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100 Cards in this Set
- Front
- Back
Gram + Aerobes
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Retains grams stain dye and appear purple.
*Cocci(round) -staph aureus-coag + -staph epi-coag - -strep pneumoniae -group streps and viridans -entercoccus *Bacilli(rods) -bacillus -Listeria monocytogenes -Nocardia |
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Gram - Aerobes
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Do not retain the gram stain dye and appear red on lab slide
-Neisseria gonorrhoeae -Neisseria meningitidis *Bacilli -E. Coli -Enterobacter -Klebsiella -Proteus -Pseudomonas -Citrobacter |
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Anaerobes
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Do not need O2 to grow
Above the diaphragm -Peptococcus -Peptostreptococcus Below the diaphragm -Clostridium difficile -Bacteroides fragilis |
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Atypical Anaerobes
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Legionella
Mycoplasma Chlamydia |
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Mouth
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peptococcus
peptostrepcoccus Actinomyces Pasteurella |
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Skin/Soft Tissue
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S. aureus
S. Pyogenes S. epidermidis N. gonorrhea |
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Bone and Joint
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S. aureus
Streptococci gram - rods |
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Abdomen
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E. Coli, Proteus
Klebsiella Enterococcus Bacteroides sp. |
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Urinary Tract
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E. Coli, Proteus
Klebsiella Enterococcus Staph saprophyticus |
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Upper respiratory
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S. Pneumonia
H. Influenzae M. Catarrhalis S. Pyogenes |
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Lower Respiratory(Community)
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S. Pneumonia
H. Influen K. Pnemonia Legionella Mycoplasma Chlamydia |
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Lower Respiratory (hospital)
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K pneumonia
P. aeroginosa Enterobacter sp. Serratia sp. S. Aureus |
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Meningitis
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S. Pneumonia
N. Meningitidis H. Influenza E. Coli Listeria |
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Classes of Antimicrobials
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Beta-lactams(PCN), Cephalosporins, Carbapenems, Monobactams, Quinolones, Aminoglycosides, Macrolides/Ketolides,Tetracyclines/Glycylcyclines, Sulfonamides, Lincosamides, Vancomycin, Streptogramins, Oxazolidinones
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Selection of an Antibiotic
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Spectrum
Cost Toxicity Routes of administration Frequency of administration |
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Time Dependent Killing
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Beta lactams and vancomycin
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Concentration Dependent Killing
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Aminoglycosides and quinolones
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Bactericidal
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Beta lactams, aminoglycosides, quinolone
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Bacteriostatic
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Macrolides, clindamycin, tetracyclines
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Beta Lactam Pharmacology
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MOA: inhibits cell wall synthesis by binding to PCN binding proteins.
Time dependent killing Widely distributed in body except CFS Most eliminated renally (except nafcillin and ceftriaxone) |
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Beta Lactam Adverse effects
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Hypersensitivity 3-10%(cross sensitivity with cephalosporins around 3-7%.
