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Antibiotics - everything else

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sgthuan's version from 2017-07-13 11:33

Antibiotics

genericBrandClassDrug pearls
gentamicinnoneaminoglycosides - hydrophilic, concentration dependent, post antibiotic effect PAE, mostly gram-, synergic gram+IV, IM, ophthalmic, *** If OBESE --> use adjusted BW, 1-2.5mg/kg/dose Q8h, renal adjustment, extended dosing 7mg/kg/day, **** Peak 5-10mcg/ml, trough <2, BBW nephrotoxicity, ototoxicity, neurotoxicity -->neuromuscular blockade, **** respiratory paralysis, *** for endocarditis gram+ synergy, peak 3-4, trough <1
tobramycinnoneaminoglycosides - hydrophilic, concentration dependent, post antibiotic effect PAE, mostly gram-, synergic gram+IV, IM, ophthalmic, inhalation *** If OBESE --> use adjusted BW, 1-2.5mg/kg/dose Q8h, renal adjustment, extended dosing 7mg/kg/day, **** Peak 5-10mcg/ml, trough <2, BBW nephrotoxicity, ototoxicity, neurotoxicity --> neuromuscular blockade, **** respiratory paralysis
amikacinnoneaminoglycosides - hydrophilic, concentration dependent, post antibiotic effect PAE, mostly gram-, synergic gram+IV, IM, *** If OBESE --> use adjusted BW, 5-7.5mg/kg/dose Q8h, renal adjustment, NO extended dosing, **** Peak 20-30mcg/ml, trough <5, BBW nephrotoxicity, ototoxicity, neurotoxicity --> neuromuscular blockade, **** respiratory paralysis
ciprofloxacinCiproquinolones - gram-, gram+, atypical, NO MRSAtab, sus, injection, ointment, eye & ear, BBW - tendon inflammation & rupture, peripheral neuropathy, CNS effect - seizures, CI use with tizanidine, *** Warning QT prolong, hepatotoxicity, photosensitivity, cipro suspension can NOT be given through feeding tube, ** AVOID in myasthenia gravis, *** Cover pseudomonas, used in uncomplicated UTI if no alternative, *** do NOT Refrigerated, *** DOC for Traveler's Diarrhea
levofloxacinLevaquinquinolones - gram-, gram+, atypical, NO MRSAtab, sus, *** 1 to 1, eye, BBW - tendon inflammation & rupture, peripheral neuropathy, CNS effect - seizures, CI use with tizanidine, *** Warning QT prolong, hepatotoxicity, photosensitivity, ** AVOID in myasthenia gravis, *** Cover pseudomonas, used in uncomplicated UTI if no alternative, ** oral sus EMPTY stomach, ** Respiratory quinolones, *** do NOT Refrigerated, *** DOC for Traveler's Diarrhea, *** AVOID taking with divalent cation like Calcium
moxifloxacinAveloxquinolones - gram-, gram+, atypical, NO MRSAtab, ** injection IV to PO is 1 to 1, eye, BBW - tendon inflammation & rupture, peripheral neuropathy, CNS effect - seizures, CI use with tizanidine, *** Warning QT prolong, hepatotoxicity, photosensitivity, *** do NOT use in UTI, ** Respiratory quinolones, **** NO RENAL adjustment
gemifloxacinFactivequinolones - gram-, gram+, atypical, NO MRSAtab, BBW - tendon inflammation & rupture, peripheral neuropathy, CNS effect - seizures, CI use with tizanidine, *** Warning QT prolong, hepatotoxicity, photosensitivity, ** AVOID in myasthenia gravis, *** used in uncomplicatd UTI if no alternative, ** Respiratory quinolones
azithromycinZithromax, Z-pak, Zmax (extended release sus)macrolides - bind 50S, liphophilic, good for atypical500mg x1 day the 250mg x4 days, IV & PO, CI cholestatic jaundice/hepatic dysfunction, concomitant use with simvastatin & lovastatin, QT prolong, SE GI upset, increased LFTs, SJS/TEN, ** Zmax EMPTY stomach, *** NO RENAL adjustment, *** do NOT Refrigerated, *** DOC for traveler's diarrhea with PREGNANCY and Children
clarithromycinBiaxinmacrolides - bind 50S, good for atypical250-500 BID only PO, CI cholestatic jaundice/hepatic dysfunction, concomitant use with simvastatin & lovastatin, QT prolong, SE GI upset, increased LFTs, SJS/TEN, *** Renal adjustment, *** do NOT Refrigerated
