Antibiotics General Above the diaphragm (Aspiration pneumonia, lung abscesses, oral infections) Below the Diaphragm (Intra-abdominal anaerobic infections) Monitoring Aminoglycosides/Vancomycin If IV ≥3 days or ≥2 days in a renal patient Penicillin causing rash Not a contraindication for cephalosporins Breathing issues, edema are CIs Amoxicillin/Clavulanic Acid (Augmentin) Ampicillin/Sulbactam (Unasyn) Ceftriaxone SE: Cholestasis Cefazolin Prophylaxis for skin flora Cefepime Coverage Pseudomonas, MSSA, Strep Pneumo, H. Influenzae Misses SE: Neutropenia, thrombocytopenia, Seizure, Delirium, C. Difficile, Transaminitis, Hemolytic anemia, interstitial nephritis Ceftaroline 5th gen cephalosporin, only one that covers MRSA Clindamycin MOA: Inhibits protein synthesis Effective against Bacteroides and c. perfringens Chloramphenicol 50S static Associated w/ blood dyscrasias Daptomycin (Cubicin) Can be considered for MRSA infections when the isolate's vancomycin MIC is ≥2 nanograms/mL or when the vancomycin MIC is close to 2 nanograms/mL and the clinical response is poor Test susceptibility first Coverage SE: LFT elevations, Acute eosinophilic pneumonia, peripheral neuropathy, Falsely elevated INR, Rhabdomyolysis (CK (DC if ≥2000 or ≥1000 w/myopathy), stop statins) Meropenem (Merrem) Coverage Metronidazole MOA: Contains a nitro group that acts as an electron sink, capturing electrons and creating free radicals which disrupts DNA synthesis via a cytotoxic intermediate (Bactericidal) Effective against Bacteroides, prevotella, fusobacterium, clostridium SE: Disulfiram-like reaction (severe flushing, tachycardia, palpitations, nausea, vomiting, hypotension) with alcohol Metallic taste Headache Piperacillin-Tazobactam (Zosyn) Coverage Misses SE: Rash, Drug fever, Prolonged PT, Leukopenia, Thrombocytopenia Telavancin Lipoglycopeptide derivative of vancomycin and can be given once daily More side effects than Vancomycin, worse kidney injury Tuberculosis Medications Rifampin Benign, red color to body secretions Isoniazid Peripheral Neuropathy Use pyridoxine to prevent Pyrazinamide Benign, Hyperuricemia (Gout) Ethambutol Optic neuritis/color vision changes Decrease dose in renal failure TMP/SMX CI: Warfarin/Methotrexate use, allergy, elderly with renal insufficiency Vancomycin Red Man Syndrome MC adverse event, hypersensitivity not reaction Usually 5-10 minutes after starting infusion Diffuse erythema, pruritus, and tenderness over the skin above the waist ± hypotension, dyspnea if severe Treatment Stop infusion, give antihistamines, restart infusion at slower rate Dosing Guidelines Area under the curve, Mean inhibitory concentration Goal for AUC/MIC to be achieved in 24-48 hours Empiric Therapy AUC/MIC calculation for empiric therapy assumes MIC to be 1 nanogram/ml or less MRSA Native Tricuspid Valve Endocarditis AUC/MIC target of 400-600 mg*hour/L of Vancomycin to maximize efficacy and minimize nephrotoxicity MRSA Prosthetic Valve Endocarditis Vancomycin, Gentamicin, and Rifampin