Infectious Disease I

presence of an infection

fever, elevated WBCS, site specific symptoms

gram stain is purple

gram positive bacteria present

gram stain is pink

gram negative bacteria present

common resistant pathogens

Kill Each And Every Strong Pathogen

Klebsiella pneumoniae (ESBL, CRE)

Escherichia coli (ESBL, CRE)

Acinetobacter baumannii

Enterococcus faecalis/faecium (VRE)

Staph aureus (MRSA)

Pseudomonas aeruginosa

antibiotics that can cause C.diff

clindamycin (BBW), broad spectrum PCNs and cephalosporins, quinolones, carbapenems

natural penicillins

cover streptococci and enterococci and gram positive anaerobes (Mouth flora)

ADEs; seizures, GI upset, diarrhea, SJS/TENS, allergic reactions, hemolytic anemia (if positive Coombs test)

BBW: PenG never used IV, can cause death

anti-staph penicillins (nafcillin, oxacillin, dicloxacillin)

cover streptococci and MSSA of soft tissue, bone, joint, endocarditis and bloodstream infections ( No enterococcus)

ADEs; seizures, GI upset, diarrhea, SJS/TENS, allergic reactions, hemolytic anemia (if positive Coombs test)

nafcillin is a vesicant—> if occur, use cold packs + hyaluronidase injections

No renal dose adjustment

aminopenicillins (ampicillin, amoxicillin)

cover strep, enterococci, gram positive anaerobes, G- :HNPE

ADEs; seizures, GI upset, diarrhea, SJS/TENS, allergic reactions, hemolytic anemia (if positive Coombs test)

IV ampicillin +/- sulbactam must be diluted in NS

Ampicillin: active against Listeria (Poor PO, prefer IV)

aminopenicillins with beta lactamase inhibitors

cover strep, enterococci, gram positive anaerobes, HNPEK, MSSA, and gram negative anaerobes (B. fragilis)

ADEs; seizures, GI upset, diarrhea, SJS/TENS, allergic reactions, hemolytic anemia (if positive Coombs test)

HNPEK

Haemophilus, Neisseria, Proteus, E. coli, Klebsiella

CAPES organisms

Citrobacter, Acinetobacter, Providencia, Enterobacter, Serratia

piperacillin

covers cover strep, enterococci, PsA, gram positive anaerobes, HNPEK, MSSA, and gram negative anaerobes (B. fragilis)

extended infusions are done over 4 hours

ADEs; seizures, GI upset, diarrhea, SJS/TENS, allergic reactions, hemolytic anemia (if positive Coombs test)

first generation cephalosporins (cefazolin, cephalexin)

covers strep, MSSA, PEK,

second generation cephalosporins (cefuroxime, cefoxitin, cefotetan)

covers strep, MSSA, HPNEK

cefoxitin and cefotetan aslo cover b. fragilis

third gen group 1 cephalosporins (ceftriaxone, cefotaxime, cefdinir)

covers resistant strep, MSSA, HPNEK, gram positive anaerobes

third gen group 2 cephalosporins (ceftazidime

covers pseudo, but no gram positives

fourth gen cephalosporins (cefepime)

covers resistant , pseudo, strep, MSSA, HPNEK, CAPES, gram positive anaerobes

fifth gen cephalosporins (ceftaroline)

covers MRSA, MSSA, strep, PEK, HPNEK, gram positive mouth flora

cefazolin

commonly used for surgical prophylaxis

warnings: cross-reactivity wtih PCN allergy

ADEs: seizures (with accumulation), GI upset, diarrhea, rash/anaphylaxis, hemolytic anemia (if positive Coombs test), SJS/TENS

monitoring: renal function

cephalexin

250-500 mg PO Q6-12H

commonly used for outpatient strep throat or skin infections (MSSA)

warnings: cross-reactivity wtih PCN allergy

ADEs: seizures (with accumulation), GI upset, diarrhea, rash/anaphylaxis, hemolytic anemia (if positive Coombs test), SJS/TENS

