Antibiotic Basics: Difference between revisions
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==Beta-Lactams==
==Beta-Lactams==
'''* Penicillin'''
*'''Penicillin'''
** Strep Pharyngitis (including scarlet fever) Streptococcal Toxic Shock and Necrotizing Fascitis
** Strep Pharyngitis (including scarlet fever) Streptococcal Toxic Shock and Necrotizing Fascitis
*** Penicillin ''plus'' clindamycin (to decrease toxin synthesis)
*** Penicillin ''plus'' clindamycin (to decrease toxin synthesis)
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** Nafcillin, oxacillin, dicloxacillin
** Nafcillin, oxacillin, dicloxacillin
*** Agents of 1st choice for treatment of S. aureus and S. epidermidis that are not methicillin-reistant
*** Agents of 1st choice for treatment of S. aureus and S. epidermidis that are not methicillin-reistant
'''* Expanded-Spectrum Penicillins'''
*'''Expanded-Spectrum Penicillins'''
** Ampicillin, amoxicillin (+ clavulanate)
** Ampicillin, amoxicillin (+ clavulanate)
*** Upper Respiratory Infections (due to S. pyogenes, S. pneumoniae, H. influenzae)
*** Upper Respiratory Infections (due to S. pyogenes, S. pneumoniae, H. influenzae)
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*** Infection following burns
*** Infection following burns
*** Neutropenia
*** Neutropenia
'''* 1st Gen Cephalosporins'''
*'''1st Gen Cephalosporins'''
** Cefazolin, cephalexin
** Cefazolin, cephalexin
*** Skin and soft tissue infections (why is agent of choice before gen sx)
*** Skin and soft tissue infections (why is agent of choice before gen sx)
** [[Ceftriaxone_Cross-reactivity|Cross-reactivity of PCN]] allergy <10%
** [[Ceftriaxone_Cross-reactivity|Cross-reactivity of PCN]] allergy <10%
'''* 2nd Gen Cephalosporins'''
*'''2nd Gen Cephalosporins'''
** Cefuroxime
** Cefuroxime
*** Intestinal anaerobes (why is agent of chioce for colorectal sx)
*** Intestinal anaerobes (why is agent of chioce for colorectal sx)
*** Largely displaced by 3rd gen agents
*** Largely displaced by 3rd gen agents
* '''3rd Gen Cephalosporins'''
*'''3rd Gen Cephalosporins'''
** Ceftriaxone, Ceftazidime, Cefixime
** Ceftriaxone, Ceftazidime, Cefixime
*** Drug of choice for serious infections due to:
*** Drug of choice for serious infections due to:
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*** Meningitis (+ vanc and ampicillin)
*** Meningitis (+ vanc and ampicillin)
*** Pseudomonas meningitis (+ AG)
*** Pseudomonas meningitis (+ AG)
* '''4th Gen Cephalosporins'''
*'''4th Gen Cephalosporins'''
** Cefepime
** Cefepime
*** Resistant, nosocomial infections
*** Resistant, nosocomial infections

Revision as of 06:43, 5 February 2014

Beta-Lactams

  • Penicillin
    • Strep Pharyngitis (including scarlet fever) Streptococcal Toxic Shock and Necrotizing Fascitis
      • Penicillin plus clindamycin (to decrease toxin synthesis)
    • Meningococcus Meningitis
    • Syphilis (Primary, 2ndary, and latent syphilis < 1 year duration)
    • Actinomycosis
    • Anthrax
    • Clostridial infections
    • Listeria
    • Pasteurella
  • Penicilinase-Resistant Penicillins
    • Nafcillin, oxacillin, dicloxacillin
      • Agents of 1st choice for treatment of S. aureus and S. epidermidis that are not methicillin-reistant
  • Expanded-Spectrum Penicillins
    • Ampicillin, amoxicillin (+ clavulanate)
      • Upper Respiratory Infections (due to S. pyogenes, S. pneumoniae, H. influenzae)
        • Sinusitis
        • Otitis media
        • Acute exacerbation of chronic bronchitis
      • Listeria
  • Antipseudomonal Penicillins
    • Piperacillin
      • Infection following burns
      • Neutropenia
  • 1st Gen Cephalosporins
    • Cefazolin, cephalexin
      • Skin and soft tissue infections (why is agent of choice before gen sx)
    • Cross-reactivity of PCN allergy <10%
  • 2nd Gen Cephalosporins
    • Cefuroxime
      • Intestinal anaerobes (why is agent of chioce for colorectal sx)
      • Largely displaced by 3rd gen agents
  • 3rd Gen Cephalosporins
    • Ceftriaxone, Ceftazidime, Cefixime
      • Drug of choice for serious infections due to:
        • Klebsiella
        • Enterobacter
        • Proteus
        • Haemophilus
      • Gonorrhea
      • Lyme disease
      • Meningitis (+ vanc and ampicillin)
      • Pseudomonas meningitis (+ AG)
  • 4th Gen Cephalosporins
    • Cefepime
      • Resistant, nosocomial infections
  • Carbapenems
    • Imipenem (+ cilastatin), meropenem
      • Cephalosporin-resistant nosocomial bacteria
      • Empirical treatment of serious infections in patients who recently received other b-lactams
  • Aztreonam
    • Antimicrobial activity more closely resembles AG's (only active against gram -)
      • Enterobacter, pseudomonas, H. influenzae, gonococci
      • Little allergic cross-reactivity with B-lactam antibiotics

Aminoglycosides

  • Gentamicin, amikacin, streptomycin (either alone or with B-lactam)
    • Serious gram-negative bacillary infections
      • Ill patient with pyelonephritis
      • Meningitis (due to Pseudomonas, Acinetobacter)
      • Peritoneal Dialysis–Associated Peritonitis
      • Bacterial endocarditis?
  • Caution: Use in patients with Myasthenia Gravis, can precipitate crisis

Sulfonamides

  • Trimethoprim-sulfamethoxazole
    • 1st line for uncomplicated lower UTI (especially chronic and recurrent infections)
    • PCP pneumonia
    • Acute exacerbations of chronic bronchitis
    • Maxillary sinusitis

Fluoroquinolones

  • UTI (2nd line)
  • Prostatitis
  • Chlamydia
  • PID
  • Traveler's diarrhea

Tetracyclines

  • Mycoplasma
  • Chlamydia
  • PID (combined with cephalosporin)
  • Epididymitis
  • Anthrax

Macrolides

  • Erythromycin, Clarithromycin, Azithromycin
    • Community-acquired PNA
    • Mycoplasma
    • Legionnaires' Disease
    • Chlamydia (single dose)
    • H. Pylori
    • Traveler's diarrhea (children and pregnant women)

Clindamycin

  • Drug of choice for lung abscess and anaerobic lung and pleural space infections
  • Toxin-mediated disease, i.e. toxic shock syndrome (TSS)

See Also

Source

Goodman & Gilman's Pharmacology

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