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Empiric Therapy
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DCPA Antibiotics
| Question | Answer |
|---|---|
| Colonization | Presence of microbe in a host does not cause a specific immune reaction or infection (Do NOT Tx w/ Abx) |
| Empiric Therapy | Abx choice based on clinically most likely pathogen |
| Definitive Therapy | Abx choise based on identified pathogen & susceptibilty patterns |
| De-escalation | Adjustment of Abx regimen from broad to narrow spectrum |
| Collateral Damage | Unwanted negative effect of an Abx on NMF |
| Minimum Inhibitory Concentration (MIC) | Minimum [] that inhibits groth of organism |
| Antibiogram | Compilation of data for bacteria vs. abx |
| Gram (+) Cocci bacteria | S. Aureus, Staph Epidermidis, Strept Pyogenes, Strep Agalactiae, S. pneumoniae, enterococci, Strp bovis, Viridans Strep, Strep intermedius |
| S. Epidermidis infections | Associated with "hardware" |
| Enterococci infections | UTI, appendicitis |
| Strep Bovis Infections | Bowel lesion = spread of infection |
| Strep. Intermedius Infections | Abcess Formers |
| Gram (+) Bacilli Bacteria | **Usually erroneous Sample** Corneybacterium Diptheriae, Listeria Monocytogenes, Bacillus Antracis, Erysipelothrix Rhusiopathiae |
| Listeria Monocytogenes Infections | Meningitis (Can't eat cheese in 2nd/3rd trimester) |
| Gram (-) Cocci Bacteria | Neisseria Meningitidis, Neisseria Gonorrhoeae, Moraxella (Branhamella) Catarrhalis |
| Gram (-) Bacilli Bacteria | Vibrio cholerae, Campylobacter jejuni, H. Pylori, Pseudomonas Aeruginosa, Salmonella, H. Influenza, Brucella, Francisella Tularensis (Tularemia), Pasturella Multocida, Legionella Pneumophilia, Bartonella, Shigella, Enterobacter (E. Coli, etc.) |
| Pasturella Multocida Caused by... | Bites (Mouths) or Cats & dogs |
| Bartonella caused by... | Cat scratch |
| Anaerobes | Clostridium tetani, C. botulinum, C. Difficile, C. Perfringens, Bacteroides, Fusobacterium, Peptostreptococcus, Prevotella |
| Clostridium Perfringens Infection | Gas Gangrene |
| Beta-Lactum Drugs | Penicillin, Cephalosporin, Carbapenems, Aztreonam |
| Beta-Lactums MOA | Interferes with cell wall synthesis |
| Glycoprotein MOA | Interferes with cell wall synthesis |
| Fluoroquinolones MOA | Interferes with DNA replication, transcription |
| Rifampin MOA | Interferes with DNA replication, transcription |
| Aminoglycosides MOA | Binds to 30s/50s Ribosomal Subunit |
| Macrolides MOA | Binds to 30s/50s Ribosomal Subunit |
| Ketolides MOA | Binds to 30s/50s Ribosomal Subunit |
| Oxazolidinones MOA | Binds to 30s/50s Ribosomal Subunit |
| Tetracyclines MOA | Binds to 30s/50s Ribosomal Subunit |
| Streptogramins MOA | Binds to 30s/50s Ribosomal Subunit |
| Broad Spectrum Drugs | PCN (Penicillin), 3rd/4th generation Cephalosporins, Carbapenems |
| Narrow Spectrum Gram(+) Drugs | Vancomycin |
| Narrow Spectrum Gram(-) Drugs | Aminoglycosides, Aztreonam |
| Narrow Spectrum Anaerobes Drugs | Metronidazole (Flagyl) |
| Pharmacokinetics | Absorption (Bioavailability), Distribution, Metabolism, Elimination |
| Pharmodynamics | Relationship between drug concentration & effect "Antibiotic Potency" |
| Bioavailability | % of oral dose available compared to IV form (100%) |
