Chapter 22: ID I - Background and Antibacterials by Class Flashcards
1
Q
Gram positive organisms have a ___ cell wall and stain ___ from the ____ stain
Gram negative organisms have a ___(thick or thin) cell wall and take up ____ counterstain, resulting in what color
A
thick
dark purple or blueish
Crystal violet
thin
Safranin
Pink or reddish
2
Q
Which organisms are gram-positive cocci clusters
A
Staphylococcus spp. (including MRSA and MSSA)
3
Q
Which organism is a gram-positive rod
A
Listeria monocytogenes
4
Q
Which organisms are gram-positive anaerobes
A
- Peptostreptococcus
- Actinomyces spp.
- Clostridium spp
(PAC = positive anaerobes combination)
5
Q
Which organisms are gram-positive cocci in pairs and chains
A
- Strep pneumoniae (diplococci)
- Streptococcus spp (including Strep. pyogenes)
- Enterococcus spp (including VRE)
6
Q
Which organism is a gram-negative cocci
A
Neisseria spp
7
Q
Which organisms are gram-negative anaerobes
A
- Bacteroides fragilis
- Prevotella spp
8
Q
Which organisms are gram-negative coccobacilli
A
- Acinetobacter baumannii
- Bordetella pertussis
- Moraxella catarrhalis
(BAM)
9
Q
Which organisms are gram-negative rods that colonize the gut (enteric)
A
- Proteus mirabilis
- E. coli
- Klebsiella spp
- Serratia spp
- Enterobacter cloacae
- Citrobacter spp
(PEECKS)
10
Q
Which organisms are gram-negative rods that do not colonize the gut
A
- Pseudomonas aeruginosa
- H. influenzae
- Providencia spp
11
Q
Which organisms are curved or spiral shaped gram-negative rods
A
- H. pylori
- Campylobacter spp
- Treponema spp
- Borrelia spp
- Leptospira spp
12
Q
The higher the MIC value, the more ____-spectrum it is
The lower the MIC value, the more ____-spectrum it is
A
narrow (choose drugs with high MIC)
broad
13
Q
What is intrinsic resistance
A
the resistance is natural to the organism
ex: E.coli is resistant to vanco bc this antibiotic is too large to penetrate the bacterial cell wall of E.coli
14
Q
What is selection pressure
A
resistance occurs when antibiotics kill off susceptible bacteria, leaving behind more resistant stains to multiply
15
Q
What is enzyme inactivation
A
enzymes produced by bacteria break down the antibiotic
16
Q
What are extended-spectrum beta-lactamases (ESBLs)
A
beta-lactamases that can break down all penicillins and most cephalosporins
17
Q
What are carbapenem-resistant Enterobacteriaceae (CRE)
A
they are multidrug-resistant (MDR) gram-negative organisms (e.g, Klebsiella spp., E. coli) that produce enzymes (e.g., carbapenemase) capable of breaking down penicillins, most cephalosporins, and carbapenems
18
Q
What is collateral damage
A
Unintended consequences of antibiotic use. Antibiotics kill normal, healthy GI flora along with the pathogens they are targeting, resulting in overgrowth or organisms that are resistant to the drug and can lead to superinfections, such as C. diff
19
Q
Common resistant pathogens
A
- Remember: Kill Each And Every Strong Pathogen*
- Klebsiella pneumoniae (ESBL, CRE)
- E. coli (ESBL, CRE)
- Acinetobacter baumannii
- Enterococcus faecalis, Enterococcus faecium (VRE)
- Staphylococcus aureus (MRSA)
- Pseudomonas aeruginosa
20
Q
Which antibiotics inhibit folic acid synthesis
A
- Sulfonamides
- Timethoprim
- Dapsone
21
Q
Which antibiotics are cell wall inhibitors
A
- BL (penicillins, cephalosporins, carbapenems)
- Monobactams (aztreonam)
- Vancomycin, dalbavancin, telavancin, oritavancin
22
Q
Which antibiotics inhibit protein synthesis
A
- Aminoglycosides
- Macrolides
- Tetracyclines
- Clindamycin
- Linezolid, tedizolid
- Quinupristin/dalfopristin
23
Q
Which antibiotics are cell membrane inhibitors
A
- Polymyxins
- Daptomycin
- Telavancin
- Oritavancin
24
Q
Which antibiotics are DNA/RNA inhibitors
A
- Quinolones (DNA gyrase, topoisomerase IV)
- Metronidazole, tinidazole
- Rifampin
25
Which antibiotics are hydrophilic
Lipophilic?
