Term
Do PCN's get into CSF or Cells |
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Definition
Not usually, CSF only with inflamed meninges No Intracellular penetration, add azithro or doxycylcine to get into cells |
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Term
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Definition
Renal T1/2B of Pen G is 30 min Probenecid inhibits renal acid transport system which secretes pen G and increases t1/2B of Pen G |
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Term
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Definition
major det - penicilloic acid breakdown product + endogenous protein minor det = penicillin or a metabolite + end protein |
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Term
Pen G administration and use |
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Definition
Always I.v. b/c it is acid labile do not use of staph aureus DOC for B-hemolytic strep |
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Term
Treatment for Strep pneumo |
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Definition
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Term
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Definition
B-hemoytic streps Groups a,b,c,f, and G |
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Term
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Definition
used to cover strep pneumo |
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Term
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Definition
If Pen G Restistant, then also Cephalosporing Resistant. However at low levels of R use cefotaxime ceftriaxone and cefepime |
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Term
Treatment of Syphilis and Neis meningitides |
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Definition
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Term
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Definition
active by p.o acid stable however low bioavailability Use Amoxicillin instead Group A strep kille dquickly by Pen G and pen VK |
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Term
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Definition
Procaine penicillin G and benzathine pen G - Do NOT give I.V. i.m. gives slow release |
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Term
used prophylactically to prevent group A strep in military recruits |
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Definition
Depot PCN's procain and benzathine |
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Term
Used to treat syphillus do to long duration |
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Definition
benzathine pen G not used for neurosyphillus |
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Term
MSSA infection godl standard treatment |
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Definition
oxacillin and nafcillin which are resistant to B-lactamase - but are still susceptible to binding site changes like in MRSA |
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Term
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Definition
first B-lactamase resistant PCN, no longer available due to nephrotoxicity |
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Term
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Definition
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Term
Treatment of soft tissue infection by MSSA and susceptible strep infections SSTI's |
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Definition
oxacillin nafcillin I.V. dicloxacillin p.o. |
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Term
Dosage of oxacillin, nafcillin, dicloxacillin |
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Definition
q4h or q6h due to short half life |
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Term
outpatient treatment of SSTI's cause by MRSA |
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Definition
clindamycin, trimeth-sulfa, or doxycycline |
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Term
current inpatient regimen or SSTI's at UH |
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Definition
doxycycline + cefazolin cefazolin is added b/c doxycycline does not cover GBS |
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Term
Treatment of inpatient infections caused by MRSA |
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Definition
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Term
Use of B-lactamase inhibitors |
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Definition
coadministration of an inhibitor of the B-lactamase protects these PCN's from inactiavtion |
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Term
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Definition
clavulanate sulbactam tazobactam |
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Term
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Definition
extended spectrum PCN's ampicillin and amoxicillin both destroyted by B-lactamase |
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Term
Aminopenicillin spectrum of activity |
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Definition
bactericidal activity comparable to pen G spectrum is extended to cover the gram (-) bugs E. coli and H. flu b/c these PCNs are better able to penetrate the outer mem brane of gram (-) bacteria |
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Term
Aminopenicillins are used in combination with what? Why? |
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Definition
Used in combination with B-lac inh like clav, sul, tazo, b/c they are not resistant to B-lactamases |
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Term
DOC for infections with Listeria spp. and Enterococcus spp. |
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Definition
Ampicillin I.V. others active against enterococcis are vanc, pen G, peracillin, doxy, tigecylin, linezolid, and daptomycin |
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Term
Are Ampicillina and Amoxicillin active against MRSA |
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Definition
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Term
Administration of ampicillin |
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Definition
i.v. only b/c it causes diarrhea |
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Term
amoxicillin administaration |
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Definition
given po.o is not affected by the presence of food, often given with clavulanate which causes diarrhea |
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Term
antipseudomonal penicillins |
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Definition
designed to kill Pseudomonas aeruginosa, with activity against Enterobacter |
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Term
Antipseudomonal pnicillins given in combination with what? Why? |
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Definition
Given with aminoglycoside gentamicin due to resistance development |
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Term
Antipseudomonal treatement I.V. or P.O.? |
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Definition
IV only, no po equivalent |
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Term
What are teh anti-pseudomonal drugs? |
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Definition
ticarcillin + clavulanate(TImentin) piperacillin - the best PCN vs. Pseudom piperacillin + tazobactam (Zosyn/piptazo) - best anti-pseudomonal should be reserved for ICU |
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Term
DOC for B-emolytic strep (group A, B, C, F and G) |
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Definition
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Term
DOC for susceptible Strep pneumo |
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Definition
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Term
DOC for meningococcal meningitis |
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Definition
use only pen G at higher doses |
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Term
DOC for MSSA - cellulities, abscesses, and other infectionsupt ot and including endocarditis and meningitis |
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Definition
oxacillin or naficillon i.v. or dicloxacillin - p.o. |
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Term
