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94 Cards in this Set
- Front
- Back
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MSSA
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Oxacillin
Cefazolin |
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MRSA
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MRSA (Skin):
Bactrim Minocycline Doxycycline Vancomycin Linezolid Daptomycin Tigecycline Mini Tiger Lines on Bac of Van Do Dapend... on skin MRSA (Blood): Vancomycin (if MIC <1.5) Daptomycin (if MIC<1) Vanpires Dapend... on blood Note: Gram +, Clusters, Coagulase + |
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Enterococcus
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DOC: ampicillin
If resistant or allergy: vanco Note: Gram +, Chains or Pairs, gamma hemolysis |
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VRE
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Linezolid
Tigecycline quinu/dalfopristine daptomycin Dat Tige linez are Pristine |
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beta hemolytic strep
drug |
penicillin
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alpha hemolytic strep
drugs |
ceftraxone, FQ
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listeria
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ampicillin
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nocardia
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bactrim
no going bact |
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stenotrophamonas
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bactrim
Stend Bact |
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pseudomonas
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imipenem
levofloxacin colistin cefepime ceftazidine ciprofloxacin aztreonam AG meropenem piper/tazo I'L CAMP |
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Atypicals
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FQ
Macrolide |
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Anaerobes
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pcn w/ betalactam inhib
clindamycin metronidazole-flagyl plz be clin metro |
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C diff
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vanco PO
metronidazole fidaxomicin |
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ESBL
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carbapenem
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KPC
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colistin
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Corynebacterium
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possible contaminant
Vanco |
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Alpha hemolytic
what are they |
strep viridians
strep pneumoniae |
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B hemolytic
what are they...groupsss |
group A- strep pyogenes
group B- strep agalactiae |
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bacillus anthracis
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tetracycline
doxycycline |
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nonfermenting gram negatives
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Burkholderia
Alcaligenes Stenotrophomonas Pseudomonas Acinetobacter Burk Al and Sten are Pseudo Aces |
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bacteroides
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ampicillin/ sulbactam
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e coli
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bactrim
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Atypical organisms
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MycoPLASMA
chlamydia legionella |
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mycoBACTERIUMq
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FAC are rapid growers (7-21 days)
fortuitum abscessus chelonae |
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b lactams
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inhib cell wall syn
cidal except enterococcus T>MIC killers DOC syphillis |
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SPACEM bugs..
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Serratia
Pseudomonas Acinetobacter Citrobacter Enterobacter Morganella IMPORTANT: avoid 1-3rd gen cephs |
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Meropenem vs Ertapenem
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APE for Mero
Acinetobacter Pseudomonas Enterococcus |
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MDR pseudomonas, acinetobacter, ESBLs
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colistin (polymixin E)
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intrathecal abx
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tobramycin
gentamycin vanco colistin |
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alpha hemolysis
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Strep viridans
Strep Pneumonia Treatment: Penicillin |
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How are most ABX eliminated?
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Most primarily by the Kidney
Liver: Nafcillin Oxacillin Ceftriaxone Cefoperazone |
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Describe cross reactivity with Penicillins, Carbapenems, and Cephalosporins
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True Allergies are IgE mediated
Allergy to PCN, then 5% chance allergic to Cephalosporins too Allergy to PCN, then 30% chance allergic to Carbapenems too Allergic to Cephalosporins, then very high chance of being allergic to both PCN and Carbapenems |
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What are Natural Penicillins good for?
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Streptococcus sp. (Gram +)
Neisseria meningitidis (Gram -) Basic anaerobes (NOT Bacteroides sp.) Treponema pallidum (Syphillus)- DOC |
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What are Antistaphylococal Penicillins good for?
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CONDM drugs...
developed to overcome resistance to S. aureus S. aureus (MSSA) S. pneumoniae Streptococcus sp. NO Gram - Minimal Anaerobe |
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Which Antistaphylococcal Pencillins are IV and which are Oral?
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IV= Oxacillin and Nafcillin
Oral= Dicloxacillin and Cloxacillin |
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What are Aminopenicillins good for?
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S. aureus (NOT MSSA or MRSA)
S. pneumoniae Streptococcus sp. Enterococcus sp (DOC= Ampicillin) Listeria sp. (DOC= Ampicillin) Neiserria meningitidis (Gram -) Proteus mirabilis (Gram -) Anaerobes (NO bacteroides sp.) |
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What are Anti-Pseudomonal Penicllins good for?
