Antibiotics Quiz

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Questions and Answers

Which type of antibiotic is Doripenem?

  • 1st generation cephalosporin
  • Carbapenem (correct)
  • 2nd generation cephalosporin
  • 3rd generation cephalosporin

How is the mechanism of action of antibiotics best categorized?

Based on the structure of the bacteria

Anti-pseudomonal penicillin includes Piperacillin-tazobactam.

True (A)

Which antibiotic is considered the last resort?

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

Which category of antibiotics kills the bacteria?

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

Fluoroquinolones are especially used for ________.

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

Beta-Lactam antibiotics inhibit the synthesis of (blank)

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

Match the following antibiotics with their types:

<p>Penicillin = Beta-Lactam Vancomycin = Glycopeptide Cephalosporin = Cephalosporin Fosfomycin = Acute cystitis</p> Signup and view all the answers

What are the mechanisms of antibiotic resistance discussed in the content?

<p>Increased inactivating enzymes (A), Increased efflux (B), Decreased target binding (C), Reduced permeability (D)</p> Signup and view all the answers

Why is reducing permeability one of the mechanisms of antibiotic resistance?

<p>To prevent antibiotics from entering the bacterial cell and exerting their effects by binding onto the target sites.</p> Signup and view all the answers

Enzymes can inactivate antibiotics, rendering them ineffective. (True/False)

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

Match the antibiotic with the correct category it belongs to:

<p>Cefotexime = 4th Generation Ceftazidime = 4th Generation Ceftaroline = 5th Generation Doripenem = Carbapenem Imipenem = Carbapenem Meropenem = Carbapenem Aztreonam = Monobactam</p> Signup and view all the answers

Which drugs can be used for MSSA + Strep A infections orally?

<p>Dicloxacillin or Cephalexin (A)</p> Signup and view all the answers

Which antibiotic inhibits RNA polymerase?

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

DNA gyrase inhibitors inhibit the ligating portion of the DNA gyrase while increasing the cutting portion, which fragments the DNA into pieces. One example of DNA gyrase inhibitor antibiotics is ___________.

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

Which drug is a common empiric antibiotic for Pyelonephritis?

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

Trimethoprim inhibits dihydrofolate reductase.

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

What is the most common pathogen for Acute Cystitis?

<p>PEcK (Proteus mirabillis, E.coli, Klebsiella)</p> Signup and view all the answers

What is the mechanism of action of Polymyxin?

<p>Increases permeability of the cell membrane</p> Signup and view all the answers

Neisseria gonorrhoeae can spread to joints.

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

Match the pathogens with the appropriate antibiotics for Community-Acquired Meningitis:

<p>S.pneumoniae, H.catarrhalis, N.meningitidis = Ampicillin</p> Signup and view all the answers

What is the mechanism of action of Levofloxacin?

<p>Inhibits bacterial DNA gyrase/topoisomerase IV</p> Signup and view all the answers

What are the three mechanisms by which DNA/RNA material can bring opportunities for bacteria when it gets destroyed?

<p>Change the permeability of the bacterial cell, Increase the efflux of the antibiotic out of the bacterial cell, Change the actual target of the protein that the antibiotics are supposed to bind to</p> Signup and view all the answers

What are the methods of horizontal gene transfer in bacteria?

<p>Conjugation (A), Transformation (C), Transduction (D)</p> Signup and view all the answers

Overprescribing antibiotics in hospitals does not contribute to the risk of antibiotic resistance, True or False?

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

In conjugation, bacteria connect via a ____.

<p>sex pilus</p> Signup and view all the answers

Match the mechanisms of resistance to antibiotics with their descriptions:

<p>Change the permeability of the bacterial cell = Allows substances to pass through the bacterial cell membrane Increase the efflux of the antibiotic out of the bacterial cell = Pumps antibiotics out of the bacterial cell, reducing their effectiveness Change the actual target of the protein that the antibiotics supposed to bind to = Alters the binding site of antibiotics within the bacterial cell</p> Signup and view all the answers

Why do we get a sputum culture for a patient with an infection like pneumonia?

<p>All of the above (D)</p> Signup and view all the answers

What is the purpose of getting a urinary culture for a patient with a UTI?

<p>Identify the bacteria causing the UTI</p> Signup and view all the answers

What method is used to determine the minimum inhibitory concentration (MIC) of antibiotics?

<p>Microdilution, Macrodilution, Kirby-Bauer method</p> Signup and view all the answers

Match the antibiotics with their categories:

<p>Aminopenicillin = HENS-PEcK 4th generation cephalosporins = HENS-PEcK Carbapenems = HENS-PEcK Monobactams = HENS-PEcK Fluoroquinolones = HENS-PEcK Aminoglycosides = HENS-PEcK</p> Signup and view all the answers

Susceptibility testing helps in determining which antibiotics the bacteria are resistant to.

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

The following drug can be used in both community and hospital-acquired meningitis:

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

What is the mechanism of action of Vancomycin?

