Which antibiotic is especially effective for Legionella?
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Fluoroquinolones.
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Which antibiotic is especially effective for Legionella?
Fluoroquinolones.
What are the common pathogens associated with Community-Acquired Pneumonia (CAP)?
S. pneumoniae, H. influenzae, M. catarrhalis, and atypicals such as Legionella, Mycoplasma, and Chlamydia.
Which antibiotics are effective against anaerobic bacteria?
Clindamycin, Metronidazole, Carbapenems, Anti-pseudomonal penicillin, Fluoroquinolones.
What components make up the glycan part of peptidoglycans?
N-acetylglucosamine (NAM) and N-acetylmuramic acid (NAG).
Which antibiotics are recommended for treating Community-Acquired Pneumonia (CAP)?
Fluoroquinolones (respiratory) or a combination of Beta-lactam (Ceftriaxone) + Macrolide or Doxycycline.
What pathogens are commonly associated with Hospital-Acquired Pneumonia (HAP)?
Multidrug resistant bacteria such as Pseudomonas and MRSA.
What is MRSA?
Methicillin-resistant Staphylococcus aureus, a type of multi-drug resistant pathogen.
What are the four categories of Beta-Lactams?
Penicillin, Cephalosporin, Carbapenem, Monobactam.
What condition can prolonged use of Linezolid (10-14 days) lead to?
Lactic acidosis due to increased production of lactic acid.
What is the initial treatment for a patient with pneumonia?
Start them on antibiotics, whether it's CAP or HAP.
What precaution should patients take when using Doxycycline?
Drink plenty of water and stay upright for a bit.
What are the two main categories of antibiotic action?
Bactericidal (kills bacteria) and Bacteriostatic (inhibits growth of bacteria).
What bacteria was identified in the sputum culture?
Klebsiella pneumonia.
What metabolic disturbance can TMP-SMX cause?
Hyperkalemia.
What can trigger mutations in bacteria that lead to antibiotic resistance?
Overprescribing antibiotics when they are not necessary.
What is a major adverse effect of penicillins?
Hypersensitivity reactions leading to anaphylactic shock.
How does exposure to antibiotics in food products contribute to antibiotic resistance?
Bacteria can develop resistance after being exposed to antibiotics used in livestock.
What pathogens should be considered for gastrointestinal infections?
Gram-negative rods and anaerobes.
What serious risk is associated with Fluoroquinolones?
Achilles tendon rupture.
What risk is increased due to vitamin K deficiency from cephalosporins?
Increased risk of bleeding.
Why is it important to prevent overprescription of antibiotics?
To reduce the opportunity for bacteria to become resistant.
Why should Fluoroquinolones be avoided in patients over 60 or those on steroids?
Increased risk of Achilles tendon rupture.
What risk is increased with the use of Carbapenems?
Risk of C. difficile infection.
What is the first-line antibiotic for pyelonephritis?
Ceftriaxone.
What should be monitored in patients taking Daptomycin?
CK enzymes.
What is a significant risk factor for antibiotic resistance in hospitals?
The presence of patients who are super sick and may develop multi-drug resistant pathogens.
What are the four mechanisms of antibiotic resistance?
Reduced permeability, increased efflux, decreased target binding, and increased inactivating enzymes.
What is the significance of the HENS-PEcK category?
It helps determine which antibiotics are effective against specific bacteria like Klebsiella pneumonia.
Which antibiotics showed susceptibility to Klebsiella pneumonia?
Ceftriaxone, Piperacillin + tazobactam (Pip-Tazo), and Meropenem.
What is increased efflux in the context of antibiotic resistance?
It refers to bacteria pushing antibiotics out of the cell, decreasing the concentration of the antibiotic inside.
What is a common mistake clinicians make that contributes to antibiotic resistance?
Overprescribing antibiotics for viral infections.
What methods are used to determine the minimum inhibitory concentration (MIC)?
