ABX Cheat Sheet - ABX QN PDF

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ABX QN...

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ANTIBIOTICS CHEAT SHEET Mechanisms of action of antimicrobial agents. Cell wall synthesis

Beta-lactams- penicillins, cephalosporins, carbapenems, bacitracin, vancomycin, monobactam, lipoglycopeptides, lipopeptides

Protein synthesis

chloramphenicol, tetracyclines, aminoglycosides, macrolides, lincosamides, oxazolidinones

Cell membrane

polymyxins

Nucleic acid function

quinolones

Intermediary metabolism

sulfonamides, trimethoprim

Inhibitors of Folate Synthesis:



Sulfonamides- alteration of dihydropteroate synthase  Trimthoprim- inhibition of dihydrofolate reductase.

ANTIBIOTICS CHEAT SHEET Spectrum of Activity Broad Spectrum- ex: tetracyclines, carbapenems, 3rd gen quinolones, 2nd/3rd/4th gen cephalosporins, chloramphenicol, PCN w/beta-lactamase inhibitors Narrow Spectrum- ex: glycopeptides, bacitracin, aminoglycosides, sulfonamides, penicillin, lincosamides, macrolides, vancomycin, aztreonam *Think about what the ABX covers and the more it covers, the broader it is when treating infections. Atypical Coverage:

Pseudomonas Coverage:

Macrolides Tetracyclines Quinolones Chloramphenicol Ampicillin

Ciprofloxacin, Levofloxacin Aminoglycosides Some 3rd Gen Cephalosporins Cefepime (4th Gen Cephalosporin) Broad Spectrum PCN (Ticarcillin, Piperacillin)

Overview of Antibiotics

PCN Spectrum

Ticarcillin/clavulanate Piperacillin/tazobactum

Amoxicillin & Ampicillin (w/ beta-lactamase inhibitor)

Amoxicillin Ampicillin

*Gm +/-, ESBL, Pseudomonas

*Gm +/-, MSSA, Gm- anaerobes

*Gm +/-



*Gm +

Time-dependent killing and are bactericidal, except against Enterococci species. No atypical coverage. Coverage: o Natural PCN- Gram +, Enterococcus and anaerobes, Little Gram o AminopenicillinsAdds activity against Gram – (HNPEK) *Haemophilus, Neisseria, Proteus, E.coli, Klebsiella lactamase inhibitor- Adds activity against MSSA, more Gram -, Gram – Anaerobes very broad coverage with expanded Gram -, Pseudomonas aeruginosa tistaphylococcal PCN- enhanced activity with MSSA, lack Enterococcus activity DDI: o Probenecid can ↑ levels of PCN o Bacteriostatic antibiotics (ex: tetracyclines) can ↓ effectiveness of PCN o ↑ levels of methotrexate o ↓ levels of mycophenolate active metabolites o Nafcillin is a moderate CYP3A4 inhibitor o Dicloxacillin & nafcillin can ↓ INR through ↑ metabolism of warfarin

Narrow



Pen V (Natural)

*Gm +, MSSA

Penicillins 

Nafcillin Oxacillin Cloxacillin Dicloxacillin

ANTIBIOTICS CHEAT SHEET

Cephalosporins  



Time-dependent killing and are bactericidal. Not active against Enterococcus, atypicals, Listeria, MRSA (except 5th Generation (LAME). Coverage: o 1st- Excel against Gram + (preferred cephalosporin against MSSA) 2nd- Split into 2 groups 1) Cefuroxime like agents cover more resistant S.pneumoniae, HNPEK; 2) Cephamycin drugs (Cefotetan, Cefoxitin) have added anaerobic coverage o 3rd- Ceftriaxone, Cefotaxime and oral drugs cover more resistant Streptococci and more Gram -; Ceftazidime lacks Gram + and covers Pseudomonas o 3rd w/beta lactamase inhibitor combo- added activity against MDR Pseudomonas and Gram o 4th- broad Gram -, including Pseudomonas, Gram + o 5th- only beta-lactam with MRSA activity DDI: o Probenecid can ↑ levels of cephalosporins o Enhance anticoagulant effect of warfarin by inhibiting production of clotting factors o Drugs that ↓ stomach acid can ↓ bioavailability of some cephalosporins

