Term
|
Definition
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|
Term
|
Definition
|
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Term
|
Definition
| 4,000 to 10,000 cells/mm3 |
|
|
Term
|
Definition
| measures different WBCs (neutrophils, basophils, eosinophils, lymphocytes, monocytes) |
|
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Term
|
Definition
immature neutrophils;
increase in immature neutrophils leads to a "left shift" |
|
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Term
|
Definition
release of immature neutrophils from bone marrow;
significant for an acute infection |
|
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Term
|
Definition
drugs that mask fever in the community setting;
ALWAYS ask pts if they have taken these! |
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Term
|
Definition
pts that may not present with a fever;
instead, present with mental status changes |
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Term
|
Definition
pt in hospital >1 week and no identifiable reason for high body temperature;
look for abcess, connective tissue disorders, drug fever (Beta-lactams) |
|
|
Term
| Enterobacteriaceae - aerobic Gram-Negative Bacilli |
|
Definition
| E.coli, Klebsiella, Enterobacter, Citrobacter, Proteus mirabilis, Providencia, Morganella morganii, Serratia, Shigella, Salmonella, Yersinia enterocolitica |
|
|
Term
| Nonenterobacteriaceae - Aerobic Gram-Negative Bacilli |
|
Definition
| Pseudomonas aeruginosa, Acinetobacter baumannii, Stenotrophomonas (Xanthomonas) maltophilia, Haemophilus influenzae, Legionella pneumophilia, Bordetella pertussis, Bartonella henselae, Pasteurella multocida, Helicobacter pylori, Brucella, Vibrio cholera, Campylobacter jejuni |
|
|
Term
| Aerobic Gram-Positive Cocci |
|
Definition
Staphylococcus aureus, Staphylococcus epidermidis, Staphylococcus saprophyticus;
Streptococcus pyogenes (Grp A Beta-hemolytic), Streptococcus agalactiae (Grp B Beta-hemolytic), Streptococcus pneumoniae (alpha-hemolytic), Viridans Gropu Streptococci (alpha-hemolytic);
Enterococcus faecalis, Enterococcus faecium; |
|
|
Term
| Aerobic Gram-Positive Bacilli |
|
Definition
Bacillus;
Mycobacterium tuberculosis |
|
|
Term
| Aerobic Gram-Negative Cocci |
|
Definition
Neisseria meningitidis, Neisseria gonorrhoeae;
Moraxella catarrhalis |
|
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Term
| Anaerobic Gram-Positive Bacilli |
|
Definition
Spore Forming: Clostridium perfringens, Clostridium difficile;
Nonspore-forming: Actinomyces, Propionibacterium acnes, Lactobacillus |
|
|
Term
| Anaerobic Gram-Negative Bacilli |
|
Definition
Bacteroides fragilis, Bacteroides melaninogenicus;
Fusobacterium;
Prevotella |
|
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Term
| Miscellaneous/Atypical Microorganisms |
|
Definition
Chlamyidia trachomatis;
Chlamydophilia pneumoniae;
Rickettsia rickettsii;
Mycoplasma pneumoniae;
Borrelia burgdorferi;
Treponema pallidum |
|
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Term
| Gram-Positive Microorganisms |
|
Definition
|
|
Term
| Gram-Negative Microorganisms |
|
Definition
|
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Term
|
Definition
initial tx in a pt w/ suspected infection prior to confirming a diagnosis;
Tx depends on clinical presentation, initial lab results, & Pt hx;
Selection depends on likely pathogens, host factors, & drug factors;
Use broad-spectrum antibiotics (alone or in combo) |
|
|
Term
|
Definition
tx changes once pathogen is ID'ed via culture & susceptibility;
Change from broad-spectrum antibiotic to narrow-spectrum agent;
Selection dependent on host & drug factors;
reduces antimicrobial resistance, toxicity, & institutional costs (formulary) |
|
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Term
|
Definition
preventing an infection in situations known to cause infections;
Ex: surgeries, dental procedures, labor & delivery |
|
|
Term
|
Definition
GOLD STANDARD - for detecting microorganisms;
definitive method for diagnosing & treating infections;
Distinguish true pathogen from colonization & contamination; |
|
|
Term
|
Definition
defends by occupying space;
stimulates cross-protective antibodies;
suppresses growth of pathogenic bacteria/fungi |
|
|
Term
|
Definition
bacteriological & clinical evidence of a new infection during chemotherapy of a primary infection;
overcomes beneficial normal flora;
