Antibiotic Pharmacology
Terms
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- Which ABX inhibit or disrupt cell wall production?
-
Beta-lactams
monobactams
Glycopeptides - Which drugs are considered beta-lactams?
- Penicillins, cephalosporins, and carbapenems
- What drug is a glycopeptide?
- Vancomycin
- Which drugs inhibit protein synthesis by interfering with bacterial ribosomes?
-
Macrolides
Ketolides
Clindamycin
Aminogylycosides
Tetracycline - Which drugs inhibit DNA synthesis?
-
Fluoroquinolones
Metronidazole - Which drug inhibits folic acid synthesis?
- TMP-SMX
- When are bacteriocidal agents prefered over static?
-
1) host is compromised (e.g. neutropenic)
2) host defenses do not operate well in that area (e.g. endocarditis, meningitis)
3) critical condition - Which ABX are generally considered bacteriocidal?
-
Beta lactams
glycopeptides (vanco)
Aminoglycosides
Fluoroquinolones
Metronidazole
Cyclic lipopeptides - Which ABX are generally considered bacteriostatic?
-
Sulfonamides (TMP-SMX?)
Tetracyclines
Macrolides
Ketolides
Lincosamides - 3 examples of concentration-dependent ABX.
-
Aminoglycosides
Fluoroquinolones
Cyclic lipopeptides - 3 examples of Time-Dependent ABX.
-
Beta lactams
Monobactams
Vancomycin - Which drugs will inc -cidal effects when you increase the dosage? C-D or T-D?
- Concentration Dependent
- Which drugs have post ABX effect?
-
Aminoglycosides
Fluoroquinolones
Cyclic lipopeptides (daptomycin) - Which ABX are active against Intracellular Organisms?
-
Tetracyclines
TMP-SMX
Fluoroquinolones
Macrolides/Ketolides
Clindamycin
Rifampin - Which organisms are intracellular?
-
Chlamydia pneumoniae
Legionella pneumophila
Mycobacteria (TB and others)
Rickettsia
Erlichiae - Which ABX achieve equivalent levels PO and IV?
-
Fluoroquinolones
Rifampin
TMP-SMX
Tetracyclines
Metronidazole
Linezolid - Which ABX undergo renal excretion?
-
Beta lactams (except two)
Fluoroquinolones (split)
Tetracyclines (split)
Vanco
Aminoglycosides - Which Beta lactams are not excreted by the kidney? (2)
-
Ceftriaxone
Nafcillin - Which ABX are excreted hepatically?
-
Ceftriaxone
Nafcillin
Mainly:
Clindamycin
Metronidazole
Others:
Sulfamethoxazole
Macrolides/Ketolides
Rifampin - ABX associated with ototoxicity (3)
-
Aminoglycosides
Vancomycin
Azithromycin
Minocycline - Which ABX are associated with nephrotoxicity?
-
Amphotericin B
Aminoglycosides
Nafcillin
Tetracycline
Vancomycin (historically) - Which ABX is associated with ATN (acute proximal tubular necrosis)?
- Aminoglycosides
- Which ABX causes AIN (acute interstitial nephritis)?
- Nafcillin
- Which drug is associated w/Fanconi syndrome?
- Tetracycline
- What are the main ABX associated with psychiatric symptoms?
-
*Fluoroquinolones*(esp levo)
Clarithromycin
Isoniazid
Metronidazole
TMP-SMX - Which ABX are associated with chemical phlebitis?
-
Nafcillin
Cefepime
Vancomycin
Clindamycin - Which ABX is associated w/a disulfiram like rxn?
- Metronidazole
- What should you educate a patient about if you prescribe Metronidazole?
- No ETOH for 3 days after they complete therapy
- Associated with yellow babies
- Sulfonamides
- Which drugs are sulfonamides?
-
Trimethoprim
Sulfamethoxazole
(e.g. TMP-SMX) - What are sulfonamides often used to treat?
- Urinary tract infections
- What ABX are associated with gray babies?
- Chloramphenicol
- What is red man syndrome associated with?
- Vancomycin
- How can you decrease the chance of a person developing "red neck syndrome" from vancomycin?
-
Slow infusion
give diphenhydramine to tx - What drug is associated with Red Lobster syndrome? And what IS red lobster syndrome?
- Rifampin --> red-orange discoloration or urine, tears, and sweat
- What drug causes discolored teeth?
- tetracyclines
- What drugs may cause pt to lose red/green color perception?
-
Ethambutol
Amiodarone - What ABX may cause Hyperkalemia?