Neuro- seizures esp with high doses. GI- N/V, diarrhea, C.diff Hematologic: neutropenia, thrombocytopenia Renal-interstitial nephritis-esp with nafcillin Bleeding: Cephs with MTT side chain Fluid overload-PCN have high NA content-Ticar |
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Penicillins
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Natural
Penicillinase-resistant(anti staph) Aminopenicillins Extendend Spectrum (anti-pseudomonal) |
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Natural PCNs
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PCN G, PCN VK
strep infections oral anaerobes enterococcus syphilis N. meningitidis Very little gram - and no s.aureus activity |
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Natural PCNs dosing
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Four times daily (IV can be up to 6 times daily)
Very inexpensive |
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Long-Acting PCNs
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Benzathine PCN(IM)
used for syphilis and strep throat Procaine PCN(IM) intermediate acting, higher serum levels that benzathine Used for sensitive pneumococcus |
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PCN resistant
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Nafcillin, oxacillin, Dicloxacillin
Activity: meth. sensitive staph aureus(50%) No activity for MRSA Streptococcus No real gram - activity skin and soft tissue infections, endocarditis Dosing: q 4-6 hours no renal dysfunction adjustment Inexpensive |
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Aminopenicillins
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Ampicillin, Amoxicillin
Activity: easy to kill gram - such as e. colu, p mirabilis, salmonella, and some H. influx Strep activity but no S aureus Enterococcus drop of choice UTIs otitis media, strep pharyngitis YID(Amoxil) to QID(amp) inexpensive |
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Extended-Spectrum PCNs
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Ticarcillin, Piperacillin
High Na content (5.2 mEq Na/gram Tougher to kill grams - Very good strep and anaerobe activity Weak staph activity Tx: HAP, resistant UTIs, skin/soft tissue/osteo infections Moderately expensive d/t IV |
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PCNs Combinations
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Amp/sulbactam(Unasyn), Amox/clavulanic acid(augmentin), Piperacillin/tazobactam(Zosyn)
Inhibits beta-lactamase Activity: extends spectrum to betal lactamase producing S. Aureus(not MRSA), H. Flu, Klebsiella, and B. fragilis No activity to pseudomonas Tx: resist OM, intraadominal infections, HAP TID-QID more expensive than single drug |
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Cephalosporins
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1-4 Generations
Gram - improves from first to fourth and gram + decreases No activity against entercoccus |
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First generation Cephalosporins
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Cefazolin(Ancef)
Cephalexin(Keflex) Cefadroxil(Duricef) Activity: MSSA and streptococcus Easy to kill gram (-)s such as E. Coli, P. mirabilis, Klebsiella Tx: UTIs, cellulitis, sx prophylaxis BID to TID in most cases Cephalexin can be QID Very expensive |
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Second Generations(General)
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Cefuroxime(Zinacef) IV
Cefuroxime axetil (Ceftin), Cefaclor(ceclor), Cefpodoxime(vantin), Loracarbef(Lorabid)-po Activity: extended gram - activity H. flu, Klebsiella, M. Catarrhalis, poor S. pneumonia Tx: OM, CAP, UTIs BID to TID Ceclor cheap but others moderately expensive. |
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Anaerobic Second Generation Cephalosporins
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Cefoxitin(Mefoxin), cefotetan (Cefotan)
Acitivity: anaerobes including B. fragilis Easy to kill gram - such as E. Coli, P. Mirabilis Cefotetan has MTT side chain can increase bleeding risk Tx: intraabdominal infections, prophylaxis for GI/GU sx Cefotetan BID vs Cefoxitin QID Inexpensive |
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Non-Pseudomonal Third Generation Cephalosporins
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Ceftriaxone (Rocephin), Cefotaxime(Claforan), Cefdinir (Omnicef)-po, Cefpodoxime(Vantin) po
Activity: good gram - except pseudomonas Resistant UTIs, CAP, bronchitis Rocephin IM good for gonorrhea and lyme disease. Rocephin and Claforan good CNS penetration and useful in Meningitis. Rocephin is usually given QD except in meningitis when it is BID Rocephin QD has advantages |
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Pseudomonal Third Generation Cephalosporins
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Ceftazidine (Fortaz), Cefoperazone(Cefobid)
Actvity: excellent gram - activity including pseudomonas Tx: documented pseudomonas infection Cefobid contains MTT side chain and has recommendations about daily Vit K and coag monitoring CefoBID is BID and Fortaz is BID-TID Expensive compared with NP 3rd generations |
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Fourth Generation Cephalosporins
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Cefepime(Maxipime)
Activity: Gram + activity similar to Rocephin Excellent gram - activity including pseudomonas and particularly with enterobacter cloacae Tx:Resistant infections such as enterbacter species Febile neutropenia BID-TID Adverse Effects:Increase seizure activity and CNS activity with increase in mortality. Very expensive no oral dose |
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Fifth Generation ??
