1. CELL WALL INHIBITORS
1.1. PENICILLINS
1.1.1. AMPICILLIN
1.1.1.1. GRAM + COCCI + LISTERIA
1.1.1.1.1. STREP
1.1.1.2. GRAM - COCCI AND RODS
1.1.1.3. 25-500mg PO q6h
1.1.1.3.1. MAX 14g
1.1.1.4. .5-2g IV/IM q6h
1.1.1.5. CI: mono, hypersensitity, asthma, HIV, seizure, renal impairment
1.1.1.5.1. CrCl <10 q10h, CrCl < 30 q8-12, CrCl 30-50 q6
1.1.1.6. AE: Anaphylaxis, erythema multiforme, SJS, Cdiff, seizures, agranulocytosis, N/V/D, urticaria, rash, glossitis, stomatitis, black hairy tongue, candidiasis
1.1.2. PENICILLIN G
1.1.2.1. GRAM + COVERAGE (non resistant)
1.1.2.1.1. SA, SP, Enterococci, Strep A/G, viridans
1.1.2.1.2. BEST for Syphilis, GAS cellulitis,
1.1.2.2. 1-24 million U IM/IV q4h
1.1.2.2.1. MAX: 24million U/day
1.1.2.3. CI: hypersensitivity, asthma, seizure, renal impairment, sodium restrictions,
1.1.2.4. AE: hypersensitivtiy, exfoliative dermatitis, Cdiff, hemolytic anemia, neutropenia, N/V/D, hives, itching, fever, resh
1.1.3. PIPERACILLIN/TAZOBACTAM (Zosyn)
1.1.3.1. BROAD SPECTRUM + ANEROBES
1.1.3.1.1. gut bugs, oral infx, aspiration pneumonia
1.1.3.2. 3.375g IV q6h
1.1.3.2.1. pneumonia = 4.5g IV q6h
1.1.3.2.2. renal adjustment
1.1.3.3. CI: hypersensitivity, asthma, cystic fibrosis, seizure, renal impairment, sodium restrictuion, hypokalemia
1.1.3.4. AE: hypersensitivity, eosinophilia, erythema multiforme, SJS, epidermal necrolysis, Cdiff, pancytopenia, seizures, hypokalmeia, bleeding, N/V/D/C, HA, rash, insomnia, itching, fever, LFT elevation
1.1.4. **AMOXACILLIN
1.1.4.1. STAPH COVERAGE
1.1.4.2. 500-875mg PO q12
1.1.4.3. STREP PHARYNGITIS: 1g PO q24h x 10 days
1.1.4.4. OTITIS MEDIA: 1g PO q8h x 5-10days
1.1.4.5. CI: hypersensitivity, mono, ashtma, ALL, HIV, seizure, CrCl <30, PKU
1.1.4.6. AE: erythema multiforme, hypersensitivty, toxic epidermal necrolysis, Cdiff, hemolytic anemia, thrombocytopenia, hepatitis, seizures, jaundice, N/V/D, rash, hives, black hair tongue, ALT/AST elevation, candidasis
1.1.5. **AMOX/CAVULANATE ACID (Augmentin)
1.1.5.1. BROAD SPECTRUM + ANEROBES
1.1.5.1.1. gut bugs, oral infx, aspiration pneumonia
1.1.5.1.2. strep, e.coli and anaeroic coverage
1.1.5.1.3. diverticulitis
1.1.5.2. 500mg/125mg - 875mg/125mg PO q12h
1.1.5.2.1. renal dosing
1.1.5.3. CI: hypersensitivity, CrCl <30, mono, ashtma, ALL, HIV, seizure, renal/hepatic impairment, PKU
1.1.5.4. AE: hypersensitivity, erythema multiforme, SJS, Cdiff, leukopenia, hepatitis, seizures, N/V/D, rash, urticaria, itching, black hairy tongue, candidiasis, LFT elevation
1.1.6. NAFCILLIN
