Infectious Disease

Gram stain color: Gram pos vs neg

Gram pos cocci in

• pairs/chains →

• clusters →

Coagulase pos staph →

Lactose neg gram neg rod →

Gram stain color: Gram pos (violet) vs neg (red)

Gram pos cocci in

• pairs/chains → strept, enteroc

• clusters → staph

Coagulase pos staph → Staph aureus

Lactose neg gram neg rod → maybe pseudomonas

Streptococcus (class)

4 species

GAS

GBS → if positive during pregnancy

Streptococcus (gram + cocci)

• Strept pyogenes (GAS)

• Strept agalactiae (GBS) → if GBS+ and pregnant, must give PCN/ampicillin prior to delivery to prevent neonatal sepsis

• Strept pneumoniae → #1 cause of many infections above diaphragm (otitis media, sinusitis, pneumonia, menigitis)

• Strept viridans

Bactroban

Generic

Indication (2)

Mupirocin

Indication

• Impetigo treatment caused by Staph aureus

• MRSA colonization eradication

MRSA Abx

PO outpatient

• 1st line:

• if sulfa allergy →

• If not → (3)

IV

• DOC

• Other

-

Zyvox

Sivextro

PO:

1st line: Bactrim

if sulfa allergy, skip bactrim → doxycycline

If not, clindamycin, linezolid (zyvox), tedizolid (sivextro) → all 3 comes in IV formulation

-

IV only

DOC → vanco

Other → Dapto, Ceftaroline (5th gen), -vancin

Staphylococcus species (3)

Gram + cocci

Staph aureus

Staph epidermidis

Staph saprophyticus

Enterococcus species

Species

Traditional Tx

Newer Tx

If amp allergy/resistance

VRE Tx (1st, 2nd, 3rd line)

Enterococcus species

Species → E faecalis, E faecium

Traditional Tx → Amp + Gent

Newer Tx → Amp + Cef

If amp allergy/resistance → Vanco + Gent

VRE Tx (usually E faecium) →

• 1st, 2nd, 3rd line: Dapto, Linezolid, Tigecycline

Aerobic gram + rods (bacilli)

3 organisms → 3 conditions

Corynbacterium Diphtheriae

Organism

Abx

Vaccine

Aerobic gram pos rod

Releases toxins that need Abx → PCN or erythromycin

Vaccine → Td or Tdap

Listeria monocytogenes

Issue in prego

Tx

Aerobic gram pos rods

Issue in prego → sepsis in pregnant women → neonatal meningitis

Tx → amp + gent

Aerobic gram neg …cocci species

2 species → conditions

Neisseria

• N. meningitidis → meningitis

• N. gonorrhoeae → gonorrhea

Moraxella catarrhalis → otitis media, sinusitis

Both species DIPLOcocci

Neisseria gonorrhoeae

Standard Tx...(if >/ 150 kg…)

If chlamydia isnt excluded…

Neonatal Meningitis

Organisms (3)

Empiric Tx

Organisms

• Listeria

• GBS

• E coli

Empiric Tx

• Amp + Gent (± Cefotaxime)

Bacterial otitis media

3 most common organisms

DOC and dosing

DOC → Amoxicillin 90 mg/kg/day

Gram neg rods species

Most common cause of UTI

Resp gram neg rod

Factor of PUD

Infectious trigger of Guillain-Barré syndrome

#1 cause of cystic fibrosis

Anaerobe

Enteric (GI, UTI)

• E coli → 90% of UTI

• Klebsiella

• Shigella and Salmonella

-

Haemophilus influenza → resp

H. pylori → factor of PUD

Campylobacter → infectious trigger of Guillain-Barré syndrome

-

Pseudomonas → #1 cause cystic fibrosis

Bacteroides fragilis → anaerobic

Anti-pseudomonas Abx

Beta lactams

Other

Zosyn

Ceftazidime (3rd gen), Cefepime (4th), Cefiderocol (5th)

Ceftazidime-avibactam (3), Ceftolozane-tazobactam (5th)

-

Carbapenems

FQ: cipro, levo → good option when switch from IV Zosyn to outpatient Abx

Aminoglycoside (adjunct)