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Ceftaroline(Teflaro)
Activity: Gram positive including MRSA Good gram negative except P. aeruginosa Tx: CAP and skin and skin structure infections 600mg IV q12h with normal renal fx Very expensive with no po |
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Carbapenem Pharmacology
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MOA: inhibits cell wall synthesis
Bactericidal and time dependent killing Highly stable to beta lactamases Cross allergic with PCN Seizures can be a problem with improper dosing esp w imipenem |
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Carbapenems
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Imipenem/cilastatin(Primaxin), Meropenem(Merrem), Ertapenem(Invanz), Doripenem(Doribax)
Activity: excellent activity again grams (+), (- ) including enterbacter species, and anaerobes, no activity against MRSA. Ertapenem-no p. aeruginosa Tx: Resistant polymicrobial infections Primaxin and Merrem TID-QID Invanz QD often for outpatients Doribax 4 h infusion Very expensive |
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Monobactams
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MOA: inhibits cell wall synthesis
Bactericidal and time dependent killing No cross allergy with PCN *Aztreonam(Azatam) Activity: only gram (-) aerobes No gram (+) or anaerobic activity Tx: used in combo with clindamycin in PCN allergic pts Used only as mono therapy in urinary infections. BID-TID Moderately expensive and no po form. |
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Fluroquinolones
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Related to nalidixic acid.
Improved spectrum of activity and pharmacokinetics(better bioavvailability) MOA: Inhibits DNA gyrase wh/ is responsible for DNA synthesis Bactericidal and concentration dependent killing |
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Ciprofloxacin
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Activty: Excellent gram (-) activity including pseudomonas and good S. aureus activity
Poor strep and anaerobic activity PO agent only available for pseudomonal infections Tx: UTIs, HAP, osteomyelitis, GI infections, prostatitis AE: GI, CNS including insomnia, hallucinations, and seizures, low risk QTc prolongation, articular/tendon damage DI: antacids, calcium supplements, iron, sucralfate, inhibit absorption May increase theophylline and warfarin(INR) levels. BID Moderately expensive for po therapy |
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3rd generation Fluroquinolones
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Moxifloxacin(Avelox(, Levofloxacin(Levaquin)
Activity: Improved activity against s. pneumonia, very good atypical coverage, not as good at pseudomonas as Cipro Avelox has some anaerobic activity. Tx: CAP, bronchitis, UTIs Moxifloxacin not as good in UTIs d/t renal excretion QD-BID Moderately expensive |
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Macrolides
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MOA: Binds to 50s ribosomal unit and inhibits protein synthesis
Bacteriostatic and time dependent killing |
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First generation Macrolides
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Erythromycin(E-mycin, EES)
Activity: Staph and strep organism Atypical pathogens including mycoplasma, shlamydia, and legionella Poor gram(-) coverage Tx: CAP often used in combo with a NP3rd generation cephaloporin Skin and soft tissue infections in PCN allergic pt. BID-QID inexpensive AE:Nausea, diarrhea,much higher erythromycin than with 2nd generations Ototoxicity DI: inhibitor of p450 system-less with azithromycin Theo, warfarin, phenytoin, dig and many others |
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Macrolides-2nd generation
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Azithromycin(Zithromax)
Clarithromycin(Biaxin) Activity: Greater gram(-) activity than erythro. H. Pylori and MAC infections Improved bioavailabilty and longer half than erythromycin Tx: CAP, sinusitis, bronchitis, H. Pylori(PUD), MAC Dosing: Z-pack(outpatient) vs 500mg qd(in patient) Clarithromycing is BID AE: Much less GI effects that e-mycin, Biaxin(metallic taste) Cost effective esp 3-5 days |
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Aminoglycosides
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MOA:
Binds to 30S ribosome and inhibits protein syntheisis Concentration dependent killing and bactericidal |
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Amino glycosides
