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How to treat serious hospital aquired gram neg?
3rd generation ceph and cefoperazone
Name 2 oral cephalosporins for each class?
- 1st gen: Keflex,Duricef
- 2nd gen: Ceftin, Ceclor
- 3rd gen: Suprax, Vantin
Wjat is the coverage for ceph in each class?
- 1st: gram positive, some gram negatives PECKSS (Proteus,Ecoli,Klebsiella,Samonella,Shigella)
- 2nd: gram positives, less than 1st, gram negatives HEN PECKSS (H. Infuenza, Neisseria)
- 3rd: less gram pos, ceftazadine and cefoperazone against pseudomonas
- 4th: coverage is 3rd gen gram neg and 1st gen gram pos
What is the 4th gen ceph?
What is vanco's coverage?
Gram positives, MRSA, MSRE
Dosing of vanco
1gm IV q12 hours slow infusion
When u give oral vanc?
C diff colitis?
What happens with fast infusion of vanc?
Redmans syndrome or red neck syndrome, some say redmans is from rifampin): erythema and pruritis usually to head neck and upper torso.
What are peaks and troughs of vanc?
- Peak 15-30 mg/ml
- Trough < 10 mg\ml
When do you take vanco peaks and troughs?
- Peak: take 30 min after 3rd dose
- Trough: take level 30 min before 4th dose
How to prevent red neck syndrome?
Slow infusion, give dose over one hour
How do you treat too rapid infusion of vanco?
Antihistamines ( benadryl 10-50mg IV tid) until symptoms go away
Major side effects of vanco?
T/F if you dont get nephro or ototoxicity ur first time with vanco ull never get it?
F, more times u take it the increase chance of having side effects
What are side effects of aminoglycosides?
- Neuromuscular blockade
What is aminoglycoside coverage?
Gram negative aerobic.rods
How to dose bactrim?
- One tab po bid
- Single strength 80mgTMP/400mgSMX
- Double strength
What allergy to avoid?
How does Bactrim work?
- TMP-inhibits bacterial dihydrofolate reductase
- SMX-inhibits folic acid production
Spectrum of Bactrim
- Staph and strep (incuding MRSA and MRSE)
- Gram negatives (including pseudomonas)
Contraindications for bactrim use?
- Pt on hypoglycemics and G6PD deficiencies
What is primaxin?
Spectrum of primaxin
- Most gram positives
- Most gram negatives including pseudomonas
- Most aerobes amd anaerobes
IV or PO for Primaxin?
Side effects of Primaxin?
What is aztreonams major side effects?
What is aztreonam's coverage?
Gram negatives, aerobes,pseudomonas
Why isnt Aztreonam used more?
What are two most common quinolones?
Cipro and levaquin
What is cipro and levaquins coverage?
- Gram negative bacilli including pseudomonas
- Staph(levaquin has increased gram positive coverage)
Who can u not give a quinolone?
Children, kills childrens cartilage
What is cipro's dosing?
200-400 mg IV q12; 250-750 mg PO bid
What is levaquins dosing?
250-500mg IV or PO
What is avelox generic name?
What class is avelox?
What is Invanz generic name?
What are 2 main causes of antibiotic diarrhea?
- Pseudomembranous colitis-clostridium dificie
- Non-specific colitis-staph aureus
How to test for cdiff?
What gives u cdiff?
How to treat cdiff?
Oral vanc or flagyl 500mg po bid