Infectious Disease 1 Flashcards
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
How do I start?
- Recognize common organisms and groups of organisms
- Focus on resistant organisms and drugs that treat them
- Learn basic spectrum of coverage
- identify important points
Gram (+) cocci cluster organisms
Staphylococcus spp. (MSSA, MRSA)
Gram (+) cocci pairs & chain organisms
Streptococcus pneumoniae (diplococci)
Streptococcus spp. (including Streptococcus pyogenes)
Enterococcus spp. (Enterococcus faecalis, Enterococcus faecium)
Gram (+) rod organisms:
Listeria monocytogenes
Gram (+) Anaerobes:
Peptostreptococcus
Actinomyces spp
Clostridium spp
Gram (-) cocci organisms:
Neisseria spp.
Gram (-) rods [ organisms that colonize gut “enteric”]:
- Proteus mirabilis
- Escherichia coli
- Klebsiella spp.
- Serratia spp.
- Enterobacter cloacae
- Citrobacter spp.
Gram (-) rods [Do NOT colonize gut]:
- Pseudomonas aeruginosa
- Haemophilus influenzae
- Providencia spp.
Gram (-) anaerobes:
Bacteroides fragilis
Prevotella spp.
(generally, of the lower GI tract)
Gram (-) coccobacilli organisms:
Acinetobacter baumannii
Bordetella pertussis
Moraxella catarrhalis
Atypical organisms
Do NOT gram-stain well
Mycoplasma pneumoniae
Mycobacterium tuberculosis
Legionella spp.
Chlamydia spp.
Curved or spiral shaped Gram (-) rod organisms:
Groups of Organisms
HNPEK
Haemophilus. influenzae
Neisseria spp
Proteus mirabilis
Escherichia coli (E. coli)
Klebsiella spp
Groups of Organisms
CAPES
- Anytime we are covering for CAPES organisms, we are normally covering for another nosocomial type pathogen called ___________
Citrobacter
Acinetobacter
Providencia
Enterobacter
Serratia
- Pseudomonas aeruginosa**
Groups of Organisms
PEK
Proteus mirabilis
E. coli
Klebsiella spp
1) Identify the organism
- Collect specimen, Gram stain, culture
2) Determine the minimum inhibitory concentration (MIC)
- susceptibility testing
- lowest concentration with no growth
3) Interpretation
MIC is compared to the breakpoint and the organism is determined to be
(S) susceptible
(I) intermediate
(R) resistant to the antibiotic
(S)- means yeah we can use that antibiotic to treat IF
- the antibiotic penetrates the site of infection/area within human body once given
- if patient doesn’t have any contraindications to its use [allergies, renal/hepatic function, ]
- ## if it is the narrowest spectrum antibiotic available to give compared to other antibiotics that work.
** Do NOT compare the MIC of one antibiotic to the MIC of another antibiotic. Those are specific to those particular antibiotics.
You are looking for a drug that is susceptible AND has the Narrowest Spectrum of Activity that follows Guidelines.
Common Resistant Pathogens:
**remember*- - “Kill Each And Every Strong Pathogen”
Klebsiella pneumoniae (ESBL, CRE)
Escherichia coli (ESBL, CRE)
Acinetobacter baumannii
Enterococcus faecalis/faecium (VRE)
Staphylococcus aureus (MRSA)
Pseudomonas aeruginosa
[ESBL-extended-spectrum beta-lactamase]
[CRE-carbapenem-resistant enterobacteriaceae]
[VRE-vancomycin resistant Enterococcus]
[Methicillin Resistant Staphylococcus aureus]
Synergy-
when you are using 2 to get a bigger benefit than using either one alone.
Mechanisms of resistence:
Selection pressure- resistance occurs when antibiotics kill of susceptible
bacteria, leaving behind more resistant strains to multiply.
-
Acquired resistance.
- bacterial DNA containing resistant genes can be transferred between different species and/or picked up from dead bacterial fragments in the environment.
Resistant pathogens require careful antibiotic selection.
ESBL producing bacteria:
Use carbapenem antibiotics.
