Infectious Disease Part 1: Background & ABX by Class Flashcards
(127 cards)
1
Q
Common Bacterial Pathogens for Select Sites of Infections pg. 345
CNS/Meningitis
A
Neisseria meningitidis
Group B Streptococcus/E. coli (young)
Streptococcus pneumoniae
Haemophilus influenzae
Listeria (young/old)
“No Girl Should Have Lice”
2
Q
Common Bacterial Pathogens for Select Sites of Infections pg. 345
Upper Respiratory
A
Moraxella catarrhalis
Streptococcus pyogenes
Haemophilus influenzae
Streptococcus pneumoniae
“My Son Has Strep”
3
Q
Common Bacterial Pathogens for Select Sites of Infections pg. 345
Heart/Endocarditis
A
Staphylococcus aureus, including MRSA
Enterococci
Staphylococcus epidermidis
Streptococci
“Souls ‘Must’ Enter SomewhEre Sacred”
4
Q
Common Bacterial Pathogens for Select Sites of Infections pg. 345
Skin/Soft Tissue
A
Pasteurella multocida +/- aerobic/anaerobic GNR (in DM)
Staphylococcus aureus
Streptococcus pyogenes
Staphylococcus epidermidis
“Pale, skin scream sunlight”
5
Q
Common Bacterial Pathogens for Select Sites of Infections pg. 345
Bone/Joint
A
Staphylococcus aureus
Staphylococcus epidermidis
Streptococcus
Neisseria gonorrhoeae GNR
“Strong Skeleton Support Nerves”
6
Q
Common Bacterial Pathogens for Select Sites of Infections pg. 345
Urinary Tract
A
Klebsiella
Proteus
E. coli
Enterococci
Staphylococcus saprophyticus
K.P.E.E.S
7
Q
Common Bacterial Pathogens for Select Sites of Infections pg. 345
Intra-abdominal
A
Bacteroides species
Enteric GNR
Enterococci
Streptococci
B.E.E.S
8
Q
Common Bacterial Pathogens for Select Sites of Infections pg. 345
Lower Respiratory (Hospital)
A
Enteric GNR (ESBL, MDR)
Pseudomonas aeruginosa
Acinetobacter baumannii
Streptococcus pneumoniae
Staphylococcus aureus, MRSA
E.P.A.S.S *M
9
Q
Common Bacterial Pathogens for Select Sites of Infections pg. 345
Mouth
A
Mouth flora (Peptostreptococcus)
Anaerobic GNR (Prevotella)
Viridans group Streptococci
10
Q
Common Bacterial Pathogens for Select Sites of Infections pg. 345
Lower Respiratory (Community)
A
Chlamydophila
Haemophilus influenzae
Atypicals: Legionella, Mycoplasma
Streptococcus pneumoniae
Enteric GNR (alcoholics)
C.H.A.S.E.
11
Q
Common Resistant Pathogens pg. 349
A
Klebsiella pneumoniae (ESBL, CRE)
Escherichia coli (ESBL, CRE)
Acinetobacter baumannii
Enterococcus faecalis, E. faecium (VRE)
Staphylococcus aureus (MRSA)
Pseudomonas aeruginosa
“Kill Each And Every Strong Pathogen”
12
Q
What does ESBL stand for?
A
Extended-spectrum beta-lactamase
13
Q
What does CRE stand for?
A
Carbapenem-resistant Enterobacteriaceae
14
Q
What does VRE stand for?
