Term
| Do PCN's get into CSF or Cells |
|
Definition
Not usually, CSF only with inflamed meninges
No Intracellular penetration, add azithro or doxycylcine to get into cells |
|
|
Term
|
Definition
Renal T1/2B of Pen G is 30 min
Probenecid inhibits renal acid transport system which secretes pen G and increases t1/2B of Pen G |
|
|
Term
|
Definition
major det - penicilloic acid breakdown product + endogenous protein
minor det = penicillin or a metabolite + end protein |
|
|
Term
| Pen G administration and use |
|
Definition
Always I.v. b/c it is acid labile
do not use of staph aureus
DOC for B-hemolytic strep |
|
|
Term
| Treatment for Strep pneumo |
|
Definition
|
|
Term
|
Definition
| B-hemoytic streps Groups a,b,c,f, and G |
|
|
Term
|
Definition
| used to cover strep pneumo |
|
|
Term
|
Definition
| If Pen G Restistant, then also Cephalosporing Resistant. However at low levels of R use cefotaxime ceftriaxone and cefepime |
|
|
Term
| Treatment of Syphilis and Neis meningitides |
|
Definition
|
|
Term
|
Definition
active by p.o acid stable however low bioavailability
Use Amoxicillin instead
Group A strep kille dquickly by Pen G and pen VK |
|
|
Term
|
Definition
Procaine penicillin G and benzathine pen G -
Do NOT give I.V.
i.m. gives slow release |
|
|
Term
| used prophylactically to prevent group A strep in military recruits |
|
Definition
| Depot PCN's procain and benzathine |
|
|
Term
| Used to treat syphillus do to long duration |
|
Definition
benzathine pen G
not used for neurosyphillus |
|
|
Term
| MSSA infection godl standard treatment |
|
Definition
| oxacillin and nafcillin which are resistant to B-lactamase - but are still susceptible to binding site changes like in MRSA |
|
|
Term
|
Definition
| first B-lactamase resistant PCN, no longer available due to nephrotoxicity |
|
|
Term
|
Definition
|
|
Term
| Treatment of soft tissue infection by MSSA and susceptible strep infections SSTI's |
|
Definition
oxacillin nafcillin I.V.
dicloxacillin p.o. |
|
|
Term
| Dosage of oxacillin, nafcillin, dicloxacillin |
|
Definition
| q4h or q6h due to short half life |
|
|
Term
| outpatient treatment of SSTI's cause by MRSA |
|
Definition
| clindamycin, trimeth-sulfa, or doxycycline |
|
|
Term
| current inpatient regimen or SSTI's at UH |
|
Definition
doxycycline + cefazolin
cefazolin is added b/c doxycycline does not cover GBS |
|
|
Term
| Treatment of inpatient infections caused by MRSA |
|
Definition
|
|
Term
| Use of B-lactamase inhibitors |
|
Definition
| coadministration of an inhibitor of the B-lactamase protects these PCN's from inactiavtion |
|
|
Term
|
Definition
clavulanate
sulbactam
tazobactam |
|
|
Term
|
Definition
extended spectrum PCN's
ampicillin and amoxicillin
both destroyted by B-lactamase |
|
|
Term
| Aminopenicillin spectrum of activity |
|
Definition
bactericidal activity comparable to pen G
spectrum is extended to cover the gram (-) bugs E. coli and H. flu b/c these PCNs are better able to penetrate the outer mem brane of gram (-) bacteria |
|
|
Term
| Aminopenicillins are used in combination with what? Why? |
|
Definition
| Used in combination with B-lac inh like clav, sul, tazo, b/c they are not resistant to B-lactamases |
|
|
Term
| DOC for infections with Listeria spp. and Enterococcus spp. |
|
Definition
Ampicillin I.V.