common w/ extended use broad-spectrum antimicrobials;
Dangerous if Multi-Drug Resistant Organisms (MDROs) |
|
|
Term
|
Definition
| Gram-Positive: Staph spp. (CoNS), Streptococcus; |
|
|
Term
| Normal Flora of Oro-pharynx |
|
Definition
| Viridans Group Streptococci |
|
|
Term
|
Definition
Gram-Positive Cocci: Enterococcus, Peptostreptococcus;
Gram-Pos Rods: Lactobacillus, Clostridium;
Gram-Neg Rods: Bacteroides, Enterobacteriaceae |
|
|
Term
|
Definition
| Gram-Pos Cocci: Streptococcus, Staphylococcus |
|
|
Term
|
Definition
kills bacteria;
beneficial for deep-seated infections (meningitis, endocarditis, osteomyelitis);
Ex: aminoglycosides, Beta-lactams, daptomycin, fluoroquinolones, metronidazole, aztreonam, nitrofurantoin, rifamycins, TMP/SMX, vancomycin |
|
|
Term
|
Definition
inhibits growth; relies on intact, active host defense system;
Ex: clindamycin, linezolid, macrolides, quinupristin/dalfopristin, telithromycin, tetracyclines, tigecycline |
|
|
Term
| Minimum Inhibitory Concentration (MIC) |
|
Definition
| lowest concentration of a specific antimicrobial agent that PREVENTS visible growth of test organism |
|
|
Term
| Minimum Bactericidal Concentration (MBC) |
|
Definition
| lowest concentration of a specific antibiotic that KILLS most (>99.9%) of test organism |
|
|
Term
| Post Antibiotic Effects (PAE) |
|
Definition
persistent suppression of an organism's growth after a brief exposure to an antibiotic;
leads to less frequent administration of antibiotic while maintaining adequate activity |
|
|
Term
|
Definition
combination results in inhibition of growth at conc. less than or equal to 25% of the MIC of each drug acting alone;
Ex: Serious infections (neutropenic pts, Enterococcus endocarditis or bacteremia, Empiric therapy against resistant Psuedomonas aeruginosa or Acinetobacter baumanii) |
|
|
Term
|
Definition
two drugs working independently of each other where each drug contributes 1/2 the inhibitory conc. required for total inhibition;
Ex: tx of pneumonia --> macrolide + ceftriaxone |
|
|
Term
| Multi-Drug Resistant Organisms (MDROs) |
|
Definition
Methicillin-Resistant Staph aureus (MRSA);
Vancomycin-Resistant Enterococci (VRE);
Multi-Drug Resistant Strep. pneumonia (MDRSP);
Extended-Spectrum Beta-Lactamases (ESBLs) |
|
|
Term
| Beta-Lactam Antibiotics - Penicillins, Cephalosporins, Carbapenems |
|
Definition
MoA: inhibits cell wall synthesis by binding to transpeptidase (PBPs);
Bactericidal;
PK/PD: distributes well into tissue & bone (lung, liver, kidney, muslce, placenta); sufficient penetration w/ inflammation (abscess, middle ear, pleural, peritoneal, & synovial fluid, eye, brain, CSF, prostate);
Elimination: urine/bile --> renal dose adjustments required;
ADRs: hypersensitivity rxns (Type I Anaphylactic Rxn), GI upset (N/V/D), infusion site rxns (IV);
Resistance: ezymatic inhibition via Beta-lactamase |
|
|
Term
| penicillin G IV, penicillin VK PO, penicillin procaine & benzathine IM |
|
Definition
very narrow spectrum (Gram-Pos organisms ONLY);
natural penicillins;
Place in Therapy:
Aerobic Gram-POS mainly:
- NOT for Staph. spp. (RESISTANT)
- SOME susceptible Strep. spp. (Strep. pneumoniae, Strep. pyogenes, Strep. agalactiae, Viridans Group Strep.);
Gram-Neg. Cocci
- Neisseria meningiditis & Neisseria gonorrhoeae (increasing resistance);
- DRUG OF CHOICE for syphilis (Treponema pallidum);
POOR/NO Activity Against: Staph. spp., Enterococcus spp., Most Gram-Neg bacilli;
Resistance: Staph. spp. secretes Beta-lactamase (penicillinase) |
|
|
Term
|
Definition
| acid labile natural penicillin (absorbs poorly in acidic environments --> can't give PO) |
|
|
Term
|
Definition
natural penicillin stable in acidic environments (can give PO);
Na+ or K+ salt --> K+ salt provides highest blood level;
- loses some spectrum of activity |
|
|
Term
| penicillin procaine & benzathine IM |
|
Definition
natural penicillin given IM;
repository forms of penicillin G;
Absorbs slowly: P - over hrs, B - over days; |
|
|
Term
| nafcillin (IV), oxacillin (IV), dicloxacillin (PO) |
|
Definition
Antistaphylococcal or Penicillinase-Resistant Pencillins;
- slightly greater spectrum of activity (more Gram-Pos);
Place in Therapy:
Aerobic Gram-Pos Cocci
- Staph. spp --> DRUG OF CHOICE for penicillin-resistant Staph. spp (MSSA/MSSE only)
- Streptococcus spp.;
POOR Activity against:
- methicillin-resistant Staph (MRSA/MRSE)
- Enterococcus spp.
