ID Part 1 Flashcards
Which of the following statements is correct regarding ceftriaxone?
A. It should be given with IV calcium in neonates.
B. It displays concentration-dependent bactericidal activity.
C. It has better Gram-negative activity than cefotetan.
D. It is available in both oral and intravenous formulations.
E. It requires dose adjustment in renal dysfunction.
It has better Gram-negative activity than cefotetan.
Ceftriaxone is a 3rd generation cephalosporin that has broader Gram-negative activity than the 2nd generation cephalosporins (e.g., cefotetan).
Similar to all beta-lactams, it displays time-dependent bacterial killing.
Ceftriaxone is only available IV and does not require dose adjustment in renal dysfunction.
Ceftriaxone is contraindicated in neonates (causes biliary sludging, kernicterus) and concurrent use with IV calcium in neonates is contraindicated.
Cephalosporins
1st Generation
Meds & Coverage
IV: Cefazolin (Ancef), PO: Cephalexin (Keflex), cefadroxil (Duricef)
Staphylococci (MSSA), Streptococci, PEK, mouth anaerobes (Peptostreptococci)
Which generation cephalosporins is preferred for MSSA?
1st Gen
Cephalosporins
1st Generation Uses
Inpatient
Cefazolin (Ancef)
Surgical PPx
Cephalosporins
1st Generation Uses
Outpatient
Cephalexin (Keflex)
Strep throat, MSSA skin infections
Cephalosporins
2nd Generation
Meds & Coverage
IV/IM/PO: Cefuroxime (Ceftin, Zinacef)
Staphylococci
Better Gram-negative activity (HNPEK) than 1st gen
IV/IM Cefotetan (Cefotan) and Cefoxitin (Mefoxin)
Additional gram (-) anaerobic activity (B. fragilis)
PO: Cefaclor, Cefprozil (Cefzil)
Cephalosporins
2nd Generation
Inpatient
Cefotetan (Cefotan) and Cefoxitin (Mefoxin)
Surgical PPx (GI procedures)
Anaerobic activity (B. fragilis)
Which cephalosporin has a disulfiram-like reaction?
Cefotetan (Cefotan)
Cephalosporins
2nd Generation
Outpatient
Cefuroxime (Ceftin)
Acute OM, CAP, sinus infections
Cephalosporins
3rd Generation
Meds & Coverage
Group 1: IV Ceftriaxone, Cefotaxime
PO Cefdinir (Omnicef), Cefixime (Suprax), Cefpodoxime
Resistant Streptococci (S. pneumonaiae & viridans)
Staphylococci (MSSA)
Gram (+) anaerobes
Resistant strains of HNPEK
Group 2: IV Ceftazidime (Fortaz, Tazicef), Ceftazidime/Avibactam (Avycaz)
Lacks gram (+) activity
Pseudomonas
Cephalosporins
3rd Generation Uses
Outpatient
Cefdinir (Omnicef)
CAP, sinus infections
Cephalosporins
3rd Generation Uses
Inpatient
Ceftriaxone, Cefotaxime (Claforan)
CAP, meningitis, spontaneous bacterial perionitis (SBP), pyelonephritis
Which cephalosporin does not required renal adjustment?
Ceftriaxone
Which cephalosporins is not used in neonates?
Ceftriaxone
Cephalosporins
4th Generation
Meds & Coverage
IV: Cefepime (Maxipime)
Broad-spectrum: Gram-positives (similar to ceftriaxone), HNPEK, CAPES, Pseudomonas
Which cephalosporins covers Pseudomonas?