others active against enterococcis are vanc, pen G, peracillin, doxy, tigecylin, linezolid, and daptomycin |
|
|
Term
| Are Ampicillina and Amoxicillin active against MRSA |
|
Definition
|
|
Term
| Administration of ampicillin |
|
Definition
| i.v. only b/c it causes diarrhea |
|
|
Term
| amoxicillin administaration |
|
Definition
| given po.o is not affected by the presence of food, often given with clavulanate which causes diarrhea |
|
|
Term
| antipseudomonal penicillins |
|
Definition
| designed to kill Pseudomonas aeruginosa, with activity against Enterobacter |
|
|
Term
| Antipseudomonal pnicillins given in combination with what? Why? |
|
Definition
| Given with aminoglycoside gentamicin due to resistance development |
|
|
Term
| Antipseudomonal treatement I.V. or P.O.? |
|
Definition
| IV only, no po equivalent |
|
|
Term
| What are teh anti-pseudomonal drugs? |
|
Definition
ticarcillin + clavulanate(TImentin)
piperacillin - the best PCN vs. Pseudom
piperacillin + tazobactam (Zosyn/piptazo) - best anti-pseudomonal should be reserved for ICU |
|
|
Term
| DOC for B-emolytic strep (group A, B, C, F and G) |
|
Definition
|
|
Term
| DOC for susceptible Strep pneumo |
|
Definition
|
|
Term
| DOC for meningococcal meningitis |
|
Definition
| use only pen G at higher doses |
|
|
Term
| DOC for MSSA - cellulities, abscesses, and other infectionsupt ot and including endocarditis and meningitis |
|
Definition
oxacillin or naficillon i.v. or
dicloxacillin - p.o. |
|
|
Term
| DOC for otitis media in children |
|
Definition
|
|
Term
| second line DOC for treatment of Otitis media |
|
Definition
| amoxicillin + clavulantate (Augmentin) |
|
|
Term
| DOC for inf cause by Pseudomonas and other nosocomial gram negatives |
|
Definition
|
|
Term
| Good MSSA and S. pneumo coverage |
|
Definition
| pip/tazo or ticarcillin + clavulanate |
|
|
Term
|
Definition
| pip/tazo, or ticarcillin + clavulante |
|
|
Term
|
Definition
| the same as PCN's but given I.v. only! and the broadset spectrum B-lactam ab drugs excetp for ertapenem |
|
|
Term
|
Definition
|
|
Term
|
Definition
| many nosocomial gram (-) rods, including Pseudomonas spp, anaerobes and gram (+) (very similar to spectrum of piptazo) |
|
|
Term
|
Definition
| worst B-lactams for the treatment of Pseudomonas infetions 50% of isolates develop resistance during terapy. Mut eliminates porins. |
|
|
Term
|
Definition
| Not hydrolyzed by most B-lactamases but are degraded by metallo B-lactamases. Klebsiella pneumo cabapenemase KPC enzyme is a huge problem. |
|
|
Term
|
Definition
Imipenem - given with renal DHP inhibitor cilastatin
meropenem - used for
ertapenem
doripenem |
|
|
Term
|
Definition
| causes seizures in high doses in patients with poor renal function and neuro surgical patients |
|
|
Term
|
Definition
| causes seizures in high doses in patients with poor renal function and neuro surgical patients |
|
|
Term
|
Definition
| used for meningitis b/c it is less likely to cause seizures. better for gram (-) bugs |
|
|
Term
|
Definition
| does not cover Pseudomonas, Acinetobacter or enterococci |
|
|
Term
| Indications for cabapenems |
|
Definition
| good tissu penetration, drugs of last resort for MDR bugs, given to patients who have failed pip-tazo or cefepime |
|
|
Term
| Febrile neutropenic patients DOC |
|
Definition
| pipericillin tazo or cefepime |
|
|
Term
| Carbapenem cross reactivity |
|
Definition
| allergic reactions occur in 10-15% of patients with a Pen allergy |
|
|
Term
| Aztreonam spectrum of activity and MOA |
|
Definition
MOA is same as PCNs
very good gram (-) activity including pseudomonas, comp to ceftazidime
NOT active against anaerobics and G+ |
|
|
Term
| Aztreonam specturm of activity is similar to? |
|
Definition
