Acute Bacterial Skin/ Skin Structure Infections (ABSSSI)

What is the DoC for Impetigo infections?

Mupirocin Ointment

What bug should you suspect with purulent SSTIs?

Staph species

What drug(s) should you use empirically for patients with purulent SSTIs treated outpatient?

TMP/SMX, Doxyxycline, or Clindamcin

What drug(s) should you use empirically for patients with purulent SSTIs treated inpatient?

Vancomycin, Daptomycin, Dalbavancin, or Linezolid

What bug should you suspect for non-purulent SSTIs?

Streptococcal species

What drug(s) should you use empirically for patients with non-purulent SSTIs treated outpatient?

Cephalexin or Clindamycin (if pt has cephalosporin allergy)

(T/F) In patients with purulent SSTIs, you should always cover for MRSA empirically

True

What is THE most important treatment to cure purulent SSTIs

Steelacillin (Incision and Drain)

What is the MOA of Vancomycin?

Cell wall active antimicrobial, Glycopeptide

What is the spectrum of activity of Vancomycin?

Gram positive bugs

Vancomycin is usually dosed empirically at

15-20mg/kg IV q8-12h

What is the target trough for vancomycin?

15-20

What is the target AUC for vancomycin?

400-600

What are the side effects of vancomycin?

Ototoxicity, nephrotoxicity (especially when combined with other nephrotoxic agents), infusion syndrome

What is the treatment for vancomycin infusion syndrome?

Slow down infusion +/- antihistamines

What spectrum does Daptomycin cover?

gram positive

What is the MOA of Daptomycin?

Irreversibly binds to the bacterial cell membrane causing RAPID DEPOLARIZATION and cell death

What are the monitoring parameters for daptomycin?

CPKs and muscle spasms

What are the monitoring parameters for vancomycin?

therapeutic drug monitoring (trough/AUC), renal function, s/sx of infusion syndrome

Which oral MRSA agent is best in children?

Clindamycin

What is the MOA of Clindamycin?

Suppress toxin production and protein synthesis via a ribosomal mechanism

What test must be preformed to confirm Clindamycin susceptibility?

D-test

What are the ADRs of TMP/SMX?

RASH (including SJS and TEN), Hyperkalemia, warfarin interaction (^ INR), bone marrow suppression, nephrotoxicity

What is the dosage of doxycycline for ABSSSIs?

100mg BID

In which populations should you avoid using TMP/SMX?

First trimester and late term pregnancy

In which populations should you avoid using doxycycline?

Children

What are the ADRs of doxycycline?

Nausea/vomiting, Pill esophagitis, neurotoxicity (mainly mino), phototoxicity

Which oral antibiotic that covers MRSA has the lowest risk for causing C. diff?

Doxycycline

What is the mechanism of Linezolid?

Decreases protein synthesis through 50S ribosomal inhibition

What are the ADRs of linezolid?

Thrombocytopenia (especially after 2+ weeks of therapy), optic neuropathy, lactic acidosis, irreversible peripheral neuropathy

What is an important DDI to look out for when giving linezolid?

Interaction with serotonergic agents. Potential to cause serotonin syndrome

Interaction with tyramine-containing foods can raise BP

(T/F) Animal and human bite wounds typically have one bacteria causing infection

False

What is the DoC for animal bite infections?

Augmentin (amoxicillin/clavulanate)

What measures can be taken to help with colonization?

intranasal mupirocin plus chlorhexidine wash

(T/F) Diabetic foot infections are often polymicrobial

True

What are the primary bugs found in diabetic foot infections?

Staph and strep

Gram negatives (E. Coli, Klebsiella, Proteus, P. aeruginosa)

Anaerobes (Bacteroides fragilis, Peptostreptococcus)

(T/F) All foot ulcers in patients with diabetes should be treated with antibiotics

False

What drugs are appropriate for mild diabetic foot infections?

Augmentin, Cephalexin, Dicloxacillin, Clindamycin

Possible MRSA: Bactrim, Clindamycin, Doxycycline

What drugs are appropriate for moderate or severe diabetic foot infections?

Gram negative, MRSA, and anaerobic coverage

ie: Pip/tazo + Vanc

What duration of treatment is appropriate for most SSTIs?

5-7 days

Why might you choose to use IV therapy for an SSTI?

Multiple antibiotic failures, hemodynamic instability, bacteremia

What is the DoC for Group A streptococcus (S pyogenes)?

Penicillin