Infectious Diseases

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Aminoglycosides (AGs)

MOA: Bind 30S subunit of ribosomes. AE: nephrotoxicity/ototoxicity. Nephrotoxicity comparison: neomycin > gentamicin=tobramycin=amikacin=netilmicin>streptomycin. DI: Administering w/ vancomycin or loop diuretic can lead to more nephro/ototoxicity. Direct contact w/ penicillins can inactivate aminoglycosides. OTH: Bactericidal. Concentration dependent killer. Most effect on gram (-) some (+). Has post antibiotic effect against gram (-). Doesn’t penetrate pulmonary tissue well.


amikacin: AVL: IV, IM. PK: t1/2=2.5h. PB~10%. DOS: Adj for renal fxn. OTH: Covers Pseudomonas.


gentamicin: AVL: Avail IV, IM, implantable beads, topical. IND: Meningitis. AE: Nephrotoxicity, ototoxicity. LAC: Safe. PK: t1/2=2.5h. PB~10%. DOS: Adj for renal fxn. Std=1.5mg/kg q8h. Extended interval=4-7mg/kg once/d. OTH: Covers some MSSA (+), some Strep (+), some Enterococcus (+), GNR, Pseudomonas (-) but 2-4 times less active than tobramycin.


neomycin: IND: Surgical prophylaxis, hepatic encephalopathy, acne. AE: Naus, Vom, Diar, sore mouth, anorectal pain/irritation. PK: F=3%.


streptomycin: AVL: IM. IND: TB, MAC. AE: ototoxicity, Naus, Vom, vertigo, rash, fever; hives, edema. PK: t1/2=2.5h. DOS: Adj for kidney fxn.


tobramycin: AVL: IV, IM, ophthalmic, oral inhalation. IND: Cystic fibrosis. LAC: Safe. PK: t1/2=2.5h. DOS: Adj for renal fxn. Std=1.5mg/kg q8h. Extended interval=4-7mg/kg once/d. OTH: Covers some MSSA (+), some Strep (+), some Enterococcus (+), GNR, Pseudomonas (-).


 

Anthelmintics

mebendazole=Vermox: AVL: PO. IND: Threadworms/pinworms. MOA: Inhibits glucose update by helminthes. EVD: Close to 100% cure rate. May be best option in prg + lac. Fewer AEs than pyrantel pamoate. AE: Drowsiness, headache, diar, vom, dizziness, increased AST/ALT, flatulence, skin itch. DI: metronidazole (SJS risk), cimetidine inhibits metabolism of mebendazole. DOS: >2yo: 100mg single dose. Repeat in 1-2w.
pyrantel=Combantrin: AVL: PO. IND: Threadworms/pinworms. MOA: Interferes with neurologic function of helminth. EVD: Cure rate~90%. AE: Headache, naus, vom, diar, dizziness, drowsiness, abdominal pain, anorexia, transient increase in AST. CI: Liver disease. PRG: CI in 1st trimester. DOS: &gt1yo: 11mg/kg (base) as a single dose. Max=1g. Repeat in 2w. OTH: Full name pyrantel pamoate.


 

Antifungals

fluconazole: IND: Candidiasis (esophageal, peritoneal, UT, vaginal) infections, pneumonia. MOA: Interferes w/ fungal CYP 450 enzymes decreasing ergosterol synthesis and inhibiting membrane formation. ADM: AE: Naus2-7%, Vom2-5%, Diar2-3%, abdominal pain2-6%, Headache2-13%, skin rash2%, dizziness1%, increased liver enzymes. Increases QT interval. PK: t1/2=30h (20-50h). F=90%. PB=11-12%. Inhibits: 2C19 (strong), 2C9 (mod), 3A4 (mod), 1A2 (weak). Food doesn’t affect F. OTH: 6 months of weekly Tx did not show increased resistance.


 

Antimalarial

Malarone=(250mg atovaquone + 100mg proguanil): IND: Malaria (Tx and prophylaxis). AE: Naus11%, Vom12%, Dia8%, anorexia5%, fever11%, abdominal pain15%. CI: CrCl<30. DI: Tetracycline, metoclopramide, rifabutin and rifampicin (increased Cl). PK: t1/2=1-3d depending on weight. PB>99%.


 

Antiparasitics

ivermectin=Stromectol: AVL: PO (tab3mg) IND: Tx of intestinal strongyloidiasis and onchocerciasis (river blindness). MOA: Broad spectrum antiparasitic that affects invertebrate nerve and muscle cells, resulting in paralysis and death of parasite. EVD: ADM: Take on empty stomach w/ water. AE: Dizziness1-3%, pruritus1-3%, diar1-3%, naus1-3%, anorexia<1%, vom<1%, const<1%, fatigue<1%, abdominal pain<1%, somnolence<1%, vertigo<1%, tremor<1%, rash<1%, urticaria<1%, arthralgia/synovitis, axillary/cervical/inguinal lymph node enlargement and tenderness, skin edema, rash, fever, orthostatic hypotension, tachycardia, headache, abnormal sensation in the eyes, eyelid edema, anterior uveitis, conjunctivitis, limbitis, keratitis, chorioretinitis. CI: No safety/efficacy data in children <15kg. DI: Possible increased INR when used w/ warfarin. MON: Stool examination after dose to verify eradication. DOS: STRONGYLODIASIS: Single oral dose ~200μg/kg. Typical=1-5 tabs. If inefective, repeat course at 2 week intervals. ONCHOCERCIASIS: Single oral dose of ~150 μg/kg. Can retreat at 3 month intervals if necessary.

