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154 Cards in this Set
- Front
- Back
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Staphylococci Gram -/+? Shape |
Gram + Cocci Cluster |
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S. pneumoniae Gram-/+? Shape |
Gram + Cocci Pairs |
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viridans streptococci, other strep Gram-/+? Shape |
Gram + Cocci Chain |
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Enterococcus sp. Gram +/- Shape? |
Gram + Cocci Pairs and Chains |
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Bacillus sp. Gram +/- Shape? |
Gram + Bacilli |
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Corynebacterium sp. Gram +/- Shape? |
Gram + Bacilli |
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Listeria monocytogenes Gram+/- Shape? |
Gram + Bacilli |
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Nocardia sp. Gram+/- Shape |
Gram + Bacilli |
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Moraxella catarrhalis Gram+/- Shape? |
Gram-Negative Aerobes Cocci |
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Neisseria gonorrhoeae Gram+/- Shape? |
Gram-Negative Aerobes Cocci |
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Neisseria meningitidis Gram+/- Shape? |
Gram-Negative Aerobes Cocci |
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Haemophilus influenzae (coccobacilli) Gram+/- Shape? |
Gram-Negative Aerobes Cocci |
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E. coli, Enterobacter sp. Gram+/- Shape? |
Gram-Negative Aerobes Bacilli |
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Citrobacter Gram+/- Shape? |
Gram-Negative Aerobes Bacilli |
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Klebsiella sp. Gram+/- Shape? |
Gram-Negative Aerobes Bacilli |
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Proteus sp. Gram+/- Shape? |
Gram-Negative Aerobes Bacilli |
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Serratia Gram+/- Shape? |
Gram-Negative Aerobes Bacilli |
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Salmonella Gram+/- Shape? |
Gram-Negative Aerobes Bacilli |
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Shigella Gram+/- Shape? |
Gram-Negative Aerobes Bacilli |
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Acinetobacter Gram+/- Shape? |
Gram-Negative Aerobes Bacilli |
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Helicobacter Gram+/- Shape? |
Gram-Negative Aerobes Bacilli |
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Pseudomonas aeruginosa Gram+/- Shape? |
Gram-Negative Aerobes Bacilli |
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What is an MSPACE organism? |
produce extended spectrum beta-lactamases (ESBLs) inactivating most beta-lactams |
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What does MSPACE stand for? |
Morganella Serratia Pseudomonas aeruginosa Acinetobacter Citrobacter Enterobacter |
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AmpC β-Lactamase most commonly found in what family of bacteria? |
Enterobacteriaceae |
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Anaerobes above the diaphragm? (5) |
Peptococcus sp. Peptostreptococcus sp. Prevotella Veillonella Actinomyces |
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Anerobes below the diaphragm? (3) |
Clostridium Bacteroides Fusobacterium |
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Atypical Bacteria? (3) |
Legionella pneumophila Mycoplasma pneumoniae or hominis Chlamydia pneumoniae or trachomatis |
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Spirochetes? (2) |
Treponema pallidum (Syphilis) Borrelia burgdorferi (Lyme Disease) |
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What groups of antibiotics have beta-lactamase structures? (4) |
Penicillins Cephalosporins Monobactams Carbapenems |
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Penicillins MOA |
Bind to PBP to inactivate cell wall synthesis |
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Penicillins Resistant Mechansims? (2) |
Beta-lactamases Modification of the PBP (some strep and staph) |
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Name 2 natural penicillins? |
PCN G PCN V-K |
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Dosing for PCN G? |
IV 2-3MU IV q 4h |
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Dosing for PCN V-K? |
PO 250-500mg po q 6h |
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Spectrum for Natural Penicillins? |
Penicillin-susceptible Streptococcus (S.pyogenes (Group A Strep), S.viridans) PCN-susceptible S.pneumoniae Upper airway anaerobes (Peptococcus, Peptostreptococcus) |
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Clinical uses of natural penicillins? |
mainly Strep-related infections URTI (Susceptible S.pneumoniae) Bacteremias (various strep) Dental infections (various strep) Endocarditis (Strep.viridans) Syphilis |
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Name 2 drugs that are in the Penicillinase-Resistant PCNs group? |
Nafcillin Dicloxacillin |
