Skin, Diabetes, Bone and Joint Infections

Brand name of Penicillin VK

Pen-VK

Main pathogen(s) Pen-VK covers:

Streptococcus spp. (G+)

Pen-VK monitoring:

Renal fxn

Pen-VK adverse effects:

Diarrhea, nausea, candidiasis

Pen-VK dosage for erysipelas:

250-500mg po q6h x7-10 days

Pen-VK dosage for prosthetic joint infection:

500mg po bid-qid

Pen-VK dosage for pharyngitis:

500mg po bid-tid x1 day

Does Pen-VK need to be renally/hepatically adjusted?

No

Boxed warning for Penicillin G Benzathine:

DO NOT USE IV

Penicillin G Benzathine renal/hepatic adjustments:

None

Main pathogen(s) Penicillin G Benzathine covers:

Streptococcus spp., Enterococcus faecalis; Borrelia burgdorferi, Neisseria meningitidis; mostly G+, some G-

Penicillin G Benzathine monitoring:

anaphylaxis with 1st dose

Penicillin G Benzathine adverse effects:

hypersensitivity

Penicillin G Benzathine dosage for erysipelas:

600,000 IU IM BID x7-10 days

Penicillin G Benzathine dosage for cellulitis:

1.2 million - 2.4 million IU IM as a single dose

Penicillin G Benzathine dosage for primary, secondary, and latent syphilis:

2.4 million IU IM as a single dose

Brand name of sulfamethoxazole/trimethoprim:

Bactrim; Bactrim DS

Main pathogen(s) Bactrim covers:

Some G+: Staphylococcus aureus (MSSA/MRSA);

Some G-: Escherichia coli, Hemophilus influenzae, Stenotrophomonas maltophilia

Bactrim monitoring:

CBC, electrolytes, SCr

Bactrim adverse effects:

C. diff, hyper/hypokalemia, hyponatremia, dermatitis, diarrhea, nausea

Bactrim renal/hepatic adjustments:

CrCl 15-30: half the dose

CrCl <15: quarter the dose

Bactrim dosage for cellulitis:

1-2 DS tabs po bid x5-14 days

Bactrim dosage for impetigo:

1-2 DS tabs po bid x7 days

Bactrim dosage for purulent SSTI:

1-2 DS tab po bid x5-10 days

Bactrim dosage for uncomplicated cystitis:

female: 1 DS tab po bid x3 days

male: 1 DS tab po bid x7 days

Bactrim dosage for complicated UTI:

female: 1 DS tab po BID x14 days

male: 1 DS tab po BID x7-10 days

Brand name for ciprofloxacin:

Cipro

Main pathogen(s) Cipro covers:

G-: Escherichia coli, Klebsiella pneumoniae, Haemophilus influenzae, Pseudomonas aeruginosa

Cipro monitoring:

LFT, SCr, BUN, glucose, tendon pain, hypersensitivity

Cipro black box warning:

tendon rupture, peripheral neuropathy, CNS effects, myasthenia gravis

Cipro adverse effects

aortic aneurysm, hepatotoxicity, c.diff, QT prolongation, peripheral neuropathy

Cipro renal/hepatic adjustments:

CrCl 30-50: 250-500 mg po q12h

CrCl <30: 500mg po q24h

Cipro dosing for osteomyelitis:

500-750 mg po q12h x6 weeks

Brand name for levofloxacin:

Levaquin

Levaquin monitoring:

renal, hepatic, hematologic fxn labs, WBC, signs of infection, altered mental status, tendinopathy, rash, hypersensitivity

Levaquin black box warning:

tendon rupture, peripheral neuropathy, CNS effects, myasthenia gravis

Levaquin adverse effects:

aortic aneurysm, c. diff, hepatotoxicity, phototoxicity, QT prolongation, tendon rupture

Levaquin renal/hepatic adjustments usual dose 500 mg po qd:

CrCl 20-50: 500 mg po once then 250 mg po q24h

CrCl <20: 500 mg po once then 250 mg po q48h

Levaquin renal/hepatic adjustments usual dose 750 mg po q24h:

CrCl 20-50: 750 mg po q48h

CrCl <20: 750 mg po once then 500 mg po q48h

Levaquin dosage for osteomyelitis:

750 mg po qd x6 weeks

Levaquin dosage for prosthetic joint infection:

750 mg po qd

Levaquin dosage for rhinosinustis:

500 mg po qd or 750 mg po qd x5-7 days

Main pathogen(s) Levaquin covers:

Some G+: Staphylococcus aureus (MSSA)

Broad G-: Escherichia coli, Haemophilus influenzae, Salmonella, Shigella, pseudomonas

Linezolid brand name:

Zyvox

Levaquin monitoring:

weekly WBC, lactic acid, rhabdomyolysis

Zyvox adverse reactions:

c. diff, lactic acidosis, myelosuppression, neuropathy, serotonin syndrome, diarrhea, neutropenia

Zyvox renal/hepatic adjustments:

CrCl >130: 450 mg IV q8h

Main pathogen(s) Zyvox covers:

Broad G+: Staphylococcus aureus (MRSA), Streptococcus spp., Enterococcus spp.