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Carboxypenicllins- Carbenicllin and Ticarcillin
Ureidopenicllins- Piperacillin and Azlocillin Ticarcillin: Streptococcus sp (beta hemolytic) Neiserria meningitidis Proteus mirabilis Salmonella Shigella E. coli b lactamase (-) H. flu Enterobacter sp. Pseudomonas Anaerobes (NO bacteroides) Piperacillin: Add Strep viridans, enterococcus, some klebsiella |
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Name the 3 Beta Lactamase Inhibitors
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Clavulanic acid/ clavulanate
Tazobactam Sulbactam |
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What does Ampicillin/ Amoxicillin cover?
What does it cover when combined with a beta lactamase inhibitor? |
Ampicillin/ Amoxicillin:
S. pneumoniae Enterococcus Listeria Neiserria meningitidis (gram -) Proteus mirabilis (gram -) Anaerobes (NOT bacteroides) With Beta Lactamase Inhibitor: Add MSSA, most gram negatives (excluding SPACEM bugs), Bacteroides |
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What does Ticarcillin-clavulanic acid cover?
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Gram +:
S. aureus Gram-: Neisserria meningitidis Proteus mirabilis Salmonella Shigella Some e. coli Beta lactamase (-) H. flu Enterobacter sp P. aeruginosa Anaerobe: Bacteroides sp |
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What does Piperacillin- tazobactam cover?
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Gram +:
Strep viridans enterococcus s. aureus Gram -: same as Ticarcillin, but ADD Klebsiella SPACEM Anaerobes: Bacteroides sp. |
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Cephalosporins in general...
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Gram Positive:
MSSA Streptococcus sp. NONE cover enterococcus Gram Negative: -differs between generations Most lack Anaerobic coverage |
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What are 1st Generation Cephalosporins good for?
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1st Generation:
Cefazolin Cephalexin Cefadroxil Good gram + coverage plus PEcK P. mirabilis E. coli K,pneumoniae Anaerobes: NONE |
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What are 2nd Generation Cephalosporins good for?
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2nd Generation:
Cefuroxime Cefoxitin Cefprozil Cefotetan Good gram positive coverage, plus HeNPEcK H. influenza Moraxella sp. Neisseria sp P. mirabilis E. coli K. pneumoniae Cephamycins are active against anaerobes: Cefoxitin Cefotetan |
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What are 3rd Generation Cephalosporins good for?
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3rd Generation:
Ceftriaxone Cefdinir Cefpodoxime Ceftazidime Good gram positive coverage: resistant streptococci Not as active against staphylococci More gram negative coverage: Citrobacter, Enterobacter, Acineobacter,Morganella,Serratia marcescens, Providencia Ceftazidime: Pseudomonas!!! Avoid use for SPACEM- harbor inducible AmpC b lactamases |
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What are 4th Generation Cephalosporins good for?
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4th Generation:
Cefepime Good gram positive Good gram negative less likely to induce AmpC gene of SPACEM organsims Treats Pseudomonas!!! |
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Zosyn vs. Cefepime
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Zosyn (Piperacillin/ Tazobactam)
Cefepime: lacks anaerobic and enterococcus sp coverage Add metronidazole to expand coverage |
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What are 5th Generation Cephalosporins good for?
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5th Generation:
Ceftaroline (Teflaro) Extend to cover MRSA |
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Carbapenem Activity in General
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Good gram positive activity:
most ampicillin susceptible enterococcus MSSA Most streptococcus sp Great gram negative coverage: ESBLS Nocardia Do NOT cover Stenotrophomonas or Legionella |
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Which Carbapenems do NOT cover E. faicium?
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Meropenem
and Doripenem |
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Which Carbapenem is used in Pediatrics Neurology?
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Meropenem
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Which carbapenems cover pseudomonas the best?
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Doripenem > Meropenem
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Ertapenem does not cover...
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Acinetobacter
Pseudomonas Enterococcus |
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What is Aztreonam good for?
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Aztreonam (Azactam)
Monobactam- may be used with PCN allergic patients Activity vs. gram negative ONLY including Pseudomonas aeruginosa!!! Inhalation product called: Cayston |
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What do FQ cover and not cover?
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Gram Positive:
excellent streptococci coverage do NOT use cipro for strep pneumoniae do NOt use for MSSA, MRSA, enterocicci Gram Negative: Enterobacteriaceae Pseudomonas (cipro and levofloxacin) Anaerobes (moxifloxacin): Legionella pneumophila Chlamydia sp Mycoplasma sp Urea urealyticum Other: Mycobacterium sp. Bacillus anthracis |
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Moxifloxacin
vs Levofloxacin vs Ciprofloxacin |
Moxifloxacin- Topoisomerase IV- s. pneumoniae
Levofloxacin- intermediate Ciprofloxacin- Topoisomerase II- Pseudomonas |
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Name some drug interactions with FQ
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Binds to cations: zinc, iron, aluminum, magnesium, antacids, enteral feedings (separate 2 hrs before or 4 hrs after)
Theophylline and Cyclosporine with Cipro (inhibition of metabolsim, increase levels, increase toxicity Warfarin (cipro is a CYP 1A2 inducer) INR will look like it is raised |
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How do Macrolides work?
