Anti-infectives Flashcards
IV: Gentamicin Tobramycin Amikacin
Oral: Neomycin Paromomycin
Topical: Framycetin Gentamicin Neomycin Tobramycin
MOA
Precautions
Monitoring
- Inhibit protein synthesis, Bactericidal, Gram -ve
- Ototoxicity (Irreversible)
- Vestibular (n&v, vertigo, nystagmus, difficulties with gait
- Cochlear (hearing loss, tinnitus, feeling of fullness in ears)
- Nephrotoxicity (Reversible)
- Neuromuscular blockade (respiratory depression) - caution with myasthenia gravis pts
- Renal function
- Auditory testing
- Vestibular function (ASK abt dizziness, tinnitus, confusion, eye movement)
- Therapeutic drug concentrations of IV aminoglycosides (if dosing continues beyond 48 hours)
IV:
Doripenem
Ertapenem
Imipenem
Meropenem
MOA
Precautions
Monitoring
- Inhibit bacterial cell wall synthesis, binds to penicillin binding proteins, Bactericidal, Gram -ve, +ve, anaerobes
- Allergy (cross reactivity)
- Neurotoxicity (myclonic activity, confusion, seizures)
- Infrequent A/E: Clostridium difficile assoc disease
- Monitor during prolonged treatment
- Renal function
- Hepatic function
- Complete blood count
MOA
Precautions
Monitoring
- Interfere with bacterial cell wall synthesis, binds to penicillin binding proteins, Bactericidal
- Allergy (cross reactivity)
- Renal impairment (dose reduction - risk of nephrotoxicity & neurotoxicity)
- Common A/E
- diarrhoea
- n&v
- rash, allergy
- headache
- dizziness
- Clostridium difficile associated disease
- Superinfection (Candida, Enterococcus)
- Monitor during prolonged (>10 days) &/or high dose treatment
- Renal function
- Complete blood count
Moderate spectrum
Cefaclor (Ceclor, Karlor) - B1
Cefuroxime (Zinnat) - B1
Cephalexin (Keflex) - A
Indications
Dose
Counselling
Indications Cefaclor & Cefuroxime
- Otitis media
- Resp tract infections (H influenzae)
- Acute bacterial sinusitis
- Cefuroxime: Gonoccocal infections (1 g 1 dose)
Dose Cefaclor
- CR: 375-750 mg q12h
- Child: 10 mg/kg q8h
Dose Cefuroxime
- 250-500 mg BD
- Child: 10 mg/kg BD - 15 mg/kg BD
Take with food
Indications Cephalexin
- Staphylococcal & streptococcal infections
- UTIs (gram -ve)
- Epididymo-orchitis
Dose Cephalexin
- 250-500 mg q6h MAX 4 g
- Child: 6.25-12.5 mg/kg q6h
MOA
Precautions
Monitoring
- Interfere with bacterial cell wall synthesis, binds to penicillin binding proteins, Bactericidal
- Allergy (cross reactivity)
- Renal impairment (high IV dose &/or prolonged tx - electrolyte disturbance, neurotoxicity, risk of neutropenia)
- Common A/E:
- diarrhoea
- nausea
- superinfection (including candidiasis)
- allergy
- Monitor during prolonged (>10 days) &/or high dose treatment
- Renal and hepatic function
- Complete blood count
Amoxycillin - A, Moderate
Amoxycillin + Clavulanic acid - B1, Broad
Indications
Dose
Counselling
Amoxycillin
Indications
- Exacerbation of chronic bronchitis, community acquired pneumonia
- Acute bacterial otitis media, sinusitis
- Gonococcal infection
- Epididymo-orchitis, prostatis, acute pyelonephritis, UTI
- Non surgical prophylaxis of endocarditis
- Acute cholecystitis, peritonitis
- Eradication of H pylori
Dose
- 250-500 mg q8h
- Child: 15-25 mg/kg q8h
Amoxycillin + Clavulanic acid
Indications
- Hospital acquired pneumonia
- Epididymo-orchitis (urinary tract source)
- PID (not sexually acquired)
- UTI
- Bites and clenched fist injuries
- Otitis media, acute bacterial sinusitis
- Acute cholecystitis
- Melioidosis
Dose
- 500-875 mg q12h
