Drugs for CAP, HAP, and VAP

Question 1

amoxicillin + clavulanate

Answer 1

• NOT effective against pseudomonas

- risk of anaphylaxis, superinfection

Question 2

piperacillin + tazobactam

Answer 2

• CAP, HAP, or VAP
• given by IV
• risk of SJS/DRESS, nephrotoxicity, rash

Question 3

ceftriaxone (IV)
cefpodoxime (oral)
cefditoren (oral)

Answer 3

• Third generation cephalosporins
• G-POSITIVE and more G-NEGATIVE coverage, d/t increased penetration through outer membrane
• CEFTRIAXONE is not excreted by kidney, so dosage adjustment is NOT needed in renal impairment

Question 4

doxycycline

Answer 4

• Tetracycline: binds to 30s of ribosome and prevents growth of peptide chain.
• CAP (use with β-lactam)

Question 5

azithromycin

Answer 5

-Cover aerobic and anaerobic G-POSITIVE, not effective against G-NEGATIVE (except pasturella, haemophilus, and neisseria)

Question 6

clarithromycin

Answer 6

• Cover aerobic and anaerobic G-POSITIVE, not effective against G-NEGATIVE (except pasturella, haemophilus, and neisseria)
• INHIBITS CYP450

Question 7

erythromycin

Answer 7

-Cover aerobic and anaerobic G-POSITIVE, not effective against G-NEGATIVE (except pasturella, haemophilus, and neisseria)

Question 8

levofloxacin

Answer 8

• broad spectrum, active against both G-POSITIVE and G-NEGATIVE
• SHOULD BE RESERVED FOR SERIOUS INFECTIONS

Question 9

gemifloxacin

Answer 9

• broad spectrum, active against both G-POSITIVE and G-NEGATIVE
• SHOULD BE RESERVED FOR SERIOUS INFECTIONS
• risk of TENDON RUPTURE

Question 10

moxifloxacin

Answer 10

• broad spectrum, active against both G-POSITIVE and G-NEGATIVE
• SHOULD BE RESERVED FOR SERIOUS INFECTIONS

Question 11

linezolid

Answer 11

• Prevents t-RNA from binding to ribosome, and inhibits peptide formation
• ORAL or IV
• Lactic acidosis

Question 12

aztreonam

Answer 12

• not active against G+ or anaerobes
• administered IM or IV
• risk of anaphylaxis, superinfection

Question 13

imipenem

Answer 13

• RESERVED for resistant strains
• administered IV
• risk of CNS effects like confusion and seizure, anaphylaxis, superinfection

Question 14

gentamicin

Answer 14

• mostly active against G-NEGATIVE including (peudomonas, proteus, E. coli) also G+ strep
• Administered by IM or IV
• risk of neurotoxicity