1.1.6.1. STAPH COVERAGE
1.1.6.2. .5-2g IV q4-6h
1.1.6.3. CI: hypersensitvity, asthma, seizure, sodium restriction, lurasidone, paritaprevir, rilpivirine, tenofovir
1.1.6.4. EA: N/V/D, urticaria, pruritus, fever, rash, eosinophilia, candidiasis, ALT/AST elevation, hypokalemia, hypersensitivity Cdiff, renal tubular necrosis, myelosuppression, tissue necrosis
1.1.7. **PENICILLIN V
1.1.7.1. 125-500 mg PO q6-8h
1.1.7.1.1. STREP PHAR: 500mg PO QID x 10 days
1.1.7.2. 250 PCN VK = 400,000 U PCN
1.1.7.3. CI: hypsersensitivity, asthma, seizures, renal impairment
1.1.7.4. AE: hypersensitivity, exfoliative dermatitis, Cdiff, hemolytic anemia, nephropathy, N/V/D, fever, rash, hives, eosinophilia, black hairy tongue
1.2. CARBAPENEMS
1.2.1. MEROPENEM
1.2.1.1. nosocomial PNA - 1g IV q8h x 7-15 days
1.2.1.2. SKIN PSEUDOMONAL INFX = 1g IV q8h
1.2.1.3. CI: hypersensitivity, seizure, CNS infx, renal impairment,
1.2.1.4. AE: seizures, SJS, hypersensitivity, Cdiff, hemolytic anemia, N/V/D, HA, paresthesia, rash
1.2.2. IMIPENEM
1.2.2.1. last resort heavy broad spectrum bugs
1.2.2.2. 250-500mg IV q6-8h
1.2.2.3. CI: hypersensitivity, renal impairment, CNS dx, seizure,
1.2.2.4. AE: hypersensitivity, SJS, toxic epidermal necrolysis, neurotoxicity, seizures, Cdiff, myelosuppression, hepatotoxicity, AKI, LFT eelvation, eosinophilia, seizures, N/V/D, anuria, rash
1.3. CEPHALOSPORINS
1.3.1. CEPHALEXIN (Keflex)
1.3.1.1. first generation
1.3.1.2. GRAM + COCCI AND GRAM - RODS
1.3.1.2.1. MSSA, GAS, bowel surgery
1.3.1.2.2. cellulitis infx + PCN allergy
1.3.1.3. SKIN AND SOFT TISSUE
1.3.1.4. 1000 - 4000 mg/day PO divided q6-12h
1.3.1.4.1. STREP PHARYN: 500mg PO q12h x 10 days
1.3.1.5. CI: hypersensitivity, renal impairment, GI disorder,
1.3.1.6. AE: anaphylaxis, angioedema, erythema multiforme, SJS, Cdiff, anemia, hepatitis, seizures, N/V/D, HA, rahs, dizziness, AST/ALT elevation,
1.3.2. CEFAZOLIN
1.3.2.1. first generation
1.3.2.2. GRAM + COCCI AND GRAM - RODS
1.3.2.2.1. bowel surgery prophylaxis
1.3.2.3. 250-1.5g IM/IV q6-8h
1.3.2.3.1. MAX 12g/day
1.3.2.3.2. PNEUMOCOCCAL PNA: 500mg IM/IV q12h
1.3.2.4. CI: hypersensitivity, renal impairment, seizure,
1.3.2.5. AE: neutropenia, thrombocytopenia, anaphylaxis, SJS, nephrotox, seizures, cdiff, N/V/D, rash, abdominal pain, ALT/AST ele, hives, thrombophlebitis,
1.3.3. CEFUROXIME
1.3.3.1. second generation
1.3.3.2. not useful for much
1.3.3.3. STREP AND GRAM - RODS
1.3.3.4. .75-1.5g IM/IV q8h
1.3.3.4.1. meningitis - 1.5-3g IM/IV q8
1.3.3.4.2. gonococcal - 750-1.5g IM q8