- Gram-Neg organisms; |
|
|
Term
| ampicillin IV/PO, amoxicillin (Amoxil) PO |
|
Definition
aminopenicillins;
Place in Therapy:
Aerobic Gram-Pos Cocci
- DRUG OF CHOICE (if suscpetible) for Enterococcus spp.
- Strep spp. --> DRUG OF CHOICE for Grp B Strep. & otitis media;
Aerobic Gram-Neg Bacilli
- only non-Beta-lactamase producing organisms;
Gram-Neg Cocci
- Neisseria meningitidis, Neisseria gonorrhea;
POOR Activity against:
- Staph. spp (including MRSA/MRSE)
- More aggressive Gram-Negs. (SPACE + K & B --> Serratia spp, Pseudomonas aeruginosa, Acinetobacter spp, Citrobacter spp, Enterobacter spp, + Klebsiella spp & Bacteroides fragilis) |
|
|
Term
| ticarcillin IV, piperacillin IV |
|
Definition
antipseudomonal penicillins;
Place in Therapy:
- similar activity to aminopenicillins, BETTER activity against most aggressive Gram-Negs especially Pseudomonas aeruginosa (P > T);
Aerobic Gram-Pos Cocci
- Enterococcus spp.
- Strep spp.;
Aerobic Gram-Neg Bacilli
- only non-Beta-lactamase producing organisms;
Gram-Neg Cocci
- Neisseria meningitidis, Neisseria gonorrhea;
Aggressive Gram-Negs:
- More aggressive Gram-Negs. (SPACE + K & B --> Serratia spp, Pseudomonas aeruginosa, Acinetobacter spp, Citrobacter spp, Enterobacter spp, + Klebsiella spp & Bacteroides fragilis)
Vulnerable to Beta-lactamases;
POOR Activity against:
- Staph. spp (including MRSA/MRSE)
- VRE |
|
|
Term
| ampicillin/sulbactam (Unasyn) IV, amoxicillin/clavulanic acid (Augmentin) PO, ticarcillin/clavulanic acid (Timentin) IV, piperacillin/tazobactam (Zosyn) IV |
|
Definition
extended spectrum penicillins (penicillins + beta-lactamase inhibitors);
Broad-spectrum agents;
Additional coverage against Beta-lactamase producing organisms, Gram-Negs (some drugs), & anaerobes;
POOR Activity:
- DO NOT cover MRSA/MRSE, VRE |
|
|
Term
| ticarcillin/clavulanic acid (Timentin) IV, piperacillin/tazobactam (Zosyn) IV |
|
Definition
extended spectrum penicillins + beta-lactamase inhibitors;
Broad spectrum Agents;
Spectrum of ACtivity:
- additional coverage against Beta-lactamase-producing organisms, Gram-Neg organisms (i.e. Acinetobacter spp.), & anaerobes;
POOR/NO Activity:
- MRSA/MRSE, VRE |
|
|
Term
| ampicillin/sulbactam (Unasyn) IV, amoxicillin/clavulanic acid (Augmentin) PO |
|
Definition
extended spectrum penicillins + beta-lactamase inhibitors;
Broad spectrum agents;
Additional coverage against Beta-lactamase-producing agents, Gram-Neg organisms, & Anaerobes;
POOR/NO Activity against:
- SPACE organisms (Serratia spp, Pseudomonas aeruginosa, Acinetobacter spp, Citrobacter spp, Enterobacter)
- NO activity against P. aeruginosa;
- NO activity against MRSA/MRSE, VRE |
|
|
Term
| cefadroxil (Duricef) PO, cephalexin (Keflex) PO, cefazolin (Ancef) IM, IV |
|
Definition
1st gen. cephalosporins;
Poor penetration across BBB;
Narrow Spectrum:
- Gram-Pos cocci: Grp A Strep., MSSA;
- few Gram-Neg bacilli: E. coli, Klebsiella spp., Proteus spp.