| Aminoglycosides such as gentamicin |
|
|
Term
| Cross Resistance of Aztreonam |
|
Definition
| cross resistance with many 3rd gen Cephalosporins especially ceftazidime and cefepime |
|
|
Term
| Clinical use of aztreonam |
|
Definition
I.V. only
little allergic cross reactivity with other B-lactams thus can be used in a patient with a PCN allergy for G(-) infections |
|
|
Term
|
Definition
same as PCN's
inhibit PG crosss linking by binding to the active site of the PBP's |
|
|
Term
| Resistance mechanism to Cephalosporins |
|
Definition
| same as PCN's changes in the PBP site, and some make cephalosporinases |
|
|
Term
| Cephalosporin Sceptrum of activity |
|
Definition
varies between generations
all are relatively resistant to hydrolysis by B-lactamases = broader spectrum
No activity against Enterococcus, Listeria, PCN R Strep Pneumo or MRSA |
|
|
Term
| DOC for surgical prophylaxis good tissue penetration and cheap, good for SSTI's |
|
Definition
|
|
Term
| Treats SSTIs, safe to use in pregnant women |
|
Definition
|
|
Term
| 1st generation cephalosporins |
|
Definition
cefazolin
cephalexin
cephradine |
|
|
Term
| 2nd generation Cephalosportins |
|
Definition
cefoxitin
cefotetan
cefuroxime
cefaclor |
|
|
Term
| The only two cephamycins which cover anaerobic bugs |
|
Definition
| cefoxitin and cefotetan I.V. ONLY |
|
|
Term
| Used to treat pedi and FP outpatients |
|
Definition
| P.O. cefuroxime and cefaclor |
|
|
Term
|
Definition
|
|
Term
| P.O. 2nd gen Cephalosportins |
|
Definition
|
|
Term
| 3rd gen I.V. Cephalosporins |
|
Definition
cefotaxime
cetriaxone
ceftzidime |
|
|
Term
| 3rd gen P.O. cephalosporins |
|
Definition
cefpodoxime
cefdinir
cefixime |
|
|
Term
|
Definition
|
|
Term
| 3rd gen drug that kills Pseudomonas |
|
Definition
|
|
Term
| Turns feces brick red in children |
|
Definition
|
|
Term
| 3rd gen cef for gonorrhea |
|
Definition
| cefixime not a good drug for Strep pneumo or MRSA |
|
|
Term
|
Definition
best against gram +
Proteus
E
coli
Klebsiella |
|
|
Term
|
Definition
gram(+), but add some gram (-) and anaerobes(only cefoxitin and cefotetan
Hen Peck
Haemophilus
enteroBacter
Neiserria
+1st gen PEcK |
|
|
Term
|
Definition
| increased gram (-) at the expense of gram + coverage (esp. MRSA) |
|
|
Term
| Can you use a 3G Ceph to treat MRSA |
|
Definition
|
|
Term
|
Definition
| moderate G+ and excellent G(-) activity |
|
|
Term
| Do cephalosporins enter cells? |
|
Definition
|
|
Term
| Do Cephalosporins enter CNS |
|
Definition
| Yes, with ceftazidime, ceftriaxone, cefotaxime, and cefepime |
|
|
Term
| Elimination of cephalosporins is mostly by |
|
Definition
| renal so decrease the does with impaired renal fxn. and diabetes |
|
|
Term
| Cephalosporing cross reactivity in patients with allergy to PCN's |
|
Definition
as the generation goes up, the allergic cross reactivity does down
significant cross reactivity btween 1st gen cephalosporins and PCNs, less between 3rd and 4th |
|
|
Term
|
Definition
| uncommon but can occur when the drugs, esp ceoxitin are gien by i.v. push |
|
|
Term
| Is superinfection common in treatement with cephalosportins? |
|
Definition
| Yes, anything with a broad spectrum coverage will give superinfection |
|
|
Term
| The other Cephalosporin side effect |
|
Definition
prolongs prothrombin time causing bleeding
inhibit vit k epoxid red, most likely occurs with cfotetan |
|
|
Term
| Do cephalosporing cover enterococci or MRSA |
|
Definition
|
|
Term
| Coverage of 1st gen cephalosporing, i.v. cefazolin and p.o. cephalexin and cephadrine |
|
Definition
| cefaxolin is agreat gram + drug with little G(-) activity, better than vancomycin for MSSA |
|
|
Term
|
Definition
MSSA, streptococci except S. pneumo, and the gram (-) bugs E.coli, K pneumo, Proteus, and H. flu
Proteus
E.
