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Principles of Disease
- Pathogen location
- Patient age and disease complications (COPD+pneumonia)
- Serious infections caused by other infections
antipyretics (Tylenol), analgesics, nutrition, respiratory care (pneumonias), and fluid hydration should always be included
- Sensitivity of pathogen
- Penetration to affected site
- Empiric therapy - first 48-72 hours
- Duration of therapy
- Supportive therapy
Effective for upper respiratory tract infections, skin and soft tissue, and urinary tract infections
(ex. otis media, sinusitis, pharyngitis)
Effective for lower respiratory tract infections...
- Macrolides- azithromycin, clarithromycin
- Fluoroquinolones- ciprofloxacin, levofloxacin, monifloxacin
- 3rd Generation Cephalosporin- Cefdinir
- Extended Spectrum Penicillin- amoxicillin, clavulanate
Effective for chlamydia, Rocky Mt spotted fever, Q fever, typhus fever, Lyme's disease, plaque, tularemia...
- Tetracyclines- deoxycycline, minocycline;
- also Azithromycin
(single 1 gram dose)
Not useful for UTIs...
- Tetracyclines: all
- Macrolides: all
- Fluoroquinolones: Moxifloxacin (Avelox, Vigamox)
- Nitroimidazole: Metronidazole (Flagyl)
Useful for UTIs and complicated pyelonephritis...
Other fluoroquinolones (ciprofloxacin, levofloxacin/Levaquin)
Effective for osteomeylitis, tuberculosis (mycobacteria), and anthrax...
Ciprofloxacin and levofloxacin (Cipro and Levaquin)
(both are fluoroquinolones)
Two for the 3-4 meds used to treat H. pylori GI infection and ulcers...
amoxicillin and metronidazole
(Amoxil/Trimox, and Flagyl)
Metronidazole (Flagyl) covers...
anaerobic only, no gram-positive (staph, strep) or gram-negative aerobes (E. coli, klebsiella, pseudomonas)
Metronidazole is used for...
- AAPC (antibiotic-associated pseudomembranous colitis caused by Clostridium difficile
- pelvic inflammatory disease caused by anaerobic bacteria
- H. pylori-related ulcers (in combo)
ADRs - Anti-infectives: GI and skin
GI: nausea, bomiting, diarrhea, stomach cramping
- Skin: hypersensitivity reactions - rash, hives, itching
- photosensitivity (fluoroquinolone tetracyclines, sulfonamides)
- hyperpigmentation (minocycline)
- MAY NOT BE ALLERGY
Used to treat AAPC - antibiotic-associated psuedomembranous colitis with C. difficile...
3. Penicillins and metronidazole
- 1. confusion, agitation, anxiety (rare)
- 2. dizziness, lightheadedness
- 3. seizures with very high doses
ADRs - Musculature
Floroquinolones may cause tendonitis and tendon rupture
(ciprofloxacin, levofloxacin, moxifloxacin)
ADRs - Pediatrics
- Tetracyclines cause tooth discoloration
- Fluoroquinolones cause joint abnormalities - usually contraindicated pregnancy through age 18!!!
- Sulfonamides cause kernicterus (extreem jaundice, brain damage) pregnancy-2months
- Antacids reduce absorbtion
- Divalent cations (incl. dairy, supplements, antacids) reduce absorbtion and effectiveness of oral tetracyclines and fluoroquinolones (Mg, Ca, Zn, Fe)
- Separate dosing of binding agents (Kaopectate, Sucralfate, Chlorestyramine)
Antibiotics may reduce effectiveness
- Clarithromycin and fluconazole can reduce p-450 metabolism of warfarin, increasing bleeding risk
- Monitor INRs, modify dose as needed
Alcohol contact warning...
metronidazole produces disulfiram-reaction (severe vomiting) with even trace contact with alcohol
Good lung penetration...
penicillins and cephalosporins - good
aminoglycosides - poor
3rd Gen cephalosporin
covers only gram-negative anaerobes...
Treat AAPC with...