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DCPA Antibiotics

Colonization Presence of microbe in a host does not cause a specific immune reaction or infection (Do NOT Tx w/ Abx)
Empiric Therapy Abx choice based on clinically most likely pathogen
Definitive Therapy Abx choise based on identified pathogen & susceptibilty patterns
De-escalation Adjustment of Abx regimen from broad to narrow spectrum
Collateral Damage Unwanted negative effect of an Abx on NMF
Minimum Inhibitory Concentration (MIC) Minimum [] that inhibits groth of organism
Antibiogram Compilation of data for bacteria vs. abx
Gram (+) Cocci bacteria S. Aureus, Staph Epidermidis, Strept Pyogenes, Strep Agalactiae, S. pneumoniae, enterococci, Strp bovis, Viridans Strep, Strep intermedius
S. Epidermidis infections Associated with "hardware"
Enterococci infections UTI, appendicitis
Strep Bovis Infections Bowel lesion = spread of infection
Strep. Intermedius Infections Abcess Formers
Gram (+) Bacilli Bacteria **Usually erroneous Sample** Corneybacterium Diptheriae, Listeria Monocytogenes, Bacillus Antracis, Erysipelothrix Rhusiopathiae
Listeria Monocytogenes Infections Meningitis (Can't eat cheese in 2nd/3rd trimester)
Gram (-) Cocci Bacteria Neisseria Meningitidis, Neisseria Gonorrhoeae, Moraxella (Branhamella) Catarrhalis
Gram (-) Bacilli Bacteria Vibrio cholerae, Campylobacter jejuni, H. Pylori, Pseudomonas Aeruginosa, Salmonella, H. Influenza, Brucella, Francisella Tularensis (Tularemia), Pasturella Multocida, Legionella Pneumophilia, Bartonella, Shigella, Enterobacter (E. Coli, etc.)
Pasturella Multocida Caused by... Bites (Mouths) or Cats & dogs
Bartonella caused by... Cat scratch
Anaerobes Clostridium tetani, C. botulinum, C. Difficile, C. Perfringens, Bacteroides, Fusobacterium, Peptostreptococcus, Prevotella
Clostridium Perfringens Infection Gas Gangrene
Beta-Lactum Drugs Penicillin, Cephalosporin, Carbapenems, Aztreonam
Beta-Lactums MOA Interferes with cell wall synthesis
Glycoprotein MOA Interferes with cell wall synthesis
Fluoroquinolones MOA Interferes with DNA replication, transcription
Rifampin MOA Interferes with DNA replication, transcription
Aminoglycosides MOA Binds to 30s/50s Ribosomal Subunit
Macrolides MOA Binds to 30s/50s Ribosomal Subunit
Ketolides MOA Binds to 30s/50s Ribosomal Subunit
Oxazolidinones MOA Binds to 30s/50s Ribosomal Subunit
Tetracyclines MOA Binds to 30s/50s Ribosomal Subunit
Streptogramins MOA Binds to 30s/50s Ribosomal Subunit
Broad Spectrum Drugs PCN (Penicillin), 3rd/4th generation Cephalosporins, Carbapenems
Narrow Spectrum Gram(+) Drugs Vancomycin
Narrow Spectrum Gram(-) Drugs Aminoglycosides, Aztreonam
Narrow Spectrum Anaerobes Drugs Metronidazole (Flagyl)
Pharmacokinetics Absorption (Bioavailability), Distribution, Metabolism, Elimination
Pharmodynamics Relationship between drug concentration & effect "Antibiotic Potency"
Bioavailability % of oral dose available compared to IV form (100%)
Clearance Determines steady state of drug (determined by blood flow to metabolizing organ & rate of extraction of the drug from blood)
Volume of Distribution Relates the amount of drug in the body to the serum drug concentration (Dependent on BMI)
Steady State After 3 half lives
Postantibiotic Effect (PAE) Delay before organisms recover & begin growing despite decrease concentration of drug
Four Primary Machanisms of Resistance. Alterations in outer membrane permeability. Alteration in drug binding sites, Production of molecules capable of inactivating drug molecules. Active efflux of antibiotic from the bacteria.
Abx. dosing & duration DONT under dose/increase duration = resistance
Bacterocidal Drugs Beta Lactams, Cephalosporins, quinolones, aminoglycosides
Bacterostatic Drugs Clindamycin, macrolides, sulfonamides, Tetracycline
Aminoglyc. Accumulation Nephrotoxic (reversible) & Toxic to the Ear (irreversible)
Drugs that penatrate the BBB to the CSF AG's, clindamycin
Difficult tissue to penetrate Bone, synovial fluid, prostate, Abscesses, Peritoneal Fluid
DOC Drug of Choice
IND Indications
ADR Adverse Reactions
W/P Warnings & Precautions
SSSI Skin & Soft Tissue Infections
Anaphylaxis (IgE) Hives (Uticaria). Respiratory Difficulty (Bronchospasm). Swelling. Occurs within the first 72 hours.