A
Vancomycin-resistant Enterococcus
15
Q
Enzyme Activation pg. 349
ESBL Treatment of Choice
A
Carbapenems or newer Cephalosporin/Beta-lactamase inhibitors
16
Q
Enzyme Activation pg. 349
CRE Treatment of Choice
A
Combination of ABX that include Polymyxins or ceftazidime/avibactam (Avycaz)
17
Q
Antibiotics MOA pg. 350
Cell Wall Inhibitors
A
Beta-lactams (PCNs, Cephs, Carbapenems)
Monobactams (Aztreonam)
Vancomycin, Dalbavancin, Telavancin, Oritavancin
“DOT. V MB”
18
Q
Antibiotics MOA pg. 350
DNA/RNA Inhibitors
A
Quinolones (DNA gyrase, topoisomerase IV)
Metronidazole, tinidazole
Rifampin
19
Q
Antibiotics MOA pg. 350
Folic Acid Synthesis Inhibitors
A
Sulfonamides
Trimethoprim*
Dapsone
20
Q
Antibiotics MOA pg. 350
Cell Membrane Inhibitors
A
Polymyxins
Daptomycin
Telavancin
Oritavancin
21
Q
Antibiotics MOA pg. 350
Protein Synthesis Inhibitors
A
Quinupristin/Dalfopristin (Synercid)
Tetracyclines
Clindamycin
Linezolid, tedizolid
Aminoglycosides
Macrolides
22
Q
Hydrophilic Agents
*Read section for description (pg. 350)
A
Beta-lactams
Aminoglycosides
Daptomycin
Glycopeptides
Polymyxins
“BAD GrandPa”
23
Q
Lipophilic Agents
*Read section for description (pg. 350)
A
Quinolones
Macrolides
Rifampin
Linezolid
Tetracyclines
“Little Quincy Ran Thru Manhattan”
24
Q
Dose Optimization Graph (pg. 351)
“CMAX:MIC”
Concentration - Dependent Classes
A
Aminoglycosides
Quinolones
Daptomycin
Goal: high peak = incr. killing | low trough = dec. toxicity
Dosing strategies: Large doses, long intervals
25
Dose Optimization Graph (pg. 351)
"AUC:MIC"
Exposure - Dependent Classes
Vancomycin
Macrolides
Tetracyclines
Polymyxins
Goal: exposure over time
Dosing strategies: variable
26
Dose Optimization Graph (pg. 351)
"Time > MIC"
Time - Dependent Classes
Beta-lactams (PCNs, Cephs, Carbapenems)
Goal: maintain drug level > MIC for most of the dosing interval
Dosing strategies: shorter dosing interval, extended or continuous infusions
27
Beta-Lactam Antibiotics
Name the Classes & MOA
Classes: PCNs, Cephs, Carbapenems
MOA: Inhibit bacterial cell wall synthesis and prevent peptidoglycan synthesis
28
Beta-Lactam Antibiotics - PCNs (pg. 352)
Natural Penicillins
Penicillin G & Penicillin VK
Gram positive cocci, Gram positive anaerobes
29
Beta-Lactam Antibiotics - PCNs
Aminopenicillins
Amoxicillin, Ampicillin
Adds Gram negative coverage (HNPEK)
30
Beta-Lactam Antibiotics - PCNs
Aminopenicillins + Beta Lactamase Inhibitors
Amoxicillin/clavulanate, Ampicillin/sulbactam
Adds MSSA, more resistant strains of HNPEK, Gram negative anaerobes (B. fragilis)
31
Beta-Lactam Antibiotics - PCNs
Extended Spectrum + Beta-Lactamase Inhibitors
Piperacillin/tazobactam
Adds CAPES, Pseudomonas
32
Beta-Lactam Antibiotics - PCNs
Antistaphylococcal
Nafcillin, Oxacillin
Covers MSSA and Streptococci only
33
When should you NOT use Beta-Lactams?
1. Beta-lactam allergy
2. Risk of seizures
3. CrCl <30 mL/min
4. Pen G not IV use
34
PCNs - Outpatient (PO) treat what infections?
Penicillin VK
Strep throat & mild skin infections
35
PCNs - Outpatient (PO) treat what infections?
Amoxicillin - Brand?
Brand: Moxatag
Acute Otitis Media (AOM)
Infective endocarditis prophylaxis
H. pylori
36
PCNs - Outpatient (PO) treat what infections?
Amoxicillin/Clavulanate - Brand?
Brand: Augmentin
AOM
**Lowest dose of clavulanate**
37
PCNs - Inpatient (Parenteral) treat what infections?
Penicillin G Benzathine - Brand?
Brand: Bicillin L-A
Syphilis
**Never use IV**
38
PCNs - Inpatient (Parenteral) effective against what pathogen?
Zosyn - Generic?
Generic: piperacillin/tazobactam
ONLY penicillin active against Pseudomonas
**Extended-infusion common**
39
PCNs - Inpatient (Parenteral) effective against what pathogen(s)?
