antibiotics Flashcards
Gentamicin*
Aminoglycoside (IV) gram neg. + pseudomonas traditional dosing= 1-3mg/kg/dose (IBW unless obese) --> CrCl>60mL/min= q8h extended interval= 4-7mg/kg AE: neurotoxicity, ototoxicity monitor trough/peak peak 5-10, trough <2 synergy for endocarditis (gram positive)
Tobramycin*
Aminoglycoside (IV) gram neg. + pseudomonas traditional dosing= 1-3mg/kg/dose (IBW unless obese) --> CrCl>60mL/min= q8h extended interval= 4-7mg/kg AE: neurotoxicity, ototoxicity monitor trough/peak peak 5-10, trough <2
Amikacin*
Aminoglycoside (IV) gram neg + pseudomonas traditional dosing= 5-7mg/kg/dose --> CrCl>60mL/min= q8h extended interval= 15-20mg/kg AE: neurotoxicity, ototoxicity peak 20-30, trough <5
Amoxicillin (+/- cavulanate)
Amoxil, Augmentin (PCN)
gram + (strep, enterococci)
Clavulanate= gram - (PEK), h.flu, MSSA, anaerobe
dosing= 8-12 hrs (PO)
AE: rash, acute interstitial nephritis, increased LFTs
reduce dose/extend interval in renal impairment
refrigerate augmentin susp
Ampicillin (+/- sulbactam)
Unasyn (PCN)
gram + (strep, enterococci)
sulbactam= gram neg. (PEK), H.flu, NSSA, anaerobe
dosing= q6h (ampicillin= PO/IV, sulbactam (IV)
AE: rash, acute interstitial nephritis, increased LFTs
reduce dose/extend interval in renal impairment
compatible with NS only
Penicillin
Pen VK, Bicillin L-A (PCN)
gram + (strep)
VK= q6-8hrs (PO), G= q4-6h (IM/IV)
AE: rash, acute interstitial nephritis, increased LFTs
reduce dose/extend interval in renal impairment
VK on empty stomach (refrigerate susp)
Nafcillin*
PCN gram + (strep, MSSA) dosing= 1-2g q4-6h (IV) AE: rash, acute interstitial nephritis, increased LFTs NO dose adjustment in renal impairment VESICANT
Cefazolin
Kefzol (1st gen. cephalosporin)
staph + PEK
IV/IM (250-2,000mg q8h)
AE: rash, acute interstitial nephritis, increased LFT, seizure with accumulation
cross reactivity with PCN allergy
decrease dose/extend interval in renal impairment
Cephalexin
Keflex (1st gen. cephalosporin)
staph + PEK
PO (250-1,000mg q6h)
AE: rash, acute interstitial nephritis, increased LFT, seizure with accumulation
cross reactivity with PCN allergy
decrease dose/extend interval in renal impairment
Cefuroxime
Ceftin, Zinacef (2nd gen. cephalosporin)
staph + HNPEK
PO/IV/IM (250-1,500mg q8-12h)
AE: rash, acute interstitial nephritis, increased LFT, seizure with accumulation
cross reactivity with PCN allergy
decrease dose/extend interval in renal impairment
Cefotetan*
2nd gen. cephalosporin
staph +HNPEK + ANAEROBES (b. fragilis)
IV/IM (1-2g q12h)
AE: rash, acute interstitial nephritis, increased LFT, seizure with accumulation
cross reactivity with PCN allergy
decrease dose/extend interval in renal impairment
–> increased risk of hypothrombinemia (bleeding) and disulfiram with alcohol (NMTT side chain)
Cefoxitin*
2nd gen. cephalosporin
staph +HNPEK + ANAEROBES (b. fragilis)
IV/IM (1-2g q6-8h)
AE: rash, acute interstitial nephritis, increased LFT, seizure with accumulation
cross reactivity with PCN allergy
decrease dose/extend interval in renal impairment
Cefdinir*
3rd gen. cephalosporin
