RXPrep Infectious Diseases| Study Guide
DNA/RNA inhibitors - Quinolones (DNA gyrase, topoisomerase IV)
M
etronidazole, tinidazole
Rifampin
Cell Membrane Inhibitors - Polymyxins
Daptomycin
Telavancin
Oritavancin
Protein Synthesis Inhibitors - Aminoglycosides
Macrolides
Tetracyclines
Clindamycin
Linezolid, tedizolid
Quinupristin/dalfopristin
Cell Wall Inhibitors - Beta lactams (penicillins, cephalosporins, carbapenems)
Monobactams (aztreonam)
Vancomycin, dalbavancin, telavancin, oritavancin
Folic Acid Synthesis Inhibitors - Sulfonamides
Trimethoprim
Dapsone
Common Resistant Pathogens? - Kill Each And Every Strong Pathogen
Klebsiella pneumoniae (ESBL, CRE)
Escherichia coli (ESBL, CRE)
Acinetobacter baumannii
Enterococcus faecalis, Enterococcus faecium (VRE)
Staphylococcus aereus (MRSA)
Pseudomonas aeruginosa
ESBL - extended spectrum beta-lactamase
-organisms producing ESBL are hard to kill, need to use carbapenems or newer
cephalosporin/beta-lactamase inhibitors.
CRE - Carbapenem-resistant Enterobacteriaceae
-CRE treatment requires combination tx including polymyxins, ceftazidime/avibactam is
also used
,VRE - vancomycin resistant enterococcus
Intrinsic resistance - Not the right drug for the job - the resistance is naturally
occurring.
(e.g. E. coli is resistant to Vanco because Vanco is too large to penetrate the cell wall of
E. coli)
Selection pressure - Good bacteria are killed instead of bad bacteria allowing for them
to multiply.
(e.g. when abx like Vanco eliminate susceptible Enterococci (healthy gut bacteria),
vancomycin-resistant enterococcus (VRE) can flourish)
Acquired resistance - resistance that develops through mutation or acquisition of new
genes
Enzyme inactivation - resistance from enzymes produced by bacteria breaking down
the antibiotic
(e.g. the need for beta-lactamase inhibitors)
Beta-lactamase inhibitors - clavulanate
sulbactam
tazobactam
avibactam
Which antibiotics carry the highest risk for C.diff infection? - broad-spectrum penicillins
and cephalosporins
quinolones
carbapenems
clindamycin
Common pathogens for CNS/Meningitis - Streptococcus pneumoniae
Neisseria meningitidis
Haemophilus influenzae
Group B streptococcus/E. coli (young)
Listeria (young/old)
Common pathogens for Mouth - Mouth flora
Anaerobic GNR
Viridans group Streptococci
Common pathogens for Lower Respiratory (Community) - Streptococcus pneumoniae
Haemophilus influenzae
Atypicals; Legionella, Mycoplasma, Chlamydophilia
Enteric GNR (alcoholics)
, Common pathogens for Lower Respiratory (Hospital) - Staphylococcus aureus (MRSA
included)
Pseudomonas aeruginosa
Acinetobacter baumannii
Enteric GNR (including ESBL, MDR)
Streptococcus pneumoniae
Common pathogens for Urinary Tract - E.coli, Proteus, Klebsiella
Staphylococcus saprophyticus
Enterococci
Common pathogens for Bone/Joint - Staphylococcus aureus
Staphylococcus epidermidis
Streptococci
Neisseria gonorrhoeae
GNR (in specific situations)
Common pathogens for Skin/Soft Tissue - Staphylococcus aureus
Streptococcus pyogenes
Staphylococcus epidermidis
Pasteurella multocida +/- aerobic/anaerobic GNR (in diabetics)
Common pathogens for Heart/Endocarditis - Staphylococcus aureus (MRSA included)
Staphylococcus epidermidis
Streptococci
Enterococci
Common pathogens for Upper Respiratory - Streptococcus pyogenes
Streptococcus pneumoniae
Haemophilus influenzae
Moraxella catarrhalis
Gram positive staining - thick cell wall, purple
Gram negative staining - thin cell wall, pink/red
Hydrophilic antibiotics - -Beta-lactams
-Aminoglycosides
-Vancomycin
-Daptomycin
-Polymyxins
*Small Vd = poor tissue penetration
renal elimination = drug accumulation and side effects if not dose adjusted
increased Cl or Vd in sepsis = consider loading dose and aggressive doses in sepsis
poor to moderate bioavailability = not used PO or IV:PO ratio is not 1:1
DNA/RNA inhibitors - Quinolones (DNA gyrase, topoisomerase IV)
M
etronidazole, tinidazole
Rifampin
Cell Membrane Inhibitors - Polymyxins
Daptomycin
Telavancin
Oritavancin
Protein Synthesis Inhibitors - Aminoglycosides
Macrolides
Tetracyclines
Clindamycin
Linezolid, tedizolid
Quinupristin/dalfopristin
Cell Wall Inhibitors - Beta lactams (penicillins, cephalosporins, carbapenems)
Monobactams (aztreonam)
Vancomycin, dalbavancin, telavancin, oritavancin
Folic Acid Synthesis Inhibitors - Sulfonamides
Trimethoprim
Dapsone
Common Resistant Pathogens? - Kill Each And Every Strong Pathogen
Klebsiella pneumoniae (ESBL, CRE)
Escherichia coli (ESBL, CRE)
Acinetobacter baumannii
Enterococcus faecalis, Enterococcus faecium (VRE)
Staphylococcus aereus (MRSA)
Pseudomonas aeruginosa
ESBL - extended spectrum beta-lactamase
-organisms producing ESBL are hard to kill, need to use carbapenems or newer
cephalosporin/beta-lactamase inhibitors.
