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40 Cards in this Set
- Front
- Back
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Staphylococcus aureus
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Usually penicillin-resistant (if not, use penicillin)
Semisynthetic penicillins / penicillinase-resistant penicillins (oxacillin, dicloxacillin, etc.) MRSA – Vancomycin If MRSA and VRSA or vancomycin intolerant – daptomycin, linezolid (oxazolidinone) |
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Group A streptococcus
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Penicillin
If allergic, macrolide or maybe 1st generation cephalosporin |
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Streptococcus pneumoniae
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Penicillin if sensitive
If intermediate resistant to penicillin, use 3rd generation cephalosporin (ceftriaxone, cefotaxime); if high-level resistance may need vancomycin or 3rd generation quinolones (levofloxacin) |
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Enterococcus
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Penicillin or Ampicillin
NB uniformly resistant to cephalosporins If resistant to penicillins – vancomycin In endocarditis, use with an aminoglycoside (e.g., gentamicin) for synergy |
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Group B streptococcus
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Penicillin or ampicillin
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Resistant Gram positive cocci (e.g., vancomycin-resistant enterococcus or vancomycin-resistant staphylococcus)
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Linezolid, daptomycin, streptogramins (dalfopristin-quinupristin; note streptogramins active against Enterococcus faecium but not faecalis)
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Anaerobes
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Metronidazole, 2nd generation cephalosporins, clindamycin (lincosamide), carbapenems, extended spectrum penicillins with a beta-lactamase inhibitor (e.g., piperacillin-tazobactam), vancomycin for clostridium
M - Triple C - VP Metronidazole Clindamycin 2nd gen cephalosporin carbapenems Vancomycin piperacillin |
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C. difficile - anaerobe
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metronidazole or vancomycin
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Enterobacteriaceae (e.g., E. coli, klebsiella, enterobacter)
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3rd generation cephalosporin, quinolones, aminoglycosides, carbapenems, extended-spectrum penicillin (i.e., piperacillin-tazobactam), aztreonam
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Pseudomonas
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Extended-spectrum penicillins, quinolones, aminoglycosides, carbapenems, 3rd generation cephalosporins (ceftazidime only), 4th generation (cefepime)
Aminoglycoside + beta lactam have synergistic activity PAQ CC piperacillin aminogylcoside quinolone clindamycin 3rd gen cephalosporin |
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Rickettsia/ehrlichia/Borrelia burgdorferi
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Tetracycline (e.g., doxycycline); (also amoxicillin and ceftriaxone for borrelia)
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Gonorrhea
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3rd generation cephalosporin (e.g., ceftriaxone)
Treat for chlamydia concurrently (macrolide or tetracycline) |
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Syphilis
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Penicillin
Maybe doxycycline if penicillin-allergic, but consider desensitization (an allergic pregnant woman should be desensitized) |
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Chlamydia trachomatis
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Macrolide/azalide, tetracycline
Treat concurrently for gonorrhea with 3rd generation cefalosporin (ceftriaxone) |
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Atypical pneumonias (mycoplasma, legionella, chlamydia, bordetella)
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Macrolides/azalides, quinolones, +/- tetracycline
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N. meningitidis prophylaxis
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Rifampin
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Rifampin
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Inhibit RNA synthesis by binding to the bacterial DNA-dependent RNA polymerase
Always used in combination with another antibiotic (except N. meningitidis prophylaxis) |
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Metronidazole
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Active against anaerobes (including C. dificile) and select parasites such as entamoeba, trichomonas, and giardia
Metronidazole is reduced and its free radicals then cause breakage of organism DNA causing cell death |
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Polymyxins
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Use surface detergent-like mechanisms to kill bateria. They penetrate into cell membranes, interact with membrane phospholipids and disrupt the membranes causing cell death.
Broad gram negative agents. Old drugs that became mainly restricted to topical and oral (not absorbed) use due to toxicity |
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Eneterococcal endocarditis
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Gentamicin (aminogylcoside) + ampicillin (penicillin)
Perturbation of cell wall by penicillin/ampicillin, allows gentamicin to get into cell |
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Metronidazole + alcohol
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disulfram reaction (flushing, throbbing, headache, copious vomitting, etc.)
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Side effect of rifampin
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Turns pee orange
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S. epidermidis
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Infection most commonly encountered with prosthetic devices. Slime/biofilm helps facilitate this.
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More likely to have S. aureus colonization in the anterior nares
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Injection drug users, diabetics, HIV-infected
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Streptococcus pyogenes
Main virulence factor |
Inhibits phagocytosis
M protein (main virulence factor) Hyaluronic acid capsule Pyrogenic exotoxins |
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Cause of Scarlet fever
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Exotoxin released by Streptococcus pyogenes
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Streptococcus pneumonia
Main virulence factor |
Polysaccharide capsule
Interferes with phagocytosis (Cell wall is involved in inflammatory response) |
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Listeria
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amoxicillin
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Broad gram negative coverage
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ampicillin + gentamicin
(for serious UTIs) |
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Broad spectrum empiric treatment
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Aminoglycoside + beta-lactam
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Meningitis
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3rd generation cephalosporin (ceftriaxone) has good CSF penetration
N. Meninigitidis: Penicillin or ceftriaxone. Rifampin for prophylaxis Pneumococcus meningitis: Vancomycin? Penicillin? |
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HMA/HME (Anaplasmosis)
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Tetracyclin (Doxycycline)
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Dermatophytes
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Topical azole, systemic azole (esp nails, itraconazole), allylamine (griseofulvin)
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Sporthrix shenkii
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Potassium iodide
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Mucosal candidiasis
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Topical polyene, topical azole, oral/IV azole, IV amphotericin B, echinocandins
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Histo, blasto, cocci
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Amphotericin B, Lipid associated Amphotericin B, Newer azoles (oral or IV)
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Cryptococcal meningitis
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Amphotericin B (synergy with 5-FC), fluconazole, itraconazole
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Systemic candidiasis
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Amphotericin B, lipid associated Amphotericin B, fluconazole, voriconazole, caspofungin
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Aspergillosis
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Amphotericin B, lipid associated Amphotericin B, voriconazole, caspofungin
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Mucormycosis
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Amphotericin B
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