc prolongation, ventricular arrhythmia, hearing loss (reversible), disabling nausea, hepatitis

Lincosamides:

Clindamycin

clindamycin is known for treating

necrotizing fasciitis

clindamycin adverse reactions

GI upset, diasbling diarrhea, c. diff infection

clindamycin black box warning

C. diff