Suad Al Sulimani

1. Suad AL-Sulimani R3

6. Spectrum of Activity Narrow-Spectrum Antimicrobial Wide-Spectrum Antimicrobial

7. ` St Re pt enterococcus Staph .aeru M R S A H.Influ morexella niesseria Psudomonus Gram –ve rods e.coli anaerob Penicillin Amoxacillin/Ampicillin + + 0 0 +/- 0 +(niesseria meningitis 0 0 0 Amoxicillin/calvu(oral + + + 0 + + + 0 + + Tazobactaum /Pipracellin (iv ) + + + 0 + + + + + + Carbapenums (imepenu meropenum + + e.fecalis only + 0 + + + + + +

8. ` cephalosporins strptococcus enterococcus Staph .aerus MRSA H.influ morexella niesseria Psudomonus Gram –ve rods ecoli 1 st generation Cephalexin + 0 + 0 + not cephalexin +/- 0 0 0 2 nd generation Cefuroxime , cefacolr + 0 + 0 + + cefacolr +/- +/- 0 +/- 3 rd generation Ceftriaxone ,cefexime + 0 + 0 + + + +/- + 3 rd generation (antipsudomonus Ceftazidine + 0 +/- 0 + + +/- + + 4 th generation cefepime + 0 + 0 + + + + +

9. */ Common antibiotics Spectrum of activities Macrolides (bacteriostatic) - Erythromycin (also azithromycin, clarithromycin) Gram-positive bacteria, Mycoplasma, Legionella Aminoglycosides (bactericidal) Streptomycin, kanamycin, gentamicin, tobramycin, amikacin, netilmicin and neomycin (topical) gram-negative and some gram-positive bacteria. They are not useful for anaerobic bacteria, Tetracyclines (bacteriostatic) Tetracycline, minocycline and doxycycline b. Spectrum of activity - These are broad spectrum antibiotics and are useful against intracellular bacteria Chloramphenicol, lincomycin, clindamycin (bacteriostatic) Chloramphenicol - Broad range Lincomycin and clindamycin - Restricted range Quinolones - nalidixic acid, ciprofloxacin, oxolinic acid (bactericidal) Gram-positive cocci , gram –ve bacteria

23. Empiric Therapy—immunocompetent Age: Preterm to <1 mo Group B strep 49%, E. coli 18%, listeria 7%, AMP + cefotaxime AMP + gentamicin Age: 1 mo– 50 yrs S. pneumo, meningococci, H. influenzae now very rare, listeria unlikely if young & immuno-competent (add ampicillin if suspect listeria: 2 gm IV q4h) Adult dosage: [( Cefotaxime 2 gm IV q4–6h OR ceftriaxone 2 gm IV q12h)] + ( dexamethasone) + Vanco [( MER 2 gm IV q8h) (Peds: 40 mg/kg IV q8h)] + IV dexamethasone + vanco

24. Age > 50 years or alcoholism or other deblitating illneesses , immunocompromized Strpt .Pnumoniae,listeria, gram –ve bacilli 1)AMP 2 gm IV q4h) + (ceftriaxone 2 gm IV q12h or cefotaxime 2 gm IV q6h) + vanco + IV Dexamethasone 2) MER 2 gm IV q8h + vanco + IV dexamethasone. Basilar skull fracture S. pneumoniae , H. influenzae , group A beta-hemolytic streptococci Vancomycin plus a third-generation cephalosporin•Δ Penetrating trauma Staphylococcus aureus , coagulase-negative staphylococci (especially Staphylococcus epidermidis ), aerobic gram-negative bacilli (including Pseudomonas aeruginosa ) Vancomycin plus cefepime; OR vancomycin plus ceftazidime; OR vancomycin plus meropenem

25. Delay in initial antibiotics in the emergency department (median delay of four hours) was associated with a worsening of hypotension, altered mental status, and seizures in about 15 percent of patients . Those patients whose delay in antibiotic therapy allowed their disease to advance from having zero or one to having two or three poor prognostic indicators had a significant increase in adverse outcomes.

30. Risk factors to develop CAMRSA soft tissue infection : = Antibiotic use (particularly cephalosporin and fluoroquinolone use) strongly correlates with the risk for MRSA colonization and infectio = residents of long-term care facilities =Homeless =IV drug users =Prisoners =Military Personnel =HIV patients 60% are abscess, 40% cellulitis , small persentage as impetigo Clin Infect Dis. 2007;45 Suppl 3:S171-6

32. Skin and soft tissue infections Parenteral therapy • Vancomycin (30 mg/kg IV every 24 hours in 2 equally divided doses; not to exceed 2 g/24 hours unless concentrations in serum are inappropriately low) • Daptomycin (4 mg/kg IV once daily) • Linezolid (600 mg IV twice daily) • Tigecycline (100 mg IV once, thereafter 50 mg IV every 12 hours) Oral therapy • TMP-SMX (2 double-strength tablets orally twice daily) • Doxycycline or minocycline (100 mg orally twice daily) • Clindamycin* (300 to 450 mg orally every 6 to 8 hours) • Linezolid (600 mg orally twice daily)

38. Common antibiotic drug interaction

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