Term
| Drug related factors- antibiotic selection |
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Definition
| Efficacy (susceptibility testing, look at MIC); Toxicity; Cost and Convenience |
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|
Term
| Patient Factors (abx selection) |
|
Definition
| Age; underlying disease; immune status (HIV- need stronger abx); foreign bodies (catheters); hyoersensitivity/angioedema; pregnancy (hormonal, pharmacokinetic changes) |
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Term
|
Definition
| Determine most likely causative organisms: (pt history, physical exam, recent travel, activities); community vs hospital acquired, primary site of infection, gram stain results, patient age, prevalence of organisms in specific institutions |
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Term
|
Definition
| Actual txt after organism identified: blood, sputum, urine, and wound cultures; narrow the spectrum of coverage; pathogen vs contaminant |
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Term
|
Definition
| Polymicrobial infections/initial empiric therapy; immunocompromised pts; decreased dose required for decreased risk of toxicity (was for ampB); synergistic activity: pseudomonal infections (2 drugs: aminoglycosides and zosyn, ceftazidine, cefipine; enterococcal infections (gentamicin and ampicillin); mycobacyerium- tuberculosis ( 4 drugs usually needed); |
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|
Term
| Mechanisms of bacterial resistance |
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Definition
| Beta lactamase enzymes; reduced permeability; alteration of PBPs; efflux pumps |
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|
Term
| Factors that may contribute to development of resistance |
|
Definition
| Inappropriate abx usage; suboptimal concentration of abx; prolonged antimicrobial stress |
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|
Term
|
Definition
| Broth dilution containing the lowest concentration of antibiotic that is able to inhibit growth/turbidity (last clear tube) |
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|
Term
|
Definition
| The lowest concentration of antibiotic that actually kills (not merely inhibits) 99.9% of the bacteria (last clear plate) |
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|
Term
| Agar Diffusion Method (Kirby-Bauer) |
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Definition
| Plates are seeded with a lawn of bacteria- paper discs containing specific antibiotic are dropped onto the plate . The zone of clearing do to inhibition corresponds with the MIC |
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|
Term
|
Definition
| Impregnated with gradient concent of the antibiotics are placed on a lawn of bacteria. The elliptical clearing intersects the strip at the MIC |
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Term
| Enzymatic bacterial resistance: hydrolytic (beta lactamase) |
|
Definition
| Beta lactams: penicillins and cephalosporins |
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|
Term
| Enzymatic bacterial resistance: modifying enzymes (acetylation, adenylation, phosphorylation) |
|
Definition
| Aminoglycosides, chloramphenicol |
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|
Term
| Decreased permeability (bacterial resistance) |
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Definition
| Aminoglycosides, quinolones, beta lactams, TMP, chloramphenicol |
|
|
Term
| Increased efflux ( bacterial resistance) |
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Definition
| Tetracyclines, macrolides, quinolones |
|
|
Term
| Altered target sites: penicillin binding proteins (PBP) |
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Definition
|
|
Term
| Altered target sites: DNA gyrase |
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Definition
|
|
Term
| Altered target sites: ribosomal RNA |
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Definition
|
|
Term
| Altered target sites: RNA poltmerase |
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Definition
|
|
Term
| Altered target site: enzyme target |
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Definition
|
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Term
|
Definition
| S. Aureus; coag-negative staph (s. Epidermidis, s. Saprophyticus, s. Haemolyticus); s. Pyogenes, s. Agalactiae, s. Bovis/s. Equinis, e. Faecalis/e. Faecium; s. Pneumoniae; viridans streptococci |
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|
Term
|
Definition
| Listeria monocytogenes; bacillus anthracis; Corynebacterium diphtheriae; mycobacterium; nocardia |
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Term