 

Antivirals

abacavir (ABC)=Ziagen: IND: HIV. ADM: T once/d w/ or without food. No food restrictions. AE: Naus,Vom, increased lipids, liver toxicity, bone loss, lactic acidosis, lipoatrophy, hypersensitivity rxn, MI risk. CI: HLA-B*5701(+) (abacavir allergy). OTH: Triumeq=(DTG+ABC+3TC) 1 tab daily. Drug Class: Nucleoside Reverse Transcriptase Inhibitors (NRTIs)


acyclovir=Zovirax: AVL: PO, topical and IV. IND: Genital HSV, shingles, and chickenpox. MOA: Inhibits DNA polymerase. EVD: IV 25% more effective than PO. AE: Naus,can crystalize in kidneys. PK: t1/2=3h. PB:9-23%. DOS:Depends on indication (first treatment, suppression, recurrent). Adjust for renal fxn.


adefovir: IND: chronic Hep B with cirrhosis. OTH: Drug Class: Nucleotide Reverse Transcriptase Inhibitors (NRTIs/NtRTIs).


atazanvir (ATV)=Reyataz: IND: HIV. ADM: T w/ food (requires gastric acidity for F). AE: Gallstones, kidney stones, dyslipidemia, insulin resistance, MI/stroke?, hepatitis. Can affect BG levels. DI: PPI, H2RA (need acidity for F). OTH: Drug class: Protease Inhibitors (PI).
darunavir (DRV)=Presista: IND: HIV. ADM: T w/ food. AE: Naus, headache, rash, sulfa allergy, dyslipidemia, insulin resistance, MI/stroke?, hepatitis. Can affect BG levels. OTH: Drug class: Protease Inhibitors (PI).
delavirdine (DLV)=Rescriptor: IND: HIV. AE: Headache, rash, increased liver enzymes. OTH: Drug Class: Non-Nucleosides/Nucleotide Revers Transcriptase Inhibitors (NNRTIs)


didanosine (DDL)=Videx: IND: HIV. AE: GI intolerance, pancreatitis, increased uric acid and lactic acid, reversible peripheral neuropathy, hepatic steatosis. DI: tenofovir (increased DDL). OTH: Drug Class: Nucleoside Reverse Transcriptase Inhibitors (NRTIs).


dolutegravir (DTG)=Tivicay: IND: HIV. MOA: Integrase Strand Transfer Inhibitor. EVD: Found superior vs other ARV drugs because of tolerabilility. ADM: T once/d w/ or without food. AE: Headache, insomnia.
DI: Ca, Fe (decreased F). DOS: 1 tab once daily. OTH: Triumeq=(DTG+ABC+3TC). Drug class: Integrase Strand Transfer Inhibitors (INSTIs)


efavirenz (EFV)=Sustiva: IND: HIV. EVD: Preferred NNRTI ADM: T once/D without food. AE: Lipoatrophy, increased lipids, rash, psychiatric effects. PRG: CI - avoid if childbearing potential. OTH: Drug Class: Non-Nucleosides/Nucleotide Revers Transcriptase Inhibitors (NNRTIs)


elvitegravir (EVG): IND: HIV. MOA: Integrase Strand Transfer Inhibitor. ADM: T OD w/ or without food. AE: Naus, Diar, Headache, Upper Respiratory Tract Infection (URTI), insomnia, increased lipids. DI: Ca, Fe (decreased F). OTH: Drug class: Integrase Strand Transfer Inhibitors (INSTIs)


emtricitabine (FTC): IND: HIV (PEP and PrEP). ADM: T once/d w/ or without food. AE: Naus, Vom, increased lipids, liver toxicity, bone loss, lactic acidosis, lipoatrophy, hyperpigmentation. OTH: Don’t use w/ 3TC since similar resistance. Truvada=(FTC+TDF). Drug Class: Nucleoside Reverse Transcriptase Inhibitors (NRTIs).


enfuvirtide=Fuzeon: AVL: SubQ. IND: HIV (2nd line). MOA: Inhibits gp41 mediated viral fusion to CD4 cells.
AE: rash/site rxn. PK: t1/2=3.8h. PB=92%. DOS: 90mg=1mL BID SubQ. No adjustment for renal fxn or dialysis.


entecavir=Baraclude: AVL: PO (tab or soln). IND: Hep B. OTH: Drug Class: Nucleoside Reverse Transcriptase Inhibitors (NRTIs).


etravirdine=Intelence: IND: HIV. ADM: T w/ food. AE: Naus, rash.
OTH: Drug Class: Non-Nucleosides/Nucleotide Revers Transcriptase Inhibitors (NNRTIs).


famciclovir=Famvir: AVL: PO,SubQ. IND: Genital HSV, shingles. MOA: Inhibits DNA polymerase. AE: Same as placebo. DI: Preobenecid may decrease Cl. PK: Hepatically converted to active drug penciclovir (famciclovir has no activity). famciclovir F=77%, penciclovir t1/2=2.3h. PB<20%. COS: DOS: Adj for renal fxn. OTH: Tabs contain lactose.


fosamprenavir=Telzir: IND: HIV. EVD: Not preferred PI. Can affect BG levels. AE: Rash, GI upset, hyperlipidemia OTH: Used with ritonavir. Drug class: Protease Inhibitors (PI).
Harvoni=ledipasvir90mg + sofosbuvir400mg): AVL: PO. IND: Chronic Hep C MOA: Both target proteins involved in viral replication. EVD: Sustained Virologic Response (SVR) at 12w=90%. ADM: T once/d w/ or without food. AE: ~=placebo: Headache4%, fatigue5%. DI: P-gp inducers ex. rifampin, SJW: decreased plasma concentrations of both. Separate antacids by 4h (need acidity for F). PK: sofobuvir is metabolized to GS-331007. ledipasvir t1/2=47h. GS-331007 t1/2=27h. ledipasvir PB >99%. GS-331007 PB minimal. OTH: Often given with ribavirin. Contains lactose.