Ceftazidime (Fortaz, Tazicef)
Cefepime (Maxipime)
Ceftolozane/tazobactam (Zerbaxa)
Cefiderocol (Fetroja)
Cephalosporins
5th Generation
Meds & Coverage
IV Ceftaroline (Teflaro),
Gram (-) similar to ceftriaxone
Broad gram (+) MRSA coverage
Cephalosporins combo
Meds & Coverage
ceftazidime/avibactam (Avycaz)
ceftolozane/tazobactam (Zerbaxa)
Similar spectrum to ceftazidime
Added activity against MDR gram (-) rods
Siderophore Cephalosporin
Meds & Coverage
IV cefiderocol (Fetroja)
PEK
Enterobacter
Pseudomonas
What cephalosporin covers MRSA?
Ceftaroline (Teflaro)
Cephalosporins do not cover?
Enterococcus
Atypicals
Cephalosporins Class Effects
Betam-lactam allergy
Risk of seizures
BV is a 42-year-old male who comes to his primary care provider with a 2-day history of new-onset shortness of breath, fever, chills, fatigue, and persistent cough. He has no other health issues and no known drug allergies. A chest x-ray confirms pneumonia. The local antibiogram shows Streptococcus pneumoniae is 60% susceptible to macrolides. What is the most appropriate antibiotic therapy for this patient?
A. Amoxicillin for 10 days
B. Azithromycin for 5 days
C. Azithromycin for 10 days
D. Doxycycline for 5 days
E. Doxycycline for 10 days
Doxycycline for 5 days
The recommended treatment options for outpatient community-acquired pneumonia in healthy patients with no comorbidities include monotherapy with amoxicillin, doxycycline, or a macrolide (if local pneumococcal resistance is less than 25%).
The typical duration of treatment is 5 to 7 days.
Longer durations of treatment offer no benefit and increase the risk of adverse effects.
Community Acquired Pneumonia (CAP) Tx
Outpatient - no comorbidities
Amoxicillin 1 g TID
Doxycycline
Macrolide (azithromycin or clarithromycin)
For 5 to 7 days
Macrolid - only rec in healthy pts if local pneumococcal macrolide resistance is < 25%
Community Acquired Pneumonia (CAP) Tx
Outpatient - w/ comorbidities
Comorbidities:
* Chronic heart, lung, liver, or renal disease
* Diabetes
* Alcohol use disorder
* Malignancy
* Asplenia
Beta-lactam (amoxicillin/clavulnate, cefpodoxime [Vantin, 3rd], or cefuroxime [Ceftin, 2nd])
+
Doxycycline or Macrolide (azithromycin or clarithromycin)
Respiratory fluroroquinolone (moxifloxacin [Avelox], levofloxacin, or gemifloxacin [Factive])
For 5 to 7 days
Macrolid - only rec in healthy pts if local pneumococcal macrolide resistance is < 25%
Respiratory fluroquinolone Mnemonic
My Good Lung Died
* Moxifloxacin (Avelox)
* Gemifloxacin (Factiv)
* Levofloxacin
* Delafloxacin (Baxdela)
Antiviral agents active against cytomegalovirus (CMV) include which of the following:
A. Valganciclovir, valacyclovir, acyclovir
B. Atazanavir, valganciclovir, foscarnet
C. Foscarnet, acyclovir, cidofovir
D. Valganciclovir, foscarnet, cidofovir
E. Acyclovir, valacyclovir, ganciclovir
Valganciclovir (Valcyte), foscarnet (Foscavir), cidofovir
Ganciclovir, valganciclovir, foscarnet and cidofovir are indicated for CMV.
Others listed are indicated for HSV (acyclovir, valacyclovir) or HIV (atazanavir).
GP is receiving amphotericin B deoxycholate for the treatment of mucormycosis. Which of the following side effects are most likely to occur with treatment?
A. Hyponatremia, hypocalcemia, hypokalemia
B. Hyponatremia, hypokalemia, chest tightness
C. Hypocalcemia, hyperkalemia, leukopenia
D. Hypomagnesemia, hypokalemia, rigors
E. Hyperkalemia, hypermagnesemia, hypotension
Hypomagnesemia, hypokalemia, rigors
Common side effects associated with amphotericin B deoxycholate include
* hypokalemia
* hypomagnesemia,
* hypotension
* fever,
* chills,
* rigors,
* headache,
* nephrotoxicity.
