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Aminoglycosides
Common examples: Gentamicin (Garamycin) Tobramycin (Nebcin) Neomycin, Amikacin (Amikin), Streptomycin
Cephalosporins
Common examples:
1st Generation
Cefazolin (Ancef, Kefzol) Cephalexin (Keflex)
2nd Generation
Cefaclor (Ceclor) Cefoxitin (Mefoxin) Cefprozil (Cefzil)
3rd Generation
Cefatoxamine ( Claforan) Ceftriaxone (Rocephin) Cefpodoxime (Vantin)
4th Generation
Cefepime (Maxipime)
Macrolides
Common examples: Azithromycin (Zithromax, Z-Pak) Clarithromycin (Biaxin) Erythromycin (Erythrocin)
*Broad-spectrum antibiotic *Good alternative for patients allergic to Penicillin. *Administer on an empty stomach, destroyed by gastric acids and acidic fruit juice. *Contraindicated with known liver disease, increased liver function tests with prolonged use. *Adverse effects include GI complaints, suprainfections, hepatotoxicity, dysrhythmias, ototoxicity, pseudomembranous colitis, and anaphylaxis.
Penicilllins
Common examples: Penicillin G (Bicillin) Penicillin V (Pen VK) Nafcillin, Oxacillin Ampicillin (Principen) Amoxicillin (Amoxil, Trimox) Ampicillin/Sulbactam (Unasyn) Amoxicillin/Clavulanate (Augmentin) Ticarcillin (Ticar) Peperacillin/Tazobactam (Zosyn)
*Treatment of Gram (+) infections *5-15% incidence of Cross-sensitivity to Cephalosporins. *Give separately from Aminoglycosides, may inactivate. *Generally well tolerated. Adverse reactions range from mild rash, N/V, to severe anaphylaxis. *Monitor use in renal patients *Oral absorption limited by the presence of food, empty stomach preferred, administer with H20, not acidic juices.
Fluoroquinolones (Quinolones)
Common examples: Ciprofloxacin (Cipro, Septra) Gatifloxacin (Tequin, Zymar) Levofloxacin (Levaquin) Moxifloxacin (Avelox)
*Treatment of Gram (-) organisms and some Gram (+) infections *Generally not used as a first-line antibiotic *Antacids, mineral supplements and multivitamin interfere with absorption up to 90% when given together *Monitor BUN and creatinine levels. *Monitor I&O *Adverse effects include: GI complaints, dizziness, headache, sleep disturbances, suprainfections, phototoxicity, cardiotoxicity, and tendon/joint toxicity (associated with small risk of tendon rupture). *Contraindicated in pregnancy and patients < 18 years of age, except with Anthrax exposure. *Cipro DOC for Anthrax exposure
Sulfonamides
Common examples: Trimethoprim/Sulfamethoxazole (Bactrim, Septra) Sulfisoxazole (Gantrisin) Sulfisoxasole/Erythromycin (Pediazole) Silver Sulfadiazine (Silvadene) **Topical form Sulfacetemide (Cetamide) **Opthalmic drops
*Broad spectrum activity *Oftenprescribed for the treatment of UTIs *Increase fluids to 2000-3000 ml/day Adverse effects include GI complaints, skin rashes, suprainfections, crystalluria, renal damage, phototoxicity, hyperkalemia, blood dyscrasias, Stevens-Johnson syndrome, anaphylaxis.
Tetracyclines
Common examples: Doxycycline (Vibramycin) Tetracycline (Sumycin) Tigecycline (Tygacil)
*Broad spectrum activity *Take on an empty stomach to maximize absorption, although may not be tolerated unless administered with food. *Strong affinity for Calcium, do not administer with antacids or dairy products. *Contraindicated during pregnancy, lactation and children < 8 years (May cause permanent staining of teeth and/or delayed bone growth). *Photosensitivity and GI disturbances common. Adverse reactions include multiple GI complaints, skin rashes, suprainfections, phototoxicity, hepatotoxicity, anaphylaxis.
