Be familiar with the interactive activities throughout course modules. You could see variations of those same questions on your exams. Week 1  Community Acquired Pneumonia (CAP) o Common pathogens S. pneumoniae, Mycoplasma spp., H. influenzae, and Staphylococcus aureus o First line treatment for previously healthy adults Streptococcus pneumoniae (pneumococcus) :Penicillin G, penicillin V, and amoxicillin in susceptible strains: Resistant strains: a cephalosporin, ampicillin Mycoplasma pneumoniae: Erythromycin, clarithromycin, azithromycin, and a tetracycline (causes discoloration in teeth in children) First line treatment is oral amoxicillin, doxycycline, or macrolides.  What to give if first drug didn’t work Streptococcus pneumoniae (pneumococcus): Erythromycin, azithromycin, clarithromycin, levofloxacin, gemifloxacin, moxifloxacin, meropenem, imipenem, ertapenem, trimethoprim/sulfamethoxazole, clindamycin, a tetracycline, and vancomycin Mycoplasma pneumoniae: A fluoroquinolone If failed macrolide or doxycycline occurs, reasons are either medication adherence issues or the presence of resistant organisms. The use of the respiratory fluroquinolones is warranted. o Treatment for M. Pneumoniae in pediatric patient (Specific/example antibiotic from drug class will be provided) o Atypical pneumonia is more commonly seen in children and young adults. Mycoplasma pneumoniae is the typical causative organism, followed by Chlamydia pneumoniae and Legionella pneumoniae. L. pneumoniae is more common in areas where moisture levels are high and carries a higher mortality risk (File, 2020). These patients are less likely to have a fever and usually present with complaints of fatigue accompanied by a cough that interferes with sleep. This form of atypical pneumonia is often thought to be a cold and managed symptomatically with over-the-counter medications unless medical care is sought. It is commonly referred to as 'walking pneumonia'. Treatment is similar to CAP. o If the patient took antibiotics in the last 3 months, the recommendation is to use medication from a different medication class. Doxycycline is an alternative to a macrolide. The preferred Beta-lactamase antimicrobial medications are high-dose (3 g daily) amoxicillin or high- NR566 Midterm Study Guide dose (4 g daily) amoxicillin-clavulanate (Augmentin®). Alternative Beta-lactamase is second-and third-generation cephalosporins such as cefuroxime (Ceftin®, Zinacef®), cefpodoxime (Vantin®), or ceftriaxone (Rocephin®) intramuscular o Treatment of CAP in pregnancy o Tetracycline cause fetal harm in animal studies, should be avoided in pregnancy. o If someone has been treated with an antibiotic in the previous 90 days of contracting CAP, a quinolone would be a prudent choice to prescribe. Floxacin  Be familiar with drug examples within the antibiotic classes. Beta-lactam: Penicillins: Narrow Spectrum PCN (PCN sensitive): PCN G & PCN V (Streptococcus Spp, Neisseria spp) Narrow Spectrum PCN (PCN resistant): Nafcillin; Oxacillin; Dicloxacillin (Staphylococcus aureus) Broad Spectrum PCN: Ampicillin, Amoxicillin (H. influenza, E. Coli, Proteus mirabilis, enterococci, and N. gonorrhoeae) Extended- spectrum PCN: Piperacillin (Same as broad spectrum plus, Pseudomonas aeruginosa, Enterobacter spp. Proteus, Bacteriodes fragilis and many Klebsiella spp) Cephalosporins: First generation (Cephalexin): (Narrow) Gram + Staphylococci or streptococci Second Generation (Cefoxitin): (More broad than 1st) Gram + & - H. influenza, Klebsiella, pneumococci, and staphylococci Third generation (Cefotaxime) (More than 1st and 2nd) Gram – Pseudomonas aeruginosa, N. gonorrhoeae, and Klebsiella Serratia Fourth generation (Cefepime) (Narrow) Gram – Pseudomonas aeruginosa Fifth generation (Ceftraroline): (Narrow) Gram + MRSA Carbapenems: Beta-lactam ABT that have a broad antimicrobial spectra, although none are active against MRSA. All are delivered parenteral, to delay resistance these drugs should be reserved for pt who cannot be treated with narrow-spectrum agents. Imipenem; Meropenem; Ertapenem; Doripenems Vancomycin (does not have a beta-lactam ring. It inhibits cell wall synthesis and thereby promotes cell lysis and death. Active only against gram + bacteria. Tetracyclines (bacteriostatic) Broad spectrum. 7 kinds. Tetracyclines (short acting), demeclocycline (intermediate-acting), (the rest are long acting) doxycycline, eravacycline, omadacycline, sarecycline, minocycline. Macrolides (bacteriostatic) Broad spectrum. Called macrolides because they are big. Erythromycin (oldest member), azithromycin, and clarithromycin. Clindamycin (bacteriostatic) (not a Macrolide) Can promote severe C Diff. Active against most anaerobic bacteria (+&-) Aminoglycosides (Bactericidal) (narrow spectrum, primarily used against aerobic gram – bacilli. Ex: Gentamicin, tobramycin, and amikacin. Sulfonamides (usually bacteriostatic) (Sulfadiazine) and Trimethoprim: Combo = Bactrim