ID

• Staphylococcus aureus (MSSA, MRSA, GISA)
• S. pyogenes
• Streptococcus pneumoniae (PRSP)
• Enterococcus faecium (VRE, LR-VRE)

• Pseudomonas aeruginosa
• Acinetobacter
• Klebseilla
• Enterobacteriacea
• E. Coli, Enterobacter,
• Citrobacter, Serratia,
• Proteus

• •Enzymatic inactivation
• •Efflux pumps : pump drug out of cell
• •Changing in antibiotic binding site
• •Change in permeability : increase thickness of cell wall
• Mutations
• Acquisition of Plasmid

• strep pnuemo: change in PBP
• MSSA: enzymatic inactivation
• MSRA: change in PBP

• Vaccinate
• use local data
• Stop treatment when cured

• AD: low cost, easy administration, excellent tissue penetration, favorable therapeutic index
• DIS: b lactamase, allergic reaction
• allergy, dosing

• hypersensitivity
• neutropenia, thrombocytopenia
• interstitial nephritis
• autoimmune hemolytic anemia

• ABCG strep
• viridans
• syphilis

cont. infusion--> should be written as infusion over 24hrs not q 24

• enteroccus
• listeria

• Ampicillin: 3g IV q 6h
• Amoxicillin: 500 mg po q 8 h
• CANNOT BE GIVE BY CONT INFUSION

• s. aureus
• e coli
• klebsiella
• anerobes
• used in polymicrobial infections (animal, human bits, bowel perforation, intra abdominal abcesses, PID, diabetic foot)

• --> amp/sulbactam
• --> amox. clav (fixed dose of clav)

• whore
• minimal nutrient req.
• in tennis shoes
• nosocomial
• presents as UTA, pneumonia, UTI, osteomyelitis, burns, otitis, endocarditis

• extended gram ned spectrum
• Ticarcillin-- high na content: CI in renal failure
• Peperacillin-- 12-16 g per day in 4 divided doses
• stable for cont. infusion

• MSSA
• h influenza
• klebsiella
• anerobes
• polymicrobial infections
• ticarcillin/ clav
• piperacillin/tazobactam: 4.5 g q 6 hours based on kidney function

• Nafcillin
• MSSA
• strep ABCG

• Coagulase positive = S. aureus
• Coagulase negative = S. epidermidis, S. saprophyticus

• Advantages
• Dosed less frequently

• Disadvantages
• select for cephalosporinases and ESBL
• no activity against Enterococcus sp.
• expensive

• cephalexin- 500mg q 6h
• cefazolin- surgical prophylaxis, cellulitis,

• s. pneumo
• S aureus

pseudomonal

• staph aureus
• pseudomans
• BID: 2g q 8h

• imipenem/ cilastatin
• peropenem
• doripenem

• MSSA
• b Fragilis
• pseudomonas

for serious nosocomial infections

SE: seizures

• once daily
• - does not cover pseudomonas or enterococcus
• - for intra-abdominal and complicaetd ssi
• - T1/2= 4 hours

• only gram neg (pseudomonas)
• used when allergic to PCNs but cross reaction with ceftazidime

Type I: Immediate hypersensitivity, IgE mediated, anaphylaxis, minutes

Type II: Cytotoxic antibodies, IgG, IgM bind to renal/blood cells, anemia, leucopenia, thrombocytopenia, nephritis, dose and duration dependant

Type III: Immune Complexes, IgG, IgM bind to antigens and form circulating complexes, serum sickness, 7-14 days after initiation

Type IV : Cell mediated, no antibody involved, T-cell dependant, T-cells recognize the antigen leading to WBC recruitment to the site leading to inflammation, contact dermatitis

• - Normal gut flora
• - E. faecalis accounts for 90% of isolates and E.faecium ~10% of isolates
• - Multidrug resistant (including vanco.) strains of E.faecium have increased and referred to as VRE
• - Not intrinsically virulent but may act synergistically with other organisms
• - Contact precautions are critical

• - gram pos for resistant organisms
• - not for MSSA
• - potential for VRE
• - for c. difficile

• 1 g q 8-12 h or 15mg/kg q 12-- dose for renal
• -AUC/MIC monitoring
• - maintain 10-20 mcg/ml
• - dont use if MRSA isolate is 2mcg/ml