Poorly active against MRSA/MRSE & Enterococcus |
|
|
Term
| cefaclor (Ceclor) PO, cefoxitin (Mefoxin) IM/IV, cefprozil (Cefzil) PO, cefuroxime (Zinacef) IM/IV/PO, cefuroxime axetil (Ceftin) IM/IV/PO |
|
Definition
2nd generation cephalosporin;
Poor penetration across BBB;
Narrow Spectrum:
- Gram-Pos cocci: Grp A Strep., MSSA;
- slightly better Gram-Neg & Anaerobic coverage: E. coli, Klebsiella spp., Proteus spp, Enterobacteriacieae (E. coli, Klebsiella, Enterobacter, Citrobacter, Proteus, Providencia, Morganella, Serratia, Shigella, Salmonella, Yersinia)
Poorly active against MRSA/MRSE & Enterococcus |
|
|
Term
| cefdinir (Omnicef) PO, cefixime (Suprax) PO, ceftibuten (Cedax) PO, cefpodoxime proxetil (Vantin) PO, cefditoren (Spectracef) PO, cefotaxime (Claforan) IM/IV, ceftriaxone (Rocephin) IM/IV, ceftazidime (Fortaz) IM/IV |
|
Definition
3rd Generation cephalosporins;
Good penetration across BBB;
Extended Spectrum Cephalosporins;
Gram-Pos & even better Gram-Neg coverage;
Good CNS penetration --> tx of bacterial meningitis (Neisseria meningitidis)
Poorly active against MRSA/MRSE & Enterococcus |
|
|
Term
| cefepime (Maxipime) IM/IV |
|
Definition
4th generation cephalosporin
Good penetration across BBB;
Extended Spectrum Cephalosporins;
Gram-Pos & even better Gram-Neg coverage;
EXCELLENT Gram-Neg activity (Enterobaceriaceae + P. aeruginosa) & maintains activity against Gram-Pos (Staph. & Strep. spp.);
Good CNS penetration --> bacterial meningitis (Neisseria meningitidis);
Poorly active against MRSA/MRSE & Enterococcus;
ADR: ENCEPHALOPATHY |
|
|
Term
|
Definition
2nd generation cephalosporin;
Enhanced resistance to Beta-lactamase produced by aerobic & anaerobic Gram-Neg organisms;
Lower affinity for PBP in Gram-Pos cocci;
Poorly active against MRSA/MRSE & Enterococcus |
|
|
Term
| ceftriaxone (Rocephin) IM/IV |
|
Definition
3rd gen. cephalosporin;
Good CNS penetration --> tx of bacterial meningitis (N. meningitidis);
Good activity against Strep. pneumoniae including MDRSP --> NO Pseudomonas aeruginosa activity;
High activity against Neisseria gonorrhoeae;
Long elimination half-life: once daily dosing;
Pronounced biliary excretion --> DOES NOT require RENAL dose adjustment;
Poorly active against MRSA/MRSE & Enterococcus;
ADR: biliary sludge (RARE) - avoid in pts w/ pre-existing gallbladder, biliary tract, liver or pancreatic dx |
|
|
Term
| cefotaxime (Claforan) IM/IV |
|
Definition
3rd gen. cephalosporin;
Good activity against Streptococcus pneumoniae, including MDRSP;
NO ACTIVITY against P. aeruginosa;
Poorly active against MRSA/MRSE & Enterococcus |
|
|
Term
|
Definition
3rd gen. cephalosporin;
ADDED ACTIVITY AGAINST Pseudomonas aeruginosa;
Loses some Gram-Pos activity;
Poorly active against MRSA/MRSE & Enterococcus |
|
|
Term
|
Definition
Hypersensitivity - 10% cross-reactivity w/ pencillin allergies (AVOID if allergic to penicillins [Anaphylaxis]);
Encephalopathy (cefepime);
biliary sludge (rare - ceftriaxone) |
|
|
Term
| Resistance to Cephalosporins |
|
Definition
Development of a Beta-lactamase produced by Enterobacetiaceae (Klebsiella, E.coli) --> Extended Spectrum Beta-Lactamases (ESBLs) --> drug inactive;
Resistance overcome by tx w/ carbapenems (imipenem/cilastatin, meropenem, ertapenem, doripenem) |
|
|
Term
| imipenem/cilastatin (Primaxin) IV, meropenem (Merrem) IV, ertapenem (Invanz) IV, doripenem (Doribax) IV |
|
Definition
carbapenems;
