ID Flashcards
common resistant pathogens
Kill each and every strong pathogen
klebsiella
e. coli
acineobacter
enterococcus
staph aureus
psuedamonas
dose optimization strategies
time>MIC: beta lactams: representative of frequent dosing, extended infusion dosing
auc:mic. vanco, macrolides, tetracyclines,…
cmax:mic. amg, quinolones, dapto
natural pcns
penecillin vk. oral
pcn g(IV)
cover strep, enterococci, g+ anaerobes
aminopcns
amoxicillin
ampicillin IV
cover aboce + HNPE( haemophilus, neisseria, proteus
e.coli,
amino pcn/ beta lactamase inhibitors
amox clav (augmentin)
amp sulbavtam (unasyn)
covers same as natrual pcn and amino pcns
additonal coverage w MSSA, HNPEK, andG_anaerobes
extended spectrum beta lactams
zosyn
MSSA, CAPES, psudamonas, g_ anaerobes
(
capes
citropacter
acinetobacter
providencia
enterobacter
serratia
anti staff pcns
dicloxicillin (oral)
nafcilin (iv)
mssa AND streptococcus
ONLY PCNS that dont need renal adjustment
class effects of pcns
beta lactam allergy,
risk of seizures (if accumulates)
when can u use a pcn if pt has pcn allergy on exam
in a child who has pcn allergy and has acute otitis
syphillis
oral pcn things to remember
pcn vk : strep throat, mild non purulent skin infections
amoxicillin
AOM: 8–90 mg/kg/day
infective endocarditis ppx: 2g POx1
h. pylori reigmens
amox clav:
AOM: 90 mg/kg/day
use lowest dose of clavulanate possibler
dicloxacillkin
no renal adjustments
iv pcns pearls
pcn G benzathine
give IM only. fatal if given IV
used in syphillis. if pt has pcn allergy, desensitize and give. esp in pregnancy pts or pts w poor compliance
nafcillin: no renal adjustments
zosyn: only pcn active against pseudamonas
1st gen cphalosporins
streptococci
MSSA
PEK
G+ anaerobes
cefazolin (IV)
cephalexin (keflex) oral
surgical ppx
2ng gen
cefuroxime
cefotetan
cefoxitimme
covers all1st gen cef. covers + HN from HNPEK)
cefuroxime, cefotetan (good for surigcal procedure)- also cover
pearls of cefotetan
disulfuran reactions
can cause bleeding
3rd gen. group1
ceftriaxone (IV)
cefdininr (oral)
same as 2nd gen covers more resistent step and HNPEK
3rd gen group 2
ceftazidime
covers pseudamonas
4th gen
cefepime
:HNPEK
CAPES
PS
G+ similar to 3rd gen
5th gen
ceftarolane
broad G+ activity
MRSA
psuedamonas
cephalosporin coverage
no enteroccus
only ceftarolane covers MRSA
cefepime, ceftazidime (-/- avibactam or ceftolozane covers psa
cephalosporin class effects
allergies, risk of seizures
oral cephalosporin class effects
1 cephalzexin
strep throat, mssa skin infections
2nd gen
cefuroxime AOM, CAP, sinus infections
3rd gen
cefdenir AOM
carbapenems pearls
risk of seizures if accumulate, active against all esbl producing organisms
very broad. but do NOT cover
atypicals, VRE, MRSA, C. diff, stenotrophomonas
Ertapenem does not cover PEA: pseudamonas, enterococcus, acinobacter
common uses: ESBL
aztreonam
can be used in pts w. pcn allergy
only covers gram- (including oseudamonas)
aminoglycosides
gram-
dosing intervals-extended interval vs traditional dosing
toxicities. nephrotoxicity. ototoxicit
goal trough: generally <2
quinolonwa
respiratory: Levo, moxi, gemifloxicin(my good lungs). reliable s. pneumonaie acitivty in pneumonia
antipseudamonal -ciprofloxacin, levofloxicin (covers pseudamonas)
key features of fql
moxi. do not use for uti: not renall adjusted but does not concentrate in urine
iv to po ratio:1 to 1 (levo and moxi)
caution w cvd, qt prolongation, achilles tendon rupture, avoid in pts w seizures, neuropathy, photosensitivity ,blood glucose,
macrolydes
atypical coverage
qt prolongation
GLOVES PACMAN( m satands for macrolides) clarithro and erythromycin inhoibitors of cyp3a4? use together CI w. lovastatin and simvastatin
tetracyclines
avoid in pregnancy and children (abnormal discoloration fo teeth)<8
photosensitivity, chelation
sulfonamides
SMX: TMP-5:1 ratio dose per tmp
se: photosensitivity, hemolytic anemia, +coombs test)
warfarin interaction
dapto
cpk
only compatible w NS
cant use in lungs. inactivate dby lungs, muscle adverse reactions,monitor cpk
linezolid
iv :po ratio
“seretonergic interactions
thrombocytopenia
tigecycline
BBW: use last line. very broad. dont use in spectrum .
