[PDF] [PDF] Pocket Guide for Antibiotic Pharmacotherapy - University Health

[PDF] Pocket Guide for Antibiotic Pharmacotherapy - University Health

Generally reserved for severe, resistant gram-positive infections (e g MRSA, VRE) if vancomycin failure or resistant Highly bioavailable, PO = IV Higher toxicity 

[PDF] Table of Contents - WHO World Health Organization

In order to revise the list, a comprehensive summary of systematic reviews and meta-analyses of antibiotics used to treat the high-priority infectious diseases 

[PDF] Antibiotics & Common Infections - RxFiles

content/uploads/info-sheet-english pdf 4 Handouts avoid antibiotics for infections of Examples: levofloxacin LEVAQUIN 500-750 mg po once daily x 5 days

[PDF] Categorisation of antibiotics - European Medicines Agency

12 déc 2019 · Global priority list of antibiotic-resistant bacteria to guide research, discovery, and antimicrobial-agents-30-european-countries-2015_en pdf

[PDF] ANTIBIOTICS

antibiotics used today in clinical medicine Examples: amphotericin B, erythromycin, streptomycin, tetracycline, neomycin, and vancomycin V Mechanism of 

[PDF] Antibacterial Drugs

Table 1 Main classes of antibiotics Class Examples β-Lactams Penicillins Penicillin G, penicillin V, methicillin, oxacillin, cloxacillin, dicloxacillin, nafcillin 

[PDF] Lecture: Bacteria, antibiotics and antibiotic resistance

Antibiotics are medicines for bacterial infections • Examples of antibiotics: – Penicillin and 0909_TER_The_Bacterial_Challenge_Time_to_React pdf  

[PDF] Antibiotics List

ANTIBIOTIC CODE MIC =g/mL REF Amount REF Amount + AMIKACIN AK 0 016 - 256 92018 30 920180 100 + AMOXICILLIN AML 0 016 - 256 92021

[PDF] Antimicrobial Treatment Guidelines for Common Infections

These guidelines provide general recommendations for appropriate antibiotic use in examples include: immunocompromised patients, diabetic foot infections, 2 2015 http://www nccn org/professionals/physician_gls/ pdf / infections pdf

[PDF] Antibiotic Overview

When several antibiotics have similar coverage, select the least expensive Antibiotic Classes by Coverage: Gram positive coverage: 1 Penicillins (ampicillin , 

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Julius Li, PharmD; Kristi Traugott, PharmD, BCPS Revised 03/15

Spectrum of Activity Against Common Bacteria

Refer to hospital antibiogram for susceptibility rates of specific organisms

Penicillin G

Oxacillin

Ampicillin

Amox -Clav Amp -Sulb Pip -Tazo

Cefazolin

Cefuroxime

Cefoxitin

Ceftriaxone

Ceftazidime

Cefepime

Ceftaroline

Ertapenem

Imipenem

Meropenem

Aztreonam

Aminoglycosies

Ciprofloxacin

Moxifloxacin

Levofloxacin

Doxycycline

Minocycline

Tigecycline

Polymyxins

Vancomycin

Daptomycin

Linezolid

Quinu/Dalfo

Clindamycin

TMP -SMX

Metronidazole

Nitrofurantoin

Azithromycin

Clarithryomycin

Beta-hemolytic streptococci * + + + + + + + + + + + + + + + + + ± + + + + + + + ± + + Viridans group streptococci + + + + + + + + + + + + + + + + + + + + + + + + + + Streptococcus pneumoniae + + + + + + + + + + + + + + + + + + + + + + + + + + Staphylococcus aureus (MSSA) ± * + + + * + + + + + + + + + + + + + + + + + + + + + + Staphylococcus aureus (MRSA) + + + + + + * + + + + + + ± ± Enterococcus faecalis + * + + + + + + + + + + + + + + Enterococcus faecium ± + + + + + + + + + + Escherichia coli + + + + + + + + + + + + + + + + + + + + + + + + +