ART unchanged for 5 years with good virologic response; elevated serum creatinine; switch ART to Biktarvy and refer to nephrology
Which medication is most likely contributing to the abnormal laboratory test identified today?
A. Emtricitabine
B. Hydrochlorothiazide
C. Pitavastatin
D. Raltegravir
E. Tenofovir disoproxil fumarate
Tenofovir disoproxil fumarate
Tenofovir disoproxil fumarate (TDF), a nucleoside reverse transcriptase inhibitor, can cause nephrotoxicity (evident by an elevated serum creatinine) with long-term use.
Tenofovir alefenamide (TAF) has a lower risk of nephrotoxicity; switching from TDF to TAF is associated with improvement in TDF-associated renal dysfunction.
Nucleoside reverse transcriptase inhibitors (NRTIs) Meds
Zidovudine (Retrovir)
Lamivudine (Epivir)
Abacavir (Ziagen)
Tenofovir disoproxil fumarate, TDF (Viread)
Tenofovir alafenamide, TAF
* Only in combination products for HIV;
* Vemlidy is a single-entity product for HBV
Emtricitabine (Emtriva)
No longer recommended:
* Didanosine
* Stavudine
Nucleoside reverse transcriptase inhibitors (NRTIs) MOA
Competitively inhibit the reverse transcriptase enzyme, preventing the conversion of HIV RNA to HIV DNA in stage 3 (reverse transcription) of the HIV life cycle
NRTIs Mnemonic
ZDS LATTE
Zidovudine (Retrovir)
Didanosine
Stavudine
Lamivudine (Epivir)
Abacavir (Ziagen)
Tenofovir disoproxil fumarate, TDF (Viread)
Tenofovir alafenamide, TAF (Vemlidy)
Emtricitabine (Emtriva)
NRTIs Effects
Lactic acidosis
Hepatomegaly with steatosis (fatty liver)
Nausea, diarrhea
Abacavir (Ziagen)
What do you need to test for?
Risk of HSR if positive for HLA-B 5701 (abacavir contraindicated)
Patients should carry warning card listing HSR symptoms
Which NRTIs is use for HBV/HIV coinfection?
Tenofovir, emtricitabine (Emtriva) & lamivudine (Epivir)
Abrupt discontinuation can cause acute HBV exacerbation
TDF (Viread)
TAF (Vemlidy)
Which NRTI causes hyperpigmentation of palms (hands) & soles of feet
emtricitabine (Emtriva)
Tenofovir
Common Toxicities
Two salt forms: TAF & TDF
Common toxicities (TDF > TAF)
* Nephrotoxicity (including Fanconi syndrome, a rare renal disorder)
* ↓ BMD (ie, osteopenia, osteoporosis)
Lipid abnormalities (primarily with TAF)
Which NRTI causes hematologic toxicity?
Zidovudine (Retrovir)
neutropenia & anemia (↑ MCV is sign of adherence)
Biktarvy
bictegravir
emtricitabine
TAF
Admit to labor and delivery and start HIV perinatal prophylaxis STAT.
Based on the assessment and plan, the pharmacist should expect to receive orders for which medication?
A. Intramuscular cabotegravir
B. Intravenous ibalizumab
C. Intravenous zidovudine
D. Oral darunavir boosted with ritonavir
E. Oral emtricitabine/tenofovir alafenamide
Intravenous zidovudine
Intravenous zidovudine is recommended to prevent perinatal (mother-to-child) HIV transmission in mothers with a new or unknown HIV diagnosis and/or an HIV viral load greater than 1,000 copies/mL.