- BL
- AMG
- Glycopeptides
- Daptomycin
- Polymyxins
- Quinolones
- Macrolides
- Rifampin
- Linezolid
- Tetracyclines
26
Lipophilic antibiotics have a (large/small) volume of distribution, giving them (excellent/poor) tissue penetration, whereas hydrophilic antibiotics have a (large/small) volume of distribution, giving them (excellent/poor) tissue penetration
Lipophilic - large Vd = excellent tissue penetration
| Hydrophilic - small Vd = poor tissue penetration
27
Hydrophilic antibiotics are eliminated ____
Lipophilic antibiotics are metabolized ____
renally, possibly causing nephrotoxicity or accumulation of drug
hepatically, possibly causing hepatotoxicity and DDI
28
Hydrophilic antibiotics have (high/low) intracellular concentrations, meaning they (are/are not) active against atypical pathogens.
Lipophilic antibiotics have (high/low) intracellular concentrations, meaning they (are/are not) active against atypical pathogens.
Hydrophilic - low intracellular concentrations; they are not active against atypical pathogens
Lipophilic - high intracellular concentrations; they are active against atypical pathogens
29
(Hydrophilic or lipophilic) antibiotics have increased clearance and/or distribution in sepsis
Hydrophilic (consider loading doses and aggressive dosing in sepsis)
30
Hydrophilic agents have (excellent/poor) bioavailability.
Lipophilic agents have (excellent/poor) bioavailability.
Hydrophilic- poor
| Lipophilic- excellent
31
Which antibiotic classes have concentration dependent killing
Drugs with concentration dependent killing can be dosed
quinolones, AMG, daptomycin (QAD - muscle is concentrated in the quad)
less frequently and in higher doses to maximize the concentration above the MIC (large dose, long interval)
32
Which antibiotic class has time-dependent killing
Drugs with time-dependent killing can be dosed
BL
more frequently or administered for a longer duration to maximize the time above the MIC (e.g., extending the infusion time from 30 min to 4 hrs or administering as a continuous infusion)
33
Beta-lactam MOA
inhibit bacterial cell wall synthesis by binding to penicillin-binding proteins (PCPs), which prevents the final step of peptidoglycan synthesis in bacterial cell walls
34
Aminopenicillins combined with beta-lactamase inhibitors (clavulanate, sulbactam, and tazobactam) have added activity against
MSSA, gram negative bacteria [e.g., Haemophilius, Neisseria, Proteus, E. coli, & Klebsiella (HNPEK)] & gram-negative anaerobes (B. fragilis)
35
piperacillin-tazobactam covers
- Gram-positive bacteria (streptococci, MSSA, Enterococci)
- Gram-positive anaerobes (mouth flora)
- more resistant strains of Haemophilius, Neisseria, Proteus, E. coli, & Klebsiella (HNPEK)
- Gram negative anaerobes (B. fragilis)
- Expanded coverage of other GNB, including Citrobacter, Acinetobacter, Providencia, Enterobacter, Serratia (CAPES)
- PsA
36
Which penicillins are Natural penicillins, brand and route of admin
Penicillin V Potassium
Penicillin G Benzathine (Bicillin L-A) - IM
Not for IV use; can cause cardio-respiratory arrest and death
37
Which penicillins are aminopenicillins, brand and route
Amoxicillin - tab, susp, cap, chew
Amoxicillin/clavulanate (Augmentin) - tab, susp, chew
Ampicillin - cap, susp, inj
Ampicillin/Sulbactam (Unasyn) - inj
38
Which penicillins are antistaphylococcal penicillins
When are they preferred
Dicloxacillin, Nafcillin, Oxacillin
MSSA soft tissue, bone and joint, endocarditis and bloodstream infections
Do not require renal dose adj
39
Penicillin CI
CrCl < 30 mL/min: do not use ER oral forms of amoxicillin and Augmentin or 875 mg strength of Augmentin
40
Penicillin side effects
Seizures (with accumulation), GI upset, diarrhea, rash (including SJS/TEN)
41
