Narrow spectrum antibiotics are good against what?
Gram positive bacteria
What meds should not be prescribed to children under the age of 8 years
The tetracyclines (to include doxycycline)
___________ are contraindicated in all persons under the age of eighteen. This class of antibiotics can weaken tendons and predispose an individual to tendon rupture.
_________work by inhibiting the bacterium’s ability to synthesize folate (folic acid), another essential nutrient necessary to maintain life.
________ is your antiseptic “drug of choice” (DOC). It is supplied in a myriad of forms (pads, swabs, bottled solutions and cleansers, etc.).
____________ should never be used on open wounds (as with alcohol). This is because when it’s concentrated enough to kill bacteria, it’s also concentrated enough to kill living tissue. (And dead tissue is not something you want to leave in a wound.)
__________________ is a preferred substance for handwashing prior to medical procedures and in-between patients.
______________ refers to a basic chemical ring structure found in some antibiotic families such as the penicillins, cephalosporins, carbapenems and monobactams.
Cautions for beta lactams
Oral contraceptives, superinfection, Diarrhea
____________ is the preferred oral penicillin. It is more acid stable in the gut than oral penicillin G.
__________________ is a long acting (1 - 4 weeks) preparation useful in the treatment of strep pharyngitis and the DOC (drug of choice) for syphilis.
Examples of Penicillinase resitance PCN
This class of penicillins is not, however, effective against MRSA (methicillin-resistant staph aureus). Nafcillin is administered IM or IV. Oxacillin, Cloxacillin and Dicloxacillin are oral drugs. methicillin
Ampicillin, amoxicillin, amoxicillin/clavunaic acid (DOC for animal bites)
DOC for animal bites?
Also known as “anti-pseudomonal” penicillins. These penicillins are expensive and for parenteral use against serious gram-negative infections, to include infections caused by Pseudomonas species.
Extended spectrum PCN
Individuals who are allergic to the penicillins may also exhibit hypersensitivity to the _________
cephalosporins (around 10%).
Cephalosprins are also known as what?
How do they work?
- Beta lactams,
- inhibiting cell wall formation (bacterialcidal)
The generations of cephalospirins (third), as they go up, what coverage decreases.
- Increased gram negative
- decreased gram positive
what is SPEcK?
- Proteus Milaribilus
- Eschericia Coli
- Kleibsiella Pneumonai
What is a common 1st generation cephalosporin and its coverage/applications?
Cephazolin (ancef)- Good tissue and bone penetration, no BBB penetration, good anti staph and pre-op (non war wound).
A common second generation cephalosporin, applications and coverage?
- Heaomophilus influenza
Cefoxitin (IV) (good anerobic coverage), Cefuroxime
What are some characteristics of 3rd generation cephalosporins??
Broad spectrum, poor anaerobic, penetrates BBB
GOOD SPEC OPS antibiotic
What third generation cephalosporin is good for pseudomonas?
ceftazidime, excellent gram (-)
What are the most commonly used 1G cephalosporins by SPEC OPS
What are the most common SPEC OPS 2G cephalosporins
_____________, is recommended by 2011 TCCC guidelines for all open combat wounds in patients who cannot take oral medications (e.g., shock, unconsciousness). It has the advantage of once daily dosing and can be administered IM or IV.
Ertapenam (Invanz), a carbapenem
What are synthetic PCNs with broad spectrum including anerobes and inhibit cell wall synthesis?
Carbapenems and monobactams
MRSA, C. dificile, NO GRAM NEG, nephro and ototoxicity, red man syndrom (histamine release)
The SOF medic must consider this superinfection in anyone presenting with significant diarrhea following prior antibiotic therapy. (What bacteria)
What medication inhibits protein synthesis, has good anaerobic coverage and is synthesized in the liver and excreted through urine. Gram POS, no Gram NEG
Used topically for acne and intravaginally for BV
May cause C. Diff overgrowth
What do you treat pseudomembranous collitis with?
Vancomycin, metronidazole (flagyl)
What types of ABX are structurally different from PCNs and good with Atypical bacteria (clamydia, legionairres)
Cautions for erythromycin
estolate-avoid in adults, may cause choleocystatic jaundice, abd cramping, nausea, vomiting.
What are some improved macrolides with less GI side effects, used to treat chlamydia, broader spectrum of activity?
- Azithromycin (clap)
This is a new class of ABX that must be used for patients 18+ and are used for pneumonia, bacterial sinusitis, acute exacerbations of chronic bronchitis, and must be contraindicated for patients with myasthenia gravis.
- Telithromycin (ketex)
What Tetracycline can be given to patients with renal comprimise?
Doxycycline (only hepatic processiing)
What class inhibits protein synthesis, metabolized in the liver, excreted hepatically and renally, broad spectrum, some BBB coverage
Tetracyclines (Doxy, Tetracycine, minocycine)
What are some adverse effects of tetracyclines?
Increased photosensitivity, GI upset, vertigo (minocycline), permanent teeth darkening in PEDs (do not give under 8)
- Anthrax (doxy per CDC)
- Malaria prophylaxis
What type of ABX has high ototoxicity and is not for SOF use? and renotoxicity
Aminoglycosides (streptomycin, gentamycin, neomycin, all the cins, amikacin.
What ABX causes grey baby syndrome, tetarogenic and DOC for typhoid fever. Causes bone marrow suppresion.
What inhibits the production of folic acid used by bacteria?
Coverage for sulfanomides
Gram POS, Fair Gram NEG, No anearobic, may be used in infants over 6 months, crosses placenta and breast milk
Uses for Sulfonamides
EENT, UTI, GI, URI, Prostate infections,
Adverse effects for sulfamidines
- Preceipitation in acidic urine
- STEVEN JOHNSONS SYNDROMe
- Displaces drugs like warfarin, diabetes drugs, digoxins, thiazides
What is a good drug for meningitis prophylaxis? Has good CSF penetration.
Rifampin (orange urins and tears)
Natrufurantoin (macrobid) good for what?
UTIs (does not reach antibacterial levels until in the urinary system)
What anti funger is for seriousl fungal infections
What are some common azole antifungals?
Common antivirals for flu
Zanamavir and Oseltavir