• VRE facium
• Step
• MRSA
• MRSE
• monitor myalgias and LFTS

• Oxazolidinone
• VRE
• MRSA
• s. pneumo
• t>mic and auc.mic
• SE: serotonin syndrome, thrombocytopenia

• MRSA
• VRE
• cSSTI and bacterema
• skeletal muscle toxicity

• MRSA
• VRE
• enterobacteriacea
• Acinebacter
• not active agains pseudo bc of efflux pumps
• SE: NV

the new miracle cephalosporin

• gentamicin
• tobramycin
• amikacin
• streptomycin

• MSSA
• enterococcus
• pseudomonas (amikacin>tobramycin>gentamycin)
• NOT anerobes

gentamicin and tobramycin

• 1-2mg/kg q 8-12 h-- for enterococcal
• 5-7 mg/ kg q 24h -- for gram neg

adjust for crcl < 60ml/min

Nephrotoxicity- elderly, renal insuff. dehydration, cirrhosis, long duration

ototoxicity- exposure dependent

cipro, levo, mox, gemi

• gram + = pnuemo
• mycoplasma
• chlamycia
• ricketssia
• legionela

peak/mic auc/mic

• staph (not first line bc of resistance)
• mycobacteria
• UTS
• BID

• s pneumo
• CAP and HAP
• qd

• CAP
• cSSI
• qd
• not removed by kidney (no UTI)

• dizziness, ha, insomnia
• nvd
• drug interactions: caffiene, metal
• tendinitis
• hypersensitivity
• QT prolongation
• dysglycemia

• Erythromycin
• -Potent P-450 inhibitor which results in multiple potential drug interactions
• -Dosed q6h, frequent GI distress associated with erythro

• Clarithromycin (Biaxin®)
• -Moderate P-450 inhibitor with significant profile for drug interactions
• -Dosed q12h

• Azithromycin (Zithromax®)
• -No interaction with cytochrome P-450
• -High drug concentration achieved intracellularly
• -Dosed QD

• 60 hr t1/2
• gram pos (strep)
• respt tract gram neg
• atypicals and mycobacteria
• not UTIs

• Doxycycline: CAP caused mycoplasma and chlamydia
• Minocycline: p. acnes

• B fragilis
• c dificile
• metallic taste
• peripheral neuropathy
• inhibits alc dehydrogenase

• b fragilis
• MRSA
• bone penetration

• broad
• MRSA
• prophylaxis

• UTI- VRE, urthritis
• precautions: peripheral neuropathy, lung, g6pd def.

• pseudo
• cystic fibrosis pts

preggers resistant UTI

• Time course
• rate of bacterial kill
• dose-kill relationshipPA

• aminoglycosides
• fluroquinolones

fluroquinolones

• carbapenems
• cephalosporins
• penicillins

• increase dose frequency
• increase duration of infusion
• select agent with lower MIC
• want it between 8 and 16

want cmax ratio to be 8-10 to get a peak of 16-20mcg/ml for gentamicinand tobramicin

first dose: 4-7 mg/kg then adjust

aim for undetectable trough

Peak occurs 2 hours after end of infusion

get peak concentration of 4-10 mcg/ml with a ratio of 2-5

for gram positive organisms

• give 1-2 mg/kg q 8 hours then adjust
• - peak concentrations range between 4-8 ug/ml and trough is 1-2 ug/ml

Peak occurs 1 hour after infusion

• crcl of <40ml/min
• entercoccus infection
• spinal chord injury
• burn pts
• meningitis

this is traditional dosing not hdoda

• t1/2a = 30 mins
• variable protein binding

• cl relates to crcl
• t1/2 = 3-9 hours

15-20mg

<15mg/min

peak: 2 hours after 1 hour infusion

Trough: within 1 hour of next dose

• <50kg= 1g
• 50-100kg = 2g
• >100kg = 3g

• 50-79kg = 1g
• 80- 100kg = 1.5g
• >100 = 2g

• q8h (CrCl> 100 ml/min)
• q12h (CrCl> 50-100 ml/min)
• 24h (CrCl< 50 mL/min)

left side

• -prosthetic valve
• - mitral valve prolapse with regurgitation
• - IV drug abuse

