ID 1: Antibiotics by drug class

Common bacterial pathogens seen in CNS Infections

S pneumo
N meningitis
H flu
Group B Strep
Lysteria (young/old)

Common bacterial pathogens seen in upper respiratory Infections

S pyogenes
S pneumo
H flu
M catarrhalis

Common bacterial pathogens seen in heart Infections

S aureus (including MRSA)
S epidermidis
Strep
Enterococci

Common bacterial pathogens seen in skin Infections

S aureus
S pyogenes
S epidermidis
Pasturella multacida

Common bacterial pathogens seen in bone/joint Infections

S aureus
S epidermidis
streptococci
N gonorrhoeae

Common bacterial pathogens seen in intra abdominal Infections

Enteric GNR
Enterococci/streptococci
Bacteroides

Common bacterial pathogens seen in mouth Infections

Anerobic GNR
Mouth flora

Common bacterial pathogens seen in COMMUNITY acquired lower respiratory tract infections Infections

S pneumo
H flu
Atypicalls
Enteric GNR

Common bacterial pathogens seen in HOSPITAL acquired lower respiratory tract Infections

S aureus (inc. MRSA)
P aeruginosa
A baumannii
Enteric GNR

Common bacterial pathogens seen in urinary tract infections

E. coli
Proteus
Klebsiella
S sprophyticus
Enterococci

Atypical bacteria

Chlamydia

Appears purple when gram stained

gram-positive bacteria

Appears pink when gram stained

gram-negative bacteria

Bacteria that do not gram stain well

atypicals

Gram positive cocci clusters

Staph

Gram positive cocci pairs and chains

Strep
Enterococci

Gram positive rods

Lysteria
Corynebacterium

Gram positive anaerobes

Clostridium (including C diff)
Propionibaterium
Peptostreptococcus

Gram negative cocci

Neisseria

Gram negative enteric rods

Proteus mirabilis
E. coli
Klebsiella
Serratia
Enterobacter
Citrobacter

Gram negative NON-enteric rods

P aeruginosa
H flu
Providencia

Gram negative curved or spiral shaped rods

H. pylori
Campylobacter spp.
Treponema spp.
Borrelia spp.
Leptospira spp.

Gram negative coccobacilli

Acinetobacter baumannii
Bordetella pertussis
Moraxella catarrhalis

Gram negative anaerobes

Bacteroides fragilis
Prevotella spp.

Monitoring for treatment response after starting abx

• fever trend
• WBC trend
• dec in s/sx
• improved radiological findings
• repeat cultures are negative
• decreased markers of inflammation

Common resistant pathogens

Klebsiella pneumoniae (ESBL

Folic Acid Synthesis Inhibitors

Sulfonamides
Trimethoprim
Dapsone

protein synthesis inhibitors

Aminoglycosides
Macrolides
Tetracyclines
Clindamycin
Linezolid

Cell wall inhibitors

beta lactams

cell membrane inhibitors

Polymyxin (colistimethate)
Daptomycin

DNA/RNA inhibitors

Quinolones (DNA gyrase

Most protein and folic acid synthesis inhibitors are (bactericidal/bacteriostatic)

bacteriostatic

Most cell wall inhibitors

cell membrane inhibitors

hydrophilic antibiotics

(BAD VP)
-Beta-lactams
-Aminoglycosides
-Vancomycin
-Daptomycin
-Polymyxins

lipophilic antibiotics

(Mom Quit Listening To Rap)
o Macrolides
o Quinolones
o Linezolid
o Tetracyclines
o Rifampin

hydrophilic antibiotics characteristics:

1. Vd
2. elimination
3. Intracellular concentration
4. clearance/distribution in sepsis
5. bioavailability

1. Vd: small (poor tissue penetration)
2. elimination: Renally. Drug accumulation can occur if not dose adjusted
3. Intracellular concentration: low (not active against atypicals)
4. clearance/distribution in sepsis: increased (consider loading dose and aggressive treatment)
5. bioavailability: not used PO or IV:PO ratio not 1:1

lipophilic antibiotics characteristics:

1. Vd
2. elimination
3. Intracellular concentration
4. clearance/distribution in sepsis
5. bioavailability

1. Vd: large

Drugs with concentration dependent killing (Cmax:MIC) are dosed ____ frequently and in ____ dose

less
higher

Drugs with time dependent (Time>MIC) killing are dosed ____ frequently and for a _____ duration

more
longer

Concentration-dependent killing antibiotics

aminoglycosides

Concentration-dependent killing goals and dosing strategies

Cmax:MIC
high peak and low trough
high dose

Exposure dependent antibiotics

vancomycin

Exposure dependent antibiotics goals and strategies

AUC:MIC
exposure over time
variable dosing strategies

Time dependent antibiotics

beta lactams

Time dependent antibiotics goals

Time>MIC
Maintain drug levels > MIC for most of the dosing interval

Beta lactams MOA

inhibit cell wall synthesis

Penicillins

Pen V
Nafcillin
Oxacillin
Amoxicillin/Clavulante (Augmentin)
Ampicillin/Sulbactam (Unasyn)
Pip/Tazo (Zosyn)

