Doxycycline, TMP-SMZ, Beta-Lactam-Lactamase Combinations, Floroquinolones Aminoglycosides Carbapanems and Monobactams

wsmithv's version from 2015-09-02 23:41


Question Answer
TMP-SMZ TXCystitis (uncomplicated = 3 days), pneumocystis pneumonia treatment and prophylaxis, MRSA of skin and soft tissue (cellulitis)
Tri-Sulfa Adverse Effectsrash, hemolysis in those with G6PD, bone marrow suppression (b/c folate antagonist; hence avoid in those with folate deficiency)

Beta-Lactam/Beta-Lactamase Combinations

Question Answer
what are the Beta-Lactam-Lactamase combinationsamoxicillin/clavulanate (augmentin), ticarcillin/clavulanate (timentin), ampicillin/sublactam (unisym), perpacillin/tazobactam (zosyn)
why beta-lactamaseadds coverage against sensitive staphylocci to these agents.
Beta Lactam-Lactamase coverageanaerobes (among other things) and are first choice for mouth and GI abscess


Question Answer
Doxycycline TXchlamydia, rickettsia, MRSA of skin and soft tissue (cellulitis), Borreila (= lyme), Ehrlichia (= tick-borne), and Mycoplasma; Primary (genital) and Secondary (skin) syphilis in those allergic to penicillin
chlamydia drugs of choicedoxycycline and azithromycin
rickettsia DX - serology, ELISA, Western Blot, TX - Doxy, Rocky Mountain Spotted Fever
Minor MRSA (skin)Doxycycline, Trimethoprim/Sulfa, Clindamycin, Linezolid
Adverse Effects of Doxytooth discoloration (children), Fanconi syndrome (Type 2 RTA proximal), photosensitivity, esophagities/ulcer


Question Answer
Floroquinolone DrugsCiprofloxacin, Gemifloxacin, Levofloxacin, Moxifloxacin
Floroquinolones Best Therapy forCommunity-acquired pneumonia (including penicillin resistant pneumococcus) BUT NOT CIPRO for Pneumo
Floroquinolones TXGram-neg bacilli including most pseudomonads; diverticulitis and GI infections (cipro, gemi, and levo must be combined with metronidazole to cover anaerobes; moxifloxacin doesn't need metronidazole for diverticulitis)
Floroquinolones CiprofloxacinUsed for Cystitis (reserved from routine use to avoid resistance) and Pyelonephritis (can send home uncomplicated pyelo on cipro)
Floroquinolones Adverse EffectsBone Growth Abnormalities in children and Pregnant Women, Tendonitis and Achilles tendon rupture, Gatifloxacin removed because of glucose abnormalities


Question Answer
Aminoglycoside DrugsGentamicin, Tobramycin, Amikacin
Aminoglycoside Coveragegram-negative bacili (bowel, urine, bacteremia) --> ascending cholangitis; synergistic with bet-lactams for enterococci and staphylococci (beta-lactam breaks down cell wall while aminoglycoside kills ribosome); no effect against anaerobes (b/c aminos need oxygen to work)
Aminoglycoside ToxicityNephrotoxic and Ototoxic (very toxic)

Carbapenems and Monobactams

Question Answer
Carbapenem DrugsImipenem, Meropenem, Ertapenem, Doripenem
Carbapenems coverGram-Negative Bacilli (including many that are resistant), anaerobes, streptococci, and staphylococci
Carbapenems TxNeutropenia and Fever
Ertapenemdiffers from other carbapanems because it doesn't cover pseudomonas like the others do
MonobactamAztreonam (only drug in class); exclusively for gram-neg bacilli including pseudomonas, NO CROSS-REACTION WITH PENCILLIN
Imipenem ToxicitySEIZURES (b/c of renal secretion, this is more likely with renal failure)