• staph
• strep
• enterococcus:  most difficult to kill

gram -

cocci & cocco-bacilli

• H. flu

• Neisseria

• Moraxella catarrhalis

EKP

E. coli

Klebsiella

Proteus

ESP

Enterobacter

Serratia

Providencia

most difficult gram -

has a "group" all to itself

acute otitis media

-S. pneumoniae (+)

-H. flu (-)

-M. catarrhalis (-)

-S. pneumoniae

-H. flu

-M. catarrhalis

-S. pneumoniae

-H. flu

-M. catarrhalis

-fungus?

-S. pneumoniae (+)

-Staph (+)

-H. flu (-)

-Pseudomonas (-)

-Mycoplasma (misc)

-S. pneumoniae (+)

-Neisseria meningitis (-)

-H. flu (-)

-Staph (+)

-Enterococcus (+)

-E. coli (- EKB)

-Klebsiella (- EKB)

-Pseudomonas (-)

-Enterococcus (Entc) (+)

-E.coli (- EKP)

-Klebsiella (-EKP)

-Proteus (- EKP)

normal WBC

and what is inc WBC with left shift

4,500-10,000cells/mm3

increase in immature neutrophils- bands

tests for non-specific signs of inflammation

note:  these are often increases in non-infectious conditions like collagen vascular disease or arthritis

ESR:  erythrocyte sedimentation rate

"how far RBCs fall in 1 hour"

CRP:  C-reactive protein

normal 0.5-1

moderate inflammation 1.0-1.5

suggestive of infection >10

-decreased perm- porin channels close

-drug efflux- ab in but pumped right out

-drug inact- bacteria make enzymes that inactivate ab

-altered target- ab cannot get to ribosomes to inhibit replication

concentration-dependent killing rate

CDKR

more bacteria killed at higher concentrations of antibiotics

exhibit:  some aminoglycosides and fluoroquinolones

not exhibit:  penicillins and other B-lactam antibiotics

postantibiotic effect

PAE

persistent effect of an antibiotic on bacterial growth after antibiotic removed from a bacterial culture

-most bactericidal antibiotics (penicillins)

-allows for less frequent dosing

1.  narrow spectrum/natural

2.  penicilinase-resistant PCNs (anti-Staph penicillins)

3.  extended spectrum PCNs

-amino-PCNs

-anti-Pseudomonal PCNs

DOC for strep pharyngitis

include dose

Penicillin V potassium (Pen VK)

500mg BID X 10days

PCN V (PO)

PCN G:  not used often (IV, IM, PO)

Nafcillin

Dicloxacillin

amoxicillin (PO)

ampicillin (IV, IM, PO)

amoxicillin/clavulanate (Augmentin)

ampicillin/sulbactam (Unasyn)

clavulanate is NOT an abx (NOT to inhibit cell wall formation), it's role is only to inhibit the b-lactamase enzyme

clav acid also tends to cause diarrhea

Ticarcillin

Piperacillin

piperacillin-tazobactam (Zosyn)

Ticarcillin-clav (Timentin)

both IV

empiric broad spectrum coverage w/wo other abx

Piperacillin-tazobactam (Zosyn)

Ticarcillin-clav (Timentin)

rash, diarrhea (d/t lower bio-availability... greater risk for gi problems) 

rarely:  anaphylaxis, increased LFTs, interstitial nephritis

seizures w/ high doses

neutropenia, thrombocytopenia

PCNs and S. pneumo

discuss clinical issue

it is becoming increasingly resistant to PCN

-time above MIC is critical to PCNs clinical success

-frequent dosing, possibly cont. infusion

sensitive:  MIC</ 0.06

intrm:  MIC 0.12-1.0

resistant:  MIC >/ 2.0

maculopapular rash w/ mono, chronic lymphocytic leukemia, allopurinol

NOT A TRUE PCN ALLERGY

do not want to give amox/amp, but other PCN may be OK