Which Antistaphylococcal PCN is a vesicant & what should be done if extravasation occurs
Nafcillin
| Use cold packs and hyaluronidase injections
42
Which drug can increase the levels of beta-lactams by interfering with renal excretion
Probenacid
43
All penicillins should be avoided in patients with BL allergy except:
- Treatment of syphilis during pregnancy (all pts)
| - HIV patients with poor compliance/follow-up - desensitize and treat with benzathine PCN
44
Which PCN is first line for strep throat and mild non-purulent skin infections (no abscess)
Penicillin VK
45
Which PCNs are first line for acute otitis media & dose
Amoxicillin (80-90 mg/kg/day), Augmentin (90 mg/kg/day)
46
Which PCN is DOC for infective endocarditis ppx before dental procedures & dose
Amoxicillin (2 grams PO x 1, 30-60 min before procedure)
47
Which PCN is used in H. pylori treatment
Amoxicillin
48
Which PCN is first line for sinus infections (if an antibiotic is indicated)
Augmentin (use the lowest dose of clavulanate to decrease diarrhea)
49
Which PCN is DOC for syphilis & dose
PCN G Benzathine 2.4 million units IM x1
50
As a class, cephalosporins are not active against
Enterococcus spp
51
First-generation cephalosporins
Cefazolin
| Cephalexin
52
Second-generation cephalosporins
Cefuroxime
| Cefotetan (Cefotan)
53
Third-generation group 1 cephalosporins
Third--generation group 2 cephalosporin & brand name
Cefdinir
Ceftriaxone (no renal adj)
Cefotaxime
Ceftazidime (Fortaz)
54
Fourth-generation cephalosporin & coverage
Cefepime
broad gram-negative activity (PsA)
55
Fifth-generation cephalosporin & brand & coverage
Ceftaroline fosamil (Teflaro)
similar broad gram-negative activity to ceftriaxone, but broad-gram positive activity
It is the ONLY BL THAT COVERS MRSA
56
Ceftriaxone CI
hyperbilirubinemic neonates (causes biliary sludging, kernicterus); concurrent use with calcium-containing IV products in neonates < / = 28 days old
57
Cefotetan contains a side chain, which can increase the risk of ____ and cause a ____ reaction
bleeding
| disulfuram-like reaction with alcohol ingestion
58
Cephalosporin SE
Seizures (with accumulation), GI upset, diarrhea, rash
59
Which cephalosporin comes as a chewable tab
Cefixime
60
Ceftazidime/avibactam covers some
CRE
61
Which cephalosporins should be separated by 2 hours from short-acting antacids
Cefuroxime, cefpodoxime
62
Which cephalosporin is commonly used for skin infections (MSSA) and strep throat
Cephalexin (outpatient)
63
Which cephalosporin is commonly used in acute otits media
Cefuroxime
64
Which cephalosporins are commonly used in CAP
Outpatient (oral):
Cefuroxime, Cefdinir
Inpatient (parenteral):
Ceftriaxone, Cefotaxime
65
Which cephalosporins are commonly used in surgical ppx
Cefazolin, Cefotetan & cefoxitin (colorectal procedures)
66
Which cephalosporins are commonly used in sinus infection (if antibiotic is indicated)
Outpatient (oral):
| Cefuroxime, Cefdinir
67
Which cephalosporins are commonly used in spontaneous bacterial peritonitis and pyelonephritis
Ceftriaxone, Cefotaxime
68
Which two cephalosporins are active against PsA
Ceftazidime and Cefepime
69
Carbapenems are very broad-spectrum antibiotics that are generally reserved for:
They do not have coverage for
MDR gram-negative infections (active against ESBL-producing bacteria, & PsA, except ertapenem)
atypical pathogens, MRSA, VRE, C. diff, Stenotrophomonas
70
Ertapenem does not have coverage for
PsA, Acinetobacter, or Enterococcus (remember PEA)
71
All carbapenems are ___ only
IV
72
Common uses of carbapenems
- Polymicrobial infections (e.g., diabetic foot infection)
- Empiric therapy when resistant organisms are suspected
- Resistant PsA or Acinetobacter infections (except ertapenem)
73
Which drug is a monobacam & brand name
When can it be used
Coverage?
