Antimicrobials 2

glycopeptides and lipoptide ABXs

vancomycin

daptomycin

oritavancin

dalbavancin

telavancin

vancomycin class

glycopeptide

vancomycin MOA

binds to D-ala-D-ala terminus of peptidoglycan

prevents peptidoglycan polymer elongation/crosslinking

cell wall weakens → osmotic lysis

vancomycin spectrum

Staph aureus (MSSA, MRSA)

coagulase NEGATIVE staph

enterococcus

streptococcus

gram + rods

vancomycin does not have activity against _

gram negatives

invasive MRSA infections cause what diseases

bacteremia

endocarditis

pneumonia

meningitis

skin + soft tissue

oral vancomycin treats _

C. diff

key MRSA agent

vancomycin

oral vancomycin consideration

limited systemic concentrations

vancomycin distribution

distributes well, including CNS

vancomycin metabolism

NOT liver

vancomycin half life

3-12 hrs

vancomycin elimination

renal (needs renal dose adjustment)

best pharmacodynamic predictor of vancomycin efficacy

AUC/MIC

AUC/MIC for vancomycin

400-600

elevated trough vancomycin levels are associated with _

increased nephrotoxicity

adverse effects of vancomycin

nephrotoxicity

ototoxicity

neutropenia

infusion reactions

how to manage vancomycin infusion reaction

slower infusion rate + diphenhydramine

bacteria that are resistant to vancomycin

enterococcus species

staph aureus

enterococcus vancomycin resistance pattern

E. faecium is more resistant than E. facealis

enterococcus with intrinsic resistance to vancomycin

E. gallinarum

E. casseliflavus

how does staph a develop vancomycin resistance

thickened cell wall

daptomycin class

cyclic lipopeptide

daptomycin MOA

contains a water soluble hydrophillic core + lipophillic tail

insertion of Ca-dependent lipid tail → cell membrane disruption

daptomycin spectrum

staph (MSSA + MRSA)

coagulase negative staph

Enterococcus

streptococcus

gram positive rods

daptomycin indications

vancomycin resitant enterococcal infections

invasive MRSA infection

avoid daptomycin use in _

pneumonia

CNS infections

why is pneumonia contraindicated with daptomycin

lung surfactants inactivate daptomycin

daptomycin route of admin

IV only

daptomycin distribution

minimal to CNS

daptomycin metabolism

minimial metabolism

daptomycin elimination

renally

daptomycin half life

8-9 hrrs

daptomycin pharmacodynamics

concentration-dependent

daptomycin adverse effects

rhabdomyolysis

eosinophilic pneumonia

rhabdomyolysis risk w/ daptomycin is higher for which patients?

renally impaired

obese

those taking statins

resistance with daptomycin

not common

telavancin drug class

lipoglycopeptide

long acting lipoglycopeptides

oritavancin

dalbavancin

ABX classes : protein synthesis inhibitors

oxazolidinones

tetracyclines

aminoglycosides

macrolides

lincosamides

linezolid class

oxazolidinone

linezolid MOA

binds and inhibits 50S ribosomal unit

inhibits mitochondrial protein synthesis (maybe)

linezolid coverage

gram positives (MRSA, MSSA, VRE)

mycobacteria

nocardia

linezolid indications

Pneumonia, SSTIs, osteoarticular infections

toxic shock syndrome

necrotizing soft tissue infections

mycobacterial infections

linzeolid route of admin

IV or PO

linezolid PK

A: 100% bioavailable

D: lungs + CSF

E: limited renal elimination

linezolid adverse effects

serotonin syndrome

thrombocytopenia

peripheral + optic neuropathy

lactic acidosis

how does linezolid cause serotonin syndrome

MAOI activity

tedizolid class

oxazolidinone

tedizolid indications

skin and soft tissue infections

tedizolid adverse effects

hematologic, serotonin syndrome (but less than linezolid)