Most common drug allergy Penicillin
Penicillin ADR Maculopapular rash, rash, uticarial rash, fever, bronchospasm, vasculitis, serum sickness, exfoliative dermatitis, Stevens-Johnson, Anaphylaxis (ordered in decreasing frequency & increasing severity.)
Penicillin half life Short: 30-60 minutes (rapid renal excretion)
Penicillin Types Natural, Penicillinase-resistant, Aminopenicillins, Extrended-spectrum ureidopenicillins, B-lactam/B-lactamase Inhibitors
Natural Penicillin Drugs & forms Penicillin G (IV/IM) & Penicillin V (PO)
Natural Penicillin effective against... B-hemolytic strept, most anaerobes, viridans strep, N. meningitidis.
Natural Penicillin DOC Strep. Pneumoniae
Natural Penicillin R Actinomyces, meningococcus, Pasteurella, S. Pneumoniae, S. pyogenes, T. Pallidum.
Natural Penicillin Pregnancy Category C
Natural Penicillin ADR Seizures or hemolytic anemia
Penicillinase-resistant penicillins drugs & forms Oxacillin/Nafcillin (IV) & Dicloxacillin (PO-empty stomach)
Penicillinase-resistant penicillins effective against... ?
Penicillinase-resistant penicillins ADR GI cramps, rash, neutropenia (prolonged Rx - especially with nafcillin), acute interstitial nephritis
Aminopenicillin Drugs Ampicillin (IV/PO), Amoxicillin (PO)
Aminopenicillin covers Enterococci, E.coli, H. influenza, Proteus, Klebsiella
Aminopenicillin W/P Renal Insufficiency & Cephalosporin allergy
Aminopenicillin ADR Rash & GI upset
Extended-spectrum ureidopenicillins drugs & forms Pipercillin (IV) usually used in combination!
Extended-spectrum ureidopenicillins covers Anaerobes, enterobactericacae & pseudomonas
Extended-spectrum ureidopenicillins W/P Severe renal impairment & allergies to cephalosporins
Extended-spectrum ureidopenicillins ADRs GI & dermatology
B-lactamase inhibitor drugs ampicillin/sulbactam (Unasyn - IV) Pipercillin/Tazobactam (Zosyn-IV) Aoxicillin/clavulante (Augmentin-PO)
Unasyn ingrediants Ampicillin & sulbactam
Zosyn ingrediants Pipercillin & tazobactam
Augmentin ingrediants Amoxicillin & Clavulanate
B-lactamase inhibitor SE Diarrhea (increased with clavulanate)
Penicillin Class drug interactions Decrease OCP efficiancy. Increases warfarins effect.
Penicillin Class ADRs Seizure potential with high doses. Inhibit platelet aggregation.
Cephalosporins types 1st generation-4th generation
Cephalosporins pregnancy categroy B
Cephalosporins ADRs Increase C. difficile colitis & VRE
1st generation cephalosporins drugs & forms Cefazolin - Ancef(IV) & Cephalexin - Keflex (PO)
Cefazolin Ancef
Cephalexin Keflex
1st generation cephalosporins coverage Better gm +
1st generation cephalosporins uses surgical prophylaxis, SSSIs & UTI
2nd generation cephalosporins coverage Less gram + & more gram -
2nd generation cephalosporins drugs Cefuroxime (Ceftin) - PO. Cefotetan (Cefotan) - IV.
Cefuroxime (Ceftin) covers strep, haemophilus, E. coli, Proteus, Klebsiella
Cefuroxime (Ceftin)uses URI/L RTIs, Otitis Media, COPD exacerbations, sinusitis.
Cefuroxime Ceftin
Cefotetan Cefotan
Cefotetan (Cefotan) covers B. frgilis & other bowel anaerobes
Cefotetan (Cefotan) uses abdominal infections, bowel surgery prophylaxis, OB/GYN infections (PID)
3rd generation cephalosporin coverage weak gram + & good gram -
3rd generation cephalosporin drugs Ceftriaxone (Rocephin) - IV. Ceftazadime (Fortaz - IV. Cefpodoxime (Vantin) - PO. Cefixime (Suprax) - PO
Ceftriaxone Rocephin
Ceftriaxone (Rocephin) ADRs Biliary sludging b/c its eliminated via biliary excretion
Ceftriaxone (Rocephin) coverage Severe gram (-) infection & Meningitis
Ceftazadime Fortaz
Ceftazadime (Fortaz) coverage Pseudomonas
Cefpodoxime Vantin
Cefixime Suprax
Cefpodoxime (Vantin) & Cefixime (Suprax) coverage URIs & RTIs
4th Generation Cephalosporin drug & form Cefepime (IV)
Cefepime covers Pseudomonas, gram (-) rods (enterobacter, serratia & citrobacter).