- Trimethoprim (usually TMP-SMX)
- What ABX may cause hypokalemia?
-
especially:
Nafcillin
Piperacillin - Associated with causing C. dif?
-
Aminopenicillins (amox, augmentin, ampicillin, amp/sulfabactam)
Cephalosporins
Clindamycin (classic) - Main drugs associated with rash when used in Infectious Mono?
- Ampicillin
- When else might a rash occur when taking ampicillin?
-
CLL
coadministration of allopurinol - What drugs does a true penicllin allergy apply to?
-
penicillins
cephalosporins
carbapenems - Can you use aztreonam (a monobactam) if pt had anaphylactic rxn to penicillin?
- Yes - but no carbapenems
- If pt had rash from penicillin what could you use?
-
possibly cephalosporins, carbapenems, if necessary
definitely aztreonam - What Oral ABX are effective against pseudomonas?
-
Ciprofloxacin
Levofloxacin - What oral ABX is gold standard to treat Methicillin susceptible Staph aureus?
- Dicloxacillin
- What IV ABX should be used for MSSA?
- Nafcillin
- What other IV drug can be used for MSSA if gold standard (naf) isn't used?
-
Cephazolin (2nd choice)
Vanco (3rd choice) - What oral drug should be used for MRSA?
-
**Linezolid
Minocycline/doxycycline
maybe TMP-SMX (not good choice) - What oral ABX work for MSSA but are not gold standard? (dicloxacillin)
-
cephalexin (2nd choice)
Minocycline/doxycycline >TMP/SMX - What oral ABX can be used if enterococcus is resistant to vanco?
- linezolid
- What are the 2 best anti-anaerobic oral ABX?
-
Metronidazole
Augmentin (amox/clav) - What is the silver standard to tx of anaerobic infxn w/oral ABX?
- Clindamycin
- If cephalexin is less active against MSSA than dicloxacillin then shy is it used often?
- better absorbed, don't need emty stomach
- What is the problem with using minocycline and TMP-SMX for MSSA?
- They are static drugs while the first and second choice (dicloxacillin and cephalexin) are cidal
- IV drugs for pseudomonas
-
piperacillin/tazobactam
aztreonam
ceftazidime
cefepime
cipro
levo
tobra
carbapenems (mero moreso than imipenem) - Top choices (in order) for IV drug against MSSA
-
#1) nafcillin
#2) cefazolin
#3) vancomycin - What is the gold standard parenteral ABX for anaerobes? (there are three)
-
beta-lactam/beta-lactamase inhibitor
Carbapenems
Metronidazole - What are the silver and bronze standard anti-anaerobes (IV form)
-
2nd choice - clindamycin
3rd choice - cefotetan, or cefoxitin - Are penicillins excreted by kidney or liver?
- kidney
- What is the difference between penicillin G and VK? what MO(s) do they cover?
-
VK is PO
G is IV - What is the difference between penicillin G and penicillin G benzathine?
- benzathine is IM and long acting. . . also it covers treponema pallidum
- When might penicillin V be used?
- strep pharyngitis
- Which penicillin is associated with Hoignes syndrome?
- penicillin C procaine (IM)
- What drugs are considered anti-staph penicillins?
-
Nafcillin
Dicloxacillin - Which anti-staph penicillin is PO?
- dicloxacillin
- What MOs do aminopenicillins cover?
-
s. pyogenes
s. aureus
Enterococci
B. burgorferi
P. multocida
Proteus
Listeria
SOME h.flu and e.coli - In what situations might you use an anti-staph penicillin?
-
cellulitis
staph aureus meningitis
endocarditis - What MOs are added by "augmenting" aminopenicillins?
-
h.flu and m.cat (even amox resistant strains)
most anaerobes
some e.coli and klebsiella
group B strep (agalactiae) - Name two augmented aminoPCNs
-
amoxicillin/clavulanate
ampicillin/sulfabactam - What drug is a Ureidopenicillin?
- piperacillin = ureido
- what organisms do augmented extended-spectrum penicillins cover that other penicillins do not?
-
Pseudomonas
Klebsiella
Enterobacter
Serratia - is piperacillin-tazobactam (extended-spectrum penicillin) IV or PO?
- IV - only used in hospitals
- Are cephalosporins excreted by the liver or kidney?
- kidney
- Name two 1st generation cephalosporins and whether they are IV or PO
-
Cefazolin (IV)
Cephalexin (PO) - What MOs do the 1st generation cephalosporins (like cefazolin and cefalexin) cover?
