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89 Cards in this Set
- Front
- Back
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what are the antibiotics that depend on time-dependant killing?
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beta-lactams, glycopeptides(vancomycin)
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what are the antibiotics that depend on concentration dependent killing?
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aminoglycosides, fluoroquinolones
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postantibiotic effect(PAE) is longer for gram ____ bacteria(especially these 2 antibiotics)
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gram negative; fluoroquinolones, aminoglycosides
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when you have renal failure, reduce dose and use caution in these 2 antibiotics
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beta lactams, aminoglycosides
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when you have liver failure, caution with _________ and avoid____________
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erythromycin/clindamycin; tetracycline
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drugs that cause anaphylaxis
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penicillin, cephalosporins
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drugs tht cause photosensitivity
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tetracycline,FQ,sulfa, TMP
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if you have incresed eosinophils you are infected with
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parasites
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increased levels of lymphocytes means
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you are infected with viral infections and TB
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increased granulocytes means presence of ____________ infection
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bacterial, fungal
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3 routes microorganisms gain access to LRT
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1. aspiration of oropharyngeal contents(most common)
2. inhalation of aerosol particles 3. via bloodstrem from extrapulmonary site of infection |
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pneumonia is defined by acute infection of pulmonary parenchyma(lung,alveoli) accompanied by _________ and _________
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more than one symptom of acute infection; acute infiltrate on chest X-ray or auscultation findings consistent with pneumonia
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in pneumonia, theres a predominance of ________, a WBC
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neutrophils
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how does pneumonia cause dehydration
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repiratory losses of fluids due to increase in RR
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classic aspiration pneumonias primarily affect the right/left lobs
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right
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what is a rapid, early test to identify potentil etiologic organisms for pneumonia?
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sputum gram stain
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how do you know when you have adequate specimen?
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when >25 neutrophils, <10 epithelial cells per LPF
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what is the hallmark of infection?
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neutrophils(PMNs)
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what exam is performed in all pts suspected of having pneumonia?
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Chest x-ray
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what are some dignostic guidelines for pneumonia?
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history
*RR>30-impt indicator of severe pneumonia physical examination CXR CBC/differential arterial blood gas sputum gram stain and culture blood culture serology transtracheal aspiration |
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for pneumonia diagnosis, pts admitted to ICU should have urine tested for ______-
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Legionella antigen test
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this organism is the most common cause of pneumonia
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s. pneumonia
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what are the 3 atypical pathogens?
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1. Mycoplasma pneumoniae
2. chlamydia pneumoniae 3. Legionella spp. |
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how is pneumonia caused by atypical pathogens different?
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1. get sick over time
2. low grade fever, dry cough, WBC count may be normal 3. doesnt kill people. |
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wht are the organisms that cause pneumonia in outpatients in the order of most common?
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s. pneumoniae>m. pneumoniae>H. influenzae>c.pneumoniae
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what are the organisms that cause pneumonia in inpatients(non-ICU)?
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s. pneumoniae>M. pneumoniae>c. pnemoniae>H. influenzae
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what are the organisms tht cause pneumonia in inpatients?(ICU)
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s. pneumoniae>s. aureus>legionella>gram- bacilli
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what are the MIC values(mg/L) for sensitive, intermediate, and resistant penicillin strains?
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<0.1
0.1-1 >2 |
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IDSA/ATS guidelines for empiric treatment for outpt(CAP) who is previously healthy
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macrolide or doxycycline
if intolerant to erythro, use clari |
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empiric treatment for outpt w/ co-morbid illness or use of abx in past 3 mths
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b-lactam(or cefuroxime) plus macrolide
or respiratory FQ |
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empiric treatment for inpt(non-ICU)
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beta lactam+macrolides(doxy as alternative)
or respiratory FQ |
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empiric treatment for inpt(ICU)
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beta lactam+macrolide(doxy as alternative)
or beta lactam+respiratory FQ |
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how do you know when one is clinically stable?
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-temperature decreases
-WBC count decreases -O2 level is good |
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what are effective abx for H. influenzae(g-), M. cattarhalis and why?
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beta lactams/beta lactamase inhibitor eg.amoxicillin/clavulanic acid
30% of strains produce beta lactamase FQ, 2/3 G cephalosporins |
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effective abx for K pneumonia
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empirical treatment with agents effective against g(-): extended spectrum penicillin(piperacilin), 3rd G cephlosporins(ceftriaxone), FQ, TMP/SMX
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abx for M pneumonia, C. pneumonia
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macrolide, doxicycline, FQ
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abx for Leginonell ppi
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high dose erythromycin, newer macrolide(azithro), FQ
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what 3 abx are not recommended for CAP?
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cephalexin, ciprofloxacin, TMP/SMX
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dosing for amox and amox/clvulanate for empiric treatment?
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amox: 1g TID
amx/clavulanate: 2g BID |
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when to switch from IV to oral?
