DIP Episode 460 - Floridly HY Antibiotic Review for Step 1-3 (Part 1)

Okay, welcome. My name is divine. This is episode 460 of the divine intervention podcasts. In today's podcast, I'm going to be doing a rapid review of antibiotics. This is actually going to be like a podcast that's helpful for step one or the way to step three. It's just a very quick and dirty rapid review of antibiotics. And for the most part, I'm going to be talking about the major indications of these. So I'm just going to be walking through like specific antibiotics and what you can see them being used for the USMLA exams. So obviously, let's start with the simplest ones. So we have the penicillin. We know the penicillin they work by inhibiting the cell wall. Many of them inhibit the enzyme known as transpeptidase. They are competitive inhibitors of transpeptidase. For those of you that are taking step one, you can already see how they can very easily throw in a question about mechalism and maintain with that. Obviously, these drugs being competitive inhibitors, they're not going to do anything to the VMAX, but they're going to raise the KM. They're going to decrease the affinity of transpeptidase for the components that are used in the formation of the bacterial cell wall. So penicillin is the one we're going to start with. They're penicillin. They're penicillin G. They're penicillin V. Penicillin G, many times, is given in an intravenous formulation. Now, what do you use penicillins for? Penicillins will use them a lot.

If you're thinking of some classic things for your exams, think of syphilis, TREPONIMA PALIDO. Syphilis responds beautifully to penicillin compounds, again, especially intravenous penicillin. Also, another reason why you may use penicillin on your test is you may use it for a person that has rheumatic fever. Rheumatic fever typically is treated on USMELY exams with penicillin and an N-set. Penicillin and an N-set. Another situation on your exams where you may also see penicillin used is in a sickle cell disease patient. Sickle cell disease patients usually up until age 5, they really should be on penicillin because remember, these people essentially have no spleen, the auto-infector spleen. So, since the auto-infector spleen is actually very helpful for them to be on penicillin prophylaxis. So, they don't get encapsulated organism especially from strep pneumo. Remember, strep pneumo is the most common cause, very, very high yield. It is the most common cause of sepsis in people that have sickle cell disease. Right? So, those are, I will say, the classic situations on exams where you would see penicillin used. Again, can you see them in many other regards? Yes, you can. But again, I'm basically teaching you this is again supposed to be a quick and dirty review. Basically, this podcast, if you know this podcast well, it's going to help you pick up a lot of pretty easy points on exams.

And then, the next set of antibiotics I'm going to talk about, I'm going to talk about amocicillin. These are the amino penicillins. They pretty much work with like the regular penicillins, but again, they just have a little, a little more coverage, right? So, the thing is, what do we use these things for? Well, they actually use for quite a number of things. Amocicillin, we know that is used for acute autotidus media. When the child has acute autotidus media on the USM in exams, amocicillin is very good. It's actually the first line treatment for acute autotidus media. But if you want to, if amocicillin doesn't work for acute autotidus media, then one thing you can strongly consider is to go ahead and say, you know what? Let me add clavolanic acid. Remember clavolanic acid is a bit of lactobacillin inhibitor. So, basically, you do amocicillin plus clavolanic acid. Many people know this drug as augmenting. It can be used to treat acute autotidus media. Now, amocicillin, remember that it has this association with, if you give it to people that have mono, they can have like this full body rash from it. They can have this full body rash from it. So, that's something you want to keep in mind with amocicillin. And then, amocicillin, remember, is the drug of choice for Listeria. Listeria is very well treated with amocicillin. Listeria is very, very well treated with amocicillin.

And also, don't forget that many times we worry about Listeria when we're trying to treat meningitis in a neonate and in a patient over age 50. So, you see a person that's a neonate that has meningitis or a person that's over age 50 that has meningitis. Usually, you impair meningitis from aotherapy. It's going to be a combination of sefiatriaxone, right? Obviously, the cover gram negatives, especially like my serum meningitis, then comizing to cover gram positives, like stuff for you, or so strep pneumonia, and then amocicillin as Listeria. Again, we don't give amocicillin to everyone that has meningitis. We give it specifically to neonates and people that are over age 50. This may seem like a very minor point, but you'd be quite shocked at how frequently it pops up on an exam. And then, another reason we can use amocicillin on the USMEL exams is to treat choral and neonitis. Choral and neonitis, remember, is an infection of the amnotic fluid. We typically would treat choral and neonitis with a combination of, I look at it as the CAG repeats, that's the mnemonic I use, right? So, we do clean the amycin plus ampe-, I mean, for choral and neonitis, sorry, for choral and neonitis, we treat it with ampeicillin. So, the choral is the C, and then we use ampeicillin, that's the A plus gentamysin, we use ampeicillin plus gentamysin. Remember, the closely related infection, endometritis, which is an infection of the uterus itself.

