Antimicrobials Flashcards
(22 cards)
Aminoglycosides consist of:
Amikacin Gentamicin Streptomycin Tobramycin Paromycin (oral)
Aminoglycosides: Gentamycin
- Class
- Indications
- Dose range
- Monitoring
- Counselling
- Gram -ve, serious infections w/susceptible organisms that are resistant to other antibacterial, surgical prophylaxis, P.aeruginosa (w/broad spectrum anti-pseudomonal penicillin, cefalosporin or carbapenem), brucellosis, eye infections
- Dose is weight based. Normal renal fn dose is IM/IV 5-7mg/kg once d. Depends on renal fn.
- Eg: Trough (multiple d dosing), AUC (once d dosing)
Tx <48hrs & normal renal fn NO MONITORING.
Tx >48hrs or renal impairment measure drug concentration and serum Cr every 3-5/7 in stable pts, daily in declining renal fn. Pts w/burns, CF, trauma or ICU (those w/altered PK) require more specialised methods of dosing and monitoring.
Renal fn - hepatotoxic
Ototoxic
Calc CrCL at beginning of tx
Minimise toxicity by empirical use for <48hrs - Taking >7-10 days your kidneys may work less well than usual but this should improve when the drug is stopped.
Hearing and balance may be affected, and there may be permanent hearing loss. Tell your doctor if you hearing becomes worse or you’re dizzy when standing.
Carbapenems:
Ertapenem
Imipenem
Meropenem
Carbapenems: meropenem
- Class
- Indications
- Dose range
- Monitoring
- Counselling
- Meningitis (not imipenem), febrile neutropaenia, hospital acquired and life-threatening infections, MDR gram -ve infections, melioidosis (CAP north AUS), severe mixed an/aerobic infections, LRTI exacerbation in CF (mero)
- Ert: 1g once d IV IM
Imi: 500mg Q6H IV max 4g d or 50mg/kg (lower) given with cilastatin
Mero: 0.5-1g Q8H max 2g Q8H.
4. Renal fn Hepatic fn - LFTs raised, hepatitis Seizures Mental status changes Complete blood count (neutropaenia, thromocytosis, thromocytopaenia, eosinophilia, agranulocytosis) mostly mero SJS
- Liver yellowing pale stools
Mental status changes
You may experience tingling in your arms legs hands or feet
Seek medical att. if you have any swelling to your face, rash or shortness of breath
Carbapenems: meropenem
- Class
- Indications
- Dose range
- Monitoring
- Counselling
- Meningitis (not imipenem), febrile neutropaenia, hospital acquired and life-threatening infections, MDR gram -ve infections, melioidosis, severe mixed an/aerobic infections, LRTI exacerbation in CF (mero)
- Ert: 1g once d IV IM
Imi: 500mg Q6H IV max 4g d or 50mg/kg (lower) given with cilastatin
Mero: 0.5-1g Q8H max 2g Q8H.
4. Renal fn Hepatic fn - LFTs raised, hepatitis Seizures Mental status changes Complete blood count (neutropaenia, thromocytosis, thromocytopaenia, eosinophilia, agranulocytosis) mostly mero SJS
- Liver yellowing pale stools
Mental status changes
You may experience tingling in your arms legs hands or feet
Seek medical att. if you have any swelling to your face, rash or shortness of breath
Glycopeptides:
Teicoplanin
Vancomycin
Vancomycin
- Class
- Indications
- Dose range
- Monitoring
- Counselling
- glycopeptide
- MRSA, severe infections w/S organisms, C.diff oral, endocarditis proph in pen allergy, surgical proph, teicoplanin = some VanB VRE
- IV 1-1.5g BD or 15-20mg/kg, oral 125mg q6h for 10-14 days
- TDM trough levels - if meets criteria (prolonged tx, renal impairment) >10mg/L minimises resistance
Give infusion over at least 60mins for doses >500mg
Renal fn AND FBE/C (eosinophilia) at least ONCE A WEEK >in ppl w/impairment or elderly
Hearing in renal impairment or prolonged tx
Red man syndrome
Oral capsules: renal fn may increase systemic effects - If you experience any hearing loss, fever, chills, rash rigors/shivering, swelling or SOB tell your doctor.
Oral capsules: you may experience GI upset.
For dr/nurse: if you notice any redness, rashes, hypotension, angioedema stop the tx and administer antihistamines.