Nafcillin, Oxacillin, Dicloxacillin
MSSA and Streptococcus (no MRSA)
**No renal dose adjustments***
40
Beta-Lactam Antibiotics - Cephalosporins
First Generation
Route of Administration(s) & Coverage
IV: Cefazolin
PO: Cephalexin (Keflex)
Staphylococci, Streptococci, PEK, mouth anaerobes (Peptostreptococci)
41
Beta-Lactam Antibiotics - Cephalosporins
Second Generation
Route of Administration(s) & Coverage
IV/IM/PO: Cefuroxime (Ceftin)
Better Gram-negative activity "HNPEK"
**Cef-o-tetan and Cef-o-xitin have anaer-o-bic activity (B. fragilis)
42
Beta-Lactam Antibiotics - Cephalosporins
Third Generation
Route of Administration(s) & Coverage
------Group 1------
IV: Ceftriaxone **no renal dose adjustments**
PO: Cefdinir
Coverage: Staphylococci < Streptococci
------Group 2------
IV: Ceftazidime, Ceftazidime/Avibactam (Avycaz)
Coverage: Pseudomonas
43
Beta-Lactam Antibiotics - Cephalosporins
Fourth Generation
Route of Administration(s) & Coverage
IV: Cefepime
Broad-spectrum: Gram-positives, HNPEK, CAPES, & Pseudomonas
44
Beta-Lactam Antibiotics - Cephalosporins
Fifth Generation
Route of Administration(s) & Coverage
IV: Ceftaroline (Teflaro)
Similar to Ceftriaxone but with MRSA coverage
45
What pathogens are HNPEK?
Haemophilus
Neisseria
Proteus
E. coli
Klebsiella
46
What pathogens are CAPES or SPACE?
Citrobacter
Acinetobacter
Providencia
Enterobacter
Serratia
47
Penicillin are NOT active against what pathogens?
MRSA (except Ceftaroline)
Atypicals
48
Cephalosporins - Inpatient (Parenteral) used when?
1st Generation: Cefazolin
Surgical Prophylaxis
49
Cephalosporins - Inpatient (Parenteral) used when?
2nd Generation: Cefotetan & Cefoxitin
Surgical Prophylaxis (GI Procedures)
**Cefotetan: disulfiram-like rxn
50
Cephalosporins - Inpatient (Parenteral) used when?
3rd Generation: Ceftriaxone & Cefotaxime
CAP, meningitis, SBP, pyelonephritis
**Ceftriaxone: no renal dose adjustments, DO NOT use in neonates***
51
Cephalosporins - Inpatient (Parenteral) used when?
Ceftazidime (3rd Gen) & Cefepime (4th Gen)
Pseudomonas
52
Cephalosporins - Inpatient (Parenteral) used when?
5th Generation: Ceftaroline
MRSA
53
Cephalosporins - Outpatient (PO) used when?
1st Generation: Cephalexin (Keflex)
Strep throat & MSSA skin infections
54
Cephalosporins - Inpatient (Parenteral) used when?
2nd Generation: Cefuroxime
AOM
CAP
Sinus infections
55
Cephalosporins - Inpatient (Parenteral) used when?
3rd Generation: Cefdinir
CAP
Sinus infections
56
What is the dosing of oral Keflex?
250 - 500 mg Q6-12H
57
Why is Ceftriaxone contraindicated in neonates?
Causes hyperbilirubinemia (AKA biliary sludging, kernicterus)
58
Which two cephalosporins cover anaerobes?
2nd generation: Cefotetan and Cefoxitin
59
Beta-Lactamase Antibiotics - Carbapenems
Class Effects
All active against ESBL-producing organisms and
Pseudomonas (except ertapenem)
Beta-lactam allergy and seizures, monitor renal function
**All are IV only*** (ertapenem only stable in normal saline)
60
Beta-Lactamase Antibiotics - Carbapenems
Does NOT cover
Atypicals
VRE
MRSA
**ErtAPenem does NOT cover "PEA" Pseudomonas, Enterococcus, Acinetobacter***
61
Monobactam
Drug & Coverage
Drug: Aztreonam (Azactam)
Coverage: many Gram-negatives, Pseudomonas but NO Gram-positives or anaerobic activity
62
Aminoglycosides (pg. 358)
Coverage, Dosing, & Monitoring
Coverage: Gram-negative + Pseudomonas; Synergy for Gram-positives (Staphylococci/Enterococci)
Dosing (Gentamicin/Tobramycin):
Traditional: 1-2.5 mg/kg IV Q8H (peaks & troughs)
Extended-interval: 4-7 mg/kg IV Q24H (random level, use nomogram)
Monitoring: renal function & serum levels
63
What weight is used for Aminoglycoside dosing?
