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Infectious disease

Terms in this set (67)

clinically important gram + bacteria
Streptococcus, Enterococcus, Clostridium, and Listeria
Atypical
Chlamydia/Chlamydophilia, Mycoplasma pneumoniae, Legionella
Aminoglycoside
Gentamicin, tobramycin, amikacin, streptomycin
.Binding to 30s and 50s ribosomal subunits
.Concentration-dependent killing and Post-antibiotic effect
.Box warnings (4):1) Neurotoxicity (hearing loss, vertigo, ataxia), 2) nephrotixicity(particularly in renal impairment or w/ concurrent use of other nephrotoxic drugs),3)fetal harm if given in pregnancy
.Use total body weight, Adjusted body weight in obese (>130% IBW)
SEs: Nephrotoxicity, hearing loss (early toxicity associated with high-pitched sounds), vestibular toxicity (balance deficits)
Pregnancy category D
Extended interval dosing is less nephrotoxic and more cost effective
Penicillins (PCNs)
.inhibit bacterial cell wall synthesis by binding to Penicillin-binding protein (PBP)
.Pregnancy category B
.Time-dependent killing, bactericidal
Cephalosporins (beta-lactams)
.inhibit bacterial cell wall synthesis
.time dependent killing with bactericidal activity
.Pregnancy category B
1st gen: staph activity, less Strept and Gram - activity compared 2nd/3rd gen
.Cefazolin, cephalexin
PEK (Proteus mirabilis, E. coli, Klebsiella species)
2nd gen: HNPEK (Haemophilus, Neisseria species)
.Cefuroxime, cefotetan, cefoxitin
3nd gen: HNPEKS (Serratia), decrease Staph activity compared to 1st gen, but increased Strept activity
.cefdinir, ceftazidime, ceftriaxone
4th gen: best gram - activity
.cefepime
.HNPEKS CAPES (citrobacter, acinetobacter, pseudomonas, enterobacter, serratia)
5th gen: best gram + activity
.Ceftaroline fosamil
.covers MRSA, some gram - coverage similar to ceftriaxone (no Pseudomonas coverage)
Kefzol
Cefazolin
Keflex
Cephalexin
Ceftin, Zinacef
Cefuroxime
Fortaz, Tazicef
Ceftazidime
Rocephin
Ceftriaxone
Maxipime
Cefepime
Teflaro
Ceftaroline fosamil
Carbapenems
.beta lactam, inhibit bacterial cell wall synthesis
.time dependent killing with bactericidal activity
.very broad spectrum
.do not cover atypical pathogen, MRSA, VRE, C. difficile, and stenotrophomonas
.SE: diarrhea, rash, seizures, bone marrow suppression w/ prolonged use, increased LFTs
.Pregnancy category B/C(imipenem)
Merrem
Meropenem
INVanz
Ertapenem
Primaxin
Imipenem/cilastatin
Doribax
doripenem
Fluoroquinolones
.Boxed warning(2): 1)tendon inflammation and/or rupture, 2)may exacerbate muscle weakness related to myasthenia gravis

.Can prolong QT interval, peripheral neuropathy, risk of seizure, hypo/hyperglycemia, hepatotoxicity, photosensitivity
.SEs: GI upset/diarrhea, HA, dizziness, insomnia
.Ofloxacin, norfloxacin, ciprofloxacin, levofloxacin, gatifloxacin, moxifloxacin, gemifloxacin
.Inhibit DNA topoisomerase IV and DNA gyrase
.Concentration-dependent killing, bactericidal
Levofloxacin and ciprofloxacin: cover Pseudomonas
Respiratory FQs (enhanced Strept. pneumoniae and atypical coverage): gemifloxacin, levofoxacin, moxifloxacin
.Pregnancy cat C
.interactions with bi-trivalent cations
Cipro, Cipro XR, Ciloxin eye drops, cetraxal ear drops
+dexamethasone (Ciprodex ear drops)
Ciprofloxacin
Levaquin, quixin eye drops
levofloxacin
Zymaxid eye drops
Gatifloxacin
Avelox, Avelox ABC pack, Moxeza eye drops, Vigamox eye drops
Moxifloxacin
Macrolides
.azithromycin, clarithromycin, erythromycin

.Pregnancy B/C(clarithromycin)