Cefuroxime
- Class
- Indications
- Dose range
- Monitoring
- Counselling
Class: Cephalosporins
Indications: Cephalosporins are rarely the drugs of first choice. Acute sinusitis, Respiratory tract infections caused by H. influenza, Acute otitis media, Gonococcal infections (alternative to amoxicillin)
Dosage range: 250–500 mg twice daily. Gonococcal infection: 1 g single dose. Child: 3 months – 2 years, oral 10 mg/kg (maximum 125 mg) twice daily. 2–12 years, oral 15 mg/kg (maximum 250 mg) twice daily (up to 500 mg twice daily has been used).
CEFALEXIN - 250 mg every 6 hours or 500 mg every 6–12 hours. Child, oral, usual dose 6.25–12.5 mg/kg (maximum 500 mg) every 6 hours. CEFACLOR - 250–500 mg every 8 hours; or 375–750 mg every 12 hours using controlled release tablet (doses of up to 4 g daily have been used). Child, oral 10 mg/kg (maximum 250 mg) every 8 hours. Up to 15 mg/kg (maximum 500 mg) every 8 hours can be used if necessary.
Monitoring:
Renal fn – dose reduction may be required – may increase neurotoxicity or neutropenia.
Safe to use in preg &breast
Adverse effects - Cefalotin is the most nephrotoxic cephalosporin, particularly if the dose is not reduced in renal impairment. Cefaclor may be more likely to cause rash; serum sickness-like syndrome also occurs (more often in children than in adults). Cefalotin, ceftriaxone and cefazolin may affect the clotting process, increasing the risk of bleeding.
Immunologic reactions - May include eosinophilia, drug fever, anaphylaxis, angioedema, urticaria, haemolytic anaemia, Stevens-Johnson syndrome, toxic epidermal necrolysis, interstitial nephritis, arthritis, serum sickness-like syndrome (infrequent with cefaclor, rare with the others).
Monitor renal function and complete blood count during prolonged (>10 days) and/or high-dose treatment
Counselling: Allergy – C/I hx of allergy, tell your doctor if you have severe ongoing diarrhoea. If you develop a rash stop taking the medicine and go see your doctor.
Cefuroxime is absorbed best if you take it with a light meal.
Tablets: swallow tablets whole.
Oral liquid: you can mix this with fruit juice or milk, and take immediately.
Lincosamides
Clindamycin
Lincomycin
Clindamycin
- Class
- Indications
- Dose range
- Monitoring
- Counselling
- Lincosamide
- Penicillin allergy where - high risk endocarditis proph, pneumonia, dental skin, soft tissue & bone infections-, toxoplasma encephalitis/abssess, bacterial vaginosis, tx of PCP w/primaquine (2nd line), malaria (w/quinine), acne (topical), anaerobic infections.
- Oral: 150-450mg q6-8h, IV: 600-2700mg D in 2-4 doses, usually 450-900mg q8h. Max 4.8g IV.
- FBE/CBC (blood dycrasias)
Hepatic fn (raised enzymes, hepatotoxicity)
Renal fn
in prolonged tx
Complete cross-resistance b/w clindamycin&linomycin
5. Safe in preg&beastf GI effects (N&V, diarrhoea(mod-severe), abdo pain/cramps), rash, itch, contact dermatitis (topical) C.DIFF HIGH chance If you experience rash, SOB or swelling stop taking and see your doctor. If your skin turns yellow or yellow eye whites tell your doctor.
Macrolides
Azithromycin
Clarythromycin
Erythromycin
Roxithromycin
Azithromycin PO/IV
- Class
- Indications
- Dose range
- Monitoring
- Counselling
- Macrolide
- Tx & prevention of infections due to S bacteria (inc. use in pen/ceph allergy)
Tx of clamydial infections, Strep throat, CAP, prev&tx of MAC w/other agents, Donovanosis (STI genital ulcer disease), para-/Typhoid, travellors diarrhoea, prev&tx of pertussis. - 500mg once on day 1, then 500g once D for 2 days or 250mg once D for 4 days. 50mmg can be given for >3 days depending on ifnection.
Child: 10mg/kg
CAP: IV 500mg once D change to oral route when possible. - Monitor for:
- resistance (cross-resistace bw/macrolides &lincosamides)
- ototoxicity
- hypersensitivity
- drug interactions (more w/erythro, clarythro)
QT PROLONGATION
Torsades de points
DIABETES - oral liquid has sucrose
Hepatic fn
INFANTILE HYPERTOPHIC PYLORIC STENOSIS - GI effects (more w/erythromycin) N&V, diarrhoea, abdo pain/cramps
Candidal infections
Rash
Headache
AZITH and ERYTH: preg monitor infant for vomiting diarrhoea
CLARYTH: label 5
ERYTH: label 5, Label 3b ONE HOUR
ROXITH: best absorbed if taken 15 mins before a meal, if it makes you feel sick take w/food.
