Antibiotic Dosing: Class (common abx)

-Pen V: 250-500mg q6 PO -Pen G: 250,000 units/kg/day IV 2nd Generation: -Dicloxacillin: 250mg q6 PO (PCNase Resistant PCN) -Oxacillin: -2g q4 IV -Nafcillin: 1-2g q4 IV 3rd Generation: -Amoxicillin: 500mg q8 PO (AminoPCN) -Ampicillin: 1g q4-6 IV 4th Generation: -Augmentin: 875mg q12 PO (Amox-/clav-), RD = 250mg-500mg q24h (-lactamase PCN) -Unasyn: 1.5-3g q6 IV (Amp-/sulbactam) -Zosyn: 3.375-4.5g q6 IV (Piper-/tazobactam) -Timentin: 3.1g q6 IV (Ticar-/clavulanate) Cephalosporins 1st Generation:
nd

Antibiotic Dosing: Bacteria DOC

Staph Aureus -PO: Keflex -500mg PO tid or 750mg PO bid Clindamycin -300mg PO qid Zithromycin -500mg PO day 1, 250mg PO days 2-5 -IV: Ancef -1g IV q8 Vancomycin -1g IV q12 Clindamycin -600mg IV q8 Streptococcus -PO: Keflex -500mg PO tid or 750mg PO bid Clindamycin -300mg PO qid -IV: Ancef -1g IV q8 Vancomycin -1g IV q12 Clindamycin -600mg IV q8 MRSA -IV: -PO:

Penicillins 1st Generation:

2 Generation: 3rd Generation:

4th Generation:

-Keflex (cephalexin): 500mg q8 PO or 750mg PO bid, RD = 250 q12-24h -Duricef: 2g q24 PO -Ancef: 1g q8 IV -Ceftin: 500mg q12 PO -Zinacef: 1.5g q8 IV -Mefoxin: 1g q6 IV -Omnicef (Cefdinir): 300mg q12 PO, RD = 300mg every other day -Vantin: 400mg q12 PO -Rocephin: 1g q24 IV -Fortaz: 1g q8 IV -Cefobid: 2g q12 IV -Maxipime: 2g q12 IV

Vancomycin -1g IV q12 Bactrim -1 tablet PO bid

Enterococcus -PO: Amoxicillin -250-500mg tid Augmentin -875mg bid or 500mg tid (or bid) Zyvox -600mg PO bid -IV: Vancomycin -1g IV q12 Zyvox -600mg IVq12 VRA/VRE -PO: Zyvox (linezolid) -600mg PO bid -IV: Zyvox (linezolid) -600mg IV q12 Synercid -7.5mg/kg/hr over 1 hour q12 Pseudomonas -PO: Ciprofloxacin -IV: Ciprofloxacin Fortaz Aztreonam E.coli, Proteus -PO: Keflex Cipro Levaquin Tequin -IV: Ancef Cipro Levaquin Tequin

Quinolones- inhibits DNA gyrase, bacteriocidal 2nd Generation: -Ciprofloxacin: 750mg q12 PO/ 400mg q12 IV, RD = 250mg q12h 3rd Generation: -Levofloxacin (Levaquin): 500-750mg q24 PO/IV, RD = 250mg q24h th 4 Generation: -Tequin: 400 q12 PO/IV -Avelox (moxloxacin): 400 q24 PO Macrolides- binds to 50s ribosome inhibiting protein synth, bacteriostatic -Biaxin: 500mg q12 PO -Ketek: 800mg q24 PO -Zithromax: 500 q12 IV/ 500mg PO Day 1; 250 mg PO Day 2-5 -Erythromycin- 500mg q6 PO Carbapenems -Invanz: 1g q24 IV -Primaxin: 500mg q8 IV -Merrem 1g q8 IV -Amikacin: 1500mg/day -Tobramycin: 3-5mg/kg/day -Gentamycin: 3-5mg/kg/day check trough after 3rd dose

-250-750mg PO bid -400mg IV q12 -2g IV q12 -1g IV q8

Aminoglycosides

-500mg PO tid or 750mg PO bid -250-750mg PO bid -500mg PO qday -400mg PO qday -1g IV q8 -400mg IV q12 -500mg IV qday -400mg IV qday