Aztreonam (Azactam)
When a BL allergy is present since it makes cross-reactivity with a BL allergy unlikely
G- organisms, including PsA
No gram + or anaerobic activity
74
Aminoglycosides coverage
GNB (including PsA)
| Gentamycin and streptomycin are used for synergy in combination with a BL or vanco when treating G+ infections
75
Traditional dosing of AMG uses ___ doses ___ frequently
Extended interval dosing of AMG uses ___ doses ___ frequently
lower doses more frequently (e.g., Q8H if renal function is normal)
higher doses (to attain higher peaks) less frequently (e.g, once daily if renal function is normal)
Extended interval dosing has been shown to decrease nephrotoxicity and cost (but it is not clinically superior to traditional dosing)
76
Which drugs are AMGs
Gentamycin, tobramycin, amikacin, streptomycin, plazomicin
77
If patients are underweight, use ___ for AMG dosing
| If patients are obese, use ___ for AMG dosing
TBW
| AdjBW
78
Traditional IV dosing of gentamicin and tobramycin
Renal dose adjustment for CrCl >/= 60 mL/min in AMG traditional dosing
1-2.5 mg/kg/dose
Q8H
79
Gentamycin and tobramycin extended interval IV dose
4-7 mg/kg/dose (remember, in extended interval dosing, you are using higher doses to attain higher peaks)
80
AMG boxed warnings
Nephrotoxicity, ototoxicity, neuromuscular blockade
Use caution with AMGs in patients with:
- impaired renal function
- elderly
- taking nephrotoxic drugs (amphotericin B, cisplatin, polymyxins, cyclosporine, loop diuretics, NSAIDs, radiocontrast dye, tacrolimus, and vancomycin)
81
With traditional dosing of AMGs, when should a trough level be drawn
With traditional dosing of AMGs, when should a peak level be drawn
Trough: right before the 4th dose
Peak: 30 min after the end of the 30-min drug infusion for the 4th dose
82
In extended interval dosing of AMGs, which level should be drawn after the first dose
Random level
83
What is the goal trough for tobramycin & Gentamycin used for G- infections
< 2 mcg/mL
84
Quinolone MOA
inhibit bacterial DNA topoisomerase IV and DNA gyrase
85
Quinolones have _____-dependent antibacterial activity & a broad-spectrum f activity against a variety of gram-negative, G+ and atypical pathogens
concentration
86
What are the respiratory quinolones & what do they have coverage against
Gemifloxacin, levofloxacin and moxifloxacin
| enhanced coverage of S. pneumo and atypical pathogens
87
Which quinolones have enhanced G- activity, including coverage of PsA
Cipro and levofloxacin [used for PsA infections including pneumonia, UTIs, intra-abdominal infections, TD (without dysentery)]
88
Which quinolone has enhanced gram+ and anaerobic activity and can be used for mixed infections (e.g., intra-abdominal infections)
Moxifloxacin (no dose adj in renal)
89
What is the only quinolone that cannot be used to treat UTIs
moxifloxacin (no dose adj in renal)
90
Which quinolone is approved for MRSA
Delafloxacin
91
Moxifloxacin brand name
Avelox
92
Quinolone BW
- Tendon inflammation and/or rupture (within hours/days of starting)
- Peripheral neuropathy
- Seizures; caution in pts with CNS disorders or with drugs that cause seizures
93
Quinolone warnings
- QT prolongation (highest risk with moxifloxacin)
- Hypoglycemia & hyperglycemia
- psychiatric disturbances
- Avoid systemic quinolones in children and in pregnancy/breastfeeding d/t risk of musculoskeletal toxicity
- photosensitivity (avoid sun exposure)
94
Which quinolone should not be put through a NG or other feeding tube
Cipro oral suspension
95
Quinolone drug interactions
- Antacids and other polyvalent cations can chelate and inhibit quinolone absorption