Nitroimidazoles
Metronidazole
Tinidazole
Metronidazole
- Class
- Indications
- Dose range
- Monitoring
- Counselling
- Nitroimidazoles
- Anaerobic infections, protozoal infections (giardiasis, trichomoniasis), amoebiasis (extra-/intestinal), bacterial vaginosis, surgical prophylaxis.
C-diff, dental infections, PID, eradication of H.pylori, rosacea, fungating wounds. - Oral: 200-400mg BD-TDS, max 4g D.
Rectal: 1g q8-12h. Severe infections: IV 500mg BD-TDS.
Tinidazole 2 g as a single dose.
4. preg and breastf safe Renal fn Hepatic fn (hepatitis, pancreatitis) CNS toxicity if treating for >10 days FBE (leucopenia, thromobocytopenia, blood dyscrasias) Optic neuritis - metro only Serious allergic reaction
- Take w/food to reduce stomach upset. Liquid best absorbed 1 hour before food.
Medicine may make you feel confused or dizzy, do not drive if your are affected.
Metallic taste
Avoid alcohol during tx and for 24 hours after finishing tx to prevent N&V, flushing, headache and palpitations.
Stop taking and check w/dr immediately if you have any numbness, tingling, pain or weakness in hands/feet.
Quinolones
Ciprofloxacin
Moxifloxacin
Norfloxacin
Ofloxacin
Ciprofloxacin PO/IV
- Class
- Indications
- Dose range
- Monitoring
- Counselling
- Quinolone
- Reserved for proven or suspected infections where alt agents are ineffective or C/I eg: complicated UTIs, bone/joint infections, epididymo-orchitis, prostatitis.
Severe salmonella, para/typhoid, shigellosis, prevention of meningococcal, febrile neutropenia w/amox/clav, kerititis or severe bacterial conjunctivitis (cipro), chronic suppurative otitis media (cipro). - Oral: 250-500mg BD, max 1.5g D.
IV: 200-300mg BD & up to 300-400mg q8-12hours, max 1.2g D - Renal fn - impairment means dose reduce <30mL/min halve dose
Heaptic fn - raised enzymes
QT interval
TENDON pain, inflammation or peripheral neuropathy and cease.
Superinfection with enterococci or Candida species may occur.
Hypersensitivity
SJS, TEN
Adequate fluid intake and output, avoid alkaline urine due to increased risk of crystalluria.
Avoid urinary alkalises (Ural) - crystalluria can lead to nephrotoxicity - Phototoxicity
Preg not recommended, breastf safe - monitor infant for S/Es.
Hypersensitivity -rash, itch-common, angioedema- rare.
GI upset (dyspepsia, N&V, diarrhoea, abdo pain
Tendon pain- cease.
Label 3b - ONE HOUR.
Drink plenty of fluids when taking.
Label 4a.
May increase effects of CAFFEINE, may need to reduce intake.
Label 8 - Avoid SUN exposure, wear protective clothing, and use sunscreen.
Avoid urinary alkalises (Ural) - crystalluria can lead to nephrotoxicity
Neurotoxicity - hallucination, confusion, seizures
Peripheral neuropathy
NUMBNESS/ TENDONS
avoid phosphate binders
Rifamycins
Rifabutn
Rifampicin
Rifaximin
Rifampicin PO/IV
- Class
- Indications
- Dose range
- Monitoring
- Counselling
- Rifamycins
- TB w/other drugs, leprosy (PBS), MRSA infection w/other drugs, srs or prothesis-associated infection w/other anti-staph agents, prevention of meningococcal or H.influenzae type b.
- ORAL AND IV DOSAGE SAME. SAME FOR ADULT/CHILD: 10mg/kg. 600mg or 450mg if <50kg.
- Obtain LFTs, serum Cr, and CBC/FBE before starting tx.
CBC/FBE regularly. Stop if thrombocytopenia occurs.
LFTs regularly if hepatic impairment
Hepatic fn - hepatitis, risk of hepatotoxicity w/other hepatotoic agents, and worsen impairment, increased enzymes.
