Penicillin G/VK/benzathine - coverage?
- Gram positives (Strep, Staph, Actinomyces)
- Oral anaerobes (Actinomyces)
- Neisseria meningitidis
- Treponema Pallidum (Syphilis)
- Spirochetes (Leptospira)
Ampicillin & Amoxicillin – coverage?
Same as Penicillin + …- H. influenzae- E. coli- Listeria- Proteus- Salmonella
Amp/Amoxicillin are best initial Tx for what?
- Otitis media (Sinusitis, Pharyngitis)- Dental infection & endocarditis proph- Lyme disease limited to rash, joint, 7th CN involvement- UTI in pregnant women- Listeria monocytogenes- Enterococcal infections
Penicillinase-resistant penicillins (PRPs)?
Oxacillin, Cloxacillin, Dicloxacillin, & Nafcillin
PRPs are used to treat what?
- Skin infections: cellulitis, impetigo, erysipelas- Endocarditis, meningitis, & bacteremia from staph- Osteomyelitis & septic arthritis only wen organism is proven sensitive
PRPs are not active against __ or __.
MRSA & Enterococcus
What’s always used instead of Methicillin? Why?
Oxacillin or Cephalosporin- b/c methicillin causes renal failure from allergic interstitial nephritis
Penicillins that cover gram-negative activity & pseudomonas?
Piperacillin, Ticarcillin, Azlocillin, Mezlocillin
Piperacillin/Ticarcillin, etc. are best initial Tx for what?
Cholecystitis & ascending cholangitis- Pyelonephritis- Bacteremia- HA- & VA- pneumonia- Neutropenia & fever
3 organisms that’re resistant to all forms of cephalosporins?
Listeria, MRSA, & Enterococcus
What organisms do all cephalosporins cover?
- Group A, B, C, & viridans Streptococcus- E. coli- Klebsiella- Proteus mirabilis
Macrolides?
Azithromycin, Clarithromycin, Erythromycin (more toxic)
1 indication for Nitrofurantoin?
Cystitis (esp. in pregnant women)
Name the 1st gen Cephalosporins
Cefazolin, Cephalexin, Cephradrine, Cefadroxyl
1st gen cephalosporins – use?
Staph (meth = ceph sensitive)- Streptococci (except enterococcus)- Some gram-neg bacilli, like E. coli (NOT pseudamonas)- Osteomyelitis, septic arthritis, endocarditis, cellulitis
Name the 2nd gen Cephalosporins
Cefotetan, Cefoxitin, Cefaclor, Cefprozil, Cefuroxime, Loracarbef
2nd gen cephalosporins – use?
Same as first + add coverage for anaerobes & more gram-neg bacilli
Name the 3rd gen Cephalosporins
Ceftriaxone, Cefotaxime, Ceftazidime
Ceftriaxone – use?
1st line in Pneumococcus- Meningitis- CA pneumonia (in combo w/ macrolides)- Gonorrhea- Lyme involving heart or brain
In whom should you avoid Ceftriaxone & why?
Neonates b/c of their impaired biliary metabolism
Cefotaxime – use?
- Superior to Ceftriaxone in neonates- Spontaneous bacterial peritonitis
Ceftazidime – what differentiates it from other 3rd-gen cephalosporins?
Has pseudomonal coverage
Which 3rd-gen Cephalosporin(s) have/has pseudomonal coverage?
Ceftazidime
Which is the 1st cephalosporin to cover MRSA?
Ceftaroline
Name the 4th-gen Cephalosporins
Cefepime
Cefepime – use?
Has better staphylococcal coverage than 3rd gen cephalosporins. Used to treat:- Neutropenia & fever- Ventilator-ass’d pneumonia
Cephalosporins – adverse effects?
Cefoxitim & Cefotetan – deplete prothrombin & increase risk of bleedingCeftriaxone – causes inadequate biliary metabolism
Which of the Carbapenems does NOT cover Pseudomonas?
Ertapenem
Carbapenems – coverage?
Gram-negative bacilli (including many that are resistant, anaerobes, strep, & staph)- used to treat neutropenia & fever
Only drug in the class of Monobactams?
Aztreonam
Aztreonam – type of drug?
Monobactam antibiotic
Aztreonam – coverage?
Gram-negative rods only (including Pseudomonas) - NO activity against gram-positives or anaerobes - NO cross-rxn w/ Penicillin
Name 4 Fluoroquinolones
Ciprofloxacin, Gemifloxacin, Levofloxacin, Moxifloxacin
Ciprofloxacin – used for what?
Cystitis & Pyelonephritis
Best therapy for C-A pneumonia?
UMass = Azithromycin IV + Ceftriaxone IVMTB2 = Fluoroquinolones (Levofloxacin)(including penicillin-resistant pneumococcus)
What do Fluoroquinolones cover?
- CA-pneumonia (best Tx)- Cipro for cystitis & pyelonephritis- Diverticulitis & GI infections (all but Moxi need combo w/ Metronidazole for Diverticulitis. Ciprofloxacin, gemifloxacin, & levofloxacin must be combined with metronidazole because they don’t cover anaerobes)- Gram-neg bacilli (including most pseudomonas)- Gram-pos cocci (Staph & Strep)
Which of the Fluoroquinolones can be used by itself for Diverticulitis?
Moxifloxacin – b/c it covers anaerobes- others must be combined w/ Metronidazole
Quinolones – adverse effects?
- Bone growth abnormalities in children & pregnant women- Tendonitis & Achilles tendon rupture
Aminoglycosides – use?
Gram-negative rods – severe (bowel, urine, bacteremia)- Synergistic w/ β-lactam antibiotics for enterococci & staph- Neomycin for bowel surgery- NO effect against anaerobes (need O2 to work)
Aminoglycosides – adverse effects?
Nephrotoxic & Ototoxic
Doxycycline – adverse effects?
Tooth discoloration (children), Fanconi syndrome (Type II RTA proximal), photosensitivity, esophagitis/ulcer
Β Lactam/Beta-lactamase combos – uses?
- cover anaerobes - 1st choice for mouth & GI abscessβ-lactamase adds coverage against sensitive staphylococci