k9 q f antibiotics part.2 fq, anti- mrsa, others - emnote...ciprofloxacin (iv, ciproxin®) spectrum...

2017/11/14 [醫學筆記] 抗生素使用 Antibiotics part.2 FQ, anti-MRSA, others – 郭查理

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[醫學筆記] 抗生素使用 Antibiotics part.2 FQ, anti-MRSA, others

by kphsienPublished 二月 10, 2017

3 Comments

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Enterococcus裡還有分faecalis跟faecium，因為排版塞不下了，請再查一下熱病。

之前Tigecycline標錯atypical pathogen，應該是susceptible(2017/02改)

需要圖檔或ai檔請留下信箱，原本的綠色不是這種螢光綠啊，為什麼顏色會跑掉嗚嗚。



= Quinolone =

GPC GNB PsA Anae Atyp

Ciprofloxacin – ＋ ++ – +

Levofloxacin + ＋ + – +

Moxifloxacin ++ ＋ – + +

PsA : Ciprofloxacin > Levofloxacin （anti-PsA裡唯一可口服！）

S.pneumoniae: Ciprofloxacin < Levofloxacin < Moxifloxacin

FQ類容易產生抗藥性且有TB masking的風險，在TB盛行區並不適合作為治療CAP的首選。不過因為他抗菌譜廣又一天一針，真是急診的好朋友無誤。又或者有時病人對β-lactam又過敏沒什麼藥好用只能選FQ。總之用FQ不是不行，但使用前要謹慎評估病人是否有TB的風險(發燒？久咳？乾咳？體重掉？夜間盜汗？胸痛？immune stauts? contact history? CXR 有無TB好發位置病灶？)，記得留個AFS。

Ciprofloxacin (IV, Ciproxin®)

Spectrum

GPC GNB : PsA better

Atypical Mycobacterium

=> PNA, IAI, Soft tissue/bone, UTI, prostatitis, STD, Mycobac.

Dosage400mg IV Q8-12H

AEQTc prolongation (Baseline EKG!), BM suppression, ∅ Pregnancy or age < 16, Tendonrupture, MG

Chelation (Ca++, Mg++) : to avoid, 1 hr before meal or 2 hrs after meal

Levofloxacin (IV, Cravit®)



Spectrum GPC GNB : PsA

Atypical Mycobacterium

=> PNA, IAI, Soft tissue/bone, UTI, prostatitis, STD, Mycobac

Dosage 250-750mg IV/PO QD

AEQTc prolongation (Baseline EKG!), BM suppression, ∅ Pregnancy or age <16, Tendon rupture, MG


Moxifloxacin (IV, Avelox®) – Respiratory FQ

Spectrum

GPC GNB : PsA

Anaerobes Atypical

Mycobacterium => PNA, IAI, Soft tissue/bone, UTI, prostatitis, STD, Mycobac

Dosage400mg IV/PO QD

AEQTc prolongation (Baseline EKG!), BM suppression, ∅ Pregnancy or age < 16, Tendonrupture, MG


= Anti-MRSA =



Vancomycin (IV, )

Spectrum GPC: MRSA

DosageLoading dose 25-30 mg/kg -> 15-20 mg/kg Q12H

Peak : 30-40 mcg/ml Trough : 5-15 mcg/ml, 15-20 mcg/ml for sever infection

AE Ototoxicity, Nephrotoxicity, Redman syndrome, drug fever

Teicoplanin (IV, Targocid®)

Spectrum GPC: MRSA

Dosage

Loading 12 mg/kg X 3doses -> 12 mg/kg QD (400mg Q12H X 3 doses -> 400mg QD )

AE BM suppression, drug fever, skin rash, less nephrotoxicity

– Teicoplanin is more potent against Streptococcus spp. – Teicoplanin is more potent against Enterococcus spp. • Esp. for VanB phenotype VRE

– Teicoplanin has slower bactericidal activity against Gram-positive pathogens than vancomycin – Teicoplanin is less potent against coagulase negative Staphylococci, esp. S. epidermidis, S. haemolyticus, S. hominis, S.

warneri, and S. xylosus.

