- < 10% reported are IgE mediated - risk of anaphylaxis with parenteral penicillin: 0.01-0.02%, risk of mortality: 0.0015-0.02% - 50% patients will lose sensitivity to penicillin after 5 years - 80% lose sensitivity after 10 years

Antibacterial Therapy Flashcards by Winnie Li

Penicillins

V (PO), G (IV)

Spectrum: streptococci

Common indications: bacterial pharyngitis, endocarditis (IV)

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Beta-lactams:
Penicilins
Cephalosporins
Carbapenems

MOA: inhibition of bacterial cell wall synthesis

bind and inactivate penicillin binding protein (PBPs) in the bacterial cell wall membrane
prevent cross-linking of peptide chains
activate’s bacterial cell’s autolytic system
clavulanic acid can be added to inhibit beta-lactamase

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Amocicillin PO and Ampicillin IV

Spectrum: streptococci and Enterococcus faecalis 
Common indications: 
- otitis media
- community acquired pneumonia (CAP) 
- enterococal infections

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Cloxacillin PO/IV

Spectrum: Methacillin susceptible staph. aureus (MSSA)
Common indications:
IV: bacteremia, endocarditis, bone/joint infections
PO: skin/soft tissue

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Amoxacillin/clavunate PO

Spectrum: Gram +/-, anaerobes
Common indications:
poly microbial infections - bite wounds, diabetic foot ulcer

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Piperacillin/tazobactam IV

Spectrum: Gram +/-, Pesudomonas aeruginosa, anaerobes
Common indications:
febrile neutropenia, intraabdominal, polymicrobial infections, sepsis unknown source

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Ticarcillin/clavunate IV

Similar to piperacillin/tazobactam

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Cephalosporins:
Cephalexin, cefazolin 
Cefuroxime, Cefprozil 
Cefotaxime, Ceffixime, Ceftazidime
Cefepime

Spectrum: Gm +, Gm- for some newer gens, no activity against enterococci, no activity vs MRSA
Common indications:
1st gen - skin/soft tissue, bone/joint
2nd gen - CA resp infections (not first line)
3rd gen - urosepsis, endocarditis, meningitis, UTI, gonorrhea
4th gen - combo with amino glycosides for Pseudomonas, febrile neutropenia, polymicrobial infections

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Carbapenems:
Ertapenem IV
Meropenem IV
Imipenem IV

Spectrum: Gm +/-, ESBL/AmpC producers, pseudomonas, anaerobes
Common indications:
- not first line for CA infections
- reserve for serious infix with known multi-drug resistance
-activity vs ampC cephalosporinase and ESBL-producing organisms
- no activity vs MRSA

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Type I allergy - Immediate

IgE mediated

Anaphylaxis, hypotension, bronchoconstriction, urticaria, laryngeal edema, angioedema
- onset within 1 hr up to 72 hrs

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Type II allergy - Cytotoxic

IgG/IgM mediated

Hemolytic anemia, neutropenia, thrombocytopenia

- onset > 72 hrs

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Type III allergy - Immune Complex

Serum sickness, drug-induced fever, interstitial nephritis

- onset 7-14 days

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Type IV allergy - T-cell mediated

Contact dermatitis, exfoliative dermatitis, maculoapular or morbiliform rash, Stevens Johnson syndrome
- onset >72 hours

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Penicillin Allergy

< 10% reported are IgE mediated
risk of anaphylaxis with parenteral penicillin: 0.01-0.02%, risk of mortality: 0.0015-0.02%
50% patients will lose sensitivity to penicillin after 5 years
80% lose sensitivity after 10 years

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Penicillin Allergy Cross-Reactivity

Related to R-side chain of antibacterial (not the beta-lactam ring)

~1% risk with cephalosporins or carbapenems with known penicillin allergy
if IgE mediated rxn to penicillin, consider 3rd/4th gen cephalosporins/carbapenems via graded challenge or desensitization
if life-threatening non-IgE mediated rxn, AVOID ALL beta-lactams

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Glycopeptides/lipopeptides:

Vancomycin (glyco)
Daptomycin (lipo)

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MOA: inhibit bacterial cell wall synthesis, bactericidal
glycopeptides: bind to terminal D-ala-D-ala residues
lipopeptides: Ca2+ dep cel memb depol/ disrupts RNA/DNA protein synthesis
Spectrum: Gm+ including MRSA
Special considerations:
- vancomycin slowly tidal
- PO vancomycin not systemically absorbed (good for C. difficile)
- daptommycin inactivated by lung surfactant - not effective for pneumonia

Vancomycin IV

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Spectrum: Gm+ including 
- enterococci
- penicillin-resistant streptococci 
- MRSA
- coagulas(-) staphylococcus 
Common indications: 
- bacteremia, pneumonia, endocarditis, bone/joint, skin/soft tissue, surgical prophylaxis

Daptomycin IV

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Spectrum: Gm+
- as for vancomycin IV
- vancomycin resistant organisms (eg. VRE)
Common indications: bacteria, endocarditis, bone/joint, skin/soft tissue

Aminoglycosides:

Gentamicin
Tobramycin

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MOA: Bind to 30S ribosomal subunit, inhibit protein synthesis, Bactericidal
Special considerations
- renal eliminated
- may cause nephrotoxicity, ototoxicity
- gentamicin synergy vs Enterococci with beta-lactams (facilitates uptake of gentamicin)

Gentamicin IV

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Spectrum: Gm -
- pseudomonas
- syngergy vs Streptococci and Enterococci with beta-lactam or vancomycin
Common indications:
- drug resistant UTI
- combo therapy for Gm - spesis
- synergy for Gm+ bacteremia and endocarditis