Management of pregnant patients with HIV infection
During pregnancy
Continue ART if already taking
Start ART as soon as possible (if not already taking); preferred regimens include:
* Darunavir/ritonavir (Prezista) or dolutegravir (Tivicay), PLUS
* Two NRTIs (eg, emtricitabine/tenofovir or abacavir/lamivudine [Epzicom])
emtricitabine/tenofovir Brand:
TAF - Descovy,
TDF - Truvada
Management of pregnant patients with HIV infection
During delivery
Prevent perinatal (mother-to-child) transmission if new/unknown HIV infection and/or HIV viral load >1,000 copies/mL
Administer IV zidovudine (Retrovir) to the mother prior to delivery
Management of pregnant patients with HIV infection
After delivery
Neonatal ART prophylaxis (regimen and duration depending on risk)
Replacement feeding (eg, formula, donor milk) eliminates the risk of postnatal HIV transmission and may be preferred over breastfeeding
An 85-year-old man is hospitalized with a fungal infection. He has CKD stage 3 and chronic pain (on methadone). Micafungin 100 mg intravenous is given. During the infusion, the man develops a drop in blood pressure, pruritis and flushing. What is the most likely cause of this reaction?
A. The micafungin dose should have been renally adjusted.
B. Micafungin is causing a histamine-release reaction.
C. Micafungin increased the methadone levels, resulting in an adverse reaction.
D. Acetaminophen and meperidine should have been given prior to micafungin.
E. It is unlikely that this reaction is due to methadone or micafungin.
Micafungin is causing a histamine-release reaction.
Micafungin, an echinocandin, can cause histamine-mediated symptoms such as rash, pruritus, facial swelling, flushing and hypotension. To decrease the potential of a histamine reaction, infuse over 1 hour.
Empiric Treatment For Select Fungal Pathogens/Infections
Candida albicans
Oropharyngeal infection (thrush)
Mild disease: topical antifungals (clotrimazole [Mycelex troche], miconazole)
Moderate-severe disease or HIV+: fluconazole
Alternative: Nystatin
Nystatin - Swish and swallow
Empiric Treatment For Select Fungal Pathogens/Infections
Candida albicans
Esophageal infection
Fluconazole
Alternative: Echinocandin
Empiric Treatment For Select Fungal Pathogens/Infections
Candida krusei and glabrata
All Candida species bloodstream infections
Echinocandin
Alternative: Amphotericin B, high-dose fluconazole (susceptible isolates only)
Empiric Treatment For Select Fungal Pathogens/Infections
Aspergillus
Invasive
Voriconazole
Alternative:Amphotericin B, isavuconazonium
Empiric Treatment For Select Fungal Pathogens/Infections
Cryptococcus neoformans
Meningitis
Amphotericin B + flucytosine (5-FC)
Alternative: High-dose fluconazole + flucytosine (5-FC)
Empiric Treatment For Select Fungal Pathogens/Infections
Dermatophytes
Nail bed infection
Terbinafine or itraconazole (confirm fungal infection prior to treatment)
Alternative: Fluconazole
The pharmacist is on rounds with the internal medicine team. They are discussing a patient who has oral candidiasis due to a recent chemotherapy treatment. The infection is very painful for the patient and is considered moderate to severe. Which of the following is the best regimen to recommend for this patient?
A. Clotrimazole troches 10 mg PO 5 times per day
B. Fluconazole 200 mg IV daily
C. Posaconazole 400 mg PO BID
D. Amphotericin B 15 mg/kg IV BID
E. Itraconazole 200 mg PO daily
Fluconazole 200 mg IV daily
Patients with severe and painful oral candidiasis will not tolerate taking medications orally without analgesics.
Localized treatment with clotrimazole is used for mild infections only, in patients without immunosuppression.
The most appropriate therapy would be an antifungal given intravenously until oral medications are tolerated.
Fluconazole has appropriate activity and the amphotericin dosing is too high.
Which of the following statements is correct regarding nafcillin?
A. Nafcillinis active against MRSA.
B. Nafcillin is a vesicant.
C. Nafcillin should be dose adjusted in renal impairment.
D. Nafcillin is compatible with NS only.
E. Nafcillin cannot be used in a sulfa allergic patient.
Nafcillin is a vesicant.
