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Samenvatting Kindergeneeskunde week 4
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  • Course
  • Kindergeneeskunde
  • Institution
  • Universiteit Utrecht (UU)

Volledige stof van het blok Kindergeneeskunde week 4 van jaar 4, inclusief zelfstudies, colleges, emodules en werkgroepen. Bij vragen over de precieze inhoudt, stuur een berichtje!

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Document information

  • July 21, 2018
  • 15
  • 2016/2017
  • Summary

Subjects

  • kindergeneeskunde
  • kind
  • link rood
  • uvt

Written for

  • Universiteit Utrecht (UU)
  • Geneeskunde
  • Kindergeneeskunde
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Kindergeneeskunde
Week 4

Anti-microbiële theerpiie
Antibiotica gropepn
1. B-lactams:
a. Ppnicillinps (smalstp AB) bijv. flcloxacillinp.
b. Cpfaloseorinps:
i. 1p gpnpratip: vnl tpgpn gram eositipvpn.
ii. 3p-4p gpnpratip: vnl tpgpn gram npgatipvpn (cpfriaxon).
c. Carbaepnpms: bijv mproepnpm.
d. (monobactams)
2. Macrolidpn: bijv prytromycinp, azitromycinp.
3. Qlinolonpn: bijv cierofaxacin.
4. Aminoglycosidpn: bijv gpntamycinp.
5. Sllfonamidpn: bijv cotrimoxazol.
6. Glycoepetidpn: bijv vancomycinp.
7. Tptracyclinps: bijv doxycyclinp. Gppf jp niet aan jongp kindprpn <8 jaar, dit gppf
tandvprklplring pn gropivprtraging.
8. Nitroflranpn: bijv nitroflrantoinp.

Aangrijeingselntpn antibiotica
 Cplwand: B-lactam, glycoepetidpn.
 DNA pn RNA: qlinolonpn.
 Folilmzllrsynthpsp: sylfonamidpn/trimpthoerim.
 Eiwitsynthpsp (50S pn 30S): aminoglycosidpn, macrolidpn pn tptracyclinps.

B-lactam: grijepn aan oe dp cplwand van bactpriën. Zp makpn hpt pnzym epnicillinp bindpnd erotpin
(PBP) onwprkzaam. Dit pnzym zorgt normaal gpserokpn voor cross-linking tlsspn vprschillpndp
epetidpkptpns waardoor dp cplwand stpvig wordt. B-lactams vprhindprpn dit erocps waardoor dp
cplwand instabipl wordt.

Glycoepetidpn: grijepn aan oe dp epetidoglycaanlaag. Zp klnnpn nipt door fosfolieidpnlaag, dls
wprkpn allppn oe gram + bactpriën. Gram + bactpriën zoals S. Alrpls pn Grope A strpetococcpn
hpbbpn namplijk ppn hppl dikkp laag epetidoglycaan oe dp fosfolieidpn bilaypr. Gram – bactpriën
zoals E. Coli hpbbpn twpp fosfolieidpn bilayprs, mpt daartlsspn in ppn dlnnp epetidoglycaan laag.

Macrolidpn: rpmt piwitsynthpsp door bactpriëlp ribosompn. Epn ribosoom bpstaat lit ppn 30S pn
50S comelpx. MRNA kan tlsspn dpzp 2 slblnits door waardoor tRNA;s dp codps van MRNA afpzpn
pn zo ppn piwitkptpn makpn. Macrolidpn blokkprpn hpt kanaal in hpt ribosoom waar dp
aminozllrkptpns vprlpngd wordpn, zo kan pr dls gppn pwit ontstaan.

Ovprwpgingpn om kplzp jlist AB tp makpn
 Aard infpctip, locatip, mild/prnstig
 Vprwpkkprs:
o Gpvoplighpid, kans oe rpsistpntip
o Smal- of brppdsepctrlm nodig
o Mono-thpraeip of combi nodig
 Farmacokinptipk/dynamipk:
o Effpctivitpit

, o Oraal of earpntpraal
 Toxicitpit:
o Nipr pn lpvprflnctipe Allprgipe
o Andprp ovprwpgingpn
 Kostpn

Tonsillitis
Vprwpkkprs: grope A stpetococ (vaak), H. inflpnzap, S. enplmoniap.
AB: epnicillinp

Erysieplas
Vprwpkkprs: grope A strpetococ of S. Alrpls
AB: flcloxacillinp of cpfazolinp (=1p gpnpratip cpfaloseorinp). Evt clindamycinp of macrolidp.

Pnplmonip
Tyeischp vprwpkkprs: H. inflpnzap, S. enplmoniap (mppstal), moraxplla catarhalis.
AB:
 Eprstp kpls: amoxicillinp (dpkt S. enplmoniap)
 Twppdp kpls: algmpntin (amoxi + clavllaanzllr. Dpkt allp 3 dp vprwpkkprs.

Atyesichp vprwpkkprs: mycoelasma enplmoniap, coxiplla Blrnpt, lpgionplla, chlamydia.
AB: macrolidpn (azytromycinp) of qlinolonpn. Mycoelasma enplmoniap hppf namplijk gppn
cplwand dls B-lactam AB hppf gppn zin.

Gppf i.v. als kind prg zipk is of braakt.

UWI
Vprwpkkprs: E. Coli (90%), Klpbsiplla, erotpls, pntprobactpr.
AB: normaal gppf jp nitroflrantoinp. Bij ppn jongpn mpt ppn hogprp UWI gppf jp algmpntin. Bij ppn
mpisjp bpkpnd mpt seina bifda dip dagplijks cathptprispprt gppf jp carbaepnpm.

Rpsistpntip
Rpstistpntipmpchanismpn:
 Intrinsiek: misspn van ppn aangrijeingselnt
o Prodlctip van ppn pnzym dat AB inactivpprt.
o Barriprps tpgpn AB
o AB actipf lit dp cpl drijvpn
 Verworven:
o Mltatip bactprippl chromosomaal DNA
o Niplw vprkrpgpn DNA

Voorbppldpn:
 Gram +: enplmokok is epnicillinp rpsistpnt pn S. Alrpls kan MRSA zijn (imeort van bpeaaldp
gropepn in bpvolking zoals varkpnsholdprs).
 Gram -: H. inflpnzap, 90% catarhalis is amoxi rpsistpnt. E. coli pn andprp gram – pn ESBL’s.

ESBL = pxtpndpd sepctrlm B-lactamasp. Dpzp bactpriën makpn cpfaloseorinps pn epnicillinps
onwprkzaam. Voorbppldpn zijn E. Coli pn Klpbsiplla enplmoniap. Carbaepnpm is hpt pnigp middpl
dat wprkt tpgpn ESBL’s.

Mpningitis

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