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53 Cards in this Set

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DOC and MLP for tonsillopharyngitis?
DOC = Penicillin VK
ADOC = Cephalexin

MLP = S. pyogenes >> Arcanobacterium haemolyticum (rare)
DOC and MLP for cellulitis?
DOC = Dicloxacillin or cephalexin; Penicillin G for S. pyogenes

MLP = S. pyogenes, S. aureus
DOC and MLP for acute otitis media (AOM)?
DOC = Amoxicillin

MLP = S. pneumoniae > H. influenzae > M. catarrhalis
DOC and MLP for refractory otitis media?
DOC = Amox/clav (Augmentin) or cefdinir

MLP = H. influenzae, M. catarrhalis (Amox would've knocked out S. pneumo)
DOC and MLP for acute bacterial sinusitis?
DOC = Amoxicillin

MLP = S. pneumoniae > H. influenzae > M. catarrhalis (same as AOM)
DOC and MLP for cellulitis?
DOC = Dicloxacillin or cephalexin PO (S. aureus produces PCNases); Naficillin/Vancomycin/cefazolinIV

ADOC: Penicillin VK if targeting S. pyogenes

MLP = S. aureus, S. pyogenes
DOC and MLP for acute bacterial endocarditis?
DOC = Penicillin G IV ( + gentimicin, aminoglycoside) for Strep
ADOC = Ceftriaxone IV (3rd gen ceph) for gm neg bacilli

**no PO abx for endocarditis--does not reach high enough serum concentration

MLP = Viridans group Strep
DOC and MLP for acute pyelonephritis?
DOC = Ceftriaxone IV; Levofloxacin (cheaper)

MLP = E. coli; other enterobacteriaceae
DOC and MLP for HA-Pneumonia?
DOC = Carbapenems to target Pseudomonas. Imipenem + cilastatin; Meropenem. Vancomycin if MRSA suspected.

MLP = P. aeruginosa, Enterobacteriaceae; MRSA?
DOC and MLP for diabetic foot ulcers?
DOC = ESP's, Piperacillin + tazobactam; Carbapenems, vanco for possible MRSA

MLP = could be anything. GNR's, GPC, anaerobes
Notable UW Formulary 1st gen oral cephalosporin?
cephalexin
1st gen IV cephalosporins? Special cautions?
cefazolin

N-MTT moiety increases potential bleeding problems --> admin w/vit K in IV
2nd gen oral cephalosporin? Special ntoes?
Cefuroxime axetil (Ceftin)

prodrug

penetrates to CNS, tx N. meningitidis and N. gonorrhoeae
3rd gen oral cephalosporin that is a prodrug? Special notes?
Cefpodoxime proxetil (prodrug, Vantin)

single 200mg dose tx N. gonorrhoeae

DOC for URI's; broad spectrum but not anaerobes
3rd gen oral cephalosporin that is NOT a prodrug?
Cefdinir

tastes great!
Cefotaxime

Which generation?
ROA?
Special notes, typical uses?
3rd gen cephalosporin

IV/IM

deacetyl-cefotaxime = metabolic byproduct that has synergy w/cefotaxime

good for PRSP, meningitis
Crap against Enterococcus and Pseudomonas
Ceftriaxone

Generation?
ROA?
Typical uses?
3rd gen IV/IM cephalosporin

broad spectrum; tx N. gonorrhoeae w/single 250mg shot; good for E. coli pyelonephritis

long half life; very popular in hospital tx

avoid Ca++ (forms ppt)
Ceftazidime
3rd gen IV/IM cephalosporin

reserved for Pseudomonas

sacrificed gm+ activity for improved gm- coverage
Cefepime

Generation? ROA?
Typical uses?
Cautions?
4th gen IV/IM cephalosporin!

does pretty much everything except anaerobes --> good for EMPIRIC THERAPY

does not activate inducible BLA's

caution: neurotoxicity
Carbapenems

bacterial mechanisms of resistance?
ROA?
uses?
induces but resistant to xsomal BLA's
largely BLA-resistant (but watch out for MBL carbapenemases, ex. NDM-1)

all IV, none PO

broad spectrum --> used for polymicrobial or MDR infections
Which drug must be combined with Cilastatin and why?
Imipenem (carbapenem)