Holkira Pak=(12.5mg ombitasvir + 75mg paritaprevir + 50mg ritonavir + 250mg dasabuvir): AVL: PO (Combination pill (ombitasvir+paritaprevir+ritonavir) w/ desbuvir in a separate tab). IND: Chronic Hep C. EVD: Sustained Virologic Response (SVR) at 12w >d90%. AE: Naus3%, fatigue4%, HA4.5%. Mild QT prolongation (3.2msec). PK: ritonavir is strong 3A4 inhibitor. All drugs >97% PB. DOS: 2 combo tabs (ombitasvir/paritaprevir/ritonavir) in am and 1 dasabuvir BID. No adj for renal fxn. OTH: dasabuvir contains lactose.


indinavir=Crixivan: IND: HIV. AE: Nephrolithiasis, chronic interstitial nephritis, liver enzyme elevations, hyperlipidemia. Can affect BG levels. PK: t1/2=2h. PB=60% (lowest in class). OTH: Drug class: Protease Inhibitors (PI).
lamivudine (3TC): IND: Chronic Hep B and HIV. MOA: T once/d w/ or without food. AE: Naus,Vom, increased lipids, liver toxicity, bone loss, lactic acidosis, lipoatrophy. OTH: Drug Class: Nucleoside Reverse Transcriptase Inhibitors (NRTIs). Don’t use w/ FTC (similar resistance). Triumeq=(DTG+ABC+3TC) T 1 tab OD w/ or without food.


lopinavir (LPV)=Kaletra: IND: HIV. EVD: Not preferred PI. ADM: T w/ or without food. AE: GI upset, QT prolongation, liver enzyme increase, dyslipidemia, insulin resistance, MI/ stroke?, hepatitis. Can affect BG levels. OTH: Used with ritonavir. Drug class: Protease Inhibitors (PI).
maraviroc=Celsentri: IND: HIV (not 1st line). MOA: CCR5 antagonist. ADM: T w/ or without food. AE: hepatotoxicity, cough, fever, rash, abdominal pain. DOS: BID. Dose depends on other antiretrovirals (150mg BID if w/ 3A inhibitors like PI). OTH: Tropism assay will determine if CCR5 receptor positive.


nelfinavir=Viracept: IND: HIV. AE: Diar, hyperlipidemia. Can affect BG levels. OTH: Drug class: Protease Inhibitors (PI).
nevirapine (NVP)=Viramune: IND: HIV. AE: Rash, increased liver enzymes. OTH: Drug Class: Non-Nucleosides/Nucleotide Revers Transcriptase Inhibitors (NNRTIs).


raltegravir (RAL)=Isentress: IND: HIV. MOA: Integrase Strand Transfer Inhibitor. ADM: T w/ or without food. AE: Elevated CK, myositis, rhabdomyolysis, skin rxn, insomnia. DI: Ca, Fe (decreased F). DOS: BID OTH: Drug class: Integrase Strand Transfer Inhibitors (INSTIs).


ribavirin=Moderiba: AVL: PO (tab). IND: Chronic Hep C. AE: fatigue4%, headache5%, naus3%, itch, insomnia. PRG: CI. PK: t1/2=300h. OTH: Often used with Harvoni or Holkira Pak.

rilpivirene (RPV)=Edurant: IND: HIV. ADM: T OD w/ food. AE: Lipoatrophy, increased lipids, rash. Less psychiatric effects vs EFV. OTH: Drug Class: Non-Nucleosides/Nucleotide Revers Transcriptase Inhibitors (NNRTIs).


ritonavir (RTV)=Norvir: IND: HIV. AE: Diar, GI upset, liver enzyme elevation. Can affect BG levels. PK: t1/2=3h. PB>96%. PK booster by inhibiting 3A4, 2D6, and 2C9. OTH: Drug class: Protease Inhibitors (PI).
saquinavir=Invirase: AE: Increased liver enzymes, GI upset, hyperlipidemia. Possible QT. Can affect BG levels. PK: t1/2=10h. PB>96%. F doubles with heavy breakfast. OTH: Used with RTV. Drug class: Protease Inhibitors (PI).
stavudine(D4T)=Zerit: AE: Reversible peripheral neuropathy, increased lactic acid, hepatic steatosis, pancreatitis, lipoatrophy, dyslipidemia. OTH: Drug Class: Nucleoside Reverse Transcriptase Inhibitors (NRTIs).


telbivudine: IND: Chronic Hep B with cirrhosis. OTH: Drug Class: Nucleoside Reverse Transcriptase Inhibitors (NRTIs).
tenofovir alafenamide (TAF): IND: HIV, Hep B. ADM: T once/d w/ or without food. AE: N,V, increased lipids, liver and renal toxicity, bone loss, lactic acidosis, lipoatrophy. Less renal and bone toxicity vs TDF. OTH: Drug Class: Nucleotide Reverse Transcriptase Inhibitors (NRTIs/NtRTIs)


tenofovir disoproxil fumarate (TDF)=Viread: IND: HIV (PEP and PrEP). ADM: T once/d w/ or without food. AE: Naus,Vom, increased lipids, liver toxicity, bone loss, lactic acidosis, lipoatrophy.
OTH: Drug Class: Nucleotide Reverse Transcriptase Inhibitors (NRTIs/NtRTIs). Truvada=(emtricitabine+TDF).


tipranavir=Aptivus: IND: HIV. AE: Hepatotoxicity, rash. Can affect BG levels. OTH: Use w/ RTV. Drug class: Protease Inhibitors (PI).
valacyclovir=Valtrex IND: Genital and oral HSV, shingles. AE: =placebo. PK: valcyclovir is a prodrug to acyclovir. DOS: Adj for renal fxn.


zidovudine (AZT)=Retrovir: AE: Naus, Headache, malaise, fatigue, rash, myositis, myocarditis, anemia, leukopenia, hepatic steatosis, elevated liver enzymes, lactic acid and CK, peripheral lipoatrophy. OTH: Drug Class: Nucleoside Reverse Transcriptase Inhibitors (NRTIs).