Rifampicin only safe on to use in preg and breastf - may discolour breastmilk.
C.diff
Contraception - Contraception
Discolouration orange-red stained, faeces, urine, sweat, tears. Contact lenses.
Tell your dr if you have any loss of appetite, N&V, unusual tiredness, jaundice or dark urine, pale faeces.
Label 5
Muscle pain or flu like pains are common in the first couple of weeks of tx.
Label 3b.
Take it regularly as you are more likely to develop an allergy if you miss doses.
Tell your dr immediately if you get a rash, fever or swollen glands.
Tetracyclines
Demeclocycline - used to treat SIADH, rather than as an antibacterial.
Doxycycline
Minocycline
Tetracycline
Doxycycline is better tolerated than minocycline.
Minocycline
- Class
- Indications
- Dose range
- Monitoring
- Counselling
- Tetracyclines
- Acne (when doxycycline unsuitable), infections due to susceptible bacteria, Leprosy, with other agents
Doxy - Acne, Rosacea (severe/failed topical tx), M. pneumoniae infections, CAP, chronic bronchitis exacerbations, acute bacterial sinusitis, chlamydial & other non-gonococcal genital tract infections, PID, Rickettsial infections, Melioidosis (Whitmore’s, CAP north AUS), Sexually acquired EO w/ceftriaxone, chronic prostatitis, malaria proph in widespread mefloquine/chloroquine resistant areas, or in people in whom mefloquine or chloroquine is not tolerated, tx of uncomplicated malaria w/quinine, Q fever. - Adult: initially 200mg, then 100mg BD. Max 400mg D.
Child >8: initial dose 4mg/kg (max 200mg), then 2mg/kg (max 100 mg) BD.
Acne: Adult/child: 50 mg once or BD or 100 mg once daily.
Leprosy: Adult: 100mg once D or once a month, depending on the regimen. - SLE - C/I worsening can occur
Oral retinoids - avoid combo - C/I by some manufacturer - increase intracranial pressure
Hepatic fn - hepatotoxicity, avoid high doses in impairment. Tx w/hepatotoxic drugs may increase risk of hepatotoxicity.
Preg- Safe if used during 1st 18 weeks (16 weeks post-conception). After this period, C/I as can inhibit bone growth in the foetus & discolour deciduous teeth.
Breastf- tx of 7–10 days considered safe.
Children - discolour teeth and may cause enamel dysplasia (which increases the risk of dental caries) in children <8 years.
Limit minocycline course to <6 months to avoid pigmentation associated with long courses; stop minocycline if pigmentation occurs.
5. Pigmentation of skin. GI effects (N&V, diarrhoea), epigastric burning, tooth discolouration, enamel dysplasia, photosensitivity, rash, stomatitis, fungal overgrowth, photo-onycholysis and nail discolouration, oesophageal ulcers (due to partly swallowed tablets or capsules), C.diff, fatty liver degeneration, Minocycline has a high incidence of vestibular and CNS adverse effects: benign intracranial hypertension, allergic reactions, hypersensitivity syndrome, TEN, serum sickness-like reactions, hepatitis.
Take w/food or milk to reduce stomach upset.
Take with a large glass of water.
Remain upright (do not lie down) for ONE HOUR after taking a tetracycline. This is to stop tablets or capsules sticking on the way to your stomach, and causing painful damage to the lining of your throat.
LABEL 4a delete dairy - Do not take antacids, Fe, Ca or Zn supplements within 2 hours of a tetracycline as they may interfere with its absorption.
LABEL 8- Avoid sun exposure, wear protective clothing and use sunscreen while taking this medicine. Mino less likely to cause photosensitivity than doxy
MINOCYCLINE SPECIFIC
LABEL 16??? This medicine may cause dizziness; be careful driving or using machinery until you know how minocycline affects you.
It may also cause changes in the colour of your skin or other areas: tell your doctor if this happens to you.
TAKE DOSE IN THE MORNING, AND NOT BEFORE LYING DOWN.
DOXY
Malaria proph- Avoid mosquito bites by using repellents and wearing protective clothing. Begin taking doxycycline 2 days before entering and continue it until 4 weeks after leaving an endemic area. See a doctor if febrile illness develops within 12 months of possible exposure.