CRE producing bacteria:
- difficult to treat
- bacteria are (MDR) Multidrug resistant to penicillin’s, most cephalosporins and carbapenems.
All Antibiotics have a warning for__________
the risk of (CDI) Clostridioides difficile infection, but the risk is highest with broad spectrum penicillin’s and cephalosporins, quinolones, carbapenems, and clindamycin, which has a boxed warning.
Antibiotic Stewardship Programs: 26min lec 1
Cell Membrane Inhibitors:
- Polymyxins
- Daptomycin
- Telavancin
- Oritavancin
Cell Wall Inhibitors:
- Beta lactams (penicillin’s, cephalosporins, carbapenems)
- Monobactams (aztreonam)
- Vancomycin, Dalbavancin. telavancin, oritavancin
Folic Acid Synthesis Inhibitors:
- Sulfonamides
- Trimethoprim
- Dapsone
Protein Synthesis Inhibitors:
- Aminoglycosides
- Macrolides
- Tetracyclines
- clindamycin
- Linezolid, tedlizolid
- quinupristin/dalfopristin
DNA & RNA inhibitors:
-Quinolones
- metronidazole, tinidazole
- rifampin
Hydrophilic agents:
- essentially are going to stay in the intravascular space more
- good for blood stream infections
- aminoglycosides
- beta lactams
- daptomycin
- glycopeptides - vancomycin
- polymyxins
- vancomycin
Lipophilic agents:
- going to distribute more in the tissues
- good for infections in the tissues
- Chloramphenicol
- Linezolid
- Macrolides
- Quinolones
- rifampin
- ## Tetracycline
Hydrophilic agents:
- Small Vd
- since hydrophilic, easily eliminated in the kidneys
- remember drugs need to be more polar to get through the kidneys
- Low intracellular concentrations “tissue concentrations”
- With Sepsis, variability with how drugs are cleared
- Increased Clearance in Sepsis
- Poor-moderate bioavailability
Cmax:MIC (concentration-dependent)
Goal: high peak = increased killing, low trough (low toxicity)
aminoglycosides “extended interval dosing strategy”
quinolones
daptomycin
Lipophilic agents:
- Large Vd
- Hepatic metabolism
- Achieve intracellular concentrations “good tissue concentrations.”
- Clearance changed minimally in sepsis
- Excellent Bioavailability
so some drugs with have a IV:PO ratio of 1:1
AUC:MIC (exposure-dependent) - - - another form of Concentration dependent
Goal: exposure over time
vancomycin
macrolides
tetracyclines
polymyxins
Time > MIC (time-dependent)
Goal: maintain drug level > MIC for most of the dosing interval
- beta-lactams (penicillin’s, cephalosporins, carbapenems)
Natural Penicillins
Includes:
Cover:
What are the drugs included in this category?
What are their dosage forms?
What do they cover?
PO: penicillin V potassium PO tablet & suspension
IV: penicillin G [Injection IV]
IM: (Bicillin L-A) penicillin G benzathine (Injection IM)- - - - - use very specific**
Cover:
Active against Gram (+) cocci (streptococci and enterococci) BUT NOT Staph
Active against Gram (+) anaerobes (mouth flora)
- peptostreptococcus
Aminopenicillin + Beta-lactamase Inhibitor
Includes:
Cover:
What are the drugs included in this category?
What are their dosage forms?
What do they cover?
PO: (Augmentin) Amoxicillin/Clavulanate
IV: (Unasyn) Ampicillin/Sulbactam
Covers:
Active against Gram (+) cocci (streptococci and enterococci)
Active against Gram (+) anaerobes (mouth flora)
-
Gram (-) coverage (HNPEK) AND “more resistant forms of these pathogens”
Haemophilus
Neisseria
Proteus
E.coli
Klebsiella
- ADDED ACTIVTY
Active against Gram (+) Staph MSSA
**Active against Gram (-) anaerobes: B. fragilis
Antistaphylococcal Penicillins
Includes:
Cover:
What are the drugs included in this category?
What are their dosage forms?