<p>Inhibits 50S ribosomal subunit</p> Signup and view all the answers

Which drug is NOT used for pseudomonas infections?

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

Which drug will you give to treat a patient's infection if the antibiotic susceptibility testing shows resistance to the commonly used drug for the particular organism?

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

A triad of rashes, muscle spasms, and hypotension are side effects of the following:

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

Which of the following is NOT an anti-Pseudomonal antibiotic?

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

Which of the following can be used conveniently in methicillin-susceptible S. aureus infection of the skin?

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

Which of the following can be used in a pregnant patient with acute cystitis?

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

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Study Notes

Introduction & Mechanism of Action

  • Antibiotics can be categorized based on the structure of the bacteria they target
  • Antibiotics can be either bactericidal (killing the bacteria) or bacteriostatic (inhibiting the growth of the bacteria)

Mechanisms of Action

  • Cell Wall Synthesis
    • Inhibits the enzymes that synthesize cell wall synthesis
    • Limits the wall synthesis, preventing bacteria from dividing properly
    • Bacteria become susceptible to materials leaking in or out of the cell, introducing opportunity for bacterial death
  • Cell Membrane Integrity
    • Creates efflux pumps in the cell membrane, increasing permeability and risk of cell lysis
    • Examples: Daptomycin and Polymyxin
  • Folic Acid Pathway
    • Inhibits nucleotide synthesis of bacteria
    • Examples: Sulfamethoxazole (SMX) and Trimethoprim (TMP)
  • DNA Integrity
    • Increases the formation of reactive oxygen species (ROS), causing damage to DNA, RNA, and/or proteins
    • Examples: Metronidazole and Nitrofurantoin
  • Messenger RNA Synthesis
    • Inhibits RNA polymerase
    • Examples: Rifampin (used in tuberculosis)
  • DNA Gyrase Function
    • Inhibits DNA gyrase, which helps maintain DNA topology
    • Examples: Fluoroquinolones (Ciprofloxacin, Levofloxacin, Gemifloxacin, Moxifloxacin)
  • Protein Synthesis Inhibitors
    • 50S Ribosomal Subunit: Macrolides (Azithromycin, Erythromycin, Clarithromycin), Clindamycin, and Chloramphenicol
    • 30S Ribosomal Subunit: Aminoglycosides (Tobramycin, Amikacin, Gentamicin) and Tetracycline (Doxycycline, Tetracycline)

Bacterial Coverage

  • Gram Positive Coverage
    • Examples: Beta-Lactams (Penicillin, Cephalosporin, Carbapenem, Monobactam) and Vancomycin
  • Gram Negative Coverage
    • Examples: Beta-Lactams (Penicillin, Cephalosporin, Carbapenem, Monobactam) and Fosfomycin
  • Anaerobic Coverage
    • Examples: Metronidazole and Nitrofurantoin
  • Atypical Coverage
    • Examples: Azithromycin and Rifampin (used in tuberculosis)

Empiric Antibiotics for Common Infections

  • Pulmonary
    • Examples: Cephalosporin and Macrolides
  • Gastrointestinal
    • Examples: Cephalosporin and Fluoroquinolones
  • Skin and Soft Tissues
    • Examples: Cephalosporin and Beta-Lactams
  • Urinary Tract
    • Examples: Fluoroquinolones and Cephalosporin
  • Bone and Joint
    • Examples: Fluoroquinolones and Cephalosporin
  • CNS
    • Examples: Beta-Lactams and Cephalosporin
  • Bloodstream
    • Examples: Beta-Lactams and Cephalosporin### Bacterial Coverage

Gram Positive Coverage

  • Methicillin Sensitive Staphylococcus aureus (MSSA):
    • Treated with anti-staphylococcal penicillin (nafcillin, oxacillin, dicloxacillin)
    • 1st generation cephalosporins (cephalexin, cefazolin)
    • Fluoroquinolones
  • Methicillin Resistant Staphylococcus aureus (MRSA):
    • Treated with 5th generation cephalosporin (ceftaroline)
    • Vancomycin
    • Trimethoprim-sulfamethoxazole
    • Clindamycin
    • Linezolid
    • Doxycycline
    • Daptomycin
  • Streptococcus pneumoniae:
    • Treated with penicillin
    • Aminopenicillins
    • 3rd generation cephalosporins (ceftriaxone)
    • Fluoroquinolones (moxifloxacin, levofloxacin)
    • Macrolides
    • Clindamycin
  • Streptococcus (Group A & B):
    • Treated with anti-staphylococcal penicillin (nafcillin, oxacillin, dicloxacillin)
    • 1st generation cephalosporins (cephalexin, cefazolin)

