1 / 27

Sukhjinder Sidhu Interior Health Pharmacy Resident Kootenay Lake Hospital

Sukhjinder Sidhu Interior Health Pharmacy Resident Kootenay Lake Hospital. Terminology. Prophylactic therapy Treatment with antibiotics to prevent an infection. Empiric therapy Treatment of an infection before specific culture information has been reported or obtained. Terminology.

siobhanl
Download Presentation

Sukhjinder Sidhu Interior Health Pharmacy Resident Kootenay Lake Hospital

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Sukhjinder Sidhu Interior Health Pharmacy Resident Kootenay Lake Hospital

  2. Terminology • Prophylactic therapy • Treatment with antibiotics to prevent an infection • Empiric therapy • Treatment of an infection before specific culture information has been reported or obtained

  3. Terminology • Bactericidal • Kill bacteria • Bacteriostatic • Stop growth of bacteria www.amrls.cvm.msu.edu

  4. Terminology • Time-dependent killing • Antimicrobial activity best when drug concentration remains constantly above MIC • Aiming for concentrations that are above MIC > 50% of the dosing interval • Ex: penicillins, cephalosporins, carbapenems, clindamycin, vancomycin • Concentration-dependent killing • Eradicate bacteria by achieving high concentrations at the binding site • Aiming for concentrations that are > 10 x above MIC • Ex: aminoglycosides, fluoroquinolones

  5. Terminology • Narrow spectrum • Active on smaller number of bacterial species • Broad spectrum • Active on a larger number of Gram-positive and Gram-negative bacteria www.amrls.cvm.msu.edu

  6. Broad vs. Narrow CloxacillinAmoxcillin Penicillin G Nitrofurantoin Cephalexin Metronidazole Amox/Clav Fluoroquinolones Ceftriaxone VancomycinLinezolid Macrolides Aminoglycosides Sulfonamides Tetracyclines Cefazolin Clindamycin Carbapenems Pip/Tazo

  7. Antibiotic Step Down • Narrow the antibiotic spectrum once culture and susceptibility are available • Step down is an important component of antibiotic therapy because it can reduce cost and toxicity and prevent the emergence of antimicrobial resistance

  8. Penicillins • Natural penicillins • Penicillin G • Penicillin V • Penicillinase-resistant • Cloxacillin • Penicillin plus β-lactamse inhibitors • Amoxicillin-clavulinic acid • Piperacillin-tazobactam • Aminopenicillins • Amoxcilin • Ampicillin • Ureidopenicillins • Piperacillin

  9. Penicillins • Inhibit bacterial cell wall synthesis • Used for prevention and treatment of infections caused by • Streptococcus, Enterococcus, Staphylococcus spp. • DO NOT COVER MRSA • Absorption of oral penicillins much improved on empty stomach • Taken with food minimizes GI upset

  10. Penicillins • Generally non-toxic • Side effects: • GI upset nausea, vomiting, diarrhea, abdominal pain • Pseudomembranous colitis broad spectrum agents • Rash • Anaphylaxis

  11. Cephalosporins • First Generation • Cefazolin • Cephalexin • Second Generation • Cefuroxime • Third Generation • Ceftazidime • Ceftriaxone • Cefixime • Fourth Generation • Cefepime

  12. Cephalosporins • Structurally and pharmacologically related to penicillins • Inhibits cell wall synthesis • 1st gen: mostly active against Gram + bacteria • Pneumococci, streptococci, staphylococci • 2nd gen: more active against Gram – bacteria • E. coli, K. pneumoniae, H. influenzae • 3rd gen: most active against Gram – bacteria • 4th gen: extended spectrum of activity against both Gram + and – bacteria • DO NOT COVER ENTEROCOCCUS or MRSA

  13. Cephalosporins • Relatively safe • Side effects: • GI upset nausea, vomiting, diarrhea, abdominal pain • Pseudomembranous colitis broad spectrum agents • Rash • Super infections • Anaphylaxis • Hematological long term use