What do they cover?
PO: dicloxacillin
IV: nafcillin
IV: oxacillin
Covers:
(MSSA)
streptococci only
No coverage for enterococcus
No coverage for MRSA
Aminopenicillins
Includes:
Cover:
What are the drugs included in this category?
What are their dosage forms?
What do they cover?
PO: amoxicillin (Moxatag), much better bioavailability
IV: ampicillin, PO has really poor bioavailability
Covers:
Active against Gram (+) cocci (streptococci and enterococci) BUT NOT Staph
Active against Gram (+) anaerobes (mouth flora)
Adds Gram (-) coverage (HNPEK)
Haemophilus
Neisseria
Proteus
E.coli
Klebsiella
Extended Spectrum Penicillins
Includes:
Cover:
What are the drugs included in this category?
What are their dosage forms?
What do they cover?
IV: (Zosyn) piperacillin/tazobactam
Covers:
Active against Gram (+) cocci (streptococci and enterococci)
Active against Gram (+) anaerobes (mouth flora)
-
Gram (-) coverage (HNPEK) AND “more resistant forms of these pathogens”
Haemophilus
Neisseria
Proteus
E.coli
Klebsiella
-
Active against Gram (+) Staph MSSA
**Active against Gram (-) anaerobes: B. fragilis
-
ADDED ACTIVITY
expanded coverage of other Gram (-) bacteria (big Nosocomial organisms)*
[CAPES] & Pseudomonas
Citrobacter
Acinetobacter
Providencia
Enterobacter
Serratia
&
Pseudomonas aeroginosa
Penicillins as a Class:
All cover:
Do NOT COVER:
Enterococcus (except antistaphylococcal penicillin’s)
No Coverage for:
1) -ATYPICALS:
Mycobacterium tuberculosis
Mycoplasma pneumoniae
Chlamydia spp
Legionella spp
-
2) - MRSA
Only one penicillin covers pseudomonas, which is?
Zosyn
Study Tip: penicillin’s
Class Effects
- beta-lactam allergy [penicillin, cephalosporin, carbapenem]
-
- risk of seizures [patient is on an antiepileptic medication OR they have a seizure history]
* Indications NOT to choose a penicillin*
- - - - –
Outpatient: (Oral)
Penicillin VK (Oral)
- strep throat, mild skin infections
- drug of choice for strep throat
Amoxicillin (Moxatag)
- acute otitis media [drug of choice]
- 90mg/kg/day
- infective endocarditis prophylaxis
- H. pylori
amoxicillin/clavulanate (Augmentin)
- acute otitis media [drug of choice]
- 90mg/kg/day
- lowest dose of clavulanate
So far what drugs cover:
Anaerobes (gram -) = Bacteroides fragilis, Prevotella spp
———————————————————————————————————–
Atypicals: [Chlamydia spp, Legionella spp, Mycoplasma pneumoniae, Mycobacterium tuberculosis]
———————————————————————————————————-
expanded coverage for Gram (-) bacteria (big Nosocomial organisms) [CAPES] = Citrobacter, Acinetobacter, Providencia, Enterobacter Serratia
Klebsiella pneumoniae (ESBL, CRE)
Escherichia coli (ESBL, CRE)
Acinetobacter baumanni
- (Unasyn) ampicillin/sulbactam “the sulbactam component has useful good activity against it.
Enterococcus faecalis, Enterococcus faecium (VRE)
Staphylococcus aureus (MRSA)
- no penicillin’s
Pseudomonas aeruginosa
- (Zosyn) piperacillin/tazobactam*
-
Anaerobes (gram -) = Bacteroides fragilis, Prevotella spp
-
-
So far what drugs cover:
Anaerobes (gram -) = Bacteroides fragilis, Prevotella spp
———————————————————————————————————–
Atypicals: [Chlamydia spp, Legionella spp, Mycoplasma pneumoniae, Mycobacterium tuberculosis]
———————————————————————————————————-
expanded coverage for Gram (-) bacteria (big Nosocomial organisms) [CAPES] = Citrobacter, Acinetobacter, Providencia, Enterobacter Serratia
Klebsiella pneumoniae (ESBL, CRE)
Escherichia coli (ESBL, CRE)
Acinetobacter baumanni
- (Unasyn) ampicillin/sulbactam “the sulbactam component has useful good activity against it.
