Chapter 72: Antibiotics That Weaken the Cell Wall: Others

Question 1

1st gen cephalosporins

Answer 1

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 -

Question 2

2nd gen ceph

Answer 2

Cefotetan (cefotan) ​

Cefuroxime (Ceftin)​

Cefoxitin (Mefoxin) = surgical prophylaxis for abdominal procedures​

primarily treats anaerobes

secondary coverage for gram + (expect MRSA) and gram - (expect pseudomonas)

Question 3

3rd gen ceph

Answer 3

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)

Question 4

4th gen ceph

Answer 4

Cefepime (Maxipime) = very good GN coverage; Pseudo​

primarily covers pseudomonas

secondary coverage for gram + (except MRSA)

Question 5

5th gen ceph

Answer 5

Ceftaroline = MRSA Coverage

primarily treats MRSA

secondary coverage other gram +, gram -

Question 6

therapeutic goal for cephs

Answer 6

Treatment of Bacterial Infections​

Question 7

baseline data for cephs

Answer 7

Identify culture and sensitivity of the infecting organism

Question 8

monitoring for cephs

Answer 8

no lab monitoring is suggested

Question 9

identifying high risk pt for cephs

Answer 9

Cephalosporins are contraindicated for patient with a history of allergic reactions to cephalosporins and penicillin’s​

Question 10

evaluating therapeutic effects cephs

Answer 10

Monitor for reduction in bacterial symptoms: fever edema, pain, inflammation​

Question 11

min ADR for ceph

Answer 11

All cephalosporins can promote Clostridia difficile infection. Instruct patients to report increase in stool frequency. if they have diarrhea d/c med.

Question 12

Carbipenims

Answer 12

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

Question 13

carbipenims coverage

Answer 13

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)​

Question 14

carbipenims resistances

Answer 14

​

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.

Question 15

vanc uses

Answer 15

Uses: MRSA, C. difficille (C Diff) diarrhea (PO)​

Wide range of efficacy and Gm + and anaerobic drugs.​

Useful for patients with severe PCN allergy

Question 16

Vanc ADRs

Answer 16

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​

Question 17

MRSA out patient tx

Answer 17

Outpatient minor infections ​
(furuncles, Carbuncles):

Bactrim, ​

Doxycycline​

Clindamycin

Question 18

Serious or Healthcare Associated infections (Sepsis) MRSA tx

Answer 18

Skin, pneumonia, surgical site​

Vancomycin

Linezolid ($$$)

Daptomycin

Question 19

MRSA colonized in nares rx

Answer 19

-Bacitracin (mupirocin)

1/3 carry staph in nares ~2% carry MRSA in nares

Question 20

therapeutic goal for vanc

Answer 20

Treatment of Serious Bacterial Infections including C Diff and MRSA and susceptible organisms in patients allergic to PCN​

Question 21

baseline data for vanc

Answer 21

Identify culture and sensitivity of the infecting organism

Question 22

monitoring for vanc

Answer 22

Vancomycin drug levels should be monitored during IV administration

Question 23

identifying high risk pt for vanc

Answer 23

Use cautiously in patients with Renal impairment​

Question 24

Evaluating Therapeutic Effects for vanc

Answer 24

Monitor for reduction in bacterial symptoms: fever edema, pain, inflammation​