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Inhibit bacterial protein synthesis via 50S robosomal subunit
Time-dependent bacterioSTATIC killing Azithromycin, Erythromycin, Clarithromycin |
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General coverage of Macrolides?
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Atypical organisms
Strep. pneumoniae H. influenza Mycobacterium |
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Azithromycin is most commonly used for?
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Community Acquired pneumoniae
Sinusitis Mycobacterium Avium Complex (MAC) Chlamydia Has anti-inflammatory properties (Good for CF patients colonized with pseudomonas sp. and burkholderia sp.) |
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What is Clarithromycin commonly used for?
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H. pylori
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Adverse reactions of macrolides?
What are the main drug-drug interactions? |
ADE:
QTc prolongation Diarrhea and nausea DDI: CYP 450 enzymes (e.g. warfarin) Less with Azithromycin Erythromycin inhibits CYP 1A2/3A4 |
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What are the most common uses for Bactrim?
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Sulfamethoxazole/ Trimethoprim (Bactrim, Septra)
UTI (e. coli) Community acquired skin and soft tissue infections (MRSA) Stenotrophomonas sp. (DOC) Nocardia sp. (DOC) PCP and Toxoplasmosis prophylaxis and treatment |
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Adverse reactions of Bactrim?
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Bone marrow suppression
Photosensitivity GI upset Hyperkalemia Crystalluria |
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Describe Tetracyclines
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Bind to 30S ribosomal subunit, inhibiting bacterial protein synthesis
Coverage to include: Atypical organisms Staph. species (MSSA and MRSA) Streptococcus pneumoniae Borriela burgdorferi (Lyme Disease) Propionobacterium acne Avoid use in persons <8 y/o or pregnancy (enamel hypoplasia and tooth discoloration) |
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Adverse reactions of Tetracyclines?
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Phototoxicity
Esophagitis Rash/ Allergy Take on an empty stomach |
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DOC for Lyme Disease?
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Borriela burgdorferi (Lyme Disease from Ticks)
DOC= Doxycycline |
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Describe Tigecycline
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Tigecycline (Tygacil)
Binds 30S ribosomal subunit, inhibiting bacterial protein synthesis; structurally related to tetracyclines, but tighter binding @ 30S and less efflux pump activity Time-Dependent bacteriostatic Coverage: Good gram positive (VRE, MSSA, MRSE, MRSA) Good gram negative (includes ESBL organisms) Anaerobes (B. fragilis) NOT: pseudomonas sp, morganella, proteus, or providencia |
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Adverse Effects of Tigecycline
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Nausea (30%) and Vomiting (20%)
Diarrhea |
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What is Tigecycline usually used for?
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Tigecycline (Tygacil)
cSSSIs and complicated intra-abdominal infections concentrates poorly in the urine limited datea for pneumonia Do NOT use for bacteremia!!! |
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Describe Metronidazole and its uses
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Metronidazole (Flagyl)
Causes loss of helical DNA structure leading to inhibition of protein synthesis and cell death CONCENTRATION dependent bacteriCIDAL killing Anaerobic coverage ( including C. difficile) Uses: serious anaerobic infections (brain abscess, skin/soft tissue, bone/joint infections), H. pylori, bacterial vaginosis, C. difficile infections, etc. |
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Side effects and Drug-Drug interactions with Metronidazole?
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Side effects:
Metallic taste GI upset Dizziness Headache Dark urine Peripheral neurophathy or seizures (rare) DDI: ETOH- disulfiram-like reaction ONLY adjust in severe renal impairment |
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Describe Clindamycin and its uses
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Clindamycin
Binds to 50S ribosomal subunit preventing protein synthesis Coverage: Anaerobic coverage MSSA, community acquired MRSA if D-test (-) Group A, B, C, G streptococci and some S. pneumoniae Uses: Surgical prophylaxis Diabetic foot aspiration pneumonia Anti-toxin effects verses Streptococcus sp. |
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Explain the D-test
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If D test (+)= USE Erythromycin (there is inducible clindamycin resistance)
If D test (-)= USE Clindamycin |
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Adverse reactions of Clindamycin
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GI Upset (25-30%)- C. difficle colitis
Rash Increased LFTs NO renal adjustment necessary |
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AG vs Vancomycin
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AG:
small/ less extensive volume of distribution use IBW Concentration Depenedent Vancomycin: Large/ distributed exensively Use ABW Time Dependent Gram Positive only |
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Describe Aminoglycosides
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Gentamicin, Tobramycin, Amikacin, Netilmicin, Streptomycin, Neomycin, Kanamycin, etc.