Broth, microdilution, macrodilution, and the Kirby-Bauer method.
Which antibiotic was recommended as a good choice for treatment?
Ceftriaxone.
What are some adverse effects associated with Linezolid?
Neurotoxicity, serotonin syndrome, peripheral neuropathy, pancytopenia, and lactic acidosis.
What serious condition can occur with the use of Daptomycin in MRSA infections?
Rhabdomyolysis.
What is a common adverse effect of Penicillins?
Anaphylaxis.
What is a significant risk of using Fluoroquinolones?
Hypo- and hyperglycemia.
What are the main mechanisms by which bacteria develop resistance to antibiotics?
Reducing permeability, pushing the antibiotic out, changing the target site structure, and producing enzymes that inactivate the antibiotic.
What are some adverse effects associated with Macrolides?
GIT dysfunction, arrhythmias, cholestasis, rash, eosinophilia.
What type of antibiotic is Vancomycin?
A glycopeptide antibiotic.
What is Torsade de Pointes?
A type of polymorphic ventricular tachycardia that can quickly progress to ventricular fibrillation.
What role do increased inactivating enzymes play in antibiotic resistance?
They break down antibiotics through processes like phosphorylation and acetylation, rendering them ineffective.
What role do bacteriophages play in antibiotic resistance?
They can transfer DNA/RNA that carries resistance mechanisms between bacteria.
Why is it important to prefer narrow-spectrum antibiotics?
To minimize the risk of developing antibiotic resistance and target the specific bacteria effectively.
What organisms are included in atypical coverage?
Mycoplasma, Chlamydia, Legionella.
What is the purpose of obtaining sputum cultures in patients with pneumonia?
To identify the type of bacteria causing the infection and determine the best-suited antibiotics.
What is a potential adverse effect of TMP-SMX?
Hyperkalemia.
Which antibiotics were found to be resistant to Klebsiella pneumonia?
Ceftazidime, Gentamicin, and Levofloxacin.
What deficiency can cephalosporins cause?
Vitamin K deficiency.
Which antibiotics can cover gram-negative rods and anaerobes?
Carbapenems and antipseudomonal penicillins (e.g., Piperacillin-tazobactam).
Which drugs can increase the risk of Torsade de Pointes?
Fluoroquinolones and Macrolides.
What is the first-line treatment for Streptococcus pneumoniae?
Penicillin, Aminopenicillins, 3rd generation cephalosporins (Ceftriaxone), Fluoroquinolones (Moxifloxacin, Levofloxacin), and Macrolides.
What is the mechanism of action of beta-lactamase?
It breaks down the beta-lactam ring, preventing antibiotics from binding to PBP.
What are the examples of beta-lactamase inhibitors?
Clavulanate, Sulbactam, Tazobactam, and Avibactam.
What antibiotic is used in tuberculosis and inhibits RNA polymerase?
Rifampin.
Which antibiotics are used for treating gastrointestinal infections involving anaerobes?
Carbapenems, antipseudomonal penicillins, and combinations like Metronidazole + Ciprofloxacin.
What antibiotics are used for acute cystitis?
TMP-SMX, nitrofurantoin, fosfomycin, or ciprofloxacin.
What antibiotics are recommended for uncomplicated acute cystitis?
TMP-SMX (for non-pregnant patients), Nitrofurantoin, Fosfomycin, and Ciprofloxacin (2nd line).
What is a common pathogen in central line bloodstream infections?
MRSA.
Which antibiotic class is associated with Vitamin K deficiency?
Cephalosporins.
What are common adverse effects associated with neurotoxicity from antibiotics?
Seizures, myoclonus, encephalopathy, serotonin syndrome.
What happens to bacteria without a proper cell wall?
They cannot divide properly and are susceptible to materials leaking in or out, leading to bacterial death.
What is pancytopenia and which antibiotics can cause it?
Pancytopenia is a reduction in red and white blood cells and platelets; it can be caused by Penicillins, Cephalosporins, TMP-SMX, Chloramphenicol, and Linezolid.
