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Antibiotic, Antifungal, and Anti-helminthic Drug Indications (DOCs)

Antibiotic, Antifungal, and Anti-helminthic Drug Indications (DOCs). Julia Jones (with fungal contributions from Wendy Chen). Primary Syphilis. What if patient is very allergic to Penicillins?. Penicillin G, IM x 1. Doxycycline p.o. x 2wks. Staphylococci with plasmid-encoded β -lactamases.

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Antibiotic, Antifungal, and Anti-helminthic Drug Indications (DOCs)

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  1. Antibiotic, Antifungal, and Anti-helminthic Drug Indications (DOCs) Julia Jones (with fungal contributions from Wendy Chen)

  2. Primary Syphilis What if patient is very allergic to Penicillins? Penicillin G, IM x 1 Doxycycline p.o. x 2wks

  3. Staphylococci with plasmid-encoded β-lactamases Dicloxacillin

  4. What if patient is a little bit allergic to Penicillins? Pseudomonas Aeruginosa 3rd gen ceph (ceftazadime) 4th gen ceph (cefepime) What if patient is a lot allergic to Penicillins, cephalosporins? Aztreonam (monobactam) Piperacillin-Tazobactam What if I wanted to use a protein synthesis inhibitor? Aminoglycosides The Big Gun? What if that drug was too nephrotoxic? Imipenem Aztreonam (monobactam)

  5. Meningitis in patients >3 months old Ceftriaxone (IV, 3rd GC)  can add Vancomycin +/- Rifampin

  6. Gonorrhea 3rd GC  Ceftriaxone (IM) or Cefixime (p.o.) What if very allergic to cephalosporins? ( 2 alternatives) FQs Azithromycin

  7. Serratia • Imapenem • Aztreonam

  8. EHEC • None. Supportive/symptomatic

  9. Typhoid Fever Or? Ceftriaxone (serious G- infxn) FQ, 2nd line TMP/SMX

  10. ETEC • Severe G- infection: • cephalosporin • Severe G- rod aerobic infection: • AG • 2nd line: • TMP/SMX • G- GI tract Tx: • FQ

  11. Shigella • 1st line: • FQ • 2nd line: • TMP/SMX • Other? • Amino-penicillin

  12. Community-acquired pneumonia Azithromycin (ML) Plus? Ceftriaxone + AG

  13. Nosocomial pneumonia Ceftriaxone + Gentamicin (aminoglycoside)

  14. Serious Gram (-) infections Ceftriaxone

  15. MRSA Vancomycin (sometimes add Gentamicin +/- Rifampin)

  16. Mycoplasma pneumonia Doxycycline (tetracycline) Azithromycin

  17. Enterobacter • DOC? • Imapenem • Other choices? • 2nd/3rd/4th gen Cephalosporins • Pipercillins

  18. Chlamydia Doxycycline (+macrolide – azithromycin or erythromycin) How do I pick? depends on desired dosing regimen What other protein synthesis inhibitor? TMP/SMX

  19. Rickettsia (RMSF) Doxycycline

  20. Vibrio cholera Doxycycline

  21. Legionella Doxycycline (+erythromycin)

  22. Skin infections caused by community-acquired MRSA TMP/SMX What if allergic to sulfonamides? Doxycycline Other drugs? Clindamycin, FQs

  23. Staph aureus drugs? • Dicloxacillin • Other drugs in this group? • “I met a nasty ox:” • Methicillin, • Nafcillin, • Oxacillin • Vancomycin • Clindamycin

  24. Proteus • Aminopenicillins • All cephalosporins

  25. Acinetobacter • This used to be a pseudomonas • Imepenem

  26. Anthrax!! • FQ • This is actually the prophylactic Tx. Not DOC.

  27. Lyme disease • Doxycycline • 3rd gen cephalosporin

  28. MAC (Mycobacterium avium) • Azithromycin • Ethambutol • (FQ)

  29. Hemophilis • Amino-penicillins • 2nd/3rd/4th gen Ceph • Aztreonam • Chloramphenicol • For prophylaxis? • Rifampin • Who gets it? • All close contacts

  30. Klebsiella • All cephalosporins • Aztreonam

  31. Strep pneumo • Penicillin • Aminopenicillin + B-lactamase inhibitor • Strep pneumo is notorious for what resistance mechanism? • Altering PBP. Solution? • 3rd/4th gen cephalosporins

  32. Dental prophylaxis for endocarditis • Clindamycin • Aminopenicillins • Rx for strep viridans/mutans? • Penicillin

  33. Lupus • INH • Ooh. Lupus is also a contraindication in which drug? • Primaquine

  34. Moraxella • Amino-penicillin • Azithromycin

  35. Corynebacterial Diphtheria Macrolides (Azithromycin or Erythromycin) What else? Pen G/V

  36. Anaerobic Abscesses Clindamycin or Metronidazole

  37. Brain Abscesses Metronidazole

  38. B.Frag Rx • Metronidazole • Imipenem (probably b/c this is a good Rx for mixed infections) • What other drug is good for mixed infections? • Clindamycin

  39. Meningitis in a patient with a β-lactam allergy Chloroamphenicol

  40. Strep Pyogenes? • Pharyngitis • Pen V • what if allergic? • Erythromycin

  41. H.Pylori • Amino penicillin + ML • Or • Doxycycline

  42. Listeria meningitis • Amino-penicillin

  43. Adult sinusitis TMP/SMX Aminopenicillins

  44. Nocardia • TMP/SMX

  45. Lower UTI TMP/SMX Upper + lower UTI FQ UTI d/t #1 cause in women E.Coli – AG UTI d/t #2 cause in women Staph saprophyticus--Dicloxaxillin

  46. Chronic Bronchitis TMP/SMX

  47. Prostatitis TMP/SMX

  48. Pneumocystis Pneumonia TMP/SMX Prevention/prophylaxis? Caspofungin Prophylaxis in an AIDS patient? Dapsone

  49. Pseudomembranous Colitis due to C. difficile Metronidazole (1st choice) Vancomycin (2nd choice) What caused it in the first place? Any antibiotic can cause. In real life, FQ is apparently the #1. In our class, #1 is Clindamycin, #2 is amino-penicillins

  50. Prophylaxis for meningitis due to H. influenzae or N. meningitidis Rifampin Side effect: Orange Pee

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