Antibiotics and Bacterial Infections Quiz

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Questions and Answers

Which type of bacterial infections are indicated for use of natural penicillins?

  • Anthrax and gas gangrene (correct)
  • Skin infections caused by fungi
  • Genital infections
  • Upper respiratory tract infections

What is the primary use of aminopenicillins?

  • Prophylaxis of bacterial endocarditis
  • Infections due to Pseudomonas aeruginosa
  • Managing meningitis with H.influenzae (correct)
  • Treating syphilis

Which aminoglycosides are commonly used in combination with carboxypenicillins for nosocomial infections?

  • Streptomycin and tetracycline
  • Neomycin and spectinomycin
  • Gentamicin and amikacin (correct)
  • Chloramphenicol and erythromycin

Which of the following is a common indication for semisynthetic penicillins?

<p>Community-acquired pneumonia (B)</p> Signup and view all the answers

What distinguishes the use of oxacillin group semisynthetic penicillins?

<p>Management of infections resistant to benzylpenicillin (B)</p> Signup and view all the answers

What type of bacteria do aminoglycosides primarily target?

<p>Gram-negative bacteria (A)</p> Signup and view all the answers

Which infection is treated with natural penicillins in high doses as monotherapy?

<p>Meningococcal meningitis (D)</p> Signup and view all the answers

Which microorganism is associated with the use of aminoglycosides in combination with carboxypenicillins?

<p>Pseudomonas aeruginosa (A)</p> Signup and view all the answers

What is a primary indication for Cefazolin?

<p>Surgical prophylaxis (C)</p> Signup and view all the answers

Which bacterial infection is Ceftriaxone indicated for?

<p>Acute otitis media (B)</p> Signup and view all the answers

What condition is Ceftazidime mainly used to treat?

<p>Infections caused by Pseudomonas (C)</p> Signup and view all the answers

Which generation of cephalosporins is Cefixime classified under?

<p>Third generation (C)</p> Signup and view all the answers

Cefoperazone is primarily utilized for treating what types of infections?

<p>Severe outpatient infections of various localizations (A)</p> Signup and view all the answers

Cephalexin is an alternative treatment for which condition?

<p>Streptococcal tonsillitis and pharyngitis (C)</p> Signup and view all the answers

What is one of the suggested usages for second generation cephalosporins in parenteral forms?

<p>Urinary tract infections requiring hospitalization (B)</p> Signup and view all the answers

For which infection type is Cefixime indicated?

<p>Pyelonephritis in pregnant women (C)</p> Signup and view all the answers

What is a potential consequence of long-term treatment with high doses of tetracyclines in children?

<p>Inhibition of bone growth (D)</p> Signup and view all the answers

Which adverse effect is specifically associated with photosensitivity due to tetracyclines?

<p>Phototoxic reactions with fever (C)</p> Signup and view all the answers

What condition may result from the combination of tetracyclines and diuretics?

<p>Nitrogen retention (C)</p> Signup and view all the answers

What is the primary disorder linked to nephrotoxic effects of tetracyclines?

<p>Fanconi syndrome (B)</p> Signup and view all the answers

Which of the following is a key reason why tetracyclines are contraindicated in pregnant women?

<p>Hepato-renal failure and jaundice (A)</p> Signup and view all the answers

What type of discoloration can tetracyclines cause in developing teeth?

<p>Brown coloration (B)</p> Signup and view all the answers

Which adverse effect is most likely from the intravenous administration of tetracyclines?

<p>Venous thrombosis (A)</p> Signup and view all the answers

What is a primary indication for chloramphenicol use?

<p>Severe brain abscesses caused by sensitive microorganisms (D)</p> Signup and view all the answers

Which of the following is NOT an adverse effect associated with amphenicols?

<p>Headaches (C)</p> Signup and view all the answers

What is a common gastrointestinal adverse effect associated with tetracyclines?

<p>Superinfections including candida (B)</p> Signup and view all the answers

In which condition might chloramphenicol be used as an alternative treatment?