1. If underweight: use total body weight (TBW)
2. If normal: IBW or TBW
3. Obese: AdjBW
64
Aminoglycosides (pg. 358)
Boxed Warnings
Nephrotoxicity
Ototoxicity
Neuromuscular blockade
65
Aminoglycosides (pg. 358)
When should the peaks and troughs be drawn up for a traditional IV dosing of Gentamicin - /Tobramycin?
Trough: drawn up 30 min BEFORE 4th dose (<2 mcg/mL)
Peak: drawn up 30 min AFTER the 4th dose (5-10 mcg/ml)
66
Quinolones (pg. 360)
MOA
Inhibit DNA topoisomerase IV and DNA gyrase (topoisomerase II).
Concentration - dependent
67
Quinolones (pg. 360-361)
Which drug(s) cover which pathogen(s)?
Respiratory FQs: Levofloxacin, Moxifloxacin and Gemifloxacin (enhance coverage of S. pneumoniae & atypical pathogens)
Cipro & Levo: active against Pseudomonas (synergy w/ another beta-lactam)
Moxi: anaerobic activity when used alone for IAI but NOT UTI
Delafloxacin: active against MRSA preferred in SSTI
68
Quinolones (pg. 360)
Boxed Warnings
Tendon Rupture
Peripheral Neuropathy
CNS effects (incl. seizures)
Use Last-line (only if no alternatives)
69
pg. 360
Warnings to monitor while on Quinolones
QT Prolongation (Moxi > Levo > Cipro)
Hypo/Hyperglycemia
Psychiatric disturbances
Photosensitivity
Avoid in: children & pregnancy/breastfeeding
70
Quinolones (pg. 360-361)
IV:PO Ratio for Levofloxacin & Moxifloxacin
1:1
71
Quinolones (pg. 361)
Respiratory Quinolones
Moxifloxacin (IV/PO 1:1; not renally adjusted, NOT for UTIs)
Gemifloxacin
Levofloxacin
"My Good Lungs"
72
Quinolones (pg. 361)
Which FQs are used for Pseudomonas infections, UTIs, IAIs & traveler's diarrhea?
Ciprofloxacin & Levofloxacin
73
Macrolides (pg. 361)
MOA & coverage
Bind to 50S ribosomal subunit, resulting in inhibition of RNA-dependent protein synthesis
Excellent coverage of "Atypicals," utility against S. pneumoniae, Haemophilus, Neisseria & Moraxella
74
Name the Atypical Pathogens
Legionella, Chlamydia, Mycoplasma, and Mycobacterium avium complex
75
Macrolides (pg. 361-362)
Agents in Class (Brand/Generic) & Common Uses
-----General Uses------
CAP & Strep
Azithromycin (Zithromax) - COPD exacerbations, chlamydia, gonorrhea, MAC prophylaxis
Clarithromycin (Biaxin) - H. pylori
Erythromycin (E.E.S) - increase gastric motility
76
Macrolides (pg. 361-362)
Warnings, Side Effects, & DDIs
QT Prolongation (Ery > Azith > Clarith)
Hepatotoxicity
SE: GI upset
DDI: Simvastatins/Lovastatins - Clarithromycin
77
Tetracyclines (pg. 362-363)
Agents in Class (Brand/Generic) & Common Uses
----General Uses----
CA-MRSA skin infections, acne
Doxycycline (Vibramycin) - tick-borne infections, CAP, COPD exacerbations, sinusitis, VRE, UTI, Chlamydia, Gonorrhea
Minocycline (Minocin, Solodyn)
Tetracycline - H. pylori
78
Tetracyclines (pg. 362-363)
Safety Issues
1. Avoid in children <8 yoa, pregnancy/breastfeeding
2. Photosensitivity
3. Interaction with divalent cations
4. IV:PO = 1:1 (doxy & mino)
5. Minocycline: DILE
79
What is DILE stand for?
