Which of the following signs and symptoms are generally not present in a bacterial infection?
A – Fever, pain, and inflammation
B – Leukocytosis, erythema, and neutrophilia
C – Presence of pus, lymphocytosis, and anemia
D – Fever, increased granulocyte count, and pain
E – Fever, pain, and swelling
C – Presence of pus, lymphocytosis, and anemia
Which blood cells are generally predominant in the cerebrospinal fluid at the onset of a bacterial infection other than tuberculosis?
A – Neutrophils
B – Erythrocytes
C – Lymphocytes
D – Monocytes
E – Macrophages
A - Neutrophils
In the presence of a suspected severe bacterial infection, which of the following statements are false:
A – Empirical antibiotic therapy should be initiated before identifying the causal microorganism of the infection.
B – The causal microorganism of the infection and its sensitivity to anti-infectives should be sought even when there is a strong suspicion of the causal agent.
C – The collection of the biological sample for identification of the causal microorganism should be carried out immediately after the start of antibiotic therapy.
D – The antibiotic initially used should have a broad spectrum of action.
E – After the causal bacterium of the infection is known, an antibiotic with a narrower spectrum should be used.
(a) A and E are false
(b) C and E are false
(c) B and D are false
(d) Only B is false
(e) Only C is false
(f) Only E is false
(g) None of the statements is false
(e) Only C is false
Mention 5 host factors to be considered in the selection of an antibiotic therapy regimen
- Alergia/histórico de reações adversas aos medicamentos
- Idade
- Gravidez/amamentação
- Distúrbios metabólicos
- Disfunção renal e hepática
Which antibiotics exhibit time-dependent antibacterial activity?
A – Amikacin
B – Amoxicillin
C – Levofloxacin
D – Clarithromycin
E – Imipenem
B - Amoxicillin
D - Clarithromycin
E - Imipenem
Which antibiotics exhibit concentration-dependent antibacterial activity?
A - Amoxicillin
B - Gentamicin
C - Imipenem
D - Levofloxacin
E - Clarithromycin
B - Gentamicin
D - Levofloxacin
Mention 4 criteria that favor the change of the route of administration from intravenous to oral:
- Melhoria clínica global
- Ausência de febre há cerca de 8-24 horas
- Progressiva diminuição da leucocitose
- Trato gastrointestinal funcional
An intravenous drug user is admitted to the ER with a fever of 39ºC and chills. The clinical examination detects the presence of endocarditis. The blood count confirms the presence of methicillin-resistant Staphylococcus aureus (MRSA). Which intravenous antibiotic is the first choice?
A – Amoxicillin
B – Vancomycin
C – Gentamicin
D – Ampicillin
E – Piperacillin + Tazobactam
B - Vancomycin
A 14-year-old adolescent is injured by stepping on a rusty nail. After 1 month, he is diagnosed with osteomyelitis caused by Staphylococcus aureus through X-rays and bone biopsy. Which antibiotic is not considered effective in this situation?
A – Dicloxacillin
B – Norfloxacin
C – Flucloxacillin
D – Cefazolin
E – Cefadroxil
B - Norfloxacin
What type of antibiotic therapy should be administered before identifying the responsible microorganism?
Antibioterapia empírica
What type of antibiotic therapy should be administered after identifying the responsible microorganism?
Antibioterapia definitiva
Name 3 drugs that cause fever
- Lamotrigina
- Heparina
- Fenitoína
In which types of diseases/infections do we generally associate lymphocytosis?
- Tuberculose
- Infeções víricas
- Infeções fúngicas
In what ways can pain and/or inflammation manifest?
- Inchaço ou tumefação
- Eritema
- Dor à palpação
- Secreções purulentas
What is the suggestive diagnosis that can be made when neutrophils are identified in the CSF, respiratory secretions, or urine?
Infeção bacteriana
When should the collection of tissue or fluid samples be carried out?
Antes de iniciar a antibioterapia
What are the factors in the selection of antibiotic therapy?
- Tipo e severidade da infeção
- Fatores do hospedeiro
- Fatores relacionados com a terapêutica recente ou concomitante
- Necessidade de utilizar diversos ABs
Host factors in empirical/initial antibiotic therapy
- Alergia ou história de reações adversas aos medicamentos
- Idade
- Gravidez, amamentação
- Distúrbios metabólicos
- Função renal e hepática
- Patologias/terapêutica concomitante
Time-dependent antibiotics
- Beta-lactâmicos
- Carbapenemos
- Vancomicina
- Clindamicina
- Macrólidos (eritromicina, azitromicina, claritromicina)
- Linezolida
Concentration-dependent antibiotics
- Aminoglicosídeos (gentamicina, tobramicina, amicacina, estreptomicina)
- Fluoroquinolonas (ciprofloxacina, levofloxacina, moxifloxacina)
What is the reason for using a combination of several antibiotics?
- Alargar o espetro de atividade antibacteriana para terapêutica empírica
- Obter atividade sinergística
- Prevenir o desenvolvimento de resistências (caso da tuberculose)
What is the most common type of synergistic association in antibiotics?
Aminoglicosídeos + Beta-lactâmicos
What are the disadvantages of combining several antibiotics?
- Aumento do custo
- Aumento da toxicidade
- Superinfeção com bactérias resistentes
- Algumas combinações de ABs são potencialmente antagonistas (cefoxitina + penicilina/imipenemo)
How can we monitor the therapeutic response?
- Contagem de leucócitos
- Proteína C reativa (muito elevada nas infeções bacterianas)
- Temperatura
- Sinais e sintomas de infeção
- Exames radiológicos
- Determinação da concentração de ABs nos fluidos corporais