erythromycinErythrocin, Erytabmacrolides - bind 50S, good for atypicalIV & PO, CI cholestatic jaundice/hepatic dysfunction, concomitant use with simvastatin & lovastatin, *** QT prolong - HIGHEST, SE GI upset, increased LFTs, SJS/TEN, ** NO RENAL adjustment
doxycyclineVibramycin, Doryx, Oraceatetracycline - bind 30S, cover CA-MRSA, good for unique pathogens100-200mg PO/IV, *** 1 to 1, Warning - children < 8 --> bone & teeth discoloration, pregnancy & nursing, photosensitivity, SE N/V/D, skin rash SJS/TEN, ** Avoid taking with antacids & divalent cations & dairy products, *** NO RENAL adjustment, it can decrease the effectiveness of PCN, *** do NOT Refrigerated, *** Good for Acute Sinusitis
minocyclineSolodyntetracycline - bind 30S, cover CA-MRSA, good for unique pathogens200mg PO/IV, *** 1 to 1, Warning - children < 8 --> bone & teeth discoloration, pregnancy & nursing, photosensitivity, SE N/V/D, skin rash SJS/TEN, ** Avoid taking with antacids & divalent cations & dairy products, *** CrCl < 80 max 200mg/d, it can decrease the effectiveness of PCN
sulfamethoxazole + trimethoprimBactrim SS & DS, Septra SS & DSsulfonamides - cover CA-MRSA, NO pseudomonas & atypical & anaerobesalways SFM to TMP is 5 to 1, dose based on TMP ONLY, *** 1 to 1, CI - sulfa allergy, pregnancy & nursing, infant < 2m, SE N/V/D, rash (SJS/TEN), photosensitivity, ** crystalluria, *** positive COOMBs test --> G6DP deficiency, hyperkalemia, hypoglycemia, hypo-folate, CrCl < 30 dose adjust, *** increased INR --> caution with Warfarin, **** for uncomplicated UTI - 1 DS BID x 3 days, *** do NOT Refrigerated, **** compatible with D5W ONLY
vancomycinVancocinglycopeptide - cover MRSA, C.diff15-20mg/kg IV q8-12h --> use ABW, CrCl < 50 Q24h, PO - NO dose adjustment, warning - ototoxicity & nephrotoxicity --> trough 15-20 or 10-15, *** Red man syndrome --> 500mg IV over 30m, *** REFRIGERATED
telavancinVibativlipoglycopeptides - concentration dependent, for SSTI, HAP10mg/kg IV qd --> extremely long half life, BBW fetal risk, ** nephrotoxicity --> REMS, increased mortality with severe renal impairment CrCl < 50, Warning increased INR, *** Red man syndrome --> infuse over 60m, CrCl < 30 dose adjust, *** QT prolong
oritavancinOrbactivlipoglycopeptides - concentration dependent, for SSTI1,200mg IV x SINGLE DOSE --> extremely long half life, CI - use with UFH within 5 days, *** red man syndrome --> infuse over 3 hours, cause increase INR, **** do NOT use with osteomyelitis, **** compatible with D5W ONLY
dalbavancinDalvancelipoglycopeptides - concentration dependent, for SSTI1,500mg IV x SINGLE DOSE --> extremely long half life, *** red man syndrome --> infuse over 30m, CrCl < 30 dose adjust, **** compatible with D5W ONLY
daptomycinCubicincyclic lipopeptides - cover MRSA, VRESSTI - 4mg/kg/day or endocarditis - 6mg/kg/day, **** Myopathy & rhabdomyolysis --> check increased CPK, can falsely increase INR, **** compatible with NS, do NOT treat pneumonia, CrCl<30 dose adjust
linezolidZyvoxOxazolidinones - cover MRSA, VRE600mg IV/PO q12h, *** 1 to 1, CI - do NOT use with MAOI, Warning duration-related myelosuppression, neuropathy if > 28d, SE decreased platelet, GI upset --> nausea, diarrhea, OPTIC neuritis (Glaucoma chapter), *** do NOT shake linezolid suspension, **** NO RENAL adjustment, *** do NOT Refrigerated
tedizolidSivextroOxazolidinones - cover MRSA, VRE200mg IV/PO daily x 6d, IV to PO is 1 to 1, **** consider replacing linezolid if neutropenia and GI upset, *** NO RENAL ADJUSTMENT
