Anti-microbials
22/8/10
Medsafe
PY Mindmaps
A-Z
Format:
TYPE OF PATHOGEN
Name (alphabetical order)
- class
- activity against
- dose
- issues with use
-> gaps in cover
ANTI-BACTERIALS
Amikacin
- aminoglycoside
- Gram –ve organisms (including Pseudomonas) + some Gram +ve cover
- 7.5mg/kg Q12 hrly (titrated to troughs)
- nephrotoxic, ototoxic, peripheral neuritis, neuromuscular blockade potentiation
->
Amoxycillin
- moderate-spectrum penicillin
- gram +ve + improved cover against gram –ve bacilli
- 1g Q4 hrly
- rash with EBV
-> staphylococcus and gram negatives
Amoxycillin-clavulanate
- broad spectrum penicillin
- gram +ve’s, anaerobes, aerobic gram –ve bacilli
- 1.2g Q6 hrly
- platelet dysfunction, blood dyscrasias
-> MRSA
Ampicillin
- broad spectrum penicillin
- Gram +ve and Gram –ve organisms (ineffective against Beta-lactamase producers)
- 500mg IV Q4 hourly
- GI upset, rash
-> staphylococcus and gram negatives
Azithromycin
- macrolide
- anaerobes and non-enteric gram negatives
- 10mg/kg LD Q24hrly -> 5mg/kg on subsequent days
- nephritis, hepatitis
Jeremy Fernando (2011)
-> gram positive, atypical mycobacteria and Toxoplasma
Aztreonam
- monobactam
- aerobic gram –ve including Pseudomonas
- 2g Q6 hrly
- phlebitis, hepatitis, thrombocytopaenia
-> gram positives
Benzylpenicillin
- a narrow spectrum penicillin
- gram +ve (streptococcus pneumoniae, listeria)
- 1-5g/day in divided doses
- increased Na+, decreased K+, GI upset – pseudomembranous colitis, seizures, nephritis,
blood dyscrasias
-> inactivated by beta-lactamases -> most staph’s are resistant
-> streptococcus pneumonia increasing resistance
Cefepime
- 4th generation cephalosporin
- gram +ve and gram –ve cover and anaerobes
- 2g Q8 hourly
- GI upset, rash
Ceftazidime
- 3rd generation cephalosporin (beta-lactam)
- gram –ve and anaerobes, some gram +ve
- 2-6g/24 hours in 2 to 3 divided doses (30-100mg/kg/day in divided doses)
-> reduced gram positive cover
Cefuroxime
- 2nd generation cephalosporin with anti-haemophilus cover
- gram +ve’s + improved gram –ve cover
- adults 1.5g Q8 hrly, paediatrics 50mg/kg Q6hrly
Ceftriaxone
- 3rd generation cephalosporin
- reduced gram +ve with improved gram –ve cover (improved CSF penetration)
- 50mg/kg Q24hrs
- reduce in renal failure
Cephazolin
- 1st generation cephalosporin + beta lactam resistant, all induce ESBL producers
- gram +ve and some gram –ve cover
- 15mg/kg Q8 hrly
- 3-6% cross reactivity with penicillins
Ciprofloxacin
- 2nd generation quinolone
- predominately gram –ve cover (Pseudomonas)
- 300mg Q12 hourly
- growing cartilage damage, achilles tendonitis, QT prolongation
-> no anaerobic or gram positive cover
Clarithromycin
- macrolide
- helicobacter pylori and mycobacterium avium complex
Jeremy Fernando (2011)
- 500mg Q12 hrly
- hepatitis
Clindamycin
- lincosamide
- gram +ve’s, anaerobes, some non-enteric gram negative (Helicobacter), intracellular
organisms (mycobacterium avium complex)
- high bone, bile and urine concentrations)
- 2-4mg/kg Q6 hrly
- GI upset, elevated LFT’s, blood dyscrasias