1.3.3.5. CI: hypersensitivity, renal/hepatic impairment, seizure, malnutrition,
1.3.3.6. AE: angioedema, SJS, nephritis, agranulocytosis, neutropenia, anemia, seizures, C.diff, ALT/AST elevation, renal impairment, diarrhea
1.3.4. CEFTRIAXONE (Rocephin)
1.3.4.1. third generation
1.3.4.2. GRAM + COCCI AND GRAM - COCCI
1.3.4.2.1. stones, urinary infx, strep pneumo, H. Flu
1.3.4.2.2. MENINGITIS**
1.3.4.2.3. does not cover atypicals (mycoplasm, chlamydia, legionella)
1.3.4.2.4. does not cover MRSA
1.3.4.3. 1-2g IM/IV q24h
1.3.4.4. GONOCCOCAL - 250-2g IM/IV q12-24h
1.3.4.5. CI: hypersensitivity, seizure, vit K, GI disorder, CaCl, CaGluconate
1.3.4.6. AE: anaphylaxis, bronchospasm, EM, necrolysis, agranulocytosis, jaundice, seizures, eosinophilia, thrombocytosis, ALT/AST elev, Diarrhea, leukopenia
1.3.5. CEFTAZIDIME (Fortaz, Tazcef)
1.3.5.1. fourth generation
1.3.5.2. GRAM + COCCI AND ALL GRAM -
1.3.5.2.1. + resistant gram -
1.3.5.2.2. hospital acquired pneumonia
1.3.5.3. 1g IV/IM q8-12h
1.3.5.3.1. MAX: 6g/day
1.3.5.4. CI: hypersensitivity, renal impairment, seizure,
1.3.5.5. AE: seizure, agranulocytosis, thrombocytopenia, hemolytic anemia, Cdiff, N/V/D, abdominal pain, itching, hives, HA, ALT/AST/BUN/Cr elevation
1.3.6. CEFEPIM MAXIPIME
1.3.6.1. fourth generation
1.3.6.2. GRAM + COCCI AND ALL GRAM -
1.3.6.2.1. + resistant gram -
1.3.6.3. PNA - 1-2g IV q8-12h x 10 days
1.3.6.3.1. 2g for pseudomonal
1.3.6.4. UTI - .5-2g IV/IM q12h
1.3.6.5. CI: hypersensitivity, renal impairment, GI disorder, Hflu infx,
1.3.6.6. AE: Anaphylaxis, seizures, aphasia, leukopenia, hemolytic anemia, aplastic anemia, toxic epidermal necrolysis, Cdiff, rash, diarrhea, ALT/AST elevation, nausea
1.4. VANCOMYCIN
1.4.1. MRSA COVERAGE
1.4.2. 15-20mg/kg IV q8-12h
1.4.2.1. CDIFF - 125-500mg PO q6h x 10-14days
1.4.3. CI: renal impairment, hearing impairment, elderly, cidofovir, streptozocin,
1.4.4. AE: anaphylaxis, hypotension, SJS, exfoliative dermatitis, necrolysis, nephritis, ototoxicity, nephrotoxicity, CDIFF, red-man syndrome, fever, N/V, rigors, urticaria, phlebitis, tinnitus, dizziness,
2. NUCLEIC ACID METABOLISM INHIBITORS
2.1. FLUOROQUINOLONES
2.1.1. BLACK BOX: tendon rupture, neuropathy, CNS effects, NO MG,
2.1.2. AE: prolonged QT, tendonopathy, C. Diff, hypersensitivity, phototoxicity, seizurs, ICP, suicidal ideation, torsades, MG, N/V/D, HA, dyspepsia, restlessness, lightheadedness, anxiety, myalgia
2.1.3. CI: MG, QT, torsades, arrhythmias, recent MI, CHF, pts >60, G6PD, tendon disorder, seizure disorder, renal/hepatic impairment, dehydration, DM, pimozide, tizanidine, cisapride, fibanserin, eliglustat
