Gram positive organisms
Staph, Strep, Enterococcus
1st line Treatment of Gram positive
Penicillins
2nd line treatment of Gram positive ... [Show More] with Penicillin Allergy
Cephalosporins: 3rd generation (cefdinir, cefuroxime) Macrolides: if anaphylactic (azithromycin, clarithromycin)
AOM and sinusitis organisms
Haemophilus influenzas, Moraxella catarrhalis, Streptococcus pheumoniae
1st line tx for AOM
high dose amoxicillin 5-10 days
AOM pain
Ibuprofen, acetaminophen
for Antibiotic resistant AOM
amoxicillin- clavulanate or ceftriaxone
AE with clavulante
diarrhea
Renders PCNs G and V inactive
beta-lactamases
to Tx Step and AOM
Ampicillin, amoxicillin
DOC for PCN allergies
Macrolides
Narrow spectrum PCNs resistant to penicillinase enzymes
Oxacillin, Nafcillin, dicloxacillin,
extended spectrum antipseudomonal PCN
Piperacillin/tazobactam
Not affected by beta lactamase bacteria
oxacillin, nafcillin, dicloxacillin
Piperacillin (given with tazobactam)=Zosyn
effective against pseudomonas, Enterobacter, Bacteroides fragilis and klebsiella. is not given alone.
Beta lactamase inhibitors
never given alone: clavulanic acid, tazobactam, sulbactam no MRSA coverage
piperacillin/tazobactam
effective against pseudomonas
amoxicillin/clavulanic acid
ears, lungs, sinus, skin, and urinary tract. used to treat infections caused by beta-lactamase producing organisms.
Beta lactamase inhibitors combined drugs
ampicillin/sulbactam; amoxicillin/clavulanic acid; Piperacillin/tazobactam NO:MRSA coverage
Cephalosporins
most widely used, has a beta lactam ring
1st generation Cephalosporins
presurgical prophylaxis, gram-positive,
2nd generation cephalosporins
mostly gram-positive. cefoxitin-(anaerobic Bacteroides fragilis),cefuroxime (URI, pneumonia from h flu, pneumococci and staph) some beta-lactamase cover
3rd generation cephalosporins
meningitis=penetrates the CSF. good Gram negative aerobe coverage. no pseudomonas or enterococcus activity.
4th generation cephalosporins
pseudomonas and hospital acquired infections; Ceftaolozane/tazobactam; cefepime
5th generation cephalosporins
Ceftaroline: MRSA, VRSA, community-acquired pneumonia, broad-spectrum with gram- and + cover, pseudomonas and some Enterobacteriaceae
3rd generation cephalosporin names
cefotaxime, cefdinir, cefditoren, cefixime, cefpodoxime, ceftazidime, ceftibuten, ceftriaxone, cefoperazone, ceftibuten, ceftizoxime
cephalosporins Side effects
Cross allergy with PCN; NO: Alcohol increased bleeding=decreased prothrombin via interference with Vitamin K
cephalosporins that cause bleeding and are contraindicated with Alcohol
Cefotetan, cefmetazole, cefoperazone
Carbapenems
weakens the cell wall, big Guns, Broad spectrum, given in hospital and not given alone. end with -enem, except for avibactam. covers gram -, gram + and anaerobes, renal excretion
Carbapenems contraindicated with
reduces levels of Valproate
Imipenem
not given alone: broadest spectrum given with vancomycin
Meropenem
meningitis
ertapenem
complicated GI, GU, soft tissue infection, CAP
Doripenem
complicated intra-abdominal infections/complicated UTIs
Avibactam
combined with ceftazidime for intra-abdominal and UTIs
Vancomycin
glycopeptide; inhibits cell wall synthesis;
narrow-spectrum used only for MRSA and C.Diff, only oral is for C. Diff.
Vancomycin AEs
ototoxicity, nephrotoxicity, red man syndrome, thrombocytopenia, rashes
Telavancin
alternative to vancomycin; Lipogycoprotein for skin infections/hospital-acquired pneumonia
Telavancin AE
Prolonged QT
Dalbavancin and oritavancin
watch renal clearance: glycopeptide antibiotics; skin and soft tissue. alternatives for Vanc with staph and MRSA, strep infections, and enterococcus faecalis.
Daptomycin
depolarizes cell membranes, inhibits DNA/RNA/Protein synthesis. good for MRSA, soft tissue infections, Enterococcus faecalis (gram
Teicoplanin
narrow spectrum gram positive only MRSA
Aztreonam
monobactam gram negative only: h. flu, pseudomonas, Enterobacteriaceae, e coli, klebsiella, proteas, salmonella, shigella
Fosfomycin
used 1st line for UTI only. one time dose. ok in pregnancy, e coli, enteroccoccus
UTI pregnant women
macrolides, PCN, cephalosporins, fosfomycin
macrolides
Broad-spectrum; inhibits bacterial protean synthesis. They are BIG (MACRO). Erythromycin, azithromycin, clarithromycin
Macrolides therapy
respiratory infections, H.pylori, Mycobacterium, alternative to PCN.
Macrolide monitoring
QT prolongation, GI disturbances: May give with food.
Tetracyclines
Bacteriostatic protein synthesis inhibitors, broad spectrum.
Names of tetracyclines
-cycline: long acting: doxycycline, minocycline, intermedicate: demeclocycline, short: tetracycline
Tetracyclines AE Test Q
stain deciduous teeth (no for children under), GI distress, liver/kidney toxicity, photosensitivity, superinfections.
Tetracycline contraindications test Q
do not take with calcium, milk, iron, magnesium or antacids
Tetracyclines therapy use
acne, respiratory infections, skin infections
demeclocycline
long acting: strep, respiratory, skin, eye, lymphatic, GI, UTI. infections caused by ticks, lice, mites, infected animals.
doxycycline most likely to be tested on
CA-MRSA, Pneumonia, RMSF, Lyme, acne, PUD, anthrax, chlamydia
minocycline
RA, Acne
drug of choice for chlamydia's
Doxycycline
Macrolides
when allergic to PCN
Macrolides
-mycin also Aminoglycosides end in -mycin
macrolide therapy
covers pneumonia, mycobacteriaum (HIV); chlamydia, H. Flu; whooping cough/pertusis
Macrolide names
azithromycin, Erythromycin(lots of drug interactions), clarithromycin, clindamycin
macrolide with most drug interactions
Erythromycin: increases carbamazepine, warfarin, theophylline
macrolide with BB warning
Clindamycin for C-diff
macrolide AE
QT prolongation (least likely=azithromycin): GI upset, may take with food
Macrolides contraindications
statins due to muscle breakdown/ simvastatin=QT prolonged
Prolongs QT=arrhythmias
macrolides, fluoroquinolones, Telithromycin, amiodarone, simvastatin
clindamycin ( TQ)
CA-MRSA [Show Less]