Colistin (polymyxin E)
- polymixin antibiotic
- gram –ve rods and New Delhi metallo-B-Lactamase mutli-resistant Enterobacteriaceae
- two forms with different dosing regimes
- nephrotoxic and neurotoxic
-> gram negatives not reliably covered: Proteus, Providencia, Serratia, Neisseria, Moraxella,
Helicobacter, Brucella, Burkholderia, Stenotrophomonas (some strains)
Co-trimoxazole
- sulphamethoxazole + trimethoprim
- sulphonamide
- gram +ve and gram –ve cover and protozoan
- covers Pneumocystitis jiroveci, Stentrophomonas maltophila, Listeria monocytogenes,
Norcardia
- 25-100mg/kg of sulphamethoxazole Q6 hrly (dose varies -> consult ID)
- SJS, blood dyscrasias, influenzae like symptoms,
Doxycycline
- tetracycline
- gram +ve and gram –ve but widespread resistance
- good cover for Chlamydophila, Mycoplasma, Rickettseiae, Spirocheataes, Brucella, Coxiella
brunetii
- 200mg LD -> 100mg Q24 hrly
- oesophagitis, tooth discolouration in kids, photosensitivity, pancreatitis, hepatitis
Erythromycin
- macrolide
- gram +ve, anaerobes, non-enteric gram –ve infections, intracellular organisms
- 20mg/kg/day in divided doses
- long QT, monomorphic VT, pancreatitis, nephrotoxicity, hepatitis
Flucloxacillin
- narrow spectrum penicillin with anti-staph cover
- staph (beta lactamase resistant)
- 50-100mg/kg/day
- cholestatic jaundice
Fusidic acid
- chemically related to the cephalosporins
- penicillin resistant staphylococcal infections (endocarditis and bone infections)
- 1g Q8hrly
- GI upset, jaundice, rashes
Gentamicin
- aminoglycoside
- aerobic gram –ve’s + pseudomonas coverage
Jeremy Fernando (2011)
- 3-5mg/kg LD -> titrate to trough
- nephrotoxic, ototoxic, peripheral neuritis, neuromuscular blockade potentiation
Imipenem-cilastatin
- carbapenem
- broad spectrum gram +ve, gram –ve and anaerobic cover
- 500mg Q6 hrly
- hepatitis, CNS stimulation, rashes
-> MRSA, VISA, VRSA, atypical pneumonia’s.
Linezolid
- oxazolidinone
- gram +ve’s (including multi resistant staphylococci and enterococci)
- 600mg Q12 hrly
- blood dyscrasias, GI upset, headache, dry mouth
Meropenem
- carbapenem
- broad spectrum gram +ve, gram –ve and anaerobic cover
- up to 2g Q8 hrly (40mg/kg)
- hepatitis, CNS stimulation, rashes
-> MRSA, VISA, VRSA, Enterococcus faecium, Stenotrophomonas and many Pseudomonas,
atypical pneumonia’s
Metronidazole
- nitroimidazole
- anaerobes and protozoa (including Trichomonas, Giardia and Entamobea)
- 7.5mg/kg Q8 hrly
- GI upset, rash, dark urine
Moxifloxacin
- 3rd generation quinolone
- gram –ve, gram +ve, anaerobic and intracellular organisms of atypical pneumonia
- 400mg Q24 hrly
- growing cartilage damage, achillies tendonitis, QT prolongation
-> Pseudomonas
Nitrofurantoin
- E.coli, Enterococcus, Staph aureus, Citerobacter, Klebsiella
- 100mg QID PO (5-7mg/kg/day)
- GI upset, headache, flatus
Norfloxacin
- 2nd generation quinolone
- predominantly gram –ve cover
- 400mg Q12 hourly
- growing cartilage damage, Achilles tendonitis, QT prolongation
Pipericillin-Tazobactam (Tazocin)
- broad spectrum penicillin
