RxPrep Infectious Diseases I - Antibiotics by Drug Class

carbapenems, cephalosporins, penicillins

What 3 antibiotic drug classes make up the beta-lactam antibiotics?

beta-lactam

antibiotic drug class that inhibits bacterial cell wall synthesis by binding to penicillin-binding proteins, preventing the final step of peptidoglycan synthesis in bacterial cell walls

atypical, MRSA

As a class, penicillins are not active against what 2 types of organisms?

enterococci, streptococci

Natural penicillins are active against what 2 types of organisms?

MSSA

Antistaphylococcal penicillins are active against what type of organism?

gram-negative anaerobes, HNPEK, MSSA

Aminopenicillins combined with a beta-lactamase inhibitor are active against what 3 types of organisms?

gram-negative anaerobes, CAPES, HNPEK, MSSA, Pseudomonas

Extended-spectrum penicillins combined with a beta-lactamase inhibitor, such as piperacillin/tazobactam, are active against what 5 types of organisms?

natural penicillins

Penicillin V potassium, and penicillin G are examples of ________.

G

Penicillin (G/V) is available as an injection.

benzathine

Penicillin G (aqueous/benzathine) is administered as an IM injection.

Bicillin L-A

What is the brand name for penicillin G benzathine?

b

Which antistaphylococcal penicillin is administered as an injection?

a) dicloxacillin

b) nafcillin

c) oxacillin

aminopenicillins

Amoxicillin and ampicillin are examples of ________.

amoxicillin

(Amoxicillin/Ampicillin) is available in a chewable dosage form.

ampicillin

(Amoxicillin/Ampicillin) is available as an injection.

Augmentin

What is the brand name for amoxicillin/clavulanate?

Unasyn

What is the brand name for ampicillin/sulbactam?

extended-spectrum penicillin

Piperacillin/tazobactam is an example of a(n) ________.

Zosyn

What is the brand name for piperacillin/tazobactam?

injection

What dosage form is piperacillin/tazobactam available in?

4 hours

Prolonged or extended piperacillin/tazobactam infusions are infused over ________.

IV

What route of administration has a boxed warning associated with it for penicillin G benzathine?

CrCl <30 mL/min, hypersensitivity

What are 2 contraindications for penicillins?

severe renal impairment

Patients with ________ should not use extended-release oral forms of amoxicillin.

875

Patients with severe renal impairment should not use the ________ mg strength of amoxicillin/clavulanate.

allergic reaction, GI upset, hemolytic anemia, rash, seizures, SJS

What are 6 side effects associated with penicillins?

Coombs

Penicillin-induced hemolytic anemia is identified with a positive ________ test.

renal function

What is a monitoring parameter for penicillins?

MSSA

Antistaphylococcal penicillins are preferred for ________ soft tissue, bone and joint, endocarditis, and bloodstream infections.

antistaphylococcal

________ penicillins don't require renal dose adjustments.

nafcillin

Which penicillin is a vesicant and is preferably administered through a central line?

cold packs, hyaluronidase injections

What are 2 treatments for nafcillin-induced extravasation?

ampicillin

Which aminopenicillin is rarely administered orally due to poor bioavailability?

normal saline

IV ampicillin must be diluted in ________ only.

probenecid

What drug can increase the levels of beta-lactams by interfering with renal excretion?

syphilis during pregnancy

Patients allergic to beta-lactams should avoid all penicillins except in what situation?

penicillin G benzathine

Patients with poor compliance or follow up who allergic to beta-lactams can be treated with ________ once desensitized.

seizures

All penicillins increase the risk of ________ if accumulation occurs.

penicillin VK

What penicillin is a first-line treatment option for pharyngitis ("strep throat") and mild nonpurulent skin infections (no abscess)?

amoxicillin (with or without clavulanate)

What penicillin is first-line for acute otitis media?

80-90

Pediatric dosing for amoxicillin for acute otitis media is ________ mg/kg/day.

amoxicillin

What penicillin is the drug of choice for infective endocarditis prophylaxis before dental procedures?

2 g PO 30-60 min before procedure

What is the amoxicillin dosing for infective endocarditis prophylaxis before dental procedures?

amoxicillin

What penicillin is used in H. pylori treatment?

amoxicillin/clavulanate

What penicillin is first-line for bacterial sinusitis?

90

The pediatric dosing for amoxicillin/clavulanate for acute otitis media is ________ mg/kg/day.

diarrhea

You should always use the lowest dose of clavulanate as possible to decrease the incidence of ________.

penicillin G benzathine

What penicillin is the drug of choice for syphilis?