staph/strep + HNPEKS
PO (300mg q12h/600mg QD)
AE: rash, acute interstitial nephritis, increased LFT, seizure with accumulation
cross reactivity with PCN allergy
decrease dose/extend interval in renal impairment
Ceftazidime
Fortaz, Tazicef (3rd gen. cephalosporin)
staph/strep + HNPEKS + PSEUDOMONAS
IV/IM (1-2g q8-12h)
AE: rash, acute interstitial nephritis, increased LFT, seizure with accumulation
cross reactivity with PCN allergy
decrease dose/extend interval in renal impairment
Ceftriaxone
Rocephin (3rd gen. cephalosporin)
staph/strep + HNPEKS
IV/IM (1-2g q12-24h)
AE: rash, acute interstitial nephritis, increased LFT, seizure with accumulation
cross reactivity with PCN allergy
NO DOSE ADJUSTMENT IN RENAL IMPAIRMENT
–> biliary sludging (avoid co-administration with Ca soln)
Cefipime
Maxipime (4th gen. cephalosporin) staph/strep + HNPEKS + CAPES IV/IM (1-2g q8-12h) AE: rash, acute interstitial nephritis, increased LFT, seizure with accumulation cross reactivity with PCN allergy dose adjustment in renal impairment
Ceftaroline
Teflaro (5th gen. cephalosporin) Gram + (MRSA) IV (600mg q12h) AE: rash, acute interstitial nephritis, increased LFT, seizure with accumulation cross reactivity with PCN allergy dose adjustment in renal impairment
Imipenem/Cilastatin
Primaxin (carbapenem)
Gram +, gram - (pseudomonas), anaerobic
IV (250-1,000mg q6-8h)
AE: CNS, SEIZURE, increased LFTs
reduce dose/extend interval in renal impairment
PCN cross-reactivity
–> decreases concentrations of valproic acid
Meropenem
Merrem (carbapenem)
Gram +, gram - (pseudomonas), anaerobic
IV (500-2,000mg q8h)
AE: CNS, seizure, increased LFTs
reduce dose/extend interval in renal impairment
PCN cross-reactivity
–> decreases concentrations of valproic acid
Ertapenem
Invanz (carbapenem) Gram +, Gram -, anaerobes NO PSEUDOMONAS IV/IM (1,000mg QD) AE: CNS, seizure, increased LFTs reduce dose/extend interval in renal impairment PCN cross-reactivity --> decreases concentrations of valproic acid
Doripenem
Doribax (carbapenem)
Gram +, gram - (pseudomonas), anaerobic
IV (500mg q8h)
AE: CNS, seizure, increased LFTs
reduce dose/extend interval in renal impairment
PCN cross-reactivity
–> decreases concentrations of valproic acid
Ofloxacin
Floxin-otic (fluoroquinolone) gram -, gram + PO (200-400mg q12h) AE: tendon rupture, neuropathy, QT prolongation, seizure/CNS, hypoglycemia, photosensitivity extend interval in renal impairment avoid in children/pregnancy separate from antacids
Ciprofloxacin
Cipro (FQ)
gram -, gram+, PSEUDOMONAS
PO/IV (250-750mg PO/200-400mg IV 8-12h)
AE: tendon rupture, neuropathy, QT prolongation, seizure/CNS, hypoglycemia, photosensitivity
extend interval in renal impairment
avoid in children/pregnancy
separate from antacids
–> oral susp= no NG/feeding tube, no refrigeration
–> can give IR tabs via feeding tube (separate from meal)
–> P-gp substrate, strong 1A2 inhibitor
Levofloxacin
Levaquin (FQ) gram -, gram+, PSEUDOMONAS, ATYPICAL respiratory FQ PO/IV (250-750mg QD) AE: tendon rupture, neuropathy, QT prolongation, seizure/CNS, hypoglycemia, photosensitivity extend interval in renal impairment avoid in children/pregnancy separate from antacids --> soln= empty stomach, room temperature --> renal clearance