Usually, the baby has been born, usually it's in the woman that has had a C section, you're going to see like three-ish days after delivery, just going to have fever and uterine pain. Then, I want you to think of endometritis. Endometritis is treated with clinda amycin and gentamysin. So, remember that ECG mnemonic, endometritis gets clinda and gentamysin. Endometritis gets clinda and gentamys. And many times on exams as well, we can actually use amoxicillin or ampeicillin for prophylaxis before dental procedures, right? So, say for example, a person is getting a dental procedure and they have certain indications, you know, for, you know, to prevent endocarditis, let's say they've had a prior hitch of endocarditis, or let's say for example, they have an unrepaired Sanodic congenital heart defect, or they have like a mechanical valve in their hearts. Those people generally all deserve endocarditis for prophylaxis. Usually, they're going to give it as a single dose right before surgery, we typically do that with ampeicillin or amoxicillin. And then, you can also use amoxicillin for like, you know, osteomyelitis prophylaxis. And people that are being beaten by a catoridog, a person gets like a cut bite or a dog bite. Usually, ampeicillin and amoxicillin are very, very, very good at prophylaxis in those circumstances.

And also, if you want to give group B strep prophylaxis to a man that is in labor or a woman that, you know, not necessarily in labor, but you know, because remember, we're checking for group B strep between ages 35 to 37 weeks of gestation. You can give amoxicillin and ampeicillin for that. And by the way, amoxicillin or ampeicillin are also very good for UT Is, especially like cystitis, not for pylos, they're not useful pylos. But for cystitis, believe it or not, our friends at the MBM Es sometimes, they can actually throw in ampeicillin or amoxicillin as the treatment for UT Is. Many times, if you're pressing as cystitis, especially a woman, you're going to reach out more for things like mitrofurantoin or try to make it stop from a thoxesol, stuff like that. So, again, just how you'll think to kind of keep in mind here. Okay, now let's go ahead and go on to the penicillin is resistant penicillins. Again, so if you say, oh, define you have another antibiotic podcast I do and I'll encourage you to listen to that one. But this one, this is more like an ex, like a very, that previous one I need is actually very, very high yield for exams. But this one I'm making is almost like a slightly different perspective. It's like different ways of learning the same thing. But I'm telling you, this one is, I promise you, if you focus on this podcast, I really know it well. You're going to get a lot of questions right on your test.

And honestly, I can already tell that this podcast is maybe going to need a second part to be honest with you. Because I'm trying to like try to hit every the most commonly testable things with these with these antibiotics. So, but let's go ahead and continue. So the penicillin is resistant penicillins. You know, these are things like methecylin, napcellin, oxacillin, ocloxacillin and dikeloxacillin. The thing is these drugs, honestly, the cover MSSA, that's kind of like the big thing methecylin sensitive stuff, warriors. And to be honest with you, they are really used in the real world and also on exams. But they are certain situations where you may see them used on exams. What are those classic situations? Mastitis. When the person has mastitis, many times mastitis is caused by methecylin sensitive stuff, warriors. In those circumstances, you're going to pull out oxacillin or ocloxacillin or dikeloxacillin or napcellin. Those are very, very good for treating mastitis. Remember, we don't use methecylin anymore. And then also don't forget that napcellin has a very strong association with acute interstitial and arthritis. Acute interstitial and arthritis. Remember, it's going to be a person that has the combination of fever, they have a rash, and they have elevated eocenophilus. So you see stuff like that? I really want you to think about them. This penicillin is resistant penicillin.

