Antibiotics
Categories:
- General
- Above the diaphragm (Aspiration pneumonia, lung abscesses, oral infections)
- 1) Clindamycin
- Below the Diaphragm (Intra-abdominal anaerobic infections)
- 1) Metronidazole
- Above the diaphragm (Aspiration pneumonia, lung abscesses, oral infections)
- Monitoring
- Aminoglycosides/Vancomycin
- If IV ≥3 days or ≥2 days in a renal patient
- Penicillin causing rash
- Not a contraindication for cephalosporins
- Breathing issues, edema are CIs
- Not a contraindication for cephalosporins
- Aminoglycosides/Vancomycin
- Amoxicillin/Clavulanic Acid (Augmentin)
- Ampicillin/Sulbactam (Unasyn)
- Ceftriaxone
- SE: Cholestasis
- Cefazolin
- Prophylaxis for skin flora
- Cefepime
- Coverage
- Pseudomonas, MSSA, Strep Pneumo, H. Influenzae
- Misses
- Enterococcus
- SE: Neutropenia, thrombocytopenia, Seizure, Delirium, C. Difficile, Transaminitis, Hemolytic anemia, interstitial nephritis
- Coverage
- Ceftaroline
- 5th gen cephalosporin, only one that covers MRSA
- Clindamycin
- MOA: Inhibits protein synthesis
- Effective against Bacteroides and c. perfringens
- Chloramphenicol
- 50S static
- Associated w/ blood dyscrasias
- Daptomycin (Cubicin)
- Can be considered for MRSA infections when the isolate’s vancomycin MIC is ≥2 nanograms/mL or when the vancomycin MIC is close to 2 nanograms/mL and the clinical response is poor
- Test susceptibility first
- Coverage
- MRSA, VRE
- SE: LFT elevations, Acute eosinophilic pneumonia, peripheral neuropathy, Falsely elevated INR, Rhabdomyolysis (CK (DC if ≥2000 or ≥1000 w/myopathy), stop statins)
- Can be considered for MRSA infections when the isolate’s vancomycin MIC is ≥2 nanograms/mL or when the vancomycin MIC is close to 2 nanograms/mL and the clinical response is poor
- Meropenem (Merrem)
- Coverage
- Pseudomonas
- Coverage
- Metronidazole
- MOA: Contains a nitro group that acts as an electron sink, capturing electrons and creating free radicals which disrupts DNA synthesis via a cytotoxic intermediate (Bactericidal)
- Effective against Bacteroides, prevotella, fusobacterium, clostridium
- SE:
- Disulfiram-like reaction (severe flushing, tachycardia, palpitations, nausea, vomiting, hypotension) with alcohol
- Metallic taste
- Headache
- Piperacillin-Tazobactam (Zosyn)
- Coverage
- Pseudomonas, Proteus
- Misses
- C. Difficile
- SE: Rash, Drug fever, Prolonged PT, Leukopenia, Thrombocytopenia
- Coverage
- Telavancin
- Lipoglycopeptide derivative of vancomycin and can be given once daily
- More side effects than Vancomycin, worse kidney injury
- Tuberculosis Medications
- Rifampin
- Benign, red color to body secretions
- Isoniazid
- Peripheral Neuropathy
- Use pyridoxine to prevent
- Pyrazinamide
- Benign, Hyperuricemia (Gout)
- Ethambutol
- Optic neuritis/color vision changes
- Decrease dose in renal failure
- Rifampin
- TMP/SMX
- CI: Warfarin/Methotrexate use, allergy, elderly with renal insufficiency
- Vancomycin
- Red Man Syndrome
- MC adverse event, hypersensitivity not reaction
- Usually 5-10 minutes after starting infusion
- Diffuse erythema, pruritus, and tenderness over the skin above the waist
- +/- hypotension, dyspnea if severe
- Treatment
- Stop infusion, give antihistamines, restart infusion at slower rate
-
Dosing Guidelines
- Area under the curve, Mean inhibitory concentration
- Goal for AUC/MIC to be achieved in 24-48 hours
- Empiric Therapy
- AUC/MIC calculation for empiric therapy assumes MIC to be 1 nanogram/ml or less
- MRSA Native Tricuspid Valve Endocarditis
- AUC/MIC target of 400-600 mg*hour/L of Vancomycin to maximize efficacy and minimize nephrotoxicity
- MRSA Prosthetic Valve Endocarditis
- Vancomycin, Gentamicin, and Rifampin
- Red Man Syndrome