<p>Brucellosis when tetracyclines are contraindicated (B)</p> Signup and view all the answers

Which of the following severe infections is chloramphenicol indicated for?

<p>Pneumonia caused by H.influenzae in adults (A)</p> Signup and view all the answers

What is a potential neurological adverse effect of amphenicols?

<p>Optic neuritis (B)</p> Signup and view all the answers

Which organism is specifically mentioned as being susceptible to chloramphenicol treatment?

<p>Salmonella paratyphi A (A)</p> Signup and view all the answers

What condition is a risk factor for hemolytic anemia when using amphenicols?

<p>Glucose-6-phosphate dehydrogenase deficiency (C)</p> Signup and view all the answers

What is a common symptom of gray baby syndrome linked to chloramphenicol?

<p>Cyanosis with gray skin (C)</p> Signup and view all the answers

Which condition is NOT treated with ansamycins?

<p>Viral meningitis (B)</p> Signup and view all the answers

What is a potential adverse effect of ansamycins?

<p>Hyperbilirubinemia (A)</p> Signup and view all the answers

Which type of infections are glycopeptides commonly used to treat?

<p>Infections caused by methicillin-resistant Staphylococcus aureus (MRSA) (B)</p> Signup and view all the answers

In combination with which antibiotic is glycopeptide used for treating infective endocarditis caused by E.faecalis?

<p>Gentamicin (A)</p> Signup and view all the answers

Which is NOT a recommended use of ansamycins?

<p>Treatment of pseudomembranous colitis (B)</p> Signup and view all the answers

Which adverse effect is associated with ansamycins rather than glycopeptides?

<p>Interstitial nephritis (B)</p> Signup and view all the answers

Which infection is NOT typically treated with glycopeptides?

<p>Clostridium difficile infection (B)</p> Signup and view all the answers

What is an indication for the use of ansamycins?

<p>Prophylaxis of meningococcal meningitis (A)</p> Signup and view all the answers

Which condition is NOT treated with Lincosamides?

<p>Severe infections with gram-negative bacilli (B)</p> Signup and view all the answers

What is one of the main adverse reactions associated with Aminoglycosides?

<p>Nephrotoxicity (C)</p> Signup and view all the answers

Which drug is indicated for tuberculosis treatment among the Aminoglycosides?

<p>Streptomycin (A)</p> Signup and view all the answers

Which infection is treated with Lincosamides in association with pyrimethamine?

<p>Toxoplasmosis (C)</p> Signup and view all the answers

What type of lesions can Aminoglycosides cause?

<p>Cochlear and vestibular lesions (C)</p> Signup and view all the answers

Which combination is NOT commonly used for enterococcal infections?

<p>Aminoglycosides with cephalosporins (B)</p> Signup and view all the answers

Which skin condition can Lincosamides be used to treat topically?

<p>Acne vulgaris (B)</p> Signup and view all the answers

What is a significant risk of Aminoglycoside use in patients with fever and leukopenia?

<p>Higher risk of nephrotoxicity (D)</p> Signup and view all the answers

Flashcards

Gram-positive cocci

Bacteria that stain purple in the Gram stain and are spherical in shape.

Gram-negative cocci

Bacteria that stain pink in the Gram stain, spherical in shape.

Aminoglycosides

A class of antibiotics that are effective against various bacteria, often used in combination.

Penicillins (natural)

Antibiotics effective against many types of bacteria, especially Gram-positive bacteria.

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Semisynthetic Penicillins

Modified penicillins that are effective against a wider range of bacteria, including some resistant to natural penicillins.

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Broad-spectrum antibiotics

Antibiotics that are effective against a wide variety of bacteria.

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Nosocomial infections

Infections acquired in a hospital or clinical setting.

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Indications for penicillin

Specific types of infections that penicillin treats effectively.

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Cefazolin indication

It is used for surgical prophylaxis, skin and soft tissue infections, and respiratory and urinary tract infections, although its use for the latter is limited due to resistance.

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Cephalexin indication

It is used for streptococcal tonsillitis and pharyngitis, mild and moderate outpatient skin and soft tissue infections.