Gram Negative Coverage

  • HENS-PEcK organisms:
    • Hemophilus influenzae
    • Enterobacter
    • Neisseria gonorrhoeae and meningitidis
    • Serratia
    • Proteus
    • Escherichia coli
    • Klebsiella
    • Treated with aminopenicillins (ampicillin)
    • Anti-pseudomonal penicillin (piperacillin-tazobactam)
    • 1st generation cephalosporins (cephalexin, cefazolin)
    • 2nd, 3rd, 4th generation cephalosporins
    • Carbapenems (doripenem, imipenem, meropenem, ertapenem)
    • Monobactams
    • Fluoroquinolones
    • Aminoglycosides
  • Extended spectrum beta lactamase bacteria (ESBL):
    • Enterobacteriaceae
    • Treated with carbapenems (doripenem, imipenem, meropenem, ertapenem)
    • 3rd generation cephalosporin + beta lactamase inhibitor (ceftazidime+avibactam)

Anaerobic Coverage

  • CBPFA organisms:
    • Clostridium
    • Bacteroides
    • Peptostreptococcus
    • Fusobacterium
    • Actinomyces
    • Treated with clindamycin
    • Metronidazole
    • Carbapenems
    • Anti-pseudomonal penicillin (piperacillin-tazobactam)
    • Fluoroquinolones
  • MCL organisms:
    • Mycoplasma
    • Chlamydia
    • Legionella
    • Treated with fluoroquinolones
    • Macrolides
    • Chloramphenicol
    • Doxycycline

Empiric Antibiotics for Common Infections

  • Pulmonary:

    • Community-Acquired Pneumonia (CAP):
      • Fluoroquinolones (respiratory)
      • Beta-lactam (ceftriaxone) + macrolide or doxycycline
    • Hospital-Acquired Pneumonia (HAP):
      • Vancomycin
      • Antipseudomonal penicillin (piperacillin-tazobactam)
      • Ceftazidime, cefepime, or an aminoglycoside

  • Gastrointestinal:

    • Gram-Negatives and Anaerobes:
      • Carbapenems
      • Antipseudomonal penicillins (piperacillin-tazobactam)
      • Metronidazole + fluoroquinolone (ciprofloxacin)
      • Metronidazole + ceftriaxone
      • Metronidazole + cefepime

  • Skin and Soft Tissues:

    • MSSA + Strep A:
      • PO: dicloxacillin or cephalexin
      • IV: nafcillin or oxacillin or cefazolin
    • MRSA + Strep A:
      • PO: TMP-SMX, doxycycline, or clindamycin
      • IV: vancomycin

  • Urinary Tract:

    • Pyelonephritis:
      • Ceftriaxone
      • Fluoroquinolone (ciprofloxacin)
      • Aminopenicillin (ampicillin)
    • Complicated UTI:
      • Vancomycin
      • Antipseudomonal penicillin (piperacillin-tazobactam)
      • Ceftazidime, cefepime, or an aminoglycoside

  • Bone and Joint:

    • Septic arthritis, osteomyelitis:
      • Vancomycin
      • Ceftriaxone
      • Cefepime, ceftazidime, or an aminoglycoside

  • CNS:

    • Community-Acquired Meningitis (CAM):
      • Vancomycin
      • 3rd generation cephalosporin (ceftriaxone)### Empiric Antibiotics for Meningitis

  • Ceftriaxone: good CNS penetration, covers H. catarrhalis and N. meningitidis

  • Ampicillin: consider for Listeria, especially in older patients (> 60 y/o), immunocompromised patients, and babies

  • Hospital-Acquired Meningitis (HAM): consider MRSA and Pseudomonas, use Vancomycin and Cefepime respectively

Empiric Antibiotics for Bloodstream Infections

  • Central Line Bloodstream Infection (CLABSI): consider MRSA, use Vancomycin and +/- Pip-Tazo
  • Sepsis: consider Vancomycin and Pip-Tazo for Gram-positives and Gram-negatives respectively

Antibiotics Pharmacology

  • Adverse effects:
    • Neurotoxicity: seizures, myoclonus, encephalopathy, serotonin syndrome
    • Pancytopenia: hemolytic anemia, especially with beta-lactams
    • Teratogenicity: avoid during pregnancy, especially with TMP-SMX
    • Hyperkalemia: TMP-SMX

Mechanisms of Antibiotic Resistance

  • Reduced permeability:
    • Vancomycin
    • Aminoglycosides
    • Tetracyclines
    • Beta-lactams
  • Increased efflux:
    • Fluoroquinolones
    • Aminoglycosides
    • Tetracyclines
    • Macrolides
  • Decreased target binding:
    • Fluoroquinolones
    • Aminoglycosides
    • Tetracyclines
    • Beta-lactams
    • Macrolides
    • Linezolid
    • Trimethoprim-Sulfamethoxazole
  • Increased inactivating enzymes:
    • Beta-lactams: beta-lactamase, carbapenemase
    • Aminoglycosides: phosphorylation, acetylation, methylation reactions
    • Macrolides

Transmission of Antibiotic Resistance

  • Bacteria can pass on resistance mechanisms to other bacteria through:
    • Reduced permeability
    • Increased efflux
    • Decreased target binding
    • Increased inactivating enzymes

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