Which drugs are associated with disulfiram reactions?
Metronidazole and Ceftriaxone.
Which antibiotics do not cover Enterobacter, Serratia, and Neisseria?
Aminopenicillins.
What are the forms of natural penicillin?
Penicillin G (IM or IV) and Penicillin V (PO).
Why should broad-spectrum antibiotics be avoided?
To prevent unnecessary broad coverage and potential resistance.
What is vertical gene transfer in bacteria?
The process where bacteria replicate through binary fission, passing resistance traits to daughter cells.
What should be done if bacteria show resistance to a chosen antibiotic?
Use methods like broth, microdilution, or Kirby-Bauer to test other antibiotics for susceptibility.
What are the four main ways bacteria can develop resistance to antibiotics?
Reducing permeability, pushing the antibiotic out, changing the target site, and producing inactivating enzymes.
Which antibiotic is used in penicillin-allergic cases?
Aztreonam.
What are the symptoms of meningitis?
Photophobia, headache, neck stiffness, and fever.
What is the action of Tetracycline on bacterial growth?
Inhibits protein synthesis and is bacteriostatic.
Which organisms are covered by antibiotics for anaerobic infections?
Clostridium, Bacteroides, Peptostreptococcus, Fusobacterium, Actinomyces.
What is a potential side effect of Doxycycline related to the esophagus?
Pill-induced esophagitis.
What is the role of tetrapeptides in the bacterial cell wall?
They cross-link to stabilize the cell wall.
What is the recommended treatment for MRSA in Hospital-Acquired Pneumonia?
Vancomycin.
What is the primary action of Beta-Lactam antibiotics?
They decrease peptidoglycan synthesis.
What syndrome is associated with Vancomycin?
Red Man syndrome.
What does 'intermediate' susceptibility mean in this context?
Ampicillin-sulbactam showed intermediate susceptibility, indicating it may not be the best choice.
What is the challenge clinicians face regarding antibiotic susceptibility?
Determining which antibiotic is best for a specific pathogen that may have developed resistance.
Which antibiotics are known for direct nephrotoxic reactions?
Aminoglycosides and Vancomycin.
Which antibiotics are affected by increased efflux?
Fluoroquinolones, aminoglycosides, tetracyclines, and macrolides.
What happens when CYP450 inhibitors are taken with certain drugs?
They reduce the metabolism of the drug, increasing serum concentration and potentially producing negative effects.
What is the treatment for Enterococcus infections?
Aminopenicillins, Penicillin, and Nitrofurantoin (only for Urinary Tract Infections).
How does Sulfamethoxazole (SMX) affect bacterial growth?
Inhibits folic acid synthetase, affecting nucleotide synthesis.
What is the role of dihydrofolate reductase in bacteria?
Converts dihydrofolate (DHF) into tetrahydrofolate (THF) for nucleotide synthesis.
What is the intravenous antibiotic of choice for MRSA?
Vancomycin.
Which antibiotic covers resistant S. pneumoniae in meningitis?
Vancomycin.
Which antibiotics are used for community-acquired meningitis?
Vancomycin, Ceftriaxone, and Ampicillin (if there is a concern for Listeria).
What is the treatment for bloodstream infections (CLABSI) caused by MRSA?
Vancomycin +/- Pip-Tazo (for Gram-negatives).
What are the risks associated with Fluoroquinolones in patients under 18?
Destruction of cartilage and arthropathies.
What is the primary structure that makes up the bacterial cell wall?
Peptidoglycans.
Which antibiotics were initially given to the patient?
Ceftriaxone and doxycycline.
What serious condition can Linezolid cause?
Lactic acidosis.
What is a disulfiram reaction?
Development of symptoms like nausea, vomiting, flushing, hypotension, and tachycardia when medications are taken with alcohol.
What organisms are covered by HENS-PEcK?