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2nd generation cephalosporins, parenteral

Used for outpatient pneumonia needing hospitalization, skin and soft tissue outpatient infections, urinary tract infections (moderate and severe pyelonephritis) and surgical prophylaxis.

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2nd generation cephalosporins, peroral

Used for upper and lower respiratory tract infections (otitis media, sinusitis, bronchitis), and urinary tract infections (pyelonephritis, cystitis)

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3rd generation cephalosporins: Cefotaxime, ceftriaxone - outpatient

Used for gonorrhea, acute otitis media (ceftriaxone).

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3rd generation cephalosporins: Cefotaxime, ceftriaxone - severe outpatient and nosocomial

Used for severe infections like lower respiratory tract infections, skin and soft tissue infections, bone and joint infections, intra-abdominal infections, pelvic infections, salmonellosis, meningitis, and sepsis.

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3rd generation cephalosporins: Ceftazidime, cefoperazona

Used for severe outpatient and nosocomial infections caused by Pseudomonas or Acinetobacter, infections due to neutropenia and immunodeficiency.

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3rd generation cephalosporins: Cefixime, ceftibuten

Used for urinary tract infections, as oral therapy for severe infections after initial parenteral treatment, and some upper and lower respiratory tract infections.

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Tetracycline Adverse Effects: Liver

High doses of tetracyclines can cause hepatic steatosis (fatty liver) and, in severe cases, liver necrosis.

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Tetracycline Adverse Effects: Kidney

Tetracyclines, especially natural ones, can cause nephrotoxicity, leading to Fanconi syndrome, characterized by proximal tubulopathy with symptoms like polyuria, polydipsia, proteinuria, aminoaciduria, glucosuria, acidosis, nausea, and vomiting.

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Tetracycline Adverse Effects: Bones & Teeth

Tetracyclines accumulate in calcified tissues, forming chelates with calcium orthophosphate. This deposition can inhibit bone growth in children (irreversible with long-term high doses) and cause teeth discoloration (brown) with enamel hypoplasia.

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Tetracycline Contraindications

Tetracyclines are contraindicated in pregnant women and children under 8 years old (sometimes up to 12 years) due to their potential to affect bone growth, teeth development, and cerebrospinal fluid pressure.

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Tetracycline Adverse Effects: Photosensitivity

Tetracyclines can cause photosensitization, making individuals more sensitive to sunlight and ultraviolet rays, often leading to skin reactions and sometimes accompanied by high fever.

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Tetracycline Adverse Effects: Vestibular System

Tetracycline use can lead to vestibular disorders, causing dizziness, nausea, and vomiting.

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Tetracycline Adverse Effects: Local Toxicity

Tetracyclines can cause local toxicity, including venous thrombosis with intravenous administration and painful irritation with intramuscular injection.

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Tetracycline Adverse Effects: Other

Tetracycline can also cause various other adverse effects, including superinfections (e.g., Candida mycosis, staphylococcal and pseudomembranous enteritis), anti-anabolic effects, leukocytosis, thrombocytopenia (long-term treatment), and allergic reactions (e.g., dermatitis, Quincke's edema, fever, anaphylactoid reactions).

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Lincosamides: What are they used for?

Lincosamides are a class of antibiotics used to treat various bacterial infections like streptococcal tonsillitis, lower respiratory tract infections, skin and soft tissue infections, bone and joint infections, intra-abdominal infections, pelvic infections, and certain parasitic infections.

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Lincosamides: What is a potential side effect?

A serious potential side effect of Lincosamides is pseudomembranous colitis, an inflammation of the colon caused by Clostridium difficile bacteria.

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Aminoglycosides: Their key roles

Aminoglycosides are a class of antibiotics commonly used in combination therapies for severe infections caused by Gram-negative bacteria.

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Aminoglycosides: When are they often combined?

Aminoglycosides are often combined with other antibiotics like penicillins, cephalosporins, and vancomycin to treat infections caused by bacteria resistant to individual antibiotics.