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What is another name for the Penicillinase-Resistant PCNs? |
Anti-Staph Pencillins |
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What is the spectrum of Penicillinase-Resistant PCNs? |
Staph Infections Methicillin-susceptible Staph (Staph aureus MSSA; Staph epidermidis MSSE) |
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Dosing for Nafcillin? |
IV 2g IV q 4h |
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Dosing for Dicloxacillin? |
PO 250-500mg po q 6h |
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Clinical use for Anti-Staph Penicillins? |
where Staph is frequent Cellulitis Osteomyelitis Infective Endocarditis Use these antibiotics only for Staph related infections (MSSA, MSSE) |
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Name 2 aminopenicillins? |
Ampicillin Amoxicillin |
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Ampicillin dosing? |
250-500mg po q 6h
1-2 g IV q 6h |
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Amoxicillin dosing? |
PO 250-500mg po q 8h |
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Aminopenicillins spectrum? |
Vulnerable to Beta-lactamases
Gram-positive: Group strep, viridans strep, some Enterococcus; Listeria
Gram-negative: Proteus, some E.coli, H.flu (ß lact-) |
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Aminopenicillin Uses? (2) |
URIs UTIs |
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Name 2 "other" aminopencillins? |
Ampicillin-Sulbactam Amoxicillin-Clavulanate |
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"other" aminopencillins spectrum? |
Suicide inhibitor extends coverage for beta-lactamase-producers Covers same pathogens as Amp / Amox H.influenzae which are beta-lactamase + M.catarrhalis Anaerobes: B.fragilis (also can produce beta-lactamse) |
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Ampicillin-Sulbactam uses? |
Intraabdominal infections Gynecologic infections |
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Amoxicillin-Clavulanate uses? |
URI (upper respiratory infections) LRI (lower respiratory infections) UTI Skin infections |
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Name 4 Antipseudomonal Penicillins? |
Piperacillin IV Piperacillin – Tazobactam IV (Zosyn) Ticarcillin IV Ticarcillin – Clavulanate IV (Timentin) |
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Antipseudomal Penicillins Spectrum? |
GNB Pseudomonas Complicated Strep infections Enterococcal infections |
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Antipseudomonal Penicillins When is combo therapy recommended? |
Serious resistance profiles of pseudomonas Systemic Enterococcal infections to prevent resistance (outside urinary tract) |
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Antispeudomonal Penicillins? What drugs do you add when combo therapy is called for? |
Add Aminoglycoside (Gentamicin) or Quinolone (Ciprofloxacin) to the beta-lactam (e.g., Pip/Tazo) |
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Clinical use of Antipseudomonal Penicillins? |
Serious GNB infections: Pseudomonas Serious GPC infections: Enterococcus Intraabdominal infection Pyelonephritis Serious osteomyelitis Serious skin infections Others |
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Penicillin PK Eliminated via? |
Kidney |
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Penicillins that are eliminated via the liver? |
Nafcillin, Dicloxacillin, Oxacillin |
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What two drugs do you want to avoid mixing together in an IV bag? |
Aminoglycoside and Probenecid. Inactivates aminoglycoside |
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Penicillins to counsel patients to take on an empty stomach? |
Dicloxacillin Ampicillin |
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Name one monobactam? |
Aztreonam |
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Aztreonam spectrum? |
aerobic Gram-negatives only including P.aeruginosa |
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When do we commonly use Aztreonam? |
in combination regimens where aminoglycoside might have been used (due to renal function) |
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Aztreonam - Advantages |
Replace aminoglycoside in combo therapy in renal patients Use in penicillin allergic patients Can use in renal patients where gram- coverage needed |
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Name 4 Carbapenems? |
Imipenem-cilastatin (Primaxin) Meropenem (Merrem) Doripenem (Doribax) Ertapenem (Invanz) |
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Carbapenem Spectrum |
GNB + GPC + Anaerobes |
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What holes does ertapenem have? |
Pseudomonas Acinetobacter |
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Carbapenem resistance due to? (4) |
Low-affinity Penicillin Binding Proteins Reduced membrane permeability Efflux of Abx across outer membrane Bacterial production of Carbapenemases noted |
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Carbapenem uses: |
