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What is Fidoxamicin (Macrolide) only indicated for and why?
C. diff, because it is not absorbed through the GI
Describe the spectrum for macrolides (chart):
- G +: No MRSA (poor staph), poor/Ok strep, no enterococcus, poor peptostreptococcus (8)
- G - : Poor H. flue (8), good N. gon, Chlamydia, Helicobacter, Legionella, Listeria, M. pneumonia
- No E. coli!
What are macrolides mainly used for?
- CAP, MAC, pertussis, chlamydia, gonococcal STDs, UTRIs, Bacterial conjunctivitis
What is a normal dose of a macrolide?
- Azithromycin 500mg x 1 then 250mg qd x 4 days
- Clarithromycin 500 mg BID
- Erythromycin – 250-500 mg TID-QID
- Fidoxamicin 200 mg BID x 10 d
What is a normal dose of Azithromycin?
500mg x 1 then 250mg qd x 4 days
What is a normal dose of Clarithromycin?
500 mg BID
What is a normal dose of Erythromycin?
250-500 mg TID-QID
What is a normal dose of Fidoxamicin?
200 mg BID x 10 d
What are the peak levels of PO macrolides?
- 0.1-2 (Erythromycin)
- 3-4 (Clarithromycin)
- 0.4 (Azithromycin)
What are the peak levels for IV macrolides?
- 3-4 (Erythromycin)
- 3.6 (Azithromycin)
What is the T1/2 of macrolides?
- Erythromycin: 2-4
- Clarithromycin: 5-7
- Azithromycin: 68
What should you monitor for with Macrolides?
- QT prolongation
What drugs can cause CYP450 interactions with Macrolides?
- (Other than Azithromycin)
- Midazolam, Triazolam
- Phenytoin, carbemazipine, valproic acid
- Theophylline, Warfarin
- Ritonavir, Lopinavir, Atazanavir, Darunavir and Ertavirine
Which oral Macrolide can stimulate GI motility?
How should you counsel/screen people for aminoglycosides?
- Counsel: warn about problematic, N/V/D
- Screen: Look for CYP450 interactions (except with Azithromycin)
What are the Tetracyclines?
Which Tetracyclines are PO?
Which Tetracyclines are IV?
Doxycycline, Minocycline and Tigecycline
Describe the spectrum of Doxycycline (chart):
- G +: Good staph, some MRSA (step down for MRSA cellulitis), Good Group A strep, OK epptostreptococcus (4)
- G-: good H. flu, N. gon and E. coli
- Good Atypical coverage: Chlamydia, Legionella, Micoplasma
Can you treat multi drug resistant acinitobacter with a doxycycline?
How does Tigecycline differ in its coverage from Doxycycline?
- Has MRSA coverage
- Better enterococcus and S. pneumonia coverage
- Better G- activity
- Added G – coverage of E. cloacae
What are the peak levels for Doxycycline ?
What is the oral bioavailability for Doxycycline?
What is the half-life for Doxycycline?
What is the half life of Tigecycline?
What is the peak level of Tigecycline?
What are the main uses for Tetracyclines?
- MRSA step down
- DOC- Ricketsial illness (Typhus, RMSF, Lyme)
- MDR acinetobacter (Tugecycline)
- DOC – anthrax
Tetracyclines are the Drug of choice for what infections?
- Ricketsial (Tyfus, RMSF and Lyme disease)
What is the dosing interval form tetracyclines?
What is the dose for tetracyclines?
- Doxycycline 100 IV/po BID
- Minocycline 100 IV/PO BID
- Tigecycline 100 LD then 50 IV BID
What is the dose for Doxycycline?
100 IV/po BID
What is the dose for Minocycline?
100 IV/PO BID
What is the dose for Tigecycline?
100 LD then 50 IV BID
What should you counsel a patient on when they receive a Tetracycline?
- N/V diarrhea (particularly with Tigecycline)
- Avoid Al, Fe and Mg with PO (all trivalent cations)
When and why should you avoid tigecycline?
- MRSA Bacteremia
- Because its levels are not high enough to be effective enough for this
What is the ending for Flouroquinolones?
What are the Flouroquinolones?
- Ciprofloxacin (Cipro)
- Levofloxacin (Levaquin)
- Moxifloxacin (Avelox)
- Gemifloxacin (Factive)
- Norfloxacin (Noroxin)