AVL: IND: MOA: EVD: ADM: AE: CI/Warning: PRG: LAC: DI: PK: COS: AUX: MON: DOS: OTH:

 

Carbapenems

IND: Meningitis, complicated UTI, pneumonia, gram (-), Pseudomonas. MOA: Inhibits cell wall cross-linking. CI: Beta lactam allergy. DI: Decreases valproic acid levels 6-100% within 2d. PK: Beta lactam structure (beta lactamase resistant). OTH: Bactericidal. Time dependent killers.


ertapenem=Invanz: AVL: IV/IM. IND: Covers MSSA (+), Strep (+), H. influenza, M. catarrhalis, GNR, anaerobes. AE: Dia, Headache, anaphylaxis, seizure risk. PK: t1/2=4h. No CYP interactions. DOS: Adj for renal fxn. IV: 1g once/d.


imipenem=Primaxin: AVL: IV. IND: Covers MSSA (+), Strep (+), some enterococcus (+), GNR, Pseudomonas (-), anaerobes. AE: Naus, hypotension, seizure (w/ high serum levels). PRG: CI. LAC: CI. DOS: Adj for renal fxn. Std=500mg q6h. OTH: Given w/ cilastatin which inhibits dehydropeptidase-I (renal enzyme which metabolizes imipenem).


meropenem=Merrem: AVL: IV. IND: Meningitis, CAP, complicated UTI. Covers MSSA (+), Strep (+), some enterococcus (+), GNR, Pseudomonas (-), anaerobes. AE: Naus, Diar, hypotention, seizures (lower risk vs imipenem). PRG: CI. LAC: CI. PK: t1/2=1h. DOS: Adj for renal fxn. Std=1g q8h.


 

Carboxypenicillins

ticarcillin: AVL: IV. IND: Covers Pseudomonas (-). OTH: Often given in combo w/ clavulin: Timentin=clavulin+ticarcillin.


 

Cephalosporins

MOA: Blocks cross linking of NAG-NAM in cell wall. EVD: More resistant to acid breakdown and beta lactamases vs penicillins. CI: Anaphylaxis with penicillin (<0.1% will cross react). Cross reactivity is mostly based on the similarity of side chains. OTH: Bactericidal. Time dependent killers. Later generation cephalosporins have better gram (-) activity. Chemical structure: beta lactam conected to six membered ring.


1st Generation
cefadroxil: AVL: PO.


cefazolin: AVL: IV. IND: CAP. Covers MSSA (+), Strep (+), some GNR. AE: Anaphylaxis, rash, GI upset, renal and hepatic dysfunction. DOS: Adj for renal fxn. Std=1-2g q8h.


cephalexin=Keflex: AVL: PO (tab250,500mg or liquid (good taste)). IND: Non-purulent cellulitis, respiratory infections, sinusitis, otitis media, prostatitis, skin infection. Less effective for OM or CAP. Covers Beta-haemolytic Strep, Staph, Strep pneumoniae, E coli, Proteus mirabilis, Klebsiella. PRG: Safe. FDA cat A. DI: Probenecid inhibits the renal excretion. DOS: Adult: Std=250mg q6h. Range=1-4g in divided doses. Children: Std=25-50mg/kg/d in divided doses. OM=75-100mg/kg/d divided QID. OTH: Store reconstituted liquid in fridge. Stable for 14d.


cephradine: AVL: PO.


2nd Generation
cefaclor=Ceclor: AVL: PO. IND: CAP. AE: Anaphylaxis, rash, GI upset, renal and hepatic dysfunction. DOS: Adj for renal fxn. Std= 250mg TID.


cefotetan: AVL: IV.


cefoxitin: AVL: IV.


cefprozil=Cefzil: AVL: PO. IND: CAP. AE: Diar3%, anaphylaxis, rash, GI upset, renal and hepatic dysfunction. DOS: Adj for renal fxn. Std=500mg BID.


cefuroxime=Ceftin: AVL: PO (cefuroxime axetil - liquid has bad taste), IV (cefuroxime sodium). IND: Covers some MSSA (+), some Strep, GNR. AE: Anaphylaxis, rash, GI upset, renal and hepatic dysfunction. PK: Food increases F. DOS: Adj for renal fxn. PO: Std=500mg BID. IV: Std=750mg q8h.