orange.
increased risk of death
clindamycin
anaerobic coverage and gram positive
d test
metronidazole
anerobic
disulfuram reactoins
nitrofuranotin (microdantin or macrobis)
avoid use in rcl<60
urine discoloration
perioperative abx
choice depends on abx type:
cardiac, vascular or orthopedic
*covers skin flora
*cefazolin (staph, step)
GI
*covers skin flora +GI flora
cefazolin+metronidazole
cefoxitine or cefotetan
amp/sulba
meningitis organsims
strep pneumonair, n miningitis, listeria coverage in neonates and ppl >50
amp drug of choice for lysteria.
CI for ceftriaxone
neonates
AOM treatment
high dose amox or amox/clav
cephalosporins for mild pcn allergy
ceftriaxone IM for treatment failure
upper respiratory tract infections
pharyngitis: most common cause group a strep: cna be treated w pcn or amox
acute sinustitiis
-symptomatic cre +/- audmentin
CAP treatment outpt:
healthy: no comorbidities or riskf actors for mrsa or pseudamonas
*amox (high dose), doxycicline or macrolide
high risk: betalactam +macrolide or doxy
OR
respiratory fq
cap inpt treatment
nonsevere(non ICU)
beta lactam+macrolide (or doxy if safety risks w macrolide)
OR
respiratory fq monotherapy
severe(ICU)
beta _macrolide
OR
meta+resp fq
in evere do not use fq monotherapy or beta lactam+doxy
HAP/VAP
anx coverage needed for psa and mssa
cefepime
zosyn
levo
add vanco or linezolid if risk for mrsa
ex: cefepime +vsnc
meropenem+linezolid
aztreonam+vanc
use 2 abx if at risk for mdr gram neg organisms
tb treatment general considerations
increase lft’s , total bilirubin
rifampin-turn fluids orange
isoniazid-peripheral neuropathy. give b6 to prevent tht (pyridoxine). cal cause DILE
pyrizonamide- increase uric acid and gout
ethambutol- visual damage
TB treatment
RIPE
rifamipin
isoniazid
pyrazinomide
ethambutol
latent tb treatment
shorter regimen
Rifapentine+I- 12 weeks weekly. cant be used in pregnancy
rifampin daily for 4 months
or RI daily for 3 months
last 2 can be used in pregnancy
SBP abx treatment
target enterric gram- and streptococci
ceftriaxone 1g iv daily for 5-7 days
ppx if prior episode:
utis
cyctities vs pyelonophrisits
uncommplicated: smx/tmp, nitrofurantoin, fosphomycin
pyelonephritis: smx/t,p, or ceftriazone (if inpt
asymptomatic bacteriuria is not treated unless pt is pregnant. amox or augment
Cdif treatment
fidoxomicin 200 mg po BID or vancomycin 125 mg po bid
for 10 days
treatment for syphillis
bicillin La 2.4 million units IM
gonnorhea
ceftriaxone 500 mg IM x1
chlamydia
cefuroxime AOM, CAP, sinus infections
bacterial vaginosis
metronidazole po or gel
trichonomoniasis
metronidazole 2 grams
