Gram Positive only antibiotics Flashcards
What is the MOA of Vancomycin?
inhibits cell wall synthesis
time dependent, bactericidal against Staph and Strep, but is bacteriostatic against enterococci
What are the main uses of Vancomycin?
GRAM POSITIVE infections, often used empirically when gram (+) suspected
-streptococcus spp (including strep pneumoniae)
-staphylcoccus spp. (MSSA and MRSA) DRUG OF CHOICE FOR MRSA
-often used empirically against enterococcus infections but Vancomycin Resistant Enterococcus is an issue
-oral vancomycin is ONLY used for C.diff infections
When should Vancomycin use be avoided?
-gram negative infections
-gut anaerobes
-atypical organisms
How is Vancomycin eliminated?
renally eliminated, dose adjustment needed and good UTI drug
What are the adverse drug reactions of Vancomycin?
-infusion reaction aka flushing reaction aka red mans syndrome
-hypersensivity reaction
-fever
-nephrotoxicity
-ototoxicity
What is the MOA of linezolid/tedizolid?
inhibits bacterial protein synthesis
weak inhibitor of monoamine oxidase- DRUG INTERACTIONS
What is the main uses of linezolid/tedizolid?
-streptococcus spp (including strep pneumoniae)
-staphylococcus (MSSA and MRSA), good penetration into lungs so could be used for pneumonia caused by staph.
-enterococcus (effective against vancomycin resistant enterococcus)
When should linezolid/tedizolid use be avoided?
-gram negative infections
-gut anaerobes
-atypical organisms
What are the unique pharmacokinetics of linezolid/tedizolid?
-linezolid= only 35% eliminated not an ideal UTI drug and tedizolid is not used as an UTI drug
-large volume of distribution so not ideal for bloodstream infections
What are the adverse drug reactions of linezolid/tedizolid?
-GI (nausea, diarrhea)
-headache
-linezolid= thrombocytopenia (see with use > 2 weeks)
-serotonin syndrome (avoid drugs that also increase serotonin)
What is the MOA of daptomycin?
binds cell membrane and causes rapid depolarization
bacterialcidal, concentration-dependent
What are the main uses of daptomycin?
GRAM POSITVE infections
-streptococcus spp(including strep pneumoniae)
-staphylococcus spp. (MSSA and MRSA)
-enterococcus spp. (effective against vancomycin resistant enterococcus)
When should daptomycin use be avoided?
-lung infections (inactivated)
-gram negative infections
-gut anaerobes
-atypical organisms
What are the adverse drug reactions of daptomycin?
-GI (nausea, diarrhea)
-headache
-rash
-myopathies with elevations of CPK, may present with myalgias and muscle weakness)
When would oral vancomycin be used?
C. diff infections
What is the drug of choice for MRSA?
vancomycin
What drugs may be used to treat vancomycin resistant enterococcus (VRE)?
-linezolid/tedizolid
-daptomycin
What are the main uses of Telavancin, Dalbavancin, Oritavancin?
GRAM POSITIVE infections, all indicated for soft tissue infections
-streptococcus (including strep pneumoniae)
-staphylococcus (MSSA and MRSA)
-vancomycin susceptible enterococcus spp. (NOT a great choice for VRE)
What are the half lives of Telavancin, Dalbavancin, and Oritavancin?
dalbavancin and oritavancin is hundreds of hours, whereas telavancin is 7-10 hours
What may be a hurdle to the use of Telavancin, Dalbavancin, or Oritavancin?
extremely expensive
What is the MOA of Sulfamethoxazole/Trimethoprim?
-gram positive infections= Staphylococcus (MRSA and MSSA), 2nd line for Listeria infections, Nocardia
-gram negative infections= PEK (Proteus, E.coli, Klebsiella (not K. aerogenes), some SPACE (Serratia, Enterobacter (also K. aerogenes), Stenotrophomonas maltophilia
-Pneumocystis jiroveci
-Toxoplasmosis
When should Sulfamethoxazole/Trimethoprim be avoided?
-Streptococcus
-Enterococcus
-gut anaerobes
-atypical organisms
What are the adverse drug reactions of Sulfamethoxazole/Trimethoprim?
-GI (nausea,vomiting, abdominal pain)
-hypersensitivity reactions
-rash, potential steven johnsons syndrome (SJS)/toxic epidermal necrolysis
-fever
-blood dyscrasias (the “-penias”, decrease in all blood lines)
-photosensitivity
-hyperkalemia
What is the drug of choice for PJP pneumonia (Pneumocystis jiroveci)?
Sulfamethoxazole/ Trimethoprim
