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Antibiotic, Antifungal, and Anti-helminthic Drug Indications (DOCs)
Julia Jones(with fungal contributions from Wendy Chen)
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Primary SyphilisPenicillin G, IM x 1
What if patient is very allergic to Penicillins?
Doxycycline p.o. x 2wks
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Staphylococci with plasmid-encoded β-lactamases
Dicloxacillin
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Pseudomonas AeruginosaPiperacillin-Tazobactam
What if patient is a little bit allergic to Penicillins?
3rd gen ceph (ceftazadime)4th gen ceph (cefepime)
What if patient is a lot allergic to Penicillins, cephalosporins?
Aztreonam (monobactam)
What if I wanted to use a protein synthesis inhibitor?
Aminoglycosides
What if that drug was too nephrotoxic?
Aztreonam (monobactam)
The Big Gun?
Imipenem
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Meningitis in patients >3 months old
Ceftriaxone (IV, 3rd GC) can add Vancomycin +/- Rifampin
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Gonorrhea
3rd GC Ceftriaxone (IM) or Cefixime (p.o.)
What if very allergic to cephalosporins? ( 2 alternatives)
FQs
Azithromycin
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Serratia
• Imapenem• Aztreonam
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EHEC
• None. Supportive/symptomatic
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Typhoid Fever
Ceftriaxone (serious G- infxn)Or?
FQ, 2nd line TMP/SMX
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ETEC
• Severe G- infection: • cephalosporin• Severe G- rod aerobic infection: • AG• 2nd line: • TMP/SMX• G- GI tract Tx: • FQ
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Shigella
• 1st line:• FQ• 2nd line:• TMP/SMX• Other?• Amino-penicillin
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Community-acquired pneumonia
Azithromycin (ML)
Plus?
Ceftriaxone + AG
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Nosocomial pneumonia
Ceftriaxone + Gentamicin (aminoglycoside)
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Serious Gram (-) infections
Ceftriaxone
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MRSA
Vancomycin (sometimes add Gentamicin +/- Rifampin)
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Mycoplasma pneumonia
Doxycycline (tetracycline)Azithromycin
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Enterobacter
• DOC?• Imapenem• Other choices?• 2nd/3rd/4th gen Cephalosporins• Pipercillins
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ChlamydiaDoxycycline
(+macrolide – azithromycin or erythromycin) How do I pick?
depends on desired dosing regimenWhat other protein synthesis inhibitor?
TMP/SMX
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Rickettsia (RMSF)
Doxycycline
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Vibrio cholera
Doxycycline
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Legionella
Doxycycline (+erythromycin)
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Skin infections caused by community-acquired MRSA
TMP/SMXWhat if allergic to sulfonamides?
DoxycyclineOther drugs?
Clindamycin, FQs
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Staph aureus drugs?
• Dicloxacillin• Other drugs in this group?• “I met a nasty ox:”• Methicillin, • Nafcillin, • Oxacillin
• Vancomycin• Clindamycin
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Proteus
• Aminopenicillins• All cephalosporins
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Acinetobacter
• This used to be a pseudomonas• Imepenem
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Anthrax!!
• FQ• This is actually the prophylactic Tx. Not DOC.
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Lyme disease
• Doxycycline• 3rd gen cephalosporin
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MAC (Mycobacterium avium)
• Azithromycin• Ethambutol• (FQ)
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Hemophilis
• Amino-penicillins• 2nd/3rd/4th gen Ceph• Aztreonam• Chloramphenicol• For prophylaxis?• Rifampin• Who gets it?• All close contacts
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Klebsiella
• All cephalosporins• Aztreonam
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Strep pneumo
• Penicillin• Aminopenicillin + B-lactamase inhibitor• Strep pneumo is notorious for what
resistance mechanism?• Altering PBP. Solution?• 3rd/4th gen cephalosporins
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Dental prophylaxis for endocarditis
• Clindamycin• Aminopenicillins
• Rx for strep viridans/mutans?• Penicillin
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Lupus
• INH• Ooh. Lupus is also a contraindication in
which drug?• Primaquine
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Moraxella
• Amino-penicillin• Azithromycin
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Corynebacterial Diphtheria
Macrolides (Azithromycin or Erythromycin)
What else?Pen G/V
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Anaerobic Abscesses
Clindamycin or Metronidazole
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Brain Abscesses
Metronidazole
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B.Frag Rx
• Metronidazole• Imipenem (probably b/c this is a good Rx for
mixed infections)• What other drug is good for mixed
infections?• Clindamycin
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Meningitis in a patient with a β-lactam allergy
Chloroamphenicol
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Strep Pyogenes?