| Clearance | Determines steady state of drug (determined by blood flow to metabolizing organ & rate of extraction of the drug from blood) |
| Volume of Distribution | Relates the amount of drug in the body to the serum drug concentration (Dependent on BMI) |
| Steady State | After 3 half lives |
| Postantibiotic Effect (PAE) | Delay before organisms recover & begin growing despite decrease concentration of drug |
| Four Primary Machanisms of Resistance. | Alterations in outer membrane permeability. Alteration in drug binding sites, Production of molecules capable of inactivating drug molecules. Active efflux of antibiotic from the bacteria. |
| Abx. dosing & duration | DONT under dose/increase duration = resistance |
| Bacterocidal Drugs | Beta Lactams, Cephalosporins, quinolones, aminoglycosides |
| Bacterostatic Drugs | Clindamycin, macrolides, sulfonamides, Tetracycline |
| Aminoglyc. Accumulation | Nephrotoxic (reversible) & Toxic to the Ear (irreversible) |
| Drugs that penatrate the BBB to the CSF | AG's, clindamycin |
| Difficult tissue to penetrate | Bone, synovial fluid, prostate, Abscesses, Peritoneal Fluid |
| DOC | Drug of Choice |
| IND | Indications |
| ADR | Adverse Reactions |
| W/P | Warnings & Precautions |
| SSSI | Skin & Soft Tissue Infections |
| Anaphylaxis | (IgE) Hives (Uticaria). Respiratory Difficulty (Bronchospasm). Swelling. Occurs within the first 72 hours. |
| Most common drug allergy | Penicillin |
| Penicillin ADR | Maculopapular rash, rash, uticarial rash, fever, bronchospasm, vasculitis, serum sickness, exfoliative dermatitis, Stevens-Johnson, Anaphylaxis (ordered in decreasing frequency & increasing severity.) |
| Penicillin half life | Short: 30-60 minutes (rapid renal excretion) |
| Penicillin Types | Natural, Penicillinase-resistant, Aminopenicillins, Extrended-spectrum ureidopenicillins, B-lactam/B-lactamase Inhibitors |
| Natural Penicillin Drugs & forms | Penicillin G (IV/IM) & Penicillin V (PO) |
| Natural Penicillin effective against... | B-hemolytic strept, most anaerobes, viridans strep, N. meningitidis. |
| Natural Penicillin DOC | Strep. Pneumoniae |
| Natural Penicillin R | Actinomyces, meningococcus, Pasteurella, S. Pneumoniae, S. pyogenes, T. Pallidum. |
| Natural Penicillin Pregnancy Category | C |
| Natural Penicillin ADR | Seizures or hemolytic anemia |
| Penicillinase-resistant penicillins drugs & forms | Oxacillin/Nafcillin (IV) & Dicloxacillin (PO-empty stomach) |
| Penicillinase-resistant penicillins effective against... | ? |
| Penicillinase-resistant penicillins ADR | GI cramps, rash, neutropenia (prolonged Rx - especially with nafcillin), acute interstitial nephritis |
| Aminopenicillin Drugs | Ampicillin (IV/PO), Amoxicillin (PO) |
| Aminopenicillin covers | Enterococci, E.coli, H. influenza, Proteus, Klebsiella |
| Aminopenicillin W/P | Renal Insufficiency & Cephalosporin allergy |
| Aminopenicillin ADR | Rash & GI upset |
| Extended-spectrum ureidopenicillins drugs & forms | Pipercillin (IV) usually used in combination! |
| Extended-spectrum ureidopenicillins covers | Anaerobes, enterobactericacae & pseudomonas |
| Extended-spectrum ureidopenicillins W/P | Severe renal impairment & allergies to cephalosporins |
| Extended-spectrum ureidopenicillins ADRs | GI & dermatology |
| B-lactamase inhibitor drugs | ampicillin/sulbactam (Unasyn - IV) Pipercillin/Tazobactam (Zosyn-IV) Aoxicillin/clavulante (Augmentin-PO) |