Klebsiella spp. + +

Enterobacter spp. + + + * + + + + + + + + + + + + + + + Citrobacter spp. + + + * + + + + + + + + + + + + + + + Serratia spp. + + + * + + + + + + + + + + + + + Proteus spp. + + + + + + + + + + + + + + + + + + + + Acinetobacter spp. + + + + + + + + + + + + + + + + Pseudomonas aeruginosa + + + + + + + + + + + Stenotrophomonas maltophilia ± + + + * Bacteroides spp. + + + + + + + + ± ± + + + + + + + Prevotella spp. + + + + + + + + + + + + + + + + + Clostridium spp. + + + + + ± ± + ± ± ± ± + Peptostreptococcus spp. + + + + + + + + + + + + + + + + + + + + + + + + ± Atypicals + + + + + + + + Bug Drug * = drug of choice

Pocket Guide for Antibiotic Pharmacotherapy

Time-dependent Concentration-dependent

x Optimize killing by maximizing time above MIC x More frequent administration or extended- infusion increases efficacy by extending T>MIC x Ex: beta-lactam antibiotics x Optimize killing by maximizing peak concentrations x Less frequent but higher doses increases efficacy by maximizing Cmax:MIC ratio x Ex: aminoglycosides, daptomycin

Bacteriostatic versus Bactericidal

DzECSTaTiC for bacteriostaticdz DzVery Proficient For Complete Cell Murderdz

Erythromycin (macrolides)

Clindamycin (lincosamides)

Sulfonamides

Trimethoprim

Tetracyclines

Chloramphenicol

Vancomycin

Penicillins

Fluoroquinolones

Cephalosporins

Carbapenems

Metronidazole

Antibiotic Pharmacokinetics & Pharmacodynamics

Julius Li, PharmD; Kristi Traugott, PharmD, BCPS Revised 03/15

Microbiome Man

Oral flora

Streptococci

Staphylococci

Lactobacillus spp.

Diphtheroids

Porphyromonas spp.

Fusobacterium spp.

Actinomyces spp.

Respiratory flora

Streptococci

Staphylococci

Diphtheroids

Neisseria spp.

Haemophilus spp.

Moraxella spp.

Yeasts

Gut flora

Enterobacteriaceae

Bacteroides spp.

Clostridium spp.

Lactobacillus spp.

Candida spp.

Streptococci

Enterococci

Staphylococci

Skin flora

Staphylococci

Streptococci

Diphtheroids

Micrococci

Propionibacterium spp.

Peptostreptococci

Erythromycin, azithromy-

cin, clarithromycin GI upset (nausea, vomiting, diarrhea) QT prolongation Inhibits 3A (ery > clari >> azi) QT prolongation risk = ery >> clari > azi

Glycopeptides

Vancomycin Red man syndrome

Nephrotoxicity

Neutropenia (rare) None Red man syndrome can be prevented by slowing infusion rates or premedicate with diphenhydramine IV vanc for systemic infections, PO vanc for C. difficile infection

Cyclic Lipopeptide

Daptomycin Skeletal muscle toxicity

Eosinophilic pneumonia None Generally reserved for severe, resistant gram-positive infections (e.g.

MRSA, VRE) if vancomycin failure or resistant

Not for pulmonary infections (deactivated by lung surfactant)

Oxazolidinone

Linezolid

Thrombocytopenia

Peripheral neuropathies Inhibits MAO (weak)

p-glycoprotein substrate Generally reserved for severe, resistant gram-positive infections (e.g.

MRSA, VRE) if vancomycin failure or resistant

Highly bioavailable, PO = IV

Higher toxicity risk with long-term therapy (>2 weeks) Higher risk for serotonin syndrome with due to MAO inhibition with serotonergic agents (e.g. SSRIs, TCAs) and foods (e.g. red wine)

Lincosamide

Clindamycin GI upset (diarrhea > nausea, vomiting) Elevated LFTs (minor) None Increasing resistance in S. aureus and streptococci may limit use Increasing resistance in anaerobes, particularly Bacteroides spp.

Sulfonamides

Trimethoprim-

sulfamethoxazole Hypersensitivity reactions

Leukopenia, anemia

Hyperkalemia, renal failure None Highly bioavailable, PO = IV Dose for severe infections = 15 mg/kg/day based on TMP component (e.g. PCP, Nocardia spp.)