.Eryth/Clar: substrates of 3A4 and strong 3A4 inhibitor
.do not used concurrently w/ agent prolong QT interval
50S ribosomal subunit, bacteriostatic
.Gram +, namely Streptococci speies and some Gr - namely Haemophilus, Neisseria, and Moraxella, Atypical (legionella, chlamydia, mycoplasma) and some mycobacterium species
.QT prolongation, hepatotoxicity
.SEs: GI upset, taste perversion, increased LFTs, ototoxicity (reversible and rare)
Zithromax, Z-pak, Zithromax Tri-pak
Azithromycin
.no adjustment in renal impairment
.better Gram - coverage compared to erythromycin
Biaxin, Biaxin XL, Biaxin XL Pac
Clarithromycin
.CrC,<30ml/min: decrease dose by 50%
.better gram + coverage
E.E.S., EryTab, EryPed, Erythrocin, PCE
Erythromycin
.no adjustment in renal impairment
Tetracycline

.Gram + (staph, strept, enterococci, Nocardia, Bacillus, Propiobacterium), Gram - include respiratory tract flora (Haemophilus, moraxella, atypicals) and other unique pathogen (spirochetes, rickettsiae, bacillus anthracis, T. pallidum)
.MRSA in mild skin infections
.VRE in UTI
.inhibit 30s, bacteriostatic
.Kid<8yo, pregnancy and breastfeeding
.Preg cat D, supression bone growth and skeletal development, permanently discolors teeth
.photosensitivity
SEs: Nausea,vomiting, diarrhea, rash
.interactions with bi-trivalent cations
Adoxa, Atridox, Doryx, Monodox, Oracea, Vibramycin
Doxycycline
IV to PO ratio 1:1
.no adjustment in renal impairment
Minocin, solodyn
minocycline
. no adjustment in renal impairment
Tetracycline
CrCl<80ml; extend dosing interval
Sulfonamides

sulfamethoxazole/trimethoprim dose is always 5:1 ratio

Preg cat D: risk of kernicterus and spinal cord defect
.inhibition of enzymes of folic acid pathway
.collectively bactericidal
.No Pseudomonas, enterococci, atypical or anaerobic coverage
.Dose is based on TMP
.CI: sulfa allergy
SE: nausea, vomiting, aronexia, diarrhea, skin reactions, crystalluria (take w/ 8oz water), photosensitivity, HyperK, hypoglycemia, QT prolongation, positive coombs test, decrease folic acid
Bactrim, Bactrim DS, Septra DS, Sulfatrim
Sulfamethoxazole/Trimethoprim
Single Strength:400/80mg
DS: 800/160mg
IV to PO ratio 1:1
Vancomycin (Vancocin)

.active against most Gram + (Staph (MRSA), Strept, Enterococci (not VRE), C. difficile

Pregnancy cat B (oral)/C (IV)
.blocking peptidoglycan
.time-dependent killing, bactericidal
.SEs: GI upset, red man syndrome, nephrotoxicity, ototoxicity
MRSA: 15-20mg/kg IV q8-12hr
CDAD: 125-500mg PO QID x 10-14d
Trough of 15-20mcg/ml-pneumonia, endocarditis, osteomyelitis, meningitis, bacteremia
Trough of 10-15mcg/ml for other infections
Daptomycin (Cubicin)

.active against most Gram + bacteria (Staph (MRSA), enterococci (VRE faecium and faecalis), approved for complicated skin and soft-tissue infections & S. aureus bloodstream infections, including right-sided endocarditis

.Do not use to treat pneumonia as drug inactivated by surfactant
.Compatible w/ NS and LR only
. Can cause false elevations in PT/INR (but no increased in bleeding risk)
.Concentration-dependent killing, bactericidal
.Preg cat B

myopathy: d/c in pt with s/sx of myopathy in conjunction w/ increased in CPK>1,000 units/L(5x ULN) or in asymptomatic pt w/ CPK>2000 units/L(10x ULN)
SE: increased CPK and myopathy, diarrhea, constipation, anemia
Vibativ
telavancin

Box warning: 1)fetal risk(obtain pregnancy test prior to starting therapy, 2)Nephrotoxicity

Prolong QT interval, red man syndrome
SE: metallic taste, nausea, vomiting
Orbactiv
oritavancin

SE: nausea, vomiting
Compatible with D5W only
Dalvance
dalbavancin

red man syndrome
SE: nausea, headache, diarrhea, rash
Compatible w/ D5W only
Zyvox
linezolid
CI: concurrent use or within 2 wks of MAOI
SE: HA/diarrea