3rd Generation
cefdinir: AVL:PO.


cefditoren: AVL: PO.


cefixime=Suprax: IND: Gonorrhea. AE: Diar16%, Naus7%, indigestion3%.


cefotaxime=Claforan: AVL: IV. IND: Meningitis, CAP. AE: Diar, Vom, rash2%, fever, leukopenia, neutropenia, eosinophilia, thrombocytopenia, seizure, nephrotoxicity. DOS: Adj for kidney fxn. Std=1-2g q8h.


ceftazidime=Fortaz: AVL: IV. IND: CAP. Covers GNR and Pseudomonas (-). AE: D, leukopenia, neutropenia, eosinophilia, thrombocytopenia, seizure, nephrotoxicity. DOS: Adj for kidney fxn. Std=1-2g q8h.


cefpodoxime: AVL: PO.


ceftazidime: AVL: IV. IND: Covers Pseudomonas.


ceftibuten: AVL: PO.


ceftriaxone=Rocephin: AVL: IV and IM. IND: Gonorrhea, otitis media, meningitis, CAP, UTI, PID, post variceal bleed. Covers some MSSA (+), Strep (+), GNR. AE: Diar3%, rash2%, leukopenia, neutropenia, eosinophilia, thrombocytopenia, seizure, nephrotoxicity. CI: Neonates. DI: Don’t mix with Ca (precipitants form). PK: t1/2~7h. DOS: No adj for renal/hepatic. IV: Std=1-2g q24h.


4th Generation
cefepime: AVL: IV. IND: CAP. Covers some MSSA (+), Strep (+), GNR, Pseudomonas (-). ADM: AE: Anaphylaxis, rash, GI upset, renal and hepatic dysfunction, seizures (especially if renal dysfunction). DOS: Adj for renal fxn. Std=1-2g q12h.


5th Generation
ceftolozane: IND: Covers Pseudomonas. OTH: Given in combo w/ tazobatem.


ceftaroline=Teflaro: AVL: IV. IND: Covers Staph (+) including MRSA, Strep (+), Enterococcus (+), GNR, minimal Pseudomonas (-).


 

Cyclic Lipopeptides

daptomycin=Cubist: AVL: IND: Covers all Staph (+) including MRSA, Strep (+), Enteroccoccus (+). MRSA skin infections. MOA: Links and breaks the bacterial cell membrane. OTH: Bactericidal.


 

Fluoroquinolones

MOA: Inhibits DNA gyrase (enzyme bacteria use for DNA replication, transcription, repair, and recombination).

ADM: Can T w/ food but avoid milk. Black Box Warning: QT prolongation, hypersensitivity/anaphylaxis, tendonitis (especially >60yo), muscle weakness (pts w/ myasthenia gravis), seizure risk, hepatotoxic. DI: Chelates with Al, Ca (including milk), Fe (space 2h before or 6h after if XR). Can inhibit elimination of warfarin, theophylline (serious) and cyclosporine. PK: Inhibits 1A2. OTH: Bactericidal. Concentration dependent killers. Has post Antibiotic effect against gram (-). Respiratory fluoroquinolones are levofloxacin and moxifloxacin.


ciprofloxacin=Cipro: AVL: PO (IR tabs, XR tabs500,1000mg + suspension), IV. IND: UTI (2nd line), CAP (2nd line), secondary prophylaxis post variceal bleed, traveller’s Diar. Covers some MSSA (+), GNR, Psudomonas (-), some atypicals. AE: GI upset, HA, dizziness, photosensitivity, hepatitis, cartilage toxicity, C. diff. CI: Children (cartilage damage). PK: t1/2=6h. F=56%. PB=20-40%. Vd=3.5L/kg. Moderate inhibitor of 1A2. Mostly excreted unchanged in the urine. MW=385.8. DOS: Adj for renal fxn. PO: IR: Std=500-750mg BID. XR: Uncomplicated UTI=500mg once/d x 3d. Complicated UTI & uncomplicated pyelonephritis=1g once/d x 7-14d. IV: Std=400mg q12h.


levofloxacin=Levaquin: AVL: PO, IV. IND: Used 2nd line for UTI, CAP. Covers MSSA (+), Strep (+), GNR, partial Pseudomonas (-), atypicals. AE: GI upset, HA, dizziness, photosensitivity, hepatitis/liver injury, cartilage toxicity, QT prolongation. PK: t1/2=7h. F=99%. DOS: Adj for renal fxn. PO: 500mg q24h x10d or 750mg q24h x 5d. IV: Std=500mg once/d.


moxifloxacin=Avelox: AVL: IV, PO. IND: CAP, prostatitis. Covers MSSA (+), Strep (+), some GNR, anaerobes, atypicals. AE: GI upset, HA, dizziness, photosensitivity, hepatitis, cartilage toxicity, prolonged QT. PK: t1/2=13h. Best prostate fluid penetration vs. other quinolones. DOS: No adj for renal/hepatic fxn. PO/IV: Std=400mg q24h.


norfloxacin=Noroxin: IND: Prophylaxis after variceal bleed.


 

Glycopeptides

vancomycin=Vancocin: AVL: IV, PO. IND: Meningitis, skin or blood infections, pneumonia. MRSA, C. difficile. Only (+) coverage. MOA: Blocks NAG/NAM cross linking in cell wall construction (gram + only). AE: Flushing, hypotension>10%, nephrotoxicity, ototoxicity, allergic rxn. PRG: Safe. DI: Coadministration w/ AGs increases risk of nephrotoxicity. PK: t1/2=4-6h. PB~55%. Vd=0.7L/kg. 75-90% renal elimination. F=0 so oral used for GI C. difficile infection. DOS: Adj for renal fxn. Std~1g q12h. Consider 20-25mg/kg (using ABW) for very ill pts. Draw trough pre 4th dose. Goal: trough level=5-15mg/L. 15–20 mg/L if life-threatening infection or MRSA. Peak: 20-40mg/L (1h after end of 1h infusion). OTH: aka Vanco. Bactericidal. Time dependent killer. Red man syndrome (max 10mg/min),

 

Glycylcyclines

tigecycline=Tygacil: AVL: IV. IND: CAP. AE: Naus, Diar, acute pancreatitisrare. OTH: Structurally similar to tetracyclines.


