ID**** Flashcards
Gram + cluster species
-MSSA
-MRSA
Gram + Pairs & Chains
-strep. pneumoniae
-strep. pyogenes
-entroccus (VRE)
Gram + Rods
- listeria
-monocytogens
-corynebacterium spp
Gram + Anaerobes
-peptostreptococcus
-propionibacterium acnes
-clostridioides difficile
-clostridium spp.
Gram - cocci
neisseria spp
Gram - rods, colonizing the gut
-proteus mirabilis
-E. coli
-Klebsiella
-serratia
-enterobacter cloacoe
-citrobacter
Gram - rods, that do not colonize gut
-pseudomonas aergunosa
-haemophilus influenzae
-providencia
Gram - Anaerobes
-bacteroides fragilis
-prevotella spp
Gram - Coccobacilli
-acinetobacter baumannil
-bordertella pertussis
-moraxella catarrhalis
Gram - curved or spiral shaped rods
-H. pylori
-Campylobacter
-treponema
-Barrelia
-Leptospira
Common Resistant Pathogens
Kill Each and Every Strong Pathogen
-klebsiella pneumoniae
-escherichia coli
-acinetobacter baumannii
-enterococcus faecalis/faecium
-staphylococcus aureus
-pseudomonas aerginosa
Natural Penicillins: Pen V, Pen G
-covers gram + cocci, gram + anaerobes (in mouth)
PO: pen V, IV/IM: pen G,
Aminopenicillins: amoxicillin, ampicillin
-covers gram + cocci, gram + anaerobes (in mouth)
-adds on gram - coverage (HNPEK)
-PO amoxicillin, IV ampicillin
Aminopenicillin + Beta-lactamase Inhibitors: amoxicillin/clavulanate, ampicilin/sulbactam
-covers gram + cocci, gram + anaerobes (in mouth)
- gram - coverage (HNPEK)
-adds MSSA, more resistant strains of HNPEK, gram - anaerobes (B. fragilis)
- PO augmentin, IV unasyn
Extended-spectrum + beta-lactamase inhibitor: piperacillin/tazobactam
-covers gram + cocci, gram + anaerobes (in mouth)
- gram - coverage (HNPEK)
-MSSA, more resistant strains of HNPEK, gram - anaerobes (B. fragilis)
-adds CAPES, + pseudomonas
-IV only
Anti-staphylococcal: nafcillin, oxacillin
-covers MSSA and streptococci only!
-both IV
PO: dicloxacillin
Penicillin class trends
-all cover enterococcus (except antistaphylococcal penicillins)
-do NOT cover atypicals (penicillin are cell wall active agents and atypical dont have cell walls) or MRSA
-do not use with beta lactam allergies or risk of seizures
outpt/PO penicillin usage: Penicillin VK
-strep throat
-mild skin infections
outpt/PO penicillin usage: Amoxicillin (Moxatag)
-acute otitis media (90 mg/kg/day)
-infective endocarditis ppx before dental procedures ( 2 g po x1 30-60 mins before)
-H. pylori tx
outpt/PO penicillin usage: Amoxicillin/Clavulanate (Augmentin)
-acute otitis media (90 mg/kg/day)
-bacterial sinusitis
–> use lowest dose of clavulanate to dec diarrhea
outpt/PO penicillin usage: Doxioxacillin
-covers MSSA and streptococci only
-does not need renal adjustment
Inpatient/parenteral use of Penicillins: Pen G (Bicillin-L-A)
-drug of choice for syphilis (2.4 mil units IM x1)
–>**never use IV = death