Nafcillin is a vesicant (blistering). If extravasation occurs, use cold packs and hyaluronidase injections to treat.
Ampicillin, ampicillin/sulbactam and ertapenem are compatible with NS only.
Extravastion: leakage of blood, lymph, or other fluid, such as an anticancer drug, from a blood vessel or tube into the tissue around it
Which beta-lactams are complatible w/ NS only?
Ampicillin, ampicillin/sulbactam and ertapenem
Natural Penicillins
PO : Penicillin V Potassium
IV: Penicillin G Aqueous
IM: Penicillin G Benzathine (Bicillin L-A)
Covers Gram-positive cocci, Gram-positive anaerobes
Aminopenicillins
PO Amoxicillin (Moxatag),
IV: Ampicillin
Adds Gram-negative coverage (HNPEK)
Aminopenicillin + Beta- Lactamase Inhibitor
PO: Amoxicillin/clavulanate (Augmentin)
IV : Ampicillin/sulbactam (Unasyn)
Adds MSSA, more resistant strains of HNPEK, Gram- negative anaerobes (B. fragilis)
Extended Spectrum + Beta- Lactamase Inhibitor
IV: Piperacillin/tazobactam (Zosyn)
Adds CAPES, Pseudomonas
CAPES:
Citrobacteer
Acinetobacter
Providencia
Enterobacter
Serratia
Antistaphylococcal
Nafcillin, oxacillin
Covers MSSA and Streptococci only
Penicillin Class coverage
All cover Eenterococcus (exceptt antistaphylococcal PCNs)
Do not cover atypicals or MRSA
Penicillin Class Effect
Beta-lactam allergy
Risk of seizures
Outpatient (Oral)
Penicillin VK
A first-line treatment for pharyngitis (“strep throat”)
Mild nonpurulent skin infections (no abscess)
Outpatient (Oral)
Amoxicillin (Moxatag)
First-line treatment for acute otitis media (pediatric dose: 80-90 mg/kg/day)
Drug of choice for infective endocarditis prophylaxis before dental procedures (2 grams PO x 1, 30-60 minutes before procedure)
Used in H. pylori treatment*
Outpatient (Oral)
Amoxicillin/Clavulanate (Augmentin)
First-line treatment for acute otitis media (pediatric dose: 90 mg/kg/day) and bacterial sinusitis (if antibiotics indicated)
Use the lowest dose of clavulanate to↓ diarrhea
Outpatient (Oral)
Dicloxacillin
Covers MSSA only (no MRSA)
No renal dose adjustment needed
Inpatient (Parenteral)
Penicillin G Benzathine (Bicillin L-A)
Drug of choice for syphilis (2.4 million units IM x 1)
Not for IV use; can cause death
Inpatient (Parenteral)
Nafcillin and Oxacillin
Covers MSSA only (no MRSA)
No renal dose adjustment needed
Inpatient (Parenteral)
Piperacillin/Tazobactam (Zosyn)
Only penicillin active against Pseudomonas
Extended infusions (4 hours) can be used to maximize T > MIC
A 32-year-old female who is receiving chemotherapy for acute leukemia is diagnosed with mucormycosis via tissue culture and will begin therapy with IV isavuconazonium. The nurse contacts the pharmacist asking what he needs to know, as he has never administered the drug before. Which of the following is an important point regarding this medication?
A. This medication requires light protection during administration.
B. This medication is not compatible with PVC containers and will be supplied in a glass bottle.
C. This medication requires a filter for administration.
D. This medication requires PTT monitoring.
E. This medication can prolong the QT interval.
This medication requires a filter for administration.
Isavuconazonium (Cresemba) is a prodrug of isavuconazole.
It does not contain a solubilizing agent as with voriconazole and posaconazole, so a filter is required for administration to prevent any particulates (undissolved drug) from entering a patient’s bloodstream.