beta-lactam antibiotics; |
|
|
Term
| imipenem/cilastatin (Primaxin) IV |
|
Definition
carbapenem w/ a DHP-1 inhibitor (prevents degradation of carbapenem);
Spectrum of Activity:
BROADEST spectrum of Beta-lactams:
- Aerobic Gram-Pos organisms (= to doripenem, > ertapenem & meropenem);
- Aerobic Gram-Neg Organisms (< ertapenem & meropenem, = to doripenem);
- Enterobacteriaceae + P. aeruginosa + Acinetobacter baumannii;
- Activity against Extended-Spectrum Beta-Lactamases (ESBLs) --> DRUG OF CHOICE;
Activity against Anaerobic Gram-Neg & Gram-Pos organisms;
Limited activity against: MRSA, Enterococcus, Clostridium difficile;
Place in Therapy:
- broad spectrum, potent Beta-lactam (reserved for infections where individiual carbapenems are S and/or to cover broadly for suspicion of severe infection;
- provides coverage against MDROs (i.e. ESBLs --> DRUG OF CHOICE);
- polymicrobial infections;
ADRs: Hypersensitivity, Seizures (dose related, adjust dose in renal impairment) |
|
|
Term
|
Definition
Carbapenem;
Spectrum of Activity:
- better in vitro against aerobic Gram-Negs (P. aeruginosa) than imipenem/cilastatin;
Place in Therapy:
- FDA approval for bacterial meningitis in pediatric pts (less risk of seizures than imipenem/cilastatin) |
|
|
Term
|
Definition
carbapenem
Spectrum of Activity:
- more narrow spectrum than all other carbapenems;
- Poor activity against Enterococcus spp. & nonfermenting Gram-Neg bacilli (P. aeruginosa, Acinetobacter spp.)
- activity resembles ceftriaxone;
Place in Therapy:
- less useful for complicated nosocomial infections (AVOID using against Enterococcus, P. aeruginosa, Acinetobacter);
- MORE USEFUL against AEROBIC & ANAEROBIC complicated community acquired (CA) infections not involving those organisms;
Long half-life: once daily dosing;
ADRs: < risk of seizures |
|
|
Term
|
Definition
newest carbapenem;
Spectrum of Activity:
- better in vitro coverage against aerobic Gram-Neg than imipenem/cilastatin (lowest MIC against P aeruginosa, active against ESBLs);
Place in Therapy:
- broad spectrum & potent Beta-lactam commonly used initially w/ or w/o another agent for severe infections;
- provides coverage against MDROs (ESBLs);
- polymicrobial infections |
|
|
Term
| aztreonam (Azactam) IV/IM |
|
Definition
monobactam;
Bactericidal;
Spectrum of Activity:
- aerobic gram-Neg bacilli (Enterobacteriaceae, P. aeruginosa);
Place in Therapy:
- Alternative agent for beta-lactam (penicillin) allergic pts --> NO cross-reactivity; |
|
|
Term
| gentamicin IM/IV, tobramycin IM/IV, amikacin IM/IV, streptomycin IV, neomycin PO/TOP |
|
Definition
MoA: inhibits protein synthesis by binding to 30S subunit of bacterial ribosomes; Bactericidal;
Spectrum of Activity:
- Aerobic Gram-Neg bacilli: Enterobacteriaceae, Pseudomonas Aeruginosa;
- Mycobacterium spp.;
Pk/Pd: all given IV, distributes freely into vascular space (highly water soluble), increased distribution in edematous states (ascites, burn pts, CHF, severe infections), decreased distribution in dehydrated & obese pts (poor distribution in adipose tissue), poor conc. in bronchial secretions, CSF, & abcesses;
Excretion: Urine, 99% excreted unchanged, renal dose adjustment necessary;
Conc. dependent killing;
Good Post-Antibiotic Effect (PAE) --> extended-interval aminoglycosides;
Place in Therapy:
- Aerobic Gram-Neg bacilli including P.aeruginosa (may be used in synergy w/ Beta-lactams);