2.1.4. **CIPROFLOXACIN
2.1.4.1. UTI**
2.1.4.1.1. 10000mg ER PO q24
2.1.4.2. bad for pneumonia - no gram + coverage
2.1.4.3. COVERS JUST GRAM -
2.1.4.3.1. and atypicals
2.1.4.3.2. SPACEK BUG COVERAGE
2.1.4.4. 250-750mg PO
2.1.4.4.1. 200-400mg IV q12
2.1.5. **LEVOFLOXACIN
2.1.5.1. "Respiratory quinolones"
2.1.5.2. COER GRAM - AND GRAM + COCCI
2.1.5.2.1. S. Pneumo & Staph
2.1.5.2.2. SPACEK BUG COVERAGE
2.1.5.2.3. and atypicals
2.1.5.3. PNA - 750mg PO/IV q24h
2.2. RIFAMYCINS
2.2.1. RIFAMPIN
2.2.1.1. TB: 10mg/kg PO/IV qd x 6mo
2.2.1.2. meningococcal prophylaxis: 600mg PO BID x 2 days
2.2.1.3. CI: IM/SC admin, porphyria, hepatic impairment, DM, -evir, -nib, voriconazole
2.2.1.4. AE: Hepatitis, thrombocytopenia, anemia, hemorrhage, DIC, nephritis, shock, psychosis,EM, SJS, CDIFF, anorexia, fatigue, diarrhea, ataxia, dyspnea, vision changes
2.2.2. RIFAXIMIN
2.2.2.1. travelers diarrhea: 200mg PO TID x 3 days
2.2.2.2. IBS: 550mg PO TID X 14days
2.2.2.3. CI: hypersensitivity, hepatic impairment,
2.2.2.4. AE: Cdiff, angioedema, anaphylaxis, N/V, edema, dizziness, ascites, HA, muscle spasm, dyspnea, arthrlgia, fever, rash
2.3. NITROIMIDAZOLE
2.3.1. **METRONIDAZOLE
2.3.1.1. BLACK BOX: CARCINOGENIC RISK
2.3.1.2. 500mg PO q6-8 x 7-14
2.3.1.3. amebiasis: 750mg PO q8h x 5-10 days
2.3.1.4. vaginosis: 500mg PO q12h x 7 days
2.3.1.5. trich 2g PO/IV x 1
2.3.1.6. GIARDIASIS: 250mg PO q8h x 5-7 days
2.3.1.7. CI: PREGNANCY, hypersensitivity, alcohol use, CNS disorder, hepatic impairment, busulfan, ritonavir,
2.3.1.8. AE: Seizures, aseptic meningitis, SJS, leukopenia, N/V/D, rash, HA, dizziness, dark brown urine, candidiasis, metallic taste
2.4. DIHYDROFOLATE REDUCTASE INHIBITORS
2.4.1. COTRIMOXAZOLE (Bactrim)
2.4.1.1. bactrim
2.4.2. **TRIMETHOPRIM
2.4.2.1. UTI: 100mg PO q12
2.4.2.2. travelers diarrhea: 200mg PO BID
2.4.2.3. CI: anemia, folate deficiency, renal/hepatic impairment, bone marrow depression, dofetilide
2.4.2.4. AE: thrombocytopenia, neutropenia, SJS, aseptic meningitis, EM, phototoxicity, jaundice, Cdiff, Rash, pruritus, N/V fever, glossitis, taste change hyperkalemia, hyponatremia photosensitivity
2.5. SULFONAMIDES
2.5.1. TRIMETHOPRIM/SULFAMETHOXAZOLE (Bactrim)
2.5.1.1. 160mg PO q12
2.5.1.1.1. UTI: 160mg PO q12h
2.5.1.2. CI: hypersensitivity to sulfa, thrombocytopenia, <2mo, pregnancy, anemia, hepatic impairment, folate deficiency, elderly, hyperkalemia, renal impairment, porphyria, malnutrition, dofetilide, methanamine, PREGNANCY