This agent can shorten the QT interval, which is unique within the azole class (all of the other agents are associated with prolonged QT).
Quinolones Boxed warnings
Concentration-dependent killing
Tendon rupture achilles
Peripheral neuropathy long-lasting
CNS effects (including seizures)
Use last-line (only if no alternatives)
Quinolones Warnings
Concentration-dependent killing
QT prolongation
Hypo and hyperglycemia
Psychiatric disturbances
Photosensitivity
Avoid use in children (risk vs. benefit)
Quinolones Interactions
Chelation with divalent cations
Quinolones Common Uses
Can vary by agent: pneumonias, UTIs, intra-abdominal infections, travelers’ diarrhea
Antipseudomonal Quinolones
Ciprofloxacin, levofloxacin
Only quinolone that is not renally adjusted
Moxifloxacin
Do not use for UTIs
Quinolones where IV to PO Ratio 1:1
Levofloxacin and moxifloxacin
Quinolones Profile Review Tips
Caution with CVD, ↓ K/Mg and with other QT-prolonging drugs (e.g., azole antifungals, antipsychotics, methadone, macrolides)
Avoid in patients with a seizure history or if using seizure drugs
Avoid in children
Quinolones Counseling
Avoid sun exposure, separate from polyvalent cations, monitor blood glucose (in diabetes)
Watch for tendon rupture, neuropathy, CNS or psychiatric side effects
An otherwise healthy patient presents withafoot infection that developed 1 week after stepping on a child’s toy. The wound culture is growingGram-positive and Gram-negative bacteria; Pseudomonas is not suspected. The physician would like to use a cephalosporinfor treatment of the patient’s infection. Which of the following statements regarding cephalosporins is correct?
A. Cefazolin is an oral cephalosporin that is considered to be the most effective therapy for mild-moderate Gram-negative foot infections.
B. Cefixime is the only oral cephalosporin with Gram-negative and enteric anaerobic coverage.
C. Cephalexin is an oral, second-generation cephalosporin with sufficient Gram-negative and Gram-positive coverage for moderate severity foot infections.
D. Cefuroxime is an oral, second-generation cephalosporin with adequate Gram-negative and Gram-positive coverage for mild-moderate foot infections.
E. Cefpodoxime is an intravenous, third-generation cephalosporin with adequate Gram-positive and Gram-negative coverage for severe foot infections.
Cefuroxime is an oral, second-generation cephalosporin with adequate Gram-negative and Gram-positive coverage for mild-moderate foot infections.
Cefazolin is an intravenous cephalosporin.
Cefixime is not effective for enteric anaerobes.
Cephalexin is a first generation cephalosporin and cefpodoxime is an oral, third-generation cephalosporin.
Cefuroxime is a second generation cephalosporin and is effective in treating Streptococci, MSSA and Gram-negative bacteria associated with mild-moderate foot infections.
A phlebotomist had an accidental needlestick injury while drawing a blood sample from an HIV-positive patient. Which drug combination is the preferred regimen for post-exposure prophylaxis?
A. Emtricitabine + tenofovir alafenamide
B. Efavirenz + tenofovir disoproxil fumarate + emtricitabine
C. Raltegravir + tenofovir disoproxil fumarate + emtricitabine
D. Dolutegravir + abacavir + lamivudine
E. Rilpivirine + emtricitabine + tenofovir alafenamide
Raltegravir + tenofovir disoproxil fumarate + emtricitabine
Post-exposure prophylaxis (PEP) guidelines recommend 28 days of Truvada (tenofovir disoproxil fumarate + emtricitabine) + Isentress (raltegravir).
