Infectious Disease Flashcards
Common drugs
MSSA
- Dicloxacillin, oxacillin, naficillin
- 1st gen cephs (cefazolin, cephalexin)
Common drugs
CA-MRSA SSTI
- Bactrim
- doxycycline
- clindamycin
- linezolid
Common drugs
VRE (E. faecalis)
- Pen G, ampicillin
- linezolid
- daptomycin
Common drugs
VRE (E. faecium)
- linezolid
- daptomycin
Common drugs
HNPEK
GNR (H. influenzae, Neisseria, Proteus, E.coli, Klebsiella)
- B-lactams/B-lactamase inhibitor (Avycaz, Zerbaxa)
- amoxicillin
- cephs (except 1st gen)
- carbapenems
- Bactrim
- AG
- FQ
Common drugs (DOC)
Atypicals
Legionella, Chlamydia, Mycoplasma, Mycobacterium tuberculosis
- macrolides (azithromycin, clarithromycin)
- doxycycline
- FQ
Common drugs
Pseudomonas
GNR
- Zosyn
- cefepime
- ceftazidime
- Avycaz, Zerbaxa
- carbapenem (except ertapenem)
- aztreonam
- cipro, levofloxacin
- AG
- colistimethate, polymyxin B
Common drugs
Acinetobacter baumannii
Gram (-) coccobacilli
- carbapenems (except ertapenem)
- Unasyn
- FQ
Common drugs
ESBL GNR
ES b-lactamase
E. coli, K. pneumoniae, Proteus mirabilis (PEK)
- carbapenems
- Avycaz, Zerbaxa
Common drugs
CRE GNR
- Avycaz
- colistimethate, polymyxin B
Common drugs
Bacteroides fragilis
aneaerobe
- metronidazole
- BL/B-lactamase inhib (Avycaz, Zerbaxa)
- cefotetan, cefoxitin (2nd gen cephs)
- carbapenem
Common drugs
Clostridium difficile
- Vancomycin (PO)
- Fidaxomicin (Dificid)
ABX - No renal dose adj
NOT CLeAReD
- naficillin
- oxacillin
- tigecycline
- clindamycin
- linezolid
- azithromycin (+ erythomycin)
- Rocephin (ceftriaxone)
- doxycycline
- metronidazole
- moxifloxacin
3rd ceph
ceftriaxone, cefotaxime
coverage AND DOC?
- MDR Strep. pneumoniae
- MDR HNPEK
DOC: sepsis, CAP, S. pneumoniae,
ceph/B-lactamase inhib combo
Avycaz, Zerbaxa
coverage?
- MDR Pseudomonas
- MDR GNR
Cephs
What do ALL cephs do not cover?
- Enterococci (E. faecalis, E. faecium)
- atypicals (Chlamydia, Mycobact…)
Cephs
Cephlasporins
Class effect?
- PCN allergy cross-sensitvity
- Seizure risk
Carbapenems
Carbapenems
Indication?
- Reserved for MDR GNR
- Pseudomonas
- ESBL grm (-)
- most grm (+)
Carbapenems
Carbapenem
Does not cover?
- atpicals
- MRSA
- VRE
Carbapenems
Ertapenem
Does not cover? (hint: PEA)
- Pseudomonas
- Enterococcus
- Acinetobacter
Carbapenem
Carbapenem
Class effect?
- CI: PCN allergy
- Seizure risks
- Monitor renal fxn
Monobactam
Aztreonam
Indication?
when b-lactam allergy is present
No cross-sensitvity to PCN
Monobactam
Aztreonam
Coverage?
- Many gm (-)
- Pseudomonas
Monobactam
Aztreonam
Does not cover?
- gm (+)
- anaerobes
Aminoglycosides
Aminoglycosides
Coverage?
- gm (-)
- Pseudomonas
- gm (+) WHEN USED FOR SYNERGY WITH b-lactam or vancomycin
Primarily used as EMPIRIC tx when in combo w/ other abx (not monotx)
Aminoglycosides
Aminoglycosides
BBW?
- nephrotoxcity (caution: renal imp.)
- ototoxicity
- neuromuscular bloackade
Aminoglycosides
Aminoglycosides
Monitoring? based on dosing?
- renal fxn
- traditional dosing - draw trough right before/30 min prior to 4th dose, draw peak 30 min after the end of 30-min infusion for the 4th dose
- extended-interval dosing - draw random level
Fluoroquinolones
Fluoroquinolones
Class effect? (BBW, SE, DDI) (note: SPRING)
- BBW - tendon rupture, peripheral neuropathy, CNS effects (seizures, tremor, hallucinations, etc)
- SE - skin (photosensitvity), prolong QT, increase C. diff risk, glycemia (hyper/hypo)
- DDI - multivitamin (polyvalent cations), antiacids, lanthum, sevelamer, QT prolonging drugs (e.g. azole, macrolides)
Fluoroquinolones
What FQs cover Pseudomonas?
Cipro, levofloxacin
Macrolides (-mycins)
Macrolides
Coverage?
- atypicals (Legionella, Chlamydia, Mycoplasma, Mycobacterium)
Macrolides (-mycin)
Macrolides
Tx indication?
- CA-URTI, LRTI
- Chlamydia (atypical)
Macrolides (-mycin)
Macrolides
DDI?
- Clarithromycin, erythromycin (CYP3A4 inhib) - do not use with simvastatin and lovastatin
- warfarin
- QT prolonging drugs (azoles, FQ)
Macrolides (-mycins)
Macrolides
Class effect
- QT prolongation
- hepatoxicity (liver)
- GI upset
Tetracyclines
Tetracyclines
Coverage?