 

Lincosamides

clindamycin=Dalacin C: AVL: PO (cap, topical, liquid-room temp), IV. IND: Acne, pneumocystis jiroveci, vaginosis. Covers Staph (+) (increasing MRSA resistance), Strep (+), some GNR, anaerobes. Can be used to block toxin production. MOA: Binds 50S subunit of ribososmes. ADM: T w/ or without food. AE: Diar1%, Naus, abdominal pain, C difficile, LFT abnormalities4%, rash1%. PRG: Safe. LAC: Safe. PK: t1/2=2.4h. F=90%. PB=60-94%. Met mainly by 3A4. Doesn’t cross BBB. DOS: Unaffected by renal or hepatic fxn. PO: Std=300-450mg q6h. IV: 600mg q8h. OTH: Bacteriostatic


 

Macrolides

IND: Used for gram (-). Increasing S pneumonia resistance (~20%). MOA: Binds 50S ribosomal subunit. AE: Increases QT (all). OTH: Bacteriostatic.


azithromycin=Zithromax=Z-PAK: AVL: PO (tab, liquidbrand tastes better), IV. IND: Chlamydia, gonorrhea, otitis media, strep throat, CAP, travellers D in Asia. Covers some MSSA (+), Strep (+), some GNR, atypicals. MOA: EVD: Better tolerated vs erythromycin. 5d Tx ~= efficacy vs 10d Tx. ADM: T w/ food. Repeat dose if vomiting <1h after dose. AE: Naus3%, Diar5%, Vom5%, stomach pain4%, allergic reaction4%, Headache5%, abnormal vision5%. PRG: Safe in 2nd and 3rd trimester. LAC: Safe. DI: Can increase digoxin levels. PK: t1/2=68h. DOS: No adj for renal/hepatic fxn. PO: Std=500mg day 1 then 250mg x 4d. IV: 500mg once/d x 7-10d.


clarithromycin=Biaxin: AVL: PO (tab or liquid). IND: H.pylori, CAP. AE: GI upset, rash, cholestatic hepatitis. PRG: Safe in 2nd and 3rd trimester. LAC: Safe. DOS: IR: Std=500mg BID. XR: Std=1000mg once/d. OTH: Suspension: Shake well. Store at Room Temp. Stable for 14d.


erythromycin=Eryc: AVL: PO. IND: Acne, chlamydia, pneumonia/RTI, syphilis, whooping cough. Poor H. influenzae coverage. EVD: Alternative to azithromycin but rarely used due to increased GI AE, dosed BID-QID, and more DIs. AE: GI upset, rash, cholestatic hepatitis. PRG: Safe. LAC: Safe. PK: t1/2=0.8-3h. PB=75-95%. Inhibits 3A4. DOS: Std=250mg q6h, 333mg q8h, 500mg BID. Children: 30-50mg/kg*d in divided doses


 

Nitrofuran Antibacterial

nitrofurantoin=MacroBID: AVL: PO. IND: UTI.Covers some Enterococcus, some GNR. Inactive vs. proteus, pseudomonas, enterobacter, klebsiella. ADM: T w/ food to increase F. AE: Naus, flatulence, loss of appetite, Headache, neuropathy, pulmonary/hepatic toxicity, rash/SJS. CI: CrCl<60 or 30 if using Beers criteria. PRG: CI in 3rd trimester. DI: Antacids can decrease F. PK: t1/2=45min. F~30%. 100% renal elim. t1/2=45min. AUX: May discolor urine/feces, T w/ food. DOS: UTI: 100mg BID x 5d.

 

Nitroimidazoles

metronidazole=Flagyl: AVL: PO (cap500mg), IV, topical. IND: Giardiasis, trichomoniasis, vaginosis, protozoans. Covers anaerobes, C. difficile, H. pylori. Often used to treat giardia in dogs and cats. MOA: Inhibits nucleic acid synthesis. Only occurs if metronidazole is partially reduced which only happens in anaerobic cells. AE: Naus10%, Diar4%, metallic taste9%, decreased appetite, vertigo, HA18%, seizure, ataxia allergic rxn. PRG: CI in first trimester. Safe in 2nd and 3rd. DI: Disulfram vomiting rxn with alcohol. Avoid EtOH 24h after last dose. PK: t1/2=7-8h. PB<20%. Inhibits 2C9 and 3A4. Tastes awful.
DOS: IV and PO: 500mg q8h. OTH: Bactericidal. Tastes terrible.


 

Novel Antibacterials

fosfomycin=Monurol: IND: UTI (women>18yo). MOA: Irreversibly inhibits enolpyruvate transferase, which form NAM part of cell wall and decreases bacterial adhesion. EVD: Cure rate~70%. ADM: T without food in 125mL of water. AE: Diar10%, Headache10% Naus5.2%, vaginitis8% abdominal pain2%, indigestion2%, rash1%. PK: t1/2=5.7h. F=35%. DOS: 3g sachet once.

methenamine mandelate=Mandelamine: IND: UTI. MOA: Metabolized to formaldehyde in bladder. ADM: Needs acidified urine so often given w/ ascorbic acid. AE: GI upset, rash. CI: Gout.


 

Oxazolidinones

linezolid=Zyvoxam: AVL: PO (tab, susp), IV. IND: Pneumonia, skin infections, resistance/intolerance to vancomycin. Covers Staph (+) including MRSA, Strep, Enterococcus. Bacteriostatic vs S. aureus but bactericidal vs S. pneumoniae. MOA: Binds 50S subunit of ribosomes and prevents formation of functional 70S initiation complex. AE: Diar7%, headache5%, Naus7%, dose and time dependent bone marrow suppression, peripheral neuropathy, optic neuritisrare. DI: MAOIs/SSRI (linezolid is a mild MAOI). PK: t1/2=5h. F~100%. PB=31%. DOS: No adj for renal/hepatic fxn. PO and IV: 600mg q12h.