Cefepime uses Febrile neutropenia, hospital acquired pneumonia, serious gram (-) infections.
Carbapenems drugs Imipenem/cilastatin (Primaxin) - IV. Meropenem (IV). Ertapenem (Invanz)- IV.
Primaxin imipenem/cilastatin
Carbapenems covers gram +'s including MSSA, grams -'s & anaerobes.
Primaxin (Imipenem/cilastatin) uses pseudomonas & polymicrobial infections.
Primaxin (Imipenem/cilastatin) ADR N/V & decreases seizure threshhold.
Primaxin (Imipenem/cilastatin) W/P Hx of seizures
Primaxin (Imipenem/cilastatin) pregnancy category C
Meropenem ADR Less seizures & N/V
Meropenem pregnancy category B
Meropenem coverage decreased in Staph & strep
Ertapenem Invanz
Ertapenem (Invanz) does not cover pseudomonas
Monobactam drug & form Aztreonam (Azactam) - IV
Aztreonam Azactam
Aztreonam (Azactam) coverage Gram negative ONLY
Aztreonam (Azactam) pregnancy category B
Aztreonam (Azactam) SE Well tolerated
Aminoglycoside drugs Gentamicin, Tobramycin & amikacin (all IV; not absorbed well)
Aminoglycoside coverage Gram - (Pseudomonas)
Aminoglycoside decreased effectivness by Abscesses
Aminoglycoside Pregnancy category D
Aminoglycoside uses Always used in combo: serious gram (-) infections or b-lactam for synergy
Macrolides drugs Erythromycin (Iv, PO, Opth). Clarithromycin (Biaxin) - PO. Azithromycin (Zithromax) - IV/PO
Clarithromycin Biaxin
Azithromycin Zithromax
Macrolides Pregnancy category B (eryth, Azith) & C (Clarith)
Macrolides coverage pneumococcus, atypicals, H. influenza
Macrolides Uses OM, CAP, COPD, STD
Macrolides ADR GI (take with food) & QT prolongation
Clarithromycin (Biaxin) DOC Eryth-sensitive strains of streptococci
Azithromycin (Zithromax) DOC H. Influenza & Chlamydia
Azithromycin (Zithromax) half life 68 hours
Fluoroquinolone drugs Ofloxacin, ciprofloxacin (Cipro), Levofloxacin (Levaquin), Moxifloxacin (Avelox), Gatifloxacin (Tequin), Gemifloxacin (Factive)
Fluoroquinolone coverage good gram (-), alright gram (+)
Fluoroquinolone DOC Legionella
Cipro & Levaquin cover Pseudomonas
Fluoroquinolone pregnancy category C
Fluoroquinolone CI <18y.o. (arthropathy)
Fluoroquinolone ADR N/V/D, CNS (HA, restlessness), decrease seizure threshhold, tendon rupture (spontaneous - achilles), increase in AST/ALT
Fluoroquinolone DI Aluminum/Mg antacids, sulcralfate, Ca2+, Fe2+ & Zinc - decrease absorption. Increases the effect of warfarin (except moxifloxacin & gatifloxacin)
Fluoroquinolone uses CAP (includes atypicals), UTIs/pyelonephritis, COPD, acute exacerbation of chronic bronchitis, sinusitis
Tetracycline drugs tetracycline, doxycycline, minocycline
Tetracycline coverage Broad - including rickettsia, mycoplasma & chlamydia
Tetracycline pregnancy category D
Tetracycline CI < 8 y.o. (permanent discoloration of the teeth & inhibits bone growth)
Tetracycline Use CAP, STD (Chlamydia), syphilis (pen-allergic pts.), Lyme dz, acne, community acquired MRSA
Tetracycline ADR GI, photosensitivity, erosive esophagitis, vestibular sx (drunk/off balance), liver damage (rare)
Tetracycline DI Increased effect of warfarin
Vancomycin Forms IV & PO(C. difficile only)
Vancomycin MOA Inhibits cell wall growth ("slowly" cidal)
Vancomycin coverage gram +'s (MRSA, MRSE) & mild-mod anaerobic
Vancomycin pregnancy category C
Vancomycin ADR Redman syndrome (nonallergic rash on face/chest, flushing & hypotension), reversible neutopenia
Vancomycin administration Given slowly (over an hour)
Vancomycin special abilities Penetrates CSF
Clindamycin Cleocin
Clindamycin (Cleocin) forms IV, PO, Topical (acne), Vaginal
Clindamycin (Cleocin) class Lincomycin
Clindamycin (Cleocin) MOA Inhibits protein synthesis
Clindamycin (Cleocin) Coverage **anaerobes** Strep & S. aureus (MRSA)
Clindamycin (Cleocin) use anaerobic abscess, abdominal infections & Gyn
Clindamycin (Cleocin) ADR N/V/D & rash - can cause C. Diff
Metronidazole Flagyl
Metronidazole (Flagyl) MOA Inhibits DNA synthesis
Clindamycin (Cleocin) coverage anaerobes & ameoba
Clindamycin (Cleocin) uses Abdominal abscess, C. diff, Rx trich, & H. pylori
Clindamycin (Cleocin) Pregnancy category B (avoid 1st trimester)
Clindamycin (Cleocin) special abilities Penetrate CSF
Clindamycin (Cleocin) ADR N/V and alcohol reaction
TMP/SMZ Trimethoprim/Sulfamethoxazole
TMP/SMZ (Trimethoprim/Sulfamethoxazole) forms PO or IV
TMP/SMZ (Trimethoprim/Sulfamethoxazole) MOA Inhibits folic acid synthesis (static)
TMP/SMZ (Trimethoprim/Sulfamethoxazole) pregnancy category B but at 3rd trimester - term = D
TMP/SMZ (Trimethoprim/Sulfamethoxazole) coverage Staph, strep, GNR's & Pneumocystis (prophylaxis for HIV pt.)