- gm (-)
- atypicals (Legionella, Chlamydia, Mycobact…)
- Rickettsiae/tick-bourne dz
Tetracyclines
Tetracyclines
Class effect?
- Do not use in pregnancy, breastfeeding, or children <8 yo
- SE: photosensitivity
Tetracyclines
Doxycycline
First-line?
- Lyme disease
- Rocky mountain spotted fever (tick-bourne)
- CAP
- COPD exacerbations
- VRE UTI
- Chlamydia
Tetracyclines
Tetracyclines
DDI
- multivitamins, antiacids (polyvalent cations)
- bismuth salicylate (Pepto-bismul)
- bile acid resins
Sulfonamides
TMP/SMX
Class effect?
- CI: sulfa allergy, pregnancy/breasfeeding
- Warnings - skin rxns (SJS, TTP), G6PD def (hemolysis risk)
- SE - inc K, photosensitvity, hemolytic anemia, crystalluria (take with 8 oz water)
Sulfonamides
TMP/SMX
Coverage
- MRSA
- CA-MRSA
- HPEK
- Shigella, Salmonella, Stenotrophomonas
- opportunistic infections (Toxiplasmosis, Pneumocystitis (PJP))
Sulfonamides
TMP/SMX
Does not cover?
- Pseudomonas
- Enterococcu
- atypicals
- anaerobes
Sulfonamides
TMP/SMX
DDI
- CYP2C9 inhibitor - warfarin (inc INR).. use alternative
- Other meds that cause hyperkalemia
Gm (+) abx; no gm (-)
Vancomycin
Covers?
- ONLY COVERS GM (+)
- MRSA
- C. diff (PO only)
Gm (+) abx; no gm (-)
Vancomycin
Class effect?
- SE - redman syndrome (infusion rxn; no >1 g/hr), ototoxicity, nephrotoxicity
Gm (+) abx; no gm (-)
Vancomycin
Therapeutic drug levels?
- AUC/MIC 400-600
- Trough 15-20 (draw 30 min before 4th or 5th dose)
Gm (+) abx; no gm (-)
Daptomycin
Warnings?
- Inc CPK - rhabdomyolysis, myopathy
- False inc of PT/INR
Monitor CPK weekly
Gm (+) abx; no gm (-)
Daptomycin
Does not treat?
Pneumonia
(inactivated by lung surfacants)
Gm (+) abx; no gm (-)
Daptomycin
Covers?
- MRSA
- VRE
Gm (+) abx; no gm (-)
Linezolid
Covers?
- MRSA
- VRE
Gm (+) abx; no gm (-)
Linezolid
Class effects?
- CI - do not use within 2 weeks of MOA inhibitors
- Warning - myelosuppression (thrombocytopenia, anemia, leukopenia), optic neuropathy, serotonin syndrome, hypoglycemia
- SE - dec plts
- Monitor CBC qweek
Gm (+) abx; no gm (-)
Clindamycin
Coverage?
- most gm (+)
- CA-MRSA
- aneaerobes
Gm (+) abx; no gm (-)
Clindamycin
BBW?
CI - colitis (C. diff)
Metronidazole
Covers?
- anaerobes
- B. frag
- protozoal organisms (bacterial vaginosis, trichomoniasis)
Metronidazole
Indication?
Used in combo for intra-abdominal infections
Metronidazole
Class effect?
- CI - pregnancy (1st trimester), alcohol during treatment or within 3 days of d/c (disulfiram rxn)
- SE - metallic taste
Metronidazole
Covers?
- anaerobes
Community-acquired pneumonia (CAP)
Common pathogens?
- S. pneumoniae
- H. influezae
- M. pneumoniae
Community-acquired pneumonia (CAP)
outpatient tx for healthy PTs
- High-dose amoxicillin
- Doxycycline
- Macrolide
Usually PO meds
Community-acquired pneumonia (CAP)
outpatient tx for high-risk PTs
- B-lactam (Augmentin OR ceph) + (macrolide OR doxycycline)
- Respiratory FQ monotx (moxi, levofloxacin)
Usually PO meds
Community-acquired pneumonia (CAP)
inpatient tx in non-severe/general med unit PTs
- B-lactam (Unasyn OR ceph) + (macrolide OR doxycycline)
- Respiratory FQ monotx (moxi, levofloxacin)
Usually IV meds
Community-acquired pneumonia (CAP)
inpatient tx in severe/ICU PTs
- B-lactam + macrolide
- B-lactam + resp FQ
Usually IV meds; no FQ monotx
HAP/VAP
Definitions?
HAP - onset >48hrs after hospital admission
VAP - onset >48 hours after start of mechanical ventilation
HAP/VAP
Common pathogens
- S. aureus (+ MRSA)
MDR GNR - Enterobacter
- Pseudomonas
- Acinetobacter
- E. coli
- Klebsiella
HAP/VAP
Tx in ALL pts
ALL PTs need abx for Pseudomonas AND MSSA
E.g.
1. cefepime
2. Zosyn
3. cipro/levofloxacin
HAP/VAP
If at risk for MRSA?
ADD vancomycin (combo regimen)
HAP/VAP
If at risk for MDR GNR?
Need 2 abx for **Pseudomonas **
E.g.
1. Zosyn + cipro/levo + vanco
2. **Cefepime + gentamicin **+ linezolid
Typically MRSA risk is present as well
DOC
MSSA
Nafcillin/oxacillin
DOC
CA-MRSA
- doxycycline
- Bactrim
DOC
non-CA-MRSA
Vancomycin
DOC
Enterococcus
Ampicillin
DOC
ESBL
Carbapenems
Cephs that cover anaerobes/B. frag
TITANIC
- Cefotetan
- Cefoxitin
2nd gen cephs