Spectrum: Gram positive and more gram negative’s  than 1st generation - gains activity vs H.influenza, Enterobacter, Neisseria.  Demystifying Drug Dosing in Renal Dysfunction, 1st ed., American Society of Health-System Pharmacists, 2019; Diagnostic Atlas of Renal Pathology, 3rd ed., Elsevier, 2017 Diseases of the Kidney & Urinary Tract, 8th ed., Lippincott Williams & Wilkins, 2007 Handbook of Dialysis Therapy, 5th ed., Elsevier, 2017 Aminoglycosides – On average, Amikacin >  Tobramycin  > Gentamicin - generally do not use as monotherapy for serious Pseudomonas infections except for UTIs (tend to have worse outcomes), only as 2nd agent added to primary beta lactam therapy. Resistance develops rapidly – not suitable for sustained therapy for severe infections. "SUPER GRAM NEGATIVE ANTIBIOTICS" THAT COVER PSEUDOMONAS, VIII. Clindamycin -50 S inhibitor (PO and IV) Similar to Zosyn, but Timentin has activity vs Stenotrophomonas, and is less effective vs Pseudomonas and Enterococci. Side Effects: photosensitivity, GI discomfort, teeth discoloration, inhibits bone growth in children, teratogenic, steatosis and hepatotoxicity. CDC’s core elements of hospital antibiotic stewardship programs. Additional Resources SUNet ID or VPN Access Required. Ampicillin/Sulbactam 3 g IV q6 hrs Minimal absorption and thus minimal side effects.  Dose = 200 mg bid. Spectrum: some Gram positives (Strep, Enterococcus, Listeria) but NOT MSSA, and limited Gram negative coverage.  Notable gram negative holes include Klebsiella, Moraxella, and SPICE A organisms. Used for:  Ceftriaxone used in many situations including community acquired PNA (with Azithromycin), meningitis (CTX has excellent CSF penetration), spontaneous bacterial peritonitis, some skin/soft tissue infections, bacteremia/endocarditis from susceptible strep, urinary tract infections/pyelonephritis, bone and joint infections, late Lyme disease, gonorrhea, pelvic infections, and more.Â, b. Ceftazidime (IV) (3rd/4th Generation Cephalosporin). Mechanism: bind to either 30 S or 50 S ribosomal unit.  Most are bacteriostatic, except for Aminoglycosides (generally considered cidal due to irreversible binding and disruption of outer cell membrane), 1. Posaconazole(PO only) Usually combined with beta lactamase inhibitors (see below) which confers broader activity; however, beta-lactamase component does not add activity vs Pseudomonas (so if Pseudomonas is sensitive, could use Piperacillin alone). 1. Main additional side effect = Lower seizure threshold – greatest risk w/ Imipenem (esp with renal failure), less w/ Meropenem. Dosing – SS = 400 mg (SMX) /80 mg (TMP), DS – 800/160 mg.  Dosing varies on indication.  Selected few: UTI – 1 DS tab po bid.  SSTI – 2 DS tab po bid.  PCP ppx – 1 DS tab po three times/week or qday, or 1 SS tab po qday.  PCP treatment – 5 mg/kg (TMP component) PO q8 hours x 21 days (usually 2 DS po q8 hours).Â, Common - Hypersensitivity (sulfas) and rashes, GI side effects, dose-dependent bone marrow suppression, increased creatinine (both from. Can be given in aerosolized form as well as IV (both forms used quite commonly in Cystic Fibrosis patients with resistant gram negative infections), Old drugs that had been long abandoned for routine use due to its toxicity Ã, CNS abscesses (Brain, epidural, subdural). Only Fluconazole has adequate urinary penetration.  Itraconazole has poor CNS penetration compared to the others.Â, Good urine penetration – used for symptomatic candidal cystitis.Â, Best bioavailability of the azoles – if GI system intact, perfectly acceptable to treat even invasive candidiasis with oral Fluconazole.