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Aminoglycosides: Potential side effects?

Aminoglycosides can cause serious side effects like ototoxicity (damage to the ears) and nephrotoxicity (damage to the kidneys).

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Streptomycin: What is its primary use?

Streptomycin is an aminoglycoside antibiotic primarily used to treat tuberculosis, tularemia, brucellosis, and plague.

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Aminoglycosides: Intestinal decontamination?

Aminoglycosides like neomycin and kanamycin can be used in combination with erythromycin to decontaminate the intestine before procedures on the large intestine.

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Aminoglycosides: Type of damage caused?

Aminoglycosides cause damage to the epithelium of the cochlear and vestibular nerve, leading to hearing loss (cochlear damage) and balance issues (vestibular damage).

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Chloramphenicol Use

Chloramphenicol is a reserve antibiotic for serious infections when other options are ineffective or contraindicated. It's used for conditions like brain abscesses caused by Bacteroides fragilis, typhoid fever, meningitis, and some pneumonias.

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Chloramphenicol Side Effects

Chloramphenicol can cause serious side effects, including bone marrow suppression leading to anemia, leukopenia, and thrombocytopenia. In rare cases, it can cause aplastic anemia, a life-threatening condition.

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Gray Baby Syndrome

A rare but serious side effect of chloramphenicol in newborns, characterized by symptoms like vomiting, cyanosis, and lethargy. It's due to the drug's accumulation in the body.

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Ansamycins Spectrum

Ansamycins are a class of antibiotics effective against various bacteria, including Mycobacterium tuberculosis, atypical mycobacteria, gram-positive cocci (e.g., staphylococci, streptococci), and gram-negative cocci.

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Ansamycins: Gram-Positive

Ansamycins are effective against gram-positive cocci such as staphylococci (including methicillin-resistant strains), pneumococci (poly-resistant strains), and streptococci.

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Ansamycins: Gram-Negative

Ansamycins target gram-negative cocci like meningococci and gonococci. They are also effective against gram-positive bacilli, including Clostridium spp. and Bacillus anthracis.

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Ansamycins: Mycobacterium

Ansamycins are particularly effective against Mycobacterium tuberculosis and atypical mycobacteria, which cause infections like tuberculosis.

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Ansamycins: Gram-Positive Bacilli

Ansamycins are effective against gram-positive bacilli like Clostridium spp., which cause diseases like tetanus and botulism, and Bacillus anthracis, the cause of anthrax.

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Ansamycins: What are they used for?

Ansamycins are a class of antibiotics used to treat various infections like tuberculosis, leprosy, staphylococcal infections, brucellosis, Legionella pneumonia, and as prophylaxis for meningococcal meningitis. They are often combined with other drugs.

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What are some adverse effects of Ansamycins?

Ansamycins can cause side effects such as liver damage (hepatotoxicity), digestive problems (nausea, vomiting, diarrhea), allergic reactions (hives, swelling), neurological issues (headache, dizziness, confusion), kidney problems (interstitial nephritis), and immune-related reactions (low platelet count, anemia).

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Glycopeptides: Main uses?

Glycopeptides are important antibiotics particularly effective against resistant Staph infections (MRSA), Enterococci, Bacilli, and certain meningitis-causing bacteria. They are also used for prevention of surgical site infections.

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When are Glycopeptides used for MRSA?

Glycopeptides are a crucial treatment option for Methicillin-resistant Staphylococcus aureus (MRSA) infections, especially when other antibiotics fail. They are often combined with other drugs for optimal effectiveness.

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Glycopeptides for Enterococci?

Glycopeptides are used for severe infections caused by Enterococcus spp., a type of bacteria known for causing various infections, particularly in hospitals.

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What is the role of Glycopeptides in infective endocarditis?

Glycopeptides are used in treatment of infective endocarditis (heart valve infection) caused by specific bacteria, especially when patients are allergic to penicillin-based antibiotics. They can be combined with other drugs like gentamicin for better results.

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Glycopeptides: Role in severe infections?