Moxifloxacin
Avelox, Vigamox- opth (FQ) gram -, gram+, ATYPICAL, ANAEROBE IV/PO (400mg QD) AE: tendon rupture, neuropathy, QT prolongation, seizure/CNS, hypoglycemia, photosensitivity NO RENAL DOSE ADJUSTMENT avoid in children/pregnancy separate from antacids
Azithromycin
Zithromax (macrolide)
gram + (strep), gram - (HNM), atypical (legionella, chlamydia, mycoplasma, mycobacterium)
upper/lower resp. tract, sexually transmitted infection
PO/IV (PO ZPak, IV 250-500mg QD)
AE: QT prolongation, hepatotoxicity, increased LFTs
no dose adjustment in renal impairment
susp= no refrigeration
minimal drug interactions
Clarithromycin
Biaxin (macrolide)
gram + (strep), gram - (HNM), atypical (legionella, chlamydia, mycoplasma, mycobacterium)
upper/lower resp. tract, sexually transmitted infection
PO (250-500mg PO q12h or 1g PO QD)
AE: QT prolongation, hepatotoxicity, increased LFTs
decrease dose in renal impairment (50% if CrCl <30)
take with food
susp= no refrigeration
3A4 substrate and INHIBITOR
Erythromycin
E.E.S, Ery-tab, Erythrocin (macrolide)
gram + (strep), gram - (HNM), atypical (legionella, chlamydia, mycoplasma, mycobacterium)
upper/lower resp. tract, sexually transmitted infection
PO/IV (q6-12h)
AE: QT prolongation, hepatotoxicity, increased LFTs
no renal dose adjustment
refrigerate EES susp
erythromycin powder stable @ RT
3A4 substrate and INHIBITOR
Doxycycline
Vibramycin, Oracea, Doryx, Monodox, Atridox, Adoxa (Tetracycline)
gram + (broad), Gram - (resp.), spirochetes, rickettsial, anthrax, syphillis, acne, chlamydia, malaria
USE: MRSA (mild skin infection), VRE (UTI)
PO/IV (100mg q12h)
–> Oracea= empty stomach
AE: photosensitivity, nephrotoxicity, DRESS rash, bone marrow suppression
NO dose adjustment in renal impairment
separate from antacids
avoid in children <8 and pregnancy
avoid with retinoic acids (pseudotumor cerebri)
IV:PO= 1:1
susp= no refrigeration
enhance neuromuscular blockin agent, warfarin
decrease effectiveness of PCN
Minocycline
Minocin, Dynacin, Solodyn (tetracycline)
gram + (broad), Gram - (resp.), spirochetes, rickettsial, anthrax, syphillis, acne, chlamydia, malaria
USE: skin infection, acne
PO/IV (50-100mg q12-24h)
AE: photosensitivity, nephrotoxicity, DRESS rash, bone marrow suppression
NO dose adjustment in renal impairment
separate from antacids
avoid in children <8 and pregnancy
avoid with retinoic acids (pseudotumor cerebri)
enhance neuromuscular blockin agent, warfarin
decrease effectiveness of PCN
Tetracycline
Tetracycline
gram + (broad), Gram - (resp.), spirochetes, rickettsial, anthrax, syphillis, acne, chlamydia, malaria
–> rarely used (in H.pylori Tx)
PO (250-500mg q6h)
take on empty stomach
AE: photosensitivity, nephrotoxicity, DRESS rash, bone marrow suppression
–> extend interval in renal impairment
separate from antacids
avoid in children <8 and pregnancy
avoid with retinoic acids (pseudotumor cerebri)
3A4 substrate and inhibitor
