ABXSH5-cases

Question 1

MRSA

Answer 1

first line IV is gonna vanco ( SOFT TISSUE )
If they fail we move on to
Daptomycin, linezolid ( tedizolid ) , Ceftaroline ( 5th gen Ceph skin) , telavancin ( dalbavancin , oritavancin -ddi hep/warf )

PO sending home:
-clindamycin
-bactrim
- doxycycline
-minocycline
-linezolid

Question 2

MRSA

Answer 2

first line IV is gonna vanco
If they fail we move on to
Daptomycin, linezolid ( tedizolid ) , Ceftaroline ( 5th gen Ceph ) , telavancin ( dalbavancin , oritavancin )

PO sending home:
-clindamycin
-bactrim
-minocycline
-linezolid

Question 3

VRE

Answer 3

E faecium increased resistance and AG. E faecalis sometime susceptible to beta lactam and Ampicillin

Therapy for ifx due to VRE.
-linezolid
-daptomycin
-tigecycline

•quinupristin -dalfopristin
•Tedizolid / telavancin / oritavancin

Question 4

Bactrim

Answer 4

Trimethoprim- sulfamethoxazole
Main therapy here trimethoprim : MOA : inhibits bacterial dihydrofolate reductase. Sulfonamide is for synergism ( trimethoprim to sulfa ratio : 1: 5) or sulfa to trimethoprim ( 5: 1)

SE: bone marrow suppression, ( folic acid reverse )
-hyperkalemia*** ( like ace arb , tekterna , SGL2 inhibitors, Drospirenone ( YAZ ) )
-rash ( Steven Johnson’s syndrome ) , crystalluria

Renal clearance
- use 50% of dose for CrCl 15-30 ml/min
- done use for CrCl < 15 ml/ min

Pregnancy C

SPEC: gram ( - ) , PCP, MRSA,
Clinical use: UTI ( first line for uncomplicated ) [ uncomplicated: 3-5, complicated 7-10, pyelonephritis: 10-14d
, PCP ( pneumocystis, Jiroveci Pneumonia) , MRSA
DDI : warfarin, avoid use or decrease by 25-50 % , rifampin reduces levels of bactrim

Contraindications: •infants < 2 months , hepatic or severe renal, Preg pt or nursing( kernicterus : encephalopathy due to excess bilirubin ) , megaloblastic anemia due to folate deficiency

Question 5

Bactrim IV

Answer 5

Call it Dactrim bc you always make it D5W
Only good for 6 hours at room temp ( oritavancin you could refrigerate ) NEVER REFRIGERATE BACTRIM

Should NOT be cloudy or crystallization ( recall mannitol and metronidazole ) those could be crystally and you would just warm it up and dissolve. If you see crystal in bactrim throw it out

Question 6

Rifaximin

Answer 6

Xifaxin
Not systematically absorbed. GI probs only
- travelers diarrhea indication at first.
- now : prevention of hepatitic encephalopathy due to cirrhosis.: kills bacteria in the gut that produces ammonia. Give it with lactulose.
- IBS -D

Question 7

Rifamycin

Answer 7

Aemcolo: a non absorbable antibiotic designed to exhibit its action on the distal small intestine and colon

Indications: travelers diarrhea caused by noninvasive strains of E. coli in adults.

Contraindicated: hypersensitivity to rifamycin or other rifamycin class antimicoribal agents ( rifaximin)

Question 8

Atovaquone

Answer 8

Mepron

Indications: PCP treatment ( recall : DOC for PCP prevention is bactrim ) and prophylaxis in HIV patients with sulfa allergy

Question 9

ABX Safe during pregnancy

Answer 9

Pregnancy category B

1) Penicillins and cephalosporins
2) Erythromycin and Azithromycin.
Avoid Clarithromycin: birth defects seen in animals )
3) Clindamycin ( alternative to metronidazole in the first trimester or anaerobic coverage )
4) Nitrofurantoin - we dont give it after 38 weeks of pregnancy
5) daptomycin

Metrondazole is B but SHOULD be avoided in 1st trimester

Question 10

What drug is safe during pregnancy for anaerobic coverage?
What is an alternative ?

Answer 10

Clindamycin : covers gram positive and anaerobes

Alternative to clindamycin for anaerobic coverage could be Metronidazole

Question 11

ABX NOT SAFE during pregnancy

Answer 11

PREG unsafe:
1) Tetracycline ( D ) : avoided in 2nd and 3rd trimester. ( we dont give to kids less than 8 y/o as well )
2) Fluoroquinolones ( preg C ) : cartilage damage seen in animal studies
3) Bactrim ( preg C ): trimethoprim may cause birth defects in 1st trimester and sulfonamides may cause high bilirubin and jaundice of the baby if near term
4) Chloramphenicaol ( C ) : cardiovascular collapse, gray baby syndrome
5) Clarithromycin ( C ) : defects seen in animal studies
6) Aminoglycosides. ( D ) : auditory dysfunction
7) Metronidazole ( preg B ) : AVOID in 1st semester due to concerns about possible defects

Question 12

ABX refrigeration and DO NOT REFRIGERATE

Answer 12

DO not refrigerate : biaxin ( clarithromycin ) , Cleocin ( clindamycin ), Omnicef ( Cefdinir )

Do not need to:
Amoxicillin, Zithromax, Suprax, duricef, ceftin, Eryped

MUST be refrigerated : Augmentin