Drug-induced lupus erythematosus
80
Tetracyclines (pg. 362-363)
Coverage
S. aureus including CA-MRSA
H. influenzae, Moraxella, Atypicals +/- S. pneumoniae
Rickettsia
H. pylori
VRE
81
Tetracyclines (pg. 362-363)
MOA
Inhibits protein synthesis by reversibly binds to 30S ribosomal subunit
82
Sulfonamides (pg. 363)
MOA & Drug (Brand/Generic)
Inhibits bacterial folic acid synthesis
Sulfamethoxazole/Trimethoprim (Bactrim)
83
Sulfonamides - SMX/TMP (pg. 363)
Types of Infection & Dosing
Severe infections (CA-MRSA): IV/PO 10-20 mg TMP/kg/day Q6H (Bactrim DS 2 tabs BID-TID)
Uncomplicated UTI: 1 DS tab PO BID x3 days
Pneumocystis Pneumonia Prophylaxis (PCP): 1 DS/SS tab daily
84
Sulfonamides - SMX/TMP (pg. 363)
Single Strength vs Double Strength Dose for each component
SS: 400 mg SMX/80 mg TMP
DS: 800 mg SMX/160 mg TMP
85
Sulfonamides - SMX/TMP (pg. 363)
SMX:TMP ratio
5:1
86
Sulfonamides - SMX/TMP (pg. 363)
When NOT to use, Warnings, & Side effects
1. Sulfa allergy or pregnant/breastfeeding
2. Warnings: SJS/TENs, thrombotic thrombocytopenic purpura (TTP), G6PD deficiency (hemolysis risk)
3. SE: Photosensitivity, incr. K, hemolytic anemia (positive Coombs test), crystalluria (drink 8 oz of water), increase INR when used with warfarin
87
ABX for Gram-positive infections - Vancomycin
MOA
Inhibit bacterial cell wall synthesis by binding to D-alanyl-D-alanine
88
ABX for Gram-positive infections - Vancomycin
Coverage, Dosing, Monitoring, & Side Effect
Coverage: Gram-positive (MRSA), Streptococci, Enterococci, C. difficile
Dosing: IV: 15-20 mg/kg Q8-12H using TBW (**need renal dose adj); CrCl 20-49: Q24H
Monitoring: SCr and avoid other nephrotoxic/ototoxic drugs (Lasix, AMG, Cisplatin)
SE: Red Man Syndrome (w/ rapid infusion)
89
ABX for Gram-positive infections - Vancomycin
First Line Treatment in what infections?
Meningitis
Some SSTIs
Bacteremia
Pneumonia
"My Shitty Bitchy Person!"
90
ABX for Gram-positive infections - Vancomycin
Target Trough for Severe Infections
15-20 mcg/mL
91
ABX for Gram-positive infections - Vancomycin
Oral Dosing and Indication
Indication: C. difficile infections
Dosing: PO 125 mg QID x 10 days
92
ABX for Gram-positive infections - Lipoglycopeptides
Drugs (Brand/Generic)
Telavancin (Vibativ)
Oritavancin (Orbactiv)
Dalbavancin (Dalvance)
93
ABX for Gram-positive infections - Lipoglycopeptides
MOA
Inhibit cell wall synthesis
94
ABX for Gram-positive infections - Lipoglycopeptides
Which agent is approved for skin infections and HAP/VAP?