enhance neuromuscular blockin agent, warfarin
decrease effectiveness of PCN
Sufamethoxazole/Trimethoprim
Bactrim, septra (Sulfonamides) gram + (MRSA), gram - (H-PEK, enterobacter, shigella, salmonella), opportunistic pathogens (nocardia, pnsumocystis, toxoplasmosis) PO/IV --> UTI= 1 DS tab BID x3 days --> PCP prophylaxis= 1 DS or SS tab QD CI in sulfa allergy AE: skin reactions (SJS, TEN), crystalluria, photosensitivity, hyperkalemia, hypoglycemia, increased LFTs, CNS, QT prolongation Avoid in pregnancy @ term (kernicterus, spinal cord defects) use caution in G6PD deficiency IV= store @ RT, dilute with D5W only susp= RT reduce dose in renal impairment IV:PO= 1:1 2C8/9 inhibitor (warfarin)
Vancomycin
Vancocin gram + (MRSA), c.diff MRSA= 15-20mg/kg q8-12h IV C.diff= 125-500mg QID x10-14 days PO AE: red man syndrome, nephrotoxicity, ototoxicity monitor trough (10-20 extend interval in renal impairment
Linezolid
Zyvox (oxazolidinone) gram + (MRSA, VRE faecium/faecalis) USE: pneumonia, SSTI, VRE PO/IV (600mg q12h) AE: HA, diarrhea, taste alteration, increased LFT/pancreatic enzymes, neuropathy weak MAOI (avoid tyramine-containing foods) IV:PO= 1:1 no adjustment in renal impairment susp= room temp
Quinupristin/Dalfopristin
Synercid (streptogramin) gram + (MRSA, VRE faecium) USE: complicated SSTI IV (7.5mg/kg q8-12h) AE: arthralgias/myaglias, infusion reaction, hyperbilirubinemia, CPK elevation no adjustment in renal impairment D5W only, refrigerate after reconstitution weak 3A4 inhibitor
Daptomycin
Cubicin (cyclic lipopeptide)
gram + (MRSA, VRE faecium/faecalis)
USE: complicated SSTI, staph bloodstream (endocarditis)
IV (4-6g/kg QD)
AE: myopathy, eosinophilic pneumonia, GI upset, increased CPK/myopathy, increased LFT
extend interval in renal impairment (q48h)
cannot use for pneumonia
only mix with NS
false elevation in PT/INR
Telavancin
Vibativ (lipoglycopeptide) derivative of Vanco gram + (MRSA) USE: complicated SSTI, HA-pneumonia IV (10mg/kg QD) AE: nephrotoxicity, QT prolongation, red man syndrome, metallic taste, N/V, increased SCr fetal risk (Category C) reduce dose/extend interval in renal impairment MedGuide admin.
Aztreonam
Azactam (monobactam) Gram - (pseudomonas) IV (500-2,000mg q6-12h) AE: increased LFTs, N/V/D, rash reduce dose in renal impairment safe in PCN allergy
Colistimethate
Colistin (polymixin Abx)
gram - (pseudomonas)
USE: MDR gram-neg pathogen
IV (2.5-5mg/kg/day divided in 2-4 doses)
AE: nephrotoxicity, neurologic disturbances
reduce dose/extend interval in renal impairment
Tigecycline
Tygacil (Minocycline derivative)
gram + (MRSA, VRE), gram -, anaerobe, atypical
use LAST LINE (complicated SSTI/intraabdominal, CAP)
IV (100mg x1 then 500mg q12h)
BBW= increased risk of death
AE: hepatotoxicity, photosensitivity, increased LFTs
avoid in children <8 and pregnancy
no adjustment in renal impairment
decrease dose in severe hepatic impairment
avoid in bloodstream infection
Clincamycin
Cleocin gram +, anaerobes PO/IV AE: SJS, increased LFTs, C.DIFF no adjustment in renal impairment
Metronidazole