- gram +ve’s, anaerobes, aerobic gram –ve bacilli (superior enterococcal cover)
- 4.5g Q8hrly
- platelet dysfunction, blood dyscrasias
-> MRSA, VISA, VRSA, multi-resistant gram negatives
Quinupristin/dalfopristin
- streptogramins
Jeremy Fernando (2011)
- VRSA, VRE, gram positive bacilli (Enterococcus faecium), gram negative aerobes (Neiserria
and Moraxella), intracellular organisms
- 7.5mg/kg Q8 hrly
- arthalgia, myalgia, GI upset, headaches
Rifampicin
- rifamycin
- gram +ve and gram –ve, mycobacterium tuberculosis and atypical mycobacteria
- 10-20mg/kg/day
- drug reactions: warfarin, OCP, cyclosporine, orange secretions, hepatitis, nephritis,
thrombocytopaenia
Roxithromycin
- macrolide
- gram +ve, anaerobes and some non-enteric gram-negative infections, intracellular
organisms
- 300mg Q24 hrly
- hepatitis
Teicoplanin
- glycopeptide
- MRSA, MRSE, gram +ve, good cover against streptococcus pneumoniae and C.difficile
- 400mg LD -> 400mg @ 12 hours -> 400mg Q24 hrs
- nephrotoxicity, blood dyscrasias, ototoxicity
Telavancin
- derivative of vancomycin
- gram +ve’s (including MRSA)
- 10mg/kg Q24 hrs
- GI upset, metallic taste, headache, foamy urine
Tetracycline
- tetracyclines
- chlamydia, rickettsia, spirochaete, brucella, mycoplasma, leptospirosis
- 500mg Q12hrly
- stained teeth in children, renal impairment, GI upset, hepatic impairment
Tigecycline
- glycylcycline
- gram +ve’s (VRE, MRSA, MRSE), gram –ve’s (ESBL), anaerobes
- 100mg LD -> 50mg Q12 hrly
- GI upset, similar to tetracyclines
Tircarcillin
- carboxypenicillin (often in combination with clavulanate)
- gram –ve organisms (especially Pseudomonas)
- 3000mg/200mg (tircarcillin/clavulanate) Q4-8 hourly
- increased Na+, decreased K+, GI upset – pseudomembranous colitis, seizures, nephritis,
blood dyscrasias
Tobramycin
- aminoglycoside
- aerobic gram –ve’s + Pseudomonas coverage
- 3-5mg/kg/day in 3 divided doses -> monitor
- nephrotoxic, ototoxic, peripheral neuritis, neuromuscular blockage prolongation
Vancomycin
Jeremy Fernando (2011)
-
glycopeptide derivative
MRSA, MRSE, gram +ves, pencillin resistant streptococcus pneumoniae and C. difficile
10mg/kg LD -> dose of plasma concentration
red man syndrome, ototoxic, nephrotoxic
Jeremy Fernando (2011)
ANTI-VIRAL
Acyclovir
- guanosine analogue
- viral DNA polymerase inhibitor
- anti-HSV
- 10mg/kg Q8hrly
- rashes, GI upset, hepatic and renal impairement, blood dyscrasias, CNS symptoms
Alpha-interferon
- interferon
- used hepatitis B and C and many other diseases
- SC injection
- complex dosing
- flu like symptoms, GI upset, haemodynamic instability, blood dyscrasias
Amantadine
- M2 channel inhibitor -> disruption of dissociation of viral matrix and riobnucleoprotein
- anti-viral and anti-parkinsonian drug
- anti-HSV and anti-influenza
- for anti-influenzae: 100mg/day
- GI upset, convulsions, hallucinations
Famciclovir
- guanosine analogue
- anti-HSV
- 1500mg OD PO (requires renal adjustment)
- well tolerated
Foscarnet
- guanosine analogue
- inhibitor of viron DNA polymerase
- anti-CMV
- 20mg/kg IV LD -> 20-120mg/kg according to renal function