Inpatient/parenteral use of Penicillins: Piperacillin/Tazobactam (Zosyn)
-only one active against pseudomonas
-extended infusion (4 hrs) can be used to maximize T > MIC
Inpatient/parenteral use of Penicillins: Nafcillin and Oxacillin
-covers MSSA and streptococci only
-does not need renal adjustment
1st gen cephalosporins
-IV: cefazolin
-PO cephalexin (Keflex)
–> cover staphylococci, streptococci, PEK, mouth anaerobes
2nd generation cephalosporins
-IV/PO/IM: cefuroxime (Ceftin)
–> better gram - activity (HNPEK),
-Cefotetan and Cefoxitine have anaerobic activity (B. fragilis)
3rd generation cephalosporins
Group 1:
-IV Ceftriaxone
-PO Cefdinir
–> less staphylococci coverage but better streptococci coverage
Group 2:
-IV ceftazidime, ceftazidime/avibactam
–> pseudomonas
4th generation Cephalosporins
IV cefepime
–> broad spectrum: gram +, HNPEK, CAPES, pseudomonas
5th generation cephalosporins
IV ceftaroline (Teflaro)
-less staphylococci coverage but better streptococci coverage
HAS MRSA COVERAGE
Cephalosporin class trends
-no enterococcus coverage
-does not cover atypical
-do not use with beta-lactam allergy and risk of seizures
outpt/oral cephalosporins: 1st gen
–> Cephalexin (Keflex)
-strep throat, MSSA skin infections (Staph)
outpt/oral cephalosporins: 2nd generation
–> Cefuroxime
-acute otitis media, CAP, sinus infections
outpt/oral cephalosporins: 3rd generations
–> Cefdinir (Omnicef)
- CAP, sinus infections
Inpt/parenteral cephalosporin use: 1st gen
–> cefazolin
-surgical prophylaxis
Inpt/parenteral cephalosporin use: 2nd gen
–> Cefotetan, Cefoxitin
-anaerobic coverage (B. fragilis)
-surgical ppx (GI procedures)
–> Cefotetan
AE: can cause a disulfiram-like reaction w/ alcohol ingestion
Inpt/parenteral cephalosporin use: 3rd gen
–> Ceftriaxone and cefotaxime
-CAP, meningitis, SBP, pyelonephritix
–> ceftriaxone does not need renal adjustment
AE: do not use with neonates (0-28 do)
–> ceftazidime:
-pseudomonas
Inpt/parenteral cephalosporin use: 4th generation
–> Cefepime
-pseudomonas
Inpt/parenteral cephalosporin use: 5th generation
–> ceftaroline
-MRSA, CAP, skin and soft tissue infections
Carbapenems: Study tip
–> IV Meropenem
–> IV/IM Ertapenem (Invanz)
Class effects:
-cover ESBL orgs (e. coli, klebsiella)
-pseudomonas (exceot ertapenem)
-beta-lactam allergy and seizures (do not use)
–> All are IV (NS must be used for ertapenem)
DOES NOT COVER:
-atypical, VRE, MRSA
-Ertapenem does not cover PEA (pseudomonas, enterococcus, acinetobacter)
Common uses:
-polymicrobial infections (severe diabetic foot infection)
-empiric therapy when multi drug resistance are suspected
Exam Scenario: if you see a carbapenem as a choice (meropenem, ertapenem (Invanz)
-PCN allergy: do not choose carbs
-if culture is growing EBSL + (e. coli) - yes choose it!