Imipenem is degraded by renal dihydropeptidase DHP-1. Cilastatin inhibits DHP-1.
Typical indications for Meropenem?
meningitis
abdominal infections
complicated non-MRSA skin infection

often used for empiric therapy bc it's broad spectrum
Typical indications for ertapenem? Cautions?
complicated abdominal infections
complicated UTI, pelvic infections
Non-MRSA skin infections
Non-PRSP CAP

does NOT cover PRSP or Pseudomonas; more susceptible to ESBL and AmpC than other carbapenems
Indications for Doripenem?
Gram negatives (incl. Pseudomonas)
anaerobes

complicated abdominal, pelvic, skin infections, UTI's
Non-PRSP CAP
Aztreonam spectrum, uses?
aerobic gram negatives

Cayston: aerosol form for Pseudomonas infection in Cystic Fibrosis pts
DOC for PRSP?
Vancomycin
Ceftriaxone

or non-beta lactam abx
DOC for MSSA (S. aureus)?
PCNase resistant Penicillins:

Dicloxacillin PO
Naficillin IV
DOC for MRSA?
Vancomycin

Linezolid; Daptomycin; Quinupristin/Dalfopristin; SMZ/TMP
DOC for Pseudomonas?
Carbapenems except Ertapenem:
Doripenem, Meropenem, Imipenem + Cilastatin

Inhaled Monobactam: Aztreonam

Piperacillin + Tazobactam (ESPcn)
Ceftazidime (3rd IV/IM)
Cefepime (4th IV/IM) <--more expensive $$$
DOC for VRE (E. faecium)?
Daptomycin
Linezolid (Zyvox)
DOC for Enterobacteriaceae?
Many!

Amox/clav PO
Amp/sulbactam IV
Carbapenems in general
2nd gen and higher cephalosporins, esp Ceftriaxone
Monobactams
DOC for N. meningitidis?
Penicillin G
3rd Generation cephalosporins (cross BBB)
DOC for N. gonorrhoeae?
Cefpodoxime proxetil (3rd gen PO)
200mg PO

Ceftriaxone (3rd gen IV/IM)
250mg IM
DOC for Bacteroides spp.?
IV Ampicillin + Sulbactam
DOC for Moraxella catarrhalis?
Amox/clav PO

2nd/3rd gen ceph if allergic (Cefpodoxime proxetil)
DOC for Haemophilus influenzae?
Augmentin

2nd/3rd gen ceph if allergic
Advantage of ampicillin over amoxicillin? (hint: GI infections)
Significant enterohepatic recycling --> concentrated in the GI tract, good for Salmonella, Shigella
Why is the side effect profile of amoxicillin better than that of ampicillin?
Less amox makes it to enterohepatic recirculation --> less perturbation of gut flora --> less diarrhea
Advantage of piperacillin over ticarcillin?
-better against gm (-)
-less Pseudomonas resistance
DOC for Enterococcus faecalis?
Ampicillin + Sulbactam IV
Which cephalosporin should not be combined with calcium?
ceftriaxone
Black box warning for Benzathine Penicillin G?
NEVER give IV--Benzathine wil cause cardiac arrest
Abx that exhibit type I concentration dependent killing?
aminoglycosides
fluoroquinolone
daptomycin
Abx that exhibit type II time-dependent killing?
beta-lactams
linezolid
macrolides
Abx that exhibit type III time-dependent killing (long PAE)?
glycopeptides
tetracyclines
lincosamides
Spectrum of ampicillin?
gram + without ESBL or MBL

gram - orgs and anaerobes only in combo w/sulbactam

E. faecalis when combined w/aminoglycoside
Penicillin G spectrum?
Gm + cocci
Gm + rods
Gm - cocci (not N. gonorrhoeae)
Spirochetes
Why can't Penicillin G treat Helicobacter pylori?
H. pylori is a stomach bug; pen G is acid-labile
Some good drugs for empiric therapy?
Extended spectrum penicillins (Piperacillin, Ticarcillin)

Meropenem

Cefepime
Structural hallmark of a cephamycin?
Cephalosporin nucleus with an O-methylated beta lactam ring
Properties of MBL's?
"carbapenemases"
hydrolyze ALL beta-lactams, except monobactams

not susceptible to inhibition by clavulanate, sulbactam, tazobactam
Properties of ESBL's?
Extended Spectrum Beta-Lactamases

Hydrolyze penicillins and 2nd-3rd gen cephalosporins, monobactams but NOT carbapenems

susceptible to inhibition
Properties of TEM and SHV beta-lactamases?
hydrolyze penicillins and 1st generation cephalosporins.

susceptible to inhibition by beta-lactamase inhibitors.