Infectious disease I Flashcards
What is collateral damage?
unintended consequences of antibiotic use
common resistant pathogens
- Kill Each And Every Strong Pathogen
- Klebsiella (ESBL, CRE)
- E.coli (ESBL, CRE)
- Acinetobacter
- Enterococcus (VRE)
- S.aureus (MRSA)
- Pseudomonas
hydrophilic drugs
- beta-lactams
- aminoglycosides
- glycopeptides
- daptomycin
- polymyxins
lipophilic drugs
- quinolones
- macrolides
- rifampin
- linezolid
- tetracyclines
hydrophilic drugs PK parameter
- small Vd -> poor tissue penetration
- renal elimination -> nephrotoxicity possibility
- low intracellular concentration -> not effective against atypical infections which is mostly intracellular
- increased Cl and/or distribution in sepsis
- poor/moderate bioavailability -> either no PO or IV:PO not 1:1
lipophilic drugs PK parameter
- large Vd -> good issue penetration
- hepatic metabolism -> hepatotoxicity possibility
- good intracellular concentrations -> yes for atyipicals
- Cl/distribution not changes in sepsis
- good bioavailability -> IV:PO 1:1
beta-lactam MOA
bind to PCN-binding proteins (PBPs) -> inhibit bacterial wall synthesis
PCN coverage
- gram positive cocci
- Streptococci, Enterococci
aminopenicillins coverage
PCN coverage + HNPEK
HNPEK
- Haemophilus
- Neisseria
- Proteus
- E.coli
- Klebsiella
aminopenicillins + beta lactamase inhibitors coverage
same as aminopenicillins plus:
- MSSA
- more resistant HNPEK
- anaerobe (B.fragilis)
Zosyn coverage
same as aminopenicillins + beta lactamase inhibitors plus:
- CAPES
- Pseudomonas
CAPES
- Citrobacter
- Acinetobacter
- Providencia
- Enterpbacter
- Serratia
antistaph PCN
- strep
- staph (MSSA)
PCN pearls
- PCN G benzathine IM only; NOT for IV (can cause cardioresp arrest and death)
- do not use extended forms of amox or augmentin or augmentin 875 in patients w/ CrCl < 30
- ADE: seizure with accumulation, GI upset, diarrhea, rash
- amox has chewable forms available
- IV amp diluted in NS only
- zosyn can be given via extended infusion (4h)
- sodium in zosyn
- no renal dose adjustments in antistaph pcn
- nafcillin is vesicant; risk of extravasation; if happens, use cold packs and hyaluronidase
PCN drug interactions
- probenecid can increase beta-lactams (interfere with renal excretion)
- beta-lactams (except naf and dicloxacillin) enhance warfarin
- PCNs increase methotrexate
- PCNs decrease mycophenolate
Key: PCN VK
1st line for strep throat and mild nonpurulent
Key: amoxicillin
- first line treatment for acute otitis media (80-90mg/kg/day)
- 1st choice for infective endocarditis prophylaxis before dental procedure (2g 30-60 min before procedure)
- used in H.pylori treatment
Key: augmentin
- 1st line for acute otitis media (90mg/kg/day) and sinus infection if indicated
- use lowest dose of clav to decrease diarrhea
Key: PCN G benzathine
- 1st line for syphilis (2.4 millions units IM once)
- not for IV use; can cause death
Key: zosyn
- active against psuedomonas
- can be used with extended infusion (4h)
Key: antistaph PCN
- cover MSSA only
- no renal dose adjustments needed
T/F: cephalosporin not active against Enterococcus
True
first generation cephalosporins
- *cefazolin (Ancef)
- *cephalexin (Keflex)
- cefadroxil