Antibiotic Basics: Difference between revisions

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Beta-Lactams
<font size="150%">Beta-Lactams</font>


* Penicillin
* '''<font size="115%">Penicillin</font>'''
* 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)
** Meningococcus Meningitis
** Syphilis (Primary, 2ndary, and latent syphilis < 1 year duration)
** Actinomycosis
** Anthrax
** Clostridial infections
** Listeria
** Pasteurella
* <font size="115%">'''Penicilinase-Resistant Penicillins'''</font>
** Nafcillin, oxacillin, dicloxacillin
*** Agents of 1st choice for treatment of S. aureus and S. epidermidis that are not methicillin-reistant
* <font size="115%">'''Expanded-Spectrum Penicillins'''</font>
** Ampicillin, amoxicillin (+ clavulanate)
*** Upper Respiratory Infections (due to S. pyogenes, S. pneumoniae, H. influenzae)
**** Sinusitis
**** Otitis media
**** Acute exacerbation of chronic bronchitis
*** Listeria
* '''<font size="115%">Antipseudomonal Penicillins</font>'''
** Piperacillin
*** Infection following burns
*** Neutropenia
* <font size="130%">'''1st Gen Cephalosporins'''</font>
** Cefazolin, cephalexin
*** Skin and soft tissue infections (why is agent of choice before gen sx)
** Cross-reactivity of PCN allergy 7% to 18% 
* <font size="130%">'''2nd Gen Cephalosporins'''</font>
** Cefuroxime
*** Intestinal anaerobes (why is agent of chioce for colorectal sx)
*** Largely displaced by 3rd gen agents
* <font size="130%">'''3rd Gen Cephalosporins'''</font>
** 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)
* <font size="130%">'''4th Gen Cephalosporins'''</font>
** Cefepime
*** Resistant, nosocomial infections
* <font size="130%">'''Carbapenems'''</font>
** 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 AGs (only active against gram -)
*** Enterobacter, pseudomonas, H. influenzae, gonococci
*** Little allergic cross-reactivity with B-lactam antibiotics


 
<font size="150%">Aminoglycosides</font>
* 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 7% to 18% 
* 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 AGs (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)
* Gentamicin, amikacin, streptomycin (either alone or with B-lactam)
* Serious gram-negative bacillary infections
** Serious gram-negative bacillary infections
* Ill patient with pyelonephritis
*** Ill patient with pyelonephritis
* Meningitis (due to Pseudomonas, Acinetobacter)
*** Meningitis (due to Pseudomonas, Acinetobacter)
* Peritoneal Dialysis–Associated Peritonitis
*** Peritoneal Dialysis–Associated Peritonitis
* Bacterial endocarditis?
*** Bacterial endocarditis?
* Caution: Use in patients with Myasthenia Gravis, can precipitate crisis
* Caution: Use in patients with Myasthenia Gravis, can precipitate crisis
 
 


Sulfonamides
<font size="150%">Sulfonamides</font>


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


Fluoroquinolones
<font size="150%">Fluoroquinolones</font>


* UTI (2nd line)
* UTI (2nd line)
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* PID
* PID
* Traveler's diarrhea
* Traveler's diarrhea


Tetracyclines
<font size="150%">Tetracyclines</font>


* Mycoplasma
* Mycoplasma
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* Epididymitis
* Epididymitis
* Anthrax
* Anthrax


Macrolides
<font size="150%">Macrolides</font>


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


Clindamycin
<font size="150%">Clindamycin</font>


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


Source: Goodman & Gilman's Pharmacology
Source: Goodman & Gilman's Pharmacology
[[Category:ID]]

Revision as of 05:13, 10 February 2011

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 7% to 18% 
  • 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 AGs (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)

Source: Goodman & Gilman's Pharmacology

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