-
s. pyogenes
s. aureus
e. coli
klebsiella
proteus - what might a 1st generation cephalosporin be used for?
-
strep pharyngitis
bone infection
UTI? - Name a 2nd generation cephalosporin
- Cefuroxime
- What formulations is cefuroxime available in?
-
IV
PO
suspension - What are possible indications for the use of a second generation cephalosporin?
- otitis, sinus infections, pneumonia
- What is the big difference between first and second generation cephalosporins?
-
2nd generation get pneumococcus
- but also m. cat, h.flu, and pasteurella - Name 4 3rd generation cephalosporins
-
Ceftriaxone (IV) - rocephen
Ceftazidime (IV)
Cefpodoxime (PO)
Cefotaxime (IM/IV) - What would make you use Ceftazidime instead of Ceftriaxone (IV Rocephen)?
- Ceftazidime covers resistant gram negatives like pseudomonas, enterobacter, and serratia but Ceftriaxone does not.
- Name the only 4th generation cephalosporin we discussed
- Cefepime (IV)
- What is the difference between cefepime (4th gen) and 3rd generation cephalosporin?
-
Cefepime, like 3rd generation cephalosporins cover gram negatives, like ceftazidime it covers the "nasty" gram negatives (pseudomonas, enterobacter, serratia)
but. . . it ALSO has better staph aureus and s. pneumo coverage than 3rd generation cephalosporins - What drug class is aztreonam?
- Monobactam
- What should monobactams be used for?
-
Pseudomonas
other resistant gram neg. (enterobacter, serratia) - What are 3 Carbapenems?
-
Imipenem
Meropenem
Ertapenem - What MOs do carbapenems cover?
-
MDR Gram negatives
Extended spectrum beta lactase gram negatives - How are monobactams excreted?
- renal excretion
- How are carbapenems excreted?
- renal excretion
- Which carbapenem is available only IV, not IM?
- Meropenem
- What is the difference between ertapenem and the other two carbapemens (Imi and Mero)?
- Ertapenem does not cover pseudomonas, Enterococci, or Acinetobacter
-
What ABX is a glycopeptide?
What formulations are avail? -
Vancomycin
PO, IV, suspension - What should oral or suspension vanco be used for?
- refractory c. dif
- MOs covered by vancomycin
-
MSSA
MRSA
MRCNS
strep
enterococci (in PCN allergic pts)
clostridial species (perfringens and dif)
coagulase negative staph - What gram neg organisms does vanco cover?
-
none!
only G+ aerobes and anaerobes - Is vancomycin time-dependent or concentration-dependent?
- time-dependent (measure troughs)
- do tetracyclines have a long or short half life?
- long
- What decreases the absorption of tetracyclines?
- Ca, Fe, Mg, Zn (di and trivalent cations)
- What side effects of tetracycline is seen with minocycline in particular?
-
1) vestibular
2) purple/blue hyperpigmentation of skin
3) drug-induced lupus - What are the three tetracyclines?
-
doxycycline
tetracycline
minocycline (only PO) - What organisms are covered by tetracyclines?
-
strep pneumo
m cat
h flu
chlamydia
legionella
mycoplasma
rickettsia
erlichia
borrelia burdorferi
pasteurella
most staph aureus (+MRSA) - What might you prescribe a tetracycline for?
-
works just as well as azithromycin for otitis, sinusitis
can use for walking pneumonia, dog/cat bite, tick bite - Where are the macrolides metabolized?
- liver
- Which macrolide does not have P450 interactions?
- azithromycin
- Are macrolides static or cidal?
-
static
(interferes w/ribosome) - Why wouldn't a macrolide work well for a bacteremia from pneumonia?
- high tissue levels but low serum levels
- What unpleasant characteristic is associated with clarithromycin?
- metallic taste
- Rank the 3 macrolides in order of potency
- clarithro > azithro > erythro
- Which macrolide is only available PO?
- clarithromycin (Biaxin)
- What MOs are covered by macrolides
-
s. pneumo
h. flu
m. cat
chlamydia
legionella
mycoplasma
strep pyogenes -
What drug is like a "supercharged biaxin"?
biaxin = clarithromycin - Ketolides
- An example of a ketolide.
- telithromycin
- What is covered by ketolides but not by macrolides?
-
s. pneumo (even macrolide resistant)
h flu (drug unaffected by beta lactamase)
m cat (" ")
s. pyogenes (macrolide resistant)
**all the same MOs as macrolides - Which patients should not recieve a ketolide?
-
1. Class Ia or III antiarrhythmics
2. pts w/prolonged QT - How are aminoglycosides excreted?
