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NCA 621 Antimicrobials

Terms in this set (61)

Minimal bactericidal concentration (MBC)
drug concentration at which the bacterial population is killed
Minimum inhibitory concentration (MIC)
lowest concentration of an antibiotic that inhibits growth of a microorganism
Gram-positive Cocci:
Strep: pyogenes, pneumoniae, viridans, bovis

Staph : aureus, epidermis, saprophyticus

Enterococcus
Gram-NEGATIVE cocci
Neisseria gonorrhea

Neisseria meningitides
gram positive bacilli
Clostridium difficile and Clostridium perfringens
Listeria
Bacillus anthracis
Corynebacterium
gram NEGATIVE bacilli (enteric)
E. Coli
Klebsiella pneumoniae
Enterobacter
Campylobacter jejuni
Proteus mirabilis
Salmonella
Serratia
Shigella
other gram NEGATIVE bacilli
Acinetobacter
Pseudomonas
Haemophilus influenzae
Helicobacter pylori
Legionella
Bacteroides
Bordetella pertussis
Brucella
Antibiotics with gram positive coverage
Penicillins (ampicillin, amoxicillin)

Penicillinase resistant penicillins (Dicloxacillin, Oxacillin)

Cephalosporins (1st and 2nd generation)

Tetracyclines

Macrolides (Erythromycin, Clarithromycin, Azithromycin)

Quinolones (moxifloxacin, and less so levofloxacin)

Sulfonamide/trimethoprim*(Increasing resistance limits use)

Clindamycin

Linezolid (VRE)

Vancomycin (MRSA)
Antibiotics with gram NEGATIVE coverage
Broad spectrum penicillins (Ticarcillin-clavulanate, piperacillintazobactam)

Cephalosporins (2nd, 3rd, and 4th generation)

Aminoglycosides

Macrolides (Azithromycin)

Quinolones (Ciprofloxacin)

Monobactams (Azetreonam)

Sulfonamide/trimethoprim

Carbapenems (Imipenem, meropenem, ertapenem)
Antibiotics with anaerobic coverage
Metronidazole

Clindamycin

Broad spectrum penicillins

Quinolones (Moxifloxacin)

Carbapenems
antibiotics that inhibit cell wall synthesis
Penicillins
Carbapenems
Cephalosporins
Glycopeptides
Beta-Lactam Antibiotics
Penicillins
Carbapenems
Cephalosporins

primarily renal excretion
Antistaphylococcal penicillins
Nafcillin
Oxacillin
Dicloxacillin
Aminopenicillins
Amoxicillin (oral)
Ampicillin (IV)
1st generation cephalosporins
cefazolin, cephalexin

Narrow spectrum: mostly all gram positive activity
2nd generation cephalosporins
cefoxitin, cefaclor, cefuroxime

Better gram NEGATIVE coverage BUT less Staph coverage

NOT active against Pseudomonas aeruginosa

Do not penetrate CSF
3rd generation cephalosporins
Cefdinir, Ceftriaxone, Ceftazidime

Wider spectrum of action mostly gram NEGATIVE

Better against Pseudomonas and Enterobacteriaceae

Clinically effective concentrations in CSF
4th generation cephalosporins
Cefepime

Broadest-spectrum, IV only!
5th generation cephalosporins
Ceftaroline
Carbapenems
Meropenem, Ertapenem, Impipenem

Broad gram NEGATIVE coverage and anaerobic coverage
Glycopeptides
vancomycin

broad gram positive activity
Cyclic Lipopeptides
Daptomycin

gram positive activity --> covers MRSA and VRE

cannot be used for PNA because it binds to surfactant in lungs
Macrolides
Azithromycin, Clarithromycin, Erythromycin
Macrolides
gram NEGATIVE and gram positive and atypicals

hepatorenal metabolism and excretion

not good for nosocomial infections
Aminoglycosides
Gentamycin, Tobramycin, Amikacin
Aminoglycosides
gram NEGATIVE coverage

heavily concentrated in the urine --> RENAL TOXICITY!
Tetracyclines
Tetracycline, Doxycycline, Minocycline
Tetracyclines
Tetra- renal, Doxy- intestinal, Mino- liver

covers gram NEGATIVE, gram positive, and atypical bacteria
Oxazolidinones (Linezolid)
gram positive including VRE and MRSA

PO drug for MRSA
Clindamycin
good for anaerobes, strep, and staph
sulfamethoxazole/trimethoprim (bactrim)
broad coverage of gram positive and gram NEGATIVE, specifically Senotrophomonas and Pneumocystis jirovecii
Metronizadole (Flagyl)
coverage of anaerobic organisms

used to treat intraabdominal and gynecologic infections

protozoal infections
Fluoroquinolones
Ciprofloxacin
Levofloxacin
Moxifloxacin
Fluoroquinolones
Broad gram NEGATIVE and some gram positive

