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Anti-Infectives Dosing Flashcards

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1
Q

What is the initial conventional dosing of gentamicin?

A

1.5-2mg/kg per dose Q8H based on ideal or adjust body weight

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2
Q

What is the initial extended-interval dosing of gentamicin?

A

5-7mg/kg per day based on ideal or adjust body weight

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3
Q

What is the renal dosage adjustment for gentamicin?

A

Individualized based on CrCL and therapeutic drug monitoring

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4
Q

What peak ranges are associated with efficacy for gentamicin?

A

5-10mcg/mL

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5
Q

What trough ranges are associated with decreased nephrotoxicity for gentamicin?

A

Less than 1-2mcg/mL

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6
Q

How is gentamicin extended interval dosing monitored?

A

Via nomograms with concentrations measured 6-14 hours from time of administration

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7
Q

How does tobramycin IV dosing compare to gentamicin?

A

Same

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8
Q

What is tobramycin inhalation dosing for preventing exacerbations in cystic fibrosis patients?

A

300mg every 12 hours

-should not be used as monotherapy to treat pneumonia

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9
Q

Which organism does tobramycin have slightly better activity against vs gentamicin?

A

Pseudomonas aeruginosa

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10
Q

Which organism does gentamicin have slightly better activity against vs tobramycin?

A
  • Klebsiella pneumoniae

- Gram positive organisms

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11
Q

What is the adult dosing of cefprozil?

A

250-500mg BID

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12
Q

What is the pediatric dosing of cefprozil?

A

7.5mg/kg BID
or
20mg/kg daily, depending on the indication

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13
Q

What is the renal dosage adjustment of cefprozil?

A

Reduce dose by 50% with a CrCL less than 30 mL/min

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14
Q

What is the adult dosing of cefdinir?

A

Most indications: 300mg BID
or
600mg QD

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15
Q

What is the pediatric dosing of cefdinir?

A

7mg/kg/dose BID
or
14mg/kg/dose QD

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16
Q

What is the renal dosage adjustment of cefdinir?

A

300mg QD if CrCL less than 30 mL/min

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17
Q

What is the adult ceftriaxone dosing for most indications?

A

1-2g QD

Maximum daily dose of 4g

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18
Q

What is the adult ceftriaxone dosing for meningitis?

A

2g IV Q12H

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19
Q

What is the adult ceftriaxone dosing for gonorrhea?

A

250mg IM once

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20
Q

What is the pediatric ceftriaxone dosing for mild to moderate infections?

A

50-75mg/kg daily (divided QD or BID)

Maximum daily dose of 2g

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21
Q

What is the pediatric ceftriaxone dosing for meningitis?

A

100mg/kg daily (divided QD or BID)

Maximum daily dose of 4g

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22
Q

What is the adult cefuroxime dosing for most indications?

A

250-500mg BID

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23
Q

What is the pediatric (younger than 12 yo) cefuroxime dosing for most indications?

A

20-30mg/kg/day divided into 2 doses

Max daily dose: 1g

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24
Q

What is the renal dosage adjustment of cefuroxime?

A

Dose every 24 hours with a CrCL less than 30mL/min

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25
What is the adult cephalexin dosing for most indications?
1-4g daily in divided doses | Most commonly: 250mg QID
26
What is the pediatric cephalexin dosing for most indications?
25-100mg/kg/day in 2-4 divided doses (max daily dose: 4g)
27
What is the pediatric cephalexin dosing for acute otitis media?
75-100mg/kg/day in 4 divided doses
28
What is the renal dosage adjustment of cephalexin?
Adjust for CrCL less than 60mL/min
29
What is the adult cefepime dosing for most indications?
2g Q8-12H
30
What is the pediatric cefepime dosing for most indications?
50mg/kg/dose Q8-12H | Maximum: 2g/dose
31
What is the renal dosage adjustment of cefepime?
Adjust for CrCL less than 60mL/min
32
What two indications does cefuroxime have that cefprozil does not have?
- UTIs | - Lyme disease
33
What indications do cefprozil and cefuroxime share?
- upper and lower RTIs - uncomplicated skin/structure infections - tonsillitis
34
What indications does ceftriaxone have?
- upper/lower RTIs - skin/structure infections - UTIs - gonorrhea - pelvic inflammatory disease - bacteremia - endocarditis - bone/joint infections - intra-abdominal infections - meningitis - surgical prophylaxis - Lyme disease
35
What is daptomycin dosing for skin/structure infections?
4mg/kg daily
36
What is daptomycin dosing for bacteremia and endocarditis?
6mg/kg daily
37
What dose of daptomycin is recommended by some experts in cases of complicated MRSA bacteremia and endocarditis?
8-10mg/kg daily
38
What is the renal dosage adjustment of daptomycin?
Administer QOD if CrCL less than 30mL/min
39
What is the adult oral ciprofloxacin dosing for most indications?
250-750mg BID depending on location and severity of infection
40
What is the adult oral ER ciprofloxacin dosing for UTIs?
500-1000mg daily
41
What is the adult IV ciprofloxacin dosing for most indications?
200-400mg BID or TID depending on location and severity of infection
42
What is the renal dosage adjustment of ciprofloxacin?
Required with CrCL of less than 30-50mL/min
43
What is the adult oral levofloxacin dosing for most indications?
250-750mg QD depending on indication
44
What is the renal dosage adjustment of levofloxacin?
Decreased dose depending on whether CrCL is 20-49mL/min or 10-19mL/min
45
What is the adult oral moxifloxacin dosing for most indications?
400mg QD
46
What is the renal dosage adjustment of moxifloxacin?
Not necessary | -excreted via the biliary tract
47
What is the adult Bactrim dosing for most indications?
1 DS tablet BID
48
What is the adult Bactrim dosing for UTIs?
1 DS tablet BID
49
What is the adult Bactrim dosing for Pneumocystis prophylaxis?
1 DS tablet QD or TIW | 1 SS tablet QD
50
What is the adult Bactrim dosing for Toxoplasmosis prophylaxis?
1 DS tablet QD
51
What is the adult Bactrim dosing for Toxoplasmosis treatment?
5mg/kg BID
52
What is the adult Bactrim dosing for P. jirovecci pneumonia?
15-20mg/kg/day based on trimethoprim divided TID-QID
53
What is the pediatric Bactrim dosing for most indications?
8-10mg/kg/day based on trimethoprim divided TID-QID
54
What is the pediatric Bactrim dosing for P. jirovecci pneumonia?
Same as adult dosing
55
What is the renal dosage adjustment of Bactrim?
50% of usual dose if CrCL of 15-30mL/min
56
What is the oral vancomycin dosing?
125-500mg Q6H
57
What is the adult injection vancomycin dosing?
15-20mg/kg BID
58
What is the pediatric injection vancomycin dosing?
10mg/kg/dose Q6H
59
What is the infant injection vancomycin dosing?
Loading dose: 15mg/kg Followed by: -10mg/kg Q12H (first week of life) -10mg/kg Q8H (1 week to 1 month of life)
60
What is vancomycin dosing determined by?
- patient characteristics - infection severity - renal function
61
What is the renal dosage adjustment of vancomycin?
Most clinicians reduce IV dose at CrCL of 50-60mL/min
62
What is a therapeutic vancomycin trough?
10-20mg/L Depends on: -characteristics of infecting organism -type of infection
63
What vancomycin troughs are associated with nephrotoxicity?
Greater than 15-20mg/L
64
Are vancomycin peaks routinely monitored?
No | -evidence correlating concentrations with efficacy is imperfect

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