Microsoft word - microbio showtunes.doc

Antimicrobials 1, to the tune of “Think of Me”

Beta-lactams bind transpeptidases, preventing formation of crosslinks in the peptidoglycan layer Glycopeptides (the only one we have available is peptidoglycan chain, preventing further cell wall Beta-lactams kill where cell walls grow, Don’t combine B-lactams with bacteriostatic They won’t work if static drugs make wall drugs! They are most effective on active bacteria Strep pneumo is the most common organism in both CAP and nosocomial pneumonia (about 1/3) H influenzae and Klebsiella are the next most likely etiologic agents for CAP severe enough to require hospitalization. Other causes of milder pneumoniae, viruses, Legionella). Standard tx for hospitalized pts is a B-lactam (PCN or ceftriaxone) and azithromycin (other regimens for elder/high risk, outpatient, and aspiration). Natural PCNs are drug of choice for GAS, also used for syphilis and Lyme dz (both spirochetes). Aminopenicillins are active against some G(-) including Proteus mirabilis, non B-lactamase- inhibitor (e.g., clavulanate) have expanded Piperacillin/tazobactam covers Pseudomonas.

UTI’s, to the tune of “Castle on a Cloud”

hematogenous seeding can occur with (subacute) bacterial endocarditis or tuberculosis. Alkaline urine (e.g., when Proteus makes urease) and Etiologic agent is usually E coli; other agent for Check for systemic/bacteremic infection with Standard tx for uncomplicated UTI is TMP-sulfa. If pt has sulfa allergy, nitrofurantoin can be used. Fluoroquinolones can be used for complicated [Extra notes that I couldn’t fit into the song: Complicated acute cystitis: stones, DM, upper UTI, men, pregnant women, resistant bacteria (recurrent, nosocomial), recent instrumentation. Test for pregnancy BEFORE choosing drug – could be toxic to fetus. N gonorrheae and Chlamydia trachomatis: urethritis in men, cervicitis in women. Co-infection 25%. Treat both: ceftriaxone(3G) (single IM dose) for gonococcus, azithromycin (single PO dose) for chlamydia.] Antimicrobials 2 - meningitis, to the tune of “Don’t Stop Believin’”
Complement is down, meningococcus going ’round, Susceptibility to N meningitides if complement But pneumococcus wins 3 times out of 5. deficient. 60% of adult bacterial meningitis is Antibodies low, H. flu’s gonna steal the show. due to S pneumo. Susceptibility to H influenzae if humoral immunity is weak. The elderly and meningitis due to Listeria monocytogenes. Fluoroquinolones and tetracyclines are potential Rx for meningitis, but they can cause fetal abnormalities. So can Bactrim (TMP-SMX). Beta-lactams are the penicillins, cephalos, The beta-lactams. 3rd and 4th generation cephalosporins have good CNS penetration. [Note also: Ceph-3s are divided into anti- Pseudomonas (ceftazidime) or not (ceftriaxone).] Carbapenems are good broad-spectrum agents but might cause seizures, esp w/ CNS dz (bad for Poor CNS penetration w/ macrolide and Ceph-1. Pregnancy = immunocompromised state, at risk for meningitis due to Listeria (small G(+) rod). [Beta-lactams, are the penicillins, cephalos, Hold onto the feelin’ Streetlight people….]

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