Good For Flashcards

Question

Glycylcyclines Tigecycline Good for

Answer 1

May have a role in treatment of complicated polymicrobial infections - intra-abdominal infections - complicated skin and skin structure infections Very large volume of distribution - distributes highly into many tissues - leads to low bloodstream concentrations (not ideal for treating primary bloodstream infections Should not be used for UTIs - eliminated hepatically - achieves low urinary concentrations

Answer 2

``` Upper and lower respiratory tract infections Chlamydia Atypical mycobacterial infections Traveler's diarrhea -azithromycin ``` Macrolides are bacteriostatic drugs (should not be used when cidal activity is usually required - meningitis - endocarditis - etc. H. pylori induced GI ulcer disease -Prevpac contains clarithromycin, lansoprazole, and amoxicillin Their spectrum makes them ideal choice for community acquired pneumonia -high resistance rate to S. pneumoniae makes them risky choices as monotherapy for infection worse than mild (treat with something else or add beta lactam active against S. pneumoniae) Erythromycin used as prokinetic agent for impaired GI motility (GI stimulant)

Answer 3

Resistant Gram+ organisms - MRSA - VRE Linezolid: - pneumonia - skin and skin structure infections - UTIs - other uses Tedizolid: - only indicated for skin and skin structure infections (studied as a 6 day therapy; comparable to 10 days of linezolid) - may be useful for other types Linezolid has dual hepatic and renal elimination -do not need to adjust dose for renal or hepatic dysfunction Tedizolid eliminated primarily by liver -may not sufficiently concentrate in urine to treat UTIs

Answer 4

Documented or suspected abdominal anaerobic bacteria -add second drug for aerobic coverage if necessary Vaginal trichomoniasis GI infection caused by susceptible protozoa - amebiasis - giardiasis - etc. Is a component of therapy for H. pylori GI ulcer disease in combination C. difficile -mild to moderate disease Metronidazole has ~100% bioavailability -switch from IV to PO when possible Tinidazole - spectrum similar to metronidazole - approved only for parasitic infections

Answer 5

Uncomplicated cystitis - only for infections of lower urinary tract - in patients who have significant renal dysfunction (CrCL < 50mL/min), there may be insufficient accumulation of the drug in the urine for activity Prophylaxis against recurrent uncomplicated lower UTI -nitrofurantoin Nitrofurantoin -can be used for 5 days instead of traditional 7 day regimen Fosfomycin -single dose Ineffective for infections outside of lower urinary tract - only reach high concentrations in the urine due to PK limitations - should not be used for more severe UTIs like pyelonephritis and urosepsis Retain excellent activity against E. coli >90% in most studies -have adequate coverage of other common community acquired urinary tract pathogens

Answer 6

MRSA or E. faecium -in patients not responding to or intolerant of other medications E. faecalis is more common in most hospitals - less likely to be VRE - only use if species is known (linezolid and daptomycin do not have this issue) No longer considered 1st line for VRE -the indication was removed from labeling due to lack of follow up data after the initial approval Must be mixed with D5W -becomes insoluble and can crystallize when given with NS

Answer 7

``` Skin and skin structure infections -caused by resistant Gram+ organisms Staphylococcal bacteremia -including right sided endocarditis (few antibiotics have this indication) Enterococcal bacteremia -not indicated or as well studied ``` Cannot be used for pneumonia - binds to human pulmonary surfactant (renders drug inactive) - however it does penetrate lung tissue well FDA approved dosing is 4-6mg/kg/day - studies show higher doses may be more effective without causing substantially more toxicity - may see up to 12mg/kg/day for difficult to treat infections

Answer 8

``` Uncomplicated lower UTIs -empirically only in areas with low resistance Prophylaxis against recurrent UTIs Listeria meningitis P. jirovecii pneumonia -treatment and prophylaxis Toxoplasma encephalitis ``` ``` Alternative for: Bacterial prostatitis Typhoid fever MRSA -predominant outpatient strain likes to cause skin infections with often large abscesses (must drain abscess) ``` Used to be first line for acute uncomplicated cystitis in women -in areas with E. coli resistance greater than 15-20%, use alternative (nitrofurantoin); in these cases at least don't use as empiric therapy for complicated UTI (pyelonephritis or urosepsis) TMP/SMX has excellent oral bioavailability Fairly insoluble in IV solutions; relatively large volumes of diluent needed for it to go into solution ``` Other drugs in class used against parasitic/fungal infections: Dapsone Pyrimethamine Sulfafoxine Sulfadiazine -toxoplasmosis ```

Answer 9

``` Skin and soft tissue infections Infections of oral cavity Anaerobic intraabdominal infections Acne -applied topically P. jirovecii pneumonia -used second line -in combination with primaquine Malaria -in combination with other drugs Bacterial vaginosis Bacterial endocarditis -prophylaxis ``` Consider it a mix of vancomycin + metronidazole - an alternative for Gram+ infections (such as beta lactam allergy) - more variable activity against MRSA (more community acquired strains are susceptible to TMP/SMX than to clindamycin) and S. pyogenes - higher level of resistance among Gram- anaerobes (B. fragilis) - best used empirically for nonsevere infections of skin and oral cavity; or definitive therapy when susceptibilities known Reasonable alternative for staphylococcal infections -organisms that are clindamycin susceptible but erythromycin resistant harbor a gene that may lead to high level clindamycin resistance during therapy (these strains should be screened with a D-test: if positive, inducible clindamycin resistance is present) Useful in necrotizing fasciitis and other toxin mediated diseases - due to inhibition of protein synthesis and activity against organisms in stationary phase growth - consider adding it onto beta lactam based therapy for these infections Nearly 100% bioavailable -oral doses usually lower than IV to improve GI tolerance

Answer 10

Multidrug resistant Gram- infections (poorly studied; other drugs should be used if pathogens susceptible) - pneumonia - bacteremia - sepsis - complicated UTIs Give both drugs with loading dose Polymixin B given in active form - has more predictable PK - not eliminated renally; should not be dose adjusted in renal dysfunction (unlikely successful in treating UTIs) - 1mg = 10,000 units Colistin given as renally eliminated prodrug - colistimethate sodium converted to active colistin in the body - 400mg colistimethate = 150mg colistin base activity - European countries dose in international units (1mg CBA = 33,333 units rounded to 30,000); (1,000,000 IU = 80mg colistimethate = 30mg CBA); (1mg CBA = 2.7mg colistimethate = 30,000 units) Oral form of colistin only for bowel decontamination -such as before GI surgery Aerosolized forms used to decrease colonization with Gram- bacteria (mainly Pseudomonas) in some patients - especially in cystic fibrosis - prepare just before administration - some experts have used for pneumonia (not very strong evidence)

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