Tetracyclines

Misc

-Minocycline (Minocin): 100mg q12 PO/IV -Doxycycline: 100mg q24 PO -Tetracycline: 500mg q6 PO -Tygacil (Tigecycline): 100mg loading dose; then 50mg q12 IV -Bactrim DS: 160/800mg q24 PO, RD = 1DS q24h -Aztreonam: 1g q8 IV -Vancomycin: 1g q12 IV, 125mg po qid for C.difficile colitis only -Clindamycin: 600mg q8 IV; 300mg q6 PO -Zyvox (linezolid): 600mg q12 PO/IV -Cubicin (Daptomycin): 4mg/kg q12 IV -Synercid (quinupristin/dalfopristin): 7.5mg/kg q8 IV -Flagyl: 500mg q8 PO -Rifampin: 300mg q12 PO/IV, RD = 300mg q24h -Primaxin (imipenem/cilistatin): 500mg q6h IV -Ertapenem (Invanz): 1g q24h IV

DOC -Aerobic Gram (+) Cocci Staph aureus MRSA Staph epi MRSE Enterococcus VRE Strept pyogenes (Group A) Strept agalactiae (Group B) Strept bovis (Group D) Strept Viridans 1-Ceph Vanco 2-PCN Vanco 3-PCN Linezolid 3-PCN 3-PCN 3-PCN 3-PCN

Alternatives Vanco, Clinda, Azithromycin Bactrim, Cubicin, Zyvox, Clinda 4-PCN, 1,2-Ceph, Vanco Zyvox, Cubicin, Synercid Vanco, Tetracyclines, Quinolones Macrobid, Cubicin, Chloramphenicol 4-PCN, 1,2-Ceph, Vanco, Clinda 4-PCN, 1,2-Ceph, Vanco, Clinda 4-PCN, 1,2-Ceph, Vanco, Clinda 4-PCN, 1,2-Ceph, Vanco, Clinda

Drug MOA/Coverage: PCN: act on PCN binding protein to inhibit cell wall synthesis, bactericidal Natural PCN- Strep, Non-PCNase Staph, Non-PCNase gonocooci, Clostridia AminoPCN- Strep, exterococci, Gram (-): E.coli, P.mirabilis, Shigella, Salmonella PCNase resistant- Staph (non-MRSA), Strep -Lactamase PCN- Staph (non-MRSA), Strep, Anaerobe (Bacteroides), Gram (-): enterobacter. pseudomonas: Zosyn (pipercillin-), Timentin (ticarcillin-) Ticarcillin/clavulanate: High sodium load (avoid in patients with CHF!!). Cephalosporins: inhibit cell wall synthesis, bactericidal, cross reactivity in 5-15% with PCN allergy 1st Generation: Staph, Strep, Anaerobes Gram (-): E.coli, P.mirabilis, Shigella, Salmonella 2nd Generation: Staph (less than 1st), Strep (same as 1st), Extended Gram (-): H.influenza, Proteus, Klebsiella, E.coli Anaerobic (Bacteroides): cefmetazole, cefoxitin rd 3 Generation: Staph, Strep (less than 1st & 2nd), Pseudomonas, Anaerobes. Neisseria Pseudomonas: ceftazadime, cefoperazone 4th Generation: greater Gram (-) coverage Quinolones: inhibits DNA gyrase, bactericidal Staph (non-MRSA), Gram(-): Pseudomonas, Enterobacter CI in children: defects in cartilage Aztreonam: Gram (-) aerobes (pseudomonas), NOT active against Gram(+) or aerobic organsims Aminoglycosides: binds 30s ribosome to inhibit protein synthesis, bactericidal Adverse rxn: ototoxicity(irreversible), nephrotoxicity (reversible), neuromuscular blockade Sulfonamides (TMP/SMX- Bactrim) Trimethoprim: inhibits bacterial dihydrofolate reductase Sulfamethoxazole: inhibits folic acid production Staph (CA-MRSA), Strep, Gram (-): Pseudomonas Macrolides: binds 50s bacterial ribosome inhibiting protein synthesis, bacteriostatic Mycoplasmic, Chlamydia, Legionella Gram (+): Pneumococcu, Strep, Staph, Cornybacteria Gram (-): Neisseria, Bordetella, B. Quintana, Camplobacter Vancomycin: binds to D-ala D-ala and inhibits cell wall mucopeptide formation Only Gram (+): Staph (DOC MRSA), Strep Given PO to treat psuedomembranous colitis: 125mg po qid Tetracyclines: binds 30s ribosomal subunit, avoid in pregnancy (affects bone growth of fetus) Staph, Strep, Gram (-): E.coli, Shigella, Klebsiella, H.influenza, some anaerobes 1st line therapy: Rocky Mountain Spotted Fever (Rickettsia), Q Fever (Coxiella) Rifampin: acts directly on messenger RNA synthesis Listeria species, N.gonorrhoeae, H.influenzae and Legionella pneumophila Mycobacterium infections, including tuberculosis & leprosy. Metronidazole: Anaerobes: B.fragilis, Clostridium, Peptostreptococcus, Prevotella 1st line for pseudomembranous colitis from C.difficile (2nd line = PO vancomycin) Renal dosing DO NOT require dose adjustment: Moxifloxacin, Clindamycin, Azithromycin, Linezolid, Minocycline, Metronidazole, Dicloxacillin DO require: Cipro, Levofloxacin, Cefdinir, Cephalexin, Amox/Clav, Rifampion, TMP/SMX

