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53 Cards in this Set
- Front
- Back
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DOC and MLP for tonsillopharyngitis?
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DOC = Penicillin VK
ADOC = Cephalexin MLP = S. pyogenes >> Arcanobacterium haemolyticum (rare) |
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DOC and MLP for cellulitis?
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DOC = Dicloxacillin or cephalexin; Penicillin G for S. pyogenes
MLP = S. pyogenes, S. aureus |
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DOC and MLP for acute otitis media (AOM)?
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DOC = Amoxicillin
MLP = S. pneumoniae > H. influenzae > M. catarrhalis |
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DOC and MLP for refractory otitis media?
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DOC = Amox/clav (Augmentin) or cefdinir
MLP = H. influenzae, M. catarrhalis (Amox would've knocked out S. pneumo) |
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DOC and MLP for acute bacterial sinusitis?
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DOC = Amoxicillin
MLP = S. pneumoniae > H. influenzae > M. catarrhalis (same as AOM) |
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DOC and MLP for cellulitis?
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DOC = Dicloxacillin or cephalexin PO (S. aureus produces PCNases); Naficillin/Vancomycin/cefazolinIV
ADOC: Penicillin VK if targeting S. pyogenes MLP = S. aureus, S. pyogenes |
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DOC and MLP for acute bacterial endocarditis?
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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 |
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DOC and MLP for acute pyelonephritis?
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DOC = Ceftriaxone IV; Levofloxacin (cheaper)
MLP = E. coli; other enterobacteriaceae |
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DOC and MLP for HA-Pneumonia?
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DOC = Carbapenems to target Pseudomonas. Imipenem + cilastatin; Meropenem. Vancomycin if MRSA suspected.
MLP = P. aeruginosa, Enterobacteriaceae; MRSA? |
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DOC and MLP for diabetic foot ulcers?
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DOC = ESP's, Piperacillin + tazobactam; Carbapenems, vanco for possible MRSA
MLP = could be anything. GNR's, GPC, anaerobes |
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Notable UW Formulary 1st gen oral cephalosporin?
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cephalexin
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1st gen IV cephalosporins? Special cautions?
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cefazolin
N-MTT moiety increases potential bleeding problems --> admin w/vit K in IV |
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2nd gen oral cephalosporin? Special ntoes?
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Cefuroxime axetil (Ceftin)
prodrug penetrates to CNS, tx N. meningitidis and N. gonorrhoeae |
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3rd gen oral cephalosporin that is a prodrug? Special notes?
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Cefpodoxime proxetil (prodrug, Vantin)
single 200mg dose tx N. gonorrhoeae DOC for URI's; broad spectrum but not anaerobes |
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3rd gen oral cephalosporin that is NOT a prodrug?
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Cefdinir
tastes great! |
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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 |
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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) |
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Ceftazidime
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3rd gen IV/IM cephalosporin
reserved for Pseudomonas sacrificed gm+ activity for improved gm- coverage |
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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 |
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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 |
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Which drug must be combined with Cilastatin and why?
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Imipenem (carbapenem)
Imipenem is degraded by renal dihydropeptidase DHP-1. Cilastatin inhibits DHP-1. |
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Typical indications for Meropenem?
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meningitis
abdominal infections complicated non-MRSA skin infection often used for empiric therapy bc it's broad spectrum |
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Typical indications for ertapenem? Cautions?
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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 |
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Indications for Doripenem?
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Gram negatives (incl. Pseudomonas)
anaerobes complicated abdominal, pelvic, skin infections, UTI's Non-PRSP CAP |
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Aztreonam spectrum, uses?
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aerobic gram negatives
Cayston: aerosol form for Pseudomonas infection in Cystic Fibrosis pts |
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DOC for PRSP?
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Vancomycin
Ceftriaxone or non-beta lactam abx |
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DOC for MSSA (S. aureus)?
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PCNase resistant Penicillins:
Dicloxacillin PO Naficillin IV |
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DOC for MRSA?
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Vancomycin
Linezolid; Daptomycin; Quinupristin/Dalfopristin; SMZ/TMP |
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DOC for Pseudomonas?
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Carbapenems except Ertapenem:
Doripenem, Meropenem, Imipenem + Cilastatin Inhaled Monobactam: Aztreonam Piperacillin + Tazobactam (ESPcn) Ceftazidime (3rd IV/IM) Cefepime (4th IV/IM) <--more expensive $$$ |
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DOC for VRE (E. faecium)?
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Daptomycin
Linezolid (Zyvox) |
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DOC for Enterobacteriaceae?
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Many!
Amox/clav PO Amp/sulbactam IV Carbapenems in general 2nd gen and higher cephalosporins, esp Ceftriaxone Monobactams |
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DOC for N. meningitidis?
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Penicillin G
3rd Generation cephalosporins (cross BBB) |
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DOC for N. gonorrhoeae?
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Cefpodoxime proxetil (3rd gen PO)
200mg PO Ceftriaxone (3rd gen IV/IM) 250mg IM |
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DOC for Bacteroides spp.?
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IV Ampicillin + Sulbactam
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DOC for Moraxella catarrhalis?
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Amox/clav PO
2nd/3rd gen ceph if allergic (Cefpodoxime proxetil) |
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DOC for Haemophilus influenzae?
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Augmentin
2nd/3rd gen ceph if allergic |
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Advantage of ampicillin over amoxicillin? (hint: GI infections)
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Significant enterohepatic recycling --> concentrated in the GI tract, good for Salmonella, Shigella
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Why is the side effect profile of amoxicillin better than that of ampicillin?
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Less amox makes it to enterohepatic recirculation --> less perturbation of gut flora --> less diarrhea
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Advantage of piperacillin over ticarcillin?
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-better against gm (-)
-less Pseudomonas resistance |
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DOC for Enterococcus faecalis?
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Ampicillin + Sulbactam IV
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Which cephalosporin should not be combined with calcium?
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ceftriaxone
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Black box warning for Benzathine Penicillin G?
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NEVER give IV--Benzathine wil cause cardiac arrest
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Abx that exhibit type I concentration dependent killing?
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aminoglycosides
fluoroquinolone daptomycin |
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Abx that exhibit type II time-dependent killing?
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beta-lactams
linezolid macrolides |
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Abx that exhibit type III time-dependent killing (long PAE)?
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glycopeptides
tetracyclines lincosamides |
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Spectrum of ampicillin?
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gram + without ESBL or MBL
gram - orgs and anaerobes only in combo w/sulbactam E. faecalis when combined w/aminoglycoside |
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Penicillin G spectrum?
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Gm + cocci
Gm + rods Gm - cocci (not N. gonorrhoeae) Spirochetes |
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Why can't Penicillin G treat Helicobacter pylori?
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H. pylori is a stomach bug; pen G is acid-labile
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Some good drugs for empiric therapy?
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Extended spectrum penicillins (Piperacillin, Ticarcillin)
Meropenem Cefepime |
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Structural hallmark of a cephamycin?
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Cephalosporin nucleus with an O-methylated beta lactam ring
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Properties of MBL's?
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"carbapenemases"
hydrolyze ALL beta-lactams, except monobactams not susceptible to inhibition by clavulanate, sulbactam, tazobactam |
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Properties of ESBL's?
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Extended Spectrum Beta-Lactamases
Hydrolyze penicillins and 2nd-3rd gen cephalosporins, monobactams but NOT carbapenems susceptible to inhibition |
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Properties of TEM and SHV beta-lactamases?
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hydrolyze penicillins and 1st generation cephalosporins.
susceptible to inhibition by beta-lactamase inhibitors. |