Serious infections! Urinary Respiratory Intra-abdominal (excellent anaerobic activity!) Polymicrobial +/- resistant pathogens |
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Name 2 First generation Cephalosporins? |
Cephalexin (Keflex) Cefazolin (Ancef) |
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Dosing for Cephalexin? |
250-500mg po q 6h |
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Dosing for Cefazolin? |
1-2 g IV q 8h |
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First Generation Cephalosporin Spectrum? |
Mainly Gram + as Staph (MSSA) and Strep Selective Gram-negative coverage (E.coli, proteus, some Klebsiella) No H.flu No Enterococcal |
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What bug has universal resistance to all cephalosporin generations? |
Enterococcus |
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Clinical Uses for Cephalosporins-First Generation |
Surgical prophylaxis (Cefazolin IV) Cellulitis (Cefazolin IV for serious cases) Cephalexin: superficial cellulitis Osteomyelitis (Cefazolin 2g IV q 8h) Infective Endocarditis (Cefazolin 2g IV q 8h) Some UTIs (relapse rates noted with Cephalexin in adults) |
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Primary role for 2nd Generation Cephalosporins |
Respiratory Infections |
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Name a 2nd generation Cephalosporin? |
Cefuroxime |
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Cefuroxime Dosing |
250mg po q 12h 1.5 g IV q 8h |
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2nd Generation Cephalosporin Spectrum |
Similar spectrum as First Generation More potent Gram-negative activity against E.coli, Proteus, Klebsiella Additional Gram-negatives: H. flu and other GNB No Pseudomonal or Enterococcal Activity |
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Second Generation Cephalosporin Anti-anaerobic action Drug? |
Cefoxitin |
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What activity does the second generation cephalosporin aerobic activity work on? |
Bacteroides fragilis, other anaerobes |
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Cefoxitin Dosing |
1-2g IV q 6h |
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Clinical uses for 2nd Generation Cephalosporins |
Respiratory tract infections: CAP, OM Good coverage vs Moraxella catarrhalis (major beta-lactamase producer!) Advantage in pediatrics: Flavors! Colors! Compliance enhancers Anti-anaerobic coverage for some cephs |
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What are the 2 groups in the 3rd Generation Cephalosporins? |
Antipseudomonal Cephalosporins
nonpseudomonal GNB activity |
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Name a drug that is an antipseudomonal 3rd generation cephalosporin? |
Ceftazidime (Fortaz) |
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Ceftazidime (Fortaz) Dosing |
2g IV q 8h |
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Ceftazidime Spectrum |
Antipseudomonal has very poor staph/strep activity |
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Name two 3rd generation cephalosporins in the nonpseudomonal category? |
Cefotaxime (Clarofan) Ceftriaxone (Rocephin) |
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Cefotaxime dosing? |
1g IV q 8h |
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Ceftriaxone dosing? |
1g IV q 24h |
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3rd Generation Nonpseudomonal Cephalosporin spectrum |
Good Staph and Strep activity |
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Oral 3rd Generation Cephalosporins Spectrum |
Good nonpseudomonal GNB activity Very poor Staph/Strep activity |
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Name one oral 3rd generation cephalosporin? |
Cefixime (suspension only) (Suprax) |
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Third Generation Cephalosporins Spectrum? |
Enterobacteriaceae (E.coli, Proteus, etc) P.aeruginosa (Ceftazidime is gold standard) |
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Clinical Uses for 3rd Generation Cephalosporins |
reserve for serious infection Pseudomonal infection (Ceftazidime) CNS infection (Cefotaxime, Ceftriaxone); Ceftazidime for pseudomonal CNS infection Intraabdominal, skin, UTI, pyelonephritis
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Name a 4th Generation Cephalosporins? |
Cefepime (Maxipime) |
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4th Generation Cephalosporin Spectrum? |
Covers GNB including Pseudomonas Covers Staph & Strep No Anaerobic coverage No Enterococcal coverage |
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Clinical Uses for 4th Generation? |
Reserve for serious infections Intraabdominal infections Neutropenic fever |
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Name a 5th Generation Cephalosporin? |
Ceftaroline (Teflaro, IV) |
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5th Generation Cephalosporin Spectrum? |
S.pneumoniae S.aureus MSSA / MRSA H.flu Klebsiella E.coli No anaerobes or enterococcus coverage |
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5th Generation Cephalosporin Clinical Uses: |
