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37 Cards in this Set

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Your decision to use an individual antibiotic will be based on several factors: coverage of the likely or cultured organisms, drug allergy, formulary availability, and cost.

Once you decide which drug to use, consult a pocket pharmcopoeia, or palm pilot program use as Epocrates for dosing, and remember to adjust for _______ .
Once you decide which drug to use, consult a pocket pharmcopoeia, or palm pilot program use as Epocrates for dosing, and remember to adjust for RENAL DOSING.
What is empirical therapy?
Empirical therapy is best guess therapy when a specific pathogen is not yet known. Patients present with signs of infection but definite culture of blood, urine or body fluid takes several days. In the interim before the pathogen is known, we frequently begin antibiotics. In many cases, especially with pneumonia or skin infections, we never isolate a specific pathogen, and our whole treatment course is based on the most likely pathogen in a given setting.
What is a good starting point for picking antibiotic therapy?
Learn a few antibiotics appropriate for use with common bacterial pathogens:
S. aureus
Gram-negative rods
anaerobes
Enterococcus
atypicals: Chlamydia, Legionella, Mycoplasma
When do I worry about S. aureus infections?

S. aureus is a very common pathogen and its drug resistance makes it particularly troublesome. Typical situations for S. aureus infections include ________ , ______________ , and _____________ .
S. aureus is a very common pathogen and its drug resistance makes it particularly troublesome. Typical situations for S. aureus infections include ENDOCARDITIS in IDVU, SKIN AND WOUND INFECTIONS (ESPECIALLY IN DIABETICS), and NOSOCOMIAL PNEUMONIA .
What are good drugs for treating S. aureus infections?

S. aureus infections are divided into ________ and _______
S. aureus infections are divided into MSSA and MRSA.
What are good drugs for treating S. aureus infections?

In otherwise healthy patients when MRSA is unlikely, the best initial IV drugs for S. aureus infections are ________ or ____________ . Oral options are _________ and ________ .

If patient has a life-threatening penicillin allergy, then ____________ is the best option.
In otherwise healthy patients when MRSA is unlikely, the best initial IV drugs for S. aureus infections are NAFCILLIN or 1st GENERATION CEPHALOSPORINS such as CEFAZOLIN. Oral options are DICLOXACLLIN and CEPHALEXIN.

If patient has a life-threatening penicillin allergy, then VANCOMYCIN is the best option.
What are good drugs for treating S. aureus infections?

When MRSA is likely, as in frequently hospitalized or institutionalized patients, _________ is used for empirical coverage until sensitivites are available.
When MRSA is likely, as in frequently hospitalized or institutionalized patients, VANCOMYCIN is used for empirical coverage until sensitivites are available.
Oral vancomycin is not absorbed and should only be used for topical therapy of ____________.
Oral vancomycin is not absorbed and should only be used for topical therapy of C. DIFFICILE COLLITIS.
Other drugs with good S. aureus activity include:
1.
2.
3.
4.
Other drugs with good S. aureus activity include:
1. clindamycin
2. quinolones
3. 2nd and 3rd gen. cephalosporins
4. combination products with B-lactamase inhibitors such as ampicllin-clavulante (Unasyn), piperacillin-tazobactam (Zosyn), or ticarcillin-clavulanate (Timentin).
What are the best drugs for Methicillin-Sensitive S. aureus?
1. Nafcillin
2. 1st generation cephalosporin
3. Vancomycin
Antibacterial Spectrum of Commonly Used Antibiotics

PENCILLIN

Excellent Activity (>85% isolates sensitive)

Antibacterial Spectrum of Commonly Used Antibiotics

PENCILLIN

Excellent Activity (>85% isolates sensitive)

Fair Activity (70%-85% isolates sensitive)

Poor Activity (Poor activity)
Antibacterial Spectrum of Commonly Used Antibiotics

PENCILLIN

Excellent Activity (>85% isolates sensitive)

1. Streptococcus spp. except enterococci
2. Oral anaerobes


Fair Activity (70%-85% isolates sensitive)

None listed

Poor Activity (Poor activity)
1. Aerobic gram-negative rods
2. Staphylococcus aureus
3. Atypical organisms
Antibacterial Spectrum of Commonly Used Antibiotics

AMPICILLIN

Excellent Activity (>85% isolates sensitive)

Fair Activity (70%-85% isolates sensitive)

Poor Activity (Poor activity)
Antibacterial Spectrum of Commonly Used Antibiotics

AMPICILLIN

Excellent Activity (>85% isolates sensitive)
1. Streptococcus spp
2. Oral anaerobes

Fair Activity (70%-85% isolates sensitive)
1. Haemophilus influenzae
2. Enterococci

Poor Activity (Poor activity)
1. Most aerobic gram-negative rods
2. S. aureus
Antibacterial Spectrum of Commonly Used Antibiotics

TRIMETHOPRIM/SULFA

Excellent Activity (>85% isolates sensitive)

Fair Activity (70%-85% isolates sensitive)