Daptomycin (IV, Cubicin®)

Spectrum GPC: MRSA => Better in soft tissue, not for PNA

Dosage bacteremia 6-10 mg/kg/day QD



skin/soft tissue 4mg/kg/day QD

AE myopathy (f/u CK), BM suppression, eosinophilic PNA

Tigecycline (IV, Tygacil®)

Spectrum

GP : MRSA, VRE, PRSP GN : ESBL, PDRAB, PsA (所以會看到tigecycline + ceftazidime這種組合), proteus

=> PNA IAI, Soft tissue ; But poor serum concentration !! not for bacteremia!!打不到：Pseudomonas aeruginosa、 Proteus spp.、 Providencia spp. Morganellamorganii、Burkholderia cepaci

Dosage 100mg STAT -> 50mg Q12H

AE GI (N/V/D), photosensitivity, pseudotumor cerebri, pancreatitis ∅ pregnancy, age2wk), N/V, GI MAOI (避免併用MAOI,SSRI, TCA, bronchodilator, dopamine, meperidine, 減少奶酪蛋

肉類攝取) Lactic acidosis, Rhabdomyolysis

= Others =



= Aminoglycoside =

Amikacin (IV, Acemycin®), Gentamycin,

SpectrumGP : with beta-lactam

GN : synergestic effect Myco (Streptomycin)

Dosage

Conventional => For IE, enterococcus

Once daily : effect not inferior (Post antibiotic effect, neutorphil-dependent), lessresistance, less toxicity

GM 3-5mg/kg/day AM 10-15 mg/kg/day

Poor in acidicity or anaerobic enviro. (PNA,BTI,CNS不適用)不能使用once daily dosing的場合:

– Impaired renal function (ex. CCr < 60, hemodialysis, peritoneal dialysis) – Altered volume of distribution (ex. ascites, severe burn)

– Neutropenia – Combination with beta-lactam for GPC infection

AE Ototoxicity, Nephrotoxicity (check trough level), NM blockade Narrow therapeutic range, cumulative toxicity (>7 days)

Trimethoprim/sulfamethoxazole (TMP/SMX) (IV Sevatrim®, PO Baktar®)



Spectrum GP: Norcardia GN: S. maltophilia, B. cenocepacia

PJP

Dosage

8-10 mg/kg/day in 2-4 doses PJP: therapeutic 15-20 mg/kg/day in 3-4 doses (不過學長姐是都抓12 mg/kg)

AE HyperK, GI, Psychosis, Sweet’s syndrome, BM suppression, SJS, Hepatitis

Clindamycin (IV, Clincin®; PO, Lindacin®)

SpectrumGPC

Anaerobes => for PCN allergy (想換MSSA口服但病人又對beta-lactam過敏時可用)

Dosage

0.6-2.7 g/day IV in 2-4 doses 150~450 mg PO Q6H

AE CDAD, allergy, GI, drug fever

Metronidazole (IV; PO, Flagyl®)

Spectrum Anaerobes => CDAD, IAI

Dosage

7.5mg/kg/day IV Q6H 500 mg PO QID

AE N/V, disulfiram reaction,

Doxycycline (PO, Doxymycin®)

Spectrum Atypical

Dosage100mg PO Q12H

AE Deposition in teeth, Hepatotoxicity ∅in Pregnancy, Breast feeding, Age < 8

Erythromycin, Azithromycin (PO, Zithromax®), Clarithromycin (PO, Colirocin®)

Spectrum Atypical

Dosage

500mg QD for 3 days

clarithromycin 有 anti-inflammatory的效果，之前看過老師在COPD的病人會選用。

AE QT prolongation, Cyt-P450 inhibition (抑制藥物代謝，藥物在體內濃度升高), GI (有時

k9 q f antibiotics part.2 fq, anti- mrsa, others - emnote...ciprofloxacin (iv, ciproxin®) spectrum...

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