ID Drugs exam 1

Natural Penicillins

Penicillin VK (PO)

Penicillin G (IV/IM) [Bicillin©]

Natural Penicillins Coverage

Strep, syphilis (Treponema pallidum), enterococcus?

frequent dosing

Anti-staphylococcal Penicillins

Nafcillin (IV)

Oxacillin (IV)

Dicloxacillin (PO).

• no Renal adjustment

Anti-staphylococcal Penicillins Coverage

Drug of choice for MSSA, strep

Aminopenicillins

Amoxicillin (PO) [Amoxil©]

Ampicillin (IV/PO)

Aminopenicillins Coverage

Strep, enterococcus (E. faecalis), some enteric GNRs

Beta-lactam combos

Amoxicillin/clavulanate (PO) [Augmentin©]

- Increased GI upset with clavulanate → take with food;

Ampicillin/sulbactam (IV/IM) [Unasyn©] - Acitenobacter

Piperacillin/tazobactam (IV) [Zosyn©]

BL combos coverage

Strep, MSSA?, anaerobes, better Gram-negative, Pseudomonas (pip/tazo only)

1st gen Cephalosporins

Cefazolin (IV) [Ancef©]

Cephalexin (PO) [Keflex©]

Cefadroxil (PO)

1st gen Cephalosporins Coverage

Drug of choice for MSSA

Streptococcus, few Gram-negative

2nd gen Cephalosporins

Cefuroxime (PO/IV) [Ceftin©]

Cefotetan (IV) - colorectal surgical prophylaxis (disulfiram reaction)

Cefoxitin (IV)

Cefprozil (PO)

Cefaclor (PO)

2nd gen Cephalosporins Coverage

Streptococcus, MSSA?, some Gram-negative; anaerobes (cefotetan/cefoxitin)

3rd gen Cephalosporins

Ceftriaxone (IV/IM) [Rocephin©] - No renal adjustment

Ceftazidime (IV) [Fortaz©] (tazmanian devil-Psuedomonas)

Cefpodoxime (PO) [Vantin©]

Cefdinir (PO) [Omnicef©]

Cefixime (PO)

3rd gen Cephalosporins Coverage

Streptococcus, MSSA?, Gram-negative;

↑ C. diff

4th Gen Cephalosporin

Cefepime (IV) [Maxipime©]

4th Gen Cephalosporin Coverage

MSSA, Streptococcus, good Gram-negative, Pseudomonas

Higher doses in renal impairment → encephalopathy/seizures;

↑ C. diff

5th Gen Cephalosporin

Ceftaroline (IV) [Teflaro©]

5th Gen Cephalosporin Coverage

MSSA, Streptococcus, few Gram-negative + MRSA

Higher-than-FDA-approved dosing for severe infections

Cephalosporin Combinations

Ceftazidime/avibactam (IV) [Avycaz©]

Ceftolozane/tazobactam (IV) [Zerbaxa©]

Cephalosporin Combinations Coverage

Ceftolozane/tazobactam for MDR Pseudomonas;

dosing varies by infection

Siderophore Cephalosporin

Cefiderocol (IV) [Fetroja©]

“Trojan horse” mechanism; renal dose adjustment

Fetroja/ Cefiderocol Coverage

Gram-negatives (MDR), Pseudomonas,

difficult-to-treat nonfermenters

Carbapenems

Imipenem-cilastatin (IV) [Primaxin©]

Meropenem (IV) [Merrem©]

Ertapenem (IV) [Invanz©]

Doripenem (IV)

Carbapenems Coverage

MSSA, Streptococcus, Enterococcus, anaerobes, Gram-negatives, Pseudomonas

Cilastatin protects imipenem from renal degradation; ertapenem once daily (narrower)

Carbapenem combinations

Meropenem/vaborbactam (IV) [Vabomere©]

Imipenem-cilastatin/relebactam (IV) [Recarbrio©]

Used for resistant organisms

Carbapenem Combinations Coverage

MSSA, Streptococcus, Enterococcus, anaerobes, Gram-negatives, Pseudomonas + MDR fram negatives

monobactam

Aztreonam (IV) [Azactam©] → Safe in IgE-mediated beta-lactam allergy

monobactam coverage (carbapenem)

Gram-negatives only (including Pseudomonas)

Peptides -Glycopeptide

Vancomycin (PO/IV) [Vancocin© (IV); Firvanq© (PO)]

Vancomycin Coverage

Gram-positives, including MRSA

(nephrotoxicity + infusion rxns)

Lipopeptide

Daptomycin (IV) [Cubicin©] -Dosed once daily; inactivated by lung surfactant

Lipopeptide coverage

Gram-positives, including MRSA & VRE

Lipoglycopeptides

Telavancin (IV)

Dalbavancin (IV)

Oritavancin (IV)

Lipoglycopeptides Coverage

Gram-positives, including MRSA & VRE

Long half-life → weekly dosing (dalba/orita);

weight-based dosing (telavancin)

Fosfomycin (PO) coverage

UTI only

3g PO once; can repeat doses;

IV approved for cUTI

Polymyxin B / Colistin (Polymyxin E) coverage

Gram-negatives

Nephrotoxicity, neurotoxicity, ototoxicity

Sulbactam-durlobactam (IV)

Acinetobacter (MDR)

Reserved for carbapenem-resistant Acinetobacter

Drug of Choice for MSSA

AntiStaph PCN (NOD)

1st gen cephalosporins

Drug choices for MRSA

Cephalasporins - 5th gen Ceftaroline (teflaro)

All Peptides

Psuedomonas Drug choices

Zosyn (pip/tazo)

3rd gen ceph- Ceftazidine (tazmanian devil)

4th gen - Cefepime

Meripenem, Doripenem, Imipenem

Aztreonam - B lactam Allergy

Enterococcus Faecium Drug choice

Anaerobes Drug choices

Augmentin

Unasyn

Zosyn

All carbapenems

Cefoxitin/cefotetan (2nd gen)