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Gram positive stain color
Gram negative stain color
gram positive aerobes
gram positive anaerobes
Intracellular bacteria have no ____?
Examples of protozoa with antibacterial susceptibility
Gram negative anaerobes
bacteroides- below belt, usually peritoneal or gynecological
Protozoa with limited susceptibility
Gram positive are ____ soluble
gram negative are ____ soluble
Side effects of all antibiotics
KNOW FOR TEST
- superinfection- broad spectrum, higher risk
- ex-oral candidis, yeast infection, c-diff
- -gi upset
- - allergy
SE of FQ and Macrolides
prolong QT interval
SE of beta-lactams and FQ
SE - FQ, Sulfa, Tetracycline
SE- FQ and tetracylcine
SE- AG and IV vanco
SE IV Vanc
red mans syndrome
drugs that are safe with renal impairment
kill the organism, but the organism must be growing generally
inhibit growth, allowing host responses to overcome infection
Cell wall active drugs (generally bactericidal)
- Beta lactams:
- PCN derivatives
- Cephalosporins (1st and 3rd generation better for gram + drugs) 2nd generation better for gram - drugs
anti staph drug DOC
oral dicloxacillin (beta-lactam)
Protein synthesis inhibitors
- macrolide (static)
- clindamycin (static)
- linezolid (static)
- aminoglycosides (cidal)
- tetracyclines (static)
sulfamethoxazole/trimethroprim- septra or bactrim
fluoroquinolones- cipro, levaquin, avelox
bacteriostatic antibiotics are _______ spectrum
# 1 way to prevent spread of infection
don't have sx
PCN drugs are bactericidal so bacteria must be ______ in order to kill them
Beta lactams will not work if bacteria does not have _____?
- cell wall.
- will not kill pnemonia
Drug that is contradicted in neonates because it can displace bilirubin and cause kenicterus
way to remember anti staph drugs
ox, diclox, meth, naf all antistaph
If pregnant women has syphilis and has an allergy to PCN what do you treat her with?
PCN just desensitize her first.
Empiric therapy is for how long?
TX based on
Get cultures on front end and then start antibiotic asap
- likely pathogens, local susceptibility trends, and patient specific factors, (allergies, organ dysfunction)
- Broad coverage antibiotics until specific pathogen is identified.
Definitive tx with antibiotics
- identify organism (microbiology, or serologic testing)
- Use most effective, least toxic, narrowest spectrum, and most cost effective agent
- (may be a combination of drugs)
Penicillin benzathine procaine
Know for test
pcn benz procaine- treats strept pharyngitis, has local antisthetic effect
pcn benz- used to treat syphillis
First line tx for AOM and neonatal meningitis
aminopenicllins (ampicillin, or amoxicillin)
First line cephalosporin
Tx's gram + or gram - ?
2nd generation cephalosporins
- better for gram -, some anaerobes, less gram+
- cefuroxime (ceftin)
- tx- early lyme disease
- aom/ uri
compound was originally isolated from a microorganism
first line tx c-diff
What to do with expired tetracyclines
SE of tetracycline
don't give to kids under 8 years b/c stains teeth
aminoglycosides enter through where?
Give what with if treating gram + bacteria
enter through pores in gram negative cell wall
Have to give with betalactam if gram + so it can break down cell wall first.
aerobic gram negative, give with cell wall agent if gram +
clindamycin (above the belt) does not work on
what abx stains contact lenses orange and makes body fluids orange
do not use rifampin alone, it is only used alone ______
Food or drug interaction with Flagyl
- no ETOH for 72 hours after tx.
