Antibiotic Therapy Study Notes
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Questions and Answers

What is a significant factor affecting the choice of antibiotics in patients with renal insufficiency?

  • Antibiotics with concentration-dependent killing require dose adjustments based on frequency. (correct)
  • All antibiotics can be administered at the same dosage regardless of renal function.
  • The timing of antibiotic administration is irrelevant.
  • Timedependent killing antibiotics should always be given less frequently.

    • Which of the following statements about Daptomycin is true?

  • It should be used as the first choice for respiratory infections.
  • It is inactivated by surfactant in the lungs. (correct)
  • It is effective against pneumonia.
  • It works best when administered orally.

    • What is the rationale for starting with broad-spectrum antibiotics in suspected septic shock?

  • Broad-spectrum antibiotics are less effective than narrow-spectrum antibiotics.
  • Broad-spectrum agents provide immediate coverage for any infection while waiting for culture results. (correct)
  • It is always possible to identify the specific pathogen immediately.
  • Narrow-spectrum antibiotics are typically preferred in emergency situations.

    • How should antibiotic dosing be adjusted for a patient with acute kidney injury taking Levofloxacin?

    <p>Extend the dosing interval to every other day without changing the dose.</p> Signup and view all the answers

    What is NOT a recommended practice when adjusting antibiotics based on culture and sensitivity results?

    <p>Cover all organisms listed on the sensitivity report regardless of relevance.</p> Signup and view all the answers

    Which statement accurately describes the action of inhaled steroids compared to oral steroids?

    <p>Inhaled steroids are safer than oral and IV steroids.</p> Signup and view all the answers

    What is a key disadvantage of moxifloxacin for treating urinary tract infections (UTIs)?

    <p>It does not achieve good levels in the urine.</p> Signup and view all the answers

    What distinguishes azithromycin from erythromycin?

    <p>Azithromycin does not cause significant GI side effects.</p> Signup and view all the answers

    Which carbapenem is known for a lower incidence of seizures compared to its counterparts?

    <p>Meropenem</p> Signup and view all the answers

    If a patient on valproic acid is started on a carbapenem antibiotic, what is a potential risk?

    <p>Breakthrough seizures due to decreased valproic acid levels.</p> Signup and view all the answers

    What is a primary use of ertapenem in clinical settings?

    <p>Outpatient therapy for Gram-negative organisms.</p> Signup and view all the answers

    What is a significant characteristic of carbapenems compared to other antibiotic classes?

    <p>They are contraindicated in valproic acid usage.</p> Signup and view all the answers

    Which macrolide antibiotic is primarily beneficial for improving GI motility?

    <p>Erythromycin</p> Signup and view all the answers

    Which antibiotic is primarily recognized for covering Gram-positive bacteria, especially Strep pneumoniae?

    <p>Levofloxacin</p> Signup and view all the answers

    What is a primary reason tigecycline is considered a niche antibiotic?

    <p>It covers MRSA and anaerobes, which are common in certain infections.</p> Signup and view all the answers

    Which type of infection are quinolones especially effective for due to their pharmacokinetics?

    <p>Pneumonias and exacerbations of chronic respiratory diseases.</p> Signup and view all the answers

    What is a significant side effect of combining quinolones with steroids in elderly patients?

    <p>Tendon ruptures, especially Achilles tendon.</p> Signup and view all the answers

    Why are tetracyclines rarely used in modern antibiotic therapy?

    <p>They have too many side effects and limited effectiveness.</p> Signup and view all the answers

    Which characteristic of quinolones makes them the only oral agents available for treating Pseudomonas?

    <p>Their effective tissue distribution, especially in lung infections.</p> Signup and view all the answers

    What type of infections are associated with anaerobes that tigecycline is particularly suited to treat?

    <p>Walled-off infections such as abscesses or empyemas.</p> Signup and view all the answers

    In what scenario might a provider be held liable related to quinolone and steroid therapy?

    <p>If an elderly patient ruptures a tendon after being prescribed both medications.</p> Signup and view all the answers

    Which antibiotic is now considered first-line therapy for C. difficile infections?

    <p>Oral vancomycin</p> Signup and view all the answers

    What does the presence of dashes under vancomycin and azithromycin suggest about their effectiveness against Gram-positive organisms?

    <p>Poor efficacy</p> Signup and view all the answers

    Which antibiotic combination is specifically targeted at multidrug-resistant Gram-negative bacteria?

    <p>Meropenem/vaborbactam</p> Signup and view all the answers

    What is the primary purpose of combining a beta-lactamase inhibitor with antibiotics?

    <p>To extend the antibiotic's spectrum of activity</p> Signup and view all the answers

    What characteristic defines a KPC strain of bacteria?

    <p>It produces enzymes that hydrolyze carbapenems</p> Signup and view all the answers

    Which of these antibiotics is noted for its effectiveness against resistant Gram-negative bacteria when combined with tazobactam?

    <p>Ceftolozane</p> Signup and view all the answers

    What does a long bar over an antibiotic column indicate in the context of the treatment slide?

    <p>Broad-spectrum coverage</p> Signup and view all the answers

    Which organism poses a significant threat with its ability to produce enzymes that confer resistance to carbapenems?

    <p>CRE</p> Signup and view all the answers

    Why is it important for healthcare providers to stay updated on antibiotic guidelines?

    <p>To ensure the most effective treatment options</p> Signup and view all the answers

    Which new antibiotic combination is used specifically for addressing multidrug-resistant Gram-negative infections?

    <p>Both A and B</p> Signup and view all the answers

    What is a primary reason aminoglycosides have fallen out of favor in clinical use?

