L33- Antibiotic Clinical Uses Flashcards
discuss the general guidelines and treatment options for bacterial endocarditis
- IV antibiotics (prolonged course)
- valve debridement, repair, replacement
Note- usually give empiric therapy after cultures are taken (not before)
Bacterial Endocarditis, empiric therapy:
- (1) choice therapy
- (2) possible adjunct, especially with (3) Pts
- (4) alternate therapy
1- vancomycin, gentamicin (aminoglycoside)
2- rifampin
3- prosthetic valve
4- linezolid, daptomycin
α-hemolytic Streptococci Endocarditis:
- (1) choice treatment
- (2) alternatives
1- Penicillins (IV): penicillin G, ampicillin + Gentamicin (aminoglycoside, limit 5-7 days)
2:
- Vancomycin; penicillin allergy [+ Gentamicin]
- IV ceftriaxone (3rd gen. cephalosporin) + Gentamicin
list the types of S. aureus Endocarditis and associated therapy
i) Oxacillin-sensitive strain: nafacillin or oxacillin +/- gentamicin
ii) Penicillin-allergic (nonanaphylactoid) Pt: cefazolin +/- gentamicin
iii) Oxacillin-resistant strain: vancomycin +/- gentamicin
list the surgical conditions for which bacterial endocarditis prophylaxis is used
- **dental surgeries
- respiratory surgeries
-GI, GU, MSK surgeries involving area with established infections
list the cardiac conditions for which bacterial endocarditis prophylaxis is used
- prosthetic cardiac valves
- previous infective endocarditis
- CHD
- cardiac transplant recipients with valvulopathy
bacterial endocarditis prophylaxis:
- (1) choice therapy
- (2) alternatives
1) Oral: amoxicillin
2) penicillin allergy, Oral: (many options) clindamycin, cephalexin, azithromycin, clarithromycin
3) oral therapy not possible, IV/IM: ampicillin
4) no oral + penicillin allergy, IV: clindamycin, cefazolin
bacterial pharyngitis, GAS Strep.:
- (1) choice therapy
- (2) alternatives
1- penicillin V (oral)
2:
- amoxicillin (oral)
- penicillin G benzathine (IV/IM)
- macrolide (penicillin-allergy)
- clindamycin
- 1st/2nd gen. cephalosporin
bacterial sinusitis:
- (1) choice therapy
- (2) alternatives
1- amoxicillin (oral)
2:
- amoxicillin-clavulanic acid
- macrolide (penicillin allergy)
- co-trimoxazole
- 2nd/3rd gen. cephalosporin
acute otitis media:
- (1) choice therapy
- (2) alternatives
1- amoxicillin (oral)
2:
- amoxicillin-clavulanic acid
- macrolide (penicillin allergy)
- co-trimoxazole
- 2nd/3rd gen. cephalosporin
CA-pneumonia, out-patient empiric therapy: healthy + no antibiotics in last 3 mos
-macrolide (pregnancy and children)
OR
-doxycyclin (no pregnancy, children)
CA-pneumonia, out-patient empiric therapy: indicate the therapy for complicated status (include criteria for complicated status)
-co-morbidities, immuno-suppressing conditions, immuno-suppression therapy, antimicrobials in last 3 mos
-respiratory fluoroquinolones
OR
-β-lactam (penicillin/cephalosporin) + macrolide
CA-pneumonia, in-patient, no ICU empiric therapy
-respiratory fluoroquinolones
OR
-β-lactam (penicillin/cephalosporin) + macrolide
CA-pneumonia, in-patient, in ICU empiric therapy
- β-lactam (penicillin/cephalosporin) + azithromycin / respiratory fluoroquinolones
- (penicillin allergy): respiratory fluoroquinolones + aztreonam (monobactam)
aspiration pneumonia (anaerobes)
- (1) preferred agent
- (2) second line agent
1- clindamycin
2- metronidazole
bordetella pertussis:
- (1) preferred agent
- (2) second line agent
(whooping cough)
1- macrolide
2- co-trimoxazole
chlamydia pneumoniae:
- (1) preferred agent
- (2) second line agent
1- macrolide, doxycycline
2- 3rd/4th gen. fluoroquinolones
H. influenzae, non-β-lactamase producing- otitis media, sinusitis:
- (1) preferred agent
- (2) second line agent
1- amoxicillin
2- 2nd/3rd gen. cephalosporin, co-trimoxazole
H. influenzae, β-lactamase producing- otitis media, sinusitis:
- (1) preferred agent
- (2) second line agent
1- 2nd/3rd gen. cephalosporin OR amoxicillin-clavulanic acid
3- co-trimoxazole
Klebsiella pneumoniae:
- (1) preferred agent
- (2) second line agent
1- ceftriaxone, cefotaxime
2- fluoroquinolones
Legionella spp.:
- (1) preferred agent
- (2) second line agent
1- fluoroquinolone, azithromycin
2- doxycycline, co-trimoxazole
Moraxella catarrhalis:
- (1) preferred agent
- (2) second line agent
(HEENT infections)
1- amoxicillin-clavulanic acid, 2nd/3rd gen. cephalosporins, co-trimoxazole
2- macrolides
Mycoplasma pneumoniae:
- (1) preferred agent
- (2) second line agent
1- macrolide, doxycycline
2- 3rd/4th gen. fluoroquinolones
Pseudomonas aeruginosa:
- (1) preferred agent
- (2) second line agent
1- anti-pseudomonal penicillin (ticarcillin, piperacillin)
2- levofloxacin, aztreonam (monobactam), aminoglycoside
Staph. aureus (non-MRSA):
- (1) preferred agent
- (2) second line agent
1- anti-staphylococcal penicillin (nafcillin, oxacillin, dicloxacillin)
2- 2nd/3rd gen. cephalosporins, clindamycin, fluoroquinolones, imipenem
MRSA:
- (1) preferred agent
- (2) second line agent
(methicillin resistant S. aureus)
1- vancomycin, linezolid
2- ceftaroline
Strep. pneumoniae (non-penicillin resistant):
- (1) preferred agent
- (2) second line agent
1- penicillin G, amoxicillin
2- cephalosporin, clindamycin, fluoroquinolone, macrolide, co-trimoxazole
Strep. pneumoniae, penicillin resistant:
- (1) preferred agent
- (2) second line agent
Note- depends on culture sensitivity testing
1- 2nd/3rd gen. cephalosporin, 3rd/4th gen. fluoroquinolones
2- vancoomycin, linezolid, streptogramins
Tularemia:
- (1) preferred agent
- (2) second line agent
1- streptomycin
2- gentamicin, chloramphenicol
list the antibiotic that cause Clostridium difficile colitis:
- (1) most common antibiotic
- (2) frequently cause it
- (3) occasionally cause it
1- Clindamycin
2- ampicillin/amoxicillin, cephalosporins, fluoroquinolones
3- penicillin, erythromycin, trimethoprim
Clostridium difficile:
- (1) preferred agent
- (2) second line agent
- (3) third line
- (4) non-antibiotic treatment
1- vancomycin
2- fidaxomicin
3- metronidazole
4- fecal microbiota transplant
Traveler’s diarrhea (indicate organism):
- (1) preferred agent
- (2) second line agent
(ETEC)
1- ciprofloxacin
2- amoxicillin, azithromycin, doxycycline
Bacterioides fragilis in suspected intra-abdominal infections: therapy options
Alone: metronidazole, carbapenems, clindamycin
Combo: β-lactam + β-lactamase inhibitor
Giardia therapy
metronidazole
list the H.pylori therapies
1st: clarithromycin + amoxicillin + metronidazole + PPI
2nd (penicillin allergy): clarithromycin + metronidazole + PPI
3rd: clarithromycin + amoxicillin + PPI
4th: bismuth subsalicylate + metronidazole + tetracycline + PPI
Uncomplicated UTI:
- (1) preferred agent
- (2) second line agent
(E. coli is majority cause)
1- co-trimoxazole
2- ciprofloxacin, nitrofurantoin, amoxicillin-clavulanic acid
Uncomplicated UTI / Simple Cystitis in pregnancy therapy
- penicillins
- cephalosporins
- nitrofurantoin (not close to term- hemolytic anemia)
- sulfonamides (not close to term- kernicterus)
acute bacterial prostatitis therapy
- fluoroquinolones: ciprofloxacin, levofloxacin
- co-trimoxazole
- doxycycline
Syphilis:
- (1) preferred agent
- (2) second line agent
1- penicillin G benzathine
2- doxycycline, azithromycin
Gonorrhea:
- (1) preferred agent
- (2) second line agent
1- ceftriaxone
2- doxycycline, azithromycin
Chlamydia (STI)
azithromycin, doxycycline
Trichomoniasis:
- (1) preferred agent
- (2) second line agent
1- metronidazole
2- tinidazole
bacterial vaginosis:
- (1) preferred agent
- (2) second line agent
1- metronidazole
2- clindamycin
bacterial meningitis empirical therapy
vancomycin + ceftriaxone
bacterial meningitis prophylaxis
rifampin
ciprofloxacin
ceftriaxone