- kidney
- Are aminoglycosides concentration or time dependent?
- concentration
- Adverse effects of aminoglycosides?
-
ototoxicity or vestibular damage
nephrotoxicity (ATN)
Neuromuscular blockade in myasthenia gravis pts - What are the two main examples of aminoglycosides and their formulations?
-
gentamycin (IV)
tobramycin (inhaled, IV) - What organisms are covered by Aminoglycosides?
- aerobic gram negatives (proteus, e. coli, klebsiella, enterobacter, pseudomonas, serratia)
- what anaerobic organisms are covered by aminoglycosides?
- none!
- Can aminoglycosides be used for gram positives?
-
Not most - except enterococcus
but. . . . must give in combination with PCN or ampicillin or vanco - Which aminoglycoside is most effective against pseudomonas? (gram neg aerobe)
- tobramycin
- Are fluoroquinolones cidal or static?
- cidal
- What is the similarity between fluoroquinolones and tetracyclines in terms of absorption?
- multivalent cations decrease absorption
- Adverse effects of fluoroquinolones
-
1. arthropathy
- CI if <18. . . except maybe cipro for complicated UTI or anthrax
2. CNS toxocity - watch kidney fcn
3. photosensitivity
4. QT prolongation
5. hypoglycemia - Hypoglycemia is most common with which fluoroquinolone?
- gatifloxacin
- What are the clinical uses of 1st generation quinolones?
- none really
- Name a 2nd generation fluoroquinolone
- Ciprofloxacin (Cipro) - PO/IV
- What organisms are covered by 2nd generation fluroquinolones?
-
gram negatives (e. coli, klebsiella, enterobacter, pseudomonas, proteus, serratia, gonorrhea, pasteurella, m. cat, h. flu)
B. anthracis - Name 3 3rd generation fluoroquinolones
-
levofloxacin (PO/susp/IV)
gatifloxacin (PO/IV)
moxifloxacin (PO/IV) - What is the difference between 2nd and 3rd generation fluoroquinolones in terms of coverage?
-
3rd offer great coverage of respiratory pathogens including atypicals (s. pneumo, s. pyogenes, legionella, mycoplasma, chlamydia)
Also - 3rd generation have significant anaerobic activity - Which fluoroquinolone would you choose to treat CAP?
- levaquin, not cipro
- What might you use ciprofloxacin to treat?
- UTI, aspiration, perforation (diverticulosis, PUD), anthrax
- Is TMP-SMX static or cidal?
- static
- How is TMP-SMX excreted?
- kidney
-
What organisms does Bactrim cover?
Bactrim = TMP-SMX -
s. pneumo
h. flu
m. cat
p. jiroveci
pasteurella
stenotrophomonas maltophila
e. coli
klebsiella
proteus
MRSA - Which patients cannot take TMP-SMX
-
sulfa allergy (have to use just trimethoprim)
G6PD deficiency (will cause hemolytic anemia) - What might you treat with TMP-SMX?
-
NOT outpatient CAP (despite pathogens covered) b/c resistance is too high
ok for ears and sinuses
PCP
UTIs (covers gram negs) - Which drug is a Lincosamide?
- clindamycin
- What organisms are covered by clinda?
-
anaerobes (best for above the diaphragm)
s. aureus and strep pyogenes in those with PCN allergies - Are lincosamides (clindamycin) cidal or static?
- static
- What is a major adverse effect of lincosamides?
- diarrhea ( + C. dif colitis)
- What categories of pathogens does clindamycin cover?
-
G + cocci
anaerobes
NOT gram negatives! - What is the difference between linezolid against staph, enterococci, and streptococci?
-
static against staph/entero
but cidal against strep - What category of drug is linezolid?
- Oxazolidinone
- 2 side effects of linezolid?
-
reversible thrombocytopenia
reversible inhibition of MAO (watch dietary tyramine) - What is linezolid used for ?
-
MRSA
VancoResistant Enterococcus - What drug is a cyclic lipopeptide?
- daptomycin
- What is the main indication for daptomycin? (cyclic lipopeptide)
-
MRSA
vanco is still standard of care in this situation - but this is another IV option - Why must you be careful with daptomycin if pt is on a statin?
-
--> myalgias
monitor the CPK more closely - Where is metronidazole excreted?
- liver
- Is metronidazole cidal or static?
- cidal
- What MOs are covered by metronidazole?