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functioning GI tract
hemodynamically stable temp<37.8 HR<100 RR<24 SBP >90 mm Hg O2 sat 90% |
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abxfor pen non-resistant
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amoxicillin, pen G
alternative: macrolide, doxycycline, new FQ, cephalosporins, clindamycin |
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abx for pen resistant
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cefotaxime, ceftriaxone,
alternative: vancomycin, linezolide |
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abx for aerobic gram -
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2nd or 3rd generation cephalosporin, carbapenem
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abx for p aeruginosa
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anti-pseudomonal beta lactam+FQ or AMG
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list drugs that cover enterococcus(g+)
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penicllin, ampicillin/amox, ticarcillin, ticar/clav
carbpenems, aminoglycosides(as synergy), vancomycin, linezolid |
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list drugs that cover pseudomonas
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ticarcillin, ticar/clav
ceftazidime, cefepime carbpenems ciprofloxacin, aminoglycosides |
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spectrum of bacterial coverage of penicillin
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g(+) strep, enterococcus
anaerobes |
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bacterial coverge of ampicillin/amox
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g(+) strep, enterococcus
easy g(-) anaerobes |
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bacteril coverage of cloxacilin
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strep, staph
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bacterial coverage of piperacillin(ticarcillin) and piperacillin/tazo(ticarcillin/clav), carbapenems
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everything except MRSA
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1st g cephalosporins cover
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g(+) strep, staph
easy grm -ve(e coli, H influenzae) |
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2nd g cephalosporins cover
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g(+) strep, staph
easy grm -ve mouth anaerobe |
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3-4th g cephalosporins cover
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+/- strep, staph
easy/hard gram -ve, anaerobe |
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macrolides cover
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strep/staph,
easy gram -ve |
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FQs cover
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strep, easy grm -ve, space(no p) bugs
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cipro covers
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easy/hard gram -ve,
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aminoglycosides covers
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everything except strep and anaerobes
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clindamycin covers
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strep, staph, +/- MRSA, anaerobes
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tetracyclines cover
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strep, staph, easy g-, anaerobes
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vancomycin covers
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all g+
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TMP/SMX covers
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strep, staph, easy g-
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metronidazole
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anaerobes
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linezolid covers
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g+
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chloramphenicol covers
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strep, easy g-, space(except p), anaerobes
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what are the bugs that are gram +(4)
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streptococcus
staphylococcus MRSA enterococcus |
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what are the bugs tht are easy gram negative
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E coli
H influenzae |
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what are the hard gram negative bugs(SPACE)bugs
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Serratia
Pseudomonas Acinetobacter Citrobacter Enterobacter |
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what are the aerobes?
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bacteroides
peptostreptococcus p. melaninogenica |
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streptococcus pneumoniae is a normal flora of
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nasopharynx
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name of group A streptococci
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s. pyogenes or strep throat
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group A streptococci causes
infectious:______________ toxin mediated:_________ immune medited:_________ |
phrayngities/tonsillitis, cellulitis
TSS rheumatic fever |
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enterococcus is not treated by ________________
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cephalosporins
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enterococcus is a normal flora in _______, and thus causes infection such as __________
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GI/GU tract; UTI, intr-abdominal infections, meningitis
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what are the abx tht treat enterococci?
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penicillin, ampicillin,
pipercillin/tazo carbapenem aminoglycoside(synergy) vancomycin/linezolid |
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abx that treat MRSA
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aminoglycosides(syn)
vancomycin/linezolid |
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abx that treat staph
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cloxacillin(DOC)
piperacillin/tazo cephalosporins carbapenems macrolide, AMG(syn) clindamycine, tetra, vanco/linezolid, TMP/SMX |
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abx that treat strep
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pen(DOC) and all penicillins,
cephalosporins carbapenem, macrolide,FQ,clindamycin, tetracycline, van/linezolid, chloramphenicol |
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lactose non-fermentor(g- aerobic)
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Pseudomonas
Acinetobacter Salmonella Shigella |
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how do you differentiate lactose fermenter vs non-fermenter on the petri dish?
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fermenter: mucoid
non fermenter:non mucoid |
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SPACE bacteria
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Serratia
Pseudomonas Acinetobacter Citrobacter Enterobacter |
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how do you treat hard gram -(SPACE)
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highly resistant-use combination treatment with beta-lactam +FQ
beta-lactam+AMG use high doses |
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penicillin, ampicillin, cloxacillin are mainly for gram____
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positive
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what is the only FQ that works for pseudomonas
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ciprofloxacin
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abx against B. fragilus(bacteroides)
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cefoxitin, ceftizoxime
clindamycin, metronidazole imipenem piperacillin/tazobactam |
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3-4th g cephalosporins work better for gram___ and less for gram _____ than 1st g
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gram -; gram +
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what are the microbiologic tests?
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gram staining
serological tests molecular tests culture susceptibility testing |
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what is the test with rapid turn around time and acceptable sensitivity and specificity?>
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serological test
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which of the 3 susceptibility tests is now most commonly used for providing exact numbers?
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E-test
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what are the 3 susceptibility tests?
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disk diffusion assay, e-test, broth dilution
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