2.4 million units IM x 1 dose

What is the penicillin G benzathine dosing for syphilis?

piperacillin/tazobactam

What is the only penicillin active against Pseudomonas?

extended infusions

What piperacillin/tazobactam administration can be used to maximize T>MIC?

increases

Generally, the gram-negative spectrum of cephalosporins (decreases/increases) with each generation.

atypical, Enterococcus

What 2 types of organisms are cephalosporins not active against?

gram-positive cocci; PEK

First generation cephalosporins have excellent activity against ________ and some activity against ________.

first

________ generation cephalosporins are preferred when a cephalosporin is used for an MSSA infection.

gram-negative rods

What type of organism is PEK?

cefuroxime

One group of second generation cephalosporins, such as ________, cover staphylococci, more resistant strains of Strep pneumo, plus HNPEK.

cefotetan, cefoxitin

One group of second generation cephalosporins, such as ________ and ________, have added activity against gram-negative anaerobes (B. fragilis).

cefdinir, cefotaxime, ceftriaxone

One group of third generation cephalosporins, such as ________, ________, and ________, cover resistant streptococci, staphylococci, gram-positive anaerobes, and resistant strains of HNPEK.

ceftazidime

One group of third generation cephalosporins, such as ________, lack gram-positive activity but cover Pseudomonas.

fourth

The ________ generation cephalosporin has broad gram-negative activity (HNPEK, CAPES, and Pseudomonas) and gram-positive activity similar to ceftriaxone.

fifth

The ________ generation cephalosporin has gram-negative activity similar to ceftriaxone and broad gram-positive activity.

fifth

What generation cephalosporin is the only beta-lactam that covers MRSA?

MDR gram-negative rods

Cephalosporin/beta-lactamase inhibitor combinations have a similar spectrum as ceftazidime but with added activity against ________.

a

What generation cephalosporin is cefazolin?

a) first

b) second

c) third

d) fourth

e) fifth

a

What generation cephalosporin is cephalexin?

a) first

b) second

c) third

d) fourth

e) fifth

b

What generation cephalosporin is cefuroxime?

a) first

b) second

c) third

d) fourth

e) fifth

b

What generation cephalosporin is cefotetan?

a) first

b) second

c) third

d) fourth

e) fifth

b

What generation cephalosporin is cefoxitin?

a) first

b) second

c) third

d) fourth

e) fifth

c

What generation cephalosporin is cefdinir?

a) first

b) second

c) third

d) fourth

e) fifth

c

What generation cephalosporin is ceftriaxone?

a) first

b) second

c) third

d) fourth

e) fifth

c

What generation cephalosporin is cefotaxime?

a) first

b) second

c) third

d) fourth

e) fifth

c

What generation cephalosporin is ceftazidime?

a) first

b) second

c) third

d) fourth

e) fifth

d

What generation cephalosporin is cefepime?

a) first

b) second

c) third

d) fourth

e) fifth

e

What generation cephalosporin is ceftaroline?

a) first

b) second

c) third

d) fourth

e) fifth

Teflaro

What is the brand name for ceftaroline fosamil?

250 mg-500 mg Q6-12H

What is the typical oral dosing for cephalexin?

neonate

What is a contraindication for ceftriaxone?

biliary sludging, kernicterus

What 2 things can occur if ceftriaxone is used in a neonate?

cross-reactivity with penicillin allergy

What is a warning associated with cephalosporins?

bleeding; disulfiram-like

Cefotetan contains a side chain on its structure that can increase the risk of ________ and cause a(n) ________ reaction.

allergic reaction, GI upset, hemolytic anemia, rash, seizures, SJS

What are 6 side effects associated with cephalosporins?

renal function

What is a monitoring parameter for cephalosporins?

ceftriaxone

What cephalosporin doesn't require renal dose adjustments?

cefixime

What cephalosporin is available in a chewable tablet?

CRE

Ceftazidime/avibactam has activity against some ________.

calcium

Insoluble precipitates may form when ceftriaxone is administered in the same line as ________-containing IV fluids.

cefdinir, cefpodoxime, cefuroxime

What 3 cephalosporins should be separated from short-acting antacids by at least 2 hours?

acute otitis media; pediatric

Patients with a penicillin allergy should not be treated with a cephalosporin except in mild cases to treat ________ in ________ patients.

cephalexin

What oral cephalosporin is commonly used in skin infections?

cephalexin

What oral cephalosporin is commonly used in strep throat?

cefdinir, cefuroxime

What 2 oral cephalosporins are commonly used in acute otitis media?

cefuroxime

What oral cephalosporin is commonly used in community-acquired pneumonia?

cefazolin, cefotetan, cefoxitin

What 3 parenteral cephalosporins are commonly used for surgical prophylaxis?

second

What generation cephalosporins have gram-negative anaerobic coverage?

cefotaxime, ceftaroline, ceftriaxone

What 3 parenteral cephalosporins are commonly used for community-acquired pneumonia?

cefotaxime, ceftriaxone

What 2 parenteral cephalosporins are commonly used in meningitis?

cefotaxime, ceftriaxone

What 2 parenteral cephalosporins are commonly used in spontaneous bacterial peritonitis?

cefotaxime, ceftriaxone

What 2 parenteral cephalosporins are commonly used in pyelonephritis?

0-28 days

Neonates are infants age ________.