Telavancin
95
ABX for Gram-positive infections - Lipoglycopeptides
Boxed Warnings, Contraindications, & Warnings
BW (Telavancin): Fetal risk, nephrotoxicity, increase mortality compared to Vancomycin in Pneumonia
------Contraindications-----
Telavancin: concurrent use of IV UFH
Oritavancin: use of IV UFH for 5 days after
-------Warnings--------
Telavancin: falsely increased aPTT/PT/INR
Oritavancin: increase PT/INR (~12H) and increase aPTT (~120H)
96
Daptomycin
MOA, Brand, Coverage, Indications, Warnings, & Monitoring
Brand: Cubicin ---> Scroll down <-----
MOA: inhibits intracellular replication process (binds to cell membrane)
Coverage: MRSA + VRE (E. faecium/faecalis)
Indications: SSTIs, bloodstream infections/endocarditis (NOT for Pneumonia)
Warnings: Myopathy/rhabdomyolysis; falsely increase PT/INR
Compatible with NS or LR **ONLY** (No Dextrose)
Monitor: CPK weekly (if taking a statin or renal impaired)
97
Oxazolidinones
Agents (Brand/Generic), MOA, Coverage, Indications, & IV/PO ratio
MOA: inhibits translation and protein synthesis by binding to 50S subunit
Linezolid (Zyvox) - SSTIs, VRE infections, pneumonia, & bloodstream infections
Tedizolid (Sivextro) - SSTI only
Coverage: similar to vanc + VRE
IV/PO Ratio = 1:1
98
Oxazolidinones - Linezolid (pg. 366)
Contraindications & Warnings
CI: MAOI use within 14 days
------Warnings-------
1. Duration related myelosuppression (thrombocytopenia) - monitor CBC weekly
2. Optic neuropathy
3. Serotonin Syndrome:
~both weak MAOI inhibitors
~caution with serotonergic drugs (SSRIs, SNRIs, TCAs)
~avoid tyramine-containing foods
99
Quinupristin/Dalfopristin
Brand, MOA, Coverage, Indications, Side Effects, & Compatibility
Brand: Synercid
MOA: Inhibit protein synthesis (50S subunit)
Coverage: Gram-positive including MRSA, VRE (E. faecium only)
Indications: SSTIs
Side Effects: Arthralgia/myalgias, infusion rxn, hyperbilirubinemia, phlebitis (admin central line)
Compatible with D5W only
100
Additional Broad-Spectrum Antibiotics - Tigecycline (pg. 367)
Brand, MOA, Coverage, Indications, Boxed Warning, & Notes
Brand: Tygacil
MOA: Inhibit protein synthesis - 30S
Coverage: Gram-positive (MRSA/VRE), Gram-negatives, Anaerobes & Atypicals
Indications: complicated SSTIs, IAIs, & CAP
BW: Increase risk of death
------Notes-----
1. Do not use in bloodstream infections
2. No activity against "3Ps" (Pseudomonas, Proteus, Providencia)
3. Solution should be yellow-orange in color "like a tiger!"
4. No renal dose adjustments
101
Additional Broad-Spectrum Antibiotics - Polymyxin (pg. 368)
Formulations, Coverage/uses & Toxicities
Formulations: Colistimethate sodium (prodrug of colistin) & polymyxin B sulfate "assess dose carefully"
Coverage/Uses: MDR Gram-negative infections
Toxicities: Nephrotoxicity (dose-dependent) & Neurotoxicity
102
What are the 3Ps?
Pseudomonas, Proteus. Providencia
103
Chloramphenicol Antibiotic
Broad-spectrum
Serious blood dyscrasias
Causes gray syndrome - high serum levels, cyanotic, coma --> death
104
Cleocin Generic & Facts
Generic: Clindamycin
-----Facts--------
1. Multiple formulations
2. Covers Staphylococci, Streptococci and anaerobes
3. No renal dose adjustments
4. Boxed warning: C. difficile colitis
5. Do Induction (D-test) - "If sensitive to clindamycin but resistant to erythromycin" --> if Positive test do NOT use Clindamycin
105
Flagyl Generic & Facts
Generic: Metronidazole -- 2C9 inhibitor
-----Facts--------
1. Anaerobic and protozoal infections
2. Multiple formulations
3. IV/PO ratio = 1:1
4. CI: Pregnancy (1st trimester), alcohol/propylene glycol (disulfiram rxn) |3 day window|
5. SE: Metallic taste & vulvovaginal candidiasis
6. Increase INR with warfarin
106
What is the first line treatment for C. difficile infection?
Name (Brand/Generic) & Formulation
Fidaxomicin (Dificid)
PO only
107
Rifaximin
Coverage, Formulation & Indications
E. coli
PO only
Indications: Traveler's diarrhea, prevention of hepatic encephalopathy, IBS-D
Off-label: C. diff
108
Urinary Agents (pg. 371)
Agents (Brand/Generic) & which is the drug of choice?