DOC for otitis media in children |
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Definition
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Term
second line DOC for treatment of Otitis media |
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Definition
amoxicillin + clavulantate (Augmentin) |
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Term
DOC for inf cause by Pseudomonas and other nosocomial gram negatives |
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Definition
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Term
Good MSSA and S. pneumo coverage |
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Definition
pip/tazo or ticarcillin + clavulanate |
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Term
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Definition
pip/tazo, or ticarcillin + clavulante |
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Term
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Definition
the same as PCN's but given I.v. only! and the broadset spectrum B-lactam ab drugs excetp for ertapenem |
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Term
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Definition
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Term
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Definition
many nosocomial gram (-) rods, including Pseudomonas spp, anaerobes and gram (+) (very similar to spectrum of piptazo) |
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Term
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Definition
worst B-lactams for the treatment of Pseudomonas infetions 50% of isolates develop resistance during terapy. Mut eliminates porins. |
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Term
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Definition
Not hydrolyzed by most B-lactamases but are degraded by metallo B-lactamases. Klebsiella pneumo cabapenemase KPC enzyme is a huge problem. |
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Term
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Definition
Imipenem - given with renal DHP inhibitor cilastatin meropenem - used for ertapenem doripenem |
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Term
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Definition
causes seizures in high doses in patients with poor renal function and neuro surgical patients |
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Term
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Definition
causes seizures in high doses in patients with poor renal function and neuro surgical patients |
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Term
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Definition
used for meningitis b/c it is less likely to cause seizures. better for gram (-) bugs |
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Term
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Definition
does not cover Pseudomonas, Acinetobacter or enterococci |
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Term
Indications for cabapenems |
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Definition
good tissu penetration, drugs of last resort for MDR bugs, given to patients who have failed pip-tazo or cefepime |
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Term
Febrile neutropenic patients DOC |
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Definition
pipericillin tazo or cefepime |
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Term
Carbapenem cross reactivity |
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Definition
allergic reactions occur in 10-15% of patients with a Pen allergy |
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Term
Aztreonam spectrum of activity and MOA |
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Definition
MOA is same as PCNs very good gram (-) activity including pseudomonas, comp to ceftazidime NOT active against anaerobics and G+ |
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Term
Aztreonam specturm of activity is similar to? |
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Definition
Aminoglycosides such as gentamicin |
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Term
Cross Resistance of Aztreonam |
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Definition
cross resistance with many 3rd gen Cephalosporins especially ceftazidime and cefepime |
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Term
Clinical use of aztreonam |
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Definition
I.V. only little allergic cross reactivity with other B-lactams thus can be used in a patient with a PCN allergy for G(-) infections |
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Term
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Definition
same as PCN's inhibit PG crosss linking by binding to the active site of the PBP's |
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Term
Resistance mechanism to Cephalosporins |
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Definition
same as PCN's changes in the PBP site, and some make cephalosporinases |
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Term
Cephalosporin Sceptrum of activity |
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Definition
varies between generations all are relatively resistant to hydrolysis by B-lactamases = broader spectrum No activity against Enterococcus, Listeria, PCN R Strep Pneumo or MRSA |
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Term
DOC for surgical prophylaxis good tissue penetration and cheap, good for SSTI's |
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Definition
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Term
Treats SSTIs, safe to use in pregnant women |
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Definition
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Term
1st generation cephalosporins |
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Definition
cefazolin cephalexin cephradine |
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Term
2nd generation Cephalosportins |
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Definition
cefoxitin cefotetan cefuroxime cefaclor |
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Term
The only two cephamycins which cover anaerobic bugs |
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Definition
cefoxitin and cefotetan I.V. ONLY |
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Term
Used to treat pedi and FP outpatients |
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Definition
P.O. cefuroxime and cefaclor |
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Term
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Definition
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Term
P.O. 2nd gen Cephalosportins |
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Definition
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Term
3rd gen I.V. Cephalosporins |
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Definition
cefotaxime cetriaxone ceftzidime |
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Term
3rd gen P.O. cephalosporins |
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Definition
cefpodoxime cefdinir cefixime |
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Term
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Definition
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Term
3rd gen drug that kills Pseudomonas |
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Definition
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|
Term
Turns feces brick red in children |
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Definition
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Term
3rd gen cef for gonorrhea |
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Definition
cefixime not a good drug for Strep pneumo or MRSA |
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Term
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Definition
best against gram + Proteus E coli Klebsiella |
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Term
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Definition
gram(+), but add some gram (-) and anaerobes(only cefoxitin and cefotetan Hen Peck Haemophilus enteroBacter Neiserria +1st gen PEcK |
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Term
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Definition