Enterococcus faecalis, Enterococcus faecium (VRE)
Staphylococcus aureus (MRSA)
- no penicillin’s
Pseudomonas aeruginosa
- (Zosyn) piperacillin/tazobactam*
-
Anaerobes (gram -) = Bacteroides fragilis, Prevotella spp
-
-
Study Tip: penicillin’s
Class Effects
- beta-lactam allergy
- risk of seizures
Inpatient: (Parenteral)
Penicillin G Benzathine (Bicillin L-A)
- syphilis [treponema pallidum]
- Never use IV
Piperacillin/Tazobactam (Zosyn)
- only penicillin active against pseudomonas
- extended-infusion common
nafcillin, oxacillin, dicloxacillin (oral)
- MSSA & strep
- NO RENAL DOSE ADJUSTMENT NEEDED*
So far what drugs cover:
Anaerobes (gram -) = Bacteroides fragilis, Prevotella spp
———————————————————————————————————–
Atypicals: [Chlamydia spp, Legionella spp, Mycoplasma pneumoniae, Mycobacterium tuberculosis]
———————————————————————————————————-
expanded coverage for Gram (-) bacteria (big Nosocomial organisms) [CAPES] = Citrobacter, Acinetobacter, Providencia, Enterobacter Serratia
Klebsiella pneumoniae (ESBL, CRE)
Escherichia coli (ESBL, CRE)
Acinetobacter baumanni
- (Unasyn) ampicillin/sulbactam “the sulbactam component has useful good activity against it.
Enterococcus faecalis, Enterococcus faecium (VRE)
Staphylococcus aureus (MRSA)
- no penicillin’s
Pseudomonas aeruginosa
- (Zosyn) piperacillin/tazobactam*
-
Anaerobes (gram -) = Bacteroides fragilis, Prevotella spp
-
-
1st Generation Cephalosporins:
What are the cephalosporin drugs included in this generation?
What are their dosage forms?
What do they cover?
(Ancef) cefazolin——– given IV/IM
(Duricef) cefadroxil—- given PO
(Keflex) cephalexin—- given PO
Cover Staphylococci- 1st generation preferred if MSSA infection
Cover Streptococci
Cover mouth anaerobes (gram +).
Cover PEK:
Proteus
E. coli
Klebsiella
- Best drugs for Staph (MSSA)
2nd Generation Cephalosporins:
What are the cephalosporin drugs included in this generation?
What are their dosage forms?
What do they cover?
(Ceclor, Raniclor) cefaclor——– given PO
(Cefzil) cefprozil ——————— given PO
(Ceftin, Zinacef) cefuroxime—– given PO/IV/IM
ALL cover:
Cover Staphylococci
Cover Streptococci
Cover mouth anaerobes (gram +)
*have better gram (-) coverage HNPEK
—————————————————————————————————–
(Cefotan) cefotetan—————– given IV/IM
- “cefotetan: has a sidechain that causes a disulfiram-like reaction WITH ALCOHOL”
(Mefoxin) cefoxitin—————— given IV/IM
- **have added gram (-) anaerobic activity (B.fragilis)
3rd Generation Cephalosporins:
Group 1-
What are the cephalosporin drugs included in this generation?
What are their dosage forms?
What do they cover?
(Omnicef) cefdinir—————- given PO
(Rocephin) ceftriaxone——— given IV/IM
(Claforan) cefotaxime———- given IV/IM
(Vantin) cefpodoxime———- given PO
(Suprax) cefixime—————- given PO
less staphylococci coverage
Better Streptococci coverage:
resistant streptococci- Streptococcus pneumoniae, Viridians group Streptococci
Cover mouth anaerobes (gram +)
resistant strains of HNPEK
===========================================================
- go to for CAP- Community acquired pneumonia
3rd Generation Cephalosporins:
Group 2-
What are the cephalosporin drugs included in this generation?