Descovy
Emtricitabine + tenofovir alafenamide
Atripla
Efavirenz + tenofovir disoproxil fumarate + emtricitabine
Isentress
Raltegravir
Truvada
tenofovir disoproxil fumarate + emtricitabine
Triumeq
Dolutegravir + abacavir + lamivudine
Odefsey
Rilpivirine + emtricitabine + tenofovir alafenamide
Allof the following statementsregarding amphotericin B are correct EXCEPT:
A. Doses of conventional amphotericin B ≥ 1.5 mg/kg/day can cause cardiopulmonary arrest.
B. It is a fungicidal agent with broad antifungal spectrum of activity.
C. Lipid formulations have a greater risk for nephrotoxicity than conventional formulations.
D. The conventional formulation requires premedication to reduce infusion-related reactions.
E. All formulations can causehypomagnesemia and hypokalemia.
Lipid formulations have a greater risk for nephrotoxicity than conventional formulations.
Lipid formulations of amphotericin B are associated with fewer toxicities (including decreased infusion reactions and decreased nephrotoxicity) compared to amphotericin B deoxycholate (also referred to as conventional amphotericin).
Lipid-based amphotericin B doses are higher than conventional, ranging from 3-6 mg/kg/day.
To help prevent dosing errors, amphotericin B deoxycholate (conventional) carries a boxed warning to confirm any dose exceeding 1.5 mg/kg/day.
Which of the following is the mechanism of action of Diflucan?
A. It binds to ergosterol in the cell membrane altering cell membrane permeability.
B. It interferes with fungal RNA and protein synthesis.
C. It inhibits the synthesis of beta (1,3)-D-glucan.
D. It decreases ergosterol synthesis and cell membrane formation.
E. It interferes with microtubule formation by binding tubulin.
It decreases ergosterol synthesis and cell membrane formation.
Diflucan is an azole. Azoles act by inhibiting the production of ergosterol, which decreases cell membrane formation.
Azoles Class Effects
↑ LFTS
QT prolongation (except isavuconazonium)
Many drug interactions
What is the only azole that requires renal dose adjustment?
Fluconazole
CrCl ≤ 50: ↓ dose by 50%
What azole has hepatotoxicity has led to liver transplantation?
Ketoconazole
Topical forms Brand: Nizoral A-D, Extina, Ketozole
What azole can cause heart failure?
Itraconazole (Sporanox)
What azole can cause visual changes and phototoxicity?
Voriconazole
Posaconazole
Noxafil
Tablet dose ≠ suspension dose (due to different bioavailability)
Take with food
Azol IV Administration
IV to PO ratio is 1:1 for all azoles
Drugs with sulfobutyl ether beta-cyclodextrin (SBECD) vehicle: voriconazole, posaconazole
Primary PPx in Pts w/ HIV
CD4 < 200
Or Oropharyngeal candidiasis
Or other AIDS-defining illness
Pneumoncystis pneumonia (PCP)
Primary PPx in Pts w/ HIV
Pneumoncystis pneumonia (PCP) Regimen
Preferred: SMX/TMP DS tab PO daily or SS tab PO daily
Alternative:
SMX/TMP DS tab 3x/week or
Dapsone or
Dapsone + pyrimethamine + leucovorin
Pentamidine (aerosolized)
Atovaquone
CD4 < 200
Leucovorin is added to reduce myelosupression associated w/ pyrimethamine
Primary PPx in Pts w/ HIV
CD4 < 100
Toxoplasma ondii encephalitis (Toxo)
w/ (+) Toxoplasma IgG
Primary PPx in Pts w/ HIV
Toxoplasma ondii encephalitis (Toxo)
Preferred: SMX/TMP DS tab PO daily
Alternative: SMX/TMP SS tab daily or 1 DS TIW
Dapsone + pyrimethamine + leucovorin
Primary PPx in Pts w/ HIV
CD4 < 50
Mycobacterium avium complex (MAC)
Must rule out active disseeminated MAC disease
Primary PPx in Pts w/ HIV
Mycobacterium avium complex (MAC)
Azithromycin 1,200 mg PO 1x/week or 600 mg PO 2x/week
Clarithromycin 500 mg PO BID
