1、Antibiotics,James Clayton Consultant Microbiologist,Antibiotic groups,-Lactams Penicillins Penicillin, Amoxicillin, Flucloxacillin PO/IV Penicillins + -lactamase inhibitor Co-amoxiclav (Amoxicillin + clavulanate) PO/IV Tazocin (Piperacillin + tazobactam) IV Cephalosporins PO/IV Carbapenems Meropenem
2、, Ertapenem IV,Other antibiotics: Aminoglycosides Gentamicin, (Amikacin) IV Macrolides Erythromycin, Clarithromycin PO/IV Glycopeptides Vancomycin, (Teicoplanin) IV Tetracyclines Doxycycline PO Others Trimethoprim, Nitrofurantoin PO Rifampicin, Clindamycin PO/IV Ciprofloxacin PO,Streptococci,Group A
3、 streptococci Skin & soft tissue infection Necrotising fasciitis Tonsillitis Toxic shock, sepsis Group B streptococci Neonatal infection, UTI Other streptococci Endocarditis, abscess,Streptococci & Enterococci,Strep. pneumoniae URTI, pneumoniaEnterococcus faecalis / E.faecium UTI, endocarditis,Staph
4、ylococcus,Staph. aureus Skin & soft tissue infection Abscess Bone & joint infection Line infections Severe pneumoniaRemember MRSA (Meticillin resistant S.aureus),E.coli & coliforms,E.coli, Klebsiella, Proteus UTIs Intra-abdominal infection E.g. cholangitis, sepsis Hospital-acquired infectionRemember
5、 ESBLs,Neisseria & Haemophilus,N. meningitidis Meningitis N. gonorrhoeae Gonorrhoea H. influenzae Respiratory tract infection Meningitis (rare),Pseudomonas,P. aeruginosa UTIs (usually complicated / catheter) Hospital acquired infectionsAnaerobesIntra-abdominal infections Skin & soft tissue infection
6、s Abscess,7 cases,Case 1,John, 18 yrs old Sore throat for 2 days, feverish Exudate on tonsils when examined by GP Tonsillitis diagnosed.What organisms cause tonsillitis? What antibiotics are appropriate?,Coventry and Warwickshire Community Antibiotic Guidelines,Tonsillitis,Majority caused by Group A
7、 streptococci Group A streptococci Penicillin susceptibility 100% Erythromycin susceptibility 80% Penicillin preferred to Amoxicillin as: Narrower spectrum EBV / glandular fever reaction Oral antibiotics in a community setting,Case 2,Bob, 70 years old COPD. 60 pack year smoking history. Retired engi
8、neer. 3 day history of cough, green sputum, malaise, raised temperature o/e crepitations, reduced air entry CXR extensive consolidation CURB-65 = 2 No allergies,And Atypicals!,Coventry and Warwickshire Treatment Guidelines (Hospital),Community acquired pneumonia,Strep. pneumoniae 30 - 40% Haemophilu
9、s influenzae 5 - 10% Staph. aureus 0.5 - 5%Severity of infection (CURB-65 score) Determines need for IV or oral treatment Determines need for broad vs narrow cover,Dont forget atypicals in CAP!,Legionella pneumophila 1 - 5% Mycoplasma pneumoniae 1 - 10% Chlamydophila pneumoniae 10% ? Chlamydia psitt
10、aci, Coxiella 2% Viruses including Influenza 15% Addition of Macrolide e.g. erythromycin or clarithromycin Tetracycline e.g. doxycycline (Ciprofloxacin),Case 3,Katie, 25 years old Presents to A&E with history of dysuria, frequency Previously well,Do all antibiotics get into urine?,These do:,Penicill
11、ins (most) Amoxicillin, co-amoxiclav Cephalosporins Carbapenems Gentamicin Trimethoprim Nitrofurantoin Ciprofloxacin Vancomycin,These dont:,Penicillins (few) Flucloxacillin (poorly only) Macrolides Erythro & Clarithromycin Tetracyclines Doxycycline Clindamycin,Coventry and Warwickshire Treatment Gui
12、delines (Hospital),UTI,Usually Gram-negatives as a cause E.coli Other coliforms (proteus, klebsiella) Less commonly enterococci, staphylococci Pseudomonas Mainly in catheterised patients or those with underlying urinary tract disorders,Case 4,Stephen, 17 years old Admitted through A&E Lethargic, dro
13、wsy, unwell High fever Photophobia & stiff neck No allergies,Coventry and Warwickshire Treatment Guidelines (Hospital),Meningitis,Neisseria menigitidis (meningococcus) Strep. pneumoniae (pneumococcus) Haemophilus influenzae (HiB) Listeria (extremes of age, immunocompromise) Need IV therapy Need anti
14、biotics with good meningeal penetration,Case 5,Albert, 82 years old Had total hip replacement 5 days ago On review today, unwell, coughing mucky sputum Poor Oxygen sats, febrile WCC 18, CRP 280 CXR widespread opacity No allergies, no previous microbiology samples,Coventry and Warwickshire Treatment
15、Guidelines (Hospital),Case 6,Ivy, 82 year old #neck of femur Had a DHS 3 days ago. Now has some erythema around the wound Tender and wound feels hot. Well otherwise Determined to be non-severe wound infection Recent MRSA screen negative Penicillin allergic (previous rash),Coventry and Warwickshire T
16、reatment Guidelines (Hospital),Case 7,Rose, 75 year old Has been on medical ward for 2 weeks Diabetic, hypertensive Catheterised to measure urine output Today, unwell, high temperature, hypotensive, MEWS score = 7. No obvious cause chest OK, abdo normal. No known allergies,Coventry and Warwickshire
17、Treatment Guidelines (Hospital),Blood cultures are returned positive:MRSA grown after 24 hours Flucloxacillin Resistant Erythromycin Resistant Gentamicin Sensitive Vancomycin Sensitive Rifampicin SensitiveOn careful examination, a cannula site is found to be very inflamed and other sources are exclu
18、ded clinically. Should the antibiotics be changed?,Sepsis,Wide variety of causes May be clear cause e.g. urosepsis or unclear Needs to be treated promptly broad spectrum antibiotics IV route empirical Targeted therapy if a cause is found subsequently,Summary,Overview / revision of microbiology Route: Oral vs IV Spectrum: Narrow vs broad Therapy Empirical vs targeted Antibiotics Single vs multiple Which antibiotics and when Allergies Resistant organisms e.g. MRSA, ESBL Guidelines will help in most cases!,