What are their dosage forms?
What do they cover?
** Also of note** everything beyond 3rd generation cephalosporins is IV. Nothing PO
(Fortaz, Tazicef) ceftazidime————— given IV/IM
lacks Gram (+) activity
BUT
Covers: Pseudomonas**
(Avycaz) ceftazidime + avibactam
(Zerbaxa) ceftolozane + tazobactam
-used for MDR gram (-) organisms: Pseudomonas**
4th Generation Cephalosporins:
What are the cephalosporin drugs included in this generation?
What are their dosage forms?
What do they cover?
(Maxipime) cefepime———— given IV
- broad gram (-) activity:
- HNPEK
- CAPES
- Pseudomonas**
- gram (+) activity similar to ceftriaxone
Cover mouth anaerobes (gram +)
less staphylococci coverage, MSSA
Better Streptococci coverage:
resistant streptococci- Streptococcus pneumoniae, Viridians group Streptococci
5th Generation Cephalosporins:
What are the cephalosporin drugs included in this generation?
What are their dosage forms?
What do they cover?
(Teflaro) ceftaroline————- given IV
Gram - similar to ceftriaxone
BUT
covers MRSA**
Cephalosporins as a Class:
All cover:
Do NOT COVER:
cover
Do NOT COVER:
- Enterococcus spp
- atypical organisms
So far what drugs cover:
“Kill Each And Every Strong Pathogen”
Anaerobes
- Gram (+)
- Gram (-)
Atypicals
Klebsiella pneumoniae (ESBL, CRE)
Escherichia coli (ESBL, CRE)
Acinetobacter baumanni
Enterococcus faecalis, Enterococcus faecium (VRE)
NONE
Staphylococcus aureus (MRSA)
- ceftaroline
Pseudomonas aeruginosa
- ceftazidime
- ceftazidime + avibactam
- ceftolozane + tazobactam
- cefepime
Anaerobes
- Gram (+)
-
-
- Gram (-) organisms [e.g. B. fragilis]
- cefotetan
- cefoxitin
Atypicals
NONE
What are the drugs included in this category?
What are their dosage forms?
What do they cover?
(neonates) = 0 -28 days of age.
Ceftriaxone CONTRAINDICATED in this population.
ErtAPenem DOES NOT COVER: “PEA” Pseudomonas, Enterococcus, Acinetobacter.
Carbapenems: -penem
Class effects:
- ALL ARE ACTIVE AGAINST (ESBL) extended spectrum beta-lactamase producing organisms
- ALL ACTIVE AGAINST Pseudomonas [Except ERTAPENEM]
- ALL DO NOT USE WITH A PENICILLIN “beta-lactam” ALLERGY, Cross reactivity
- ALL HAVE Seizure Risk
- # ALL ARE GIVEN IV [NS required ONLY FOR ERTAPENEM]DO NOT COVER: Atypicals
DO NOT COVER: VRE
DO NOT COVER: MRSA
Common uses:
- Polymicrobial infections
- Empiric treatment when MDR pathogens suspected.
Do NOT USE IN THOSE WITH A HIGH RISK OF SEIZURES*
- Hydrophilic agents
- Can accumulate in renal failure AND PRECIPITATE A SEIZURE
So far what drugs cover:
Anaerobes (gram -) = Bacteroides fragilis, Prevotella spp
———————————————————————————————————–
Atypicals: [Chlamydia spp, Legionella spp, Mycoplasma pneumoniae, Mycobacterium tuberculosis]
———————————————————————————————————-
expanded coverage for Gram (-) bacteria (big Nosocomial organisms) [CAPES] = Citrobacter, Acinetobacter, Providencia, Enterobacter Serratia
Klebsiella pneumoniae (ESBL, CRE)
Escherichia coli (ESBL, CRE)
Acinetobacter baumanni
- (Unasyn) ampicillin/sulbactam “the sulbactam component has useful good activity against it.