Aztreonam

H pylori Tx

Bismuth quadruple therapy

Triple therapy

Concomitant therapy

Bismuth quadruple therapy → Bismuth + metronidazole + tetracycline + PPI

Triple therapy → clarithromycin + amp + PPI (only if resistance levels of macrolides <15%)

• PCN allergy → switch amp for metronidazole

Concomitant therapy → triple therapy + metronidazole

Prevpac (→ generic)

H pylori therapy

Clarithromycin + ampicillin + lansoprazole

Pylera (→ generic)

H pylori therapy

Metronidazole + bismuth + tetracycline (still need separate PPI)

Meningitis

Top 3 causing species

Signs/symptoms

Empiric Tx

Organisms

PHN → first two species same as PHM for otitis media

• Pneumococcus

• Haemopillus influenza

• Neisseria

Signs/symptoms

• Kernig = Knee Kicks out

• Brudzinski = Bring knees in

Empiric tx

• Ceftriaxone + Vanco

• Add Ampicillin if >50 yo for listeria covg

Legionella DOC…

Children

Adults

Children → Azithro

Adults → resp quinolones (levo, moxi)

Bordetella pertussis

Species category →

Condition →

Abx →

Vaccine →

Species category → gram neg coccibacilli

Condition → whooping cough

Abx → macrolides (only reduce transmission, doesnt shorten duration)

Vaccine → Tdap

Gram pos anaerobe (4)

• Species → Condition

Gram neg anaerobe (1)

C diff Treatment

Type of organism

Initial episode

Fulminant CDI

Gram pos anaerobic rod

Initial episode

• PO Vanco 125 mg QID for 10 days OR

• Fidaxomicin (Dificid) 200 mg BID for 10 days

Fulminant CDI: defined by shock, illeus or toxic megacolon

• PO Vanco 500 mg QID + IV metronidazole 500 mg TID

Zinplava

MOA, indication

Make sure to screen for…before use

Bezlotoxumab

Monoclonal Ab to prevent recurrent of C diff (not treat active infection)

Make sure to screen for HF before use

C. tetani

Symptoms/condition

Neutralize toxin

Vaccine for prevention

Abx

Prevent spasm

Gram pos anaerobic rod

Symptoms/condition → lockjaw, tetanus

Neutralize toxin → tetanus immune globulin

Vaccine for prevention → Td or Tdap

Abx → Metronidazole, alt PCN G IV

Prevent spasm → BZD

B fragilis

Always want to think about it if…

DOC

…also covers

Gram neg anaerobe rod

Always want to think about it if anaerobic infection below diaphram (ie intraabdominal, plevic infection)

DOC → metronidazole

Cefoxitin, Cefotetan also covers

Genital Chlamydia

Tx

• DOC

• 2 Alt

  • Preferred in pregnancy →

EPT

TOC

Most common STI

Tx

• DOC: Doxy 100 BID, 7 days

• Alt

  • Levo 500 mg QD, 7 days

  • Preferred in pregnancy: Azithro 1 g once

Expedited Partner Tx (EPT): abstain for a week

TOC (test of cure, to see full eradication of the disease) not necessary unless pregnant/symptomatic

Retest in 3 months

Trichomonas

Presentation →

Tx →

Presentation → yellow-green odorous discharge

Tx → metronidazole, tinidazole, secnidazole

Mycopaslama pneumoniae

No cell wall →

Type of pneumonia →

Tx →

No cell wall → cannot be classified on gram stain, cant use PCN/ceph that work on cell well

Type of pneumonia → atypical pneumonia (mostly asymptomatic)

Tx →

• DOC: macrolide, doxy

• Alt: resp quinolone (levo, moxi)

Syphilis

Organism

A…bacteria

Test (2)

Primary, secondary, latent (early/late), tertiary

Tx

• Early latent (primary, secondary, early latent)

• Late latent

• Neurosyphilis

• PCN allergy

Treponema pallidum

Bicillin LA for early, late and tertiary → PCN G for neurosyphilis

PNC allergy → doxy for 14-28 days

syphilis (painless) vs herpes (painful)