 

Penicillins

MOA: Inhibits cell wall crosslinking. OTH: Bactericidal.
amoxicillin=Amoxil: AVL: PO (chewable, tab, liquid). IND: CAP, chlamydia (2nd line), otitis media, sinusitis. AE: Rash, GI upset.
PRG: Safe in 2nd and 3rd trimester. LAC: Safe. DI: Could decrease COC efficacy. DOS: Adj for renal fxn. Std=500mg TID. High dosed=1g TID. OTH: Can be w/ clavulanate=Clavulin at 4:1 or 7:1 ratio to cover S.pneumonia.


ampicillin: AVL: IV. IND: CAP, meningitis. EVD: Better than amoxicillin against shigella, citrobacter, enterobacter, listeria. AE: Diar, Vom, rash, hypersensitivity, seizure. DI: Increased risk of rash while using allopurinol.Decreased birth control efficacy. PK: t1/2=1.25h. F=62%. DOS: Adj for renal fxn. Std=1g q6h.


cloxacillin: AVL: PO (cap, liquidbad taste). IND: CAP. Covers MSSA (+), Strep (+) AE: Rash, GI upset, hemolytic anemia, nephritis. PRG: Safe. DOS: No adj for renal/hepatic fxn.


penicillin G=Crystapen: AVL: IV. IND: Covers Strep (+) and some enterococcus (+). AE: Rash, GI upset, hemolytic anemia, nephritis, seizures. DI: Tetracycline may decrease efficacy. DOS: Adj for renal fxn. Std=2 million units q4h.


penicillin V=Pen VK AVL: PO. IND: Pharyngitis, CAP. AE: Rash, GI upset, interstitial nephritis. PRG: Safe. LAC: Safe. DOS: Adj for renal fxn. Std=300-400mg TID or QID.


piperacillin/tazobactam: AVL: IV. IND: Covers MSSA (+), Strep (+), Enterococcus(+), GNR, Pseudomonas (-), anaerobes. DOS: Adj for renal fxn. Std=3.375g q6h.


 

Rifamycins

rifampin=Rifadin=Rofact AVL: PO. IND: CAP (not monotherapy), meningitis (Tx + prophylaxis), tuberculosis. MOA: Inhibits DNA-dependent RNA polymerase. AE: GI upset, flu like symptoms, heartburn, liver toxicity, thrombocytopenia. Changes fluids reddish orange color (tears, urine, contact lenses, saliva). CI: Jaundice. PRG: CI. LAC: CI. DI: Decreased COC efficacy, alcohol. Potent inducer of 3A4, 1A2, 2C9, 2C19. PK: t1/2= 3-5h. PB=80%. Potent inducer of 3A4, 1A2, 2C9, 2C19. DOS: No adj for renal/hepatic fxn. Std=300mg BID.

 

Sulfa Antibiotics

sulfamethoxazole+trimethoprim(SMX/TMP)=Bactrim=Septra AVL: PO. IND: Meningitis, UTI, traveller’s D. Covers MSSA (+), some MRSA (+), some GNR. AE: Naus, Vom, Diar, rash/itch, false Cr increase, renal impairment, anemia, bone marrow suppression, increased K. CI: Sulfa allergy. PRG: CI in 1st and 3rd trimester. LAC: Safe. DI: Increased phenytoin, increased warfarin, hypoglycemia with sulfonylureas, increased nephrotoxicity with cyclosporine. PK: Both F=100%. t1/2= 8-11h. Inhibits 2C9. OTH: Septra DS= Septra at double strength.

 

Tetracyclines

MOA: Binds 30S subunit of bacterial ribosomes. ADM: Stay upright for 30min after swallowing. PRG: CI. DI: Ca, Fe, decreased efficacy of COCs and penicillins. OTH: Bacteriostatic. Time dependent killers.
doxycycline: AVL: PO. IND: CAP, chlamydia. Covers some MSSA (+), some Strep (+), some GNR, atypicals. ADM: T w/ food. AE: Diar5%, GI upset, photosensitivity. PRG: CI. DOS: No adj for renal/hepatic fxn. Std=100mg BID day 1 then 100mg once/d.


minocycline=Minocin: IND: Acne. AE: Lupus, vertigo. PRG: CI.


tetracycline: ADM: T without food. Warning: Don’t T if expired. PRG: CI. LAC: Safe.


 

Vaccines

FLU/INFLUENZA
influenza vaccine (aka flu shot)=Fluzone: AVL: Nasal spray (Flumist=live attenuated), IM (inactivated). Recombinant egg-free vaccine available. EVD: Antibodies form after 2w. Efficacy by year according to CDC: 10% 2004-05, 21%2005-06, 52% 2006-07, 41%2008-09 , 56%2009-10 , 60%2010-11 , 47% 2011-12 49%2012-13, 52%2013-14 , 19%2014-2015, 48% 2015-16 , 40%2016-17 , 36% 2017-18 . AE: Site pain24.3%, muscle pain18.3% headache14.4%, malaise14%, redness10.8%, swelling5.8%, fever2.3%. CI: < 6months old, fever. PRG: Safe and recommended. LAC: Safe and recommended. DOS: 0.5mL yearly. Fluad Pediatric used for 6-24 months old (0.25mL). Children 6months-9yo getting the flu shot for the fist time should have a second dose in the same year. (>4w apart). The high dose vaccine is indicated if >65yo. OTH: Can’t cause flu.