Carbapenems  



Time-dependent killing and are bactericidal. Not active against atypical, MRSA, VRE. Coverage: o VERY BROAD COVERAGE “BIG GUN”, generally used for MDR Gram -, most Gram +, Gram – (including ESBL producing bacteria), anaerobes o Ertapenem is different and has NO activity against Pseudomonas, Acinetobacter or Enterococcus DDI: o Probenecid can ↑ levels of cephalosporins o ↓ levels of valproic acid leading to a loss of seizure control o Use in caution in patients at risk for seizures

Monobactam   

Aztreonam (similar to ceftazidime); acts like a beta-lactam, but it’s not…like splenda to sugar Structure makes cross-reactivity with beta-lactam allergy unlikely, primarily used when beta-lactam allergy is present. Coverage: o Similar to Ceftazidime lacks Gram +, covers Gram - and covers Pseudomonas

Aminoglycosides   

Concertation dependent killing and has post-antibiotic effect. Can use extended dose interval nomograms. Coverage: o Gram -, Pseudomonas DDI: o Use in caution with patients with impaired renal function

Quinolones  

Concertation dependent killing and are bactericidal. Coverage: o Broad spectrum (Gram +, Gram -, Atypicals)

ANTIBIOTICS CHEAT SHEET

o o

Gemifloxacin, Levofloxacin, Moxifloxacin (GLM)- respiratory quinolones due to enhanced coverage of S.pneumoniae and atypical coverage Ciprofloxacin, Levofloxacin- enhanced Gram -, including Pseudomonas Moxifloxacin- enhanced Gram + and anaerobic

o o o o

Products contained multivalent cations (ex: antacids, vitamins, calcium rich foods) can chelate and inhibit absorption ↑ effects of warfarin, sulfonylureas/insulin and QT-prolonging drugs (moxifloxacin prolongs QT interval the most) Probenecid and NSAIDs can ↑ quinolone levels Ciprofloxacin is a P-gp substrate, strong 1A2 inhibitor and weak 3A4 inhibitor

o



DDI:

Macrolides   

Bacteriostatic activity related to total exposure of the drug (AUC/MIC). Coverage: o Good Atypical activity DDI: o Erythromycin and clarithromycin are 3A4 inhibitors and substrates o Azithromycin is a substrate for 3A4 and inhibitor of 1A2 and P-gp; it has fewer drug interactions o ALL MACROLIDES: DO NOT USE WITH AGENTS THAT CAN PROLONG THE QT INTERVAL

Tetracyclines  



Bacteriostatic activity related to total exposure of the drug (AUC/MIC). Coverage: o Many Gram +, Gram -, including respiratory flora o Doxy- used in mild MRSA skin infections, VRE in UTI o Mino- enhanced Gram + and preferred for skin infections (acne) o Tetra- rarely used, can be used in H.pylori regimens DDI: o Absorption is impaired by medications that contain divalent cations o Tetracycline is a substrate of 3A4 and an inhibitor o Doxycycline is a weak 3A4 inhibitor o Enhance the anticoagulant effect with warfarin

Sulfonamides   

Individually they are bacteriostatic, but collectively they are bactericidal. Lacks Pseudomonas, Enterococci, atypical or anaerobic coverage. Coverage: o Gram +, including Staphylococci/MRSA, many Gram – DDI: o Inhibitors of 2C8/9 o Cause ↑ INR with warfarin o ↑ levels of sulfonylureas, metformin, phenytoin, dofetilide, azathioprine, methotrexate and mercaptopurine o Levels of SMX/TMP can be ↓ by 2C8/9 inducers o ↑ in hyperkalemia when used with ACE inhibitors, ARBs, aliskiren, potassium-sparing diuretics, cyclosporine, tacrolimus and more

Glycopeptide   

Vancomycin Coverage: o Gram +, MRSA, Streptococci, Enterococci (not VRE), C.difficile DDI: o ↑ toxicity of other nephrotoxic drugs and ototoxic drugs

Lipoglycopeptide  

Concentration-dependent killing and are bactericidal; (similar to Vancomycin, but have extended MOA) Coverage:

ANTIBIOTICS CHEAT SHEET 

o

Gram +, MRSA, Streptococci, Enterococci (not VRE), C.difficile

o

Telavancin- cause QT prolongation

DDI:

Daptomycin (Cubicin)   

