Deranged Physiology » Required Reading » Infectious Diseases, Antibiotics and Sepsis » Chapter 2.2.2 » Specific Antibiotic Choices Selected Pathogens

Specific Antibiotic Choices for Selected Pathogens

Our college enjoys throwing exotic bugs at its candidates to see what we would try to kill them with. Here is a table of bug vs. antibug, from Question 15.1  of the second paper of 2013; it has been modified to include other organisms and clinical scenarios which have been asked about. Links point to discussions, or at least to the specific question which prompted the inclusion of this organism in the list.

Numerous other questions have asked some variation on the them of "which antibiotic would be the appropriate choice for this organism?" They have included the following:

Microorganisms and Appropriate Antibiotics

Organism

Agent

Candida glabrata

Voriconazole or caspofungin or Amphotericin B

Clostridium perfringens

Peniciliin or Meropenem or Metronidazole

Listeria monocytogenes

Penicillin or Ampicillin

Neisseria meningitides

Ceftriaxone or Penicillin (high dose)

Multi-resistant Acinetobacter

Amikacin. Polymyxins

Nocardia

Sulphonamides

Penicillin-intermediate pneumococcus

Ceftriaxone or Vancomycin

Toxoplasma gondii

Pyrimethamine plus cotrimoxazole

Enterococcus faecalis

Ampicillin is usually enough (unless it is VRE)

Vancomycin-resistant enterococcus

Linezolid

Daptomycin

Tigecycline

Leptospira

Benzylpenicillin, doxycycline, ceftriaxone

ESCAPPM organisms

Meropenem

HACEK organisms

Ceftriaxone

Aspergillus

Voriconazole or amphotericin

Clostridium difficile

Oral metronidazole or oral vancomycin

Clostridium tetani

Benzylpenicillin and metronidazole

Pneumococcal meningitis

Vancomycin, ceftriaxone and dexamethasone

Vibrio vulnificus

Doxycycline plus ceftriaxone, or just ciprofloxacin

Imipenem-resistant Gram-negatives

Amikacin, colistin, cotrimoxazole

Abdominal catastrophe (faecal peritonitis)

Triple therapy: ampicillin, metronidazole, gentamicin

Single agent therapy: timentin or tazocin

MRSA

Vancomycin

Tigecycline

Linezolid

Quinupristin/dalfopristin

Daptomycin

Fosfomycin

Rifampicin/fusidic acid

Telavancin, dalbavancin and oritavancin

Ceftobiprole and ceftaroline

Iclaprim

Trimethoprim/sulfamethoxazole

Moxifloxacin

Varicella Zoster

Acyclovir, famciclovir or valaciclovir

Cryptococcus neoformans (meningitis)

Amphotericin

Tuberculosis

Isoniazid plus rifampicin plus ethambutol plus pyrazinamide

Herpes simplex meningitis

Aciclovir - 10mg/kg q8h.

Mucor

Amphotericin

Pneumocystis j.

Sulfamethoxazole and trimethoprim (Bactrim)

A list of organisms intrinsically resistant to imipenem:

  • Stenotrophomonas maltophila
  • Pseudomonas maltophilia
  • Pseudomonas cepacia
  • Enterococcus faecium
  • MRSA

Generally speaking, carbapenem-resistant Enterobacteriacea tend to receive treatment with older (more toxic) drugs such as amikacin and colistin.

A word about Listeria monocytogenes

For whatever reason the college seem to love Listeria. Most recently, they asked the candidates to not only identify it (the suspicious Gram-positive rod in a confused woman's blood culture, from ) but also to discuss the risk factors for such an infection.

These risk factors are discussed in two reference-worthy papers: J Rocourt (1996) and Schuchat et al (1992), which talks about food-related risk factors.

  • Patient factors
    • Malignancy
    • Pregnancy
    • Organ transplantat recipient
    • HIV/AIDS
    • Corticosteroid therapy
    • Anything that interferes with T-cell mediated immunity
    • Extremes of age (neonates, the elderly)
  • Food factors
    • ​Soft cheese
    • Food "purchased from store delicatessen counters"
    • Undercooked chicken
    • Broadly speaking, foods which are "ready to eat", stored at refrigeration temperature for prolonged periods

 

References

For the antibiotic choices, I have used the Sanford Guide.

Local practice may vary (wildly).

Morrill, Haley J., et al. "Treatment Options for Carbapenem-Resistant Enterobacteriaceae Infections." Open Forum Infectious Diseases. Oxford University Press, 2015.

Tichy, E. M., B. F. Luisi, and G. P. C. Salmond. "Crystal Structure of the Carbapenem Intrinsic Resistance Protein CarG." Journal of molecular biology 426.9 (2014): 1958-1970.

Schuchat, Anne, et al. "Role of foods in sporadic listeriosis: I. Case-control study of dietary risk factors." Jama 267.15 (1992): 2041-2045.

Rocourt, J. "Risk factors for listeriosis." Food Control 7.4 (1996): 195-202.