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Gentamycin, Tobramycin, Amikacin
Activity: Very good gram (-) including pseudomonas (amikan is best) Good in gram(+) including MSSA and enterococci (Gent. is best) Usually used in combo with a beta-lactam unless UTI Tx: Used with beta-lactams for HAP and other serious (-) infections, endocarditis AE: nephrotoxicity, ototoxicity, neuromuscular blockade Very inexpensive Traditional: 1-2 mg/kg q8-24h based on renal fx Must monitor peaks and troughs PKs 6-8 mcg/ml(T,G); Tr <2 mcg/ml. Daily: 5-7 mg/kg daily. Levels checked b/w 6-14 hours and placed on nomogram Peaks usually around 20mcg/ml and troughs should be close to ). But not usually checked. |
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Advantages to once daily dosing of Aminoglycosides
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Greater efficacy d/t concentration dependent killing
Less toxicity Ease of administration and levels Less costly Disadvantages: Not useful in gram(+) infections |
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Vancomycin
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MOA: inhibits well wall synthesis differently than beta lactams
Bactericidal for most pathogens Increasing usage d/t rate of MRSA in hospitals Seeing increasing incidence of VRE Activity: Excellent gram + including MRSA, entercoccus, c. diff. No gram (-) activity TX; MRSA, HAP, bacteremia and PCN resistant entercoccus its with severe B lactam allergies Orally for metronidazole resistant C. diff Usually 1 gram q12h, trough levels(15mcg/ml) AE: very rarely nephrotoxcity, and ototoxicity (Redman syndrome-slow infusion) Inexpensive |
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Sulfonamide
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Trimethoprim/Sulfamethoxazole(Bactrim, Septra)
MOA: PABA antagonist, inhibits folic acid synthesis Bacteriostatic Activity: Gram (-) urinary pathogens, protozoans, PCP, community acquired MRSA, UTIs BID AE: rash, renal dysfunction, hematologic Very inexpensive |
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Lincosamides
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MOA: Binds to 50S ribosomal subunit and inhibits protein synthesis
Mostly bacteriostatic Clindamycin(Cleocin) Activity: Anaerobes including B. fragilis MSSA, strp pneumo Tx: anaerobic infections above the diaphragm and with Cipro in beat lactam allergy Usually TID-IV to QID po No dose adjustment for renal dysfunction AE: C. Difficile colitis Inexpensive |
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Flagyl
|
MOA: Inhibits DNA synthesis
Concentration dependent killing and bactericidal Activity: Anaerobes, C. diff, protozoal infections, H. Pylori Tx: Anaerobic infections below diaphragm, DOC for C. Diff colitis, H. Pylori infections (PUD) TID-QID AE: Disulfiram rx with alcohol Inexpensive |
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Streptogramins
|
Synercid-combo of 2 agents quinupristin:dalfopristin
MOA: works of 50S ribosomal subunit and inhibits protein synthesis Bacteriostatic Activity: E. Faccium, MRSA, other grams +s TX: VRE, MRSA and can't take Vancomycin QID Expensive |
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Oxazolidinones
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Linezolid(Zyvox)
MOA: Binds to 50S ribosomal subunit Activity: E. Faecium and E.Faecalis, MRSA, VRSA Tx: VRE, MRSA, in vanc intolerant pts. BID AE: GI, HA, thrombocytopenia DI: SSRIs, tyramine foods since Zyvox is an MAOI Expensive |
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Tetracyclines
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Doxycycline(Vibramycin)
MOA: Inhibits protein synthesis Bacteriostatic Activity: Atypical pathogens, rickettsia, some gram + and gram - Tx: RMSF, VRE urinary infections, chlamydia BID AE: GI, rash, photosensitivity, tooth discoloration Inexpensive |
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Glycylcycline
|
Tigecycline(Tygacil)
Semisynthetic derivative of minocycline MOA: Bids to 30S ribosomal subunit Activity: Very broad spectrum with gram +, -, anaerobes, MRSA, VRE Tx: complicated intraabdominal infections, complicated skin and soft tissue infections BID IV only Expensive |
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Fosfomycin(Monurol)
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Activity: E. Faecium and e. faecalis including VRE
Gram - including ESBL producing urinary pathogens TX: uncomplicated/complicated ??? lower urinary infections NOT for pyelonnephritis or abscesses Single 3 gram packet mixed with 4oz of water. May repeat in 3 days Expensive per dose $50, but only one dose |
