antimicrobial therapy Flashcards
pathogens
sterile fluids are CNS, urine, and blood
classes of abx
cell wall active agents: -bela lactase ( PCN, cephalosporins), Aztreonam, Vancomycin, carbapenems
protein synthesis inhibitors:
macrocodes, clinda, tetracyclines, linezolie
interfere with DNA synthesis: fluroquinolones, rifamycin
PCN class
MOA: Beta lactam-binds to PCN -binding protein to inhibit cell wall synthesis
spectrum: gram positive gram negative
AE: hypersensitivity, GI, hematologic, lowers seizure threshold
DI: OCs
PCN G- IM, IV
PCN VK:PO- best on empty stomach
antistaph PCN-staph and and fair streptococcal activity
amino PCN: ampicillin amoxicillin
- spectrum: enterococci, listeria, H. pylori
Extended spectrum- zosyn, mezlocillin, azlocillin
- spectrum: anti-pseduomasal coverage
indications: serious infections
Inpatient tx
beta lactate inhibitors
- combined with PCN
sublactam, clavuulanic - activity for wide range of infections, respiratory tract, animal bits, skin infections
SE: diarrhea
cephalosporins
spectrum: broader are cephalosporin progresses
Gram + –> gram + and gram -
No Enterococcus spp or listeria
eliminated via renal
don’t adjust cefriaxone
MOA: inhibit cell wall synthesis
SE: allergic rnn, cross reactivity with PCN
first gen cephalosporins
Reflex, Ancef
skin infections, strep, prepop prophylaxis
second generate
ceclor, cefprozil, caftan
- increases risk for bleeding
- avoid ETOH
- more gram negative, less gram positive
indication: URI, UTI, skin infection
third generation
ceftriaxone
- excellent CNS penetration
- use for meningitis
- ceftaz has pseudomas activity
Drug of choice: gonorrhea
fourth/fifth generation
cefepime- gram postive and gram negative
Teflaro- IV
-gram pos, gram neg, MRSA , and resistant to S. pneumonie
Aztreonam
use for pt who has anaphylactic rx to PCN
cover gram negative including pseudomonas
renally cleared
carbapenems
broadest class of abx
excellent for gram negative and gram positive
No MRSA, MRE
NO pseudomonas-ertapenems
indications: lower respiratory infections, intra-abdominal infections, bacterial sepsis
UTI
skin/skin structures, endocarditis
meropenem- CNS -related infections
ertapenem- Invanz IM
renal elimination
precipitates seizure activity
cross sensitivity with PCN
fluroquinolones
cipro, levaquin
MOA: bind and inhibitor DNA synthesis
good tissue penetration
good gram positive
gram negative( cipro)
indications: URI, skin infections, anthrax, traveler’s diarrhea
AE: GI, CNS, cartilage toxicity ( no pets), tendon rupture, photosensitivity, QT prolongation( cipro least), rash, worsens MG
check drug interactions: warfarin, theophylline, drugs affecting blood glucose,
always separate calcium intake with abx
macrolides
erythromycin, clarithromycin, azithromycing
MOA: inhibits protein synthesis
- gram postive, some gram negative and atypical
indications: resp infections lyme, GI ulcers, MAC chlamydia, skin infections
AE: GI, ototoxicity, prolong QT, tate changes
DI: inhibit cytochrome P450
ketolides
ketek-telithromycin
MOA: protein synthesis inhibitor
spectrum: gram postive,gram negative,
AE: hepatic dysfunction( not used in pads), CI with MG
DI: inhibitor CYP 3A4
tetracyclines
cover H.pylori, spirochetes, community acquire MRSA
tetracycline, doxycycline ,minocycline
indications: acne, resp tract, lyme, ricettsia
AE: photosensitivity, deposition in teeth and bones ( dont use in peds and preggers)
DI: chelation with calcium supplements, OC, warfarin
glycycyclines