Enterococcus faecalis, Enterococcus faecium (VRE)
Staphylococcus aureus (MRSA)
- no penicillin’s
- no carbapenems
Pseudomonas aeruginosa
- (Zosyn) piperacillin/tazobactam*
-
Anaerobes (gram -) = Bacteroides fragilis, Prevotella spp
-
-
Aminoglycosides:
What are the drugs included in this category?
What are their dosage forms?
What do they cover?
What do they NOT cover?
- demonstrate concentration dependent activity AND have a post-antibiotic effect (the bacterial killing continues after the serum level drops below the MIC)
- =============================================================
gentamicin—————– given IM, IV, ophthalmic, topical.
amikacin——————– given IM, IV
streptomycin————– given IM.
plazomicin (Zemdri)—- given IV.
tobramycin—————- given INHALED, IM, IV, ophthalmic
Coverage:
- gram (-) negatives, including pseudomonas
- Can be used in LOWER DOSES in Synergy for gram (+) positives infections (Staphylococci/Enterococci),
Do NOT Cover:
Penicillins
class:
Indications:
MOA:
Agent type [hydrophilic- stay in bloodstream or lipophilic- distributes out of blood into tissues and organs]
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
Cephalosporins:
class:
Indications:
MOA:
Agent type [hydrophilic- stay in bloodstream or lipophilic- distributes out of blood into tissues and organs]
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
Carbapenems:
class:
Indications:
MOA:
Agent type [hydrophilic- stay in bloodstream or lipophilic- distributes out of blood into tissues and organs]
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
Aminoglycosides:
class:
Indications:
MOA:
Agent type [hydrophilic- stay in bloodstream or lipophilic- distributes out of blood into tissues and organs]
Dosing:
Max dose:
Boxed Warnings:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
class:
Indications:
MOA:
Agent type:
Dosing:
Traditional Dosing
Extended Interval Dosing
Max dose:
Boxed Warnings:
*Nephrotoxicity
* Ototoxicity (hearing loss, vertigo, ataxia- without coordination)
Contraindications:
Warnings:
Side Effects:
Monitoring:
renal function, drug levels
Pearls/Notes:
– have low resistance
– low cost
Drug-Drug/Food interactions:
Dosing for gentamicin:
(Traditional IV dosing): “a smaller dose given more frequently”
[1-2.5mg/kg IV Q8 hours]
Traditional IV dosing uses:
Peaks-
Troughs-
(Extended-Interval) dosing strategy: “used typically for concentration-dependent antibiotics.” “So, we are giving a bigger dose less frequently.”
–{4-7mg/kg IV Q24H}
** dosing interval is really dependent on patients renal function**
With Extended-Interval dosing:
we, Draw a random level AND using a nomogram.
[Monitoring] = renal function, serum levels
Traditional dosing:
- Draw a Trough level 30min before the 4th dose.
- Then Draw a Peak level 30 MINUTES AFTER the end of the 4th dose.
(drug is usually infused over 30min), so for example if 4th dose infusion starts at 8am, then peak would be drawn at 9am.**
Peaks- 5-10 mcg/mL
Troughs- less than < 2mcg/mL, Do NOT want Trough accumulation, this causes toxicities.
===========================================================
Extended Interval Dosing:
Draw a RANDOM LEVEL per the timing on the nomogram.
Dosing for tobramycin:
(Traditional IV dosing): “a smaller dose given more frequently.”
[1-2.5mg/kg IV Q8 hours]
Traditional IV dosing uses:
Peaks-
Troughs-
(Extended-Interval) dosing strategy: “used typically for concentration-dependent antibiotics. “So, we are giving a bigger dose less frequently.”
–{4-7mg/kg IV Q24H}
** dosing interval is really dependent on patients renal function**
With Extended-Interval dosing:
we, Draw a random level AND using a nomogram.
[Monitoring] = renal function, serum levels
Traditional dosing:
- Draw a Trough level 30min before the 4th dose.
- Then Draw a Peak level 30 MINUTES AFTER the end of the 4th dose.
