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Flashcards in Gram positive antibiotics Deck (42):
1

List of gram positive abx

vancomycin, daptomycin (Cubicin), quinupristin/dalfopristin (Synercid), linezolid (Zyvox), tedizolid (Sivextro), telavancin (Vibativ), dalbavancin (Dalvance), oritavancin (Orbactive)

2

MOA of vancomycin

glycopeptide, inhibits cell wall synthesis by binding to D alanin-D-alanine of peptidoglycan, slow bactericidal, time dependent

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Spectrum of Vancomycin

DOC for MRSA, S pneumo, MSSA but not as good as B-lactams, enterococcus faecalis, E. faecium, listeria monocytogenes, corynebacterium, clostridia

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Kinetics of vancomycin

very large, cannot be absorbed by GI, only IV for systemic therapy, PO for GI, very lipophilic, well distributed, too big to cross BBB so give high dose or use shunt

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ADRs of vancomycin

renally eliminated, nephrotoxic usually reversible, ototoxicity with prolonged therapy, red man syndrome- not allergy, phlebitis

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Dosing of vancomycin

pt specific requires intense monitoring, based on body wt

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Clinical use of vancomycin

B-lactam allergy, c. diff, surgical prophylaxis, MRSA, febrile neurtopenia, UTI- low dose, osteomyelitis/septic arthritis/meningitis, SSTI

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Vancomycin Pearls

potential S. aureus resistance in future, use with aminoglycosides, pip/tazo, nephrotoxic agent inc nephrotoxicity, used regularly for pt with ESRD

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Quinupristin/Dalfopristin (Synercid) MOA

bind to 50S ribosome to inhibit protein synthesis, time dependent, bactericidal

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Quinupristin/Dalfopristin (Synercid) spectrum

broad spectrum, used rarely

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ADRs of quinupristin/Dalfopristin (Synercid)

hyperbilirubinemia, arthralgias

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Clinical use of quinipristin/dalfopristin (Synercid)

VRE bacteremia, central line associated blood infxn, SSTI

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DI of quinipristin/dalfopristin (Synercid)

many! why its usse is rare

14

Daptomycin (Cubicin) MOA

a cyclic lipoppetide, cell death gram + bacteria by binding to cell membrane and depolarizes loses ion, inhibits proteins, DNA, RNA, concentration dependent, rapid bactericidal

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Spectrum Daptomycin (Cubicin)

staph (MRSA, VRSA etc), enterococcus (including VRE), stretpococci (penicillin resistant)

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ADRs of Daptomycin (Cubicin)

very well tolerated, can give long term, myalgias- hold statin therapy, NVD

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Clinical use of Daptomycin (Cubicin)

SSTI, bacteremia, endocarditis

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What illness should not be treated w/ daptomycin

pneumonia

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Dosage of Daptomycin (cubicin)

SSTI- 4mg/kg IV qd, bacteremia- 6-8mg/kg IV qd, endocarditis- 8 mg/kg IV qd

20

Linezolid (Zyvox) dosage

600 mg po BID

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Linezolid (Zyvox) MOA

an oxazolidinone, bind to 50 S ribosome near the 30 S interface to inhibit protein synthesis, bacteriostatic, unique!

22

Linezolid (Zyvox) spectrum

MRSA, MSSA, MRSE, MSSE, little gram neg activity, strep- bactericidal, enterococcus (VRE)

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ADRs of linezolid (zyvox)

NVD, thrombocytopenia with long term (>2 weeks)

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DI of linezolid

Serotonin syndrome

25

Pearls of linezolid

IV and PO dose the same, not renally eliminated, $$$$

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Clinical use of linezolid

pneumonia, SSTI, bacteremia- 3rd line

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Tedizolid (sivextro) MOA

an oxazolidinone, binds 50S inhibit protein synthesis, bacteriostatic

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Spectrum of Tedizolid (Sivextro)

staph (MSSA, MRSA), strep, entero faecalis

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ADR of tedizolid (Sivextro)

NVD, hematologic rxn

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Clinical use of tedizolid (Sivextro)

SSSI

31

Pearl of tedizolid (sivextro)

new, once daily, $$$

32

Telavancin (Vibativ) MOA

glycopeptide, inhibits cell wall synthesis by blocking polymerization of peptidoglycan D-A-D-A, concentration dependent

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ADR of telavancin (Vibativ)

nephrotoxic, NV, metallic test

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Telavancin (Vibatic) spectrum

staph (MRSA, MSSA), entero (VSE, faecalis), strept

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Clinical use of telavancin (Vibatic)

SSSI, HAP, VAP

36

Dalbavancin (Dalvance) MOA

a glycopeptide, inhibit cell wall synthesis by forming a complex with D-A-D-A

37

Spectrum of dalbavancin (Dalvance)

MRSA, MSSA, linezolid resistant, strep including pcn resistant, enterococci not VRE, clostridia

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Kinetics of dalbavancin (Dalvance)

8.5 day T1/2, once weekly dosing

39

Clinical use of dalbavancin (Dalvance)

acute bacterial SSSI

40

Pearls of dalbavancin (Dalvance)

Good ADR, $4500 for 2 doses

41

Oritavancin (Orbactiv) MOA

glycopeptide, T1/2 10 day

42

Spectrum of oritavancin (Orbactiv)

SSSI