Fosfomycin (Monurol)
Nitrofurantoin (Macrobid, Macrodantin)*****
109
Urinary Agents - Nitrofurantoin
Dosing, Warnings, & Counseling
------Dosing------
Macrobid 100 mg BID x 5 days***
Macrodantin is QID
Avoid if CrCl < 60 mL/min
Warnings: Avoid in G6PD deficiency, can cause hemolytic anemia (positive Coombs test)
Counseling: take with food, discolor urine (brown)
110
Urinary Agents - Fosfomycin
Coverage & Dose Regimen
Coverage: E. coli (including ESBL), E. faecalis (incl. VRE)
Single-dose regimen
111
Topical Decolonization - Drug of Choice (Brand/Generic)
Mupirocin (Bactroban) Nasal ointment x 5 days
**eliminates Staphylococci MRSA colonization***
112
Drugs of Choice/Active Drugs for Specific Pathogens (pg. 372)
Nosocomial MRSA
Vancomycin (consider using alternative if MIC >2)
Linezolid
Daptomycin (not in pneumonia)
113
Drugs of Choice/Active Drugs for Specific Pathogens
C. difficile infections
Fosfomycin & Vancomycin
114
Drugs of Choice/Active Drugs for Specific Pathogens
Community-acquired methicillin-resistant S. aureus (CA-MRSA) and skin & soft tissue infections "SSTIs"
SMX/TMP (Bactrim)
Linezolid
Doxycycline/Minocycline
Clindamycin (D-test must be performed before using)
"Bad Lungs Do More Coughing"
115
Drugs of Choice/Active Drugs for Specific Pathogens
Methicillin-sensitive S. aureus (MSSA)
Nafcillin, Oxacillin, Dicloxacillin
Cefazolin, Cephalexin
116
Drugs of Choice/Active Drugs for Specific Pathogens
VRE (E. faecalis)
Pen G or Ampicillin
Linezolid
Daptomycin
---Cystis only-----
Nitrofurantoin, fosfomycin or doxycycline
117
Drugs of Choice/Active Drugs for Specific Pathogens
Acinetobacter baumannii
Carbapenems (except ertapenem)
118
Drugs of Choice/Active Drugs for Specific Pathogens
VRE (E. faecium)
Daptomycin
Linezolid
---Cystic only------
Nitrofurantoin, fosfomycin or doxycycline
119
Drugs of Choice/Active Drugs for Specific Pathogens
Bacteroides fragilis
Metronidazole
Beta-lactam/beta-lactamase inhibitors
Cefotetan, Cefoxitin
Carbapenems
120
Drugs of Choice/Active Drugs for Specific Pathogens
Carbapenem-resistant Gram-negative rods (CRE)
Ceftazidime/avibactam (Avycaz)
Colistimethate, polymyxin B sulfate
121
Drugs of Choice/Active Drugs for Specific Pathogens
HNPEK
Beta-lactam/Beta-lactamase inhibitors
122
Drugs of Choice/Active Drugs for Specific Pathogens
Extended-spectrum beta-lactamase producing Gram-negative rods (ESBL GNR) - E. coli, K. pneumoniae, P. mirabilis
Carbapenems
Ceftazidime/avibactam (Avycaz)
Ceftolozane/tazobactam (Zerbaxa)
123
Drugs of Choice/Active Drugs for Specific Pathogens
Atypical Organisms
Azithromycin
Doxycycline
Quinolones
124
Storage Requirements - Liquid Oral ABX (pg. 373)
Refrigeration Required after Reconstitution
Pen VK
Ampicillin
Augmentin
Keflex
125
Storage Requirements - Liquid Oral ABX
Which drug should NOT Refrigerated? Which drug is recommended for taste?
NOT: Cefdinir
Taste Enhancement: Amoxicillin
126
Storage Requirements - IV Antibiotics
DO NOT Refrigerate!
Metronidazole
Moxifloxacin (Avelox)
SMX/TMP
127
Key Drugs That do NOT require renal adjustments
Anti Staphylococcus PCNs (Naf, Oxa, Diclox)
Ceftriaxone
Clindamycin
Doxycycline
Macrolides (EES & Zithromax only**)
Metronidazole
Moxifloxacin
Linezolid
Vancomycin (PO only**)