|
Definition
| Neisseria gonorrhoeae; neisseria meningitis; moraxella catarrhalis |
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|
Term
|
Definition
| Enterobacteriacae family; pseudomonas aeruginosa; strentotrophomonas maltophilia; haemophilus influenza; legionella pneumophilia; mycoplasma pneumoniae; acinetobacter; campylobacter; eikenella/pasturella |
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Term
|
Definition
| Peptostreptococcus; veillonella; clostridium difficile; clostridium perfringes; clostridium tetani; clostridium botulinum; propionibacterium; bacteroides fragilis |
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Term
|
Definition
| Coagulase-positive: roughly 50% are MRSA- use vancomycin- threat of VRSA and/or VISA |
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Term
| S. Epidermis, S. Saprophyticus, S. Haemolyticus |
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Definition
| Coagulase-negative staph; roughly 50-70% are methicillin-resistant - use vancomycin |
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Term
|
Definition
| S. pyogenes- pharyngitis, scarlet fever, otitis, skin |
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Term
|
Definition
| S. agalactiae- neonates, otitis media |
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|
Term
|
Definition
| non-enterococci- S. bovis/S. equinis; enterococci- E. faecalis/E. faecium |
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|
Term
|
Definition
| May produce toxins which can result in rapid invasive infections |
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|
Term
|
Definition
| Tend to be very susceptible to PCN or any of the beta lactams, macrolides, sulfas |
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|
Term
| Non enterococci (s. bovis/s. equinis) |
|
Definition
| Not frequently encountered clinically |
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|
Term
| Enterococci (e. faecalis/s. faecium) |
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Definition
| Can cause UTIs, bacteremi, endocarditis and others; standard therapy is synergistic combination with ampicillin plus gentamicin |
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Term
| S. Pneumonia (pneumococcus/diplococcus) |
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Definition
| Most commonly encountered bug in the community setting; causes both upper and lower respiratory tract, CNS infections and others. PCN was doc but increase in resistance |
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|
Term
| Intermediate level of PCN resistance |
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Definition
| Beta lactams still work, higher doses (cefotaxime) (MIC 0.1-1) |
|
|
Term
| High level of PCN resistance |
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Definition
| Rely on vanco/imipenem/quinolone (MIC > 2) |
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|
Term
| Viridans streptococci (consists of several species) |
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Definition
| Mostly encountered in endocarditis; usually treat synergistically with PCN plus gentamicin |
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|
Term
|
Definition
| Causes anthrax in livestock; bioterrorism: cipro, PCN, doxycycline |
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|
Term
|
Definition
| Causes meningitis in immunocompromised/cancer patients; therapy of choice: ampicillin +/- gentamicin |
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|
Term
| Corynebacterium diphtheriae (diphtheroids or diphtheria) |
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Definition
| Part of the normal flora of the skin and a frequent contaminant of blood cultures; infections treated with PCN or erythromycin (+/- anti-toxin for cases of diphtheria) |
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|
Term
| Mycobacterium (acid fast bacilli) |
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Definition
| Genus responsible for many infections (tuberculosis, MAI in AIDS patients, leprosy, etc) ; tend to be difficult to treat; |
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|
Term
|
Definition
| Treat with combo therapy: rifampin, INH, ethambutol, pyrazinamide, others |
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|
Term
|
Definition
| Common opportunistic infection in HIV - clarithro, ethambutol and rifampin |
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|
Term
|
Definition
| Soil bug that can cause significant pneumonia- TMP/SMX is drug of choice |
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|
Term
|
Definition
