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Antibiotics (Cytoplasmic Membrane (Polymyxins (haven't seen used)…

- - - - Aerobic gram - including pseudomonas, NO gram + activity, no anaerobes
        
        Used for multi‐drug resistant (MDR) infections including MDR pseudomonas and acinetobacter
- - - - Metronidazole
        "Flagyl"
        
        covers most gram - and + anaerobes
        
        Used in combination with other antibiotics for
        infections of the CNS, GI tract, pelvic/gynecologic infections, dental infections
        
        C.difficile infection, protozoal Infections
        
        bacterial vaginosis 500mg PO BIDx7d
        
        part of "CLAMET" treatment of h. pylori ulcers
        
        high dose, long term treatment can cause neuropathy or even CNS toxicity
        
        disulfiram-like reaction with alcohol
    - - Ciprofloxacin
        
        only gram -
        
        severe gastroenteritis 500mg PO BID x3-5 days
      - "Respiratory quinolones"
        
        pneumococcus haemo influenza, mycoplasma, chlamydia
        
        Moxifloxacin
        
        more gram +
        Intra-abdominal infections, pelvic/gynecologic
        infections, pneumonia, UTIs, SSTI
        
        Levofloxacin
        
        Pneumonia, SSTI, UTIs
      - General Quinolone Notes:
        
        Good oral bio-availability: oral ~ IV
        
        Good CNS penetration (Moxi>cipro>>levo)
        
        Formulations oral, IV, topical (drops for
        ophthalmologic & otic infections)
        
        Good bone & joint & renal & prosthetic penetration
        
        Atypical coverage including TB
        
        **FDA warning limits use for certain minor infections due
        to side effects (prolongs QT interval, damages cartilage)**
  - - - Rifampin
        
        Used in combination therapy (with vanco+cipro) for prosthetic joint infection involving Staphylococci (good biofilm penetraIon)
        
        One of the first line Mycobacterium tuberculosis drugs
        
        Prophylaxis for contacts of invasive Neisseria meningitis & Haemophilus influenzae infections
      - rifabuIn, rifapenIn, & rifamyxin
      - Significant drug interactions
        
        Rifampin CYP450 inducer
        
        May increase or decrease serum concentration of many drugs
        
        Hepatotoxic
- - - - Tobramycin, Gentamicin, Streptomycin, Amikacin, Paramomycin
        
        Broad spectrum aerobic gram - and +, and mycobacteria. However, not adequate as monotherapy for some serious gram + infections.
        
        Note that anaerobic bacteria are intrinsically resistant.
        
        Therefore, used for treatment or empiric coverage for resistant gram negative infections
        
        When used in combination with Beta-lactam antibiotics, exhibit synergistic activity for infections with some gram positive cocci
        
        Poor oral absorption so given IV (except paramomycin)
        
        Less frequently used due to toxicity (oto, renal, neuromuscular block)
  - - - Broad spectrum bacteriostatic with activity against many aerobic gram + and -, as well as atypical pathogens
        
        CAP: doxy 200mg PO x1, then 100mg PO BID x5-7 days, +/- amox 1g PO TID
        
        Chlamydia: azithro 1g PO x1 dose or doxy 100mg PO BID x7 days
        
        Treatment of atypical infections, rikettsial infectIons (bacteria that live in ticks, mites, fleas, lice), leptospirosis
        
        MRSA coverage for non-complicated SSTI
        
        Non‐infectious uses: dermatological use for several conditions including acne, rosaceae
        
        Can leave a brown discoloration in the teeth <8y/o; doxy does this the least
    - - Clindamycin
        
        Covers gram+ and anaerobes; primarily used to treat anaerobes
        
        part of CLAMET therapy for h. pylori peptic ulcers
        
        Dental infections
        
        Skin & soft Issue infections
        
        Bone & Joint infections
        
        Useful in combination for abdominal and pelvic/gynecologic infections
        
        Adjunct medication in some toxin mediated diseases (Streptococcal toxic shock syndrome, NecroIzing fasciiIs)
        
        increases risk of C. Diff by 4x
    - - Linezolid
        
        most gram + bacteria, even MRSA resistant to vanco
        
        Vancomycin resistant enterococcal infections (VRE)
        
