pneumonia Flashcards
name antipseudomonal penicillins
tazocin/ piperacillin with tazobactam
indications for tazocin
- severe infections esp where broad spectrum needed or where abx resistance likely. Or patients immunocompromised
- LRTI, URI, Intrabdo sepsis, skin and soft tissue infection
SE tazocin
- GI upset
- c diff colitis
- hypersensitvity
lower dose of tazocin in which patient
moderate to severe renal impairment
interactions of tazocin
- methotrexate; increased risk of toxicity
- enhance warfarin effect by killing vit k synthesising gut flora
how is tazocin given
IV infusion
normal dose of tazocin
4.5g pip and 500mg taz. every 6-8hrs
how dose tazocin come to administer
powder to be reconstituted in 10ml sterile water or nacl. this is diluted further in 50-150ml of nacl or 5% glucose for infusion.
what should you be mindful of when give tazocin
- it contains 11mol na+ so think about other electrolytes being given
name quinolones
ciprofloxacin
moxifloxacin
levofloxacin
quinolone indications
2nd/3rd line due to c diff chance
- UTI
- severe gastroenteritis
- LRTI
quinolone spectrum of activity
broad spectrum esp gram -ve
cipro is good for which organism
pseudomonas
what are the advantages of newer quinolones e.g. moxiflox/ levoflox
- more gram +ve activity
MOA quinolonea
- inhibit DNA synythesis = bactericidal .
- bacteria become resistant
SE quinolones
- GI upset
- immediate/ delayed hypersensitivity
- neurological; lowers seizure threshold and hallucinations
- infla and rupture of muscle tendons
- esp moxi but all = prolonged QTi
- c diff
Use quinolones with caution in which patients
- risk of seizures
- kids and young adults still gorwing -= risk of arthropathy
- QT prolonged patients
interactions of quinolones
- drugs with divalent cations e.g. ca and antacids reduce absorption and efficacy
- cipro inhibits cyp 450 so increased toxicity if some drugs esp theophylline
- co prescription with NSAIDS= increased risk seizure
- with prednislone = increased tendon rupture
- careful with arrhythmia inducing drugs
typical dose cipro
250-750mg PO 12-hrly
400mg IV 12hrly
typical dose moxi
400mg PO/IV dialy
Typical dose levo
- 500mg PO/IV
how do IV quinolones come pre packed
- in solution for infusion over 60mins
what travellers diarrhoea is cipro good for
- shigella, salmonella, campylobacter
what abx is used for pneumocyatis jiroveci pneumonia
trimethoprim combined with sulfamethoxazole as co-trimoxazole
trimethoprim indications
- acute lower UTI
- Propyhlaxis of recurrent UTI
Alternatives include nitro, amoxi and cefalexin.
also used for acne, resp infections and prostatis
co-trimoxi for prevention of pneumocystis pneumonia in immunosuppresion
Trimethoprim spectrum
broad spec, gram pos and -ve. but high resistance. combo with sulfonamide as co trimoxi is what extends the spectrum
trimethoprim MOA
- inhibits bacterial folate synthesis - slows bacterial growth; bacteriostasis.
- but widespread bacterial resistance
- sulfa also onhibits bacterial folate synthesis but at different steps in the pathway
trimethoprim SE
- GI uupset
- skin rash
- severe hypersensitivity inc anaphylaxis, drug fever and erythema multiforme - more common with sulfonamides
- impair haematopoeoises causing haematological disorder sich as megaloblastic anaemia, leucopenia and thrombocytopenia
- hyperkalaemia and elevation of plasma creatinine concentrations
CI to trimethoprim
- first trimester of pregnancy ; NTDs
- relatice CI;folate deficiency who are more susceptible to adverse haematological effects
relative CI; Renal impariment - dose reduce
- neonates, elderly and HIV patients are susceptible so reduce dose or avoid
trimethoprim interactions
- potassium elevating drugs
- folate antagonists - be careful combining use
- drugs that increase folate metabolism e.g. phenytoin , increase risk of adverse haematological effects
- can enhance the anticoagulant effect of warfarin by killing normal gut flora that synthesis vit k
usual dose of trimethoprim for UTI
200mg 12hrly
how can you give co-trimoxazole
- oral or IV;
weight based dose 120mg.kg.day.
or IV in 2-4 divided doses.
- 14-21 days to treat pneumocystis
lower dose for pneumocystis prohphylaxis
what does trimethoprim do to creatinine
- inhibits creatinine secretion by tubules. so small reversible rise in serum creatinine on bloods.