Concentration-dependent killing and are bactericidal. Coverage: o Gram +, MRSA, Streptococci, Enterococci, including VRE, *same coverage as Vancomycin but covers more organisms DDI: o Additive risk of muscle toxicity with statins

Oxazolidinones   

Bacteriostatic activity. Coverage: o Gram +, MRSA, Streptococci, Enterococci, including VRE, *same coverage as Vancomycin but covers more organisms DDI: o Weak MAOI (caution in patients taking concurrent serotonergic or adrenergic drugs o Avoid tyramine-containing foods o Can exacerbate hypoglycemic episodes

Polymyxins   

Concentration-dependent killing and bactericidal. Use in combo with another antibiotic due to the emergence of resistance. Coverage: o Gram -, Pseudomonas, used primarily with MDR Gram – pathogens DDI: o Other nephrotoxic agents can enhance nephrotoxicity

Chloramphenicol  

Bactericidal Coverage: o Gram +, Gram -, anaerobes and atypicals

Lincosamides  

Bacteriostatic Coverage: o Most aerobic and anaerobic Gram +, some MRSA, does not cover Enterococcus

Urinary Agents  

 

Fosfomycin (Monurol)- inhibits bacterial cell wall synthesis by inactivating the enzyme pyruval transferase; bactericidal Coverage: o E.coli (including ESBLs) and E.faecalis (including VRE) Nitrofurantoin (Macrodantin, Macrobid, Furadantin)- bacterial cell wall inhibitor; bactericidal Coverage: o E.coli, Klebsiella, Enterobacter, S.aureus, Enterococcus (VRE)

ANTIBIOTICS CHEAT SHEET

Side Effect Chart (list not all inclusive) PCN Cephalosporins Carbapenems Monobactam Aminoglycosides Quinolones

Caution w/ anaphylaxis allergy, GI upset, diarrhea, rash, ↑ LFTs, seizures w/accumulation (Pregnancy B) Similar to PCN (N/V/D, rash and ↑ LFTs) (Pregnancy B) Nephrotoxicity, Ototoxicity (Pregnancy D) GI upset/diarrhea, QT prolongation, peripheral neuropathy, CNS effects, Hypoglycemia/hyperglycemia, ↑ LFTs, photosensitivity, crystalluria, Boxed warning: tendon inflammation and/or rupture, muscle weakness (Pregnancy C) QT prolongation, hepatotoxicity, GI upset, taste perversion, ↑ LFTs (Pregnancy B/C) Rash, ↑BUN, photosensitivity, N/V/D (Pregnancy D) Caution w/G6PD deficiency, N/V/D, anorexia, skin reactions, crystalluria, photosensitivity, ↑K, hypoglycemia, ↓ folate, ↑LFTs (Pregnancy C/D) GI upset, infusion reaction (red man syndrome), nephrotoxicity, myelosuppression, fever, ototoxicity (Pregnancy B-oral/C-IV) Metallic taste, N/V, QT prolongation (Pregnancy C)

Macrolides Tetracyclines Sulfonamides Vancomycin Lipoglycopeptides (Telavancin) Daptomycin Oxazolidinones Polymyxins Chloramphenicol

N/V/D, ↑CPK and myopathy (Pregnancy B) Thrombocytopenia, headache, N/D, anemia, myelosuppression (Pregnancy C) Nephrotoxicity, neurologic disturbances (Pregnancy C) Gray syndrome, myelosuppression, dermatologic (angioedema, rash, Uticaria) *rarely used due to side effects C.diff, Severe or fatal skin reactions (SJS), N/V/D, rash, urticaria (Pregnancy B) Peripheral edema, dizziness, headache, flatulence, nausea, rash (Pregnancy C) Optic neuritis, hepatoxicity, pulmonary toxicity, anemia, GI upset, headache, rash, brown urine discoloration (harmless)

Lincosamides Fosfomycin (urinary) Nitrofurantoin

Storage Refrigeration after reconstitution Pen VK, Ampicillin, Augmentin, Cephalexin, Cefpodoxime, Cefprozil, Cefuroxime, Vancomycin (oral) *all other do not refrigerate

No Renal Dose Adjustment *not all inclusive

Dicloxacillin, oxacillin, nafcillin Ceftriaxone Moxifloxacin Azithromycin, erythromycin Doxycycline, minocycline, tigecycline Linezolid Clindamycin Chloramphenicol

Refrigeration Recommended Amoxicillin (improves taste)...