Flagyl anaerobes, protozoal PO/IV --> c.diff= 500mg TID x10-14 days AE: GI upset, metallic taste, furry tongue, darkened urine, CNS no adjustment in renal impairment ER tabs= empty stomach IV:PO= 1:1 avoid in 1st trimester avoid alcohol (disulfiram) 3A4 and 2C9 inhibitor
Rifaximin*
Xifaxan
structurally related to rifampin
USE: traveler’s diarrhea, hepatic encephalopathy prevention
PO (200-550mg BID-TID)
AE: flatulence, GI, rash, peripheral edema
not for systemic infection
no adjustment in renal impairment
Nitrofurantoin
Macrodantin, Macrobid, Furadantin USE: uncomplicated UTI macrodantin= QID PO (QD prophylaxis) macrobid= BID PO AE: pulmonary toxicity (long-term), hepatotoxicity/neuropathy (rare), N/HA, darkened urine Category B (CI @ term) CI when CrCl<60
Fidaxomicin
Dificid USE: c.diff AE: N/V, abdominal pain, GI bleed not for systemic infection no adjustment in renal impairment
Rifampin
Rifadin, Rifamate (isoniazid), Rifater (INH/pyrazinamide)
USE: TB
PO (empty stomach)
AE: increased LFT, GI upset, rash, orange-red discoloration of fluids, flu-like syndrome
CYP INDUCER
Isoniazid
Rifamate (isoniazid), Rifater (rifampin/pyrazinamide) USE: TB PO (empty stomach) AE: HA, GI upset, increased LFT, peripheral neuropathy, lupus-like syndrome, hyperglycemia, hepatitis, agran/thrombocytopenia/anemia pyridoxime (Vit B6)= reduce neuropathy avoid in liver disease CYP inhibitor avoid tyramine-containing foods increase folic acid, niacin, and Mg
Pyrazinamide
Rifater (rifampin/INH)
USE: TB
PO (empty stomach)
AE: GI upset, malaise, hepatotoxicity, arthralgias, hyperuricemia/gout
extend interval if CrCl <30
fatal hepatotoxicity with rifampin (monitor)
Ethambutol
Myambutol
USE: TB
PO (2-3x/week)
AE: optic neuritis
Streptomycin*
USE: TB
PO (2-3x/week)
AE: neurotoxicity, nephrotoxicity, neuromuscular blockage/respiratory paralysis
extend interval for CrCl <50
Bedaquiline
Sirturo USE: MDR-TB PO (QD--> 3x/week) AE: QT prolongation, increased risk of death, chest pain, increased LFTs Take with food
Amphotericin B
Lipid formulations= Abelcet, AmBisome (antifungal)
broad spectrum= yeast, mold, dimorphic fungi
AE: fever, chills, malaise, rigors, hypokalemia, hypomagnesemia, nephrotoxicity, anemia, hypotension/hypertension
Ambisome= back/chest pain with 1st dose
D5W only
lipid formulations= decreased nephrotoxicity
infusion related reaction (premedicate= APAP/NSAID, Benadryl, Merperidine, Fluid bolus)
Ketoconazole
Nizoral, Ketodan, Extina, Xologel (azole antifungal)
USE: androgen-related disorders
AE: hepatotoxicity, increased LFTs, QT prolongation, hypertriglyceridemia, hypokalemia
hepatic clearance
CYP 3A4 inhibitor
pH dependent absorption
Fluconazole
Diflucan (azole antifungal)
yeast (candida albicans, cryptococcus), dimorphic fungi
IV/PO (100-800mg QD)
AE: increased LFTs, QT prolongation, hypertriglyceridemia, hypokalemia
CNS penetration (fungal meningitis)
IV:PO= 1:1
CYP 3A4 inhibitor (not hepatically cleared)
Voriconazole
VFEND (azole antifungal)
yeast, dimorphics, ASPERGILLOSIS (DOC), mold
IV/PO (q12h)