quinupristin/dalfopristinSynercidstreptogramin class - lipophilic, cover MRSA, VRE7.5mg/kg IV q8-12h, SE arthralgias/myalgias, infusion reaction --> edema & pain, phlebitis, hyperbilirubinemia, CPK elevation, limited use due to SE & typical for VRE (**faecium only) infection --> do NOT use for bloodstream infection, *** NO RENAL adjustment, **** dilute ONLY in D5W
tigecyclineTygacilglycylcycline - bind 30S, cover MRSA & VRE, NO pseudomonas, proteus, providencia100mg IVx1, then 50mg IV q12h, BBW increased risk of death --> last line, Warning hepatotoxicity, pancreatitis, photosensitivity, teeth discoloration, increase INR with warfarin, AVOID in bloodstream infection, *** NO RENAL adjustment, **** solution should be yellow-orange color
colistimethate or colistinColy-Mycin Mpolymyxins - cover gram- including pseudomonasWarning nephrotoxicity, neurotoxicity --> respiratory paralysis, *** CrCl < 80 dose adjust
Polymyxin Bnonepolymyxins - cover gram- including pseudomonasWarning nephrotoxicity, neurotoxicity --> respiratory paralysis, *** CrCl < 80 dose adjust
chloramphenicolnoneprotein sysnthesis - cover everythingrarely use due to SE, myelosuppression, *** NO RENAL adjustment, **** Gray baby syndrome
clindamycinCleocin, Clindagel, Clindamaxlincosamides - cover Aerobic & Anaerobic gram+150-450mg PO q6h, 600-900mg IV q8h, ** BBW colitis (C.diff), SE N/V/D, *** NO RENAL adjustment, **** positive D-test --> do NOT use clindamycin, *** do NOT Refrigerated
metronidazoleFlagylDNA/RNA - cover anaerobes & protozoal infectionC.diff 500mg IV/PO TID x10-14d, *** 1 to 1, BBW carcinogen, *** disulfiram reaction --> NO alcohol, SE CNS effects, seizures, HA, rash (SJS/TEN), metallic taste, increase INR with warfarin, extended release EMPTY stomach, *** NO RENAL adjustment
tinidazoleTindamaxDNA/RNA - cover ONLY protozoal infection2g PO daily, BBW carcinogen, *** disulfiram reaction --> NO alcohol, SE CNS effects, seizures, HA, rash (SJS/TEN), metallic taste, increase INR with warfarin, *** NO RENAL adjustment
rifaxaminXifaxanRNA synthesis - cover E.colitravelers diarrhea 200mg PO TID x 3d, IBS-D 550mg PO TIDx14d, *** not effective for systemic infection, **** NO RENAL adjustment
fosfomycinMonurolCell wall - cover E.coli & E.faecalisuncomplicated UTI 3g PO x 1 mixed in cold water, SE HA, diarrhea, nause
nitrofuratoinMacrobid, MacrodantinCell wall - cover E.coliMacrodantin 50-100 QID with food x 3-7d, Macrobid 100mg BID x 7d, CI renal impairment CrCl < 60 due to inadequate [ ] & accumulation of neurotoxins, jaundice/hepatic dysfunction, pregnancy, SE GI upset, hemolytic anemia --> G6DP deficiency, lung problem --> trouble breathing/SOB, ** brown urine discoloration, *** NO RENAL adjust
rifampinRifadinRIPE for TBlatent 600mg qd x 4m if INH resistant --> take on EMPTY stomach, CI - use with PIs in HIV, SE increased LFTs --> hepatotoxicity, **** orange-red discoloration of bodily secretions, ** rifabutin can replace in case of DDI
isoniazidINHRIPE for TBlatent 300mg qd x 9m for HIV, pregnancy, children --> take on EMPTY stomach, BBW Hepatotoxicity, SE GI upset, drug induced LUPUS, positive COOMBS test, **** peripheral Neuropathy --> use PYRIDOXINE (vit B6) 25mg qd to decrease risk of peripheral neuropathy
pyrazinamidenoneRIPE for TBCI - acute gout, severe hepatic damage, SE increase LFTs, hyperuricemia, gout, GI upset, CrCl < 30 extend interval
ethambutolMyambutolRIPE for TBCI - EYE --> optic neuritis, children, SE- optic neuritis, increased LFTs
rifampin + isoniazidRifamateRIPE for TB
rifampin + isoniazid + pyrazinamideRifaterRIPE for TB
phenazopyridinePyridium, Azo, UristatUrinary analgesics200mg TID x 2 days MAX take with FOOD and water, SE HA, stomach cramps, **** red-orange body secretion
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