Fluroquinolones Flashcards
Fluoroquinolone resistance occurs through what mechanisms
Chromosomal gene mutations: alteration of gyrase or topoisomerase, drug efflux pumps, or outer membrane diffusion channels
Plasmids: proteins that block protect drug target or acetylate cipro
Fluoroquinolone moa
Directly inhibit dna synthesis by inhibiting dna gyrase and topoisomerase IV
Why are fluoroquinolones not approved in children?
Joint cartilage injury due to chelation of mg++ damaging chondrocyte interactions
Adverse events of fluoroquinolones
Use in children
Hyper/hypoglycemia
Cns toxicity - light headedness to seizures and psychosis (worse with nsaids sue to gaba receptor interference)
Myasthenia gravis - increased muscle weakness
Tendonopathy (60+ steroid, renal disease post transplant are highest risk)
Opiod screen false positives
Elongated qtc interval (torsades and vfib, highest risk: women, decreased K+, decreased Mg++, bradycardia, other drugs)
Gi upset
C. Diff
Chelation with metals
Retinal detachment
Which fluoroquinolone has the greatest potentency against aerobic gram neg bacilli
Ciprofloxacin
Brand name of ciprofloxcin?
Cipro
Adult Dose of ciprofloxacin for cutaneous anthrax
500 mg po q12h x 60 days
Adult Dose of ciprofloxacin for inhalated anthrax post exposure anaphylaxis
50 mg po q12h x 60 days
Adult Dosage of ciprofloxacin for active disease of inhaled, gi, or oropharyngeal anthrax
400 mg iv q12h x 60 days
With clindamycin or rifampin
Adult Dose of ciprofloxacin for arthritis or osteomyelitis
400 mg iv q 8-12h x 6 weeks
Adult Dose of ciprofloxacin for infectious diarrhea caused by salmonella
500 mg po bid x 7 days
Adult Dose of ciprofloxacin for infectious diarrhea caused by shigella (travelers diarrhea)
750 mg po bid x 3 days
Adult Dose of ciprofloxacin for infectious diarrhea caused by vibrio cholerae
1000 mg po once
Adult dose of ciprofloxacin for Intra-abdominal infection (peritonitis)
400 mg IV q12h
with metronidazole IV
Adult dose of ciprofloxacin for Typhoid Fever
500 mg po q12h x 10 days
Adult dose of ciprofloxacin for UTI, acute uncomplicated cystitis, urethritis
250 mg po q12h x 3 days, or 500 mg Extended release once daily x 3 days
Adult dose of ciprofloxacin for UTI, polynephritis
500 mg po q12h x 7-10 days, or 1000 mg extended release once daily x 7-10 days
adult dose of ciprofloxacin for P. aeruginosa infections
for parenteral therapy, increase dose to 400 mg IV q8h
pediatric dose of ciprofloxacin for anthrax, cutaneous
10-15 mg/kg po q12h x 60 days (max 1000 mg/day)
pediatric dose of ciprofloxacin for anthrax, inhalational post exposure prophylaxis
15 mg/kg po q12h X 60 days (max 500 mg/dose)
pediatric dose of ciprofloxacin for active disease anthrax (inhalational, GI, or oropharyngeal)
10-15 mg/kg IV q12h x 60 days (max 500 mg/dose switch to po when stable)
pediatric dose (5-17 years) of ciprofloxacin for cystic fibrosis
30 mg/kg/day IV divide q8h x 1 week or 40 mg/kg/day po divided q12h x 1 week
pediatric dose of ciprofloxacin for complicated UTI or pyelonephritis
IV: 6-10 mg/kg IV q8h x 10-21 days (max 400 mg/dose)
PO: 20-30 mg/kg/day in 2 divided doses q12h x 10-21 days (max 1500 mg/day)
Hepatic dose adjustments for ciprofloxacin extended release
No adjustments needed