And one other thing I guess I want to say about occicilin that I forgot to mention is occicilin is actually part of the triple therapy for Hpylori. Remember, Hpylori is treated with a combination of a macrolid like clarithromycin and we use occicilin in a proton pump inhibitor. That triple therapy, again, occicilin is part of that triple therapy for Hpylori. Okay, and then I'm going to go ahead and talk about the antisoed mono-penicillins. The penicillins that literally work by covering pseudomonas. So these ones, I'm going to go a little bit out of order, but I'm just going to talk about all the things that cover pseudomonas. So what are those drugs? Well, the drugs that cover pseudomonas can include your Pipyracelina and Tisobactam. Pipyracelina and Tisobactam. That's a combination. Tisobactam is actually a bit of lactamines inhibitor. Those things all cover pseudomonas. And then the second pseudomonas drug, think about astroenom. Astroenom is a mono-bactam. It's really used on exams, but it's very good in people that have penicillin allergies and you need to, for whatever bizarre reason, cover pseudomonas. Astroenom is pretty good. You can also use your carbapenemes to cover pseudomonas. You can also use your carbapenemes to cover pseudomonas. They actually very, very good at covering pseudomonas. And then don't forget your fluoroquino loans. Also excellent for covering pseudomonas. And then don't forget your amino glycosides as well.

A very, very good for covering pseudomonas. And then don't forget that your, what are these drugs? Your third generation cephalosporing, safe tazidim. Remember, it is not every third generation cephalosporing that covers pseudomonas. It's only safe tazidim that covers pseudomonas. Cephtriaxumin cephalotaxim do not have pseudomonas coverage for USMLE purposes. And then the fourth generation cephalosporing, like cephepim, cephepim has the ability to cover pseudomonas as well. Okay, cephepim has the ability to cover pseudomonas as well. Okay, now the next thing we're going to jump into are the cephalosporins. And again, again, you know, I'm going to pick out the ones that are high yield. There's not every cephalosporing that they love to test on exams. I'm going to just pick out the ones that are pretty, pretty high yield. So like for example, I'm going to start off with cephazolins. cephazolins are first generation cephalosporing. Many of you know this as ansef. If you're going into surgery, you don't know about ansef. You need to know about ansef, right? So many times when people are getting antibiotic prophylaxis before surgery, typically we're going to give cephazolins. We usually like to give it 30 to 60 minutes before surgery. That's pretty high yield to know. cephalectin is another first generation cephalosporing that's high yield to know. Typically on USMLE exams, we use it for skin infections.

It's actually very, very good for skin infections, like cellulitis and things like that. But another very kind of weird, but pretty high yield use for cephalectin is to treat UT Is. cephalectin is actually very, very excellent for treating cystitis. It's one of these drugs and it's safe in pregnancy. Many times when a person has a UTI in pregnancy and you're like, man, this person I don't want to use nitroferontoid or you don't see it as an answer or man, I don't want to use TMPSMX because you know it's a fully synthesis inhibitor. You want to go ahead and whip out cephalectin. cephalectin is actually pretty good for UT Is on on exams. Now in terms of the second generation cephalosporins, the only one I'm going to talk about is cephaloroxin. cephalu-roxin. One of the weird bizarre things you kind of want to know about cephaloroxin is that it's actually very, very good for treating Lyme disease. Although remember, the first Lyme treatment for Lyme disease for pretty much any age is doxycycline. But cephaloroxin actually has pretty good coverage against Lyme disease. Okay, remember Lyme disease is caused by Borrelia Bocdofer which is a spirochid which is carried by the exodistect. Don't forget, the exodistect also has the ability to carry things like an aplasma and also Babisia Mycrodis. Babisia Mycrodis.

Okay, and then if we go ahead and go to the third generation cephalosporins, all these ones, I'll say of all the cephalosporin generations, the third generation ones, they're the most important ones, right? So we're going to talk about cephalectin. cephalectin is used for many things. cephalectin is the drug of choice for pylonophritis. When pressing as pylonophritis, reach out for cephalectin. cephalectin is also the drug of choice for gonococcal infection. For an iciragronorea, really an iciraclyne infection, septraxone is the drug of choice. cephalectin is the drug of choice. And then don't forget for most GI infections, septraxone is also excellent. Okay, septraxone is very, very good for most GI infections because remember, the most common cause of most GI infections is E-coli. E-coli is covered beautifully by septraxone. Now, there is, you can also use septraxone for spontaneous bacterial period, two-nighties. You can use it for SBP. You can use it for SBP. You can use it for SBP. Again, third generation of cell phones are great for SB Ps. Pantones by trope or Tonitis. It's going to be a person that has a sideys. They have mild abdominal pain. They have altered mental status. They have a mild fever. Think of SBP. Reach out for septraxone. Also, we can use cephalectin. Pretty much anything you can use septraxone for. You can use cephalectin as well. We tend to love cephalectin when USMLA exams for little kids though.

