Antibiotics: Cephalosporins

Question 1

1st generation cephalosporin (cefazolin, cephalexin) coverage:

Answer 1

Most streptococci, MSSA, most oral anaerobes, some sensitive GNRs (like E. coli).
Little use against MRSA, ENTEROCOCCUS, nosocomial GNRs, bowel anaerobes.

Question 2

1st generation cephalosporin indications:

Answer 2

Soft tissue infections (staph and strep), UTIs, patients with MILD penicillin allergies.

Question 3

2nd generation cephalosporin (cefuroxime, cefotetan) coverage:

Answer 3

Similar coverage as 1st generations, but slightly less activity against GPCs and more activity against GNRs (Klebsiella, B. fragilis)

Question 4

3rd generation cephalosporin (ceftriaxone, ceftazidime) coverage:

Answer 4

Streptococci, MSSA, pneumococcus, most oral anaerobes, Neisseria, MOST GNRs, Lyme disease. CEFTAZIDIME COVERS PSEUDOMONAS.
Little use against MRSA, enterococcus, nosocomial GNRs, bowel anaerobes.

Question 5

3rd generation cephalosporin indications:

Answer 5

Meningitis, serious pneumonia, GONORRHEA, otitis, sinusitis.

Question 6

5th generation cephalosporin (ceftaroline) coverage:

Answer 6

Many GNRs (E. coli, Klebsiella, H. flu), many GPCs (including MRSA and MSSA).

Question 7

Cephalosporin adverse effects:

Answer 7

Can produce similar allergic reactions as penicillins. DO NOT GIVE TO PEOPLE WITH SERIOUS PENICILLIN ALLERGIES.

Question 8

Meropenem coverage:

Answer 8

Most GPCs, most GNRs (except Pseudomonas), and all anaerobes. MRSA is resistant.

Question 9

Meropenem indications:

Answer 9

Mixed nosocomial infections with resistant GNRs, complicated meningitis, peritonitis, serious pneumonia, sepsis. GOOD CSF PENETRATION.

Question 10

Monobactams (aztreonam) coverage:

Answer 10

ONLY AEROBIC GNRs. Tolerated by virtually all patients who are allergic to penicillin.

Question 11

Vancomycin coverage:

Answer 11

All GPCs (MSSA, MRSA) and C. diff. All GNRs are resistant.

Question 12

Vancomycin side effects:

Answer 12

May cause RED MAN SYNDROME with rapid infusion. Also, neutropenia and nephrotoxicity.

Question 13

Vancomycin indications:

Answer 13

Empiric treatment for serious infections likely caused by GPCs, treatment for serious infections caused by GPCs that are resistant to other drugs. ORAL TREATMENT for C. diff.

Question 14

Vancomycin is synergistic with ___ against ___:

Answer 14

Gentamicin, enterococcus or staphylococci.

Question 15

Daptomycin coverage:

Answer 15

Most GPCs. All GNRs are resistant.

Question 16

Daptomycin side effects:

Answer 16

Cardiac failure, pseudomembranous colitis, hypoglycemia. Use cautiously with STATINS (may increase risk of myopathy). May alter response to warfarin.

Question 17

Daptomycin indications:

Answer 17

Treatment of serious infections caused by resistant GPCs (bacteremia, endocarditis, skin and soft tissue infections).