- Lanthanum carbonate and sevelamer (Renelva) can decrease the serum conc of oral quinolones and should be separated
96
Macrolide MOA
bind to the 50S ribosomal subunit
97
Macrolide activity
- atypicals
- community-acquired upper and lower respiratory tract infections (CAP & as an alternative to BL for strep throat)
- Chalmydia and gonorrhea
98
Which drugs are macrolides
Azithromycin, clarithromycin, erythromycin
99
Z-pak dosing
Tri-Pak dosing
500 mg on day 1, then 250 mg on days 2-5
500 mg daily for 3 days
100
Do not use clarithromycin and erythromycin with which 2 drugs
lovastatin and simvastatin (increases risk of muscle toxicity)
101
Macrolide warnings
```
QT prolongation (caution with CVD, low K/Mg, and drugs like azole antifungals, antipsychotics, methadone, and quinolones)
Hepatotoxicity
```
102
Clarithromycin should be used with caution in patients with
CAD
103
Macrolide SE
GI upset
104
Erythromycin and clarithromycin are ___ inhibitors
3A4 (may need to avoid warfarin)
105
Azithromycin is used for
COPD exacerbations, monotherapy for chlamydia, combination therapy for gonorrhea, and ppx for MAC; DOC for severe TD
106
Clarithromycin is used for treatment of
H. pylori
107
Erythromycin is used for
gastroparesis (increases gastric motility)
108
Tetracycline MOA
reversibly bind to 30S ribosomal subunit
109
Tetracycline coverage
- atypicals
- CAP, tick-borne/rickettsial diseases, chlamydia, gonorrhea, CA-MRSA, VRE, acne, COPD exacerbations, sinusitis, UTI (doxycycline)
- H. pylori treatment (tetracycline)
110
Doxycycline brand name
Minocycline brand names
Vibramycin (no renal adj)
Minocin, Solodyn
111
Tetracycline warnings
Children < 8 years of age, pregnancy and breastfeeding, photosensitivity
112
Minocycline can cause
DILE
113
counseling for doxycycline
Sit upright for at least 30 min after dose to avoid esophageal irritation & take with 8 oz of water
114
Tetracycline drug interactions
Antacids and other polyvalent cations, sucralfate, bismuth subsalicylate, and bile acid resins can chelate and inhibit tetracycline absorption. Doses should be separated
115
TMP/SMX coverage
- Gram-negative: Shigella, Salmonella, Stenotrophomonas
- Some opportunistic pathogens (Pneumocystitis, Toxoplasmosis)
- NOT COVERED: PsA, Enterococci, atypicals and anaerobes
116
TMP/SMX single strength dose
TMP/SMX double strength dose
TMP/SMX dosing is based on which component
400 mg SMX/80 mg TMP
800 mg SMX/160 mg TMP
TMP (Ratio of SMX/TMP 5:1)
117
TMP/SMX dosing for uncomplicated UTI
1 DS tablet PO BID x 3 days
118
TMP/SMX dosing for PCP prophylaxis
1 DS or SS tablet daily
119
TMP/SMX warnings & SE
- SJS/TEN, TTP
- G6PD Deficiency - d/c if hemolysis occurs
- Photosensitivity
- Increased K
- Hemolytic anemia (identified with a positive Coombs test)
- Crystalluria
120
SMX/TMP is a strong inhibitor of ____ & can cause significantly elevated ___
2C9
| INR (caution with warfarin)
121
SMX/TMP common uses
CA-MRSA, UTI, PCP
122
Vanco inhibits bacterial cell wall synthesis by binding to which cell wall precursor and blocking peptidoglycan polymerization
D-alanyl-D-alanine
123
Consider an anternative to vanco when MRSA MIC >/= __ mcg/dL
2
124
Vanco dosing for systemic infections (IV only)
15-20 mg/kg Q8-12H (use TBW)
125
Vanco dosing interval for systemic infections (IV only) when CrCl 20-49 mL/min
Q24H
126
Vanco dosing for C. diff infections (PO only)
125-500 mg QID x 10 days
127
Vanco warnings
Ototoxicity, nephrotoxicity
| Infusion reaction/red man syndrome
128
Goal trough for vanco in serious MRSA infections
15-20 mcg/mL
129
Lipoglycopeptide MOA
