Therapeutics - Infectious disease 5
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. What would you like to do?
What is the route of administration for all carbepenems?
All are IV only
Why are Carbapenems problematic for stepdown therapy?
There are no Oral formulations
Do carbepenems have good MRSA coverage?
Which antibiotics are described as the atom bomb of antibiotics?
- Carbepenems, because they have such broad spectrum
- Widest spectrum of all antibiotics
What is the spectrum for Carbepenums?
Everything on the charts except MRSA, E faecium and fungus
What group of antibiotics has the widest spectrum?
Do carbepeneums have cross reactivity with PCNs?
What are the major uses for Carbepenums?
- ESBL (extended spectrum beta lactamase producing organisms)-producing E. coli, K. pneumoniae
- Intra-abdominal infx
What is the dose for Ertepenem?
1 gram Q24 hours IV
What is the dose for Meropenem?
500 mg to 1 gram Q8 IV
What is the peak level of Meropenem?
49 ug/mL (1g)
What is the peak level of ertapenem?
154 ug/mL (1g)
What is the t1/2 for Meropenem?
- 1 hour
- Renal insufficiency: 10 hours
What is the t1/2 for Ertapenem?
- 4 hour
- Renal insufficiency: >4 hours
Which Carbapenem does not treat pseudomonas?
Which Carbepenems treat pseudomonas?
Meropenem, Imipenem or Doripenem
What is the advantage to Ertapenem?
Only carbepenem that is dosed daily
What are the AE of carbepenems?
- Seizure with unadjusted dose in renal insufficiency
- Rash, anaphylaxis, serum sickness
- C. difficile colitis
Why is Imipenem-cilastatin given together?
Cilastatin is used to inhibit the renal dihydropeptidase that is responsible for metabolizing imipenem. Other carbapenem – don’t have this problem
What are the aminoglycosides?
- Gentamicin – Garamycin
- Tobramycin – Nebcin, Tobi (inhalation)
- Amikacin – Amikin
What is the inhalation version of tobramycin?
What is streptomycin primarily used for?
Would you use an aminoglycoside against a G+ bug?
Would you use an aminoglycoside against G – bugs?
Yes, no G + coverage
What is the spectrum of aminoglycosides?
- G -:
- H flu
- N gon
- E. coli
- K. pneumon
- E. cloacae
- S. marcescenes
- P. aureuginosa
What is the route of administration for aminoglycosides?
What type of PK/PD activity do aminoglycosides have?
Peak conc dependant acviity
What other antibiotics are synergistic with aminoglycosides?
What is toxicity of aminoglycosides dependent on?
Trough concentration dependent
What are the main uses for Aminoglycosides?
- Enterococcal endocarditis
- TB tx – streptomycin, amikacin (usual resistant to other drugs)
- Option for Gm-negative infections
- Pseudomonal lung infx – tobi (inhalation)
What route of elimination is used by aminoglycosides?
What should you monitor for with aminoglycoside use?
- Renal (renal elimination) = BUN, SCr
- Neuromuscular blockade
- Potentiating drugs: ampho B, cisplatinum, cyclosporine, loops, vanco, contrast dyes, NSAIDs
What are the AEs for Aminoglycosides?
- Renal failure-leading to dialysis
- Ototxicity- 8th cranial damage/vestibular damage (irreversible)
- Neuromuscular blockade – often post-surgery
How do you treat neuromuscular blockade by Aminoglycosides?
Give calcium IV
What drugs potentiate the SEs of aminoglycosides?
Ampho B, cisplatinum, cyclosporine, loops, vanco, contrast dyes, NSAIDs
What are the macrolides ?
- Erythromycin – E-mycin
- Clarithromyin – Biaxin (XL)
- Azithromycin – Zithromax (ER)
- Fidaxomicin – Dificid
What are the PO macrolides ?
What are the IV Macrolides (-mycin)?
Are Macrolides (-mycin) bacteriostatic or bactericidal?
Do you need to adjust the dose of Macrolides (-mycin)for renal insufficiency?
What is the most important PK/PD factor for Macrolides (-mycin)?
What are macrolides (-mycin) CI in?
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