-
anaerobes (esp below diaphragm)
some protozoa (trichomonas, giardia, entamoeba) - 2 main side effects of metronidazole?
-
disulfiram-like rxn
metallic taste if you give too much - Possible long term side effect of Nitrofurantoin?
- pulmonary fibrosis
- What does nitrofurantoin cover?
-
gram negatives
enterococcus
for UTIs! - What organisms are covered by chloramphenicol?
-
h. flu
s. pneumo
n. meningitidis
some anaerobes - Why isn't chloramphenicol used much?
- toxicities - but used as last resort in CNS infxn because it reaches therapeutic levels in CNS
- What is Fosfomycin used for?
- uncomplicated UTIs due to enterococci or e. coli
- What is Polymyxin B used for?
-
only against gram negatives
(often topical) - What is Methanamine used for?
-
uncomplicated/chronic UTIs
(no systemic effects) - What is Rifaximin used for?
- Traveler's diarrhea from noninvasive strains of e. coli
- Which diarrheal infections can Rifaximin not be used for?
- those associated w/fever or bloody stools
- What are 2 ABX associated with hemolytic anemia in pts with G6PD deficiency?
-
Sulfa (Bactrim)
Nitrofurantoin
(anti-malarials also) - What ABX are most commonly associated with immune-mediated urticaria?
- Beta lactams and sulfonamides
- What ABX is associated with nonimmune-mediated urticaria?
- Vanco (red neck syndrome)
- With what ABX do you worry most about anaphylaxis?
- Beta lactams
- What drugs are associated with Drug-induced exanthems? (a drug eruption)
- beta lactams and sulfonamides
- What ABX are associated with hypersensitivity vasculitis?
- Beta lactams and sulfonamides
- What drugs are associated with exfoliative dermatitis/erythroderma?
-
Penicillins mostly
but also sulfa - What ABX is associated with SJS (Stevens Johnson Syndrome) and TEN (toxic epidermal necrolysis)?
- Sulfonamides
- How is SJS from a sulfonamide managed?
-
stop drug
tx like burn
high dose steroids - What two ABX are associated witha fixed drug eruption? (plaques with grayish center or frank bullae)
-
tetracyclines
sulfonamides - What abx is classically associated with serum sickness
-
cefaclor (2nd gen cephalosporin)
also. . .sulfonamides of course - Which ABX have photosensitivity as a side effect?
-
fluoroquinolones
tetracyclines
sulfonamides - What ABX might be associaled with drug-induced lupus?
-
minocycline
sulfonamides
rifampin
nitrofurantoin - What ABX are associate with drug fever?
-
beta lactams
sulfonamides
nitrofurantoin
minocycline
phenytoin
carbamazepine
allopurinol
H2blockers (cimetidine) - What ABX cause yellow-brown urine?
-
Nitrofurantoin
Sulfamethoxazole - What abx causes orange/pink urine?
- rifampin
- What 2 abx cause brown-black urine?
-
Metronidazole
Nitrofurantoin - What is the P450 action of rifampin?
- inducer of 3A4 and 2C9
- What is the P450 action of macrolides?
-
Both substrates and inhibitors of 3A4
(except azithromycin) -
The elimination of which ABX is affected by glomerular filtration?
(will build up if filtration is affected) - Aminoglycosides
- What ABX (IV and oral) work against pseudomonas?
-
Piperacillin/tazobactam
aztreonam
ceftazidime (3rd)
cefipime
ciprofloxacin (IV/oral)
levofloxacin (IV/oral)
tobramycin (not gent)
meropenem
imipenem - What ABX cover strep pneumo?
-
Cefuroxime (2nd gen)
Ceftriaxone (3rd gen)
Cefepime(4th)*better than 3rd
Doxycycline
Macrolides/Ketolides
Fluoroquinolones (3rd gen - not cipro)
TMP-SMX (but not CAP)
Aminopenicillins & augmented
Betalactam/Betalactamase - What ABX cover staph? (MSSA)
-
Nafcillin*
Dicloxacillin (PO)*
Cefazolin (1st gen)
Cephalexin (PO 1st gen)*
Cefuroxime (2nd gen)
Cefepime (IV only)
Minocycline*
Doxycycline* (may get MRSA)
TMP-SMX*
Clindamycin - What ABX is the #1 cause of chemical phlebitis?
- Nafcillin
- How are aminopenicillins excreted?
- renal
- What might you treat with amoxicillin or ampicillin?
- Would cover strep throat, pneumo (if strep pneumo), lyme disease, animal bite
- What is the gold standard for treating anaerobic infxns?