inhibit bacterial cell wall synthesis by binding to the D-alanyl-D-alanine portion of the cell wall
130
Lipoglycopeptides have ___-dependent killing
concentration
131
Televancin is approved for
SSTIs
132
Televancin BWs
fetal risk, nephrotoxicity
133
Televancin warnings
Can falsely increase coagulation tests (aPTT/PT/INR)
| Red man syndrome
134
What should be used after oritavancin & dalbavancin administration due to interference with aPTT lab results & for how long
IV UFH for 5 days (120 hrs)
135
oritavancin & dalbavancin SE
red man syndrome
136
What is the dosing regimen for oritavancin & dalbavancin
single-dose regimen due to extremely long half-life
137
Daptomycin has ___-dependent killing
concentration
138
Daptomycin coverage & brand name
MRSA and VRE
cubicin, cubicin RF
DO NOT USE IN PNEUMONIA
139
Daptomycin warnings & SE
Myopathy and rhabdomyolysis; increases CPK (monitor weekly)
| Can falsely increase PT/INR
140
Linezolid MOA
Binds to the 50S subunit of the bacterial ribosome
141
Linezolid coverage & brand name
MRSA, VRE
Zyvox
142
Linezolid CI
do not use with or within 2 weeks of MAOi; avoid tyramine-containing foods and serotonergic drugs
143
Linezolid warnings & SE
duration-related myelosuppression (thrombocytopenia), optic neuropathy, serotonin syndrome, hypoglycemia
144
Which antibiotic suspension should not be shaken
linezolid
145
Quinupristin/dalfopristin MOA
binds to the 50S ribosomal subunit inhibiting protein synthesis
146
Quinupristin/dalfopristin coverage
MRSA, VRE (but NOT E. faeclais)
147
Quinupristin/dalfopristin SE
Arthralgias/myalgias, infusion reactions, hyperbilirubinemia
148
Quinupristin/dalfopristin should only be diluted with ___ and administered via ___ line
```
D5W
Central line (such as PICC)
```
149
Among the G- bacteria, tigecycline has no activity against:
The 3 Ps: PsA, Proteus, Providencia spp
DO NOT USE FOR BLOODSTREAM INFECTIONS
150
Tigacycline brand name
Tygacil
151
Tigacycline BW
increased risk of death
152
Tigacycline reconstituted solution should be which color & should be discarded if it is a different color
yellow-orange (think of tiger colors)
153
Due to the risk of toxicities, polymyxins are used primarily for which pathogens
MDR gram-negative pathogens
154
Colistimethane sodium & polymyxin B sulfate warning
dose-dependent nephrotoxicity, neurotoxicity (can result in respiratory paralysis from neuromuscular blockade)
155
Chloramphenicol can cause
gray syndrome
156
Clindamycin MOA
binds to the 50S subunit of the bacterial ribosome inhibiting protein synthesis
157
Clindamycin coverage
anaerobes and G+ bacteria
158
Clindamycin systemic brand name
| Clindamycin topical brand names
Cleocin
topical: Cleocin-T, Clindagel
159
Clindamycin BW
Colitis (C. diff)
160
Clindamycin SE
N/V/D
161
Which test should be performed on S. aureus that is susceptible to clindamycin but resistant to erythromycin
When do you know if clinda is resistant
An induction test (D-test)
A flattened zone between the disks (positive D-test) indicates clindamycin resistance - do not use
162
Metronidazole coverage & uses
anaerobes and protozoal infections
bacterial vaginosis, trichomoniasis, intra-abdominal infections
163
Secnidazole is given in how many doses
single dose
164
Metronidazole CI
Pregnancy (1st trimester), use of alcohol or propylene-glycol containing products during treatment or within 3 days of treatment discontinuation - can cause a disulfuram-like reaction (abdominal cramping, N/V, HA, and flushing)
165
Metronidazole SE
Metallic taste
166
Secnidazole SE
vulvovaginal candidiasis
167
Metronidazole can increase which lab value
INR
168
Fidaxomicin is used for
Brand name?