| Unasyn ingrediants | Ampicillin & sulbactam |
| Zosyn ingrediants | Pipercillin & tazobactam |
| Augmentin ingrediants | Amoxicillin & Clavulanate |
| B-lactamase inhibitor SE | Diarrhea (increased with clavulanate) |
| Penicillin Class drug interactions | Decrease OCP efficiancy. Increases warfarins effect. |
| Penicillin Class ADRs | Seizure potential with high doses. Inhibit platelet aggregation. |
| Cephalosporins types | 1st generation-4th generation |
| Cephalosporins pregnancy categroy | B |
| Cephalosporins ADRs | Increase C. difficile colitis & VRE |
| 1st generation cephalosporins drugs & forms | Cefazolin - Ancef(IV) & Cephalexin - Keflex (PO) |
| Cefazolin | Ancef |
| Cephalexin | Keflex |
| 1st generation cephalosporins coverage | Better gm + |
| 1st generation cephalosporins uses | surgical prophylaxis, SSSIs & UTI |
| 2nd generation cephalosporins coverage | Less gram + & more gram - |
| 2nd generation cephalosporins drugs | Cefuroxime (Ceftin) - PO. Cefotetan (Cefotan) - IV. |
| Cefuroxime (Ceftin) covers | strep, haemophilus, E. coli, Proteus, Klebsiella |
| Cefuroxime (Ceftin)uses | URI/L RTIs, Otitis Media, COPD exacerbations, sinusitis. |
| Cefuroxime | Ceftin |
| Cefotetan | Cefotan |
| Cefotetan (Cefotan) covers | B. frgilis & other bowel anaerobes |
| Cefotetan (Cefotan) uses | abdominal infections, bowel surgery prophylaxis, OB/GYN infections (PID) |
| 3rd generation cephalosporin coverage | weak gram + & good gram - |
| 3rd generation cephalosporin drugs | Ceftriaxone (Rocephin) - IV. Ceftazadime (Fortaz - IV. Cefpodoxime (Vantin) - PO. Cefixime (Suprax) - PO |
| Ceftriaxone | Rocephin |
| Ceftriaxone (Rocephin) ADRs | Biliary sludging b/c its eliminated via biliary excretion |
| Ceftriaxone (Rocephin) coverage | Severe gram (-) infection & Meningitis |
| Ceftazadime | Fortaz |
| Ceftazadime (Fortaz) coverage | Pseudomonas |
| Cefpodoxime | Vantin |
| Cefixime | Suprax |
| Cefpodoxime (Vantin) & Cefixime (Suprax) coverage | URIs & RTIs |
| 4th Generation Cephalosporin drug & form | Cefepime (IV) |
| Cefepime covers | Pseudomonas, gram (-) rods (enterobacter, serratia & citrobacter). |
| Cefepime uses | Febrile neutropenia, hospital acquired pneumonia, serious gram (-) infections. |
| Carbapenems drugs | Imipenem/cilastatin (Primaxin) - IV. Meropenem (IV). Ertapenem (Invanz)- IV. |
| Primaxin | imipenem/cilastatin |
| Carbapenems covers | gram +'s including MSSA, grams -'s & anaerobes. |
| Primaxin (Imipenem/cilastatin) uses | pseudomonas & polymicrobial infections. |
| Primaxin (Imipenem/cilastatin) ADR | N/V & decreases seizure threshhold. |
| Primaxin (Imipenem/cilastatin) W/P | Hx of seizures |
| Primaxin (Imipenem/cilastatin) pregnancy category | C |
| Meropenem ADR | Less seizures & N/V |
| Meropenem pregnancy category | B |
| Meropenem coverage decreased in | Staph & strep |
| Ertapenem | Invanz |
| Ertapenem (Invanz) does not cover | pseudomonas |
| Monobactam drug & form | Aztreonam (Azactam) - IV |
| Aztreonam | Azactam |
| Aztreonam (Azactam) coverage | Gram negative ONLY |
| Aztreonam (Azactam) pregnancy category | B |
| Aztreonam (Azactam) SE | Well tolerated |
| Aminoglycoside drugs | Gentamicin, Tobramycin & amikacin (all IV; not absorbed well) |
