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33 Cards in this Set

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Infection:
Invasion and multiplication of microorganisms in body tissue, which may result in local cellular injury
Classification of Infections:
1.Community Acquired

2.Nosocomial
Classification of Microorganisms
bacteria
fungus
virus
paracite
Classification of Antibiotic Use
1.Prophylaxis
2.Empiric
3.Culture Documented
Colonization vs infection
Contaminant vs infectious pathogen
Classification of Antibiotics
Antimicrobia
Spectrum of Activity
Mechanism of Action
a.Inhibition of bacterial cell wall synthesis
b.Alteration in cell membrane function
c.Inhibition of protein synthesis
d.Interference of nucleic acid metabolism
e.Interference with intermediate cell metabolism
Factors Affecting the Choice of Antibiotic
1.Empiric Antibiotic Selection
2.Therapy Beyond Empiric Therapy
Empiric Antibiotic Selection
a.signs and symptoms
b.suspected site of infection
c.suspected causative organism
d.antibiotic susceptibilities
e.prior antibiotic usage
f.patient allergies
g.cost
h.patient age
i.renal or hepatic insufficiency
j.pregnancy or lactation
Therapy Beyond Empiric Therapy
a.gram stain
b.culture and susceptibility results
c.patient’s sign and symptoms
BETA-LACTAM ANTIBIOTICS
Penicillins
Beta Lactamase Inhibitors: (clavulanic acid, sulbactam, tazobactam)
Cephalosporins
Carbapenems
Penicillins
MOA: binds to specific penicillin binding proteins (PBP) and inhibits cell wall synthesis
Mechanism of resistance
a.bacterial production of an enzyme (penicillinase/beta lactamase) which cleaves the beta lactam ring inactivating the drug
frequently seen with Staphylococcus aureus
Natural penicillins (Penicillin G, Penicillin V):
respiratory tract infections, gonorrhea (no longer drug of choice), syphilis, pneumococcal pneumonia, aspiration pneumonia (community acquired), meningitis due to susceptible organisms
Penicillinase resistant penicillins (Dicloxacillin, Oxacillin, Cloxacillin, Methcillin, Nafcillin):
infections due to Staphylococcus spp., skin and skin structure infections
Aminopenicillins (Ampicillin, Amoxicillin, Becampacillin, Hetacillin):
UTI, respiratory tract infections, ear infections, pneumonia, meningitis due to susceptible organisms
Extended spectrum penicillins:
various infections involving gram negative bacteria or mixed gram negative aerobic/anaerobic infections e.g., intra abdominal infections, pelvic infections, pneumonia
- Carboxypenicillins (Carbenicillin, Ticarcillin)
- Ureidopenicillins (Azlocillin, Mezlocillin, Pipercillin)
Adverse Effects of pennicillans
hypersensitivity reactions
GI: nausea, vomiting, diarrhea
phlebitis: local irritation at the IV site
seizures
hematologic
superinfection with Candida spp.
pennicillan Drug Interactions
tetracycline, chloramphenicol
Uricosuric agents
aminoglycosides
oral contraceptives:
Beta Lactamase Inhibitors:
clavulanic acid, sulbactam, tazobactam
Beta Lactamase Inhibitors: MOA
Agents which have little or no antibacterial activity but bind to beta lactamase (penicillinase)
Cephalosporins
Mechanism of Action: same as penicillins
MOR: bacterial production of beta lactamase which may cleave the beta lactam ring OR may bind to the drug preventing its access to target proteins
1st generation cephalosporins (FGC)
Cefazolin
Cephalexin*
Cefadroxil
-good activity against gram positive organisms
-good activity against E. coli, K. pneumoniae, and P. mirabilis but less active against other gram negative organisms
2nd generation cephalosporins (SGC)
Cefpodoxime*
Cefuroxime
Cefuroxime axetil*
Cefaclor*
Cefprozil*
Loracarbef*
Defdinir
anti anaerobic-Cefoxitin,Cefotetan
2nd generation cephalosporins (SGC) activity
1)good activity against gram positive organisms but less active than 1st generation cephalosporins
2)good activity against gram negative organisms covered by FGC plus H. influenzae, but less active than 3rd generation cephalosporins
3)active against a variety of anaerobic bacteria including B. fragilis (cefoxitin and cefotetan only)
3rd generation cephalosporins (TGC)
Cefotaxime
Ceftriaxone
Ceftizoxime
Cefoperazone
Cefixime*
Ceftibuten*
Anti pseudomonas:
Ceftazidime
1)some activity against gram positive organisms but less active than 1st and 2nd generation cephalosporins
2)very active against a wide variety of gram negative bacteria including Enterobacter, Serratia, and other species generally resistant to FGC and SGC
3)activity against P. aeruginosa (cefoperazone and ceftazidime only)
4th generation cephalosporins
Cefepime
1)good activity against gram positive organisms; exception: methicillin resistant Staph. aureus and methicillin-resistant Staph. epidermidis, enterococcus
2)very active against a wide variety of gram negative bacteria including Enterobacter, Serratia, and other species generally resistant to FGC and SGC
3)activity against P. aeruginosa
BBB
only 3rd generation cephalosporins and cefuroxime can penetrate the cerebrospinal fluid (better penetration with inflamed meninges)
FGC treatment of
staphylococcal and streptococcal infections in penicillin-allergic patients, otitis media, urinary tract, respiratory tract, skin and soft tissue infections
SGC treatment of
respiratory tract infections involving beta lactamase producing H. influenzae, skin and soft tissue, urinary tract, CNS (cefuroxime only), and abdominal infections
TGC treatment of
lower respiratory tract, skin and skin structure, complicated or uncomplicated urinary tract, gynecologic, intra abdominal, and bone and joint infections, CNS infections (not cefoperazone and cefixime)
Carbapenems
Imipenem/Cilastatin (Primaxin®) and Meropenem (Merrem®)
Ertapenem (Invanz®)
Ertapenem (Invanz®)
Mechanism of Action: bactericidal
Resistant to most beta lactamases
broad spectrum
Imipenem/Cilastatin (Primaxin®) and Meropenem (Merrem®)
bactericidal
Resistant to most beta lactamases
very broad spectrum
Aztreonam (Azactam®): monobactam
similar to beta lactams
No activity against gram positive or anaerobic bacteria