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Monitoring parameters
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WBC, WB with diff, temperature, s/s(CXR ,mental status, pain, redness, etc)
Culture data |
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Sensitivity Testing
|
Organism grown on special culture medium then id
Once id antibiotic disks placed on medium to check sensitivity and resistance |
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Community Acquired Pneumonia(CAP)
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Outpatient:
-Standard Regimen *Macrolide *Doxycycline(alterative) -COPD Patient *Moxifloxacin *Augmentin plus Macrolide(alternative) Hospitalized to a ward service: Ceftriaxone plus Azithromycin Moxifloxacin Unasyn plus Macrolide(alternative) |
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Health Care Acquired Pneumonia(HCAP)
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Hospital stay <5 days and no risk factors for drug resistant pathogens
Treat like CAP with Moxifloxacin Risk factors for multi resistant bacteria -Antibiotics in previous 90 days Resident of nursing home Hospitalized >2 days in last 90 days Dialysis within 30 days Immunosuppressive disease or therapy Hospital stay 5-9 days or risk factor of MDR pathogen (Zosynor Maxipime) Check cultures and clinical response and de-escalate if possible Hospital stay >10 days (Vanco plus Amikacin plus Zosyn or Maxipime) Check cultures and clinical response and de-escalate if possible |
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Upper respiratory infections(URIs)
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otitis media
sinusitis pharyngitis acute/chronic bronchitis |
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Otitis Media
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Usually middle ear
Follows a viral URI Pathogens: S. Pneumoniae, H. Flu, M. Cararrhalis Tx: Amoxicillin drug of choice (high dose with resistant s. pneumo) Failure usually d/t beta lactamase producing H. Flu or , M. cat.( Augmentin, 2nd generation cephalosporin TX duration 7-10 days |
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Sinusitis
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Tx: Amoxicillin is drug of choice but often something stronger needed.
Second line agents include: Augmentin, 2nd generations cephalosporins, TMP/SMX, macrolides Tx duration can be up to 3 weeks. |
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Pharyngitis
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Acute infection of oropharynx
Commonly viral Bacterial pathogens include: Group A beta hemolytic strep strep pyogenes Tx to prevent rheumatic fever Tx: PCN drug of choice, kids-Amoxil PCN allergic: Keflex, Erythromycin Tx is 10 days |
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Acute Bronchitis
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Almost always viral
Routine antibiotics not recommended OTC cough and cold preps discouraged Limiited efficacy with inhaled beta agonist |
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Chronic Bronchitis
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Usually seen in COPD
Pathogens: H. flu, M. Cat, S. Pneumo Tx: Augmentin, 2nd or 3rd generation fluoroquinolone, 2nd generation macrolide Tx. duration is 10-14 days |
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Urinary Tract Infections
|
Uncomplicated-Cystitis
Complicated-Pyelonephritis(Men) Catheter associated -Foley catheter prior to UTI Urinalysis-look for presence of nitrites and leukocyte esterase Microscopic-look for presence of WBC, RBC, and bacteria Gram Stain-not always what grows on culture Culture-base final antibiotic selection on culture Previous pathogens helpful in selection empiric antibiotics Common pathogens: E. Coli, P. Mirabilis, S. Saprophyticus, Enterococci-catheters-some VRE |
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Urinary Tract Infections
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Lactose fermenters
-CAKE *Citrobacter *Acinoetobacter *Klebsiella *E. Coli Non lactose fermenters -P's and S's *P. Mirabilis *P.aeruginosa *Providencia *Salmonella *Shigella *Serratia |
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Categories of UTIs
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CA: Ampicillin or TMP/SMX
HA: TMP/SMX or Cipro, Rocephin Catheter associated: Cipro or ampicillin/gent. Fosfomycin for VRE-single dose. Duration: 3-14 days |
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Cellulitis
|