2.5.1.3. AE: SJS, toxic epidermal necrosis, aplastic anemia, hepatotoxicity, myelosuppresion, seizures, SLE, hypoglycemia, N/V/D, dizziness, HA, lethargy, dyspepsia
2.5.2. **SULFAMETHOXAZOLE
2.5.2.1. in bactrim
2.6. OTHER
2.6.1. DAPTOMYCIN (Cubicin)
2.6.1.1. MRSA COVERAGE
2.6.1.2. SKIN: 4mg/kg IV q24h
2.6.1.3. STAPH BACTEREMIA: 6mg/kg IV q12h
2.6.1.4. CI: hypersensitivity, <1, elderly, renal impairment,
2.6.1.5. AE: Cdiff, pNA, anaphylaxis, thrombocytpenia, myopathy, rhabdo, insomnia, CK elevation, edema, abdominal pain, itchy, HTN, HA, diarrhea, rash, UTI, dizziness, dyspnea
2.6.2. FIDAXOMICIN
2.6.2.1. CDIFF: 200mg PO BID x 10 days
2.6.2.2. CI: hypersensitivity
2.6.2.3. AE: hypersensitivity, GI bleed, neutropenia, anemia, N/V, abdominal pain, neutropenia,
2.6.3. **NITROFURANTOIN (Macrobid)
2.6.3.1. UTI
2.6.3.1.1. IR: 50-100mg PO q6h x 7 days
2.6.3.2. CI: hypersensitity, hepatic impairment, pts <1, oliguria, anuria, PREGNANCY, labor and delivery, anemia, DM, G6PD, articaine, -ivacaine,
2.6.3.3. AE:hemolytic anemia, aplastic anemia, leukopenia, thrombocytopenia, pancreatitis, hepatitis, cyanosis, CDiff, EM, SLE, N/VD, anorexia, abdominal pain, asthenia, vertigo dizzines, HA, drowsiness, confusion, alopecia, fever, rash itching, myalgia, rigors
3. PROTEIN SYNTHESIS INHIBITORS
3.1. AMINOGLYCOSIDES
3.1.1. BLACK BOX: neuro/oto/nephro toxicity & neuromuscular blockade
3.1.2. CI: renal impairment, dehydration, impaired auditory, neuromuscular dx, lyte abnormaltiies, prolonged use, high dose, infants, elderly, cidofovir, streptozosin
3.1.3. AE: nephrotoxicity, fanconi syndrome, ototoxicity, neurotoxicity, NM blockade, seizures, BUN/Cr elevation, dizziness, vertigo, tinnitus, hearing loss
3.1.4. GENTAMICIN
3.1.4.1. 1-1.7mg/kg IV q24h
3.1.4.1.1. gonococcal: 240mg IM x 1
3.1.4.1.2. PID: 1.5mg/kg IM/IV q8h
3.1.5. AMIKACIN
3.1.5.1. 7.5mg/kg IM/IV q12h
3.1.5.2. active TB: 15mg/kg IM/IV q24h
3.1.6. NEOMYCIN
3.1.6.1. colorectal surgery prophylaxis: 1000 mg PO
3.1.6.2. hepatic encephalopathy: 1000-3000 mg PO q6h
3.1.7. STREPTOMYCIN
3.1.7.1. 1-2g/day IM divided q6-12h
3.1.7.2. active TB: 15mg/kg IM/I q24h
3.1.8. TOBRAMYCIN
3.1.8.1. 1.-1.7mg/kg IM/IV q8h
3.2. MACROLIDES
3.2.1. CI: elderly, hepatic/renal impairment, QT prolongation, MI, bradycardia, CHF torsades, lyte abnormalities, mGF, cisapride, dronedarone, pimozide, thioridazine
3.2.2. AE: angiedema, anaphylaxis, jaundice, hepatotox, pancreatitis, SJS, necrolysis, CDIFF, QT prolongation, MG, N/V/D, HA, abdominal pain, vaginitis, dyspepsia, rash, anorexia, impaired hearing
