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Antibiotics Overview - the barest facts

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My final revision slides for microbiology in 2nd clinical year pathology finals at the University of Cambridge.

My final revision slides for microbiology in 2nd clinical year pathology finals at the University of Cambridge.

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  • 1. Antibiotics – The barest facts Penicillins – gram +ve bacilli/cocci and gram –ve cocci (proliferating bacteria) - Flucloxacillin – b-lactamase resistant - Amoxicillin – H. influenzae - Augmentin (Co-amoxiclav = Amoxicillin and Clavulanate) – b-lactamase resistant, gram –ve bacilli - Tazocin (Piperacillin and Tazobactam) – b-lactamase resistant, Pseudomonas Cephalosporins – broad spectrum - Ceftazidime – Pseudomonas Carbapenems – exceptionally broad spectrum - Meropenem – EXCEPT MRSA, VRE, Mycob.. Mycopl., Chlam., Ricketts., Klebs. Macrolides – gram +ve bacilli/cocci and gram –ve cocci (similar to penicillins) - Clarithromycin – + Myocbacteria (not TB), Mycoplasma, Chlamydia, some gram -ve Lincosamines – narrow spectrum, gram +ve cocci incl. MRSA (?) and anaerobes - Clindamycin Sulfonamides – broad spectrum - Trimethoprim – H. influenza, E. coli, Klebsiella Tetracyclines – broad spectrum - Doxycycline – Chlamydia, Rickettsia, Brucella, Borrelia Glycopeptides – narrow spectrum, gram +ve cocci - Vancomycin – MRSA Aminoglycosides – gram –ves unless synergism with other antibiotic - Gentamycin Imidazoles – as a class of compounds they are antifungals - Metronidazole – anaerobes, C. diff! Quinolones – broad spectrum - Ciprofloxacin – only oral AB against Pseudomonas, Chlamydia, E.coli, Klebsiella ATYPICALS GRAM –ve BACILLI AND BACTERIA OF THE GUT
  • 2. Treating Infectious Diseases – The barest facts UTI – E. coli, Klebsiella, Enterococci = Gram –ve bacilli - Trimethoprim (better if resistance likely) - Co-Amoxiclav - Ciprofloxacin possible but likelihood of C. diff - If ESBL (Extended spectrum b-lactamase) o Meropenem – hospital o Nitrophenytoin – community Pneumonia – COMMUNITY: 90% Strep. pneumoniae, Haemophilus influenzae, atypical – HOSPITAL: MRSA, gram –ve - COMMUNITY o Severity determined by CURB65 o Low: Amoxicillin OR Doxycycline (if allergic) Strep. pneumoniae + H. influenzae o Moderate: Amoxicillin + Clarithromycin OR Doxycycline Strep. pneumoniae + H. influenzae + atypicals o High: Co-amoxiclav + Clarithromycin Strep. + H. influenzae + gram -ve cocci + atypicals - HOSPITAL o Early onset: Co-amoxiclav Gram +ve + H. influenzae + gram-ve cocci o Late onset: Tazocin/Ceftazidime/Ciprofloxacin Pseudomonas Skin and Tissue Infections – gram +ve, mainly Staph - Flucloxacillin OR Clarythromycin (if allergic) b-lactamase resistant Staph (doxycycline if allergic also possible as Staph less sensitive to Clarythromycin than Strep) - Vancomycin MRSA Meningitis - Penicillin Empirical - Benzylpenicillin/Cefotaxime OR Chloramphenicol (if allergic) Neisseria meningitides - Cefotaxime OR Chloramphenicol Strep. pneumoniae, H. influenzae - Amoxicillin AND Gentamycin Listeria - Think cef for cephalic? Diarrhoea - Ciprofloxacin (can cause C. diff) gram –ve cocci - Metronidazole C. diff

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