Hemophilus influenzae, Enterobacter, Neisseria gonorrhoeae & meningitidis, Serratia, Proteus, Escherichia coli, Klebsiella.
How do bacteria decrease target binding to resist antibiotics?
They alter the target site, changing the amino sequence or structural morphology, preventing the antibiotic from binding.
What is a significant risk associated with Clindamycin?
Increased risk of C. difficile infection.
What is a notable adverse effect of Doxycycline?
Teeth discoloration.
What is the effect of certain antibiotics on Myasthenia Gravis?
They can worsen the condition.
Which antibiotics are affected by decreased target binding?
Fluoroquinolones, aminoglycosides, tetracyclines, beta-lactams, vancomycin, macrolides, linezolid, and trimethoprim-sulfamethoxazole.
Which drug's serum concentration increases when taken with a CYP450 inhibitor, raising the risk of bleeding?
Warfarin.
What is hemolytic anemia?
Destruction of red blood cells (RBCs) that can cause hypersensitivity reactions.
Which drugs can produce a positive Coombs test?
Penicillins and Cephalosporins.
What pathogens are commonly associated with community-acquired pneumonia?
S. pneumoniae, H. influenzae, M. catarrhalis, and atypicals such as Legionella, Mycoplasma, and Chlamydia.
Which drugs are known to cause phototoxicity?
Doxycycline and TMP-SMX.
What is the first-line treatment for hospital-acquired meningitis?
Vancomycin for MRSA and Cefepime for Pseudomonas.
Which antibiotics are known to cause neurotoxicity?
Penicillins, Cephalosporins, Carbapenems, Polymyxins, Linezolid.
What types of cultures are mentioned for diagnosing infections?
Sputum cultures, skin cultures, urine cultures, and blood cultures.
Which antibiotic is used for Treponema pallidum?
Penicillin G.
What antibiotics are used for Methicillin Sensitive Staphylococcus aureus (MSSA)?
Nafcillin, Oxacillin, Dicloxacillin, 1st generation cephalosporins (Cephalexin, Cefazolin), and Fluoroquinolones.
What does the minimum inhibitory concentration (MIC) indicate?
The minimum amount of a drug needed to kill a particular bacteria.
Which generation of cephalosporins covers PEcK organisms?
1st generation cephalosporins.
What is the mechanism of action of Daptomycin?
Creates efflux pumps in the cell membrane, increasing permeability and risk for cell lysis.
What is Gray Baby Syndrome and which antibiotic is associated with it?
Gray Baby Syndrome is a condition in newborns caused by Chloramphenicol, leading to a gray-ash appearance and cardiovascular issues.
What is the role of blood cultures in antibiotic therapy?
To identify pathogens in septic patients or those with suspected bloodstream infections.
What is the mechanism of action of Metronidazole?
Increases the formation of reactive oxygen species (ROS) causing damage to DNA, RNA, and proteins.
Which antibiotic is used for Stenotrophomonas?
Trimethoprim - Sulfamethoxazole.
Which class of antibiotics includes Ciprofloxacin and Levofloxacin?
Fluoroquinolones.
Which antibiotics are classified as aminoglycosides?
Tobramycin, Amikacin, Gentamicin.
What effect does Doxycycline have on teeth?
Teeth discoloration due to binding with calcium.
What is the role of cultures in treating pneumonia?
To identify the specific agent and use the appropriate antibiotic for that agent.
What is the significance of the HENS-PEcK acronym in antibiotic selection?
It refers to a group of antibiotics effective against certain gram-negative bacteria, including Klebsiella pneumonia.
How does conjugation facilitate antibiotic resistance?
Bacteria connect via a sex pilus to transfer plasmids containing resistance genes.
What is the combination of antibiotics used for anaerobic infections below the diaphragm?
Metronidazole + fluoroquinolone (ciprofloxacin).
What condition can Metronidazole potentially cause?
Rhabdomyolysis.