Pathogens: Likely staph or strep
Diabetes-increased risk of gram (-) and anaerobes Tx: non-diabetic (Ancef, Nafcillin, Keflex) Diabetic: Unasy, Zosyn, Cipro/Flagyl |
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Meningitis
|
Diagnosis:
CSF from LP Elevated WBC-neutrophils particularly Increase protein and decreased glucose Grams stain very helpful Follow culture for definitive diagnosis Pathogens: Strep Pneumoniae, Neisseria meningitdis Elderly-Listeria monocytogenes also seen Children- < 2 H. Flu also seen Tx: Empiric tx Rocephin BID/Claforan plus Ampicillin (if pt > 50 years old) Steroids- Dexamethasone used in adults. |
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Endocarditis
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Diagnosis
-TTE/TEE-vegetations -splinter hemorrhages, osler nodes -blood cultures(check 6 cultures) Pathogens: Strep viridans, S. aureus-usually in IVD users Enterocococcus Tx:Varies based on native valve vs mechanical valve and of course on cultures General Recommendations: Vancomycin/Nafcillin for 4-6 weeks plus gentamycin for first 2 weeks(4 wks if enterocococcus) PCN G can be used for sensitive viridans |
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Rickettsial Diseases
|
Lyme Disease
Rocky Mountain Spotted Fever Doxycycline is the drug of choice for both diseases |
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Clostridium difficile
|
Leads to mild diarrhea to fatal pseudomembranous colitis
Hx of previous antibiotic can cause it-Clindamycin highly Diagnosis: Diarrhea symptoms plus + c. diff toxin stool High sensitivity test available now Tx: Initial mild/mod-Metronidazole 500mg po TID x10-14 days, Severe WBC > 15,000 Vanc 125mg po qid x10-14days Severe complicated(shock, hypotension, ileus) Vanc 500mg po QID plus Metronidazole 500mg po/IV Prevention: Hand washing with antimicrobial soap and water, isolation or pts, minimize use of antibiotics |
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Levels of Fungal Infections
|
Cutaneous-Tinea infections(athlete's foot, jock itch)
Mucocutaneous-Candidal infections (thrush, vaginitis) Invasive- Candidiasis, aspergillus, cryptococcus |
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Cutaneous Infections
|
Tx: Usually topical(lotion, cream, ointment, gel, powder, or shampoo depending on location)
Options: Nystatin(Mycosatin) Miconazole(Lotrimin AF) Tolnaftate(Tinactin) Terbinafine(Lamisil) |
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Mucocutaneous Infections
|
Tx: thrush usually lozenges, troches, or suspensions that swish and spit
Vaginitis usually uses creams or vaginal tabs Options: Magic mouthwash(combo that includes nystatin) Clotrimazole(Mycelex) Miconazole(Monistat) |
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Invasive
|
Tx: Involves systematic antifungals
Options: Amphotericin B Fluconazole Voriconazole Caspofungin |
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Amphotericin B
|
Adverse Effects:
Infusing related-fever, chills, rigors(premed with APAP, benadryl, heparin? Nephrotoxicity- may be minimized by sodium loading Lipid based formulations Reduced nephrotoxcity but with a huge cost increase Better in treating aspergillosis and histoplasmosis Preparations: Ampho B lipid complex (abelcet) Liposomal Ampho B (AmBisome) Ampho B colloidal dispersion (Amphotee) |
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Fluconazole
|
MOA: Inhibits enzyme responsible for ergosterol synthesis
Used for esophageal candidiasis and for cryptococcal meningitis Single dose for vaginitis AE:Very well tolerated, heptatoxicity DI: Numerous interactions (Warfarin, Phenytoin, Theophylline) |
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Voriconazole
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MOA: Similar to fluconazole
Drug of choice for aspergillosis infections AE: Numerous Blurred vision, altered visual and color perception, photophobia Photosensitivity LFT abnormalities DI: Potent inhibitor of p450 system Interactions: Warfarin, statins, omeprazole, cyclosporine |
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Caspofungin
|
MOA: Inhibits the cell wall of fungal pathogens(the PCN of antifungals)
An echinocandin class of anti fungal Very broad spectrum anti fungal agent AE: Very well tolerated (Some infusion related effects including fever, HA, flushing) Asymptpmatic elevations in LFTs DI: Not as significant as some other antifungals (cyclosporine) |
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Viral Infections
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60% of illness, self limiting.