Fluzone High-Dose: AVL: Comes in packs of 5 x 0.5mL single dose syringes. IND: Flu protection pts >65yo. MOA: Same as standard flu shot but older people have a weaker immune system that is less responsive to the standard vaccine. EVD: ~30% more effective vs standard dose for those >65yo. ADM: IM injection (not in the buttocks. AE: Slightly More AE vs std dose - site pain35.6%, muscle pain21.4%, malaise18%, headache16.8%, redness14.9%, swelling8.9%, fever3.6% CI: Severe egg allergy, Guilain-Barre syndrome (GBS). Postposne if fever. DI: Use caution w/ pts on anticoagulants (more bleeding). DOS: 0.5mL IM yearly. Contains 60ug hemagglutinin (HA) (4 times the std dose). OTH: Trivalent inactivated vaccine. Latex free.
HEPATITIS
Havrix=hepatitis A vaccine: AVL: IM. Havrix=1mL (>19yo). Havrix Junior=0.5mL (1-18yo). EVD: Efficacy=99% at 1 month. Projected to last 20y. AE: headache 10%, site pain/redness>10%, irritability >10%, diar/naus/vom<10%, site rxn<10%, fever<10%, malaise<10%. CI: <1yo, neomycin allergy (trace amount). DOS: Can give single dose but booster recommended 6-12m later for long term protection.


Twinrix=hepatitis A (inactivated) + B (recombinant) vaccine: AVL: Avail IM. Twinrix=1mL (>19yo). Twinrix Junior=0.5mL (1-18yo). Lasts at least 15y in adults, 10y in children. Protection starts after 2-4w. EVD: Efficacy after 3 doses: A=98% B=99.9%. AE: Headache>10%, site pain/redness>10%, diar<10%, naus<10%, vom<10%, site rxn<10%, malaise<10%. CI: <1yo, neomycin allergy (trace amounts), fever. COS: ~$75/dose. DOS: Standard schedule: 0,1m,6m. Rapid 4 dose: 0,7d, 21d,12m. OTH: Hep A part=inactivated. Hep B=recombinant.


HPV
Gardasil 9=HPV vaccine: IND: Protects against HPV types 6,11, 16, 18, 31, 33, 45, 52, 58. Prevents genital warts and cervical cancer. AE: Pain90%, swelling40%, redness34%, headache15%, itch5%, fever5%, naus4%, dizziness3%, bruising2%, fatigue2%. DOS: 0.5mL at 0, 2m, 6m. If alternate schedule necessary, 2nddose >1 month after 1stdose and 3rd> 3 months after 2nd. 2 doses found to be non-inferior to 3 dose. No booster later in life recommended. OTH: Recombinant vaccine. Avail for Males and Females 9-26yo.


OTHER
tetanus + diphtheria vaccine=Td Adsorbed: AVL: IM. IND: Protects against Chlostridium tetani (toxins cause rigidity ex. lockjaw). AE: redness8%, swelling16%, pain81%, fever4%, sore/swollen joints5%. COS: Free at clinic. DOS: 0.5mL. Children get a few doses starting at birth then q10y. OTH: Sometimes given w/ pertussis (Adacel).


PNEUMOCOCCAL
Prevnar 13=PCV13: AVL: IM. IND: Protects against 13 strains of Strep pneumoniae (36% of pneumonias). Indicated in infants (regular schedule) and adults >65yo (>19yo if immunocompromised, smoker).
EVD: Immunosuppressed pts may have less benefit. COS: $95/dose. DOS: 0.5mL IM once. Given 8w before Pneumovax. If after, separate by 1y. OTH: Conjugate vaccine. Suspension needs to be shaken vigorously. Store in refrigerator.


Pneumovax 23=PPSV23: AVL: IM, SubQ. IND: Recommended for immunocompromized people >2yo, adults > 65yo, people in nursing homes, alcoholics, smokers, homeless, IVDU. DOS: 0.5mL IM. Typically given 8w or 1y after Prevnar.


SHINGLES VACCINE
Shingrix=shingles vaccine: AVL: IM. IND: Prevent shingles 50yo and older. Can be used in immunocompromised. EVD: Higher incidence of local and systemic AE vs Zostavax. AE: Pain77%, redness38%, swelling at injection site25%, muscle pain45%, fatigue42%, headache37%, shivering27%, fever20% GI symptoms16%. DOS: 0.5mL (2 vials combined entire vial) given IM. Schedule: 2 doses 2-6 months apart. OTH: Inactivated adjuvented vaccine.


TRAVELLER'S DIARRHEA/CHOLERA

Dukoral: AVL: PO (oral susp). IND: Traveller’s Diar from E.coli and Cholera from Vibrio cholera. EVD: Travellers Diar protection for 3y. Cholera protection 2y. AE: Headache, Diar, stomach pain, gas. CI: <2yo. PRG: Safe. LAC:Safe. DOS: 2 dose vaccine. Separate by >1w. Last dose >1w before trip. 2-6yo should receive 3 half doses. 1 dose booster if more than 3 months since last dose. 2 dose booster if more than 5y since last dose. OTH: Inactivated vaccine.


 

AVL: IND: MOA: EVD: ADM: AE: CI/Warning: PRG: LAC: DI: PK: COS: AUX: MON: DOS: OTH:
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AVL: IND: MOA: EVD: ADM: AE: CI/Warning: PRG: LAC: DI: PK: COS: AUX: MON: DOS: OTH:


AVL: IND: MOA: EVD: ADM: AE: CI/Warning: PRG: LAC: DI: PK: COS: AUX: MON: DOS: OTH: