A summary of antibiotics used to fight infections caused by gram positive organisms, with a focus on MRSA (methicillin resistant staph aureus) and VRE (vancomycin resistant enterococcus).
Errata: @5:12 TMP/SMX should get, at best, at "+/-" for Group A and B Strep. (It's probably more like a "+" for GAS, and a "-" for GBS, though using it for a GAS infection would be unconventional and is best probably avoided.)
It's true that vancomycin is available in PO form, but it's not absorbed through the GI tract and is only used to treat C.diff colitis where systemic absorption is usually not needed.
Hey Eric, great lectures! A suggestion: ~11 min in, I would consider mentioning under your Daptomycin column "cannot be used for pulmonary infections" as it is bound up by pulmonary surfactant.
pandnh4, thanks for suggestion. Somewhere I thought I may have mentioned that, but looking over the relevant videos, I see I didn't. Will add an annotation. Thx!
Good day Eric - Ali from Samoa again . I forgot which teaching you related the following quotable -- " ... Solidify clinical experience into knowledge ... " Man I Love that saying and Love you more for sharing your wisdom and knowledge with the rest of us . Bless you for all your help .
Great video! In lecture 3 you said that none of the penicillins have good strep viridans coverage, however in this video at 5:35 penicillin G is listed as the preferred antibiotic for viridans strep
um08cjk, Thanks for pointing this out! I think this may be the most significant error to slip through my proofreading process on any of these videos to date. Natural penicillins (i.e. PCN G) do NOT generally work against MSSA. That + you referred to should be a -. I've added an annotation addressing this in lecture 3.
Hi Eric! I love the way you make it digestible for a non-pro like yourself. However, I was wondering it these are still "up to date"? Or has treatment changed a lot over the past 6 years? Thanks
Hi Eric! I know you haven't discussed spirochetes anywhere and maybe dropped it on purpose but I think from a clinical perspective the use of Penicillin G for syphilis warrants mention. No?
+basim ali I didn't include either spirochetes or mycobacteria as part of the video series because those pathogens and diseases act a fair amount differently than others, and the video series was already on the long side. Hopefully a future video will address syphilis and its antibiotic treatment.
+basim ali Thanks for mentioning this. In particular, there is some data that clindamycin may be helpful in suppressing toxin formation in toxic shock syndrome.
Eric... excellent lectures overall; however, TMP-SMX is actually NOT a good choice for Group A or B Streptococcus species. These organisms are intrinsically resistant to this agent. In fact, this agent can be used in the microbiology laboratory in an identification scheme for these organisms based upon the resistance.
Dr. Eric good day , I hope you are okay please in the previous lecture number 3 classification of antibiotics you mention in the tablet that Penicillin G has activity for the MSSA then in this lecture you mention in the table for gram positive that Penicillin has no activity ....... please can you clarify this point ?
You are quite right. Unfortunately, I make occasional mistakes in the videos (which I think have been fewer in number in recent years...). You probably have annotations turned off or are viewing in mobile, as there is an annotation overlaying the table in question in video 3: "As pointed out by a viewer, there should be a negative sign next to MSSA (at least here in the United States) due to the high rates of penicillinase production in Staph aureus. For example, MSSA is ~20% sensitive to PCN among patients at both Stanford and San Francisco General, which is definitely low enough to be considered inadequate. This may be different in other parts of the world."
It is second-line, but it can be used if necessary. It is one of several drugs that is an option for treatment of MSSA in patients who have life-threatening penicillin allergies (e.g. anaphylaxis). The issue here is that unfortunately, many patients with MSSA and milder penicillin-allergies who could safely receive a preferable cephalosporin are probably inappropriately placed on vancomycin out of a mistaken belief that penicillin allergies and cephalosporin allergies have more overlap than they do. Here's a paper that discusses some of the issues: www.ncbi.nlm.nih.gov/pmc/articles/PMC4542891/ I discuss this specific issue in lesson 8 in this antibiotic series, around (the 5:20 mark).
