Antibiotics

Question 0

Fluoroquinolones

Answer 0

broad gram - spectrum but quickly develop resistance
Uses: complicated UTI, Pseudomonas, Anthrax, resistant gram - ‘s
SE: inhibit cardiac K channels (increase risk arrhythmia if long QT)
hypo/hyperglycemia if given w/insulin or DM meds
more CNS SE if used w/NSAID’s
Interactions:
decreased absorption d/t Al, Mg, Ca, antacids, coumadin
increase levels of caffeine, coumadin

Question 1

Ketoconazole

Answer 1

Class: imidazole
MOA: prevent synthesis of cell membrane sterols > leakage
Indications: candidiasis, coccidiomycosis, histoplasmosis, blastomycosis, paracoccidiomycosis
*not cryptococcosis, aspergillosis, mucormycosis
SE: anorexia/N/V, rash, HA
*rare but fulminant hepatitis: other agents preferred

Question 2

Sulfonamides/Trimethoprim

Answer 2

Uses: MRSA, IBD, burns, umbilical cord care, vaginitis, Chlamydia urethritis, conjunctivitis, toxoplasmosis, Stenotrophomonas, Burkholderia, Brucella
First-Line: UTI, PCP (P jiroveci), gastro (Shigella, Salmonella, Isospora)
Alternative: AOM, sinusitis

Question 3

Amphotericin B

Answer 3

Multiple fungal infections: Candida, Aspergillus, Zygomycetes, Histoplasma, Coccoides

SE: fever, hypokalemia, nephrotoxicity

Liposomal form: less nephrotoxic but more expensive so only used when renal dz

Question 4

Metronidazole

Answer 4

Bactericidal: most anaerobes, many microaerophilic, some parasites
C diff, Trich, Treponema, Gardnerella, H pylori, Campylobacter
Bacterial overgrowth syndrome
complication of gastric bypass
ileostomy dysfunction
Prevent cholestasis if long-term TPN

Question 5

Clindamycin

Answer 5

20% develop diarrhea
C diff usu 4-7d after starting, can be10 weeks later
10% maculopapular rash
Rare SE: SJS, TCP, leukopenia

Question 6

Acyclovir

Answer 6

HSV, VZV
Always IV if neonatal
SE: 
    GI (N/V/D)
    Neuro (HA, malaise)
    Nephro (precipitation >> AKI)- avoid w/hydration and slow infusion 
    Heme (TTP, HUS)