Community-acquired pneumonia (CAP) ( S. pneumoniae, MSSA, H.flu, Klebsiella, E.coli) Skin and Skin Structure Infections (MSSA/MRSA, Streptococcus pyogenes (group A strep), Streptococcus agalactiae (group B strep)) |
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Cephalosporin Pharmacokinetics Elimination |
Renally |
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Which cephalosporin has mixed liver/kidney elimination? |
Ceftriaxone |
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Do you take cephalosporins with food? |
Yes |
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Aminoglycosides MOA |
Inhibits protein synthesis (50S/30S) |
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Aminoglycoside Resistance caused by? |
Ribosomal resistance Ineffective transport |
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Name 3 Aminoglycosides? |
Gentamicin, Tobramycin, Amikacin |
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Aminoglycoside Spectrum? |
Excellent GNB activity + Pseudomonas Activity versus Staph / Strep Increasing resistance: Enterococcus, selective GNB |
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Aminoglycoside General Use? |
serious GNB infection as combination therapy
Tobra>Gent for P.aeruginosa in vitro; no greater clinical efficacy |
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Aminoglycoside Clinical Use? |
Complicated UTI GNB pneumonia Joint infections GNB Bacteremia Enterococcal systemic infections – Combo Tx – Ampicillin + Gent; Piperacillin + Gent Endocarditis regimens of Am Heart Assoc Meningitis – intrathecal administration possible Serious Pseudomonal infections – Combo Tx – Piperacillin + Gent; Ciprofloxacin + Gent; Ceftazidime+ Gent |
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AMG Pharmacokinetics Elimination? |
Glomerular filtration; CrCl |
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How to calculate LBW for CrCL calculations? |
LBW = 2.3 (inches>5’) + 50 Male LBW = 2.3 (inches>5’) + 45 Female |
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AMG Once-Daily Dosing |
Use 4.5-5mg/kg/day IV depending on CrCl – Appropriate for CrCl > 70 mL/min – Some indications may require higher dosing
Serum Troughs: < 1.0 mcg/mL |
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Toxicity of AMG |
Nephrotoxicity Ototoxicity Vestibular toxicity Neuromuscular paralysis |
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Quinolone MOA |
Inhibition of DNA gyrase (Topoisomerase II) Inhibition of DNA synthesis Moxifloxacin inhibits Topo II & IV (Requires 2 mutations for resistance) |
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How resistance develops in Quinolones? |
altered target sites cell wall permeability active efflux |
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Name 3 Quinolones? |
Ciprofloxacin (Cipro) Levofloxacin (Levaquin) Moxifloxacin (Avelox) |
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Quinolone Spectrum? |
Primarily GNB coverage (very poor Staph / Strep) No Enterococcal or Anaerobic coverage Covers atypical respiratory pathogens |
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Which quinolone is the most potent when it comes to treating Pseudomonas? |
Ciprofloxacin |
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Ciprofloxacin Dosing for Lower RTI? |
500mg po (400mg IV) q 12h x 7-14 days |
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Ciprofloxacin Dosing for Urinary tract (including pyelonephritis) |
500mg po q 12h x 7-14 days
1000mg XR q 24h x 7-14day |
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Ciprofloxacin Dosing for Prostatitis |
500mg po q 12h x 4 weeks |
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Levofloxacin Spectrum |
Gram-negative pathogens Less anti-pseudomonal potency than Cipro Good activity vs Staph / Strep In vitro activity vs Enterococci Covers Atypical respiratory pathogens No Anaerobic activity |
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Levofloxacin Dosing for CAP |
500-750mg q 24h x 7-14 days (750/5days) |
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Levofloxacin Dosing for UTI uncomplicated |
250mg po q 24h x 3 days |
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Levofloxacin Dosing for complicated UTI |
250mg po q 24h x 10 days |
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Levofloxacin Dosing for prostatitis |
500mg po q 24h x 4 weeks |
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Moxifloxacin Spectrum of Activity |
Gram-positive patho gens incl Staph/Strep S.pneumoniae including resistant forms Selective Gram-negative activity incl H.flu Anti-anaerobic activity: limited clinical data – Peptococcus, Peptostreptococcus No Pseudomonal activity Covers Atypical respiratory pathogens |
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Moxifloxacin Dosing for CAP |
400mg po/IV q 24h x 7-14 days |
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Moxifloxacin Renally Adjusted? |
No |
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Considerations for Clinical Use All Quinolones?