- GI upset, renal failure, hypocalcaemia, convulsions
Gancicilovir
- inhibition of CMV DNA polymerase
- anti-CMV
- administered as a prodrug (valganciclovir)
- 5mg/kg Q12hrly IV
- blood dyscrasias, rash, hepatorenal impairment, GI upset
Valaciclovir
- guanosine analogue
- anti-HSV
- 1000mg TDS PO
- headache, nausea, SOB
Oseltamivir
- neuraminidase inhibitor
- anti-influenzae
- 75mg BD PO
- GI upset
Ribavirin
- guanosine analogue
Jeremy Fernando (2011)
-
DNA synthesis inhibitor -> active against many RAN and DNA viruses
RSV and Lassa fever
20mg/mL nebulised for 12-18 hours for 3-7 days
anaemia, worsening respiratory failure
Jeremy Fernando (2011)
ANTI-FUNGALS
Amphortericin B
- polyene
- all Candida species except C.lustanae + anti-protozoan
- 0.5-1mg/kg Q24 hr
- nephrotoxic, hepatotoxic, GI upset, blood dyscrasias
Caspafungin
- echinocandin
- all Candida species, Aspergillus
- 70mg LD -> 50mg Q24 hrly
- GI upset, headache, myalgia, increase in LFT’s,
Fluconazole
- azole
- Candida albicans and Cryptococcus
- 50-400mg Q24 hr
- GI upset, hepatic dysfunction, arrhythmias
Itraconazole
- azole
- broader anti-fungal activity than fluconazole but not as much as voriconazole – Candida
albicans, Cryptococcus, aspergillus
- 200mg Q12 hrly for 4 doses -> 200mg Q24 hrly
- increased LFT’s, GI upset
Nystatin
- polyene
- Candida albicans
- topical application
Voriconazole
- azole
- broadspectrum anti-fungal – Candida albicans, glabrata, krusei, Cryptococcus, Aspergillus
- 6mg/kg Q12 hourly (loading for 24 hours) -> 4mg/kg Q12 hourly
- transient visual disturbance, fever, rash, GI upset
Jeremy Fernando (2011)
ANTI-PARASITES
Albendazole
- benzimidzole
- anti-nematode and cestode (worms)
- 800mg PO in divided doses (give with fatty meal or grape juice -> increases bioavailability)
- GI upset, headache, dizziness, hepatic impairment, pancytopaenia
Ivermectin
- synthetic antibiotic derivative
- anti-nematode
- 200-400mcg/kg
- side effects related to parasitic load in host
Mebendazole
- benzimidzole
- anti-nematode and cestode (worms)
- 100mg OD PO
- minimal side-effects
Metronidazole
- nitroimidazole
- anaerobes and protozoa (including trichomonas, giardia and entamobea)
- 7.5mg/kg Q8 hrly
- GI upset, rash, dark urine
Jeremy Fernando (2011)
ANTI-PROTOZOANS
Aretemether + Lumefantrine
- anti-malarial
- 20/120mg
- complex dosing
Artesunate
- IV anti-malarial
- 2.4mg/kg IV Q 12 hrly
Atrovaquone + proguanil
- anti-malarial
- 250/100mg
- complex dosing
Clindamycin
- lincosamide
- gram +ve’s and anaerobes (high bone, bile and urine concentrations)
- 2-4mg/kg Q6 hrly
- GI upset, elevated LFT’s, blood dyscrasias
Doxycycline
- tetracycline
- gram +ve and gram –ve but widespread resistance
- 200mg LD -> 100mg Q24 hrly
- oesophagitis, tooth discolouration in kids, photosensitivity, pancreatitis, hepatitis
Mefloquine
- anti-malarial
- 15mg/kg LD -> 500mg Q6 hrly
Quinine sulphate
- anti-malarial
- IV 20mg/kg LD over 4 hours -> 10mg/kg Q 8hourly
- take with doxycycline or clindamycin or atovaquone+proguanil or mefloquine
Jeremy Fernando (2011)