Nitroimidazole

Metronidazole GI upset (nausea)

Peripheral neuropathy

Taste disturbances (metallic) None Highly bioavailable, PO = IV

Excellent anaerobic activity

Avoid alcohol due to disulfiram reaction

Higher risk for peripheral neuropathies with long-term therapy

Nitrofurans

Nitrofurantoin Peripheral neuropathy

Pulmonary toxicity

Hepatotoxicity (rare) None Only used for UTIs, but without pyelonephritis Do not use with poor renal function (low urinary penetration) Low resistance = good option for multidrug resistant organisms

Aminoglycosides

Gentamicin, tobramycin,

amikacin Nephrotoxicity

Ototoxicity

Vestibular toxicity None Tobramycin preferred for P. aeruginosa infections May be used synergistically for severe gram-positive infections Ami = may have activity even if gent or tobra resistant

Polymyxins

Colistin, polymyxin B Nephrotoxicity

Neurotoxicity (oral/peripheral paresthesias) None Last line for MDR-GNs due to high toxicity risk and limited efficacy

Consider polymyxin B for systemic infections and colistin for UTIs Antibiotic Adverse Reactions Drug Interactions Clinical Pearls

Penicillins

Penicillin G, oxacillin,

ampicillin, amoxicillin

GI upset (nausea, diarrhea)

Hypersensitivity reactions

Leukopenia, thrombocytopenia (rare)

Neurologic (altered mental status, seizures)

Interstitial nephritis

Hepatotoxicity (oxacillin) None Generally drugs of choice for bacteria once susceptibility known (e.g. MSSA, penicillin-susceptible S. pneumoniae, ampicillin- susceptible enterococci)

Beta-lactam inhibitor

combinations amoxicillin-clavulanate, ampicillin-sulbactam, piperacillin-tazobactam None Excellent anaerobic activity Sulbactam has unique activity against Acinetobacter spp. (doses based on sulbactam, >6 g/day) Consider amox-clav 500-125 mg q8h dosing for gram-negative, an- aerobic, or mixed infections (more clavulanate needed)

Cephalosporins

Cefazolin, ceftriaxone,

ceftazidime, cefepime, ceftaroline None Cross-reactivity with penicillin allergy <5% Caution with third generation cephalosporins (e.g. ceftriaxone) and

SPACE bugs+ (ampC producers)

Carbapenems

Ertapenem, imipenem,

meropenem, doripenem None Generally reserved for multidrug resistant gram-negatives (MDR-GN)

Drug of choice for ESBL producers

Excellent anaerobic activity

Cross-reactivity with penicillin allergy <5%

Monobactams

Aztreonam None Generally reserved for severe penicillin allergy (e.g. anaphylaxis), but may cross-react with ceftazidime allergy

Fluoroquinolones

Ciprofloxacin

Moxifloxacin

Levofloxacin GI upset (nausea, vomiting, diarrhea)

Neurologic (dizziness, AMS, seizures)

Phototoxicity

Tendonitis, cartilage erosion

QT prolongation

Dysglycemia

Peripheral neuropathies Caution with cations (reduced bioavailability) Inhibits 1A2 (cipro) Increasing resistance may limit use, particularly with E. coli Higher dose for P. aeruginosa (e.g. cipro 750 mg q12h, levo 750 q24h)

Highly bioavailable, PO = IV

Moxifloxacin = poor urine penetration (not used for UTIs)

QT prolongation risk = moxi > levo >> cipro

Tetracyclines

Doxycycline

Minocycline

Tigecycline GI upset (nausea, vomiting, epigastric distress)

Photosensitivity

Teeth discoloration

Vertigo (minocycline) Caution with cations (reduced bioavailability) Highly bioavailable, PO = IV (doxy, mino) Tige = severe nausea, may need scheduled antiemetics pre-dose Mino, tige = has activity against multidrug resistant organisms (even if tetra or doxy resistant) Antibiotic Pharmacotherapy by Class

Refer to Guidelines for Dosing in Renal Failure for both dosing in normal renal function and renal dose adjustments

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