FIGHTING BACK WITH ANTIBIOTICS



What Are Multi Drug Resistant Organisms?

Multidrug-resistant organisms are bacteria that are resistant to one or more classes of antimicrobial drugs. These include:
MRSA- Methicillin-resistant
Staphylococcus Aureus
VRE- Vancomycin-resistant Enterococcus ESBLs- Extended-spectrum beta-lactamase producing organismsKPC- Klebsiella pneumoniae carbapenemase producing organisms
Why Worry So Much?Infected patients may become untreatable if the bacteria forms a resistance. Resistance is occuring with even the strongest antibiotics. For Example: A patient is admitted with a KCP producing organism infection. The only ABX treatment options are tigecycline and colistimethate. Some Multi Drug Resistant Organisms become resistant to these ABXs, making the patient untreatable.
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Such organisms are spread through contact = HAND HYGEINE
Infected patients are placed on contact isolation.






So You've Got the "Big Bug" Now What? Let's Talk about your options.........


1) AMINOGLYCOSIDES

Fighting In the RED Corner representing a group of potent, natural and semisynthetic bactericidal antibiotics:

external image boxing.gif AMIKACIN
GENTAMYCIN
TOBRAMYCIN
NEOMYCIN

Fighting in the BLUE corner is gram negative bacteria ran by Captain E. Coli and his multi drug resistant organisms
Joining in the fight are gram positive bacteria including Enterococcus and S. Aureus

Providing synergistic assistance For the Red Corner:

Beta-Lactam (These medications are given first to break down the cell wall and allowing the Aminoglycoside to fight the ribosomes inside)
Vancomycin
Aminoglycosides use the synergistic help when the blue corner brings out its gram positive bacteria fighters, sadly they just can't win that fight alone



Training Hard: How to Fight Like an Aminoglycoside

Prevents the protein synthesis of the bacteria by binding to the 30S Ribosome of the bacteria
Once Aminiglycosides enter the bacteria's ribosomes, the fight begins
These meds pack a punch so hard you can feel it after they stop working- Post Antibiotic effect
Aminoglycoside (Neomycin) is often used as a prophylaxis for surgery of the abdomen and GI tract to prevent enteroccocal bacteremia
In order to bring their 'A' game, aminoglycosides must be given parenterally because they have such poor absorption when taken PO
Neomycin, however is an exception to that rule and can be given


Aminoglycosides are known to cause adverse effects in patients. These effects include ototoxicity and nephrotoxicity. Due to the occurence of these adverse effects the duration of treatment with these drugs should be kept as short as therapeuticaly possible.

Nephrotoxicity occurs in 5-25% of patients and is detected in urinary casts which are visible reminents of destroyed renal cells, proteinuria, increased BUN and serum creatinine. A renal functions test should be monitored throughout treatment. Nephrotoxicity is usually reversible.

Ototoxicity occures less frequently but it is rarely reversible. It causes permanent hearing loss. tinnitus, feeling of fullness in the ears. It is believed that this is due to damage of CN VIII.

!!!!!!!!!!!!!!!!!!!Whenever a patient is on an Aminoglycoside monitor peak and trough levels!!!!!!!!!!!!!!!!!!!!!!!!!!!!!


2) QUINOLONES




Quinolones kill gram-negative, and some susceptible gram-positive organisms. They destroy the bacteria by
altering its DNA. Currently available Quinolone antibiotics include the following:
- Norfloxacin
- Ciprofloxacin
-Levofloxacin
-Moxifloxacin
Let's take a closer look at these antibiotics!




Antibiotic
Indications
Adverse Effects
Norfloxacin
Urinary tract infections, prostatitis, STDs
CNS: Headache, dizziness, fatigue, insomnia, depression, convulsions.

GI: nausea, constipation, flatulence, heartburn, diarrhea, oral candidiasis, dysphagia.

Integumentary: rash, pruritis, urticaria, flushing.

Other: ruptured tendons + tendonitis, fever, chills, blurred vision, tinnitus.
Ciprofloxacin
Anthrax, UTIs, STDs, typhoid fever, slected nosocomial pneumonias
Levofloxacin
Respiratory infections, UTIs, prophylaxis in transrectal/transurethral prostate surgical procedures
Moxifloxacin
Resiratory and skin infections, anaerobic infections





3) OTHER ANTIBIOTIC TREATMENTS THAT DO NOT FALL INTO THE PREVIOUSLY MENTIONED CATEGORIES INCLUDE:




ANTIBIOTIC
INDICATIONS
ADVERSE EFFECTS
Linezolid (Zyvox)
To treat infections associated with VRE, skin infections caused by MRSA
headache, nausea, vomiting, diarrhea
Quinupristin/Dalfopristin (Synercid)
To treat VRE infections and skin infections caused by MRSA
Arthralgias, myalgias and pain, inflammation and edema at IV site.
Vancomycin (Vancocin, Vancoled)
Antibiotic of choice for treatment of MRSA and other serious gram-positive infections.
Ototoxicity, nephrotoxicity, red man syndrome
Daptomycin (Cubicin)
Treats complicated skin and soft tissue infections caused by MRSA, VRE and other gram-positive bacteria
Hypotenstion, hypertension, headache, dizziness, rash, GI discomfort, renal failure
Colistimethate (Coly-Mycin)
One of the only drugs available to treat KPC.
Serious adverse effects including renal failure, paresthesia, vertigo, impairment of speech