-if the culture is growing pseudomonas: do not choose ertapenem
-PMH: seizures, epileptic drug- do not use
Monobactam: Aztreonam (Azactam)
-IV only
CAN BE USED IN PTS WITH BETA LACTAM/PEN ALLERGY
-covers gram -, including pseudomonas
Aminoglycosides facts
Gentamicin, tobramycin (trough < 2, draw 30 mins before 4th dose) , amikacin
Coverage:
-gram -, including Pseudomonas, synergy for gram + (staphylococci/Enterococci)
SEs:
-toxicities like nephroxicity, ototoxicity
-taking advantage of the concentration dependent killing –> give larger doses less frequently –> this gives the kidneys time to recover in between doses
Quinolones
–> ciprofloxicin, levofloxicin, moxifloxicin, ofloxacin
-concentration-dependent killing
BBW: tendon rupture, peripheral neuropathy, CNS effects (use last line)
Warnings: QT prolongation, hypo/hyprtglycemia, psychiatric disturbances, photosensitivity, avoid use in children
Interactions: chelation with divalent cations
Respiratory quinolones (My Good Lungs)
-active againse S. pneumoniae
Levofloxacin
Gemifloxicin
Moxifloxaxin (IV:PO = 1 to 1, not renally adjusted, do not use for UTIs)
Anti-pseudomonal quinolones
-levofloxacin ( IV:PO = 1 to 1)
-Ciprofloxacin
–> pseudomonas infections, UTI, intra-abdominal infections, travelers diarrhea
Quinolones profile review tips
-caution in pts with CVD, dec mg/k, use of other QT prolonging drugs
-avoid if seizure hx or suing an antiepliptic drug
-avoid in children
-watch for tendon rupture, neuropathy, CNS/psychiatric SEs
Macrolides
-Azithromycin (Zithromax)
-Clarithromycin (Biaxin)
-Erythromycin (EES)
Coverage:
-atypical pathogens (Legionella, chlamydia, Mycoplasma, Mycobacterium avium)
-H. influenzae
-S. pneumoniae
Common uses of macrolides
-CAP, strep throat
–> Azithromycin: COPD exacerbation, pertussis, chlamydia (in prego pts), ppx for mycrobacterium avium complex, severe travelers diarrhea
- z pack: 500 mg (2 350 mg on day 1), then 250 mg x 4 days
–> Clarithromycin: H. pylori tx
–> Erythromycin: inc gastric motility, used in gasteroparesis
Macrolide safety issues
-QT prolongation: caution in CVD, dec Mg/K, use other QT prolonging drugs
-drug interactions: clarith/erthyo: CI with simvastatin and lovastatin
Tetracyclines agents & coverage
-Doxycycline (Vibramycin)
-Minocycline (minocin, Solodyn)
-Tetracycline
Coverage:
-S. aureus (including CA-MRSA)
-H. influenzae, Moxraella, atypicals +/- S. pneumo
-Rickettsiae
-H. pylori
-VRE
Common uses of tetracyclines
-CA-MRSA skin infections, acne (doxy and mino)
-Doxycycline: tick-borne illness (lymes, rocky mountain spotted fever), chlamydia, CAP, COPD exacerbation, bacterial sinusitis, VRE, UTI
-Tetracycline: H. pylori
Safety issues with tetracyclines
-avoid use in children < 8 y/o, pregnancy and breast feeding
-photosensitivity
-interactions w/ divalent cations
-IV:PO = 1 to 1 (doxy, mino)
-mino: DILE
Sulfonamides: sulfamethoxazole/trimethoprim (Bactrim)
-dosed based on TMP component
-treat uncomplicated UTI: 1 DS tab PO BID x 3 days
-do not use if sulfa allergy, pregnant or breastfeeding
Warnings: skin reactions (SJS/TEN), G6PD deficiency
SE: photosensitivity, in K, hemolytic anemia (positive Coombs test), crystalluria
SMX/TMP (bactrim) uses and SEs
Common uses:
-CA-MRSA infections
-UTI
-Pneumocystis pneumonia
5:1 Ration SMX/TMP: *dosing
-SS tab = 80 mg
-DS tab = 160 mg
Sulfa allergy:
-rash/hives are common
-can causes severe skin reactions
–> can inc INR when used with Warfarin (bactrim is 2C9 inhibitor
Abx for gram + infections: Vancomycin
Coverage:
-MRSA
-streptococci
-Enterococci
-C. diff (only time to use PO, 125 mg QID x10d)
Dosing:
-IV: 15-20 mg/kg q8-12 h using TBW (adjust in renal failure)
–>monitor SCr and avoid other nephrotoxic or ototoxic drugs (furosemide, aminoglycosides, cisplatin)