Glycopeptides are used empirically for severe infections when the cause is suspected to be staphylococcal. This includes endocarditis, catheter-related infections, meningitis, and neutropenic fever.

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Glycopeptides: Other important uses?

Glycopeptides are also used orally for C. difficile-related colitis, surgical site infection prevention, and as prophylaxis for infective endocarditis in high-risk patients.

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Study Notes

Antibiotics

  • Antibiotics are natural byproducts of fungi, actinomycetes, and bacteria, or semisynthetic/synthetic derivatives that selectively kill or inhibit bacterial growth in a diluted form.

Beta-Lactama Antibiotics

  • Biosynthetic Penicillins:

  • Benzylpenicillin

  • Benzathine benzylpenicillin (extencilline, retarpen)

  • Procaine benzylpenicillin (bicilinele)

  • Phenoxymethylpenicillin (ospen)

  • Semisynthetic Penicillins:

  • Isozaxolyl penicillin (antistaphylococcal antibiotics)

  • oxacillin

  • cloxacillin

  • flucloxacillin

  • dicloxacillin

  • nafcillin

  • Aminopenicillins:

  • ampicillin

  • amoxicillin

  • Carboxypenicillins:

  • Carbenicillin

  • Carfecillin

  • Carindacillin

  • Ticarcillin

  • Ureidopenicillins:

  • Mezlocillin

  • Azlocillin

  • Piperacillin

  • Other Beta-lactams:

  • Mecillinam

  • Pivmecillinam

  • Temocillin

Cephalosporins

  • First-generation:

  • Cefazolin

  • Cefalexin

  • Cefadroxil

  • Second-generation:

  • Cefaclor

  • Cefuroxime

  • Cefamandole

  • Cefotetan

  • Cefotiam

  • Cefonicid

  • Cefoxitin

  • Loracarbef

  • Third-generation:

  • Ceftriaxone

  • Cefotaxime

  • Ceftazidime

  • Cefoperazone

  • Cefodizime

  • Ceftizoxime

  • Cefsulodin

  • Latamoxef

  • Fourth-generation:

  • Cefepime

  • Cefpirome

  • Fifth-generation:

  • Ceftobiprole

  • Ceftaroline

  • Ceftolozane

  • Cefditoren

Other Antibiotic Classes

  • Aminoglycosides:

  • Generation I: Streptomycin, Neomycin, Kanamycin, Paromomycin

  • Generation II: Gentamicin, Tobramycin, Sisomicin

  • Generation III: Amikacin, Netilmicin, Isepamicin

  • Lincosamides:

  • Clindamycin

  • Lincomycin

  • Macrolides:

  • With 14-membered lactone rings: erythromycin, clarithromycin, roxithromycin, flurithromycin, davercin

  • With 15-membered lactone rings (azalides): azithromycin

  • With 16-membered lactone rings: spiramycin, josamycin, midecamycin, rokitamycin

  • Ketolides: telithromycin

  • Tetracyclines:

  • Generation I: Tetracycline, Oxytetracycline, Rolitetracycline

  • Generation II: Doxycycline, Metacycline, Minocycline

  • Amphenicols:

  • Chloramphenicol

  • Chloramphenicol hemisuccinate

  • Tiamphenicol

  • Polymyxins:

  • Polymyxin M

  • Colistin

  • Ansamycins:

  • Rifampicin

  • Rifaximin

  • Rifamycin

  • Rifabutin

  • Glycopeptides:

  • Vancomycin

  • Ristomycin

  • Teicoplanin

  • Lipoglycopeptides: Dalbavancin, oritavancin, telavancin, daptomycin

  • Others:

  • Nystatin

  • Levorin

  • Amphotericin B

  • Griseofulvin

  • Natamycin

  • Cycloserine

  • Capreomycin

  • Fosfomycin

  • Fuzafungine

  • Bacitracin

  • Mupirocin

  • Gramicidin

  • Fusidic acid

Classification of Antibiotics by Mechanism of Action

  • I. Cell wall inhibitors: Beta-lactams, glycopeptides
  • II. Membrane-active antibiotics: Polymyxins
  • III. Protein synthesis inhibitors (30S subunit): Tetracyclines
  • III. Protein synthesis inhibitors (50S subunit): Chloramphenicol, macrolides, lincosamides
  • IV. Nucleic acid synthesis inhibitors: Ansamycins