• Pharyngitis• Pen V• what if allergic?• Erythromycin
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H.Pylori
• Amino penicillin + ML• Or• Doxycycline
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Listeria meningitis
• Amino-penicillin
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Adult sinusitis
TMP/SMXAminopenicillins
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Nocardia
• TMP/SMX
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Lower UTITMP/SMX
Upper + lower UTIFQ
UTI d/t #1 cause in womenE.Coli – AG
UTI d/t #2 cause in womenStaph saprophyticus--Dicloxaxillin
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Chronic Bronchitis
TMP/SMX
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Prostatitis
TMP/SMX
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Pneumocystis PneumoniaTMP/SMX
Prevention/prophylaxis?Caspofungin
Prophylaxis in an AIDS patient?Dapsone
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Pseudomembranous Colitis due to C. difficile
Metronidazole (1st choice)Vancomycin (2nd choice)
What caused it in the first place?Any antibiotic can cause.
In real life, FQ is apparently the #1. In our class, #1 is Clindamycin,
#2 is amino-penicillins
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Prophylaxis for meningitis due to H. influenzae or N. meningitidis
Rifampin
Side effect: Orange Pee
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DOC for TB (5 in order; adverse effects in parentheses)
IRPES (rhymes with “herpes”):INH (peripheral neuropathy – give Vitamin B6)Rifampin (orange bodily fluids; ramps up P450)PZA (gout)Ethambutol (visual disturbances; gout)Streptomycin (ototoxic; nephrotoxic)
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Leprosy
Dapsone + Clofazimine + Rifampin
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Systemic fungal infections (especially life-threatening)
Amphotericin B
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Ringworm
Terbinafine (could also include itraconazole or ketoconazole)
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Tinea capitis in kids
Griseofulvin
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Prevention of cryptococcal meningitis in AIDS patients already
on Amphotericin B
Fluconazole
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Cryptococcal meningitis
Amphotericin B + Flucytosine (then maybe add fluconazole)
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Coccidiodal meningitis
Fluconazole (could also use intrathecal Amphotericin B)
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Non-meningeal coccidiosis
Ketoconazole
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Non-meningeal histoplasmosis
Itraconazole
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Blastomycosis
Itraconazole
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AIDS patients on amphotericin B-stabilized histoplasmosis
Itraconazole
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Invasive aspergillosis (1st & 2nd line drugs)
Itraconazole (1st line)Caspofungin (2nd line)
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Chromoblastomycosis
Flucytosine (alone)
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Neutropenic patient with fever and unresponsive to antibiotics
Amphotericin B
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Induction of AIDS therapy
Amphotericin B
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Sporothrix schenkii
Itraconazole
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Systemic Candidiasis
Amphotericin B(if this doesn’t work, then use
Caspofungin)(if that doesn’t work, then use
Fluconazole)
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Localized candidiasis (oropharyngeal, esophageal,
vaginal)
•Amphotericin B (oral/topical; “swish and swallow” for oropharyngeal; topical use for vaginal; nystatin)•Itraconazole•Ketoconazole (for mucocutaneous candidiasis)•Fluconazole
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Anti-fungal drugs eliminated by the kidney
FluconazoleFlucytosine
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Anti-fungal drugs eliminated by the liver
KetoconazoleItraconazole
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Fungicidal Drugs
Amphotericin BCaspofunginTerbinafine
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Fungistatic Drugs
AzolesFlucytosineGriseofulvin
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IV only (or main method)
Caspofungin(Amphotericin B is usually IV-
administered; Candida is the only indication for oral/topical use)
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Immunocompetent patient suspected of having histoplasmosis
Do not prescribe anything(this was one of the questions in the
syllabus… tricky)
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Pinworm
Mebedazole (1st choice)Pyrantel (2nd choice)
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Hookworm
Mebedazole (1st choice)Pyrantel (2nd choice)
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Cestodes
Praziquantel
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Trematodes
Praziquantel
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Cysticercosis
Albendazole
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Cystic Hydatid Disease
Albendazole
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Cutaneous larva migrans
Albendazole
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Filiariasis
Ivermectin (1st choice)Diethylcabamazine (2nd choice)
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Loiasis (worms in connective tissue)
Diethylcarbamazine
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Tropical eosinophilia
Diethylcarbamazine
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Onchocerciasis
Ivermectin
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Strongyloidiasis
Ivermectin
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Schistosomiasis
Praziquantel
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Malaria (erythrocytic form)
ChloroquineMefloquineDoxycycline
Atovaquone-ProguanilArteminsinin
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Malaria (P. vivax & P. ovale in liver)
Primaquine
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Amebiasis
Metronidazole
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Giardiasis
Metronidazole
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Trichomoniasis
Metronidazole
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Cyclospora Infections
TMP/SMX
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Email me about any corrections or DOC additions!
- Julia ([email protected] )