monitoring: renal function

Cefuroxime

common uses: AOM, CAP

warnings: cross-reactivity wtih PCN allergy

ADEs: seizures (with accumulation), GI upset, diarrhea, rash/anaphylaxis, hemolytic anemia (if positive Coombs test), SJS/TENS

monitoring: renal function

Cefotetan

common use: GI surgical prophylaxis, B fragilis coverage

contains a side chain that can increase risk of bleeding and cause disulfiram reaction with alcohol

warnings: cross-reactivity wtih PCN allergy

ADEs: seizures (with accumulation), GI upset, diarrhea, rash/anaphylaxis, hemolytic anemia (if positive Coombs test), SJS/TENS

monitoring: renal function

cefoxitin

common use: B. fragilis coverage

warnings: cross-reactivity wtih PCN allergy

ADEs: seizures (with accumulation), GI upset, diarrhea, rash/anaphylaxis, hemolytic anemia (if positive Coombs test), SJS/TENS

monitoring: renal function

cefdinir

common use: AOM

warnings: cross-reactivity wtih PCN allergy

ADEs: seizures (with accumulation), GI upset, diarrhea, rash/anaphylaxis, hemolytic anemia (if positive Coombs test), SJS/TENS

monitoring: renal function

ceftriaxone

common use: CAP, meningitis, SBP, pyelonephritis

Contraindications: neonates, use with calcium containing IV products

warnings: cross-reactivity wtih PCN allergy

ADEs: seizures (with accumulation), GI upset, diarrhea, rash/anaphylaxis, hemolytic anemia (if positive Coombs test), SJS/TENS

NO RENAL ADJUSTMENTS

cefotaxime

common use: CAP, meningitis, SBP, pyelonephritis

warnings: cross-reactivity wtih PCN allergy

ADEs: seizures (with accumulation), GI upset, diarrhea, rash/anaphylaxis, hemolytic anemia (if positive Coombs test), SJS/TENS

monitoring: renal function

ceftazidime

common use: PsA coverage

available in combination with avibactam --> increases coverage CRE

warnings: cross-reactivity wtih PCN allergy

ADEs: seizures (with accumulation), GI upset, diarrhea, rash/anaphylaxis, hemolytic anemia (if positive Coombs test), SJS/TENS

monitoring: renal function

cefepime

common use: PsA coverage

warnings: cross-reactivity wtih PCN allergy

ADEs: seizures (with accumulation), GI upset, diarrhea, rash/anaphylaxis, hemolytic anemia (if positive Coombs test), SJS/TENS

monitoring: renal function

ceftaroline

Teflaro

common uses: CAP, SSTIs

warnings: cross-reactivity wtih PCN allergy

ADEs: seizures (with accumulation), GI upset, diarrhea, rash/anaphylaxis, hemolytic anemia (if positive Coombs test), SJS/TENS

monitoring: renal function

meropenem

covers MSSA, S. pnuemo, Viridians strep, Enterococcus, PEK HPNEK, CAPES, PsA, gram positive and negative anaerobes

DOES NOT COVER: MRSA, VRE, atypicals, c. diff, or steno

do not use with PCN allergy

ADEs: CNS adverse effects, seizures, diarrhea, SJS/TENS

monitor: renal function

ertapenem

covers MSSA, S. pnuemo, Viridians strep, HPNEK, C-PES, gram positive and negative anaerobes

DOES NOT COVER: MRSA, PsA, Enterococcus, Acinetobacter VRE, atypicals, c. diff, or steno

do not use with PCN allergy

ADEs: CNS adverse effects, seizures, diarrhea, SJS/TENS

monitor: renal function

stable in NS only

aztreonam

covers PEK, HNPEK, CAPES, PsA

can be used with PCN allergy

aminoglycosides

covers gram negatives, PsA

gentamicin is used for synergy in combo with a PCN or vanco

use TBW for dosing unless underweight (use IBW) or obese (use AdjBW)

trad dosing: 1-2.5 mg/kg q8h (crcl >60)

extended interval dosing: 4-7 mg/kg

warnings: nephrotox, ototox, neuromuscular blockade

goal trough:

<2 for tobramycin or gentamicin in GN infections

fluroquinolones

MOA: inhibit bacterial DNA topoisomerase II and IV

warnings: tendon rupture, peripheral neuropathy, seizures, qtc prolongation, hypo/hyperglycemia, psychiatric disturbances, photosensitivity

avoid in children

space from antacids / polyvalent cations

ciprofloxacin

covers PsA, HPNEK, atypicals

do not put oral cipro in feeding tubes

levofloxacin

covers S. pneumo (in pneumonia) PsA, HPNEK, atypicals

moxifloxacin

covers S. pneumo (in pneumonia) PsA, HPNEK, atypicals, anaerobic activity

cannot be used to treat UTI infections

no renal adjustments

macrolides

binds to the 50s robosomal subunit

covers atypicals

warnings: qtc prolongation, hepatotoxicity

azithromycin

Zithromax, Z-Pak

Z pack: 500 mg on day 1, 250 mg days 2-5

Tri-Pak: 500 mg for 3 days

do not use with simvastatin or lovastatin (GPACMAN)

clarithromycin

do not use with simvastatin or lovastatin (GPACMAN)

erythromycin

E.E.S., Ery-Tab, Erythrocin

tetracyclines

reversibly bind to the 30s ribosomal subunit

cover gram positive, gram negative, and atypicals

warnings in children under 8 (teeth)

photosensitivity

space from antacids and polyvalent cations

doxycycline

vibramycin

commonly used for CAP, tickborne diseases, rickettsial, chlamydia

IV:PO 1:1

sit upright for 30 minutes after taking

no renal dosing

minocycline

minocin

can cause DILE

IV:PO 1:1

sulfamethoxazole/trimethoprim

Bactrim

SS: 400 mg SMX/80 mg TMP

DS: 800 mg SMX/160 mg TMP

SMX:TMP 5:1

contraindications: sulfa allergy

warnings: SJS/TENS, G6PD deficiency

vancomycin

Vancocin

covers gram positive, c.diff

MOA: inhibits bacterial cell wall

warnings: ototoxicity, nephrotoxicity, vanco infusion reaction

IV: 15-20 mg/kg q8-12h, do q24h if crcl 20-49 mL/min

PO: 125 mg QID x 10 days

draw trough 30 min before 4 or 5th dose

for MRSA infections: AUC/MIC 400-600 and trough 15-20

goal trough for other infections: 10-15

daptomycin

cubicin

covers: gram positive bacteria, MRA, VRE

warning: myopathy, rhabdomyolysis, can falsey increase PT/INR

ADEs: increased CPK

compatible with NS

linezolid

Zyvox

MOA: binds to the 50S subunit of the bacterial ribosome, inhibiting protein synthesis and translation

covers: gram positive, MRSA, and VRE

CI: use within 2 weeks of MAOIs

warnings: myelosuppression, serotonin syndrome, hypoglycemia

ADEs: thrombocytopenia

IV:PO 1:1

Quinupristin/Dalfopristin

Synercid

MOA: binds to 50S subunit

covers: gram positice, MRSA, VRE (but not E. faecalis)

Tigecycline

Tygacil

broad spectrum, but no P-bugs

polymixins

warnings: nephrotoxicity, neurotoxicity

Chloramphenicol

warnings: gray syndrome

rarely used

Clindamycin

Cleocin

covers: gram positice, CA MRSA, anaerobes

warnings; c. diff

metronidazole

Flagyl

CI: pregnangy, alcohol use up to 3 days after use

ADEs: metallic taste

IV:PO 1:1

fidaxomicin

dificid

used for c. diff only

fosfomycin

use for uncomplicated UTI only

single dose

nitrofurantoin

Macrodantin, Macrobid

CI: renal impairment

warninngs: G6PDP deficiency

ADEs: broen urine, GI upset

take with food