| Causative bug in the STD gonorrhea and joint infections, also referred to as gonococcus; increasing number are penicillinase producing (PPNG); single IM dose is now DOC due to PPNG, 50% of pts also have chlamydial infections and need azithromycin or dozycycline |
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|
Term
|
Definition
| Purplish lesions associated with infections; parenteral PCN is DOC, ceftriaxone as alternative |
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|
Term
|
Definition
| Usually seen in respiratory infections; majority of strains are beta lactamase producing; use augmentin, septra, 2-3rd gen oral cephs, macrolides |
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|
Term
|
Definition
| Citrobacter, enterobacter, e. Coli, klebsiella, morganella, proteus, providencia, shigella, salmonella, serratia, yersinia |
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|
Term
|
Definition
| One of the most significant hospital acquired organism; typically rely on synergistic coverage with tobramycin and ceftazidime ( or anti-Ps PCN) |
|
|
Term
| Stenotrophomonas maltophilia |
|
Definition
| More colonizer vs true pathogen- tends to develop resistance rapidly; TMP/SMX, minocycline, and +/- ticarcillin/clavulanate are considered DOC |
|
|
Term
|
Definition
| 40% resistant to ampicillin so beta lactamase needed; for significant hospital acquired infections consider 3rd gen ceph |
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|
Term
|
Definition
| Causative agent in legionnaires disease; macrolides preferred (+/- rifampin), TMP/SMX and quinolones are alternatives |
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|
Term
|
Definition
| Fairly common in children and young adults with CAP; similar to Legionella, macrolides preferred or perhaps doxycycline |
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|
Term
|
Definition
| Hospital acquired bug involved in bacteremia/pbeumonia; use imipenem |
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|
Term
|
Definition
| Important in GI infections; use macrolides or possibly quinolones |
|
|
Term
|
Definition
| Infections involving human/cat bites, respectively; use IV PCN |
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|
Term
|
Definition
| Infections of the genitourinary tract and wounds; PCN works well |
|
|
Term
|
Definition
| Mouth flora that can cause dental infections; PCN works well |
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|
Term
|
Definition
| Causes antibiotic associated pseudomembraneous colitis; oral Flagyl |
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|
Term
|
Definition
| Causes gas-gangrene and food poisoning; IV PCN +/- clindamycin |
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|
Term
|
Definition
| Causes tetanus or lockjaw; IV PCN or doxycycline (vaccinate) |
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|
Term
|
Definition
| Causes botulism, treat with anti-toxin (no role for abx) |
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|
Term
|
Definition
| Causes acne, treat with either PCN or clindamycin, oral or topical |
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|
Term
|
Definition
| Most significant of the anaerobic infections, frequently seen with abcesses; PCN = NO good, rely on Flagyl, clindamycin, 2nd generation, Unasyn or zosyn +/- imipenem |
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|
Term
| 25-40% of Haemophilus influenza |
|
Definition
|
|
Term
| Virtually 100% staphylococcus aureus |
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Definition
|
|
Term
| 50% of staphylcoccus aureus |
|
Definition
| Resistant to methicillin (MRSA) ; varies with institution |
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|
Term
| 50-70% of coagulase-negative staphylococci |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Drug of choice for infections involving MRSA and coagulase negative staph |
|
Definition
|
|
Term
| Enterococcus should preferably be treated with a combo of beta lactation and aminoglycoside |
|
Definition
| Usually ampicillin (or vancomycin) and gentamicin |
|
|
Term
| Preferred parenteral 1st gen cephalosporin due to longer half life |
|
Definition
|
|
Term
| Cephalosporin with longest half life and once daily indication but tends to be overused to a significant extent |
|
Definition
|
|
Term
| Should be only cephs considered for treating meningeal (CNS) infections |
|
Definition
|
|
Term
| Undergo biliary excretion and therefore cause biliary sludge |
|
Definition
| Ceftriaxone and cefoperazone |
|
|
Term
| the only cephalosporins with a 3-methiotetrazole substitution, which is likely responsible for both the coagulation problems observed with cephalosporins and the disulfiram reaction that can occur |
|
Definition