What adverse effect can occur if vancomycin is pushed too quickly?
Phlebitis and Red Man syndrome.
Which antibiotics are classified as carbapenems?
Doripenem, imipenem, meropenem, ertapenem.
What adverse effect can Tetracyclines have on infants?
They can discolor the infant’s developing milk teeth and affect bone growth.
What are the exceptions for antibiotic treatment in gram-positive organisms?
Vancomycin Resistant Staphylococcus aureus (VRSA) and Vancomycin Resistant Enterococcus (VRE).
What are the empiric antibiotics for pyelonephritis?
Ceftriaxone, fluoroquinolone (ciprofloxacin), or aminopenicillin (ampicillin).
How does reduced permeability contribute to antibiotic resistance?
It prevents antibiotics from entering bacterial cells, reducing their accumulation and effectiveness.
What is horizontal gene transfer in bacteria?
The process by which bacteria transfer genetic material to one another, including transformation, conjugation, and transduction.
What arrhythmia risk is associated with Macrolides?
Prolonged QT interval leading to Torsade de Pointes.
What type of kidney injury can be caused by antibiotics?
Both direct nephrotoxic reactions and indirect kidney injury.
What is the anti-pseudomonal penicillin mentioned?
Piperacillin-tazobactam.
What methods were used for susceptibility testing?
Microdilution, Macrodilution, and Kirby-Bauer method.
What does DRESS stand for?
Drug-related eosinophilia and systemic symptoms.
What antibiotic is used for Neisseria gonorrhoeae in joint infections?
Ceftriaxone.
Which drugs can cause hemolytic crisis in patients with G6PD deficiency?
TMP-SMX, Fluoroquinolones, and Nitrofurantoin.
What are the antibiotics for Pseudomonas in complicated UTIs?
Pip-Tazo, Cefepime, aminoglycoside, or Ceftazidime.
What is the treatment for Lyme disease caused by Borrelia burgdorferi?
Doxycycline, Chloramphenicol, Ceftriaxone.
What immune response occurs after initial exposure to penicillin?
Immune cells produce IgE.
What occurs during transformation in bacteria?
A bacterium releases DNA/RNA upon destruction, which can be taken up by another bacterium, allowing it to gain resistance mechanisms.
What is Fosfomycin primarily used for?
Used in acute cystitis.
What is a potential risk associated with ceftriaxone?
Increased risk of biliary sludge.
What does Ceftriaxone provide coverage against?
Good Gram-negative coverage against E. coli, Klebsiella, and Enterobacter.
What are the two types of pathogens for skin and soft tissue infections?
S. aureus (MSSA and MRSA) and Strep A.
What is the significance of plasmids in antibiotic resistance?
Plasmids can encode proteins or enzymes that confer resistance and can be transferred between bacteria.
What is the first step in treating a patient with a suspected UTI?
Obtain a urinary culture to identify the bacteria before starting treatment.
What intravenous antibiotics can be used for MSSA and Strep A?
Nafcillin, Oxacillin, or Cefazolin.
What is the role of Penicillin-Binding Protein (PBP)?
It synthesizes the peptidoglycan layer by cross-linking NAG and NAM.
What are the common pathogens for pyelonephritis?
PEcK (Proteus mirabilis, E. coli, and Klebsiella) and Enterobacter.
What is the action of Macrolides on bacterial protein synthesis?
Inhibit the 50S ribosomal subunit.
What are the classic antibiotics used for sepsis?
Vancomycin for MRSA and Pip-Tazo for Gram-negatives and anaerobes.
Which antibiotics can lead to respiratory failure?
Polymyxins and Nitrofurantoin.
Which antibiotic can penetrate the CNS for neuroborreliosis?
Ceftriaxone.
Which antibiotic is specifically used for Methicillin Resistant Staphylococcus aureus (MRSA)?
Ceftaroline, Vancomycin, Trimethoprim-sulfamethoxazole, Clindamycin, Linezolid, Doxycycline, and Daptomycin.