- q8h in acute bacterial sinusitis
Counselling
- Absorbed best if taken with food
Dicloxacillin (Distaph) - B2, Narrow
Flucloxacillin (Flopen, Staphylex) - B1, Narrow
Indications
Dose
Counselling
Indications
- Staphylococcal skin infections: folliculitis, boils, carbuncles, bullous impetigo, mastitis, crush injuries, stab wounds, infected scabies
- Pneumonia
- Osteomyelitis, septic arthritis
- Flucloxacillin: Septicaemia, Empirical tx for endocarditis, surgical prophylaxis
Dose
- 250-500 mg q6h
- MAX 4 g daily
- Child: 12.5-25 mg/kd q6h
Counselling
- Absorbed best if taken on an empty stomach
Phenoxymethylpenicillin (Abbocillin, Cilicaine VK) - A, Narrow
Indications
Dose
Counselling
Indication
- Streptococcus pyogenes tonsilitis, pharyngitis, skin infections
- Prevention of rheumatic fever
- Moderate-severe gingivitis
Dose
- 250-500 mg q6h
- MAX 3 g daily
- Child: 10-12.5 mg/kd q6h
Counselling (3a or 3b)
- Absorbed best if taken on an empty stomach
Vancomycin - B2
Teicoplanin - B3
MOA
Precautions
Monitoring
- Inhibit bacterial cell wall synthesis, bactericidal
- Thrombocytopenia
- Ototoxicity, Nephrotoxicity
- Red man syndrome
- Monitor
- Renal function
- Complete blood count
- Concentration monitoring - Vancomycin
- Hearing (during long courses)
Oral: Clindamycin (Cat A)
IV: Lincomycin
MOA
Monitoring
Counselling
- Indications
- Alternative in pts with severe allergy to penicillin & cephalosporins (endocarditis prophylaxis, aspiration pneumonia, dental, skin, soft tissue & bone infections)
- Toxoplasma encephalitis/abscess
- Anaerobic infections
- Malaria
- Tx of PCP
- Bacterial vaginosis
- Acne
- Dose: 150-450 q6h-q8h
- Bacterial vaginosis: 300 mg BD for 7 days
- Monitor during prolonged tx
- Complete blood count, hepatic & renal function
- Counselling
- Full glass of water
- Diarrhoea, no antidiarrhoeals
- Common A/E: diarrhoea, n&v, abdo pain, rash, itch
IV, Oral: Azithromycin (B1)
Oral: Clarithromycin (B3), Erythromycin (A), Roxithromycin (B1)
MOA
Precautions
Label 5, prolonged QT interval: Clarithromycin, Erythromycin
Monitoring
Counselling
- Inhibit protein synthesis, immunomodulatory & anti-inflammatory effects, bacteriostatic
Azithromycin
Indications & Dose
Usual range: 500 mg daily for 2 days OR 500 mg daily on Day 1, then 250 mg daily for 4 days
- Treatment of choice for chlamydial infections
- 1 g as a single dose
- Streptococcal pharyngitis / tonsilitis
- Community acquired pneumonia
- Traveller’s diarrhoea
- 1 g as a single dose OR 500 mg daily for 3 days
- Prevention and tx of pertussis
- Prevention and tx of MAC infections
Clarithromycin
Indications & Dose
Usual range: 250 mg BD (reduce dose renal impair)
Indications:
- Lower resp tract infections
- Eradication of h. pylori
- 500 mg BD for 7 days
- Prevention & tx of MAC, pertussis
Erythromycin (ethyl succinate: w/o regards to meals, base: 1 hr before 2 hrs after) - A
Roxithromycin (at least 15 mins before meals) - B1
Indications
Dose
Erythromycin
Indications & Doses: (decrease dose in renal impair)
Usual range: 250-500 mg q6h-q8h, MAX 4 g daily
- Upper & lower resp tract infec
- Rheumatic fever prophylaxis
- Legionnaires disease
- Campylobacter enteritis
- Coral cuts
- Chlamydial infections
- Prevention & tx of pertussis
- Acne
- Rosacea (severe or failure of top tx)
- 250 -500 mg BD
Roxithromycin
Indications & Doses: (decrease dose in severe hepatic impair)
Usual range: 150 mg BD or 300 mg daily