- Synergy w/ Beta-lactams & vancomycin against aerobic Gram-Pos cocci (infective endocarditis[IE])
ADRs: Nephrotoxicity (reversible), Ototoxicity (Irreversible) |
|
|
Term
| Traditional (conventional) Aminoglycoside Dosing |
|
Definition
Used in pts w/ fluctuating parameters & can't use a nomogram (pregnant, poor renal fcn);
Gentamicin & Tobramycin: IV q8 hrs;
Amikacin: IV q12 hrs; |
|
|
Term
| Extended-Interval (once-daily) Aminoglycoside Dosing |
|
Definition
concentration-dependent kinetics & PAE allow these drugs to be given once daily;
Gentamicin, tobramycin, amikacin: IV Qdaily;
Benefits:
- decreases need for routine levels;
- decreases toxicity |
|
|
Term
| ciprofloxacin (Cipro) IV/PO, levofloxacin (Levaquin) IV/PO, moxifloxacin (Avelox) IV/PO, gemifloxacin (Factive) PO, ofloxacin PO, norfloxacin PO |
|
Definition
Fluoroquinolones;
MoA: inhibits DNA synthesis by binding to DNA gyrase & topoisomerase IV;
Spectrum of Activity:
- Aerobic Gram-Neg bacilli: Enterobacteriaceae, Haemophilus spp., Pseudomonas aeruginosa (C > L);
- Aerobic Gram-Pos cocci: Strep. pneumoniae (G > M > L >>> C);
- Atypicals: Legionella pneumophilia, Mycoplasma pneumoniae, Chlamydophila pneumoniae;
- some anaerobes: Bacteroides, Clostridium perfringes (M);
Pk/Pd: 100% absorption;
Excretion: Urine/Bile --> concentrates well in urine (renal dose adjustmants necessary (C, L, G, NOT M);
Concentration dependent killing;
PAEs w/ Gram-Neg. organisms;
Place in Therapy:
Popular class due to broad spectrum of activity, excellent absorption, overall good tolerability;
ADRs: arthropathy, tendonitis, tendon rupture (avoid in children <12, pregnancy, breast-feeding), hypo/hyperglycemia (rare - severe w/ G [now off market]);
D-D Interactions: decreased absorption w/ multi-valent metal cations; |
|
|
Term
| moxifloxacin (Avelox), levofloxacin (Levaquin), gemifloxacin (Factive) |
|
Definition
| respiratory fluoroquinolones - covers Strep. pneumoniae (including MDRSP) & atypyical coverage; |
|
|
Term
|
Definition
| fluoroquinolone with POOR activity against Strep. pneumoniae & Gram-Pos infections in general |
|
|
Term
| moxifloxacin (Avelox), gemifloxacin (Factive) |
|
Definition
| fluoroquinolones that are LESS EFFECTIVE against Pseudomonas aeruginosa; |
|
|
Term
|
Definition
| fluoroquinolone that is excreted (60%) in the bile --> renal dose adjustments not necessary |
|
|
Term
|
Definition
| fluoroquinolone removed from market due to serious ADR of hypo/hyperglycemia |
|
|
Term
| polymixin E (Coly-Mycin M, aka colistimethate sodium [Colistin]) IM/IV |
|
Definition
MoA: prodrug (hydrolyzed to active drug in vivo); Bactericidal;
Spectrum of Activity:
- aerobic Gram-Neg bacilli including MDROs (E.coli, H.influenzae, Klebsiella, SPACE organisms);
Place in Therapy:
- dose-related toxicity (fell out of favor from 60's-80's);
- last line agent (in combo) against aerobic Gram-Neg MDROs (when more effective, less toxic agents are resistant or C/I);
ADRs: nephrotoxicity (dose-related), neurotoxicity (drug overdose, renal insufficiency);
D-D Interactions: nephrotoxic agents (i.e. aminoglycosides), neuromuscular blockers; |
|
|
Term
| vancomycin HCl (Vancocin) IV/PO |
|
Definition
MoA: binds to D-Ala-D-Ala, interferes w/ peptidoglycan cross-linking --> cell wall lysis; Bactericidal;
Spectrum of Activity:
- Aerobic Gram-Pos Cocci
- Enterococcus spp. (bacteriostatic, add aminoglycoside or rifampin for synergy) - watch out for VRE!!!