3.2.3. **AZITHROMYCIN
3.2.3.1. COVERS GRAM - RODS, GRAM + COCCI
3.2.3.1.1. NO SPACEK BUGS
3.2.3.1.2. Added to ceftriaxone to cover hospital acquired pneumonia
3.2.3.2. 500mg PO x1 then 250mg PO q24h x 4 days
3.2.4. ERTHYROMYCIN
3.2.4.1. MRSA
3.2.4.2. 1000mg/day PO divided q6-12h
3.2.4.3. CI: + eliglustat, fluconazole, lovastatin, quinidine, simvastatin, thioridazine
3.3. STREPTOGRAMINS
3.3.1. QUINUPRISTIN/DALFOPRISTIN
3.3.1.1. BLACK BOX: indication for VREF bacteremia
3.3.1.2. 7.5mg/kg IV q12h
3.3.1.3. CI: hypersensitivity, alfuozsin, cisapride, eletriptan, pimozide
3.3.1.4. AE: Cdiff, angioedema, anaphylaxis, arthralgia, N/V rash, LDH elevation, anemia
3.4. LINCOSAMIDES
3.4.1. **CLINDAMYCIN
3.4.1.1. MRSA COVERAGE
3.4.1.2. BLACK BOX: CDIFF
3.4.1.3. 150-450mg PO q6h
3.4.1.4. CI: hypersensitivity, UC, neonates, GI dx, elderly, atopic, renal/hepatic impairment
3.4.1.5. AE: CDIFF, hypersenstivity, SJS, necrolysis, granulocytopenia, rash, N/V/D, abdominal pain, jaundice, urticaria, hypotension, metallic taste
3.5. OXAZOLIDINONES
3.5.1. **LINEZOLID (Zyvox)
3.5.1.1. MRSA COVERAGE
3.5.1.2. 600mg PO/IV q12h
3.5.1.3. PNA, VRE, skin/suture infx
3.5.1.4. CI: hhypersensitivity, myelosuppression, uncontrolled HT, pKU, hepatic impairment, seizure, renal impairment, amitriptyline, amoxapine, bupropion, duloxetine, fluoxetine, imipramine, isocarboxazid,
3.5.1.5. AE: CDIFF, anemia, lactic acidosis, SJS, serotonin syndrome, vision loss, seizures, N/V/D, HA, rash, HTN
3.6. TETRACYCLINES
3.6.1. AE: CDIFF, photosensitivity, skin rxn, anemia, hepatitis, toxicities, HA, N/V/D, dyspepsia, URI, dysmenorrhea, candidiasis, HTN, tooth discoloration
3.6.2. CI: hypersensitivity, PREGNANCY, <8, hepatic impairment, SLE, candidiasis, acitretin,
3.6.3. MRSA
3.6.4. **DOXYCYCLINE
3.6.4.1. 100mg PO/IV qd
3.6.4.2. ACNE: 50-100mg PO QD-BID
3.6.4.3. ROSACEA: 40mg pO qAM
3.6.4.4. CHLAMYDIA: 100mg PO x7days
3.6.5. TIGECYCLINE
3.6.5.1. BLACK BOX: ALL CAUSE MORTALITY
3.6.5.2. 50mg IV q12h
3.6.5.2.1. PNA, skin, intra abdominal
3.6.6. **MINOCYCLINE
3.6.6.1. 100mg PO q12
3.6.6.2. ACNE: 1mg/kg ER PO x 12wk
3.6.7. TETRACYCLINE
3.6.7.1. 1-2g/day PO divided BID-QID
3.6.7.2. ACNE: 125-250mg PO QID
3.6.7.3. SYPHILIS: 500mg PO QID x 14days
3.7. OTHER
3.7.1. AZTREONAM
3.7.1.1. 1-2g IM/IV q8-12h
3.7.1.2. CI: hypersensitivity, renal/hepatic impairment,
3.7.1.3. AE: anaphylaxis, necrolysis, seizures, Cdiff, hepatitis, neutropenia, anemia, phlebitis, N/V/D, rash, AST/ALT/Cr elevation,