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48 Cards in this Set
- Front
- Back
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Gram positive characteristics
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purple
thick layer of peptidoglycan |
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Gram negative characteristics
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red
outer membrane of lipopolysaccharides inner membrane of peptidoglycan |
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staphylococci formation
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clusters
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streptococci formation
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pairs or chains
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Gram positive anaerobic cocci
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peptococcus
peptostreptococcus |
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gram-positive aerobic cocci and catalase + & coagulase +
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staphylococcus aureus
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gram-positive aerobic cocci and catalase + & coagulase -
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staphylococcus epidermidis
staphylococcus saprophyticus |
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gram-positive anaerobic bacilli
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lactobacillus
propionibacterium actinomyces clostridium |
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gram-positive aerobic bacilli
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corynebacterium
listeria lactobacillus gardnerella bacillus |
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gram-positve aerobic cocci and catalse - & a-hemolysis
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streptococcus pneumoniae
viridans streptococci |
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gram-positive aerobic cocci and catalase - & b-hemolysis
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streptococcus pyogenes (grp A)
streptococcus agalactiae (grp B) |
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gram-positive aerobic cocci and catalase - & non-hemolytic
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enterococcus faecium
enterococcus faecalis |
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gram-negative anaerobic bacilli
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bacteroides
prevotella fusobacterium |
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gram-negative aerobic bacilli, rapid growth on standard agar, and glucose fermenters
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vibrio
aeromonas |
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gram-negative aerobic bacilli, rapid growth on standard agar, nonfermenters
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E. coli
Klebsiella Serratia Enterobacter Citrobacter Proteus Salmonella Shigella Pseudomonas Acinetobacter Strenotrophomonas Burkholderia |
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gram-negative aerobic bacilli and fastidious organisms
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haemophilus
campylobacter helicobacter bartonella Actinobacillus Cardiobacterium Eikenella Kingella |
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Gram-negative cocci
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Neisseria
Moraxella |
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Bactericidal
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MBC/MIC ratio < 4
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Bactericidal and Time > MIC
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Penicillins
Cephalosporins Carbapenems Monobactams |
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Bactericidal and AUC/MIC
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Vancomycin
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Bactericidal and Peak: MIC
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Fluoroquinolones
Aminoglycosides Metronidazole Daptomycin |
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Bacteriostatic and AUC/MIC
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Macrolides
Tetracyclins Clindamycin Linezolid |
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Beta-lactam
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Penicillin, Cephalosporins, Carbapenems
All cause hypersensitivity rxns c some cross sensitivity among classes seizures at high doses MOA: inhibition of transpeptidases in the bacterial cell wall 2 Beta-lactams in combo generally not useful Lack activity against atypical organisms (mycoplasma, chlamydophila) All lack activity against MRSA To be -cidal against enterococci, must be combined c aminoglycosides |
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Penicillin
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very short half-lives and need to be dose multiple times/day
if hypersensitivity rxn, must avoid other penicillin. If not severe, can use cephalosporins and carbapenems Diarrhea with PO |
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Natural penicillin
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Pen G (IV), Pen V (PO)
Good for: Treponema pallidum, most strep Moderate for: S. pneumoniae, enterococci Pen G: drug of choice for syphilis |
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Antistaphylococcal penicillins
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Methicillin, Cloxacillin, dicloxacillin*, nafcillin*, oxacillin*
Good for: MSSA, strep ADR: acute interstitial nephritis, phlebitis Eliminated by liver so no need for renal dosing All these are interchangeable. If a bug is resistant to one, it's resistant to all Kill faster than vanco so switch to this when MSSA |
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Aminopenicillins
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Amoxicillin (PO)*, Ampicillin (IV)*
More water-soluble so have GNB coverage but not staph Good for: strep, enterococci Moderate for: enteric GN rods, Haemophilus Amp: drug of choice for susceptible enterococci Good for URIs (strep throat and OM) |
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Antipseudomonal Penicillins
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Piperacillin*, mezlocillin, carbenicillin, ticarcillin*
Good for: Pseudomonas aeruginosa, strep, enterococci Moderate for: enteric GN rods, Haemophilus. Not good empiric tx but useful for narrow spectrum |
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Beta-Lactam/Beata-Lactamase Inhibitor Combos
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ampicillin/sulbactam*, amoxicillin/clavulanate*, ticarcillin/clavulanate*, piperacillin/tazobactam*
Good for MSSA, strep, enterococci, many anaerobes, enteric GNRs, pseudomonas aeruginosa (only pip and tic) Moderate for: GNRs with advanced beta-lactamases Only amoxicillin/clav is PO Amp/sul: good activity against Acinetobacter baumanni Good for empiric therapy, but need to choose a narrow one later |
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Cephalosporins
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All have reduced cross-allergenicity with penicillins
None work against enterococci |
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First-generation Cephalosporin