C. diff (oral)
Dificid
169
Rifaximin uses
TD, to decrease recurrence of hepatic encephalopathy, IBS-D, C. diff (off-label)
170
Fosfomycin coverage
E. coli (including ESBLs) and E. faecalis
| Single dose regimen is used for uncomplicated UTI
171
Nitrofurantoin MOA
bacterial cell wall inhibitor
172
Nitrofurantoin use & dosing & brand name
DOC for uncomplicated UTI
100 mg BID x 5 days (macroBID is dosed BID)
Macrobid, Macrodantin
173
Nitrofurantoin CI
CrCl < 60 mL/min
174
Nitrofurantoin warnings & SE
hemolytic anemia (caution in patients with G6PD deficiency)
```
GI upset (take with food)
Brown urine discoloration
```
175
Mupirocin nasal ointment use & brand name
to eliminate MRSA colonization of the nares
Bactroban
176
DOCs for MSSA
Dicloxacillin, nafcillin, oxacillin
Cefazolin, cephalexin
Amoxicillin/clavulanate, ampicillin/sulbactam
177
DOCs for CA-MRSA & SSTIs
SMX/TMP
Doxycyline, minocycline
Clindamycin (perform D-test first)
Linezolid
178
DOCs for severe SSTIs requiring IV treatment or hospitalization (cover MRSA and streptococci)
Vancomycin
Linezolid
Daptomycin
Ceftaroline
179
DOCs for nosocomial MRSA (hospital-acquired)
Vanco
Linezolid
Daptomycin (not in pneumonia)
180
DOCs for VRE (E. faecalis)
- Pen G or ampicillin
- Linezolid
- Daptomycin
181
DOCs for VRE (E. faecium)
Daptomycin
Linezolid
Cystitis only: nitrofurantoin, fosfomycin, doxycycline
Remember VRE stands for vancomycin resistant enterococcus
182
DOCs for PsA
```
Piperacillin/tazobactam
Cefepime
Ceftazidime
Ceftazidime/avibactam
Ceftolozane/Tazobactam
Carbapenems (except ertapenem)
Ciprofloxacin, levofloxacin
Aztreonam
Aminoglycosides
Colistimthane, Polymyxin B
```
183
DOCs for ESBL gram-negative rods (E. coli, K. pneumo, P. mirabilis)
Carbapenems
Ceftolozane/Tazobactam
Ceftazidime/Avibactam
184
DOCs for carbapenem-resistant (CRE) gram-negative rods
Ceftazidime/avibactam
| Colistamethane, Polymyxin B
185
DOCs for Acinetobacter naumannii
Carbapenems (except ertapenem)
186
DOC for HNPEK
Beta-lactam/beta-lactamase inhibitor
187
DOCs for Bacteroides fragilis
Metronidazole
BL/beta-lactamase inhibitor
Cefotetan, cefoxitin
Carbapenems
188
DOCs for C. diff
Vanco (oral)
| Fidaxomicin
189
DOCs for atypical organisms
Azithromycin
Doxycycline
Quinolones
190
Which oral antibiotics require refrigeration after reconstitution
Penicillin VK
Ampicillin
Augmentin
191
Which oral antibiotic should NOT be refrigerated
Cefdinir (formerly Omnicef)
192
Which IV antibiotics should NOT be refrigerated
Metronidazole, moxifloxacin, SMP/TMX
193
Antibiotics that do not require renal dose adjustment:
- Doxycycline
- Ceftriaxone
- Moxifloxacin
- Antistaphylococcal PCNs: Dicloxacillin, Nafcillin, Oxacillin
- Linezolid
- Clindamycin
- Macrolides: azithromycin & erythromycin only
- Metronidazole
194
Antibiotics with 1:1 IV:PO ratio
- Levofloxacin, moxifloxacin
- Doxycycline, minocycline
- Linezolid
- Metronidazole
195
Which antibiotics should be taken on an empty stomach
```
Ampicillin oral capsules and suspension
Ceftibuten suspension
Levofloxacin oral solution
Penicillin VK
Rifampin
Isoniazid
Itraconazole solution
Voriconazole
```
196
Which antibiotics require light protection during administration
Doxycycline
| Micafungin
197
Which antibiotics are compatible with dextrose only
Saline only?
NS/LR only?
-DEXTROSE
Quinupristin/Dalfopristin
SMX/TMP
Amphotericin B
```
-SALINE
Ampicillin
Ampicillin/sulbactam
Ertapenem
Daptomycin (Cubicin RF)
```
-NS/LR
Caspofungin
Daptomycin (Cubicin)