(drug is usually infused over 30min), so for example if 4th dose infusion starts at 8am, then peak would be drawn at 9am.**
- Then Draw a Peak level 30 MINUTES AFTER the end of the 4th dose.
Peaks- 5-10 mcg/mL
Troughs- less than < 2mcg/mL, Do NOT want Trough accumulation, this causes toxicities.
===========================================================
Extended Interval Dosing:
Draw a RANDOM LEVEL per the timing on the nomogram.
Quinolones:
What are the drugs included in this category?
What are their dosage forms?
What do they cover?
What do they NOT cover?
drugs inhibit bacterial DNA topoisomerase IV and DNA gyrase (topoisomerase II) inside the bacteria. This prevents supercoiling of DNA and promotes breakage of double stranded DNA.
Concentration-dependent killing
*ciprofloxacin– given tablet, suspension, injection, ointment ophthalmic, otic
**delafloxacin– given tablet, injection
ofloxacin—— given tablet, ophthalmic, otic
(respiratory quinolones)—– active against S. pneumoniae
*Levofloxacin– given tablet, injection, ophthalmic. solution
moxifloxacin- given tablet, injection, ophthalmic.
DO NOT USE FOR UTIs*
No renal dose adjustment
Antipseudomonal quinolones———- active against Pseudomonas
Levofloxacin (IV:PO = 1:1)
Ciprofloxacin
- Broad spectrum of activity against Gram (-), Gram (+) and atypical pathogens
[* have enhanced gram (-) activity including Pseudomonas.]
[** is active against MRSA]
Quinolones:
class:
Indications:
MOA:
Agent type [hydrophilic- stay in bloodstream or lipophilic- distributes out of blood into tissues and organs]
Dosing:
Max dose:
Boxed Warnings:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
class:
Indications:
MOA:
Agent type [hydrophilic- stay in bloodstream or lipophilic- distributes out of blood into tissues and organs]
Dosing:
Max dose:
Boxed Warnings:
*Tendon rupture
*Peripheral neuropathy
CNS effects (including seizures)
——Used Last line (Only if No Alternatives)
Contraindications:
Warnings:
*QT Prolongation
*Hypo and hyperglycemia
*Psychiatric disturbances
*Photosensitivity
*Avoid use in Children (risk vs, benefit)
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
- Chelation with divalent cations.(Fe, Ca, Mg,)
Macrolides
What are the drugs included in this category?
“ACE”
What are their dosage forms?
What do they cover?
What do they NOT cover?
azithromycin (Zithromax)—— give as tablet, suspension, injection, ophthalmic.
clarithromycin (Biaxin)———- give as tablet, ER tablet, suspension.
erythromycin (E.E.S) ————– give as capsule, tablet, suspension, injection, ophthalmic, topical.
Cover:
- Atypicals (Legionella, Chlamydia, Mycoplasma, Mycobacterium avium)
- H. influenzae
- S. pneumoniae
=============================================================
Do NOT Cover:
Zithromax
class:
Indications:
MOA:
Agent type [hydrophilic- stay in bloodstream or lipophilic- distributes out of blood into tissues and organs]
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
azithromycin
class: macrolide antibiotic
Indications:
MOA:
Agent type
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
DO NOT USE WITH LOVASTATIN & SIMVASTATIN
Biaxin
class:
Indications:
MOA:
Agent type [hydrophilic- stay in bloodstream or lipophilic- distributes out of blood into tissues and organs]
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
DO NOT USE WITH LOVASTATIN & SIMVASTATIN
clarithromycin
E.E.S
class:
Indications:
MOA:
Agent type [hydrophilic- stay in bloodstream or lipophilic- distributes out of blood into tissues and organs]
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
erythromycin
class:
Indications:
MOA:
Agent type
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
Ery-Tab
class:
Indications:
MOA:
Agent type [hydrophilic- stay in bloodstream or lipophilic- distributes out of blood into tissues and organs]
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
erythromycin
class:
Indications:
MOA:
Agent type
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
Tetracyclines:
What are the drugs included in this category?
What are their dosage forms?
What do they cover?
What do they NOT cover?