  14. Carbapenems • Imipenem, meropenem, ertapenem • Inhibit cell wall synthesis • Most broad spectrum activity of all antimicrobials • Active against Gram + and – bacteria • Side effects: • GI upset nausea, vomiting, diarrhea • Rash • Seizures  those with compromised renal function • Hematological eosinophilia, neutropenia • Nephrotoxicity secondary to metabolite

  15. Vancomycin • Inhibits cell wall synthesis at different site than β-lactams • Active against Gram + bacteria only • Use restricted for MRSA and Clostridium difficile • Always given IV, except for treatment of antibiotic associated enterocolitis • Must give over of at least 1 hour to minimize risk of “red man syndrome” • Red man syndrome = sudden drop in BP with flushing &/or rash on face, neck, chest and upper extremities

  16. Vancomycin • Troughs are taken within 30 min prior to dose • Side effects: • Ototoxicity at supratherapeutic doses of > 80 mg/mL • Nephrotoxicity • Fever, chills, phlebitis at infusion site

  17. Sulfamethoxazole/Trimethoprim • Prevent bacteria from synthesizing folic acid thereby disrupting DNA synthesis • Active against both Gram + and – bacteria • Mostly used in uncomplicated UTIs, and some respiratory infections • Side effects: • GI upset nausea, vomiting, diarrhea • Skin rashes, photosensitivity • Hematologic when used for long durations

  18. Fluoroquinolones • Ciprofloxacin, levofloxacin, moxifloxacin • Inhibit bacterial DNA synthesis • Broad spectrum of activity against Gram + and – bacteria • Well absorbed orally • Concentrations achieved after PO dose are comparable to those with IV dose • Not recommended for use in children or pregnancy

  19. Fluoroquinolones • Absorption limited when administered within 2 hours of cations aluminum, magnesium, calcium, iron, zinc • Side effects: • GI upset nausea, vomiting, diarrhea, abdominal pain • Pseudomembranous colitis with ciprofloxacin • Rash, photosensitivity, pruritus

  20. Aminoglycosides • Gentamicin, tobramycin • Inhibit bacterial protein synthesis • As single agent active against Gram – bacteria • Used with other agents, some Gram + synergy • Only administered IV • Troughs are taken within 30 min prior to dose • Usually obtained when dosing q8h

  21. Aminoglycosides • Side effects: • Nephrotoxicity irreversible • Ototoxicity irreversible • Skin rash • Fever • Paresthesia

  22. Tetracyclines • Tetracycline, doxycycline, minocycline • Inhibit bacterial protein synthesis • Some Gram + and some Gram – bacteria coverage, but many strains resistant • Used primarily for infections caused by susceptible Rickettsia, Chlamydia, Mycoplasma and other uncommon bacteria • Avoid use in young children and pregnancy

  23. Tetracyclines • Decreased absorption when administered with dairy products, antacids, and iron salts • Space by at least 2 hours • Side effects: • GI upset nausea, vomiting, diarrhea • Esophagitis and esophageal ulcers swallow with lots of water and avoid laying down for at least 30 min • Photosensitivity, rash

  24. Macrolides • Azithromycin, erythromycin, clarithromycin • Inhibit bacterial protein synthesis • Active against Gram + bacteria and atypical pathogens Mycoplasma, Chlamydophila, Legionella • Numerous drug interactions with clarithromycin inhibits metabolism • Side effects: • GI upset nausea, vomiting, abdominal cramping • Especially with erythromycin

  25. Clindamycin • Inhibits bacterial protein synthesis • Activity against Gram + and anaerobic bacteria • Side effects: • GI upset nausea, vomiting, diarrhea • Pseudomembranous colitis** • Skin rashes

  26. Metronidazole • Inhibits protein synthesis • Activity against anaerobic bacteria • Treatment of choice for C. difficile • Side effects: • GI upset nausea, vomiting • Metallic taste

  27. Nitrofurantoin • Mechanism not fully understood • Used primarily for lower UTIs caused by E. coli and Enterococcus, • Not to be used in pyelonephritis • Take with meals to improve absorption • Side effects: • Discolored urine (brown)

More Related