-
ampicillin/sulfabactam
or
amoxicillin/clavulanate
**these also cover everything that nL AminoPCNs do plus m. cat and h.flu - Which augmented aminopenicillin is IV and which is oral?
-
Amp/sulf is IV
Amox/Clav is PO - Piperacillin/tazobactam is the gold standard treatment for which (2) infections?
-
Pseudomonas and anaerobes
*the augmented aminoPCNs are also considered gold standard for anaerobes - Anaerobic organisms include. . . .
-
b. fragilis
bacteroides
prevotella
fusobacterium
(above are all gram neg)
peptostreptococci
actinomyces
clostridium - Which cephalosporins are anti-pseudomonal?
-
ceftazidime (3rd)
cefepime (4th) - Examples of infections when anaerobes are suspected
-
Diverticulitis (b frag)
GI infections (b frag)
lung or dental infxn (prevotella)
C. dif colitis
brain, liver, lung abscesses?
gangrene?
*anaerobes are nL flora in the oral cavity, GI tract, and vagina - What is zosyn?
- piperacillin/tazobactam
- Piperacillin/tazobactam is ideal for pseudomonas and anaerobic infxns. . . what other organisms does it cover?
-
s. pyogenes
s. pneumo
enterococci
m. cat/h. flu
GN-enterics - What are the "gram negative enterics"?
-
proteus
e.coli
klebsiella
enterobacter
serratia
pseudomonas - How are the cephalosporins excreted?
-
kidney
EXCEPT CEFTRIAXONE - What is a major SE of cephalosporins?
- Associated with C. dif diarrhea
- which macrolide covers MAC (mycobacterium avium complex)?
- Azithromycin
- Name two drugs that cover a chlamydia GU infection.
- Azithromycin and Doxycycline
- Doxycycline and Azithromycin can both be used to treat CAP, which one can also be used for animal and tick bites?
- Doxycycline
- In which patients is doxycycline contraindicated?
-
<8
or pg - WHich cephalosporins can be used to treat community-acquired pneumonia? and what must they be given with?
-
Cefuroxime or Cefpodixime
(give w/macrolide or doxycycline to cover atypicals) - What infections can be treated with a first or second generation cephalosporin?
- Cystitis or skin/soft tissue infection
- What cephalosporin can be used to treat amoxicillin resistant forms of m. cat and h.flu?
- Cefuroxime
- what organisms do second generation cephalosporins cover that first do not?
-
pasturella
m cat
h flu - what kind of URI would you use an augmented aminopenicillin for?
-
amox. failure URI
(AOM, sinusitis, ABECB) - What three beta lactams can be used for CAP if you add something to cover atypicals?
-
Amox/Clav
Cefuroxime
or cefpodoxime - what are clinical indications for use of amoxicillin?
-
Tick/dog/cat bites
pharyngitis
AOM
sinusitis
endocarditis prophylaxis
strep skin infxn
ABECB
cystitis - What does clarithromycin cover that azithromycin does not?
- H. pylori
- Which beta lactam does not cover enterococci or listeria?
-
Cephalosporins
(and obviously the nonaminopenicillins) - Rank the respiratory fluoroquinolones in their efficacy against strep pneumo (greatest to least)
- Moxi > gati > levo
- Which respiratory fluoroquinolone is least effective against resistant gram negatives?
- moxifloxacin
- Which abx covers stenotrophomonas maltophila?
- TMP-SMX
- Which oral abx can be used for traveler's diarrhea?
-
quinolones (all)
TMP-SMX - What is Pediazole?
-
erythromycin-sulfasoxazole
(alternative for AOM) - What two GU infections might you use metronidazole for?
-
bacterial vaginosis
trichomonas - If you use metronidazole for an anaerobic infxn (abscess), what must be added to it?
- beta lactam or fluoroquinolone
- What oral drugs can be used to treat strep pharyngitis in patient w/beta lactam allergy?
-
Clindamycin
or macrolide - What oral drugs can be used to treat cystitis?
-
nitrofurantoin
TMP-SMX
Amoxicillin or Ampicillin
Cephalexin or Cefuroxime - which abx is used for endocarditis prophylaxis?
- amoxicillin
- what is the big difference between amox and amox/clav or amp and amp/sul?
- the augmented aminopenicillins also cover m.cat h.flu and anaerobes
- what can you treat with an augmented aminopenicillin that you can't with an aminopenicillin?
-
CAP (but must add macrolide or doxy)
(and of course amox failure URIs)