        2nd line TB drug
    - - wider than penicillins but still more gram + than gram -
        
        CAP: amox 1g PO TID x5-7 days + azithro 500mg PO daily x3 days
        
        Traveler's diarrhea 1g PO x1 dose
        
        Chlamydia: azithro 1g PO x1 dose or doxy 100mg PO BID x7 days
        
        pertussis: azithro 500mg PO x1 then 250mg PO daily x 4 days; clarithromycin 500mg PO bid or XL 1g po daily x 7 days
      - Erythromycin, Clarithromycin, Azithromycin
- - - - effective only against aerobic Gram-negative bacteria
        
        not cross-reactive for people with allergies to pen, cephalosporins or carbapenems
    - - VERY broad coverage
        
        often used for multi-drug resistant bacteria
        
        Used as empiric therapy for severe healthcare associated infections
        
        Used as definitive therapy for certain resistant bacteria
    - - 3rd generation
        (Ceftriaxone IV, Cefixime oral)
        
        Much broader gram negative coverage, not as good gram + (still have excellent coverage of strep; S. aureus only at higher doses)
        
        Gonorrhoeae: ceftriaxone 250mg IM x1 or cefixime 800mg PO x1 (+ azithro or doxy - I think for chlamydia proph)
        
        crosses blood brain; meningitis: 2g ceftriaxone IV q12h + vanco (vanco continued only if C&S indicate ceftriaxone resistant S. pneumo)
        
        complicated UTI: ceftriaxone IV, cefixime 400mg PO x 10 days PO 3 days simple, 10 days complicated
      - 2nd generation (much less used than 1st/3rd gen)
        (e.g. cefuroxime IV, cefuroxime oral)
        
        Expanded gram negative coverage, incl. respiratory (Hemophilus influenza) and other (Enterobacter aerogenes, Neisseria sp) = HEN
        
        Slightly less activity vs. S. aureus, but still adequate
      - 1st Generation
        (e.g. cefazolin [Ancef] IV, cephalexin [Keflex] oral)
        
        Mostly gram +: Effective against penicillinase-producing Staphylococcus aureus, streptococci, S. pneumoniae, Some gram negatives (E coli); no meaningful anaerobic coverage
        -does not cross blood-brain
        
        Pre-op prophylaxis: cefazolin 2g IV 60min before incision
        
        Cellulitis: mild - cephalexin 500-1000mg PO qid x5 days; severe - cefazolin 1-2g IV q8h x 5-10 days
    - - Can be used with Beta-latamase inhibitors which increase their gram + coverage, e.g. amox-clav and pip-tazo
        
        Ureidopenicillins (e.g. Piperacillin)
        
        Like aminopenicillins, but broader gram negative coverage, including Pseudomonas
        
        pip-tazo has very broad action and is often used emperically in serious infections
        
        Aminopenicillins (e.g. ampicilin, amoxicillin)
        
        Improved gram neg repsiratory (Hemophilus influenza) and urinary (E. coli) coverage, better against Enterococcus fecalis and Listeria
        
        acute otitis media: peds - amox 90mg/kg/day divided BID x5-10days for peds; adult - 500mg PO TIDx5-7days (same Rx for Rhinosinusitis)
        
        CAP, outpatient: adult - amox 1g PO tid x 5-6 days + doxy 200mg PO once, then 100mg PO bid x 5-7 days
        
        part of CLAMET therapy for h. pylori peptic ulcers
      - Semi-synthetic penicillins (e.g. cloxacillin)
        
        Effective against penicillinase-producing Staphylococcus aureus, most Streptococci, loses Enterococcus, Listeria
        
        cellulitis: mild 500mg PO qid x 5 days, moderate severe 1-2g IV q6h x 5-10 days
      - Natural Penicillins (Pen G IV, Pen V oral)
        
        Active against most strepococci, Enterococcus fecalis, some gram positive anaerobes, a few gram negatives (Neisseria sp.)
        
        Strep throat (GAS): Adult Pen V 600mg PO BID x10d, Peds 40mg/kg/d x10d
        
        GBS intrapartum prophylaxis
        
        Pen G 2.4MU IM for syphilis