- will make them very sick- called disulfiram reaction
gram positive that is not a coccus
Drugs with cell wall synthesis
- beta lactams- pcn, cephalosporins
Nitrofurantoin (Macrobid, macrodantin)
Drugs that inhibit DNA replication
Drugs that inhibit RNA synthesis
Drugs that inibit protein synthesis (50S) ribosome
Drugs that inhibit protein synthesis (30S) ribosomes
Drugs that are antimetabolites
Cells must be actively growing for _____?
penicillin to do the killing
What organisms are resistant to beta-lactams
organisms without cell walls
Do not use ___ to treat mononucleosis
amoxicillin, will cause rash
Most beta lactams are ____ cleared?
with the exception of ______
ceftriaxone (rocephin)- undergoes biliary elimination (causes kernicterus in neonates)
3rd line cephalosporin
IV/IM ceftriaxone- rocephin
- CAP- community acquired pnemonia
bacteriostatic, or cidal?
narrow or broad spectrum
tetracycline (PO), doxycycline (IV or PO), minocycline (IV or PO).
broad spectrum- many gram +, gram -, toxin secreters (cholera), rickettsia, sphirochetes, mycoplasma, and chlamydia (intracellular)
Often effective against community acquired MRSA
First line tx for COPD exacerbation
cidal or static ?
requires what to work?
Gentamycin, Neomycin, streptomycin,
MOA-binds to irreversibly to a site of 30S subunit, preventing inhibition of protein synthesis, leading to cell death.
requires 02, will not work against anaerobic infections.
- aerobic gram negative, including pseudomonas
- Give with cell wall agent (beta lactam) if gram +
Azithromycin (Zithromax), clarithromycin, erythromycin
MOA- bind to 50S ribosome subunit, inhibit peptidyl transferase and blocks release of peptide chain
Spectrum- some gram +, gram -, and intracellulars, h pylori
2nd line tx for c-diff
Adverse effects of macrolides (Zithromax, clarithromycin)
- diarrhea, cramping
MOA- binds with 50S, preventing translocation
Spectrum- gram +, some gram -, including anaerobes, but NOT c-diff
Tx's stuff above the belt, ie- skin infections with pcn allergy.
Cleared hepatically so safe in renal impaired
Treatment for VRE
Linezolid (zyvox) - Macrolide
Don't want to get linezolid resistance because VRE is very hard to treat
Head ache, thrombocytopenia, neuropathy
Don't take quinolones or flouroquinolones if .....
pregnant or with a glass of milk
- cipro- usually tx gram -
- Moxiflox- covers bacteroides (a below the belt anaerobe) but does not achieve urinary levels
adverse effects of FQ
- QT prolongation
Folate antagonists drugs
- sulfonamides- sulfa, silvadene, sulfadoxine
- DHFR inhibitors- Pyrimehtamine (malaria), trimethoprim
- Pneumocystis jiroveci
Adverse effects of folate antagonists
- Steven Johnson syndrome
- LOTS OF SE
Rifampin- drug that interferes with RNA polymerase
MOA- form very stable complex with RNA polymerase. low affinity for human enzyme
Spectrum- love to kill bacteria in the phagasome- very broad including mycobacterium
- USE- monotherapy is only for prophylaxis for meningitis
- Combo tx for tb, leprosy, bone infections
- Adverse effects- body fluids orange/red
- hepatotoxic, flu like hypersensitivity, many drug interactions (decrease effectiveness of oral contraceptives)
Flagyl (metronidazole) (below the belt)
spectrum: protozoa, anaerobes, h pylori, FIRST LINE FOR C-DIFF, diverticulitis.
- Adverse effects- neurotoxic effects- ototoxicity, and neuropathy.
- NO alcohol within 72 hours of treatment, will make patient deathly ill.
Nitrofurantoin (Macrobid and Macrodantin)
- spectrum- e coli, enterococci
- ONLY TX LOCAL CYSTITIS
AE- pneumonitits, pulmonary fibrosis, neurotoxicity.
Drugs for TB
- never monotherapy for active infection
- ethambutol- test for color blindness before use
- ALL THESE DRUGS ARE HEPATOTOXIC
Tx for vaginal candidis
oral fluconazole (diflucan)
Drug for viral herpes
Acyclovir and valacyclovir
Remember hydration, hydration, hydration
What is dual tropism
- can use both doors to enter cell!!
- Assess for this when treating HIV
What is used to reduce odds of passing HIV from mother to newborn
Zidovidine- used during labor and delivery as prophylaxis for maternal to fetal transmission
Treatment for HIV
- highly active antiretroviral therapy
- -partial therapy and non compliance causes resistance.
If you discontinue these drugs you must consider the half life of each drug
Don't use rifampin with these drugs (enzyme inducer)