AE: QT prolongation, increased LFTs, visual changes, increased SCr, CNS, photosensitivity
avoid direct sunlight and driving at night
avoid IV formulation for CrCl <50
take on empty stomach
CYP3A4 inhibitor
CYP substrate (2C9, 2C19, 3A4)*** (michaelis-menten kinetics)
Posaconazole
Noxafil (azole antifungal)
yeast, dimorphics, aspergillosis, mold, MUCORMYCOSIS, ZYGOMYCOSIS
PO (6-12h)
must be taken with full meal
AE: QT prolongation, increased LFTs, hypokalemia
CYP 3A4 inhibitor
Caspofungin
Cancidas (echinocandin)
USE: systemic candida infection
IV (QD)
do not mix with dextrose
AE: increased LFTs, hypotension, fever, diarrhea, hypokalemia, hypomagnesemia, rash
no dose adjustment in renal impairment (few DI’s)
+ cyclosporine= hepatotoxicity (reduce dose)
Micafungin
Mycamine (echinocandin)
IV (candidemia 100mg QD, esophageal 150mg QD)
AE: increased LFTs, hypotension, fever, diarrhea, hypokalemia, hypomagnesemia, rash
no dose adjustment in renal impairment (few DI’s)
Terbinafine
Lamisil (antifungal)
PO (250m in 1-2 divided doses)/topical
AE: taste disturbances, systemic lupus exacerbation, HA, skin rash, increased LFTs
strong CYP 2D6 inhibitor (SSRIs)
Oseltamivir
Tamiflu (antiviral) PO (Tx 75mg BID x5d, prophylacis 75mg QD x10d) AE: CNS, vomiting start within 48 hrs of symptoms decrease frequency for CrCl <30
Acyclovir
Zovirax (antiviral)
USE: HSV, VZV
PO/IV (IBW in obese patients), topical
AE: thrombocytopenic purpura/hemolytic uremic syndrome, renal impairment, malaise, HA/N/V/D, increased LFTs/SCr/BUN, neutropenia
infuse over 1 hr (min) + hydration (prevent renal damage)
full glass of water (PO)
extend interval in renal impairment
Valacyclovir
Valtrex (antiviral) prodrug of acyclovir USE: HSV, VZV PO (500-1,000mg QD-TID) AE: thrombocytopenic purpura/hemolytic uremic syndrome, renal impairment, malaise, HA/N/V/D, increased LFTs/SCr/BUN, neutropenia full glass of water extend interval in renal impairment
Valganciclovir
Valcyte (antiviral)
prodrug of ganciclovir
USE: CMV (DOC), HSV, VZV
PO (450-900mg QD-BID)
TAKE WITH FOOD
AE: myelosupression, fever, N/V/D, anorexia, thrombocytopenia, neutropenia, leukopenia, anemia, increased SCr, seizure (rare)
extend interval and reduce dose in CrCl <60
Atovaquone/Proquanil
Malarone (antimalarial) PO (QD) initiation 1-2 days, D/C 7 days AE: increased LFTs take with food or milk avoid prophylaxis when CrCl <30
Mefloquine
Lariam (antimalarial) PO (qWeek) initiation 1-2 weeks, D/C 4 weeks DOC for resistance AE: seizure, neuropsychiatric effects, loss of balance/dizziness, GI upset, chills, tinnitus take with food and 8oz. water
Quinine
Qualaquin (antimalarial)
PO (q8h)
must be given with doxy, tetracycline, clindamycin
AE: QT prolongation, SJS/TEN, visual changes, hypoglycemia
avoid in G6PD deficiency
Chloroquine
Aralen (antimalarial)
PO (qWeek)
initiation 1-2 weeks, D/C 4 weeks
AE: retinopathy, QT prolongation, GI upset, visual disturbances, hair loss, myopathy/neuropathy, psoriasis exacerbation
Primaquine*
(antimalarial) PO (QD) initiation 1 day, D/C 7 days USE: p.vivax AE: agran, anemia avoid in G6PD deficiency (hemolytic anemia)