Pk/Pd:
- PO drug not well absorbed in GI tract (<5%);
- tx severe gram-Pos SYSTEMIC infections w/ IV;
- tx LOCAL GI infections (C. difficile) w/ PO;
Distribution of IV Drug:
- wide distribution
- CSF (inflamed meninges): 15-30% of serum, negligible with uninflamed meninges;
Elimination: Urine - 90% unchanged in urine, renal dosage adjustments necessary;
Place in Therapy:
IV - Hospitalized pts who cannot receive/have failed/are resistant to Beta-lactams for Gram-Pos infections;
- DRUG OF CHOICE for MRSA;
- synergy w/ aminoglycosides against Staph. aureus, Enterococcus, Viridans Group Strep;
- alternative agent for PCN allergic pts w/ Gram-Pos infections;
PO -
- 2nd line to metronidazole for severe Clostridium difficile-associated diseases (CDAD);
Resistance:
- VRE;
ADRs: "Red-neck" or "Red-man" syndrome (infusion related - flushing, hypotension, erythematous/puritic rash involving face/neck/torso) - occurs w/i minutes of IV placement --> NOT a reason to D/C drug;
- nephrotoxicity (risk increases if used w/ other nephrotoxic agents), renal adjustments needed |
|
|
Term
|
Definition
Start at 1 gm IV q12 hrs (15 mg/kg/dose)
- monitor SCr & BUN, calculate CrCl;
- obtain trough just before 4th dose (30 min);
Target levels:
Trough > 10 mg/L;
Renal adjustments necessary in renal impairment |
|
|
Term
|
Definition
MoA: inhibits protein synthesis by binding to 23S ribosomal subunit;
Bactericidal: Strep. spp.; Bacteriostatic: Staphylococci spp., Enterococci spp.;
Spectrum of Activity:
- Aerobic Gram-Pos cocci (MSSA/MRSA, MSSE/MRSE, MDRSP, VRE);
Pk/Pd: 100% Absorption, NO renal dose adjustment necessary;
Place in Therapy:
- VRE infections;
- MRSA infections;
- Strep. pneumoniae (MDRSP) infections;
Drug-Drug/Food Interactions:
- reversible mild nonselective MAO-I --> interacts w/ tyramine containing foods, adrenergic & serotonergic agents;
- Serotonin agents: risk of serotonin syndrome (cognitive dysfunction, hyperpyrexia, hyperreflexia, incoordination);
Relative C/I's: SSRIs, TCAs, triptans, merperidine, buspirone;
ADRs: occur if >14 days on med
- myelosuppression (monitor CBC qWk);
- peripheral/optic neuropathy (monitor vision [Sx of blurry vision]);
- lactic acidosis (monitor closely - severe N/V) |
|
|
Term
|
Definition
MoA: bactericidal;
Spectrum of Activity:
- Aerobic Gram-Pos organisms: Enterococcus (VRE), Staph. spp. (MSSA/MRSA, MSSE/MRSE, VISA,VRSA), Beta-hemolytic Strep.;
Pk/Pd: 75% eliminated in urine- renal dose adjustment necessary;
Place in Therapy:
- reserved for infections where vanco is less effective or C/I'd;
- NOT indicated for pneumonia --> inactivated by pulmonary surfactant;
ADRs:
- myopathy (check CPK levels at baseline & every week - D/C if S/Sx & >5x ULN or if >10x ULN & NO S/Sx)
- caution use with statins & nephrotoxic agents |
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Term
| rifampin (rifampicin [Rifadin]) PO/IV |
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Definition
Mainly used to tx tuberculosis;
Lipophilic --> distributes well into tissue & fluid (urine, tears, saliva, sweat, aqueous humor);
- Discolors body fluid orange-red;
- permanent staining of clothes & contact lenses;
Metabolized by CYP3A4 oxidase;
Most drug interactions of drug class (CYP3A4 inducers) |
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Term
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Definition
| used to tx Traveler's diarrhea, hepatic encephalopathy |
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Term
| trimethoprim/sulfamethoxazole - TMP/SMX (Bactrim, Septra) IM/IV/PO |
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Definition
fixed drug combination --> synergistic --> bactericidal;
Spectrum of Activity:
- aerobic Gram-Pos organisms (Staph, Strep, Viridans Group Strep)
- Aerobic Gram-Negs (most Enterobacertiaceae, NO activity against P.aeruginosa)
- Atypical organisms (Chlamydia, Listeria)
- Others: Stenotrophomonas maltophilia, Toxoplasma gondii, Pneumocystis jiroveci pneumonia (PJP), Nocardia;
Place in Therapy:
- rising resistance limits use (2nd/3rd line)
- UTIs
- prostatitis/epididymitis
- CA-MRSA infections;
ADRs:
- Rash (SULFA allergy)
- Others (rare): hyperkalemia, jaundice, hepatic necrosis, SJS/TEN, drug-induced lupus, serum sickness, tubular necrosis/interstitial nephritis, hemolytic disorders (acute hemolytic anemia, aplastic anemia, agranulocytosis, thrombocytopenia, leukopenia);
Pregnancy: AVOID in 3rd trimester;
D-D Interactions: warfarin --> increases PT/INR |
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Term
| clindamycin (Cleocin) IV/IM/PO/Top |
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Definition
MoA: bacteriostatic;
Spectrum of Activity:
- aerobic Gram-Pos cocci (Staph. [MSSA/MRSA], Strep. pneumoniae, Grp A Strep., Viridans Grp Strep.)