| Aminoglycoside coverage | Gram - (Pseudomonas) |
| Aminoglycoside decreased effectivness by | Abscesses |
| Aminoglycoside Pregnancy category | D |
| Aminoglycoside uses | Always used in combo: serious gram (-) infections or b-lactam for synergy |
| Macrolides drugs | Erythromycin (Iv, PO, Opth). Clarithromycin (Biaxin) - PO. Azithromycin (Zithromax) - IV/PO |
| Clarithromycin | Biaxin |
| Azithromycin | Zithromax |
| Macrolides Pregnancy category | B (eryth, Azith) & C (Clarith) |
| Macrolides coverage | pneumococcus, atypicals, H. influenza |
| Macrolides Uses | OM, CAP, COPD, STD |
| Macrolides ADR | GI (take with food) & QT prolongation |
| Clarithromycin (Biaxin) DOC | Eryth-sensitive strains of streptococci |
| Azithromycin (Zithromax) DOC | H. Influenza & Chlamydia |
| Azithromycin (Zithromax) half life | 68 hours |
| Fluoroquinolone drugs | Ofloxacin, ciprofloxacin (Cipro), Levofloxacin (Levaquin), Moxifloxacin (Avelox), Gatifloxacin (Tequin), Gemifloxacin (Factive) |
| Fluoroquinolone coverage | good gram (-), alright gram (+) |
| Fluoroquinolone DOC | Legionella |
| Cipro & Levaquin cover | Pseudomonas |
| Fluoroquinolone pregnancy category | C |
| Fluoroquinolone CI | <18y.o. (arthropathy) |
| Fluoroquinolone ADR | N/V/D, CNS (HA, restlessness), decrease seizure threshhold, tendon rupture (spontaneous - achilles), increase in AST/ALT |
| Fluoroquinolone DI | Aluminum/Mg antacids, sulcralfate, Ca2+, Fe2+ & Zinc - decrease absorption. Increases the effect of warfarin (except moxifloxacin & gatifloxacin) |
| Fluoroquinolone uses | CAP (includes atypicals), UTIs/pyelonephritis, COPD, acute exacerbation of chronic bronchitis, sinusitis |
| Tetracycline drugs | tetracycline, doxycycline, minocycline |
| Tetracycline coverage | Broad - including rickettsia, mycoplasma & chlamydia |
| Tetracycline pregnancy category | D |
| Tetracycline CI | < 8 y.o. (permanent discoloration of the teeth & inhibits bone growth) |
| Tetracycline Use | CAP, STD (Chlamydia), syphilis (pen-allergic pts.), Lyme dz, acne, community acquired MRSA |
| Tetracycline ADR | GI, photosensitivity, erosive esophagitis, vestibular sx (drunk/off balance), liver damage (rare) |
| Tetracycline DI | Increased effect of warfarin |
| Vancomycin Forms | IV & PO(C. difficile only) |
| Vancomycin MOA | Inhibits cell wall growth ("slowly" cidal) |
| Vancomycin coverage | gram +'s (MRSA, MRSE) & mild-mod anaerobic |
| Vancomycin pregnancy category | C |
| Vancomycin ADR | Redman syndrome (nonallergic rash on face/chest, flushing & hypotension), reversible neutopenia |
| Vancomycin administration | Given slowly (over an hour) |
| Vancomycin special abilities | Penetrates CSF |
| Clindamycin | Cleocin |
| Clindamycin (Cleocin) forms | IV, PO, Topical (acne), Vaginal |
| Clindamycin (Cleocin) class | Lincomycin |
| Clindamycin (Cleocin) MOA | Inhibits protein synthesis |
| Clindamycin (Cleocin) Coverage | **anaerobes** Strep & S. aureus (MRSA) |
| Clindamycin (Cleocin) use | anaerobic abscess, abdominal infections & Gyn |
| Clindamycin (Cleocin) ADR | N/V/D & rash - can cause C. Diff |
| Metronidazole | Flagyl |
| Metronidazole (Flagyl) MOA | Inhibits DNA synthesis |
| Clindamycin (Cleocin) coverage | anaerobes & ameoba |
| Clindamycin (Cleocin) uses | Abdominal abscess, C. diff, Rx trich, & H. pylori |