- common in mouth and gingiva

found in gi tract

• found in gi tract
• - includes enteroccus faecalis and faecium
• - difficult to treat and needs combination therapy always

• IVUD
• MRSA
• low mortality
• treated with abs

• mostly prosthetic valves
• MRSA and MRSE
• surgery + abs
• three drug regimen

• 1. penicllin/ ceftriaxone only
• 2. penicillin/ ceftriaxone + gentamicin
• 3. vanco only

• 1.penicillin/ ceftriaxone + gentamicin
• 2. vanco only

• 1. Penicillin/ Amp + gent/ strep
• 2. vanco + gent/ strep

• 1. Vanco + gent/ strep
• 2. Gent+ amp/sulbactam

• 1. nafcillin/ cefazolin + gent
• 2. vanco only (pen allergy)

• for prostetic
• 1. add gent + rifampin

1. vanco

• for prostetic
• 1. vanco + gent + rif

• Amox 2g
• clindamycin 600mg po
• cephalexin
• azith
• clarith
• one hour prior to procedure

• –Neisseria meningitidis
• –Haemophilus inflenzae

• stiff neck
• headache
• photophobia
• irritable
• kernig and brudzinski
• seizures

• normal is 100
• over 200 is concerning

• glucose
• protein

• 1-2 years: pneumo, h influenzae
• 2-50: s pneumo, maybe flu, neisserria
• >50: pneumo, nesserria, listeria,

• 1-2: dex if h.flu or pneumo + ceftriazone + vanco
• 2-50: dex if pneumo + ceftriaxone + vanco
• >50 : dex if pneumo + ceftriaxone + vanco + amp

• children: .4mg/kg q 12h for 2 days
• adults: .15mg/kg q 6 h for 2-4 days

• ceftriaxone: 2g q 12 hours
• vanco: 15 mg/kg q 12

• Behavioral change, seizures, coma
• •Up to 50% , DIC, purpuric lesions

• •Drug of choice (high doses) X 7 days:
• •Penicillin G IV (if Pen MIC= S)
• •Ceftriaxone or cefotaxime (if Pen MIC= I/R)

Rifampin po for 4 days

• DOC (x10-14 days)
• –Ceftriaxone or (cefotaxime)
• –Vancomycin (Cephalosporin allergy or resistance)

DOC: ceftriaxone or cefotaxime

• can be infection or non-infectious etiology
• ► 2 or more of the following are clinical insults:
• -Temperature >38°C or <36°C
• -HR >90 beats/min
• -Respirations >20/min
• -WBC count >12,000/mL or <4,000/mL or >10% immature neutrophils

• clinical insults which are due to infection
• ► 2 or more of the following are clinical insults:
• -Temperature >38°C or <36°C
• -HR >90 beats/min
• -Respirations >20/min
• -WBC count >12,000/mL or <4,000/mL or >10% immature neutrophils

sepsis with >1 organ dysfunction

• severe sepsis thats hypotensive
• perfusion abnormalities

• SA
• pneumo
• e coli
• klebisiella
• psuedo

• Hemodynamic- fluid - NS. vasopressor, inotropic
• oxygen
• nutritional support (high protein low carbs)

• isotonic cyrstalloids
• 0.9% nal --> may need 10L in 24 hours

dopamine and dobutamine

norepinephrine, phenylephrine, epinephrine

• anti b lactam
• cephalexin
• ceftriaxone/ ceftaxime
• cefepime
• cipro
• aminoglycosides
• nafcillin

• pen
• ceftriaxone/ ceftaxime
• linezolid
• levo
• azith

• anti-pseudo
• ceftazidime
• cefepine
• cipro
• aminoglycosides
• azetreonam
• azith
• carbapenams
• colistin
• fosphamycin

• NOT CEPHS
• aminopens
• tigecycline
• aminoglycosides (Td)

• klebsiella
• e coli
• h influenza
• anerobes
• MSSA

• vanco
• quin.dal
• dapto
• trigecycline
• trim/sul

• carbapenams
• trigecyclin

• carbapename
• ertapenem
• metronazole
• clindamycin

• quiolones
• macrolides