Chapter 72: Antibiotics That Weaken the Cell Wall: Others Flashcards
1st gen cephalosporins
Cefazolin (Ancef)(IV) = GP other than MRSA, surgical prophylaxis
Cephalexin (Keflex)(PO)
commonly used for skin (lots of staph on skin)
primary coverage of gram +
no gram -
2nd gen ceph
Cefotetan (cefotan)
Cefuroxime (Ceftin)
Cefoxitin (Mefoxin) = surgical prophylaxis for abdominal procedures
primarily treats anaerobes
secondary coverage for gram + (expect MRSA) and gram - (expect pseudomonas)
3rd gen ceph
Cefdinir (Omnicef)(PO) = 2nd line in otitis media
Ceftazidime (Fortaz) = Anti-pseudomonal
Ceftriaxone (Rocephin)(IV/IM) = Gonorrhea; Pyelonephritis
treat lung infections
primarily treats gram - (only ceftaz for psuedomonas)
secondary coverage for gram + (expect MRSA)
4th gen ceph
Cefepime (Maxipime) = very good GN coverage; Pseudo
primarily covers pseudomonas
secondary coverage for gram + (except MRSA)
5th gen ceph
Ceftaroline = MRSA Coverage
primarily treats MRSA
secondary coverage other gram +, gram -
therapeutic goal for cephs
Treatment of Bacterial Infections
baseline data for cephs
Identify culture and sensitivity of the infecting organism
monitoring for cephs
no lab monitoring is suggested
identifying high risk pt for cephs
Cephalosporins are contraindicated for patient with a history of allergic reactions to cephalosporins and penicillin’s
evaluating therapeutic effects cephs
Monitor for reduction in bacterial symptoms: fever edema, pain, inflammation
min ADR for ceph
All cephalosporins can promote Clostridia difficile infection. Instruct patients to report increase in stool frequency. if they have diarrhea d/c med.
Carbipenims
Is the Most broad spectrum Beta-Lactam (everything besides MRSA)
Examples:
Meropenem (Marrem);
Ertapenem (Invanz);
Doripenem (Doribax)
only available in IV form -common inpatient med
carbipenims coverage
Generally covers everything EXCEPT:
MRSA, VRE, Acinetobacter, stenotrophomonas, and atypicals
Ertapenum is NOT useful for pseudomonas. Others are
Used often BC of resistance against PCN and Cef for gram - rods.
Empiric Coverage for Highly resistant organisms: ESBL’s (Extended Spectrum Beta Lactamase) -e coil and kesbiellla become ESBLs
Seen in ECF Patients (Extended Care Facility Patients on AB for years)
carbipenims resistances
Resistance: Carbipenims Resistant Enterobacteriaceae (CRE)- A family of germs that are difficult to treat BC of high resistance to AB including PCN, Ceph and Carbipenims.
vanc uses
Uses: MRSA, C. difficille (C Diff) diarrhea (PO)
Wide range of efficacy and Gm + and anaerobic drugs.
Useful for patients with severe PCN allergy
Vanc ADRs
Red man Syndrome -If vanc is pushed too fast, get skin flushing (red man syndrome) tx is slow down vanc
Ototoxicity
Nephrotoxicity
Very caustic thus needs extended infusion or central line.
Needs Concentration Monitoring
MRSA out patient tx
Outpatient minor infections
(furuncles, Carbuncles):
Bactrim,
Doxycycline
Clindamycin
Serious or Healthcare Associated infections (Sepsis) MRSA tx
Skin, pneumonia, surgical site
Vancomycin
Linezolid ($$$)
Daptomycin
MRSA colonized in nares rx
-Bacitracin (mupirocin)
1/3 carry staph in nares ~2% carry MRSA in nares
therapeutic goal for vanc
Treatment of Serious Bacterial Infections including C Diff and MRSA and susceptible organisms in patients allergic to PCN
baseline data for vanc
Identify culture and sensitivity of the infecting organism
monitoring for vanc
Vancomycin drug levels should be monitored during IV administration
identifying high risk pt for vanc
Use cautiously in patients with Renal impairment
Evaluating Therapeutic Effects for vanc
Monitor for reduction in bacterial symptoms: fever edema, pain, inflammation