    <p>Their complex dosing and potential for nephrotoxicity</p> Signup and view all the answers

    What unique property does aztreonam have compared to aminoglycosides?

    <p>It can be used in patients with beta-lactam allergies</p> Signup and view all the answers

    Why is the combination of vancomycin and gentamicin no longer recommended?

    <p>It can cause nephrotoxicity when used together</p> Signup and view all the answers

    What distinguishes linezolid from other antibiotics in its class?

    <p>It has good oral availability and high cost</p> Signup and view all the answers

    For treating C. difficile infection, what is the appropriate administration route for vancomycin?

    <p>Oral only</p> Signup and view all the answers

    Which statement best describes the activity spectrum of the anti-MRSA drugs discussed?

    <p>They exclusively target Gram-positive bacteria</p> Signup and view all the answers

    What is a significant concern when prescribing linezolid with SSRIs?

    <p>It may lead to serotonin syndrome</p> Signup and view all the answers

    Which aminoglycoside is noted for having a broader spectrum of activity compared to gentamicin, tobramycin, and netilmicin?

    <p>Amikacin</p> Signup and view all the answers

    Why might a patient with a systemic infection also receive oral vancomycin?

    <p>To simultaneously treat a C. difficile infection</p> Signup and view all the answers

    What is a factor contributing to the high cost of linezolid when it was first introduced?

    <p>It was the only oral antibiotic effective against MRSA</p> Signup and view all the answers

    Study Notes

    Antibiotic Therapy Study Notes

    • Extended-Spectrum Beta-Lactamase Inhibitors: Ineffective against extended-spectrum beta-lactamase inhibitors produced by E. coli and Klebsiella. Tetracyclines are generally not used due to numerous side effects, though tigecycline is an IV medication with a niche use. It covers MRSA and anaerobes, beneficial in localized infections (e.g., abscesses, empyemas).

    Quinolones

    • Clinical Pearl: Quinolones are the only oral agents for Pseudomonas.
    • Lungs: Quinolones effectively reach the lungs, widely used in pneumonia, bronchitis, and COPD exacerbations.
    • Stewardship: Careful use is crucial due to potential side effects.
    • Drug Interaction (Elderly): Combining quinolones with oral steroids like prednisone in elderly patients can lead to tendon rupture. Inhaled steroids are generally considered safe with quinolones.

    Quinolone Spectrums

    • Levaquin (Gram-positive): Best for Streptococcus pneumoniae, a leading cause of community-acquired pneumonia.
    • Ciprofloxacin (Gram-negative): More effective against gram-negatives than gram-positives; effective against Pseudomonas.
    • Moxifloxacin: Covers gram-positive and gram-negative bacteria, including anaerobes (less effective coverage). Poor urinary penetration, not used for UTIs.

    Macrolides

    • Erythromycin: First macrolide, side effects outweigh advantages, not used for antibiotic properties. Used for GI motility, primarily relieving constipation.
    • Azithromycin: Improved macrolide with a longer half-life and fewer GI side effects. Often given once daily for 5 days (10-day course).
    • Clarithromycin: Less commonly used than azithromycin; used for H. pylori infections (GI problem.)

    Carbapenems

    • Broad-Spectrum: Hospital-only, powerful against Pseudomonas, Gram-negative bacteria producing extended-spectrum beta-lactamases (ESBLs).
    • Drug Interaction (Valproic Acid): Carbapenems can dramatically decrease valproic acid levels, potentially causing breakthrough seizures.
      • Alternative medications or treatments are necessary if valproic acid is required
    • Imipenem (Primaxin): Initially for critical care, high risk of seizures, thus modified, leading to meropenem.
    • Meropenem: Popular in intensive care, lower seizures risk, same spectrum as imipenem.
    • Doripenem: Similar activity to Meropenem.
    • Ertapenem: Outpatient use, broad-spectrum, once-daily dosing, but does not cover Pseudomonas.

    Aminoglycosides

    • Gram-negatives Only: Primarily for synergistic effect in endocarditis.
    • Difficult Dose, Nephrotoxicity: Dosing is challenging and can cause kidney damage.
    • Aztreonam (Monobactam): Used for gram-negatives, safe for patients allergic to beta-lactams.

    Anti-MRSA Drugs

    • Vancomycin: Proven activity against MRSA over decades.
    • Linezolid: Oral availability, formerly expensive but less costly currently. Drug interactions with antidepressants can cause serotonin syndrome
    • Other specific antibiotics in the study: specific organism coverage

    Oral Vancomycin (C.diff)

    • Single indication: Clostridium difficile (C.diff) infections (bowel issues). Does not reach systemic circulation.
    • IV administration needed for broader systemic infections.

    General Principles for Prescribing Antibiotics:

    • Broad-spectrum/Initial Treatment: Start with a broad-spectrum drug (i.e., carbapenems), particularly in critical/emergency situations, to cover unknown pathogens.
    • Culture and Sensitivity data: Once results are available, prioritize tailored therapies avoiding unnecessary or harmful combinations. Consider the possibility of colonizer or contaminant.
    • Duration of treatment: General duration guidelines exist, individualized based on patient factors and pathogen involved.
    • Renal insufficiency: Modify antibiotic dosage based on patient's kidneys ability; concentration-dependent drugs adjust intervals, while time-dependent drugs adjust dosages.

    Pharmacist Involvement

    • Antibiotic stewardship decisions benefit from pharmacist input and consultation.

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    Description

    Explore the critical aspects of antibiotic therapy with a focus on extended-spectrum beta-lactamase inhibitors and quinolones. This quiz provides insights into their usage, effectiveness against specific bacteria, and important clinical considerations for patient care. Perfect for students and professionals in the medical field.

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