Borrelia burgdorferi: Lyme disease

Kind of bacteria, where →

Prevention →

Tx based on age →

Kind of bacteria, where → spirochete bacteria carried by deer ticks found in wooded, overgrown grassy areas

Prevention →

• Light colored long sleeves

• Insect repellent: DEET on skin, permethrin on clothes

• Remove tick with tweezers

• PPX: single dose of doxy

Tx based on age →

• At least 8 yo: doxy for 14 days

• Under 8 yo: amox or cefuroxime (Ceftin), 14 days

Treatment for the following (organism)

Vaginal thrush → (dose)

Oral thrush → (3 with frequency)

Esophageal/severe thrush → (dose, duration)

Systemic candidemia →

Treatment for the following (Candida albicans, yeast)

• Vaginal Thrush → systemic oral Fluconazole (Diflucan) 150 mg PO x 1 dose.

• Oral Thrush (Mild) → Localized treatment

  • Nystatin suspension QID

  • Clotrimazole 5 times/day

  • Fluconazole QD

• Esophageal/Severe Thrush → systemic oral Fluconazole 200 mg on 1st day → 100 mg x at least 2 weeks

• Systemic Candidemia → Preferred first-line is an IV Echinocandin (e.g., micafungin); step-down to fluconazole later

Vusion

Generic

Treats…

0.25% miconazole + zinc oxide + petrolatum

Treats diaper rash

Cryptococcus neoformans

…yeast found…

Causes infection like…in…

Meningitis Tx

Crypto → encapsulated yeast found in bird droppings and decaying wood

Causes infections like pneumonia and meningitis in immunocompromised patients (ie Meningitis in AIDS)

Meningitis tx: Ampho B + Flucytosine → Fluconazole

Aspergillus fumigatus

Kind of organism

DOC →

Alt →

Salvage / Combo Only →

Kind of organism → mold

DOC → Voriconazole (Vfend) or Isavuconazonium (Cresemba).

Alt → Liposomal Amphotericin B (AmBisome) or Posaconazole (Noxafil).

Salvage / Combo Only → Echinocandins

Dimorphic yeast

Infections caused by all →

• → pneumonia by coccidioides

Mild infection

• Coccidioidomycosis:

• Histoplasma capsulatum, Blastomyces dermatitis →

Severe infection

• DOC

Infections → pneumonia, meningitis

• Valley fever: pneumonia by coccidioides

Tx →

Mild infection

• Coccidioidomycosis: fluconazole PO

• Histoplasma capsulatum, Blastomyces dermatitis → itraconazole PO

Severe infection

• Amph B IV

→ Candida, Crypto

→ Aspergillus

→ Histo/Blasto, Cocci

Fungi

Yeast → Candida, Crypto

Mold → Aspergillus

Dimorphics → Histo/Blasto, Cocci

Tenia capitis → Tx

Tenia Versicolor

Tenia Corporis

Tinea Cruris

Tinea Pedis

Onychomycosis → Tx

-

Tx

Lamisil

Sporanox

Penlac

Jublia

Onychomycosis

• Itraconazole (Sporanox) x 12 weeks (regardless of toe/fingernails)

• Terbinafine:

  • toenails → 12 weeks

  • fingernails → 6 weeks

Seasonal Influenza virus

Types →

High risk patients →

Best if started…

Tx

Types A and B

High risk patients: <2 yo, >65 yo, pregnant or 2 weeks postpartum, comormidities

Best if started in 48 hrs

Neuraminidase inhibitors

• Oseltamivir (Tamiflu) PO

• Zanamivir (Relenza) Diskhaler, avoid in asthmatics

• Peramivir (Rapivab) IV

Polymerase acidic endonuclease inhibitor

• Baloxavir (Xofluza)

