Antibiotics review

Site of action Antibiotic class/Name Common Uses Caution/Contraindications/SE Cell Wall -cidal Penicillins – Category B • Penicillin V PO QID • Amoxicillin(an extended spectrum PCN) PO BID -TID • Amoxicillin/clavulanic acid (Augmentin) PO BID • Benzathine penicillin G IM • Dicloxacillin PO QID *Amoxicillin: 1 st line AOM *PCN V QID: 1 st line strep throat *Augmentin:1 st line sinusitis, 2 nd line AOM *Benz PCN G: 1 st line Syphilis *Dicloxacillin: cellulitis (not MRSA), impetigo, erysipelas, mastitis *Diarrhea, vaginitis (candida)- recommend probiotic or yogurt daily *C. diff *Type 1 IgE-mediated anaphylaxis & angioedema *avoid amoxicillin in mononucleosis- will cause rash not related to allergy -cidal 1 st Gen Cephalosporins – Category B • Cephalexin (Keflex) PO QID *UTI in pregnancy (if bacteria sensitive) *cellulitis (not MRSA), impetigo, mastitis *cross reaction with PCN allergies * diarrhea *Interaction with warfarin * caution if renal impairment -cidal 2 nd Gen Cephalosporins – Category B • Cefuroxime axetil (Ceftin) PO BID • Cefprozil (Cefzil) PO BID • Cefaclor (Ceclor) PO BID *broad spectrum (gram +/-) *Sinusitis *AOM *CAP *Skin *cross reaction with PCN allergies * diarrhea *Interaction with warfarin * caution if renal impairment -cidal 3 rd Gen Cephalosporins – Category B • Ceftriaxone (Rocephin) IM • Cefdinir (Omnicef) daily-BID • Cefixime (Suprax) daily-BID *Ceftriaxone 250mg IM in a single dose 1 st line for gonococcal infections *AOM (not 1 st line) *cross reaction with PCN allergies * diarrhea *Interaction with warfarin * caution if renal impairment -cidal Glycopeptide • Vancomycin IV or PO *severe MRSA *C. diff (must give PO) *Sepsis *Endocarditis *Inpatient treatment *Red Man’s syndrome-histamine release *nephrotoxic *ototoxicity Protein synthesis -cidal Amioglycosides • Gentamicin • Tobramycin • Streptomycin • neomycin *Otic or ophthalmic gtts *bacterial conjunctivitis *Poor GI absorption, needs parenteral admin & serum monitoring *Nephrotoxicity *Ototoxicity *Teratogenic, avoid use in pregnancy -static Tetracyclines - Category D • Tetracycline • Doxycycline PO BID • Minocycline *Tetra-severe acne (usually over 13-14 yo), rosacea *Doxy-MRSA, Lyme, chlamydia 100mg BIDx7days, H Pylori, mycoplasma, in Rocky Mt Spotted Fever only give to BOTH children & adults unless SEVERE allergy *Mino-more SEs *Photosensitivity (wear hat, sunblock) *Binds with iron, Ca, Mg, Zinc (take on empty stomach 1 hr bf or 2 hr after meals) *decrease effectiveness of OCPs *Pseudotumor cerebri *esophageal ulcers (take c full glass water) *Mino-vestibular dysfunction, vertigo *toss expired pills-nephropathy or Fanconi syndrome *teeth staining: avoid in pregnancy, breastfeeding, and children under 8 -static Macrolides • Erythromycin PO BID • Azithromycin (Z-Pack) – Category B • Clarithromycin (Biaxin) PO BID • Telithromycin (Ketek) once daily (18 + only) * Azithromycin: CAP, Pertussis, Chlamydia 1 Gram PO single dose *GI distress-esp. Erythromycin (switch to Z-pack if GI issues) *ototoxicity *cholestatic jaundice, hepatitis *QT Prolongation, bradyarrhythmias: watch for CCB interactions *Black box: Do not use on Myasthenia Gravis pts (liver failure) *Drug interactions: warfarin, digoxin, theophylline, Salmeterol, benzos, anticonvulsants, Tegretol, statins, etc -static Lincosamide • Clindamycin (Cleocin) *topical – acne *MRSA 1 st line TID 5-10 days *Higher risk of C. diff -static Chloramphenicol *serious infections only *last resort *Blood dyscrasias *Grey syndrome, death