TMP/SMZ (Trimethoprim/Sulfamethoxazole) uses UTIs, gram - infections, MRSA
TMP/SMZ (Trimethoprim/Sulfamethoxazole) DOC PCP
TMP/SMZ (Trimethoprim/Sulfamethoxazole) ADR Rash, CNS disturbances, photosensitivity, GI Sx.
TMP/SMZ (Trimethoprim/Sulfamethoxazole) Increase toxcity of... warfarin, oral hypoglycemics, phenytoin, methotrexate, cyclosporin
Rifampin Form PO
Rifampin MOA Inhibits bacterial synthesis
Rifampin Uses TB, Meningococcal prophylaxis, nasal carriers of MRSA
Rifampin ADR GI upset, rash, turns secretions red-orange-brown, hepatotoxic, potent cyt P450 inhibitor
Linezolid Zyvox
Linezolid (Zyvox) forms IV & PO (100% available)
Linezolid (Zyvox) class Oxazolidinone
Linezolid (Zyvox) coverage Staph (MRSA), Coag (-) staph, strept, enterococci (VRE). Minor against anaerobes
Linezolid (Zyvox) ADR Thrombocytopenia (reversible) or anemia
Linezolid (Zyvox) uses variety of infections from MRSA and VRE
Synercid Quinupristin/Dalfopristin
Synercide Quinupristin/Dalfopristin class Streptogramin
Synercide Quinupristin/Dalfopristin form IV via central line only!
Synercide Quinupristin/Dalfopristin coverage MRSA, VRE
Synercide Quinupristin/Dalfopristin ADR Myalgia, arthalgia
Synercide Quinupristin/Dalfopristin amount used Rarely
Daptomycin Form IV
Daptomycin coverage MRSA
Daptomycin use complicated skin & soft tissue infection
Tygecycline coverage MRSA, VRE, strep, enteric GNRs, bowel anaerobes
Mupirocin Bactroban
Mupirocin (Bactroban) form Topical
Mupirocin (Bactroban) use Impetigo due to S.aureus, group A strept (pyogenese) or decolonize the nasal passages of MRSA carriers (+/-)
Nitrofurantoin Macrodantin
Nitrofurantoin (Macrodantin) coverage gram +'s, enterococci, E. coli
Nitrofurantoin (Macrodantin) Pregnancy B
Nitrofurantoin (Macrodantin) DI decreased absorption with antacids
Nitrofurantoin (Macrodantin) W/P G6PD deficiency = interstitial pulmonary fibrosis with chronic use.
Nitrofurantoin (Macrodantin) use ONLY UTIS - Tx/prophylaxis
Bacteria that must be treated for > 4 weeks S. Aureus bacteremia, endocarditis, ostomyelitis
Anti-Staphylococcal **Nafcillin, oxacillin, dicloxacillin, cefazolin
Anti-MRSA Vancomycin, Clindamycin, Doxycycline, TMP/SMZ, Linezolid, Quinupristin/dalfopristin, daptomycin, tygecycline.
Anti-anaerobic Metronidazole, clindamycin, carbapenems, ceftotetan, Penicillin, B-lactamase inhibitors
Anti-pseudomonal pipercillin/tazobactam, aminoglycosides, ceftazadime, cefepime, imipenem, meropenem, ciprofloxacin, levofloxacin.
Created by: 147401391
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