tygvacil
gram positive and gram negative but no pseudomonas
indications: second line agent for CAP or intra-abdominal infections
AE: n/v
ahminoglycosides
gentamicin, tobramycin
IV only
indications: generally gram negative and infections in hospital
AE: neprotoxicty, ototoxic, neuromuscular blockade
sulfonamides
Bacterium
DOC: UTI, PCP
CAP
AE: GI, hypersensitivity, bone marrow suppression, photosensitivity
DI: OC, warfarin, sulfonylureas
metronidazole ( flagyl and Tindzdazole
trichimonas
c.diff
AE: metallic tate, urine changes
DI: ETOH, warfarin
clindamycin
gram postive and anerobic
Community-acquired MRSA
PCN allergic pt
AE: GI, c.diff
fidaxomicin ( difcid)
recurrent C.diff
Rifampin
TB, meningicoccal
AD: organs-red body fluids, hepatotoxicity, GI, flu-like sxs
MRSA abx
vance, zyvox
vancomycin
IV- MRSA
oral - used for C.diff
AE: red man syndrome, thrombophlebitis, nephrotoxicity, toxicity
check trough -10- 20 mg/L , if not then they get resistant
zyvox -linezolid
oral/ IV
used for pneumonia
AE: myelosuppression until 2 weeks of tx,
inhibits MAO, SSRI
UTI managetment
macrobid- avoid if they have renal issues
bactrim
anti-vitals
acyclovir, famvir, valtrex
- goal is to tx first episodes
herpes zoster- varicella( speeds healing, dec. pain/ neuralgia)
severe infection: –> acyclovir
AI: GI headache
influenza tx
relenza and tamiflu- cover flu a and b
Amantadine and rimantadine- influenza A and prevention
AE: GI, CNS
CMV
gancilovir, fosacir, visited
manage counts
hep b management
interferon alpha
entecavir
goal: dec. hep b levels
and improve liver histories
Interferon ( SQ) 4mon-1 year flu-like scans bone marrow suppressions psych symptoms
hep c tx
peg interferon and ribavarin
SE: ribavarin- hemolytic anemia, tetragenic
neutropenia
anti fungals
azoles, polyenes ( ampotericin- covers everything)
lamisil- use for dermatophyte infections
AE: ampho- nephrotoxit
azoles- hepatic, QT prolongation
terbinafine- liver enzymes
drugs interactions are common
ketokonzaole/ itraconazole- check on h2 blockers, needs acidic environment
rifampin- increased cleared for azoles
bug and drugs
MSSA
MRSA- vance
community -acquired MRSA- clinda, bacterium
complicated: vanc, dap
strep pyogenies: PCN V or G,
for PCN-allergic: clinda or macrolide
strep pneumo: PCN V or G or amox
moraxella ca- caftan
nester gone- ceftrizxone
n. meningi- pCN g
c.diff- metronidazole, recurrent vanco oral
e.coli/kelb- cefrixone
proteus mirablis- ampicillin
h. flu- URI: bacterium
h. pylori: PPI+ clarithro+ amor or flagyl
chlaymdia- macrolide
mycoplasma pneumonia: macrolides
drug interactions
macrocodes- inhibit cytochorne p50 rifampin- induces Cp50 fluroquin and tetracyclines- chelated by divalent cations linezolid- MOA ETOH- flagyl, cefotetan oral contraceptives -amox, PCN
photosensitivity: bacterium, tetracycline
Rash: fluroquin
QT prolongation: fluroquinolones, macrolides,
Red man syndrome- vanco, slow down infusion
Nephrotoxic/ ototoxic: vanco and aminoglycodies
seizures: PCN, fluroqin
Mono: amor
bone marrow suppression: bacteria, linezolie
GI: multiple drugs ( clauvante)
taste: clarithromycin, metronidazole
tendonitis: fluroquinolodes
orange/red-rifampin
CI with peds: tetra, fluroquinolones, telithromycin, bacterium
anti fungal efficacy
gold standard: amphotericin B( renal issues)
aspergillosis: voriconazole, amphotericin
blastomycosis: itraconazole
amphoterecin, fluconazole
candidemia: fluconazole, amphotereicin, voriconazole
coccidiomycosis: itraconazole, fluconazole