Because remember, septraxone has the ability to bind an chileid calcium. So because you can bind an chileid calcium, it can cause biliary stasis. That can cause all these biliary problems. We try to not use it in very little kids. But again, cephalectin can also be used for SBP. You can use it for sepsis in a newborn, like in a neonate. Sephalectin is really, really good for that purpose. Again, septraxone is a pretty high-yield drug to know about. I promised you one of these drugs that you see pervasive Lyon on the USMLA exams. Then septazidein is also a third-gen cephalosporing. When you see a third-gen cephalosporing, septazidin, it covers pseudomonas. That's the big, big claim to fame with septazidin. Remember, many times you give an antiso-domonal antibiotic when a person has an intropinic fever. The intropinic fever, the drugs of choice, your drug of choice for any case of intropinic fever you exam, has to be some kind of antiso-domonal antibiotic. And then one other thing I guess I want to say about septraxone is remember, you can actually use septraxone for close contact prophylaxis. If you've been around the person that has misermin ingitis, you're around the person that has misermin ingitis, your close contact, especially if you're contacted, they're respiratory secretions. Because remember, misermin ingitis spreads by droplet secretions. That's actually pretty high-yield to know. Droplet secretions. You can do close contact prophylaxis receptor-axle.

Although remember, you can also use c-pro for close contact prophylaxis. You can also use rifampine for close contact prophylaxis. Again, if you've been around a person that has been incococcal infection. Although remember rifampine is the preferred agent. But if you're pregnant, we're probably going to reach out more for septraxone. Because you know rifampine and c-pro are kind of bothersome drugs in people that are pregnant. And then septraxone is the fourth gen septal osporin. The big thing I'm going to say about septraxone is there's one more thing I want to say about septraxone. Septraxone is also very, very good for treating many cases of pneumonia. Especially for a person who has pneumonia from like strep pneumo, president has pneumonia from like hemofluosin fluenza. Septraxone is actually pretty good for that. Although for those cases of pneumonia as you can also use some of these respiratory thruquinolones. So things like levo-floxasine or moxifloxacine. And then the fourth gen septal osporin to know about is septepine. Septepine, the big, big thing to know is septepine is that it covers pseudomonas. And remember septepine is associated with diarrhea and abdominal pain. Okay, septepine is a zero-direna abdominal pain. Septaroline is a fifth generation septal osporin. You see the many resources every now and then the test it is pretty loyal for the exams. The reason I'm going to say about septarolines that it covers merse. Septaroline covers merse.

Okay, septaroline covers merse. Septaroline covers merse. Okay, so now let's go ahead and jump into a vancomycin. Vancomycin is a pretty important drug to know about for exams. Vancomycin is the drug of choice for merse. It's the drug of choice for merse infections. And many times if a person has many anxieties and you want to give empiric antibiotics, right, for everybody everybody that has many anxieties, for empiric, let's say you don't know the bog. Obviously, if you know the bog, they're going to narrow your antibiotics selection. But if you don't know what you're dealing with, then go ahead and do septaroline vancomycin. Right, do septaroline vancomycin. But again, remember what I said earlier about adenampicillin? If you know the person that's a neonate, represent that's over age 50. Repeated up point many times because it's not a low yield point. I promise you it's a pretty, pretty high yield point to know for exams. And then don't forget that you can also use vang for cdiff. It's actually the first length treatment for cdiff, right, oral vancomycin, oral vancomycin, oral vancomycin. Although, remember, you can also use fidaxal vang, as first life for the management of cdiff infections. Right, and also if a person has like a stuff, it'll be very disinfection. Vancomycin is actually pretty good for that purpose. Vancomycin is actually pretty good for that purpose. Okay, it's actually pretty pretty pretty good for that purpose.