MISCELLANEOUS ANTIBIOTICS
Vancomycin
Daptomycin (Cubicin) Class: Cyclic-lipopeptide Imipenem-cilastin (Primaxin) Class: Carbapenems Clindamycin (Cleocin)
*Broad spectrum antibiotic *Often used for oral infections *Associated risk of Pseudomembranous colitis limits use *Other adverse effects include rash, pruritis, difficulty swallowing *Primary use for the treatment of Vancomycin-resistant Enterococcus *Hepatotoxic, nephrotoxic *Other adverse effects include pain and irritation at IV site, GI complaints, muscle pain and rash *Effective for Vancomycin resistant MRSA infections *Cautious use in patients with history of hypertension or patients taking serotonin reuptake inhibitors; may precipitate a hypertensive crisis *Other adverse effects include thrombocytopenia, bleeding, GI complaints, fever
ANTI-INFECTIVES
Antihelminthics
Common examples: Mebendazole (Vermox) Pyrantel (Antiminth, Pinworm caplets, Pin-X)
Antimalarials
Common examples: Hydroxychloroquine (Plaquenil)
*Easier to prevent the disease of malaria than to treat it. Persons traveling to infested areas should take prophylactic antimalarials prior to travel. *Adverse effects include GI complaints, headache, agitation, photophobia, agranulocytosis, EKG changes. *Baseline CBC and EKG indicated with long-term therapy.
Antiprotozoals (nonmalarial)
Common examples: Metronidazole (Flagyl)
*Dual activity against bacteria and parasites *May cause dark or reddish brown discoloration of urine *Cautious use with known hepatic disease *Adverse effects include GI complaints, headache, dizziness, thrombophlebitis, bone marrow suppression.
*Indicated for the treatment of HSV-1, HSV-2, CMV (Cytommeegalovirus), EBV (Epstein Barr), VZV (Varicella) *Do not cure patients of the virus. Used to relieve symptoms and decrease recurrence rate *For IV routes: Monitor I&O and encourage fluids, monitor BUN and creatinine. *Adverse effects vary with drug.
Influenza
Common examples: Oseltamivir (Tamiflu) Zanamivir (Relenza) Prophylaxis Amantadine (Symmetrel) Rimantidine (Flumadine)
*Prophylactic medications should be started within 48 hours after exposure. *Screen for history of substance abuse and/or suicide, may exacerbate preexisting mental disease. *Prevention of influenza through annual vaccination is the best alternative
Hepatitis
Common examples: Antivirals Adefovir dipivoxil (Hepsera) Entecavir (Baraclude) Tenofovir (Viread) Lamivudine (Epivir HBV)
*Indicated for the treatment of chronic Hepatitis B infections *Adverse effects include GI complaints, fatigue, and hepatotoxicity. *Monitor ALT, AST and blood counts.
Inteferons Peginterferon alfa-2a (Pegasys) Antivirals Ribavirin (Copegus, Virazole, Rebetol, Ribasphere)
*Indicated for the treatment of Hepatitis C *Adverse effects include fatigue, headache, malaise, anorexia, diarrhea, suprainfections, thrombocytopenia, suicidal thoughts *Flulike symptoms likely after IV administration. *Increase fluids to 2500ml or more/day and monitor I&O.
*Monitor CD4+ Tcell counts and HIV RNA viral load with all Antiretrovirals *Administer in combination therapy only. *Adverse effects include abdominal pain, fatigue, GI complaints, neutropenia, thrombocytopenia, nephrotoxicity,cough, dizziness, pyrexia, rash, upper respiratory infections, hepatotoxicity and increased risk of myocardial infaction. *Use caution when administering to patients with known cardiac disease. *Monitor ALT and AST. *Subq injection site reactions occur in nearly all patients *Resistance develops rapidly, always administer in combination therapy with at least one NRTI. *St John's Wort contraindicated, greatly reduces efficacy. *Adverse effects include GI complaints specifically severe diarrhea, anemia, leucopenia, lymphadenopathy, hemorrhagic colitis, and pancreatitis
*Adverse effects include rash, malaise, GI complaints, bone marrow suppression, neutropenia, anemia, neurotoxicity.
**Adverse effects include rash, GI complaints, parasthesia, hepatotoxicity, Stevens-Johnson syndrome. *Monitor ALT and AST.