Macrolides, Tetracyclines, FQ's Flashcards
Azithromycin brand name
Zithromax, Zmax
Azithromycin indications, bugs, and doses
L/URTI, skin/skin structure infections caused by H. influenzae, M. catarrhalis, S. pneumo, S. pyogenes, S. aureus, S. agalactiae: 500mg on day 1 followed by 250mg daily for 4 days (ZPAK)
Mild/Moderate COPD exacerbations: 500mg daily x3 days or ZPAK
AOM: 10mg/kg on day 1, 5mg/kg on days 2-5
pharyngitis/tonsilitis: 12mg/kg daily x5 days
MAC prevention in HIV:1200mg weekly
CAP caused by C. pneumo, H. flu, L. pneumo, M. cat, M. pneumo, S. aureus, or S. pneumo: 500mg IV x2 days, then 250mg daily x7-10 days
Pelvic Inflammatory Disease due to C. trach, N. gon, or M. hominis: 500mg IV x2 days, then 250mg daily x7-10 days (same as CAP)
Azithromycin mechanism
macrolide
binds to 50S ribosomal subunit of susceptible bacteria, suppressing protein synthesis
Azithromycin distribution
most body tissues EXCEPT CSF
Azithromycin excretion
excretion through bile as unchanged drug
Azithromycin drug interactions
antacids slow absorption
food decreases absorption
nelfinavir increases (x2) serum concentrations of Azithromycin
caution with drugs that prolong QT interval
Azithromycin CI/precautions
CI: hypersensitivity to macrolides or ketolides
caution: hepatic dysfunction, prolonged QT interval, low serum K or Mg, and bradycardia. patients being treated for arrhythmias
colitis/secondary infections have occurred, contact physician with persistent diarrhea
DO NOT USE FOR complicated pneumonia, gonorrhea, or syphilis
Azithromycin pregnancy category
B
Azithromycin ADR’s
DIARRHEA, nausea, vomiting, abdominal pain
IV: pain at injection site and local inflammation
Azithromycin patient education
prefer to be taken with food, except ZMAX should be taken on empty stomach
do not take antacids within 1 hour of administration
report severe persistent diarrhea
Ciprofloxacin brand name
Cipro (XR)
Ciprofloxacin indication/dosage
infectious diarrhea
UTI’s
uncomplicated pyelonephritis
LRTI, SSTI, and bone and joint infections
Typhoid fever: all ~500mg BID for 7-10 days
gonorrhea: 250mg once
uncomplicated cystitis: 100mg q12h for 3 days
aerosolized anthrax: 500mgorally or 400mg IV q12h for 60 days
Ciprofloxacin mechanism
prevents synthesis of bacterial DNA
Ciprofloxacin coverage
wide range of activity against Gram- and Gram_ bacteria
Ciprofloxacin drug interactions
Antacids and iron salts decrease bioavailibility
Probenicid increases serum levels by decreasing excretion
NSAIDs may lower seizure threshold (mostly important for levofloxacin)
THEOPHYLLINE coadmin may lead to elevated plasma concentrations of theophylline
Ciprofloxacin CI/precautions
CI: hypersensitivity. discontinue at first sign of rash or other allergic reaction, may be fatal
Do not use in patients receiving theophylline
caution: known or suspected CNS disorders, esp predisposed to seizures
Convultions, ICP, and psychosis have been reported
May rupture shoulder, hand, or Achilles tendon muscles, discontinue immediately
Ciprofloxacin pregnancy category
C
may cause permanent lesions in weight-bearing joints in children and adolescents, do not use in pregnant women
Ciprofloxacin ADRs
nausea, diarrhea, sun sensitivity, dizziness, RASH, MUSCLE RUPTURE
Ciprofloxacin patient education
avoid prolonged sun exposure
take full course
discontinue if rash develops or tendon rupture occurs
take with full glass of water, without regard to meal
do not take antacids during therapy, or iron/calcium supplements within 2 hours before or 6 hours after
suspension can be stored at room temp, discard after 14 days
may cause dizziness or lightheadedness
do not chew, crush, or split XR tabs
Clarithromycin brand name
Biaxin (XL)
Clarithromycin indication/dosage
mild/mod pharyngitis or tonsilitis (S. pyogenes), mild/mod maxillary sinusitis (S. pneumo), Chronic bronchitis exacerbation (S. pneumo, M. cat, H. flu), pneumonia, CAP, uncomplicated SSTI, etc.
General dosing: 1000mg daily for 7-14 days
Clarithromycin mechanism
inhibits protein synthesis by binding to 50S ribosomal subunit.
Clarithromycin drug interactions
may increase serum theophylline and carbamazepine levels
Erythromycin may increase digoxin, warfarin, ergotamine, and triazolam, unsure if clarithromycin does too
Clarithromycin CI/precautions
CI: hypersensitivity to macrolides
C. diff has been associated with use
caution or decrease dose in severe renal impairment
Clarithromycin pregnancy category
C
caution in pregnant and nursing women
Clarithromycin ADRs
nausea, DIARRHEA, disruption in taste, dyspepsia, abdominal pain, headache
Clarithromycin patient education
take XL with food, IR does not matter with food or not
complete full course!
Report worsening diarrhea
store suspension at room temp, discard unused after 14 days. Follow each dose with liquid to rinse from mouth