- Upper & lower resp tract infections
- Community acquired pneumonia
- Skin infections
Metronidazole - B2
Tinidazole - B3
MOA
Precautions
Monitoring
- Metabolized to active metabolites thought to interfere with DNA synthesis
- Bactericidal against anaerobes & protozoa
- Neurotoxic - CNS disorders including seizures
- Leucopenia - Blood dyscrasias
- Infrequent A/E
- furry tongue
- glossitis, stomatitis
- tingling hands, feet
- Rare A/E:
- hypersensitivity reactions
- leucopenia
- peripheral neuropathy
- seizures
- dark urine
Metronidazole - B2
Tinidazole - B3
Indications
Dose
Metronidazole
Indications & Dose:
- Gram +ve and gram -ve anaerobic bacterial infections e.g. B. Fragilis
- Protozoal infections
- Giardiasis - 2 g once daily for 3 days
- Trichomoniasis - 2 g single dose (tx sexual partner)
- Bacterial vaginosis - 400 mg BD for 7 days
- Clostridium difficle assoc disease - 400 mg q8h for 10 days
- Dental infections
- Intra-abdominal infections
- Aspiration pneumonia
- Lung abscess
- PID
- Amoebiasis
- Surgical prophylaxis
- Eradication of H pylori
- w Clarithromycin 400 mg BD for 7 days
- w Amoxycillin 400 mg TDS for 14 days
- Rosacea
- Fungating wounds
NO Alcohol for 24 hrs after finishing course
Tinidazole
Indications & Dose:
- Protozoal infections
- Giardiasis - 2 g as a signle dose
- Trichomoniasis - 2 g as a single dose (tx sexual partner)
- Bacterial vaginosis - 1 g once daily for 5 days OR 2 g once daily for 2 days
- Prophylaxis in GI and gynaecological surgery
NO Alcohol for 72 hrs after finishing course
Ciprofloxacin (tabs, inj, eye & ear drops)
Moxifloxacin (tab, inj)
Norfloxacin (tab)
Ofloxacin (eye drops)
Cat B3
MOA
Precautions
Monitoring
- Inhibit bacterial DNA synthesis, blocking DNA gyrase & topoisomerase IV, Bactericidal
- H. influenzae, enteric and other gram -ve bacteria e.g. P aeruginosa
- Neurological - indicue seizures, worsen muscle weakness
- Achilles tendon rupture
- Use in children & adolescents only in severe infections
Ciprofloxacin
Norfloxacin (poor systemic BA)
Indications
Dose
Counselling
Ciprofloxacin
Indications:
- Severe Salmonella enteritis
- Typhoid, parathyphoid
- Shigellosis
- Complicated UTI
- Bone or joint infections
- Epididymo-orchitis, Prostatis
- Prevention of meningococcal disease
- P. aeruginosa infections e.g. cystic fibrosis
- Febrile neutropenia
- Keratitis or severe conjunctivitis
- Chronic suppurative otitis media
Dose:
- 250-500 mg BD. MAX 1.5 g daily
Norfloxacin
Indications & Dose:
- Uncomplicated UTI - 400 mg BD for 3 days
- Shigellosis
- Traveller’s diarrhoea - 800 mg as a single dose OR 400 mg BD for 3 days
- Campylobacter enteritis
- Prostatis - 400 mg BD for 28 days
- Prophylaxis in cirrhotic pt with GI haemorrhage
Counselling:
- Label 3b (1 hr before), 4, 8, 12
- Increase effects of caffeine
- Drink plenty of fluids
- Tendon soreness & inflammation OR numbness & tingling in fingers or toes, stop & see dr
Rifabutin - C
Rifampicin - C
Rifaximin - B1
MOA
Precautions
Monitoring
Counselling
- Inhibit bacterial RNA polymerase, bactericidal against Mycobacteria
- Indications for Rifampicin
- TB with other drugs
- Leprosy
- Other mycobacterial infections
- MRSA infection with other agents
- Selected serious or prosthesis assoc infection with other agents
- Prevention of infection in close contacts of ppl with meningococcal or H influenzae type b idisease
- Hepatic
- Liver funcition test, serum creatinine, full blood count