Trimethoprim-sulfamethoxazole PO/IV
- Class
- Indications
- Dose range
- Monitoring
- Counselling
- Folate inhibitor for bacteria
- Tx & 1 & 2 prev of PCP, infections caused by L. monocytogenes (alt. to ampicillin or benzylpenicillin), Melioidosis (CAP north AUS) w/other agents, Shigellosis, 1 prevention of cerebral toxoplasmosis in HIV patients, prevention & tx of pertussis (if macrolide unsuitable), Community-acquired MRSA infections.
- Ratio of trimeth to sulfameth is 1:5. Doses expressed as: 160/800 mg = trimethoprim 160 mg with sulfamethoxazole 800 mg (equivalent to 1 double strength tablet). 8/40 mg is equivalent to 1 mL of oral liquid.
80mgtri/400mg sulfa=Resprim
160mgtri/800mg sulfa=Resprim Forte - Drugs that cause potassium retention, eg ACEI—increase risk of hyperkalaemia.
MONITOR POTASSIUM CONC. - beginning on day 3, if the pt has renal impairment, is taking drugs that can cause hyperkalaemia, or is taking a high dose, eg for PCP.
CBC/FBE & FOLATE status during prolonged or high-dose tx.
RENAL fn & obtain urinalysis each month during prolonged tx, esp people w/pre-existing renal impairment.
Allergic reaction to sulfonamides—C/I.
HIV infection—increases frequency of allergic reactions to drugs.
SLE - may worse due to sulfonamide.
Slow acetylator phenotype—greater risk of adverse effects with sulfonamides.
Tx with oral typhoid vaccine—trimethoprim with sulfamethoxazole is active against S. typhi and may inactivate the vaccine.
- Take w/food to reduce stomach upset.
Drink a lot of fluid (at least 2–3 L daily) during prolonged or high-dose treatment- to prevent crystalluria maintain adequate urine output.
Drink plenty of fluids
Take at night to maximise urinary concentration (trimeth only).
Tell your doctor if you develop a rash
LABEL 8: To reduce risk of rash from the sun avoid sun exposure, wear protective clothing and use sunscreen.
Tell your doctor straight away if you get a sore throat, fever, troublesome rash, cough, difficulty in breathing, joint pain, dark urine or pale stools.
Stop if rash or other symptom of hypersensitivity develops.
Piperacillin with tazobactam
- Class
- Indications
- Dose range
- Monitoring
- Counselling
- Broad spectrum penicillin
- Mixed (aerobic and anaerobic) infections, especially if P. aeruginosa is involved, and Febrile neutropenia (often used with an aminoglycoside).
- Doses are expressed as piperacillin component.
Adult: IV, usual dose 2–4g q6–8h.
Renal impairment reduce dose.
Child: 1–6 months, IV 80–100mg/kg q8h. >6 months, IV 100mg/kg (max 4 g) q8h. In srs pseudomonal infection, give q6h. - Sodium restriction, HF—contains approx 64mg of Na+ per gram piperacillin with 125 mg tazobactam.
Coagulation disorder—increases risk of bleeding abnormalities - prolonged bleeding times and altered platelet aggregation w/high doses.
CF—higher incidence of rash and drug fever.
Renal fn - reduce dose if CrCl <40 mL/min.
Hepatic fn - C/I w/hx of jaundice and/or hepatic dysfunction from pip-tazo. Transient increases in liver enzymes and bilirubin, cholestatic jaundice,
MONITOR SERUM K+ and ELECTROLYTES - Hypokalaemia (high doses in people treated with cytotoxics, diuretics or with hepatic disease)
Multi-organ hypersensitivity syndrome
Febrile neutropenia - combo w/aminoglycoside may not increase efficacy and increases risk of adverse effects (MONITOR renal function due to increased risk of renal impairment)
Superinfection (incl. candidiasis) esp. during prolonged tx w/broad-spectrum penicillins
FBE/CBC: blood dyscrasias (eg neutropenia, which is related to dose and duration of treatment, thrombocytopenia) - Generally well tolerated.
Interaction: MTX, Probenecid
GI effects common (diarrhoea, nausea)
C.diff
Pain and inflammation at injection site
RARE: black tongue, electrolyte disturbances (Na+ & K+) due to high sodium content in parenteral doses.
NEUROTOXICITY: w/high doses, eg drowsiness, hallucinations, coma, seizures
Bleeding
Signs of ALLERGY: rash, swelling SOB/ Immunologic reactions: urticaria, contact dermatitis, fever, anaphylaxis, angioedema, bronchospasm, interstitial nephritis, haemolytic anaemia, eosinophilia, serum sickness-like syndrome, etc.