IV to PO ratio 1:1
Store oral suspension at room tempt, use within 21 days
IV: requires light protection during admin
Sivextro
tedizolid
Tygacil
tigecycline
BBW: increased risk of death
pregnancy cat D
Avoid use in bloodstream infections
Reconstituted solution should be yellow-orange; discard if not this color
Cleocin
clindamycin
BBW: can cause severe and possibly fatal colitis
SE: GI upset (N/V/Diarrhea)
Flagyl
Metronidazole
BBW: possibly carcinogenic based on animal data
CI: pregnancy (1st trimester), use of disulfiram within past 2 wks, use of alcohol during therapy or within 3 days of therapy discontinuation
SE: metallic taste, darkened urine, rash, headache
IV:PO ratio 1:1, requires light protection during admin
Tindamax
tinidazole
BBW: possibly carcinogenic based on animal data
CI: breastfeeding, use of alcohol during therapy or within 3 days of therapy discontinuation
Xifaxan
rifaximin
SE: peripheral edema, dizziness, headache

Not effective for systemic infections <1% oral absorption
Dificid
fidaxomicin
SE: N/V/abs pain, GI bleed, anemia
Not effective for systemic infections, absorption minimal
Monurol
fosfomycin
tx uncomplicated UTI (cystitis only)
3g PO x 1, mixed in 3-4 oz of cold water
Macrodantin, Macrobid, Furadantin
Nitrofurantoin
CI: CrCl <60 ml/min

SE: GI upset, headache, rash, brown urine discoloration (harmless)
Preg cat B (contraindicated at term)
PO antibiotic refrigeration
Augmentin, cefuroxime (ceftin), keflex, erythromycin ethysuccinate/sulfisoxazole (E.S.P), penicillin VK, Amoxicillin (improved taste)
Nizoral, Nizoral AD, Ketodan, Extina, Xolegel
Ketoconazole
Diflucan
Fluconazole
VFEND
Voriconazole
Noxafil
Posaconazole
Echinocandin
inhibit synthesis of B(1,3)-D-glucan
effective against most Candida spp., including non-albicans strains resistant to azole antifungals, activity against Aspergillus spp. but should not be part of combo regimen

SE: increased LFT, HoTN, fever, diarrhea, HypoK, HypoMg
Cancidas
Caspofungin
Mycafungin
Mycamine
Eraxis
Anidulafungin
Lamisil, Terbinex

inhibit squalene epoxidase
Terbinafine
Neuraminidase inhibitors
.inhibit neuraminidase enzyme which affects the release of viral particles, active against both influenza A and B
Tamiflu
30,45,75mg capsule, 6mg/ml (60ml) suspension
Tx >12 years: 75mg BID x 5 days
Prophylaxis>12 yrs: 75mg daily for 10 days
Peds patients (2wks-12 yrs): dosed on body weight
CrCl <60ml/min: decreased dose and/or extend interval
Oseltamivir

start within 48hrs of symptoms

Preg cat C
Relenza Diskhaler

Tx>7yo: 10mg (two 5mg inhalation) BID x 5D
Prophylaxis>5yo: 10mg QD x12D (household setting) or 28D (community outbreak
Zanamivir

Bronchospasm risk: do not use in ashma/COPD

SE: headache, throat pain, cough

preg cat C
start within 48hrs of symptoms
Zovirax
Acyclovir
Valtrex
valacyclovir
Famvir
famciclovir
Cytovene IV, Zirgan ophthamic gel
Ganciclovir

BBW: myelosupression
SE: fever/N/V, diarrhea, anorexia, thrombocytopenia, neutropenia, leukopenia, anemia
Valcyte
valganciclovir
BBW: myelosupression
SE: fever/N/V, diarrhea, anorexia, thrombocytopenia, neutropenia, leukopenia, anemia, retinal detachment
Vistide
Cidofovir
CMV tx in HIV pt only
BBW: dose-dependent nephropathy, neutropenia, carcinogenic/teratogenic
SE: similar to ganciclovir with increased risk of nephrotoxicity and lower risk for bone marrow suppression
preg cat C
Foscavir
Foscarnet
Restant HSV, CMV
BBW: renal impairment occurs t some degree in majority of pts, seizures due to electrolyte imbalance
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