increased gram (-) at the expense of gram + coverage (esp. MRSA) |
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Term
Can you use a 3G Ceph to treat MRSA |
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Definition
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Term
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Definition
moderate G+ and excellent G(-) activity |
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Term
Do cephalosporins enter cells? |
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Definition
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|
Term
Do Cephalosporins enter CNS |
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Definition
Yes, with ceftazidime, ceftriaxone, cefotaxime, and cefepime |
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Term
Elimination of cephalosporins is mostly by |
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Definition
renal so decrease the does with impaired renal fxn. and diabetes |
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Term
Cephalosporing cross reactivity in patients with allergy to PCN's |
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Definition
as the generation goes up, the allergic cross reactivity does down significant cross reactivity btween 1st gen cephalosporins and PCNs, less between 3rd and 4th |
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Term
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Definition
uncommon but can occur when the drugs, esp ceoxitin are gien by i.v. push |
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Term
Is superinfection common in treatement with cephalosportins? |
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Definition
Yes, anything with a broad spectrum coverage will give superinfection |
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Term
The other Cephalosporin side effect |
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Definition
prolongs prothrombin time causing bleeding inhibit vit k epoxid red, most likely occurs with cfotetan |
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Term
Do cephalosporing cover enterococci or MRSA |
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Definition
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Term
Coverage of 1st gen cephalosporing, i.v. cefazolin and p.o. cephalexin and cephadrine |
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Definition
cefaxolin is agreat gram + drug with little G(-) activity, better than vancomycin for MSSA |
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Term
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Definition
MSSA, streptococci except S. pneumo, and the gram (-) bugs E.coli, K pneumo, Proteus, and H. flu Proteus E. coli Klebsiella |
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Term
Only cephalosporin with significant activity against anaerobic bugs? |
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Definition
Cefoxitin and cefotetan 2nd gen cephs |
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Term
Used to trat pelvic inflammatory disease and intra-abdominal infections |
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Definition
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Term
DOC for prophylaxis for intra-abdominal surgery |
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Definition
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Term
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Definition
gram (-) bugs including Pseudomonas aer. and bugs which end in bacter, but it has very little G+ activity |
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Term
DOC for treatement of strep pneumo infections including meningitis |
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Definition
Cefotaxime and ceftriaxone, b/c they are effective against low level Pen G R strep pneumo and are very potent with low MIC |
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Term
What is the difference between cefotaxime and ceftriaxone |
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Definition
t1/2 of ceftriaxone is 8h versus 1 hour for cefotaxime |
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|
Term
given in a single large I.M. dose for cervical, urethral, oropharyngeal or rectal gonorrhea |
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Definition
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Term
CDC recommended oral alternative for uncomplicated gonorrhea |
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Definition
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Term
Used to treat meningities caused by strep pneumo and Neisseria spp. |
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Definition
Cefotaxime and ceftriaxone |
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Term
Good for the treatment of otitis media after tow failures with amoxacillin or augmentin(amox + clav) |
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Definition
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|
Term
|
Definition
I.V. in the ICU esp in neutropenic patients |
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|
Term
4th gen ceph, cefepime spectrum of activity |
|
Definition
moderate G+ and excellent gram (-) activity, active against Pseudomonas aer |
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|
Term
Improved activity over ceftazidime |
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Definition
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|
Term
only ceph active against MRSA |
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Definition
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|
Term
#1 drug for surgical proph |
|
Definition
cefazolin 1st gen cephalosporin |
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|
Term
Used to treat MSSA SSTI's but not MRSA |
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Definition
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|
Term
along with oxacillin and nafcillin, better than vancomycin for MSSA |
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Definition
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|
Term
First line agent for patients with mild PCN allergy and MSSA infection |
|
Definition
1st gen ceph cefaxolin, cephalexin, cephradine |
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|
Term
#1 drugs for intra-abdominal surgical prophylaxis |
|
Definition
2nd gen cephs cefoxitin and cefotetan |
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|
Term
used with gentamicin until the antibiotic suscept of the isolate is known |
|
Definition
ceftazidime, i.v. for Pseudomonas aer |
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|
Term
|
Definition
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|
Term
Used for strep pneumo infections including meningitis and B-hemolytic strep |
|
Definition
cefotaxime and cetriaxone i.v. |
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|
Term
used for community acquired meningities, H. flu, strep pneumo and Neisseria |
|
Definition
cefotaxime 3rd gen cephalosporin |
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|
Term
Used for inpatient community acquired pneumonia = H. flu, strep pneumo, and Moraxella |
|
Definition
cefotaxime and cetriaxone i.v. a macrolide like clarithromycin can be added to cover the atypical bugs |
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|
Term
Used to treat uncomplicated gonorrhea with a single dose of |
|
Definition
i.m. ceftriaxone or a single p.o. dose of cefixime |
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|
Term
febrile neutropenic patients where gram (-) bugs can kill in two hours so you need a bactericidal drug with stron gram (-) coverage |
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Definition
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|
Term
Treat inpatient strep pneumo, pseudomonas, ICU patients, mixed infections, unknown infections |
|
Definition
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|
Term
Do cephalosporins cover enterococci or MRSA? |
|
Definition
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|
Term
Gram + cephalosporin activity trend |
|
Definition
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|
Term
Gram (-) ceph activity trend |
|
Definition
|
|
Term
Cephs with good anaerobic activity |
|
Definition
Cefoxitin and cefotetan 2nd gen cephs |
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