Penicillin NOT to be used IV

Pen G: can cause cardiac arrest and death

Extended release amoxicillin should not be used if…

CrCl<30

Penicillins AE

GI (N/V/D)
CNS - seizures (accumulation occurs when failure to dose adjust in renal dysfunction)
hypersensitivity
renal toxicity

Nafcillin administration

is a vesicant

When is PO ampicillin used?

Very rarely (poor bioavailability)

Antistaphylococcal Penicillins

Nafcillin
Oxacillin
Dicloxacillin

Antistaphylococcal Penicillins are preferred for…

MSSA soft tissue

Antistaphylococcal Penicillins renal dosing adjustment

none

Only penicillin active against pseudomonas

Piperacillin/tazobactam (Zosyn)

drug of choice for syphilis

Penicillin G

First line treatment for acute otitis media and bacterial sinusitis

amoxicillin/clavulante (Augmentin)

Penicillin which is first line treatment for strep throat and nonpurulent skin infection outpatient

Penicillin VK

Drug of choice for infective endocarditis before dental procedure

Amoxicillin

First generation cephalosporins

Cefazolin
Cephalexin
(-fa/-pha)

Second generation cephalosporins

Cefuroxime
Cefoxitin
Cefotetan
(Tan Fox Fur)

Third generation cephalosporins (group 1)

Cefdinir
Ceftriaxone
Cefotaxime
(Cefdinir/-ime/-one/-ten)

Third generation cephalosporins (group 2)

Ceftazidime

Fourth generation cephalosporins

Cefepime

Fifth generation cephalosporins

Ceftaroline

Cefotetan can have an increased risk of…

bleeding

Ceftriaxone CI

neonates (biliary sludging

Cephalosporins adverse effects

Similar to penicillins
Seizures with accumulation if not renally dose adjusted
N/V/D
hemolytic anemia

Cephalosporin which dose not need to be renally dose adjusted

ceftriaxone

only cephalosporin that covers MRSA

Ceftaroline

Cephalexin common uses

skin infections (MSSA)

cefuroxime common uses

acute otitis media

cefdinir common uses

acute otitis media

cefazolin common use

surgical prophylaxis

cefotetan and cefoxitin common uses

surgical prophylaxis (GI procedures)

Ceftriaxone and cefotaxime common uses

CAP

cephalosporins active against pseudomonas

Ceftazidime
Cefepime

cephalosporins commonly used for MDR gram-negative organisms

ceftolozane/tazobactam and ceftazidime/avibactam

caftaroline common uses

CAP

Carabpenems

ertapenem (Invanz)
meropenem
imipenem

carabapenems are most often used for

MDR gram negative infections

carbapenems AE

do not use with pen allergy
seizure

Unlike other carbapenems

ertapenem does NOT cover

carbapenems do NOT cover

atypicals

aztreonam is used for

many gram negative organisms (no gram positive coverage) when there is a beta-lactam allergy

Aminoglycosides

Gentamicin
Tobramycin
Amikacin

aminoglycosides cover

gram negatives

aminoglycosides toxicities

nephrotoxicity (use caution in elderly and with other nephrotoxic drugs like loop diuretics

aminoglycoside monitoring

Renal dose adjust

Weight to use for aminoglycoside dosing

Underweight: TBW
Normal: IBW or TBW
Obese: ABW

Penicillin coverage

S pneumo
Viridans Group Strep
Enterococcus (not VRE)
Mouth flora

Amoxicillin coverage

S. Pneumoniae
Viridans Group Strep
Enterococcus (not VRE)
PEK
HNPEK
Gram positive mouth flora

PEK

Proteus

HNPEK

Haemophilus

CAPES

Citrobacter

Oxacillin/nafcillin coverage

MSSA
S.Pneumoniae
Viridans Group Strep

amox/clav and amp/sul coverage

MSSA
S. Pneumoniae
Viridans Group Strep
Enterococcus (not VRE)
PEK
HNPEK
Gram positive mouth flora
B frag

Pip/tazo coverage

MSSA
S. Pneumoniae
Viridans Group Strep
HNPEK
CAPES
Pseudomonas
gram positive anaerobes (mouth flora)
B frag

cefazolin and cephalexin coverage

MSSA
S pneumo
Viridans Group Strep
PEK
gram positive anaerobes (mouth flora)