| Clindamycin (Cleocin) Pregnancy category | B (avoid 1st trimester) |
| Clindamycin (Cleocin) special abilities | Penetrate CSF |
| Clindamycin (Cleocin) ADR | N/V and alcohol reaction |
| TMP/SMZ | Trimethoprim/Sulfamethoxazole |
| TMP/SMZ (Trimethoprim/Sulfamethoxazole) forms | PO or IV |
| TMP/SMZ (Trimethoprim/Sulfamethoxazole) MOA | Inhibits folic acid synthesis (static) |
| TMP/SMZ (Trimethoprim/Sulfamethoxazole) pregnancy category | B but at 3rd trimester - term = D |
| TMP/SMZ (Trimethoprim/Sulfamethoxazole) coverage | Staph, strep, GNR's & Pneumocystis (prophylaxis for HIV pt.) |
| TMP/SMZ (Trimethoprim/Sulfamethoxazole) uses | UTIs, gram - infections, MRSA |
| TMP/SMZ (Trimethoprim/Sulfamethoxazole) DOC | PCP |
| TMP/SMZ (Trimethoprim/Sulfamethoxazole) ADR | Rash, CNS disturbances, photosensitivity, GI Sx. |
| TMP/SMZ (Trimethoprim/Sulfamethoxazole) Increase toxcity of... | warfarin, oral hypoglycemics, phenytoin, methotrexate, cyclosporin |
| Rifampin Form | PO |
| Rifampin MOA | Inhibits bacterial synthesis |
| Rifampin Uses | TB, Meningococcal prophylaxis, nasal carriers of MRSA |
| Rifampin ADR | GI upset, rash, turns secretions red-orange-brown, hepatotoxic, potent cyt P450 inhibitor |
| Linezolid | Zyvox |
| Linezolid (Zyvox) forms | IV & PO (100% available) |
| Linezolid (Zyvox) class | Oxazolidinone |
| Linezolid (Zyvox) coverage | Staph (MRSA), Coag (-) staph, strept, enterococci (VRE). Minor against anaerobes |
| Linezolid (Zyvox) ADR | Thrombocytopenia (reversible) or anemia |
| Linezolid (Zyvox) uses | variety of infections from MRSA and VRE |
| Synercid | Quinupristin/Dalfopristin |
| Synercide Quinupristin/Dalfopristin class | Streptogramin |
| Synercide Quinupristin/Dalfopristin form | IV via central line only! |
| Synercide Quinupristin/Dalfopristin coverage | MRSA, VRE |
| Synercide Quinupristin/Dalfopristin ADR | Myalgia, arthalgia |
| Synercide Quinupristin/Dalfopristin amount used | Rarely |
| Daptomycin Form | IV |
| Daptomycin coverage | MRSA |
| Daptomycin use | complicated skin & soft tissue infection |
| Tygecycline coverage | MRSA, VRE, strep, enteric GNRs, bowel anaerobes |
| Mupirocin | Bactroban |
| Mupirocin (Bactroban) form | Topical |
| Mupirocin (Bactroban) use | Impetigo due to S.aureus, group A strept (pyogenese) or decolonize the nasal passages of MRSA carriers (+/-) |
| Nitrofurantoin | Macrodantin |
| Nitrofurantoin (Macrodantin) coverage | gram +'s, enterococci, E. coli |
| Nitrofurantoin (Macrodantin) Pregnancy | B |
| Nitrofurantoin (Macrodantin) DI | decreased absorption with antacids |
| Nitrofurantoin (Macrodantin) W/P | G6PD deficiency = interstitial pulmonary fibrosis with chronic use. |
| Nitrofurantoin (Macrodantin) use | ONLY UTIS - Tx/prophylaxis |
| Bacteria that must be treated for > 4 weeks | S. Aureus bacteremia, endocarditis, ostomyelitis |
| Anti-Staphylococcal | **Nafcillin, oxacillin, dicloxacillin, cefazolin |
| Anti-MRSA | Vancomycin, Clindamycin, Doxycycline, TMP/SMZ, Linezolid, Quinupristin/dalfopristin, daptomycin, tygecycline. |
| Anti-anaerobic | Metronidazole, clindamycin, carbapenems, ceftotetan, Penicillin, B-lactamase inhibitors |
| Anti-pseudomonal | pipercillin/tazobactam, aminoglycosides, ceftazadime, cefepime, imipenem, meropenem, ciprofloxacin, levofloxacin. |
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