CRE - Carbapenem-resistant Enterobacteriaceae
-CRE treatment requires combination tx including polymyxins, ceftazidime/avibactam is
also used
,VRE - vancomycin resistant enterococcus
Intrinsic resistance - Not the right drug for the job - the resistance is naturally
occurring.
(e.g. E. coli is resistant to Vanco because Vanco is too large to penetrate the cell wall of
E. coli)
Selection pressure - Good bacteria are killed instead of bad bacteria allowing for them
to multiply.
(e.g. when abx like Vanco eliminate susceptible Enterococci (healthy gut bacteria),
vancomycin-resistant enterococcus (VRE) can flourish)
Acquired resistance - resistance that develops through mutation or acquisition of new
genes
Enzyme inactivation - resistance from enzymes produced by bacteria breaking down
the antibiotic
(e.g. the need for beta-lactamase inhibitors)
Beta-lactamase inhibitors - clavulanate
sulbactam
tazobactam
avibactam
Which antibiotics carry the highest risk for C.diff infection? - broad-spectrum penicillins
and cephalosporins
quinolones
carbapenems
clindamycin
Common pathogens for CNS/Meningitis - Streptococcus pneumoniae
Neisseria meningitidis
Haemophilus influenzae
Group B streptococcus/E. coli (young)
Listeria (young/old)
Common pathogens for Mouth - Mouth flora
Anaerobic GNR
Viridans group Streptococci
Common pathogens for Lower Respiratory (Community) - Streptococcus pneumoniae
Haemophilus influenzae
Atypicals; Legionella, Mycoplasma, Chlamydophilia
Enteric GNR (alcoholics)
, Common pathogens for Lower Respiratory (Hospital) - Staphylococcus aureus (MRSA
included)
Pseudomonas aeruginosa
Acinetobacter baumannii
Enteric GNR (including ESBL, MDR)
Streptococcus pneumoniae
Common pathogens for Urinary Tract - E.coli, Proteus, Klebsiella
Staphylococcus saprophyticus
Enterococci
Common pathogens for Bone/Joint - Staphylococcus aureus
Staphylococcus epidermidis
Streptococci
Neisseria gonorrhoeae
GNR (in specific situations)
Common pathogens for Skin/Soft Tissue - Staphylococcus aureus
Streptococcus pyogenes
Staphylococcus epidermidis
Pasteurella multocida +/- aerobic/anaerobic GNR (in diabetics)
Common pathogens for Heart/Endocarditis - Staphylococcus aureus (MRSA included)
Staphylococcus epidermidis
Streptococci
Enterococci
Common pathogens for Upper Respiratory - Streptococcus pyogenes
Streptococcus pneumoniae
Haemophilus influenzae
Moraxella catarrhalis
Gram positive staining - thick cell wall, purple
Gram negative staining - thin cell wall, pink/red
Hydrophilic antibiotics - -Beta-lactams
-Aminoglycosides
-Vancomycin
-Daptomycin
-Polymyxins
*Small Vd = poor tissue penetration
renal elimination = drug accumulation and side effects if not dose adjusted
increased Cl or Vd in sepsis = consider loading dose and aggressive doses in sepsis
poor to moderate bioavailability = not used PO or IV:PO ratio is not 1:1
