1. Describe the differences between the terms antibiotic, disinfectant and antiseptics and give examples for each group.

2. Describe the aspects of bacteria that determine the ATB spectrum.

3. How do G + and G- cell walls differ between bacteria? Can a different cell wall structure affect the effect of ATB?

4. Define the following abbreviations and indicate their importance for antimicrobial therapy:

           a. MIC

           b. MBC

5. Indicate the classification of antibacterial drugs.

B) Mechanisms of action

1. Indicate the basic mechanisms of action of antibacterial drugs, including the examples.

2. Which of the above mechanisms of action are primarily bacteriostatic and which bactericidal effect?

3. Define the postantibiotic effect and give examples of ATB where it is significant.

4. Based on the information in the table add to each ATB its characteristics: group and MoA.

C) Antimicrobial resistance and prevention of its development

1. Describe the effect of bacterial resistance. In what ways can resistance spread in the population?

2. Explain the differences between the different types of resistance. Do you know examples of individual types of resistance?

         a. primary resistance

         b. secondary resistance

3. Name typical resistant strains of bacteria.

4. Describe the mechanisms of resistance of bacteria and give examples of groups that show the type of resistance.

5. What is the role of β-lactamases in bacterial cells? Define the benefits of using β-lactamase inhibitors in combination with penicillins. Give examples of β-lactamase inhibitors.

D) Antibiotics´ indications

1. Based on the information in the table add to each ATB its characteristics: target organisms and indications.

2. Which antibiotics are suitable for use in children?

3. Which antibiotics can be used in pregnancy?

4. Which antibiotics are reserved for infections judged to be severe/life-threatening, with treatment initiated only in the inpatient setting and when the benefits outweigh the risks?

E) Adverse effects of antibiotics

1. Based on the information in the table add to each ATB its characteristics: adverse effects

2. Which groups of antibiotics are contraindicated in children and why?

3. Which antibiotics are second choice drugs (side effects, resistance, etc.)?

4. Which antibiotics can cause nephrotoxicity and ototoxicity?

5. What is red man syndrome? How can it be prevented?

F) Combination of antibiotics

1. Which antibiotics are recommended for combinations and why?

2. Which ATB groups or representatives are not suitable to combine with each other and why?

3. Explain why you would not combine rifampicin and clarithromycin in therapy.

2. PK/PD parameters

1.       Explain the concept of time and concentration-dependent ATB.

2.       What will be the appropriate daily dosing regimen depending on PK / PD parameters?

3.       Give examples of time-dependent, concentration-dependent, and AUC-dependent ATBs.

4.       Analyze the following case reports based on your PK / PD parameters knowledge:

1.     Cefotaxime:

The patient was hospitalized in an internal clinic for bronchopneumonia. He was given cefotaxime at the dose of 2 g every 8 hours. The next day, a more experienced doctor took the patient over. He thought that the cefotaxime dose was too low considering the patient's clinical condition. He decided to increase the dosage of cefotaxime.

How would you change the dosage?

Plot the possible dosing regimens graphically and justify, based on the beta-lactam PK / PD parameters, why the proposed scheme is optimal for the patient.

2.     Piperacillin

The patient was admitted to ICU. Piperacillin/tazobactam was administered at the doses of 4 g / 0.5 g every 6 hrs. Within a few days, the patient developed severe renal insufficiency. Therefore, doctors decided to reduce the ATB dose.

How would you reduce the dose of piperacillin and tazobactam according to SPC?

Can you suggest another way how to increase the time above the MIC for time-dependent ATBs in addition to shortening the dosing interval?

Draw time course of systemic drug concentration following drug administration via prolonged and continuous infusions.

3.     Gentamicin:

Based on the knowledge of PK / PD principles and TDM modelling from the previous semester, try plotting the optimal administration of gentamicin in the concentration-time chart.

3) Antimicrobial resistance

Check the website of the European Centre for Disease Prevention and Control. See the part Data and tools: Atlas of Infectious Diseases. 

Discuss the topic of antimicrobial resistance of pathogens in the Czech Republic. See data available from 2019.

Search the relevant data on the website. Pay attention to the individual classes of antibiotics and answer questions.

1.Assess the current status of Streptococcus pneumoniae resistance to penicillins and macrolides in the Czech Republic and compare the values ​​with Slovakia or South and South-eastern European countries.  How resistance to macrolides has developed over the last 10 years? What conclusions can you derive from the data?

2. Assess the current status and development of resistance in the last 10 years for MRSA in the Czech Republic. What conclusions can you derive about MRSA?

3. Compare the resistance to aminopenicillins between Enterococcus faecalis and Enterococcus faecium. What medicine would you choose for Enterococcus faecium?

4. What is the status of aminopenicillin resistance in E. coli? What drug would you choose in case of resistance?

5. Which of the following drugs would you choose for Klebsiella pneumoniae in the Czech Republic? What is the trend in the development of resistance to cephalosporins of the 3rd generation, aminoglycosides, and fluoroquinolones in recent years?

6. Compare resistant isolates among antibiotics in the therapy of Pseudomonas aeruginosa infection. Compare the data found in the Czech Republic with Slovakia and South-eastern Europe.