clindamycin class

lincosamide

clindamycin MOA

50S ribosomal subunit inhibition

inhibited toxin production

clindamycin spectrum

gram positive

anaerobics

parasites (toxoplasma, plasmodium)

pnemocystis jiroveci

clindamycin resistance

staph auerues

group B strep

group A strep

test for clindamycin resistance

D-test

indications of clindamycin

skin and soft tissue

toxic shock syndromes

aspiration pneumonia

surgical prophylazis in penicillin allergy

clindamycin route of admin

IV, oral

clindamycin absorption/distribution/elimination

high absorption

high distribution

no renal adjustment required

clindamycin adverse effects

GI (N/V/D)

C. diff

tetracyclines coverage

staph aureus

strep pneumo

enterobacterales

actinobacter

stenotropho

yersinia

vibrio

atypical bacteria

tetracyclines are unreliable against _

most streptococus

doxycycline indications

skin and soft tissue

community aquired pneumonia

tick-borne diseases

STDs

_ is an alternative to penicillin for syphyllis

doxycycline

minocycline uses

skin and soft tissue infections

pneumonia

avoid tetracyclines with:

UTIs

bloodstream infections

CNS infection

absorption of tetracyclines

high oral absorption

tetracyclnes distribution

distributes well into TISSUES

POOR serum concentration / CNS

renal adjustment for tetracyclines

not needed

tetracyclines drug interactions

decrease efficacy of OCPs

decreased absorption with metal cations

rank order of tetracyclines GI side effects

tetracyclines > doxycycline > minocycline

counseling for taking tetracyclines

take with 8oz water, sit upright for 30 mins

which tetracycline is most associated with pill-associated esophageal ulceration

doxycycline hyclate

hyperpigmentation is most associated with which tetracycline

minocycline

tetracycline adverse effects

GI upset

esophageal ulceration

photosensitivity

hyperpigmentation

teratogenicity

tigecycline class

semisynthetic tetracycline

tigecycline can overcome _

efflux pump resistance

eravacycline class

synesthetic flurocycline

omadacycline class

frist aminomethyl cycline

eravacycline is better against _

gram positives and gram negatives

tigecycline indications

intra-abdominal infections

soft tissue

respiratory infections caused by drug resistant gram negatives

eravacycline indications

intra-abdominal infections caused by gram negative resitant orgs

omadacycline indication

complicated community aquired pneumonia

soft tissue infection

synthethic tetracyclines are alternatives in _ diseases

mycobacterial

macrolides MOA

50S ribosomal unit inhibitors

macrolides spectrum:

community acquired pneumonia

• strep pneumo

• moraxella

• HiB

• atypical pneumonias

strep pyogenes

N. gonorrhea

chlamydia

mycobacterium

erythomycin indications

GI stimulant

azithromycin indications

upper and lower respiratory tract infections

STDs

travelers diarrhea

mycobacterium avium complex infection

don’t use azithromycin monotheapy to treat _

CAP (strep pneumo resistance)

clarithromycin indication

H. pylori infection

azithromycin pharmacokinetics

high absorption

high tissue penetration

no renal adjustments needed

azithromycin adverse reactions

GI intolerability

• Prolongation of cardiac repolarization (QTc prolongation)

• Ototoxicity (reported in long-term use)

azithromycin CYP3A4 association

inhibitor

aminoglycosides MOA

30S subunit inhibitor

gentamicin coveragre

staph aureues

enterococcus

enerobacter

tularemia

yersenia

brucella

tobramycin coverage

enterobacter

pesudomonas

brucella

amikacin coverage

eneterobacter

pseudomonas (urine only)

TB

NTMs

nocardia

plazomicin coverage

staph auerues

enterobacc

pseudomonas

tularemia

yersenia

brucella

aminoglycosides indication

UTIs

pyelonephritis

MDR - gram negatives

endocarditis

STDs

_ is recommended as synergy to beta-lactams for endocardidtis

gentamicin