Tamiflu

Generic, class

Formulation, regards to food

Frequency and duration of therapy for

• Influenza Tx →

• Influenza PPx →

Oseltamivir, neuraminidase inhibitors

PO taken with food → avoid GI upset

Frequency and duration of therapy for

• Influenza Tx → BID x 5 days

• Influenza PPx → QD x 5 days

Relenza

Generic, class

Formulation

Zanamivir, neuroaminidase inhibitors

Diskhaler, avoid in asthmatics

Rapivab

Generic, class

Formulation

Peramivir, neuroaminidase inhibitor

IV

Dose adjust in renal impairment

Xofluza

Generic, class

For what indication in age…

Avoid…

Baloxavir, polymerase acidic endonuclease inhibitor

Single dose

For treatment and post-exposure prophylaxis to influenza in age at least 5 yo

Avoid calcium

Hep B and C → ….transmission, can lead to…

• Causes for both

Hep A → …transmission, long term

Hep B and C → blood transmission, can lead to cirrhosis or liver cancer

• Hep B: pregnant mom → baby (vertical), sexual

• Hep C: IV drug user

Hep A → fecal-oral transmission, not long term

Presentation

• Herpes type 1 vs type 2 → usually presents as…

• Varicella () vs Zoster ()

Tx

• For the above conditions

• Epstein-Barr virus

• Cytomegalovirus

Tx

• Epstein-Barr virus → no viral tx

• Cytomegalovirus → ganciclovir, valganciclovir, cidofovir, foscarnet

  • usually in immunocompromise (HIV patients with CD4 <50)

Post Herpetic Neuralgia

Complication that…

Tx

Complication that is left when Zoster is gone but the nerve pain remains

Tx

• Gabapentin (Neurontin), Pregabalin (Lyrica)

• TCA (Nortriptyline)

• Lidocaine 5% patch, Capsaicin

• Prednisone

Infective Endocarditis (IE)

Organisms (3)

Empiric treatment (always cover…)

• Native valves IE:

• Prosthetic valves IE:

Organisms (3)

• Staph (MSSA, MRSA) → common health-care acquired

• Strep → common community aquired

• Enterococcus

Empiric treatment (always cover MRSA)

• Native valves IE: Vanco + Ceftriaxone

• Prosthetic valves IE: Vanco + Zosyn or Cefepime

Infective Endocarditis Dental Prophylaxis

Done in cardiac patients with structural heart disease EXCEPT…

DOC

If PNC allergy (3)

…not recommended

PPX done in cardiac patients with structural heart disease, valve issue, or congenital heart defects EXCEPT…mitral valve prolapse, regurgitation or rheumatic heart disease

-

DOC amoxicillin 2 g PO

If PNC allergy

• Cephalexin 2 g PO

• Azithromycin or Clarithromycin 500 mg PO

• Doxycycline 100 mg PO

Clinda not recommended

Cellulitis

Organism

Tx

Organism → Strept, MSSA

Tx → cephalexin, dicloxacillin

Abscess

Organism

Tx

Organism → MRSA

Tx → Bactrim, Doxy, Clinda plus drainage

Diabetic foot infection

Organism

Tx

Organism → polymicrobial

Tx → broad coverage like zoyn or meropenem

Animal/Human Bites

DOC

Alt

Shot

DOC: Augmentin

Alt: Doxy

Tetanus (Td/Tdap) shot

Intra-abdominal infection

Organisms post-surgical (4)

Organisms post-surgical (4)

• Enterococcus gram + rod

• E. coli gram - rod

• pseudomonas gram - rod

• B fragilis gram - anaerobe → can use cefoxitin and cefotetan (2nd gen)

Acute gastroenteritis

Viral → …(in adults), …(in children)

Bacteria → organism → 1 Abx

Giardia → often when… → 1 Abx

Viral → norovirus (in adults), rotavirus (in children)

Bacteria → shigella, salmonella, campylobacter (bloody diarrhea) → quinolones

Giardia → often when camping/traveling → metronidazole

Diverticulosis vs Diverticulitis

Presentation

Abx cover…

Tx: Abx to cover…(2)

• Abx choices (3)

Presentation: lower left quadrant pain

Osteomyelitis

…IV Abx via…at least for…

UTI

Acute cystitis vs Pyelonephritis

Simple vs complicated UTI

UA

Organisms (acronym)

Tx and Duration for

• Acute cystitis

• Acute cystitis AND Pyelonephritis

Pregnancy Tx

• Avoid…

• Acute cystitis

• Pyelo

Acute cytitis (only bladder) vs Pyelonephritis (kidney involvement)