- Anaerobic organisms;
Pk/Pd: Excretion (urine[10%],bile[4%],inactive metabolites) --> NO renal adjustments needed --> ADJUST doses for SEVER HEPATIC impairment;
Place in Therapy:
- Alternative agents for infections caused by aerobic Gram-Pos cocci (more effective against severe, nosocomial infections [MRSA], use w/ Beta-lactam or vanco for Toxic Shock Syndrome [Grp A Strep or Staph aureus])
- infections caused by anaerobes (Bacteroides fragilis [abcesses, intra-abdominal/genitourinary/oropharyngeal infections])
- use in PCN-allergic pts;
ADRs: diarrhea --> be aware of CDAD (C.difficile) |
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Term
| tetracyclines - tetracycline PO, doxycycline (Vibramycin) IV/PO, minocycline (Minocin) PO |
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Definition
MoA: Bacteriostatic;
Spectrum of Activity:
- widespread resistance (limited activity);
- Chlamydia trachomatis, Neisseria gonorrhea, Borrelia burgdorferi [Lyme Dx];
Place in Therapy:
- alternative for mild infections if suscpetible, more effective agents are C/I, or if pts allergic to PCNs;
- commonly used to treat STDs, acne vulgaris, atypicals;
ADRs:
- photosensitivity, epigastric distress, (take w/ full glass of H2O, avoid taking at bedtime), discoloration of teeth |
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Term
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Definition
MoA: overcomes tetracycline resistance, bacteriostatic;
Spectrum of Activity:
- aerobic Gram-Pos (VRE, MSSA/MRSA, beta-hemolytic Strep, Viridans Grp Strep)
- aerobic Gram-Neg (Enterobacteriaceae, Acinetobacter)
- POOR activity against P.aeruginosa;
Pk/PD: NO RENAL dose adjustments needed;
Place in Therapy:
- used in pts w/ allergy or C/I to alternative agents & infected w/ organism susceptible to drug;
ADRs: more significant nausea, DO NOT use in ages <18 yrs |
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Term
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Definition
Place in Therapy: rarely used today
Causes Gray Baby Syndrome |
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Term
| Macrolides - erythromycin (Erythrocin) IV/PO/Top, azithromycin (Zithromax) IV/PO, clarithromycin (Biaxin) PO |
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Definition
MoA: inhibits protein synthesis by binding to 23S subunit of ribosome, bacteriostatic;
Sectrum of Activity (A/C >> E):
- atypicals (Mycoplasma, Chlamydia)
- aerobic Gram-Pos (Strep pneumoniae, Grp A Strep, MSSA [C > A])
- limited activity against aerobic Gram-Negs (Legionella pneumophilia, Moraxella catarrhalis/H.influenzae [A > C];
Pk/Pd: A --> affected by food, take 1-2 hrs before or after meals; C --> NOT affected by food; E --> inconsistent PO absorption;
Excretion: renal adjust C;
Place in Therapy:
E: bowel decontamination, opthalmic tx, acne vulgaris;
A/C: mild to moderate infections or community acquired infcetions (respiratory infections (Strep pneumoniae, Moraxella, H.influenzae, atypicals, Mycoplasma pneumoniae, Chlamydophilia pneumoniae);
ADRs:
- GI upset (E > A/C): N/V/D, gas;
D-D Interactions: multi-valent cations, CYP3A4 substrate & inhibitors; |
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Term
| nitrofurantoin (Macrodantin, Macrobid) PO |
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Definition
MoA: Bactericidal;
Spectrum of Activity:
- good activity against organisms associated w/ UTIs: E.coli, Grp B Strep, Staph saphrophyticus, Enterococcus faecalis & faecium;
Pk/Pd: adequate conc. in kidney & urine;
Place in Therapy:
- DRUG OF CHOICE for tx & prophylaxis of uncomplicated UTIs;
C/I if CrCl <60 ml/min;
ADRs (rare): hemolytic anemia, peripheral neuropathy, hepatitis, rash; |
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Term
| metronidazole (Flagyl) IV/PO/Top |
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Definition
MoA: bactericidal;
Spectrum of Activity:
- Anaerobic Gram-Neg (Bacteroides fragilis)
- Anaerobic Gram-Pos (C.diff, C.perfringens)
- H.pylori;
Pk/Pd: NO Renal adjustment necessary;
Place in Therapy:
- DRUG OF CHOICE for Clostridium Difficile-Associated Diseases (CDAD);
ADRs:
- Nausea, diarrhea, metallic taste, dry mouth, epigastric distress, anorexia;
- C.difficile infection;
- dark urine;
- teratogenicity (avoid during 1st trimester & during breast feeding);
D-D Interactions:
- EtOH --> disulfiram-like rxn;
- warfarin --> prolongs PT (reduce warfarin dose or avoid this drug) |
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