- Your urine, faeces, sweat & tears may become orange-red & soft contact lenses may be permanently stained
- Tell your dr if you ahve any loss of appetitie, n & v, unusual tiredness, jaundice, dark urine or pale faeces
- This medicine interacts with many drugs, tell your dr & pharmacist that you are taking this med
Demeclocycline
Doxycyline
Minocyline
Tetracycline
MOA
Precautions
Safe first 19 weeks of pregnancy –> after this C/I (Category D)
Counselling
- Inhibit bacterial protein synthesis, bacteriostatic
- C/I in chlildren under 8 y/o - discolour teeth, enamel dysplasis, dental caries, deformities and inhibit bone growth
- Minocycline: Vestibular & CNS A/E - Benign intracranial hypertension; pigmentation
- Take w food or milk to reduce stomach upset
- Take w a glass of water & remain upright for 1 hr after taking med. This is to stop tabs or caps sticking on the way to your stomach & causing painful damage to the lining of your throat
- Label 4, 8
Doxycycline
Minocycline
Indications
Dose
Doxycycline
Indications & Dose:
- Acne - 50 mg daily for at least 6 weeks
- Rosacea - 50 mg daily
- Infections caused by M Pneumonia
- Community acquired penumonia
- Exacerbation of chronic bronchitis
- Acute bacterial sinusitis
- Chlamydial & other non gonococcal genital tract infections - 100 mg BD
- PID
- Sexually acquired epididymo-orchitis
- Chronic prostatitis
- Rickettsial infections
- Melioidosis
- Prophylaxis of malaria - 100 mg daily start taking 2 days before entering, & continue for 4 weeks after leaving
- Treatment of P falciparum malaria
- Q fever
Minocycline
Indications & Dose:
- Acne - 100 mg daily in 1 or 2 doses
- Infections due to susceptible bacteria
- Leprosy
MOA
Indication
Dose
Monitoring
Counseling
- Inhibit bacterial protein, DNA, RNA & cell wall synthesis
- Indications & Dose:
- Acute lower UTIs - 50-100 mg QID (3 days women, 14 days men)
- Prophylaxis or long term suppressive tx in recurrent UTIs - 50-100 mg at bedtime
- Cat A short term use –> risk of haemolytic anaemia in infants near term
- Monitoring during long term tx
- Pulmonary function - pulmonary toxicity
- Liver function - hepatotoxicity
- Renal function - peripheral neuropathy
- Take with food or milk
- Drowsiness & dizziness
- Tell dr if difficulty breathing, cough or numbness or tingling
- Make your urine brownish, soft contact lens may be stained
MOA
Indication
Dose
Monitoring
Counseling
- Competitively inhibits bacterial folate production essential for bacterial growth
- Trimethoprim: dihydrofolate reductase inhibitor
- Sulfamethoxazole: dihyropteorate synthetase inhibitor
- Bacteriostatic
- Indication
- Empirical tx for uncomplicated lower UTIs - 300 mg at night for 3 or 14 days
- Epididymo-orchitis - 300 mg daily for 2 weeks
- Prostatis - 300 mg at night for 4 weeks
- Mild - moderate PCP
- Indication + SMX
- Tx and primary&secondary prevention of PCP
- Infections casued by L monocytogenes, Nocardia spp, Stenotrophomonas maltophilia
- Melioidosis
- Shigellosis
- Primary prevention of cerebral toxoplasmosis in HIV pts
- Prevention & tx of pertussis
- Dose (trimethoprim: SMX = 1:5)
- 80/400 - 160/800 mg BD
- Monitoring
- complete blood count, folate status
- U&Es - potasium conc (hyperkalaemia!)
- renal function
- urinanalysis
- Counselling
- Take with food
- Drink a lot of lfuid
- Label 8
- Tell your dr straightaway if you get a sore throat, fever, rash, cough, difficulty breathing, joint pain, dark urine or pale stools