Poor Activity (Poor activity)
TRIMETHOPRIM/SULFA

Excellent Activity (>85% isolates sensitive)
1. Streptococcus spp except enterococci
2. Escherichia coli (increasing resistance of E. coli, approaching 15%)

Fair Activity (70%-85% isolates sensitive)
1. Staph. aureus

Poor Activity (Poor activity)
1. Anaerobes
2. Hospital acquired gram-negative rods
Antibacterial Spectrum of Commonly Used Antibiotics

CLINDAMYCIN

Excellent Activity (>85% isolates sensitive)

Fair Activity (70%-85% isolates sensitive)

Poor Activity (Poor activity)
Antibacterial Spectrum of Commonly Used Antibiotics

CLINDAMYCIN

Excellent Activity (>85% isolates sensitive)
1. Streptococcus spp. except enterococci
2. Anaerboes
3. Staph. aureus

Fair Activity (70%-85% isolates sensitive)
None listed

Poor Activity (Poor activity)
1. Aerobic gram-negative rods
2. Atypical organisms
Antibacterial Spectrum of Commonly Used Antibiotics

AZITHROMYCIN

Excellent Activity (>85% isolates sensitive)

Fair Activity (70%-85% isolates sensitive)

Poor Activity (Poor activity)
Antibacterial Spectrum of Commonly Used Antibiotics

AZITHROMYCIN

Excellent Activity (>85% isolates sensitive)
1. Streptococcus spp except enterococci

Fair Activity (70%-85% isolates sensitive)
None listed

Poor Activity (Poor activity)
1. Most GNR
Antibacterial Spectrum of Commonly Used Antibiotics

CLARITHROMYCIN

Excellent Activity (>85% isolates sensitive)

Fair Activity (70%-85% isolates sensitive)

Poor Activity (Poor activity)
Antibacterial Spectrum of Commonly Used Antibiotics

CLARITHROMYCIN

Excellent Activity (>85% isolates sensitive)
1. H. influenzae
2. Chlamydia
3. Helicobacter pylori
4. Mycobacterium avium complex
5. Mycoplasma penumoniae

Fair Activity (70%-85% isolates sensitive)

Poor Activity (Poor activity)
Antibacterial Spectrum of Commonly Used Antibiotics

QUINOLONES: Ciprofloxacin

Excellent Activity (>85% isolates sensitive)

Fair Activity (70%-85% isolates sensitive)

Poor Activity (Poor activity)
Ask Dr. Paauw
Antibacterial Spectrum of Commonly Used Antibiotics

QUINOLONES: Ofloxacin

Excellent Activity (>85% isolates sensitive)

Fair Activity (70%-85% isolates sensitive)

Poor Activity (Poor activity)
Ask Dr. Paauw
Antibacterial Spectrum of Commonly Used Antibiotics

QUINOLONES: Levofloxacin

Excellent Activity (>85% isolates sensitive)

Fair Activity (70%-85% isolates sensitive)

Poor Activity (Poor activity)
Ask Dr. Paauw
Antibacterial Spectrum of Commonly Used Antibiotics

QUINOLONES: Moxifloxacin, Gatifloxacin

Excellent Activity (>85% isolates sensitive)

Fair Activity (70%-85% isolates sensitive)

Poor Activity (Poor activity)
Ask Dr. Paauw
Classify cephalosporins by generation, with first generation drugs having better _________ coverage and third generation drugs having better _________ coverage.
Classify cephalosporins by generation, with first generation drugs having better GRAM-POSTIVE coverage and third generation drugs having better GRAM-NEGATIVE coverage.

gram positives: 1st generation greater than 2nd generation greater than 3rd generation

gram negatives: 3rd generation greater than 2nd generation greater than 1st generation
Special features of cephalosporins:

_________ and ________ are the only cephalosporins with good anaerobe activity (both are second generation.
CEFOTETAN and CEFOXITIN are the only cephaolsporins with good anaerobe activity (both are second generation.
Special features of cephalosporins:

________ and _________ are the only 3rd generation cephalosporins with activity against Pseudomonas aeruginosa.
CEFTAZDIME and CEFOPERAZONE are the only 3rd generation cephalosporins with activity against Pseudomonas aeruginosa.
Special features of cephalosporins:

_______ is a "fourth" generation cephalosporin which has antipseudomonal activity.
CEFEPIME is a "fourth" generation cephalosporin which has antipseudomonal activity.
Special features of cephalosporins:

_________ is a 3rd generation cephalosporin that can be given once a day.
CETRIAXONE is a 3rd generation cephalosporin that can be given once a day.
Special features of cephalosporins:

No cephalosporin covers __________ .
No cephalosporin covers ENTEROCOCCUS (group D strep).
When do I worry about gram-negative or anaerobic infections?