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UTI: Reserve for complicated infection, resistant infection, pts with allergy – Moxifloxacin has no UTI indication; limited data for use in less complicated UTI
Prostate infections: Consider TMP/SMZ 1st unless resistance, etc.
URIs – Ciprofloxacin does not cover GPC
Skin / bone: Ciprofloxacin has extensive data for GNB infection |
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Quinolone Pharmacokinetics Distribution |
Poor CSF penetration |
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Cipro Drug interactions? |
Inhibits hepatic CYP1A2 caffeine, cyclosporine, theophylline, warfarin |
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Quinolones: Rx-Rxs |
Inhibition of quinolone clearance by Probenecid Decline in Phenytoin serum levels Prolongation of PT with Warfarin - Bleeds |
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Quinolones: Rx-Rxs Cations to Avoid during Dosing |
Magnesium, calcium, aluminum, iron, zinc; avoid antacids, calcium products, sucralfate (Carafate), multivitamins with iron
Cipro: 2 hr before/6hr after Moxi: 4 hr before/8hr after |
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Macrolide MOA |
binds 50S ribosome to inhibit protein synthesis |
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Name 2 Macrolides? |
Clarithromycin* (Biaxin) Azithromycin* (Zithromax) |
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Macrolides Resistance Mechanisms |
Active efflux Altered target sites Cross-resistance occurs between all macrolides |
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Macrolide Spectrum of Activity |
Various Streptococcus: – S.pneumoniae (susceptibilities vary) – S.pyogenes (alternative choice)
H.influenzae (resistance with erythromycin)
Moraxella catarrhalis
Atypicals
Staphylococcus (MSSA)-Not primary option |
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Avoid Macrolid Use with? (3) |
MRSA Staphylococcus epidermidis (usually MRSE) Enterococci |
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With what bacteria do you need susceptibility results with Macrolide use? (2) |
MSSA (alternative therapy) H.flu (erythromycin, dirithromycin) |
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What 2 macrolides will concentrate themselves in the lungs? |
Clarithromycin Azithromycin |
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Macrolides are eliminated primarily by what means? |
Hepatic |
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Macrolides have variable half lives, but what macrolide has the longest? How long is it? |
Azithromycin 68 hours |
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Can remove macrolides by hemodialysis? |
None of them can be removed by hemodialysis |
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What macrolide is eliminated by the kidney? |
Clarithromycin |
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Main Adverse Events of Macrolides? |
Ab pain N/V Diarrhea HA |
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Macrolide Rx-Rxs |
Inhibitor of CYP3A4: Cyclosporine, Tacrolimus, Carbamazepine, Digoxin, Warfarin, Theophylline, Verapamil, Phenytoin, Ergot alkaloids
Macrolide + Statin = possible rhabdomyolysis
Azithromycin interacts with antacids |
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Macrolide Instructions |
Erythromycin: prefer empty stomach but if GI distress then take with food; take with at least 250 mL water
Azithromycin tablets: with or without food
Azithromycin suspension: take – > 1h prior to a meal – > 2h after a meal
Clarithromycin: with or without food |
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Clindamycin MOA |
Protein synthesis inhibitor of 50S ribosome |
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Clindamycin Spectrum? |
aerobic Gram-positives & anaerobes |
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Clindamycin Uses: |
lung abscess empyema skin infection osteomyelitis in combination therapies to diminish toxin production (inhibits toxic proteins from being made) |
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Clindamycin Adverse Drug Effects? |
GI distress!! C.difficile diarrhea neutropenia, leukopenia rash thrombophlebitis elevated LFTs |