Simple UTI (infection confided to the bladder in afebrile men/women) vs Complicated UTI (everything else)

UA: pos for WBC, nitrites

Organisms (PEKEPS): Proteus, E coli, Klebsiella, Enterococcus, Pseudomonas, Staph saprophyticus

Tx

Acute cystitis

• Nitrofurantoin (Macrobid): 1st line, avoid in CrCl <30 (elderly)

• Fosfomycin: usually used for MDR bacteria

Acute cystitis AND pyelonephritis

• Bactrim (avoid if CrCl <15)

• Urinary quinolones (cipro and levo)

• Alternatives: beta-lactams

Pregnancy

• Avoid nitrofurantoin, bactrim, urinary quinolones

• Acute cystitis: b-lactam, fosfomycin

• Pyelo: IV ceftriaxone, cefepime, aztreonam

CAP Tx

Organisms

• Typical

• Atypical

Outpatient

• No comorbidities → if viral test comes back pos…

  • 2 Tx

  • Alt (if resistance <25%)

• Comorbidities

  • 2 Tx

Inpatient

• Non-severe:

  • 2 Tx

• Severe:

  • Same as non-severe except add …

  • Add…if

Shorter duration for….

…systemic steroids

Pediatric CAP → organism → tx

• Outpatient: (1)

• Inpatient: (2)

• Add…if…

Organisms

• Typical: S. pneumoniae, Haemophilus, Moraxella

• Atypical: Mycoplasma, Legionella, Chlamydia pneumoniae

Outpatient

• No comorbidities → if viral test comes back pos, dont give Abx

  • High dose amox OR doxy

  • Alt: macrolide (if resistance <25%)

• Comorbidities

  • Augmentin + (macrolide or doxy)

  • Resp FQ (levo, moxi)

Inpatient

• Non-severe:

  • beta-lactam + macrolide

  • Resp FQ

• Severe:

  • Same as non-severe except add beta-lactam to resp FQ

  • Add pseudomonas/MRSA coverage if recent hospital and IV Abx in last 90 days

Shorter duration for non-severe stable CAP (<5 days, minimum 3)

Don’t use systemic steroids unless severe

Pediatric CAP → pneumococcus → tx

• Outpatient: high dose amox

• Inpatient: IV ampicillin or ceftriaxone

• Add macrolide if mycoplasma

HAP and VAP

No risk of MDR → …agent

• Tx

Risk of MDR → …agent

• Tx

Risk factors of MDR → (4)

No risk of MDR → 1 anti-pseudomonal agent

• Zosyn, cefepime, Levofloxacin

Risk of MDR → 2 anti-pseudomonal agent + 1 anti-MRSA

• Zosyn, cefepime, or Levofloxacin +

• Aminoglycoside (amikacin, genta, tobra)

• Anti-MRSA: vanco, linezolid, telavancin

Risk factors of MDR → IV Abx in the last 90 days, sepsis, ARDS, dialysis

Scabies

DOC → Tx, safe for…

Systemic alternative → Tx but not recommended for…

Infant exception → Tx for age

Decontamination rule

-

Elimite

Stromectol

DOC → Permethrin 5% (Elimite), safe for pregnancy

Systemic alternative → Oral ivermectin (Stromectol) but not recommended for children <15 kg

Infant exception → Topical sulfur for infants <2 months

Decontamination rule → wash all clothes, bedding and treat anyone in close contact

Pinworm

Organism

Classic presentation

Diagnosed using the

OTC

Rx

Public health rule

-

Emverm

Albenza

• Organism: Enterobius vermicularis, intestinal nematode

• Classic presentation: nocturnal anal itching

• Diagnosed using the scotch tape test

• OTC Option → Pyrantel pamoate

• Rx Options → Mebendazole (Emverm) 100 mg and albendazole (Albenza) 400 mg are prescribed as a single dose and can be repeated if needed

• Public Health Rule: You must treat the entire household simultaneously to prevent reinfection