Classification according to Spectrum of Action

  • I. More potent influence on gram-positive flora
  • II. More potent influence on gram-negative flora
  • III. Broad spectrum
  • IV. Ultra-broad spectrum

Classification According to Bactericidal/Bacteriostatic Effects

  • I. Bactericidal (irreversible intoxication of microbial germs)

  • II. Bacteriostatic (inhibition of germs multiplication)

Indications for Combination Antibiotic Therapy

  • Empirical treatment: Unknown pathogen
  • Polymicrobial infections
  • Potentiation of the antibacterial effect: certain pathogens
  • Prevention of bacterial resistance

Combination Antibiotic Therapy

  • Most effective and recommended: Beta-lactams + aminoglycosides
  • Allowed for spectrum extension:
  • Beta-lactamics + macrolides, lincosamides
  • Aminoglycosides + fluoroquinolones
  • Macrolides, lincosamides + fluoroquinolones
  • Tetracyclines + chloramphenicol + macrolides
  • Tetracyclines + chloramphenicol + fluoroquinolones
  • Aminoglycosides + tetracyclines
  • Beta-lactams + fluoroquinolones
  • Antagonistic combinations (not recommended)
  • Prohibited combinations

Adverse Reactions of Antibiotics

  • Site of administration: oral, i/m; i/v
  • Toxic: nephrotoxicity, hepatotoxicity, ototoxicity
  • Allergic: general, cutaneous-mucous, pulmonary
  • Biological: dysmicrobisms, superinfections
  • Bacteriological: Herxheimer's Phenomenon
  • Metabolic: dysmetabolism, vitamin deficiency
  • Embryo/fetotoxicity: in newborns & children
  • Immunological Interference: relapses, reinfections, chronicity
  • Drug interactions: with solvents & other antibiotics
  • Other: "Red Man Syndrome"

Microbial Resistance

  • Natural and acquired: Streptomycin, Penicillin
  • Mechanisms of resistance
  • Enzyme production
  • Altered permeability
  • Change in action site of the antibiotic
  • Enzyme modification
  • Efflux pumps.

Ways to Decrease Bacterial Resistance

  • Use new enzyme-resistant antibiotics
  • Synthesis of bacterial enzymes to inactivate substances
  • Synthesis of new classes of antibiotics
  • Use higher doses
  • Exclusion of antibiotic use for a period
  • Prohibition of unjustified antibiotic use

WHO Pathogens with Dangerous Resistance

  • I. Very high: Acinetobacter, Pseudomonas, Enterobacteria
  • II. High degree: Enterococcus, Staphylococcus, Helicobacter, Campylobacter, Salmonella
  • III. Moderate: Streptococcus, Haemophilus, Shigella

Antistaphylococcal Antibiotics

  • Sensitive to methicillin: Ist-line: oxacillin, dicloxacillin, flucloxacillin
  • Reserve group: Vancomycin, IIIrd-IVth generation cephalosporins
  • Resistant to methicillin: Ist line: Vancomycin
  • Reserve group: teicoplanin, fluoroquinolones (levofloxacin, moxifloxacin)

Antibiotics Effective in Gram-Negative Infections

  • Pseudomonas: Ist-line: antipseudomonas penicillins, cephalosporins, third/fourth generation penicillins

  • Hemophilus influenzae: Ist-line: Ceftriaxone, cefotaxime, cloramfenicol, amoxicillin-clavulanate

  • Enterobacter: Ist-line: Aminoglycosides, imipenem, extended spectrum penicillin

  • Proteus, vulgaris: Ist -line: aminoglycosides; IIIrd generation cephalosporins

  • Serratia: Ist-line: Imipenem, cefoxitin, cefotetan or cefalosporin gen III

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