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cefazolin* (IV), cephalexin* (PO), cefadroxil (PO), cephalothin (IV)
Used prior to sx against sx site infections Goof for: MSSA, strep Moderate for: some enteric GNRs Good alternative to antistaphylococcal penicillins Do not cross BBB |
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Second-generation Cephalosporin
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cefamandole (IV), cefuroxime* (IV/PO), cefoxitin* (IV), cefotetan (IV), loracarbef (PO), cefdinir (IV), cefmetazole (IV), cefonicid (IV), cefaclor (PO), cefprozil* (PO)
good for: some enteric GNRs, Haemophilus, Neisseria Moderate for: strep, staph, anaerobes (cefotetan, cefoxitin, cefmetazole... therefore good for prophylaxis with abd sx) Cefamandole, cefmetazole, cefotetan: inhibit Vit K production and prolong bleeding; also do not drink Do not cross BBB |
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Third-generation Cephalosporins
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Ceftriaxone*, Cefotaxime*, ceftazidime*, cefpodoxime*, defixime*, ceftibuten
Good: strep, enteric GNRs, pseudomonasa (ceftazidime only) Moderate: MSSA (except ceftazidime) Strongest association with C. difficile diarrhea Cefpodoxime inhibits Vit K production Ceftriaxone, cefotaxime, and ceftazidime cross BBB Ceftriaxone is qd except for meningitis where it is q12h |
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Fourth-generation Cephalosporin
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Cefepime*
Good for: MSSA, strep, pseudomonas, enteric GNRs Moderate: acinebacter Good for broad spectrum nosocomial infections |
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Carbapenems
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Imipenem/cilastatin*, meropenem*, ertapenem*, doripenem*
Good: MSSA, strep, anaerobes, enteric GNRs, pseudomonas (not ertapenem), Acinetobacter (not ertapenem), ESBL-producing GNRs Moderate: enterococci (not ertapenem Higher chance for seizures Imipenem is metabolized in the kidney to a nephrotoxic product, therefore needs cilastatin May elicite an allergic rxn in penicillin allergy pts |
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Monobactams
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aztreonam*
Safe in those with beta-lactam allergies (except ceftazidime) Good: pseudomonas, most GNRs Moderate: Acinetobacter |
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Glycopeptides
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Vancomycin*
Good: MSSA, MRSA, strep, C. difficile Moderate: enterococci ADR: ototoxicity, nephrotoxicity, red man syndrome from histamine Oral is used only for C. diff If MSSA, use nafcillin or cefazolin instead. |
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Fluoroquinolones
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Ciprofloxacin*: good for enteric GNRs, H. influenzae. Moderate for pseudomas, atypicals (Mycoplasma, chlamydia, legionella) levofloxacin*,moxifloxacin*, gemifloxacin*: good for enteric GN, S. pneumoniae, atypicals, H. influenzae. Moderate for MSSA, pseudomonas (levofloxacin)
ADR: GI side effects, HA, photosensitivity, dizziness, confusion, hallucinations Caution with diabetes, seizure, arrhythmia pts Absolutely contraindicated in preg woman and relatively in kids Do not administer with calcium, iron, antacids, milk, multivitamins Moxifloxacin can't be used for UTIs |
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Aminoglycosides
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Gentamicin*, Tobramycin*, amikacin*, streptomycin, spectinomycin
Good for: GN Moderate: in combo with a beta-lactam or glycopeptide it covers staph, MRSA, vididans strep, enterococci ADR: nephrotoxicity, ototoxicity |
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Tetracyclines and Glycylcyclines
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doxycycline*, miniocycline, tetracycline*: good for atypicals, rickettsia, spirochetes (T. pallidum, B. burgdorferi, H. pylori). Moderate for staph, MRSA, S. pneumoniae, S. pyogenes
tigecycline*: good for atypicals, enterococci (including VRE), staph, MRSA, S. pneumoniae, S. pyogenes. Moderate for most GN, anaerobes ADR: N/D, photosensitivity. must take with water due to esophageal irritation. discolored teeth in children < 8 yrs old DO not take with calcium, iron, antacids, milk, multivitamins |
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Macrolide and Ketolide
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erythromycin, clarithromycin*, azithromycin*: good for atypicals, H. influenzae, Moraxella catarrhalis, H. pylori, Mycobacterium avium. Moderate for S. pneumoniae, S. pyogenes
telithromycin*: better for drug resistant S. pneumoniae ADR: N/V/D esp with erythromycin, hepatic failure, prolongation of QT interval Potent inhibitors of 3A4 Azithromycin has long half-life so Z-pack and Z-max work |
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Oxazolidinones
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linezolid*
Good: MSSA, MRSA, strep, enterococci (including VRE), Nocardia Moderate: some atypicals ADR: bone marrow suppression Causes serotonin syndrome with SSRIs |
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Nitroimidazole
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Metronidazole*: Good for GN and GP anaerobes (Bacteroides, Fusobacterium, C. diff), protozoa (Trichomonas, Entamoeba, Giardia)
tinidazole ADR: N/V/D, peripheral neuropathy Do not consume alcohol Inhibits warfarin |
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Nitrofurans
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Nitrofurantoin*
Good: E. coli, Staph aprophyticus Moderate: Citrobacter, Klebsiella, enterococci Only good for lower UTIs ADR: N/V (tx by taking with food), acute pneumonitis, chronic pulmonary fibrosis, peripheral neuropathy |
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streptogramins
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quinupristin/dalfopristin*
both are -static but together are -cidal Brand name: Synercid Good for: MSSA, MRSA, strep, enterococcus faecium (VRE) ADR: phlebitis so must be administered via central line, myalgia, arthralgia Inhibit 3A4 Must be mixed with D5W Does not work against E. faecalis |
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Cyclic Lipopeptides
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daptomycin*
MOA: makes GPB leaky Good: MSSA, MRSA, strep Moderate: enterococci (VRE) ADR: rhabdo, fever Tx staph endocarditis Does not tx pneumonia |
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Trimethoprim/Sulfamethoxazole
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TMP/SMX*
Good: MSSA, MRSA, H. influenzae, Stenotrophomonas maltophilia, Listeria, PCP Moderate: enteric GNRs, S. pneumoniae, Salmonella, Shigella, Nocardia ADR: rash, bone marrow suppression, acute interstitial nephritis Drug interation with warfarin |
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Lincosamides
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clindamycin*
Good: many GP anaerobes Moderate: MSSA, MRSA, strep pyogenes, GN anaerobes, Chlamydia, PCP, Actinomyces, Toxoplasma ADR: diarrhea, C. diff, rash If the bacteria is clinda susceptible and erythro resistant, may be also clinda resistant. |