Cystitic fibrosis common pathogens (2)

pseudomonas, haemophilus

Tdap covers what bacteria (3)

C. tetani (gram + anaerobic rod) → tetanus/lockjaw

Corynebacterium diphtheriae (gram + rod) → diphtheria

B pertussis (gram - coccobacillus) → whooping cough

Penicillin

Inhibits…

Cannot be used in…

DOC for …

… excretion → dose adjust except for …

…in pregnancy

Inhibits cell wall synthesis (PCN, ceph, carbapenem, aztreonam, vanco, -vancin)

Cannot be used in mycoplasma pneumonia

DOC for syphilis (used in all 3 categories)

Renal excretion → dose adjust except for nafcillin

Okay in pregnancy

Probenecid

Used to… (2)

Used to …

• Prolong penicillin serum level

• Protect the kidneys while using Cidofovir

Bicillin LA → generic, formulation

Bicillin CR → generic

Do NOT

Bicillin LA → Benzathine Penicillin, IM

Bicillin CR → Benzathine Penicillin + Procaine penicillin

Do NOT substitute CR for LA in syphilis

Penicillin V

Formulation, frequency

Regards to food

PO QID

on empty stomach

Penicillinase resistant penicillins

Which one needs no dose adjustment in renal

PO empty stomach →

IV →

CONDM

Cloxacillin

Oxacillin

Nafcillin → no dose adjustment in renal

Dicloxacillin

Methicillin

PO on empty stomach → DC

IV → MON

PO Penicillins

Regards to food → all…except for…

• (2)

Regards to food → all on empty stomach except for…

• Amoxicillin (without regards to food)

• Augmentin (with food)

Moxatag

Generic, Dosing, Frequency
Indication

ER Amoxicillin 775 mg tab QD

Strept throat

Zosyn → added coverage

Unasyn → diluent

Augmentin → storage

Generic, formulation

IV

• Zosyn (Piperacillin / tazobactam) → anti-pseudomonal

• Unasyn (Ampicillin / sulbactam) → NS (just like Ampicillin, Ertapenem)

PO

• Augmentin (Amoxicillin / clavulanate) → refrigerate

Augmentin ES → med ratio, frequency

Augmentin XR → med ratio, frequency

• CI in …

Regards to food

Storage

Cannot substitute…

Augmentin ES → 600 mg BID

Augmentin XR → (1000 mg amox + 62.5 mg clav) BID

• CI in CrCl <30 mL/min

Both with food

Refrigerate

Cannot substitute ES for XR to create higher dose because clav accumulation → can cause severe diarrhea

HENPEKS acronym

…gen ceph

Covers…

-

Keflex

Ancef

Duricef

Generic, Formulation

First gen ceph

Covers mostly gram pos + PEK

-

Keflex → Cephalexin PO

Ancef → Cefazolin IV

Duricef → Cefadroxil PO soln

…gen ceph

Covers…

-
Ceftin → generic

(Cefoxitin)

(Cefotetan) → note

Formulation → all come…and…

2nd gen ceph

Covers more gram - (HENPEKS)

-

Ceftin → Cefuroxime

Cefoxitin

Cefotetan

• NMTT side chain → increase bleeding, disulfiram reaction with alcohol

Formulation → all come IV/IM and cefuroxime also comes PO (can be switched to outpatient easily)

3rd gen ceph

2 PO

3 IV

PO

• Cefdinir (Omnicef)

• Cefpodoxime

IV

• Ceftriaxone (Rocefin)

• Cefotaxime

• Ceftazidime (Fortaz)

• Ceftazidime/avibactam (Avycaz)

Formulation, …gen ceph

Rocephin → generic

• Renal

• Don’t exceed…in renal/hepatic impairment

• Don’t reconstitute with….

