(2) RELIABLE ANTIBIOTIC SENSITIVITIES OF ORGANISMS ORGANISM ANTIBIOTIC NOTE Strep pyogenes (‘group A strep’)
erythromycin active but does NOTcross the blood-brain barrier
sepsis usually with a cephalosporin– see later
Oral anaerobes often sensitive topenicillin as well
drugs in UK: may needstreptomycin, ciprofloxacin etc
(3) IMPORTANT ANTIBIOTIC TREATMENTS – General medical infections INFECTION ANTIBIOTICS
Classically penicillin (Alternatives: cefotaxime or ceftriaxone very often used
not cross BBB! Chloramphenicol Haemophilus : Cephalosporins as above Rifampicin or ciprofloxacin or ceftriaxone for prophylaxis of close contacts Piperacillin/tazobactam (‘TAZOCIN’), or
resistant Klebsiella, Enterobacterin hospitals Gent enhances killingAdd gentamicin if severe:once daily dose Penicillin (or amoxicillin) & clarithromycin [clarithro is similar to Cephalosporin (e.g. cefuroxime) + Gent enhances killing of organismsmetronidazole Add gentamicin if severe:once daily dose Penicillin/Amoxycillin or Ciprofloxacin,
cephalosporins). Tetracyclines for Chlamydia infection. Penicillin for syphilis Trimethoprim, co-amoxiclav
("Augmentin"), oral cephalosporins (e.g.
shows E. coli is sensitive (50%).
cefadroxil); as for septicaemia if severe
Penicillin or amoxycillin; erythromycin
Many sore throats are viral. Butpenicllin may be given because of
and glomerulonephritiscomplications after GAS
Hospital – Clostridium difficileINFECTION ANTIBIOTICS Isoniazid + Rifampicin + Ethambutol +/- Pyrazinamide NB use all four if drug resistance cannot be ruled out
MAI complex: Clarithromycin,rifabutin, ciprofloxacin
Penicillin, tetracycline
e.g. Syphilis, Borrelia (Lymedisease), Leptospira
Tetracyclines, erythromycin [or clarithro]
Falciparum: Quinine + Fansidar
Other species: Chloroquine
Invasive: Amphotericin B
(topical) & fluconazole (oral/IV). Note on some of antibiotics:
⇒ AMOXICILLIN and AMPICILLIN are more or less the same but these days most people use AMOX because it can be given three times a day (not four) and is better absorbed. Amoxicillin is often (wrongly) spelt amoxycillin, it is the same.
⇒ CO-AMOXICLAV (‘Augmentin’) is souped-up amoxicillin, i.e. amox plus clavulanic acid. The latter blocks the enzyme beta-lactamase that is produced by some bacteria e.g. Staph aureus, E. coli, Bacteriodes (an anaerobe present in the colon)
⇒ CLARITHROMYCIN is a new version of ERYTHROMYCIN. It is better tolerated (fewer GI symptoms) so is commonly used. Otherwise it is similar in activity.
⇒ When we talk about ‘MRSA’ it stands for ‘methicillin-resistant Staphylococcus aureus’. Methicillin is an old version of flucloxacillin so really it means flucloxacillin-resistant Staph aureus. However the important point is that these staphs are resistant to many other agents including gentamicin, erythromycin etc. Vancomycin is reliable but recently (USA, June 2002) totally resistant vancomycin resistant strains have been reported.
⇒ Note that a lot of Vancomycin is also used for Coagulase-negative staph infections (e.g. Staph epidermidis) as these are common in lines, prosthetic implants etc., especially in high-dependency patients.
Colour relates to Gram stain…if that helps…
ANTIBIOTIC Staph MRSA Strepto- Entero- GC & Coli- Haemo Pseudo Anaer- Spiro- Chlamydia, TB aureus & CNS cocci coccus Meningo forms -philus -monas obes chaetes mycoplasma, rickettsias
cefadroxilInjectablecephalosporins:Cefuroxime
(4) = poor activity, resistance common or not appropriate for therapy
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