Just something again, you want to keep out the back of your mind for, for exams. Okay, and then remember, vang can obviously cause red man syndrome, right? You can obviously cause red man, red man syndrome. Usually try to prevent that by, you know, appreciating what that anti-histamine or giving like a pretty slow infusion, given a pretty slow infusion. And then remember your carbopenemps, right? Your carbopenemps, these are like drugs you give when a person is like, has a very serious infection, right? Because this stuff just covers a lot of stuff. It covers a lot of stuff. Your carbopenemps, they cover most gram negatives, most gram positives, but remember your carbopenemps do not cover a merse. So if you're worried about a merse infection, a carbopenemps, nobody is supposed to be doing. What carbopenemps, their drugs, you try to use last, because if a person has infections that are resistant to carbopenemps, that preparation should probably be in the ICU at that point, right? It's probably being the ICU at that point is what I'm going to say. Again, as Trionam, as I've mentioned already, it's for pseudomonas, that's probably the only claim to fame. Those polymixings like colistin, again, they're really used on exams, so I'm not even going to talk about them. One other thing I'm going to say though, muperosin, muperosin, the key thing to keep in mind is we use it for like, in petygo.

In petygo is, you know, those honey colored cross-fed papules that you see on the presynzous skin. Those things actually respond pretty, pretty well to to topical muperosin, topical muperosin. And also if you want to do like, you know, stuff where it's prophylaxis, you can actually put muperosin in people's nose as well, okay? So I think I'm going to go ahead and stop here. Again, I don't want because this podcast, it seems like just a 20 minute podcast, but as you can see, there's a lot of detail in it. So I think I'm going to pause here. I'm going to go ahead and continue this in another series. I'm going to actually go ahead and continue this in another series. So thank you for joining me to listen today. Again, if you're interested, I have review classes that I offer for step one, as a 25 hour class for step two. There's a 20 hour class. There's actually an ongoing 50 hour class. I'm very right now for step two. But step two, step three, offer a 20 hour class. Or if you want a very good review for all your shelf exams or 20 hour classes, exactly what you need. Have a 2 and a half hour MB Me testing and strategies class, a four hour biostatistics class, that's for step one to step three. The testing class is actually for step one to step three as well. And then I have a five hour social sciences quality improvement, ethics, healthcare systems, communications class. That one is five hours. That's also for step one of the way to step three.

If you're interested in many of these classes, we actually have a bunch coming up pretty soon. Shoot me an email through the website. I'll give you some more information on that. I also offer one or one children for step one of the way to step three. And then I have this podcast on Apple podcasts on Google podcasts and on Spotify. I have a You Tube channel called Divine Intervention, USMD podcast and videos. That's where I post all the videos that I make. And then finally, I have another website called Divine Intervention Lifelessence.com. Divine Intervention Lifelessence.com. Many of you know I'm a Christian. So using the Bible, I deal with life lessons. I post two podcasts every week, usually on Fridays and on Sundays. We have, we really have almost 180 podcasts. Many people have listened to those and they found it to be really, really helpful. There's actually an Apple podcast associated with that. It's called Divine Intervention Lifelessence Podcast. So thank you for listening to me today. I will see you in the next, really, I think the next podcast I'm going to make. I'm just going to continue rambling about these antibiotics. So thank you for joining me. God bless you. Have a wonderful week and bye for now. Thank you.

Prophylaxis against encapsulated organisms (especially Streptococcus pneumoniae) due to functional asplenia.

Amoxicillin (or amoxicillin/clavulanate).

Listeria monocytogenes and potentially other encapsulated organisms.

Clindamycin, Gentamicin, and often Metronidazole (or a combination including these two).

Vancomycin.

Ceftazidime.

Penicillin compounds (e.g., Penicillin G).

Rheumatic fever treatment and prevention of complications.

Oxacillin (or other penicillins like amoxicillin).

ECG (Clindamycin + Gentamicin).

Extended-spectrum beta-lactams.

Mupirocin.

Ampicillin (to cover Listeria).

Penicillin compounds (e.g., Penicillin G).

Rheumatic fever treatment and prevention of complications.

Oxacillin (or other penicillins like amoxicillin).

ECG (Clindamycin + Gentamicin).

Extended-spectrum beta-lactams.

Mupirocin.

Ampicillin (to cover Listeria).