IV, 3rd gen ceph

Rocephin → Ceftriaxone

• No renal adjustment

• Don’t exceed 2 g/day in renal/hepatic impairment

• Don’t reconstitute with Ca products

Formulation, …gen ceph

Fortaz → generic, unique coverage

IV, 3rd gen ceph

Fortaz → Ceftazidime, only 3rd gen that covers pseudomonas, but zero gram + coverage

Formulation, …gen ceph

Avycaz → generic, used for…

IV, 3rd gen ceph

Avycaz → Ceftazidime/avibactam, used for complicated UTI/abdominal infection

Formulation, …gen ceph

Omnicef → generic

• Separate from…

Cefpodoxime

• Need …for absorption

  • Dont give with

  • Regards to food

• Suspension good for…

PO, 3rd gen ceph

Omnicef → Cefdinir

• Separate from iron, multivitamins or antacids by 2 hrs

Cefpodoxime

• Need acidic environment for absorption

  • Dont give with antacids

  • Take with food

• Suspension good for 14 days days in the fridge

Formulation,…gen ceph

Maxipime → generic, unique coverage

Exblifep → generic for what indication

ADE → increased risk in…

IV, 4th gen

Maxipime → Cefepime, has pseudomonas coverage

Exblifep → Cefepime / enmetazobactam, for complicated UTI

ADE: CNS toxicity → increased risk in renal impairment

Formulation, gen ceph

Fetroja → generic

Unique MOA

Coverage → indication

IV, 5th gen

Fetroja -> Cefiderocol

Unique siderophore cephalosporin acts like Trojan horse (can sneak past outer membrane)

Covers last resort MDR gram - (CRE, pseudo, acineto) → complicate UTI/pyelo, HAP/VAP

Teflaro → generic

Formulation, gen ceph

Indication (2)

Teflaro (Ceftaroline)

IV, 5th gen

Zerbaxa → generic

gen ceph

Dosing

• Indication

Zerbaxa → ceftolozane/tazobactam

5th gen ceph

1.5 g IV Q8h for

• Intrabdominal infection with metronidazole

• Complicated UTI/pyelo

Carbapenem

MOA

Formulation

Coverage

Dose adjust…except…

ADE

DDI

MOA: inhibit synthesis of cell wall synthesis (PCN, ceph, carbapenem, aztreonam, vanco, -vancin)

IV

Covers gram + (except MRSA), gram - and anaerobes

Dose adjust in renal except moxi

ADE: seizures, fungal infections (kills everything)

DDI: reduce VPA levels → loss seizure control

Primaxin

Generic, class

Imipenem/Cilastatin, Carbapenem

Merrem → generic, class

Meropenem, carbapenem

Vabomere → generic, class

Vaborbactam + Meropenem

Carbapenem

Invanz

Generic, class

Unique coverage

Ertapenem, carbapenem

IV in NS (just like ampicillin, unasyn)

Does not cover PAE (pseudomonas, acineto, enterococcus) but still used because dosed the least frequent (QD vs other penems Q8h)

Azactam

MOA

Generic

Formulation

Covers

Indicated for

Aztreonam

MOA: inhibit synthesis of cell wall synthesis (PCN, ceph, carbapenem, aztreonam, vanco, -vancin)

IV

Covers only gram neg (including pseudomonas)

Indicated for severe systemic infection, include cystic fibrosis (pseduomonas)

VaNcOmycin

MOA

Covers

IV Dosing → prevent…

ADE

-

AUC/MIC

Trough

MOA: inhibit synthesis of cell wall synthesis (PCN, ceph, carbapenem, aztreonam, vanco, -vancin)

Covers gram pos only (esp MRSA)

1 g IV Q12h over 1 hr → prevent Red man syndrome (infusion reaction) → if happens, still give it but at slower rate and give diphenhydramine

Dose adjust renal → nephrotoxic

Also ototoxic

-

AUC/MIC ratio: 400-600

Trough guided Tx: trough 10-20 mcg/mL

• 15-20 mcg/mL if bacteremia, endocarditis, osteomyelitis, meningitis, HAP caused by S. aureus

• Taken before 4th dose

AmiNOglycosides

Coverage

MOA

ADE

• (3)

…Abx effect

…dependent killing

Gent, tobra — amikacin → peak and trough

Conventional dosing →

Once daily dosing →

Weight to calculate dose

Coverage → gram - (like pseudomonas)

MOA → inhibit protein synthesis by binding to 30s ribosomal subunit (like tetracyclines)

