Not beta lactams Flashcards
What is vancomycin?
Antibiotic
Useful in gram +, MRSA, penicillin-resistant enterococci and streptococci
How is vancomycin administered?
Parenteral
Oral only for c diff if metronidazole doesn’t work
What is vancomycin used for?
Severe infections only
Useful in gram +, MRSA, penicillin-resistant enterococci and streptococci
Also used for pseudomembranous colitis due to c diff
What is the first choice for pseudomembranous colitis due to c diff?
Metronidazole
Use vancomycin only if that doesn’t work
How is vancomycin excreted?
Kidneys
What does vancomycin target?
Transglycosylases
Blocks connection of NAM-NAG to NAM-NAG
What are adverse effects of vancomycin?
Fever, chills, shock
Redman syndrome (Histamine release, head and neck mostly)
Nephrotoxicity with inappropriate dosing
Ototoxicity - high concentrations when given with other ototoxins
True or false: There is no resistance to vancomycin
False, resistance is becoming a problem in E. faecium
What is televancin?
Bactericidal cell wall synthesis inhibitor, derivative of vancomycin
What is televancin used for?
Used for skin and skin structure, MRSA, gram +, nosocomial pneumonia
What is the mechanism for televancin?
Similar to vancomycin - inhibits cell wall synthesis
but also depolarizes bacteria by disrupting the membrane
What are the adverse effects of televancin?
Nausea, vomiting, foamy urine
Decreases renal function
Redman syndrome
Taste disturbances
May interfere with clotting tests (not blood clotting itself, just the test - draw blood 23 hours after dose)
What are the SERIOUS adverse effects of televancin?
Adverse fetal effects (avoid during pregnancy)
QT prolongation
Renal insufficiency
Which agent has to be given only after a pregnancy test is done?
Televancin
How does Daptomycin work?
Depolarizes bacteria, bacteria lose membrane potential and cell death occurs
What is daptomycin used for?
Broad spectrum gram +
Vancomycin resistant bacteria
Staphylococci and streptococci
How is daptomycin administered?
IV Once daily dosing
Which agent has renal dosing?
Daptomycin
If CRCL is less than 30 mL/min, give dosing every 48 hours instead of every 24
Which agent is inactivated by pulmonary surfactant?
Daptomycin
What toxicities are associated with daptomycin?
Muscle damage, rhabdomyolsis (do not give with statins, aminoglycosides)
Which agent can cause muscle damage/rhabdomyolsis?
Daptomycin
How does fosfomycin work?
Blocks first step in peptidoglycan synthesis (inside the cell)
What is fosfomycin used for?
Single dose therapy for uncomplicated UTI’s due to Ecoli or Enterococci faecalis
How is fosfomycin excreted?
Concentrated and unchanged in the urine
What are adverse effects of fosfomycin?
Diarrhea, nausea/vomiting
Vaginitis
Asthenia
What is Bacitracin?
Cyclic polypeptide that blocks the lipid carrier molecule to move peptidoglycan to cell wall
What does bacitracin target?
Gram + bacteria
How is bacitratin administered?
Topical OTC
Often formulated with polymixin (Polysporin) or neomycin (Neosporin)
Why can’t bacitracin be taken by mouth?
It’s nephrotoxic systemically