| Cefamandol, cefoperazone, moxalactam, cefmetazole and cefotetan |
|
|
Term
| of the currently available 3rd generation cephalosporins, only one with an active metabolite |
|
Definition
|
|
Term
| of currently available cephalosporins, only these should be considered adequate coverage of Bacteroides fragilis infections |
|
Definition
| cefoxitin, moxalactam, cefmetazole and cefotetan |
|
|
Term
| provide adequate coverage for Bacteroides fragilis infections |
|
Definition
| Clindamycin, metronidazole, imipenem/cilastatin, piperacillin/tazobactam, ampicillin/sulbactam and ticarcillin/clavulanate |
|
|
Term
| of the currently available cephalosporins, this should be used to treat infections involving penicillinase producing Neisseria gonorrheae (PPNG) |
|
Definition
|
|
Term
| currently available cephalosporins considered adequate for treating Listeria infections- especially CNS infections |
|
Definition
|
|
Term
| drug of choice for Listeria infections |
|
Definition
|
|
Term
| Haemophilus influenza, Streptococcus pneumoniae, and Moraxella catarrhalis |
|
Definition
| most common bacteria encountered in community acquired infections- especially upper respiratory |
|
|
Term
| Haemophilus influenza and Moraxella catarrhalis |
|
Definition
| common beta lactamase producers |
|
|
Term
| effective against the "atypical" respiratory pathogens: Chlamydia pneumoniae, Mycoplasma pneumoniae, and Legionella pneumophilia |
|
Definition
|
|
Term
| had the broadest spectrum of activity relative to all other antibiotics |
|
Definition
|
|
Term
| most frequently seen in Enterobacter cloacae, Pseudomonas aeruginosa, Citrobacter, Serratia, Proteus and Acinetobacter |
|
Definition
| Type I beta-lactamase productions |
|
|
Term
| have greater gram-positive activity compared to ciprofloxacine; however their activity against Pseudomonas is not as good compared to ciprofloxacin |
|
Definition
| Levofloxacin and newer quinolone agents (moxifloxacin, gatifloxacin and gemifloxacin) |
|
|
Term
| potentially hepatotoxic quinolone and is limited to severe, life-threatening infections |
|
Definition
|
|
Term
| should be reserved for patients unable to take meds orally or patients with compromised absorption from the GI tract |
|
Definition
| IV formulations of fluoroquinolones |
|
|
Term
| associated with hypo- and hyperglycemia, particularly in diabetic patients and is no longer available on the market |
|
Definition
|
|
Term
| Newer antibiotics targeted at resistant gram (+) infections like MRSA, VRE, resistant pneumococci include: |
|
Definition
| linezolid (Zyvox) an oxazolidinone abx, daptomycin (Cubicin) a lipopeptide agent; and tigecycline (GAR-936 or Tygacil) a glycylcycline abx |
|
|
Term
| Initial Empiric CAP Therapy- Outpatient: previously healthy, no prior abx therapy |
|
Definition
|
|
Term
| Initial Empiric CAP Therapy- Outpatient: Previously healthy with recent antibiotic: |
|
Definition
| fluoroquinolone alone OR new macrolide PLUS high-dose amox/Aug |
|
|
Term
| Initial Empiric CAP Therapy- Outpatient: comorbidities (COPD, CHF, diabetes, CA) |
|
Definition
| new macrolides or fluoroquinnolone |
|
|
Term
| Initial Empiric CAP Therapy- Outpatient: comorbidities with recent abx |
|
Definition
| fluoroquinolone alone OR new macrolide PLUS high-dose amox/Aug |
|
|
Term
| Initial Empiric CAP Therapy- Outpatient: suspected aspiration |
|
Definition
| amox/Clavulanate OR clindamycin |
|
|
Term
| Initial Empiric CAP Therapy- Inpatient: General medical ward- no prior antibiotics |
|
Definition
| fluoroquinolone alone OR new macrolides plus cefotaxime, ceftriaxone, or amp/sulbactam |
|
|
Term
| Initial Empiric CAP Therapy-Inpatient: Medical ward with recent antibiotics |
|
Definition
| fluoquinolone alone Or new macrolide PLUS cefotaxime, ceftriaxone, or amp/sulbactam--- but therapy is dependent on the prior abx used in the patient |
|
|
Term
| Initial Empiric CAP Therapy- Inpatient: ICU- Pseudomonas is unlikely |
|
Definition
| cefotaxime, ceftriaxone, or amp/sulbactam PLUS new macrolides or a fluoroquinolone (B-lactam allergy: fluoroquinolone +/- clindamycin) |
|
|
Term
| Initial Empiric CAP Therapy- Inaptient: ICU- Pseudomonas Likely |
|
Definition
| anti-Pseudomonal agent PLUS ciprofloxacin OR anti-pseudomonal agent PLUS aminoglycoside PLUS either a fluoroquinolone or a macrolide ( beta-lactam allergy: use aztreonam in place of beta-lactam) |
|
|
Term
| Initial Empiric CAP Therapy- Inpatient: Nursing home patient |
|
Definition
| fluoroquinolone alone OR new macrolide PLUS amox/clavulanate |
|
|
Term
| Initial Empiric CAP Therapy- Inpatient: Hospitalized nursing home patient |
|
Definition
| same as medical ward or ICU patients |
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|