Inhibit protein synthesis by binding to 30S ribosomal subunits Minimal gram-positive coverage Cover most gram-negative organisms -including Pseudomonas aeruginosa Activity against Mycobacterium sp. Develop rapid resistance (monotherapy only for UTIs) Poorly absorbed from GI tract Poorly distributed into adipose tissue and CSF Eliminated renally |
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Adverse Effects of Aminoglycosides
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Nephrotoxicity (monitor troughs for toxicity)
Ototoxicity (dizziness, vertigo, ataxia, tinnitus, decreased hearing) Risk factors: prolonged high troughs long duration of therapy |
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Adverse Effect of Vancomycin
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Red-Man Syndrome (can give Benedryl before admin.)
Nephrotoxicity Otoxicity Dermatologic- rash Hematologic- neutropenia and thrombocytopenia Thrombophlebitis |
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Describe Linezolid
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Oxazolidinone: Linezolid (Zyvox)
Inhibits 23S ribosomal RNA of the 50S subunit preventing formation of functional 70S complex essential for bacterial translation Bacteriostatic for staphylococci and enterococci (NOT for MRSA bacteremia) NO gram negative coverage Gram Positive Coverage: VRE MRSA Resistant Streptococcus sp. Some Mycobacterium sp. (including Tb) |
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Adverse Effects and Drug-Drug Interactions of Linezolid
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Adverse Effects:
Thrombocytopenia (>10 day tx) Peripheral neuropathy Optic neuritis (irreversible) GI upset Drug-Drug Interactions: Beware serotonin syndrome (agitation, confusion, hallucinations, shivering, tachycardia, hyper-reflexia, myoclonas, ect.) |
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Describe Daptomycin
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Lipoglycopeptide: Daptomycin (Cubicin)
Binds to cell membrane and causes rapid depolarization Broad Gram-Positive coverage: enterococcus sp. (including VRE) MSSA and MRSA Streptococcus sp. NO gram-negative coverage NEVER use for pneumonia!!! -surfactant inactivation |
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Adverse Effects with Daptomycin
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CPK elevations: myopathy and rhabdomyolysis
(hold or decrease dose of concomitant statin) GI Upset (11%) NEVER use for pneumonia!!! |
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Describe Dalfopristin/ Quinupristin
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Dalfopristin/ Quinupristin (synercid)
Inhibits protein synthesis at the 50S subunit (bacteriostatic) Covers: VRE (NOT faecalis) MRSA Most Gram-Positives |
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Adverse Effects of Dalfopristin/ Quinupristin
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Sinercid
Venous irritation infusion site pain and inflamation (42%) Myalgia/ arthralgia (up to 47%) Hyperbilirubinemia (up to 35%) |
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Describe Fidaxomicin
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Fidaxomicin (Dificid)
Developed to treat C. difficile infections Inhibits RNA polymerase sigma subunit, interfering with protein synthesis and causing cell death BacteriCIDAL ADR: Nausea (11%) |
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Describe Nitrofurantoin
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Nitrofurantoin (Macrobid)
Interferes with bacterial acetyl coenzyme A interfering with metabolism Gram Positive and Gram Negative Coverage -Including E. coli, Klebsiella sp.,and S. aureus -only use is UTI treatment or prophylaxis Contraindicated when CrCl <60mL/min and pregnancy (38-42 weeks) |
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Describe Polymixin E
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Polymixin E (Colistin)
Acts as cationic detergent that damages the cytoplasmic membrane and causes leakage of intracellular substances Concentration dependent bacteriCIDAL killing Coverage: broad gram- Negative -MDR Pseudomonas sp., Acinetobacter sp,ESBL+ organsisms, etc. No coverage for Providencia, proteus, or serratia |
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Adverse Effect of Polymixin E
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Extremely Nephrotoxic!
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What species are not covered by Polymixin E
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Providencia sp.
Proteus sp. Serratia sp. |
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Describe Fosfomycin
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Fosfomycin (Monurol)
Inactivates pyruvyl transferase, an enzyme critical for bacterial cell wall formation BacteriCIDAL Coverage: Broad gram-positive and gram-negative MRSA and VRE Pseudomonas is usually resistant Acinetobacter is always resistant |
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Describe Rifampin
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Inhibits bacterial RNA synthesis, blocking RNA transcription
RARELY used alone- rapid development of resistance Penetrates biofilms -hardware (prosthetic joints, valves, catheter tips, etc) Beware Drug-Drug Interactions (CYP-450 inducer) |
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Antibiotics with inhalation formulations
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Tobramycin
Aztreonam Colistin |
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ABX NOT requiring Renal Adjustment
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Levofloxacin
Doxycycline Tigecycline Clindamycin Linezolid ... need to add the rest still |
