What generation is
cefazolin
cephalexin
1st gen
what generation is
cefuroxime
cefotetan
2nd gen
What generation is
ceftriaxone (Rocephin)
Cefotaxime
Ceftazidime
3rd gen
what generation is
cefepime
4th generation
what generation is
ceftolozane/Tazobactam
ceftaroline
5th generation
what are the 2 main uses for a 1st gen cephalosporin?
Cefazolin
Cephalexin
good coverage for skin infections
Also this covers E.coli so good coverage for a uncomplicated UTI
What does the 2nd gen cephalosporins provide good coverage for
cefuroxime
cefotetan
intra-abdominal infections due to the anaerobic coverage
What does the 3rd generation cephalosporin provide good coverage for
ceftriaxone
cefotaxime
ceftazidime
lung infections
What cephalosporin would you use for community acquired pneumonia for someone who is not in a nursing home?
Ceftriaxone (Rocephin)
What does the 4th generation cephalosporin provide good coverage for
cefepime
Serious infections
This generation provides the gram positive coverage strength of the 1st gen plus the gram neg strength of the 3rd generation
what generation of cephalosporins provides anaerobic coverage
2nd gen
5th gen
what cephalosporin antibiotics cover pseudomonas
Ceftazidime (3rd gen)
Cefepime (4th gen)
Ceftolozane/Tazobactam - 5th gen and most potent
where is pseudomonas most commonly found?
who is highest risk
nursing homes
immune comprimised
what generation is destroyed by B lactamases
1st generation
As you progress from 1st gen to 5th, what changes
1) increasing activity against gram neg bacteria and anaerobes
2) increasing resistance to destruction by b lactamases
3) increase ability to reach CSF
what generations have access to CSF
3rd-5th
almost all cephalosporins are eliminated by _____ except _______
kidneys
ceftriaxone - liver
what cephalosporins can produce a disulfiram effect
Cefazolin
cefotetan
what cephalosporins can promote bleeding and should be avoided with anticoagulants, thrombolytics, NSAIDS, other antiplatelet agents
Cefotetan
Cefazolin
Ceftriaxone
is cephalosporin bactericidal or bacteriostatic
bacteriocidal
what gen is used in pt with mild pcn allergy and surgical prophylaxis
first gen
what gen is used to treat otitis, sinusitis, resp tract infections
2ng gen
what gen is used to treat meningitis
3rd gen
what gen is used to treat hospital acquired pneumonia and complicated intra-abdominal and UTI
4th gen
what gen is used to treat MRSA associated infections
5th gen
what gen covers staph or strep
1st gen
what gen covers H. influenzae, Klebsiella, pneumococci, staph
2nd gen
what gen covers pseudomonas aeruginosa, neisseria gonorrhoeae and Klebsiela, serratia
3rd gen
what gen covers psudomonas aeruginosa
4th gen
what gen covers MRSA
5th gen
cephalosporins are contraindicated in pt
with history of severe allergy to PCN
All cephalosporins can promote ______, what should be monitored
C. diff
report increase in stool frequency
what are the 1st gen cephalosporins
cefadroxil
cefazolin
cephalexin
2nd gen cephalosporins
cefaclor cefotetan cefoxitin cefprozil cefuroxime
3rd gen cephalosporin
cefdinir cefditoren cefixime cefotaxime cefpodoxime ceftazidime ceftibuten ceftriaxone
4th gen cephalosporin
cefepime
ceftolozane
5th gen cephalosporin
ceftaroline
what gen is cefdinir
3rd gen cephalosporin
what gen is cefixime
3rd gen cephalosporin
what gen is cefotaxime
3rd gen cephalosporin
what gen is ceftriaxone
3rd gen cephalosporin
what do you treat C-diff with
oral Vancomycin
stop other abx
What type of bugs does Vancomycin treat
only gram positive
esp active against S aureus and Staph epidermidis
including strains for both that are Methicillin resistant
other is strep, penicillin resistant pneumococci and c.diff
major adverse effect of vanc
renal tox
drug interaction with vanc
nephrotoxic drugs can increase risk of renal tox ->aminoglycosides, cyclosporine, NSAIDS)
lab sign of kidney damage secondary to vanc
Serum creatinine increased by 50%
Pt severe allergy to PCN, what do you give for c-diff
oral vancomycin - no b lactam ring
c diff can lead to
toxic megacolon pseudomembranous colitis colon perforation sepsis death
alternate abx for c diff
flagyl
what cephalosporins are responsible for promoting C-diff
second and third gen cephalosporins such as cipro and levaquin
how is c-diff defined
3 or more unformed stools in 24 hours plus a positive stool test for c-diff
what increases risk for c diff
gI surgery
serious illness
prolonged hospitalization
immunosuppression
what antibiotic do you use in c.diff with leukocytosis with WBC of 15,000 or higher plus hypotension/shock, ileus or megacolon
add in Metronidazole (flagyl) with vancomycin
what drug is reserved for treating vancomycin resistant infections? also an alternative to zyvox, daptomycin, tygacil.
what class?
Telavancin
lipoglycoproteins - active against gram positive bacteria
inhibits bacterial cell wall synthesis and disrupts membrane function
adverse effects of Telavancin
taste disturbance n/v foamy urine Red mans prolong QT nephrotoxic
who cannot have Televanciin
history of QT
GFR less than 50
flushing rash pruritis urticaria tachycardia hypotension
Red mans syndrome
drug drug interaction televancin
NSAIDS
ACE inhibitors
aminoglycosides
(nephrotoxic)
abx in monobactams
Aztreonam (single b lactam ring)
resistant to B lactamases
Aztreonam is only active against
gram negative aerobic bacteria
adverse effect Aztreonam
pain and thrombophlebitis at site of injection
single dose therapy in women with uncomplicated UTI
Fosfomycin
adverse effects Fosfomycin
diarrhea headache vaginitis nausea abd pain rhinitis drowsiness dizziness rash