Herpes Simplex(Type1, Type 2) Influenza-causes epidemics of acute illness transmitted respiratory route Influenza type A(common) and type B |
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Anti-Viral Treatment for Herpes
|
Acyclovir, valacyclovir and famiciclovir(inhibit viral DNA synthesis
Topical Therapy-less effective than oral Oral Therapy more effective the earlier the tx Acyclovir is the least expensive Doses vary but usually several times daily Can crystallize in the kidneys adjust for renal fx Can cause common GI complains of N/V diarrhea. |
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Anti-Viral Treatment for Influenza
|
Receive yearly influenza vaccine
Contains 3 strains (2 type A and 1 type B) Inactivated vaccine Flu-Mist is an inhaled vaccine that is a live attenuated vaccine For ages 2-49 years Amantadine and rimantadine are now poor agents for prophylaxis Tamiflu(oseltamivir) significantly decreases transmission in nursing homes and personal homes May be effective in avian influenza For treatment begin within 2 days of symptoms Risk of neuropsychiatrin adverse events. |
|
Anti-Protozoal Therapy
|
Malaria
-plasmodium falciparum, p. vivax, p.ovale, p. malariae *Giardiasis -Giardia lamblia |
|
Malaria Presentation
|
Headache
Malaise Myalgias Cyclical fevers (48-72 hours) Must have visited an endemic area |
|
Malaria Treatment
|
Acute attack:
-Chloroquine(if sensitive) or -Mefloquine , PLUS Primaquine if suspect p.vivax or p.ovale |
|
Malaria prophylaxis
|
Chloroquine- 500 mg q weekly beginning 1-2 wks before and continuing 4 weeks after last exposure
Mefloquine 250mg q weekly and similar regimen as above Doxycycline 100 mg DAILY for 1-2 days before, daily while in area and daily for 4 wks after return Malarone (atovaquone/proquanil) 1 tab DAILY for 1-2 days before, daily while in area and then daily for 7 days after return |
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Giardia Presentation
|
Acute onset of diarrhea, abd cramps, bloating, and flatulence
Contracted from contaminated water found in mountain streams Systems occur 5-15 days after ingestions of the cysts Most common protozoal infection in US. |
|
Giardia Treatment
|
Metronidazole(Flagyl) 250mg TID for 5-7days
Tinidazole (Tindamax) 2g once Often cheaper to treat empirically than to send a giardia sample |
|
Tubercular (TB) Infections
|
Caused by Mycobaterium tuberculosis
Symptoms: Fever, cough, painful breathing, blood sputum, and wt loss Risk factors: HIV, contact with TB pt, foriegn born, IVDA, HC workers exposed. Diagnosis: skin testing (ID injection of 5 TB units, measure area of indurations(not redness) >15 mm=positive but 5-10mm can be positive in certain populations CXR (may not be diagnostic) |
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(TB) infections cont'd
|
Culture- acid fast smear (AFB) of sputum is a fast and simple method
Follow with a culture of sputum that may take up to 5 weeks to grow. (confirms diagnosis) |
|
Treatment of TB
|
Latent infections:
Isoniazide (INH) 300mg daily for 6 months (non HIV) Must assess compliance, may give 900 mg twice weekly Monitor LFTs monthly, give Vit B6 (pyridoxine) daily Active TB: respiratory isolation until 3 negative AFB smears. Tx with 4 drugs: INH, rifampin, pyrazinamide(PZA), and ethambutol or strptomycin Continue 4 drugs for 8 weeks(until susceptibility testing is done) |
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INH (TB)
|
monitor LFTs
monitor signs of peripheral neuropathy no alcohol ingestion take on an empty stomach minimize tyramine-containing foods |
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Rifampin (TB)
|
Take on an empty stomach
Monitor LFTs Red/Orange coloring of urine, feces, saliva and tears(may stain soft contacts) Potent inducer of P-450 hepatic metabolism |
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Pyrazinamid (PZA) (TB)
|
may cause hyperuricemia and gout
Monitor LFTs May cause a mild arthralgia and myalgia |
|
Ethambutol (TB)
|
Requires renal adjustment
Can cause hyperuricemia gout May cause optic neuritis and visual testing is essential(periodically) Be aware of visual acuity changes or a loss of red-green discrimination. |