Infection/Antibiotics (High Risk) Flashcards
Aminoglycosides
Gentamicin - mainly in the UK
- all given IV as not absorbed in the gut
- doses calculated from weight (IBW if obese) and renal function
- monitoring of serum concentrations needed (peak and trough), 1 hour after dose & just before next dose
- wherever possible treatment should not exceed 7 days
- contraindicated in myasthenia gravis
- cautions: conditions of muscle weakness, auditory disorders, impaired renal function
- side effects: nephrotoxic, ototoxic, skin reactions
Carbapenems
β-lactam antibacterials - Meropenem
- Meropenem - seizure-inducing potential
- Imipenem given with Cilastatin to block renal enzymes
- Meropenem used for Pseudo. ariginosa, sepsis, meningitis, endocarditis
- side effects: GI, skin reactions, allergy to β lactam
- monitor liver function as risk of hepatotoxicity
- dose adjustments needed in renal impairment
Cephalosporins
similar to Pencillins - allergy
1st Gen = Cefalexin, Cefradine, Cefradoxil
2nd Gen = Ceflacor, Cefuroxime
3rd Gen = Cefixime, Cefotaxime, Ceftazidime, Ceftriaxone
- contraindicated in those with immediate sensitivity to penicillin and other β lactase
- cautioned in those with sensitivity to penicillin
- side effects: antibiotic associated colitis, C diff, SCARs, GI upset
- dose adjustments needed in renal impairment - be cautious when used alongside other nephrotoxic drugs
- interacts with Warfarin - increases bleeding risk
Glycopeptides
Teicoplanin/Vancomycin
- used for C diff, diabetic foot infections, cellulitis
- vancomycin C/I in those with previous hearing loss
- cautioned if sensitivity to Vancomycin
- side effects: nephrotoxicity (more so Vancomycin), ototoxicity, neutropenia, agranulocytosis, RED MAN SYNDROME
- monitoring: renal function, auditory function, serum peak/trough concentration, blood counts, liver function
- monitoring for vancomycin: leucocytes
Macrolides
an alternative to penicillin-allergic patients
- erythromycin, azithromycin, clarithromycin
- cautions: electrolyte disturbances (due to QT), myasthenia gravis, any predisposition to QT interval
- side effects: associated colitis, hypokalaemia (pre-disposing to QT, SCARs, hearing loss/tinnitus
- azithromycin & erythromycin avoid ingestion remedies 2 hours either side of the dose
- clarithromycin & erythromycin are enzyme inhibitors
Penicillins
Pen V, Flucloxacillin, Amoxicillin, Co-Amoxiclav (β Lactamase Inhibitor
- caution: history of allergy or allergy to other β Lactam drugs (cephalosporins, carbapenems)
- side effects: GI upset, thrombocytopenia, antibiotic associated colitis, anaphylaxis/hypersensitivity
- Pen V & Fluclox - take 1 hour before food/empty stomach
- Amoxicillin + Co-Amox - doesn’t matter about food
- interactions with Warfarin & Methotrexate
Quinolones
(fluroroquinolones) Ciprofloxacin
- quinolone may induce convulsions in those with a history of them OR taking an NSAID at the same time
- tendon damage/rupture - so C/I in those with a history of tendon disorders, careful as those over 60 more susceptible, increased risk concomitant use of steroids (so avoid use together)
- cautions: prolongs the QT interval, seizure conditions (epilepsy), myasthenia gravis, diabetes, exposure to sunlight
- NOT for children, may cause athropathy
- side effects: convulsions, QT prolongation, hypersensitivity, tendon damage, C diff
Tetracyclines
Oxytetracyclin, Tetracycline, Doxycycline,
- cautioned in myasethenia gravis (muscle weakness) and
- side effects: GI upset, photosensitivity/skin reactions, (avoid sunlight and IV), teeth discolouration (avoid in those under 12), intracranial hypertension
- administration: taken with a good amount of water to avoid ulceration, not within 2 hours of indigestion remedies (Oxytet & Tetracycline)
- avoid in renal impairment
Which antibiotics do you have to avoid indigestion remedies within 2 hours of taking?
Doxycycline
Azithrmocin
Minocycline
Which antibiotics do you have to avoid milk and indigestion remedies containing zinc/iron within 2 hours of taking?
Oxytetracycline
Ciprofloxacin
Tetracycline
What antibiotics do you have to take on an empty stomach?
Azithrmocyin Pen V Flucloxacillin Oxytetracycline Ampircillin Fosfomcyin
What antibiotics do you have to take with/after food?
Metronidazaole Pivmecillinam Clarithromyicn Cefuroxime Griseofulvin Itraconazole Nitrofurantoin
Which antibiotics do you have to take with a full glass of water?
Clindamycin
Doxycycline
Metronidazole
What is the treatment pathways for UTIs?
1st Line:
- Nitrofurantoin OR Trimethoprim
2nd Line:
- Nitrofurantoin, Pivmecillinam OR Fosfomycin
Pregnant Women - CANNOT have Trimethoprim, teratogenic
What antibiotics are associated with C difficile?
Clindamycin
Cephalosporins
Broad-Spec Penicillins
Fluoroquinolones