Â. 1. We would like to show you a description here but the site won’t allow us. Ceftriaxone 1 g IV qday,  Ciprofloxacin 400 mg IV bid, or Levofloxacin 500 mg IV qday Anti-MRSA antibiotic: Vancomycin 15-20 mg/kg IV q12 hrs or Linezolid  600 mg PO/IV bid  Tetracyclines – Doxycycline, Tetracycline, Minocycline - 30S Inhibitors (PO and IV) Bactrim DS 1 tb po bid x 3 days, or Restricted Antibiotic Policy . From anesthesiologists and nurse anesthetists to emergency physicians and residents, this medical reference book will effectively prepare you to handle any critical incident during anesthesia. Ceftriaxone 1 g IV qday + Metronidazole 500 mg IV q8hrs, or a call to end use of the term “Red Man Syndrome. Comparison of the 3 broadest spectrum beta-lactams: Cefepime, Zosyn, and Carbapenems (non-Ertapenem) have activity against both Gram positive (MSSA, Strep) and Gram negative including Pseudomonas.  They do NOT cover: MRSA, VRE, Atypicals, among others. It explores the epidemiology of emphysema, the management of complications and surgical controversies in lung volume reduction surgery for emphysema (LVRS). Despite broad spectrum, only used for select indications. Included are drugs with activity against MRSA, Coag-negative staph, Streptococci, Enterococcus including VRE (except Vancomycin). Sepsis is a clinical syndrome of life-threatening organ dysfunction caused by a dysregulated response to infection. Spectrum: Relatively broad spectrum with some gram positive (MSSA, Strep), some gram negatives, and anaerobes.  Notable holes include NO Pseudomonal activity and other SPICE A organisms. *Ciprofloxacin is 2nd-line due to high rates of resistance (and should be reserved for other purposes). Used for:  all sorts of situations with suspected or proven gram positive infections from above organisms, including bacteremia, meningitis, PNA, skin/soft tissue, and more.  Drug of choice for gram positive infections in patients with severe beta-lactam allergy. Spontaneous Bacterial Peritonitis (SBP) in patients with ascites. Beware increasing resistance among Bacteroides – not a good choice for severe intraabdominal infections. 15 day course for Pseudomonas associated with decreased recurrence of disease. Anti-Staphylococcal Penicillins - Methicillin / Nafcillin / Oxacillin (IV), Dicloxacillin (PO) Check out the antimicrobial stewardship program guidelines below and other documents for more in-depth details, Vancomycin can be used for many infection types from bacteremia to infective endocarditis to osteomyelitis to pneumonia to meningitis, Each gram of vancomycin should be infused over at least 60 minutes, Too rapid of infusion of vancomycin can lead to histamine release which has been referred to as “red man” or “red neck” or “red person” syndrome. 3. 2016. Â. C. CEPHALOSPORINS - higher resistance to beta-lactamases à better anti-staph activity Oral options: Cephalexin 500 mg po q6 hours, Clindamycin, Dicloxacillin. ileus or toxic megacolon) where absorption of PO vancomycin may be unreliable.  Not recommended after 1st relapse due to cumulative neurotoxic effect. Load 200 mg IV once, then 100 mg IV qday. Macrolides - Erythromycin, Clarithromycin, Azithromycin -50S Ribosomal Inhibitor (PO and IV) Used for: Limited use in the U.S. due to potential toxicity (see below) – mainly for bacterial meningitis in patients with severe beta-lactam allergy (has activity vs S.pneumo, N.meningitidis, and H.influenza).  Used more widely in developing countries where benefit often outweighs risk. Spectrum: “Respiratory Fluoroquinolone” -  excellent activity vs. Strep pneumo, slightly less reliable Pseudomonas coverage than Cipro. 2. If MRSA (or MSSA) appears susceptible –, Traditionally causes highest rate of C.diff among all Abxs (~10%).