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Antibiotics

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An in-hospital teaching presentation

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Antibiotics

  1. 1. The basics Brooke Sachs 2017
  2. 2. http://tmedweb.tulane.edu/pharmwiki/doku.php/antibiotic_targets
  3. 3.  Bacteriocidal antibiotics  Beta lactams  Vancomycin  Daptomycin  Fluoroquinolones (ciprofloxacin)  Metronidazole  Nitrofurantoin  co-trimoxazole  Aminoglycosides (gentamycin)  Bacteriostatic antibiotics  Chloramphenicol  Lincosamides (Clindamycin)  Ethambutol  Macrolides (azithromycin etc)  Sulfonamides (sulfamethoxazole)  Tetracyclines (doxycycline)
  4. 4. http://alkam.tripod.com/GRAM.HTM
  5. 5. https://en.wikipedia.org/wiki/Gram-positive_bacteria
  6. 6.  Obligate intracellular bacteria  Rickettsia  Chlamydia  No cell wall  Mycoplasma  Spirochetes  Treponema pallidum (syphillis) – gram negative, thin, spiral shape  Borrelia  Leptospira  Mycobacterium  Thick mycolic acid cell wall means neither gram negative nor gram positive  Aerobic, acid fast (Ziehl-Neelson stain)
  7. 7. https://commons.wikimedia.org/wiki/File:Bacterial_infections_and_involved_species.png
  8. 8.  The right DRUG  The right DOSE  DE-ESCALATION to pathogen-directed therapy  The right DURATION
  9. 9.  Things that cause fevers that aren’t bacteria:  Viral infections  Pancreatitits  Operations and post-operative atelectasis  PE/DVT/fat embolus  Subarachnoid haemorrhage  Myocardial infarct, stroke, ischaemic bowel  Cancer, tumour lysis syndrome  Drugs  Alcohol/drug withdrawal  Gout/rheumatic processes  ARDS, aspiration pneumonitis  Transfusion  Transplant reaction  Adrenal insufficiency  Thyrotoxicosis, thyroiditis  Phelbitis/thrombophlebitis  Infections that don’t need antibiotics:  Small skin abscesses that will self-resolve  Asymptomatic bacturia (except in specific cases)  Bacterial colonisation (e.g. coag-negative staph from a skin swab) http://www.derangedphysiology.com/main/required-reading/infectious-diseases-antibiotics-and-sepsis/Chapter%203.7.0/infectious-and-non-infectious-causes-fever
  10. 10.  Most commonly affected by aerobic bacteria, due to the available oxygen  Can be gram positive or gram negative, mycoplasma, tuberculosis  CURB-65, SMART-COP for assessing severity  Stratification will help decide in/outpatient treatment and strength of antibiotics if required  Make sure to do appropriate tests – CXR, respiratory viral swab, sputum culture, 2x blood culture, routine chemistry, urine legionella/pneumococcal antigens  Treated empirically based on the most common causes  B-lactams for the gram-positive bacteria  Tetracyclines/macrolides for atypicals https://www.safetyandquality.gov.au/wp-content/uploads/2012/02/3.3-Adult-Pneumonia-CPG-CAP-HAP-combined-post-AQUM-HNE-Health.pdf
  11. 11.  Diagnosis based on clinical symptoms, UA and urine culture  Most common cause is E. coli  Treatment depends on how high up the tract the infection goes (cystitis mostly outpatient, pyelonephritis inpatient)  Often treated with agents that act on protein synthesis, but also use ampicillin www.nps.org.au/medical-info/consumer-info/urinary-tract-infections-utis
  12. 12.  Often aerobic  Staph, strep, pseudomonas are the most common bacteria  Cellulitis often requires treatment, though small areas can be monitored  Often treat with cephalosporins, tetracyclines (doxy), erythromycin  Beware of MRSA http://www.medscape.org/viewarticle/529347
  13. 13.  Most diarrhoea, even if from a bacterial cause, will be self-resolving  Beware C.diff (treat with metronidazole or vancomycin PO)  H. pylori requires multi-modal therapy  Ascending cholangitis is life-threatening (and often the infection is secondary to another cause that must be treated)
  14. 14.  Sore throats can spell strep throat, and the association with rheumatic fever means antibiotics are required in those scoring highly on the Centor Criteria  New murmurs require investigation – and empiric treatment is often warranted  The new severe headache or neurological syndrome may be a CNS infection – consider LP BEFORE antibiotic administration where possible and remember many antibiotics do not penetrate the BBB easily

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