-Anaerobic Gram (+) Cocci Peptostreptococcus Clinda -Aerobic Gram Positive Rods Bacillus anthracis Cipro Corynebacterium diphtheriae Macrolide Listeria Monocytogenes 3-PCN -Anaerobic Gram Positive Rods Clostridium perfringens Ertapenam Clostridium difficile Flagyl Clostridium tetani Clinda -Aerobic Gram Negative Rods Pseudomonas Zosyn E. coli 3-Ceph Enterobacter Bactrim Proteus 3-PCN Vibrio Tetracyclines Y. pestis Aminoglycosides Shigella Cipro Salmonella Cipro Klebsiella 3-Ceph Serratia 3-Ceph/ E. Corrodens Augmentin P. multocida Doxycycline -Anaerobic Gram Negative Rods Bacteroides fragilis Ertapenam -Aerobic Gram Negative Cocci Neisseria Rocephin -Spirochetes Treponium pallidum Borrelia burgdorferi

3-PCN, 4-PCN, Carbapenems

3-PCN, Vanco, Clinda Clinda, Vanco, Bactrim, Carbapenems

Vanco, Clinda, 4-PCN, Tetracyclines Vanco Flagyl

1,2-Quin, Aztreonam, Primaxin 4-PCN, Bactrim, Quinolones Quinolone, Aztreonam, Carbapenems 3-Ceph, 4-PCN, Bactrim, Quinolones Bactrim, Cipro Bactrim, Cipro Bactrim, Amp, 4-PCN 3-PCN, 4-PCN, Bactrim 4-PCN, Bactrim, 2-Quin, Aminoglycosides Zosyn, Bactrim, Aztreonam, Quin Tetracyclines Bactrim, 3-PCN

Clinda, Flagyl

3-PCN, Quinolones

1-PCN 1-PCN

Tetracyclines, Macrolides Amox, Macrolides

MRSA Drugs: ORAL CA-MRSA- Bactrim, Linezolid, Minocycline, Doxycycline, Clindamycin HA-MRSA- Linezolid MRSA Drugs: PARENTERAL CA-MRSA & HA-MRSA - Quinupristin/Dalfopristin, Daptomycin, Tigecycline, Vanco PCN Extended Spectrum: anti-pseudomonal PCNs): Carcenicillin, Pipercillin, Mezlocillin, Ticarcillin, Azlocillin Vancomycin Peak/Trough: Monitor peaks (15-30mg/ml) & troughs (10-15mg/ml) Ototoxicity can be seen with vancomycin peak levels (>80 ug/mL) Surgical Prophylaxis: Indications: prolonged surgery (>2hrs), use of implants, trauma surgery, immunocompromised Cefazolin 1g IV, Clindamycin 600mg IV, Vacnomycin 1g IV Clindamycin susceptible / Erythromycin resistant staph Suspect inducible clindamycin resistance and ask lab to confirm with the D test. Disulfiram Reaction Drugs: Moxalactam, Cefoperazone, Metronidazole, Cefomandol, Cefoetan Empiric Therapy for Mammalian Bite Wounds 1) Ampicillin/sulbactam (Unasyn). 2) Amoxicillin/ clavulante (Augmentin). 3) Ciprofloxacin/Clindamycin (Cipro/Cleocin) *

Odor, Color and Appearance as Clues to the Infecting Organism yellow pus S. aureus (coagulase positive Staph) white pus S. epidermidis (coagulase negative Staph) green pus/exudate P. aeruginosa dishwater pus Strep. group A (necrotizing fasciitis) draining sinuses /granules* Mycetoma (Madura foot) Fruity odor P. aeruginosa Foul, fetid odor Anaerobes (B.fragilis in diabetic foot) Woods Light fluorescence Coral red C. minitissimum Green P. aeruginosa Red Bacteroides melaninogenicus Yellow Pityriasis versicolor