ABX NC.txt

penicillin & aminoglycosides for endocarditis

• 1) PCN
• 2) CEPHS
• 3) Carbapenems
• 4) Vancomycin

• 1) FQs
• 2) AMGs
• 3) Daptomycin
• 4) Telithromycin

May increase INR (vitamin K absorption in gut)

inhibit ABX absorption - esp FQs - 2 hrs B4, 4 hrs after

• 1) Cipro (1A2 inh)
• 2) Erythro (1A2 & 3A4 Inh)
• 3) Quin/Dalfo (3A4 inh)
• 4) Telithromycin (3A4 inh)

FQs

Inhibit bacterial cell wall synthesis - B Lactam antibiotics

• 1) ex - primarily kidneys (ex naf & oxa)
• 2) pen - good - lung, liver, kidney, muscle, bone

• 1) Diarrhea
• 2) Rash
• 3) Fever
• 4) Neutropenia
• 5) Thrombocytopenia
• 6) Seizures

• 1) High Na+ in IV form - watch in pts with HTN
• 2) Hepatically eliminated, no renal adj.

Ampicillin, Amoxicillin, Bacampicillin

• (Carboxypenicillins, Ureidopenicillins)
• Piperacillin,
• Ticarcillin

• 1) Augmentin PO (Amox/Clavulanate)
• 2) Timetin IV (Ticarcillin/Clavulanate)
• 3) Zosyn IV (Piperacilli/nzobactam)
• 4) Unasyn IV (Ampicillin/Sulbactam)

• Inhibit bacterial cell wall synthesis
• - renal excretion
• - GI, rash, neutropenia, seizures

• 1) Cefazolin
• 2) Cephalexin (PO)
• 3) Cefaclor
• 4) Cefadroxil

• Cefuroxime (IV, PO)
• Cefotetan
• Cefoxitin
• Cefprozil (PO)

1) Gram (+) - >60%: Strep: Pneumo, ABCG, viridans, MSSA -30-60%: Staph epidermidis 2) Gram - >60%: Proteus, E. Coli, Klebsiella, Moraxella, Neisseria gonorrheae, H. Influenzae, Serratia (cefotetan only) - 30-60%: Citrobacter, Enterobacter (not cefoxitin Cefotetan/Cefoxitin: anaerobic coverage - >60%: Clostridium (not difficile), B. fragilis

• IV: Ceftriaxone, Ceftazidime, Cefotaxime
• PO: Cefpodoxime, Cefixime, Cefdinir, Ceftobiprole

Lysis of bacterial cell wall - only IV

gram - bugs

renal - may require adjustment

QD

QID & TID dosing

inhibit bacterial cell wall synthesis - gram - only - covers psuedomonas

• Vacomycin
• Teicoplanin
• Televancin

Inhibit bacterial cell wall synthesis - 1) Ototoxicity 2) Renal Dysfunction (trough 5-15 mg/dL)

Red Man's Syndrome - always infuse vanco over 6- min - less with ticoplanin

• 1) Quinpristin/Dalfopristin (Synercid)
• 2) Linezolid (Zyvox)

target bacterial topoisomerases - inhibit bacterial DNA replication - many QD dosing - post antibiotic effect vs gram -

• Gi
• - Seuizures
• - Rash
• - Tendon Rupture
• - CNS SE
• - Hyper/Hypoglycemia
• - Photosensitivity
• - QT prolongation
• - Bone Effects: chondrocyte tox, growth in kids, risk vs benefit

Older, cover primarily gram -

most potent vs pseudomonas - less gram - vs levo/gati

new agents - respiratory quinolones - good gram -, some gram + - better coverages vs. strep, H flu, atypic, pseudos

like levo/gemi, adds anaerobic coverage

inhibit protein synthesis by binding to 30s ribosomal subunit

• Ototoxicity (irreversible, uncommon)
• - Renal dysf - moon BUN/ Scr, adj dose - goal trough <1mg/dL for QD dosing - neuromuscular block is rare, associated with rapid IV infusion

extended interval dosing - post antibiotic effect against gram -

• - Gentamycin
• - Tobramycin
• - Amikacin
• - Netilmicin
• - Streptomycin

**GRAM -** - Including Pseudomonas - very little gram + - synergy for endocarditis - staph, enterococcus

inhibit bacterial protein synthesis - bind to 50s subunit

more SE (esp GI) & more DI (cyp1A2 & 3A4 inhibitor)

better tolerated - less SE, QD - BID dosing vs QID

needs renal adj at circle <30 ml/min

very few clinically significant drug interactions

GI upset, rash, LFTs, rare hearing loss

Gi upset - rare rash, lfts, transit hearing loss

• erythromycin
• clarithromycin
• azithromycin

**ATYPICALS** clamydia, legionella, mycoplasma - mod gram + & -

inh bacterial protein synthesis, bind to 50s subunit - activity against resistant strains

• conc dependent, bactericidal
• - Po formulation
• - many DIs
• - 3A4 inhibitor

community acq pneumonia

renal and hepatic

Vision problems, di, nausea, dizziness, HA - preg category C

each inhibits step in folic acid synthesis - bactericidal - high urinary conc

UTI, HIV prophylaxis of opportunistic infections

N/V, di, rash, feer, leuko/thrombo, stevens-johnson syndrome

bacterium may displace other highly protein bound drugs (warfarin, phenytoin, methotrexate)

- Pregnancy (3rd trimester only), severe liver disease

Grouped together - potent at treating anaerobes

inhibit bacterial protein synthesis

GI!!!!!!! - number one cause of C diff - inc LFs, rash

may enhance nm blockade of such agents

Strep, MSSA

damage bacterial DNA --> bacteriocidal

gi, seizures, pancreatits rare, DARK URINE

ETOH: disulfram-like reaction

only if <10 ml/mind

binds to 30s ribosomal subunit to inhibit bacterial protein synthesis - not used as much anymore

output tx of CAP

acne

inhibits protein synthesis

only entercoccus faccium

increase bilirubin, infusion rxn, myalgia/arthlalgia

CYP3A4 inhibitor

thrombocytopenia, GI, CNS

- weak MAOI - PPA or sudafen (HTN, SSRI, TCAs (SS) - Tramadol

binds to bacterial membrane, causes rapid depolarization of membrane potential

few DIs, not hepatically metabolized - complicated skin & skin-structure infections (CSSSIs)

>30 = 4mg/kg IV q 24h - < 30 ml/min: 4 mg/kd IV q 58

constipation, di, vomiting, CPK increase = peg cat B