Tobramycin IV

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Spectrum: Gm - 
- pseudomonas (better than gentamicin) 
Common indications:
- drug-resistant UTI
- combo therappy for serious Pseudomonas infx

Macrolides

- azithromycin

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MOA: bind to 23S rRNA of 50S subunit, inhibit protein synthesis, Bacteriostatic
Special considerations:
- active vs intracellular organisms
- long half-life (3 day = 10 day course)

Azithromycin IV/PO

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Spectrum: 
- Chlalmydophila
- Legionella
- Moraxella catarrhalis
- Chlamydia trachomatis 
- Neisseria gonorrhea 
- Mycobacterium avium complex (MAC) 
Common indications: 
- combo for MAC tx
- MAC prophylaxis in HIV pts
- 2nd line for STIs
- combo with beta-lactam for CAP

preferred macrolide over erythormycin and clarithromycin b/c broader spectrum, fewer drug interactions, once daily dosing, tolerability, IV option

Lincosamides

- Clindamycin

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MOA - binds to 50S ribosomal subunit, inhibit protein synthesis, Bacteriostatic

Special Considerations:

Excellent bioavailability
possibly inhibits toxin production form GAS, active vs bacteria in resting phase
used in combo with penicillin for necrotizing fasciitis
high risk of C. difficile

Clindamycin PO/IV

``` Spectrum: - Streptococci - S. aureus - MRSA - Anaerobes Common indications: - skin/soft tissue - bone/joint - abscesses - alternative for dental infections - poly microbial infections in combo with Gm- agent - combination vs necrotizing fascitis ```

Tetracyclines and Glycycyclines - Doxycycline (PO) - Tigecycline (IV)

MOA: Bind 30S and 50S ribosomal subunits, inhibit protein synthesis, Bacteriostatic Special considerations: - active vs intracellular pathogens

Doxycycline PO

Spectrum: - mycoplasma, chlamydophila, Legionella, Chlamydia thrachomatic, S.penumoniae, Haemophilus, Moraxella, S aureus (incl MRSA) Common indications: - COPD, CAP, chlamydial STIs, purulent cellulitis (Suspected MRSA)

Tigecycline IV

``` Spectrum: - broad Gm+/- (incl E. faecalis, MRSA) - anaerobes Common Indications: - last line option of polymicrobial, multi drug resistant organisms if susceptibility confirmed ```

Fluoroquinolones - ciprofloxacin - levofloxacin

MOA: inhibition of DNA gyrase and topoisomerase, Bactericidal Special considerations: - excellent bioavailability - levofloxacin and moxifloxacin active vs. intracellular pathogens - High risk of C. difficile - widespread use leading to Gm - resistance

Ciprofloxacin IV/PO

Spectrum: - Gram-, Pseudomonas Common indications: - usu not 1st line due to increasing Gm - resistance - UTI - in combo with metronidazole or clindamycin for polymicrobial infections

Levofloxacin IV/PO

``` Spectrum: - Streptococci - Mycoplasma - Chlamydophila - Legionella - Gm neg Common indications: - not 1st line - reserve for suspected drug-resistant respiratory infection or allergy to 1st line agents ```

Anti-folates - Trimethroprim-sulfamethoxazole (TMP-SMX) - Nitrofurantoin

MOA: TMP-SMX: inhibit DHFR and DHPS [Bacteriostatic] - excellent oral bioavailability - increasing resistance for S. pneumoniae and E.coli Nitrofurantoin: reduced to reactive intermediates that damage ribosomal proteins, DNA etc. [Bactericidal] - effective for cystitis, not pyelonephritis - may not be effective if CrCl <40-60ml/min

Trimethoprim/Sulfamethoxazole IV and PO

``` Spectrum: - Gm- - S. aureus (incl MRSA) - S pneumoniae - Nocardia, Pneumocystis jiroveci Common indications: - UTI (not first line) - purulent cellulitis - nocardia infections - PCP treatment and prophylaxis ```

Nitrofurantoin PO

``` Spectrum: - E. Coli - Klebsilela - E. faecalis Common indications: - first line for cystitis ```

Nitroimidazoles | - Metronidazole

``` MOA: inhibits DNA synthesis, bactericidal Special considerations: - excellent bioavailability - excellent CNS penetration - avoid alcohol (disulfiram rxn) ```

Metronidazole PO/IV

``` Spectrum: - anaerobes, including C. difficile - protozoa (eg. Giardia) Common indications: - C. difficile - used in combo for polymicrobial infections/abscesses - Trichomoniasis ```

Oxazolidinones | - Linezolid

MOA - inhibition of protein synthesis by binding to 23S rRNA in 50S ribosomal subunit (prevent 70S formation); Bacteriostatic Special considerations: - activity vs beta-lactam resistant and vancomycin resistant organisms - excellent bioavailability - cytopenias with prolonged therapy (>2 weeks)

Linezolid IV/PO

``` Spectrum: - Streptococi - Enterococci - Staphylococci - anaerobes Common indications: - resistance, allergy or failure with vancomycin therapy ```

Anti-tuberculous Drugs - Rifampin - Isoniazid - Pyrazinamide - Ethambutol

Special considerations: - four drug combo for TB empirically due to increasing resistance - bactericidal - well absorbed - drug interactions due to induction of Cyp3A4 by rifampin - monitor for hepatotoxicity

Antibacterial Therapy Flashcards

(39 cards)