coli
Klebsiella |
|
|
Term
| Only cephalosporin with significant activity against anaerobic bugs? |
|
Definition
| Cefoxitin and cefotetan 2nd gen cephs |
|
|
Term
| Used to trat pelvic inflammatory disease and intra-abdominal infections |
|
Definition
|
|
Term
| DOC for prophylaxis for intra-abdominal surgery |
|
Definition
|
|
Term
|
Definition
| gram (-) bugs including Pseudomonas aer. and bugs which end in bacter, but it has very little G+ activity |
|
|
Term
| DOC for treatement of strep pneumo infections including meningitis |
|
Definition
| Cefotaxime and ceftriaxone, b/c they are effective against low level Pen G R strep pneumo and are very potent with low MIC |
|
|
Term
| What is the difference between cefotaxime and ceftriaxone |
|
Definition
| t1/2 of ceftriaxone is 8h versus 1 hour for cefotaxime |
|
|
Term
| given in a single large I.M. dose for cervical, urethral, oropharyngeal or rectal gonorrhea |
|
Definition
|
|
Term
| CDC recommended oral alternative for uncomplicated gonorrhea |
|
Definition
|
|
Term
| Used to treat meningities caused by strep pneumo and Neisseria spp. |
|
Definition
| Cefotaxime and ceftriaxone |
|
|
Term
| Good for the treatment of otitis media after tow failures with amoxacillin or augmentin(amox + clav) |
|
Definition
|
|
Term
|
Definition
| I.V. in the ICU esp in neutropenic patients |
|
|
Term
| 4th gen ceph, cefepime spectrum of activity |
|
Definition
| moderate G+ and excellent gram (-) activity, active against Pseudomonas aer |
|
|
Term
| Improved activity over ceftazidime |
|
Definition
|
|
Term
| only ceph active against MRSA |
|
Definition
|
|
Term
| #1 drug for surgical proph |
|
Definition
| cefazolin 1st gen cephalosporin |
|
|
Term
| Used to treat MSSA SSTI's but not MRSA |
|
Definition
|
|
Term
| along with oxacillin and nafcillin, better than vancomycin for MSSA |
|
Definition
|
|
Term
| First line agent for patients with mild PCN allergy and MSSA infection |
|
Definition
1st gen ceph
cefaxolin, cephalexin, cephradine |
|
|
Term
| #1 drugs for intra-abdominal surgical prophylaxis |
|
Definition
| 2nd gen cephs cefoxitin and cefotetan |
|
|
Term
| used with gentamicin until the antibiotic suscept of the isolate is known |
|
Definition
| ceftazidime, i.v. for Pseudomonas aer |
|
|
Term
|
Definition
|
|
Term
| Used for strep pneumo infections including meningitis and B-hemolytic strep |
|
Definition
| cefotaxime and cetriaxone i.v. |
|
|
Term
| used for community acquired meningities, H. flu, strep pneumo and Neisseria |
|
Definition
| cefotaxime 3rd gen cephalosporin |
|
|
Term
| Used for inpatient community acquired pneumonia = H. flu, strep pneumo, and Moraxella |
|
Definition
cefotaxime and cetriaxone i.v.
a macrolide like clarithromycin can be added to cover the atypical bugs |
|
|
Term
| Used to treat uncomplicated gonorrhea with a single dose of |
|
Definition
| i.m. ceftriaxone or a single p.o. dose of cefixime |
|
|
Term
| febrile neutropenic patients where gram (-) bugs can kill in two hours so you need a bactericidal drug with stron gram (-) coverage |
|
Definition
|
|
Term
| Treat inpatient strep pneumo, pseudomonas, ICU patients, mixed infections, unknown infections |
|
Definition
|
|
Term
| Do cephalosporins cover enterococci or MRSA? |
|
Definition
|
|
Term
| Gram + cephalosporin activity trend |
|
Definition
|
|
Term
| Gram (-) ceph activity trend |
|
Definition
|
|
Term
| Cephs with good anaerobic activity |
|
Definition
| Cefoxitin and cefotetan 2nd gen cephs |
|
|