Â. If severely ill - Cefepime 1 g IV q12 hrs, or Ceftazidime 1 g IV q8 hrs, or carbapenem if high risk for ESBL, or history of prior infections. Chapter 29 from the Competence Assessment Tools for Health-System Pharmacists Fourth Edition. Fosfomycin (PO) Example: Levofloxacin 500mg IV Q24H to ciprofloxacin 500mg PO Q12H. Used for: generally reserved for multidrug-resistant gram negative infections from above organisms, including pneumonia, bacteremia, and others. *Avoid Nitrofurantoin and Fosfomycin if pyelonephritis is a possibility (do not penetrate kidney tissue). Main side effects: Hypersensitivity reactions including anaphylaxis, Rashes, Bone marrow suppression, Interstitial Nephritis,  GI (nausea, diarrhea, and C.diff) interstitial nephritis, GI (nausea, diarrhea, and C.diff), seizures (mainly with high doses in renal failure). 1. Aztreonam – high rates of resistance at most institutions, so use only if PCN-allergic, and empirically double-cover. Dosing ; Reviews (25) Overview . Used for: Azithromycin - low-risk bronchitis, COPD exacerbations,  community-acquired pneumonia, sinusitis, Strep throat in PCN allergic patients, and more.  Used in conjunction with Ceftriaxone for CAP that requires hospitalization.  Used for MAC treatment (combination therapy) and for prophylaxis in HIV/AIDS patients with CD4 <50. Used for: Doxycycline - Skin and soft tissue infections when suspect community-acquired MRSA, respiratory tract infections, and unusual infections as above.  Drug of choice for early Lyme disease, and for Lyme prophylaxis after tick bite.  Also used for malaria prophylaxis, acne and rosacea.Â, 3. Used for: skin/soft tissue infections, pelvic infections, lung abscess, sinusitis.  Also has activity vs PCP (combine with primaquine) and toxoplasmosis (combine with pyrimethamine). 4. Bone marrow suppression – direct, dose-related effect that is reversible. 1. The only notable nonsusceptible organisms are Pseudomonas aeruginosa, the mycoplasmae and Francisella tularensis (the causative organism of tularaemia).. Pregnancy and breast feeding. Add MRSA coverage if purulent or severe disease.  Oral options include Bactrim 2 DS tabs bid (best) or Doxycycline 100 mg po bid (both have poor strep coverage so should be paired with one of the oral beta-lactams).  Clindamycin is an option but CA-MRSA resistance can exceed 50%. 3. Surgical Outcomes of Glansectomy and Split Thickness Skin Graft Reconstruction for Localized Penile Cancer. Hudes G, Carducci M, Tomczak P, et al. Bactericidal agent that is excreted into the urine and inhibits cell wall synthesis by interfering with peptidoglycan synthesis. Used for: Anaerobic infections usually in conjunction with other agents (since anaerobes usually part of a polymicrobial infection).  Also used for mild-moderate C.diff , and protozoal infections as above. Mechanism: Oxazolidinone class –unique ribosomal inhibitor (acts on 50S subunit).  Bacteriostatic agent. Southern Health Quick Guide for IV to PO Switch, Alberta Health Services IV to PO Quick Reference, University of Rhode Island IV to PO Quick Reference, Jackson Memorial Hospital Antibiotic IV to PO Conversion Policy & Procedure, Stanford Health Care IV to PO Policy & Procedure, Northern Health IV to PO Conversion Clinical Practice Standard, Nottingham University Hospitals Guideline for IV to PO Switch, Gloucestershire Hospitals IV to PO switch Guideline, Children’s Health Queensland Hospital and Health Service IV to PO Guideline, New York-Presbyterian Community Acquired Pneumonia and IV to PO Guideline, Infectious Diseases & Antimicrobial Stewardship, How Comirnaty Was Named: The Story Behind Pfizer’s Oddly Named mRNA Vaccine, Five Things For Pharmacists To Know About the COVID Delta Variant, IDstewardship Hard Enamel Pins – Best Pharmacy Gifts, Some of The Best Journal Article Titles In The Medical Literature, A Look At Piperacillin/Tazobactam Versus Carbapenems For ESBL Infections, A Comparison Of Bamlanivimab Versus Bamlanivimab-Etesevimab, COVID-19 Vaccine Resources For Pharmacists.

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