NO anaerobic coverage
Pseudomonas
gram NEGATIVE bacilli

Manifestations:
• Swimmer's ear
• UTI
• PNA(most common cause of ventilator associated PNA)
• Bacteremia
Treatment of Pseudomonas
Anti-pseudomonal beta lactam (Ceftaz, Cefepime, Zosyn, Carbapenem) + Aminoglycoside (gent, tobra, amikacin)

Anti-pseudomonal Beta lactam + fluoroquinolone (Cipro)
Acinetobacter
gram NEGATIVE bacilli

*Can be Multi-drug resistant (MDR)*

Found in water, soil, vegetables, and component of normal skin flora
Treatment of Acinetobacter
Carbapenems

Broad spectrum cephalosporin (Ceftazidime (3rd) or Cefepime (4th)) IF not resistant
Legionella
gram NEGATIVE bacilli

PNA

More common in immunocompromised, smokers, and chronic lung disease

Hospital outbreaks associated with contaminated showerheads, faucets, air conditioning units
treatment of legionella
Azithromycin
OR
fluoroquinolone ± rifampin
OR
doxycycline ± rifampin
Haemophilus influenzae
gram NEGATIVE bacilli, aerobic or anaerobic

Manifestations:
• Meningitis in children
• Epiglottitis
• COPD exacerbations
• Otitis media
• Sinusitis
Treatment of Haemophilus influenzae
Meningitis: Rocephin

Respiratory:
Augmentin
Azithromycin
Doxycycline
Neisseria meningitidis
aka meningococcus, gram NEGATIVE cocci

Manifestations:
Bacterial meningitis
Septicemia
Treatment of Neisseria meningitidis
Preferred: Penicillin

Ampicillin or a 3rd generation cephalosporin (Rocephin or Cefotaxime)
Moraxella
gram NEGATIVE cocci

Manifestations:
Respiratory infections
COPD exacerbations
Treatment of Moraxella
Cephalosporin (Cefuroxime or Rocephin)
OR
Fluoroquinolone
OR
Augmentin
OR
Azithromycin
OR
Doxycycline
Staphylococci
gram positive cocci

Manifestions:
Skin and soft tissue infections
Osteomyelitis
Respiratory infections-usually nosocomial PNA or can follow viral infections
Endocarditis among IV drug abusers
Sepsis
Coagulase negative staph
gram positive cocci

most common cause of prosthetic-device infections, not typically virulent

80% is methicillin resistant
treatment of Staph aureus
PO:
Cephalexin
Minocycline/Doxycycline
Bactrim
Clindamycin
IV:
Preferred: PCN (nafcillin, dicloxacillin)
THEN
1st generation Cephalosporin: Ancef
Unasyn
Augmentin
Zosyn for penicillinase producing
Treatment of MRSA
PO:
Linezolid
Minocycline/Doxycycline
Bactrim

IV:
Preferred: Vancomycin
THEN
Linezolid
Daptomycin
Manifestations of Group A Strep (S. pyogenes)
Pharyngitis
Cellulitis
Necrotizing fasciitis • Group B=S. agalactiae Sepsis and meningitis in babies • Group D=S. bovis Associated with GI neoplasms Endocarditis, bacteremia • Strep viridans normal flora of mouth Endocarditis, dental abscess
Manifestions of Group B Strep (S. agalactiae)
Sepsis
meningitis in babies • Group D=S. bovis Associated with GI neoplasms Endocarditis, bacteremia • Strep viridans normal flora of mouth Endocarditis, dental abscess
Manifestations of Group D Strep (S. bovis)
Associated with GI neoplasms
Endocarditis
Bacteremia
Manifestations of Strep viridans
*normal flora of mouth*
endocarditis
dental abscess
Treatment of Group A Pharyngitis
Preferred: PCN

Alternatives: azithromycin, clindamycin, cephalosporins
Treatment of Group B Strep
higher dose of PCN than Group A
Treatment of Group D and Strep Viridans
-PCN ± Gent

*May have to change to vancomycin because commonly resistant to PCN
Strep pneumoniae aka Pneumococcus
gram positive cocci

Manifestations:
"Lobar" Pneumonia- most common
Otitis media
Bacteremia
Meningitis
UTI
caused by gram negative organisms

1. Escherichia coli (80-85%)
2. Klebsiella pneumoniae
3.Proteus
4.Pseudomonas
5.Enterobacterium
treatment of uncomplicated cystitis
• Macrobid x 5-7 days
Avoid if suspect pyelonephritis
Contraindicated when Creatinine Clearance <60 • Bactrim x 3-7 days
Fluoroquinolone (Cipro, Levofloxacin) x 3 days
Reserve for more severe infections if possible
treatment of pyelonephritis
OUTPATIENT:
Fluoroquinolones (Cipro or Levofloxacin) x 7 days
If hypersensitive or resistant to fluoroquinolones, use
Bactrim or susceptible betalactam x 14 days
INPATIENT
Fluoroquinolone • Aminoglycoside • 3rd generation Cephalosporin • Carbapenem
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