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Antibiotics - beta-lactams, monobactams, cephalosporins

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sgthuan's version from 2017-07-03 14:57

Beta-lactam - hydrophilic, time dependent

genericBrandClassdrug pearls
penicillinPen VKbeta-lactam - natural PCN gram+ & mouth anaerobes(+)125-500mg Q6-12h on an EMPTY stomach, SE GI upset, diarrhea, rash, renal failure, seizures with accumulation
penicillin G BenzathineBicillin L-Abeta-lactam - natural PCN gram+ & mouth anaerobes(+)1.2-2.4 million units IM x 1 --> *** DOC syphilis, **** BBW do NOT give IV --> cardiorespiratory arrest, SE GI upset, diarrhea, rash, renal failure, seizures with accumulation
amoxicillinAmoxil, Moxatag XRamino PCN - add gram- HNPEK & mouth anaerobes(-)250-500mg Q8h, tab, cab, chewable, suspension, NO IV *** First line for otitis media 80-90mg/kg/d, DOC for endocarditis prophylaxis before dental 2g x 1, SE GI upset, diarrhea, rash, renal failure, seizures with accumulation
amoxicillin + clavulanateAugmentinamino PCN/beta-lactamase inhibitortablet, chewable, suspension, *** first line for otitis media 90mg/kg/d, ** use the lowest dose of clavulanate to decrease DIARRHEA
ampicillinnoneamino PCN - add gram- HNPEK & mouth anaerobes(-)1-2g IV/IM q4-6h, *** very poor bioavailability --> give amoxicillin PO, **** must be diluted in NS ONLY, SE GI upset, diarrhea, rash, renal failure, seizures with accumulation
ampicillin + sulbactamUnasynamino PCN/beta-lactamase inhibitorinjection only, *** must be diluted in NS ONLY, SE GI upset, diarrhea, rash, renal failure, seizures with accumulation
piperacillin + tazobactamZosynextended PCN/beta-lactamase inhibitor3.375g IV q6h or 4.5g IV q6-8h infused over 4 hours, contain 65mg Na in 1g piperacillin, *** cover pseudomonas, SE GI upset, diarrhea, rash, renal failure, seizures with accumulation
nafcillinnoneantistaphylococcal PCN - cover MSSA1-2g IV/IM q4-6h, cover MSSA ONLY, *** is a VESICANT --> use cold pack & hyaluronidase injection, central line preferred, SE GI upset, diarrhea, rash, seizures with accumulation, *** NO renal dose adjustment
oxacillinnoneantistaphylococcal PCN - cover MSSASE GI upset, diarrhea, rash, seizures with accumulation, *** NO renal dose adjustment
dicloxacillinnoneantistaphylococcal PCN - cover MSSA125-500mg PO q6h, SE GI upset, diarrhea, rash, seizures with accumulation, *** NO renal dose adjustment
memorize

cephalosporins - do NOT cover enterococcus & Atypical

Question Answer Column 3 Column 4
cefazolinAncef1st gen - good for MSSA1-1.5g IV/IM q8h, SE GI upset, diarrhea, rash, seizures with accumulation, cross sensitivity with PCN, *** for surgical prophylaxis
cephalexinKeflex1st gen - good for MSSA250-2000mg PO Q6-12h, SE GI upset, diarrhea, rash, seizures with accumulation, cross sensitivity with PCN, *** usually for skin infection
cefaclorCeclor2nd gen - add HNPEK250-500mg q8h, SE GI upset, diarrhea, rash, seizures with accumulation, cross sensitivity with PCN
cefuroximeCeftin2nd gen - add HNPEK250-1500mg PO/IV/IM q8-12h, take suspension with food, SE GI upset, diarrhea, rash, seizures with accumulation, cross sensitivity with PCN, **** good for mild-moderate foot infection
cefotetanCefotan2nd gen - add HNPEK & gram- anaerobes1-2g IV/IM q12h, **** contains NMTT side chain --> risk of hypoprothrombinemia (bleeding) & disulfiram reaction, SE GI upset, diarrhea, rash, seizures with accumulation, cross sensitivity with PCN, *** for surgical prophylaxis with colorectal procedures
cefdinirOmnicef3rd gen group 1300mg BID or 600mg qd, SE GI upset, diarrhea, rash, seizures with accumulation, cross sensitivity with PCN, *** usually for CAP
cefpodoximeVantin3rd gen group 1100-400mg BID, SE GI upset, diarrhea, rash, seizures with accumulation, cross sensitivity with PCN, *** usually for CAP
cefiximeSuprax3rd gen group 1400mg BID or QD, available in chewable, SE GI upset, diarrhea, rash, seizures with accumulation, cross sensitivity with PCN
ceftriaxoneRocephin3rd gen group 11-2g IV/IM q12-24H --> ONLY 1 to be given DAILY, *** CI hyperbilirubinemic neonates or calcium containing IV products in neonates < 28 days, SE GI upset, diarrhea, rash, seizures with accumulation, cross sensitivity with PCN, **** NO RENAL adjustment, *** usually for CAP, meningitis, pyelonephritis, **** DOC for primary peritonitis 1g IV qd x 5-7d
cefotaximeClaforan3rd gen group 11-2g IV/IM q4-12h, SE GI upset, diarrhea, rash, seizures with accumulation, cross sensitivity with PCN, *** same as ceftriaxone but OK to use in neonate
ceftazidimeFortaz, Tazicef3rd gen group 2 - little gram+ & cover pseudomonas1-2g IV/IM q8-12h, SE GI upset, diarrhea, rash, seizures with accumulation, cross sensitivity with PCN
ceftazidime + avibactamAvycaz3rd gen/lactamase inhibitor - little gram+ & cover pseudomonas2.5g IV/IM q8h, *** cover some CRE, SE GI upset, diarrhea, rash, seizures with accumulation, cross sensitivity with PCN
ceftolozane + tazobactamZerbaxa3rd gen/beta-lactamse inhibitor - little gram+ & cover pseudomonas1.5g IV/IM q8h, SE GI upset, diarrhea, rash, seizures with accumulation, cross sensitivity with PCN
cefepimeMaxipeme4th gen - cover pseudomonas1-2g IV/IM q8-12h, SE GI upset, diarrhea, rash, seizures with accumulation, cross sensitivity with PCN
ceftaroline fosamilTeflaro 5th gen - cover MRSA, NO pseudomonas600mg IV q12h, SE GI upset, diarrhea, rash, seizures with accumulation, cross sensitivity with PCN
doripenemDoribaxcarbapenem - cover pseudomonas, NO MRSA500mg IV q8h, CrCl < 50 dose adjust, SE diarrhea, rash, seizures with higher dose
imipenem + cilastatinPrimaxincarbapenem - cover pseudomonas, NO MRSA250-1000mg IV q6-8h, CrCl < 70 dose adjust, SE diarrhea, rash, seizures with higher dose
meropenemMerremcarbapenem - cover pseudomonas, NO MRSA500-1000mg IV q8h, CrCl < 50 dose adjust, SE diarrhea, rash, seizures with higher dose, **** DOC for Acinetobacter
ertapenemInvanzcarbapenem1g IV/IM qd, *** stable ONLY in NS, **** NO pseudomonas, Acinetobacter, Enterococcus, *** common use in diabetic foot infection, SE diarrhea, rash, seizures with higher dose
aztreonamAzactammonobactam - cover many gram- & pseudomonas, NO gram+ activity500-2000mg IV q6-12h, CrCl < 30 dose adjust, **** can be use in PCN allergy,
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