Zyvox dosage for SSTI:

600 mg IV q12h x5-14 days

Zyvox dosage for osteomyelitis:

600 mg IV q12h

Zyvox dosage for prosthetic joint infection:

600 mg IV q12h x4-6 weeks

Zyvox dosage for septic arthritis:

600 mg IV q12h x3-4 weeks

Metronidazole brand name:

Flagyl

Flagyl monitoring:

CBC, neurologic symptoms

Flagyl black box warning:

carcinogenic

Flagyl adverse reactions:

CNS effects, disulfiram-like reaction, nausea, vaginitis, headache

Main pathogen(s) Flagyl covers:

Some G+: Clostridium difficile

Some G-: Bacteroides, fusobacterium

Flagyl renal/hepatic adjustments:

None

Flagyl dosage for necrotizing infection:

500 mg IV q6h

Doxycycline brand name:

Doxycin

Doxycin monitoring:

CBC, renal fxn, LFT

Doxycin adverse reactions:

bone growth suppression, esophageal injury, photosensitivity, skin/dental discoloration, diarrhea, abdominal pain

Doxycin renal/hepatic adjustments:

None

Main pathogen(s) Doxycin covers:

Some G+: Staphylococcus aureus (MRSA), Clostridium spp.

Some G-: Borrelia burgdorferi, Haemophilus influenzae, Legionella spp., chlamydia trachomatis

Doxycin dosage for moderate purulent SSTI:

100 mg po bid x5-10 days

Doxycin dosage for mild MRSA infection:

100 mg po bid

Doxycin dosage for prosthetic joint infection:

100 mg po bid x3 months

Doxycin dosage for rhinosinustis:

200 mg po qd (or 100 mg po bid) x5-7 days

Doxycin dosage for Lyme prophylaxis:

200 mg po as a single dose

Doxycin dosage for Lyme treatment:

100 mg po bid x10 days

Doxycin dosage for moderate malaria prophylaxis:

100 mg po qd 1-2 days before travel - 4 weeks after leaving

Doxycin dosage for chlamydia:

100 mg po bid x7 days

Vancomycin brand name:

Vancocin

Vancocin black box warning:

embryo-fetal toxicity

Vancocin monitoring:

SCr, CBC, AUC (trough target: 15-20 mg/L)

Vancocin renal/hepatic adjustments:

CrCl 50-90: 15-20 mg/kg q12h

CrCl 15-49: 10-15 mg/kg q24h

CrCl <15: 10-15 mg/kg q18-72h

Vancocin adverse reactions:

anaphylaxis, C. diff, thrombocytopenia, nephrotoxicity, ototoxicity, tinnitus

Main pathogen(s) Vancocin covers:

Broad G+: Staphylococcus aureus (MRSA), Streptococcus spp., Enterococcus spp.

Clostridioides difficile (oral dosage form only)

Vancocin dosage for severe non-purulent SSTI:

15-20 mg/kg IV q8h

Vancocin dosage for severe purulent infection:

15 mg/kg IV q8h

Vancocin dosage for prosthetic joint infection:

15-20 mg/kg/dose IV q8-12h x2-6 weeks

Vancocin dosage for septic arthritis:

15-20 mg/kg/dose IV q8-12h x3-4 weeks

Dalbavancin brand name:

Xydalba

Xydalba monitoring:

BUN, SCr, LFT

Xydalba adverse reactions:

flushing, skin rash, n/v, anemia, headache, bronchospasm

Xydalba renal/hepatic adjustments:

CrCl <30

Single dose regimen: 1.125g

Two-dose regimen: 750mg, 375mg 1 week later

Main pathogen(s) Xydalba covers:

Broad G+: Staphylococcus aureus (MRSA), Streptococcus spp., Enterococcus spp.

Xydalba dosage for SSTI:

1.5 g IV as a single dose or

1 g IV initially and 500 mg IV a week later

Tigecycline brand name:

Tygacil

Tygacil monitoring:

LFT, anaphylaxis

Tygacil black box warning:

increase in all cause mortality

Tygacil renal/hepatic adjustments:

None

Main pathogen(s) Tygacil covers:

Broad G+: Staphylococcus aureus (MRSA), Streptococcus spp., Enterococci spp. (including VRE)

Tygacil dosage for SSTI:

100 mg IV as a single dose the 50 mg IV q12h x5-14 days

Daptomycin brand name:

Cubicin

Cubicin monitoring:

CPK, signs of C. diff

Cubicin adverse reactions:

C. diff, eosinophilic pneumonia, myopathy, peripheral neuropathy, edema

Cubicin renal/hepatic adjustments:

CrCl <30: usual dose, q48h

Main pathogen(s) Cubicin covers:

Broad G+: Staphylococcus aureus (MRSA), Streptococcus spp., Enterococci spp.

Cubicin dosage for SSTI:

6 mg/kg IV qd x5-14 days