Gram-negative bacteria are generally seen with ____________ infections or infection from a __________ source.
Gram-negative bacteria are generally seen with GENITOURINARY TRACT INFECTIONS (PYELONEPHRITIS, UTI) or infection from a BOWEL source (BILIARY TRACT DISEASE, or PERITONITIS from a bowel wall perforation).
When do I worry about gram-negative or anaerobic infections?

In addition to gram-negative rods, the bowels can also be the source of __________ and/or ______________ .
In addition to gram-negative rods, the bowels can also be the source of ANAEROBES and/or GRAM-POSITIVE COCCI like ENTEROCOCCUS.
When do I worry about gram-negative or anaerobic infections?

The __________ is another common source of anaerobic infections (tooth abscess, aspiration pneumonia).
The ORAL GINGIVA is another common source of anaerobic infections (tooth abscess, aspiration pneumonia).
When do I worry about gram-negative or anaerobic infections?

A subcategory of less common gram-negative rods includes nosocomial, or hospital acquired gram-negative rods such as ________ and ___________ .
A subcategory of less common gram-negative rods includes nosocomial, or hospital acquired gram-negative rods such as KLEBSIELLA and PSEUDOMONAS.
What are the best antibiotics for treating gram-negative infections?

_______ and ________ provide narrow coverage of aerobic gram-negative rods only. They are useful for almost all gram-negative infections, though are usually not used alone as empirical therapy due to their narrow spectrum.
AMINOGLYCOSIDES and AZTREONAM (MONOBACTAM) provide narrow coverage of aerobic gram-negative rods only. They are useful for almost all gram-negative infections, though are usually not used alone as empirical therapy due to their narrow spectrum.
What are the best antibiotics for treating gram-negative infections?

For situations where multiple types of organisms are possible, choose broader spectrum empirical therapy such as:
1.
2.
3.
4.
5.
For situations where multiple types of organisms are possible, choose broader spectrum empirical therapy such as:
1. quinolones (superb gram-negative coverage)
2. extended specturm penicillins (meziocillin, piperacillin and ticarcillin)
3. 3rd or 4th generation cephalosporins
4. imipenem
5. meropenem

Of this group, imipenem and meropenem have the broadest spectrum of activity including gram-positive organisms as well as aerobic and anaerobic gram-negative rods.
What are the best antibiotics for treating gram-negative infections?

Although it is tempting to always use the broadest antibiotics, in fact this wipes out _________ and ________.

Choose the narrowest spectrum possible and narrow therapy promptly when culture results are available.
Although it is tempting to always use the broadest antibiotics, in fact this wipes out NORMAL COLONIZING GUT AND VAGINAL FLORA.

Choose the narrowest spectrum possible and narrow therapy promptly when culture results are available.
What antibiotics provide excellent coverage for anaerobic infections?

Anaerobes can be either gram-negative or gram-positive; and are distinguished by their inability to grow well in the presence of oxygen. Their response to antibiotics is unque.

Anaerobic infections of the mouth are generally sensitive to _________ or ___________ .

By contract, anaerobes of the GI tract (especially Bacteroides fragilis) manufacture B-lactamase, therefore these "below the diaphragm anaerobe are frequently resistent to penicillin. The best anaerobe drugs in this situation are:
1.
2.
3.
4.
5.
Anaerobic infections of the mouth are generally sensitive to PENICILLIN or AMPICILLIN.

By contract, anaerobes of the GI tract (especially Bacteroides fragilis) manufacture B-lactamase, therefore these "below the diaphragm" anaerobes are frequently resistent to penicillin. The best anaerobe drugs in this situation are:
1. clindamycin
2. metronidazole
3. penicillin derivative with B-lactamase
4. cefotetan/cefoxitin
5. meropenem/imipenem
Best Drugs for Anaerobes:
1.
2.
3.
4.
5.
Best drugs for Anaerobes

1. clindamycin
2. metronidazole
3. penicillin derivative with B-lactamase
4. cefotetan/cefoxitin
5. meropenem/imipenem
How do you treat enterococcal infections?

These are difficult to treat.
Penicillin, ampicillin, vancomycin and linezolid are options. Ampicillin has the most activity, but resistance is growing.

For enterococcal bacteremia, ________ are frequently combined with ampicillin or vancomycin for synergy. Only about one third of enterococcal strains are sensitive to _________ .
For enterococcal bacteremia, AMINOGLYCOSIDES are frequently combined with ampicillin or vancomycin for synergy. Only about one third of enterococcal strains are sensitive to AMINOGLYCOSIDES.
What drugs are best for the atypical organisms Legionella, Chlamydia, Mycoplasma?

ERYTHROMYCIN and TETRACYCLINE are the traditional drugs for these infections.

AZITHROMYCIN and CLARITHROMYCIN are new medications in the same class as ERYTHROMYCIN and are just as effective against atypical organisms with the benefit of less frequent dosing and fewer side effects, but the drawback of higher cost.
________ and _______ are the traditional drugs for these infections.

________ and _______ are new medications in the same class as ________ and are just as effective against atypical organisms with the benefit of less frequent dosing and fewer side effects, but the drawback of higher cost.