Chapter 4 - Antimicrobials Flashcards
Excellent oral absorption (5)
Fluoro Clinda Bactrim Doxy Linezolid
Pseudomonas ABx
Pip-tazo (zosyn), tic-clav Ceftaz, Cefepime Levo, Cipro Carbapenem (not erta) Aztreonam Aminoglyc Polymyxin B
MRSA ABx (6)
Vanc, Daptomycin, Linezolid, Ceftaroline (IV)
Bactrim, Clinda, Tetracyclines, oral Linezo
Don’t use fluoro on its own for MRSA (resistance develops)
Two bugs not covered by ertapenem but covered by other carbapenems
Pseudo, Entercocc
Increased C Diff Risk
Clinda
Ceph
Fluoro
Carbapen
Less frequent: macrolide, pen, sulfa
Why use liposomal AMP-B
Less nephrotoxicity
When to definitely use bacteriocidal
Immunocompromised
Route of administration of ABx for patients in shock
IV (erratic oral absorption)
Penicillins: MOA
Cidal
Inhibit cell wall synthesis
Spectrum of Natural and Amino Penicillins
(Penn G, V) (Amoxicillin, Ampicillin)
GPC, GNC, some GNR
Spirochetes, Actinomyces
Aminopenn include H Flu
Susceptible to B lactamase
Spectrum of Anti-Staph Penn
(Oxacillin, Nafcillin, Dicloxacillin)
MSSA, Strep, Anaerobic GPC
No GN coverage
Spectrum of Tic-Clav (Trimentin) and Zosyn
More gram negative, but Trimentin is less active against penicillin-resistant Strep
Zosyn best coverage of pens, even works against some B-lactamases
First Gen Ceph
IV Cefazolin, PO Cephalexin
GPC (Staph/Strep)
2 Gen Ceph
Cefuroxime (Zinacef), Cefoxitin (IV)
Ceftin, Cefprozil, Cefaclor, Loracarbef (PO)
More Gm neg (H Flu, Moraxella)
Not for enterobacter
3 Gen Ceph
Ceftriaxone, Ceftazidime (IV)
Cefixime, Ceftidorin (PO)
4 Gen Ceph
Cefepime
Includes Pseudo
5 Gen Ceph
Ceftaroline
Excellent MRSA
Similar GN as 3rd Gen
Penicillin Allergy: Skin testing, use Ceph?
10% have positive skin test
3.4% with + also react to cephalosporin
Do skin testing, if +, avoid/desense/graded
If no skin testing: If penn allergy is severe, avoid Ceph or do graded challenge/rapid desense
Fluoroquinolone mechanism and coverage
Cidal
Inhibit DNA synthesis
GNR (Enterobacter, H Flu)
Gm + Resp (Neisseria, Moraxella)
Atypical Pneumo (legionella, mycoplasma, chlamydia)
Special Cipro coverage
Broad GN (Pseudo) Not good for Strep (so don’t use much for h/n infxn)
Special Levo/Moxi/Gatifloxacin
Best Strep coverage
Levo also Pseudo
Macrolides: Members, MOA, Spectrum
Static, INH RNA protein Synthesis
Erythro: GM + and -
Azithro/Clarithro: even broader, fewer GI AE
Clindamycin
Static, binds 50S ribosome
Gm + (MRSA, Strep)
Anaerobes (esp oral)
Symptoms of C Diff
Watery diarrhea
May be preceded by leukocytosis
Fever, bloody, Abd pain if severe
Bactrim
Cidal, INH Folate synth
MRSA, Strep/Mor/H Flu, Enteric GNR
AE: GI, Rash (SJS), nephrotoxic
Tetracyclines
Doxy, Mino, Tetra, Tiga
Static INH protein synth
Respiratory (S Pneumo/H Flu/Mycoplasma), Gm+/-
Tiga (IV) for GM-
Antifungals
Flucon- Candida
Voricon- Asperg
Mica/Caspofungin- Invasive Candida
AMP B
Bacteriocidal ABx
Pen, Ceph, Carba
Fluoro (INH gyrase)
Vanc (bind D-ala-D-ala)
Aminoglyc (30S)
Bacteriostatic ABx
Macrolide (50S)
Clinda (50S)
Bactrim (Folate)
Tetracycline (protein synth)