What are some other drugs that can increase the risk of C. difficile?
Carbapenems, TMP-SMX, 3rd and 4th Cephalosporins, Fluoroquinolones.
What role do CYP450 enzymes play in drug metabolism?
They catalyze a drug’s biotransformation process, making a drug more polar to exert its effects.
What antibiotics are effective against Group A and B Streptococcus?
Penicillin, Aminopenicillins, 1st generation cephalosporins (Cephalexin), Trimethoprim-sulfamethoxazole, Macrolides, and Clindamycin.
Name a first-generation cephalosporin.
Cefazolin or Cephalexin.
What types of reactions do inactivating enzymes perform on antibiotics?
Phosphorylation, acetylation, and other modifications to inactivate the antibiotics.
When are Vancomycin and Trimethoprim-sulfamethoxazole used for gram-positive organisms?
When the patient is allergic to penicillin or there is resistance to other drugs.
What is the combination used for extended spectrum beta-lactamase bacteria?
3rd generation cephalosporin + beta-lactamase inhibitor (e.g., Ceftazidime + avibactam).
What is phototoxicity?
A condition that can produce rashes and skin burning effects.
What is the treatment for septic arthritis caused by MRSA?
Vancomycin.
Which antibiotics are affected by decreased permeability?
Vancomycin, aminoglycosides, tetracyclines, and beta-lactams.
What is the purpose of combining Amoxicillin with Clavulanate?
To inhibit beta-lactamase activity.
What type of therapy is Polymyxin used for?
Salvage therapy for multi-drug resistant bacteria.
What are the oral antibiotics for MSSA and Strep A?
Dicloxacillin or Cephalexin.
Which antibiotic is used for MRSA in bone and joint infections?
Vancomycin.
Which antibiotic can be used for post-surgical prophylaxis?
Cefazolin.
What pathogens are commonly associated with community-acquired meningitis?
S. pneumoniae, H. catarrhalis, and N. meningitidis.
What is the first-line treatment for skin and soft tissue infections caused by MSSA?
Dicloxacillin or Cephalexin (PO), Nafcillin, Oxacillin, or Cefazolin (IV).
What pathogens are associated with complicated UTIs?
Pseudomonas, MRSA, and Enterococcus.
What pathogens are involved in complicated urinary tract infections?
MRSA, Enterococcus, and Pseudomonas.
Name a 3rd generation cephalosporin that provides coverage for Pseudomonas.
Ceftazidime.
What are the symptoms of Red Man syndrome?
Red, itchy rashes, muscle spasms, hypotension, and tachycardia.
Which antibiotics are used for Listeria infections?
Aminopenicillins, Trimethoprim-sulfamethoxazole, and Vancomycin.
Which antibiotics do not cover Neisseria?
Fluoroquinolones and aminoglycosides.
What are the oral antibiotics for MRSA and Strep A?
TMP-SMX, doxycycline, or clindamycin.
What is the recommended antibiotic treatment for hospital-acquired pneumonia caused by Pseudomonas?
Double therapy with Pip-Tazo, Ceftazidime, Cefepime, or an aminoglycoside.
What antibiotic is usually used for Enterococcus in complicated UTIs?
Vancomycin.
Which antibiotics are teratogenic and should be avoided during pregnancy?
TMP-SMX, Fluoroquinolones, Chloramphenicol, Tetracyclines.
What are common infections treated with empiric antibiotics in bone and joint infections?
Septic arthritis and osteomyelitis.
What is the role of polymyxins in antibiotic treatment?
Last resort for resistant infections.
What are the classic symptoms of DRESS?
Fever, rash, increased eosinophils, and lymphadenopathy.
Which antibiotics are preferred for Pseudomonas in bone and joint infections?
Cefepime and ceftazidime.
What is the function of DNA gyrase?
Maintains the topology of DNA by unwinding supercoils for new DNA strand creation.