ADE →

• Nephrotoxicity

• Ototoxicity

• Neuromuscular block

Post-Abx effect

Concentration-dependent killing

Gent, tobra

• Peak 5-10, trough <2

Amikacin

• Peak 20-30, trough <5

Conventional dosing → 1-2.5 mg/kg/dose IV Q8-12h

Once daily dosing → 4-7 mg/kg/dose IV Q24h

Use IBW to calculate dose

Daptomycin

Class, MOA

Diluent

Frequency, ..vials

ADE

• DDI

• Labs

Used for…

Not for…, doesnt cover…

Cyclic lipopeptide, bind to cell membrane causing depolarization

IV in NS/LR (like capsofungin)

QD, Single use vials

ADE: neuropathy, myopathy

• Consider holding statins

• Check CK at baseline and weekly

Used for complication SSTI (MSSA, MRSA)

Not for pneumonia, doesnt cover Strept pneumonia

Fluoroquinolones

MOA

Don’t use in…

Interact with → separate..before and …after

Increase…with…

CIPRO DDI acronym

Also…

MOA: inhibit bacterial DNA gyrase

Don’t use in pregnant patients (category c) and kids <18 yo

Interact with milk and antacids → separate 2 hrs before or 6 hrs after

Increase INR with warfarin

CIPRO

C =

• CNS (seizures, dizziness)

• Crystalluria

I = Increase (or decrease) glucose
P =

• Peripheral neuropathy, exacerbate muscle weakness in patients with myasthenia gravis

• Pseudomembranous colitis

R = Rupture of the tendon

O =

• phOtosensitivity

• Qt prolongation (especially Moxifloxacin)

Also nephrotoxicity

Cipro, Cipro XR, ProQuin XR → generic

Ciprodex → generic, formulation

Ciloxan → generic, formulation

-

gen FQ

Used …, never…

IV is…% of oral dose

…inhibitor → increase …

Don’t give…through feeding tube

Cipro, Cipro XR, ProQuin XR → Ciprofloxacin

Ciprodex Otic → Cipro + dexamethasone, ear drops

Ciloxan → Cipro, eye drops

(eye drops can be used as ear drops, not vice versa)

-

2nd gen FQ

Used for UTI, never pneumonia

IV is 80% of oral dose

CYP1A2 inhibitor → increase theophylline and caffeine levels

Don’t give oral susp through feeding tube

Levaquin

Used for…, can be used for …

Which formulation on empty stomach

Dosing

• mg for x days → CAP, acute sinusitis

• mg for x days → chronic bronchitis

• x days→ chronic bacterial prostatitis

Dose adjust after CrCl…

Levofloxacin

Used for pneumonia, can be used for UTI but cipro preferred

Oral solution on empty stomach

Dosing

• 750 mg x5 days → CAP, acute sinusitis

• 500 mg x 7 days, chronic bronchitis

• 28 days for chronic bacterial prostatitis

Dose adjust after CrCl <50

Avelox

Vigamox → formulation

Generic

Used for…, NEVER for…

Highest risk of …

• IV infused over …

• CI with …

Dose adjust

Avelox → moxifloxacin

Vigamox → ophthalmic

Used or pneumonia, NEVER for UTI

Highest risk of QTc prolongation

• IV infused over an hour to avoid

• CI with ziprasidone

No renal dose adjustment (vs other FQ)

Baxdela

Generic

Indicated for

Unique

• Covg

• No ADE

Delafloxacin

Indicated for SSTI

Unique

• Covers MRSA, pseudomonas, other gram neg → unique FQ coverage

• No QTc prolongation

Macrolides

MOA

ADE

Which have more DDI

MOA: inhibit protein synthesis by binding to 50s ribosomal subunit (like Chloramphenicol, clinda, linezolid)

ADE: QTc prolongation (just like moxifloxacin, FQ)

Erythromycin and Clarithromycin → CYP inhibitor, give Azithromycin instead (less DDI)

Erythromycin

Class

Abx that can also be used for…

Formulation

Macrolide

Abx that can also be used for GI motility (causes severe diarrhea)

Oral, IV, topical, gel, ointment, soln, pads, ophthalmic