train-the-trainer series – exploring antibiotics...– interfere with dna formation: quinolones,...
TRANSCRIPT
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Exploring AntibioticsPresented by Jane C. Pederson, MD, MS
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Antibiotics
• A form of chemotherapy used to treat infections• Effective against bacteria• Not effective against viruses • One of the most significant medical advances of the
20th century
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Bacteria Characteristics
• Single cell organisms• Characterized in the laboratory by:
– Shape: cocci (round), bacilli (rods), chains, spirals– Gram Stain: positive, negative
• Can also be classified as:– Aerobic – which need oxygen to survive– Anaerobic – which survive without oxygen
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Bacteria – Gram Stain
Gram Stain Positive (purple)
Gram Stain Negative (pink/red)
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Bacteria - shape
Gram positiveMany are cocci, “round bacteria”•Examples: Streptococci, Staphylococci, Enterococci•Clostridium difficile (C. diff) is an anaerobic, Gram positive rod
Gram negativeMost are bacilli, “rod-shaped bacteria”•Examples: E. coli, Klebsiella, Enterobacter, Proteus, Pseudomonas, Acinetobacter
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Describing antibiotics
• Spectrum of action– Narrow-spectrum target a few specific bacteria– Broad-spectrum can kill a wide variety of bacteria
• Classification– Penicillins, Cephalosporins, Fluoroquinolones,
Aminoglycosides, Monobactams, Carbapenems, Macrolides, and others
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How do antibiotics work with the immune system?
• Antibiotics do not take the place of the immune system – they help the immune system– Bacteria reproducing faster than immune system can
activate itself– Bacteria are rapidly producing toxins that cause
damage before the immune system alone can eliminate them
– Immune system is weakened and needs help killing bacteria
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Antibiotics
Bactericidal antibiotics kill bacteria
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Antibiotics
Bacteriostatic antibiotics do not kill bacteria but instead prevent the growth of bacteria
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How do antibiotics work?
Antibiotics stop the bacteria’s ability to stay intact or reproduce making it vulnerable to the body’s immune system
– Block protein formation: macrolides, tetracycline, aminoglycosides
– Inhibit cell wall formation: beta lactams, vancomycin, bacitracin
– Interfere with DNA formation: quinolones, rifampin– Prevent folic acid synthesis: sulfonamides,
trimethoprim
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How are antibiotics used?
• To treat a known infection
• Prophylactic treatment - treatment with antibiotics to prevent an infection (e.g., prior to specific surgeries)
• Empiric therapy – treatment of an infection before specific culture information has been obtained
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Tools to help choose antibiotics
• Direct examination– Lab prepares or stains the specimen to allow for
identification of the infecting organism• Cultures
– Isolate and grow the microorganism in the lab• Sensitivities
– Once the microorganism is cultured antibiotic susceptibility can be determined
• Antibiograms– Summary of antibiotic susceptibility and resistance for
a setting such as a hospital or nursing home
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Pulling it all together
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Antibiotics: Beta Lactam classes
• Penicillin, methicillin, amoxicillin and ampicillin– Extended spectrum agents: piperacillin, ticarcillin– Can be to help overcome bacterial resistance Amoxicillin + Clavulanate = Augmentin Ampicillin + Sulbactam = Unasyn Piperacillin + Tazobactam = Zosyn
• Cephalosporins – More gram positive activity: Cephalexin, Cefazolin– More gram negative activity: Ceftriaxone, Ceftazidime,
Cefepime– New broader spectrum, including MRSA: Ceftaroline
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Antibiotics: Carbapenems
• Extremely broad-spectrum, among the most powerful antibiotics we currently have available
• Spectrum includes Streptococci, susceptible Staphylococci, Enterobactericeae, Pseudomonas, Acinetobacter sp., and anaerobic bacteria
Drug Route of Administration
Imipenem IVMeropenem IVErtapenem IM, IVDoripenem IV
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Antibiotics: Gram positive agents
• Vancomycin – Treats methicillin-resistant Staphylococcus aureus (MRSA)– Oral form NOT absorbed from gut; only used to treat C. difficile– IV form gets good systemic levels - used for all other infections
• Daptomycin – Covers resistant gram-positive organisms: MRSA and VRE– Only available as IV formula
• Linezolid– Covers MRSA and VRE– Both oral and IV forms available and get good systemic levels
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Antibiotics: Gram negative agents
Fluoroquinolones (Oral and IV forms)• Ciprofloxacin: Mostly gram negative activity
– Commonly used for UTI treatment• Levofloxacin/Moxifloxacin: Broader activity
– Also used for treating UTIs and infections from gram-negative bacteria
– Also covers Streptococcus pneumoniae and other respiratory bacteria
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Antibiotics: Gram negative agents
Aminoglycosides (only IV)– Examples: Gentamicin, Tobramycin, Amikacin– Excellent gram negative drugs – especially for urinary
tract– Limited use because of toxicity (kidney,
hearing/balance)
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Antibiotics: Miscellaneous
• Trimethoprim/Sulfamethoxazole (Bactrim)– Mainly given in oral form – must watch renal function– Narrow spectrum – activity against both Gram negative and Gram
positive bacteria– Commonly used to treat UTIs– Also used for MRSA skin infections
• Azithromycin– Commonly given in oral dose pack called “Z-pack” – Considered narrow spectrum, used for respiratory/sinus infections
• Metronidazole (Flagyl) (oral and IV form)– A primary treatment for C. difficile infections– Oral form can cause nausea and stomach upset
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Key points
• Antibiotics are a powerful treatment against infections due to bacteria
• Choosing antibiotics wisely requires taking into account a number of factors regarding the targeted bacteria and the individual being treated
• Antibiotics are not a substitute for the immune system
• There are a number of tools that should be used to guide antibiotic selection
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This material was prepared by Telligen, the Quality Innovation Network National Coordinating Center, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S.
Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. (Add sequencing number here)