Urinary Agents & Topical Declonization PDF

22 I INFECTIOUS OISEASES I: BACKGROUND & ANTIBACTERIALS BY DRUG CLAS 5 URINARY AGENTS FOSFOMYCIN Inhibits bacterial cell wall synthesis by inactivating the enzyme pyruval transferase, which is critical in the synthesis of cell walls. It covers E. coli (including ESBLs) and E. faecalis (including VR...

22 I INFECTIOUS OISEASES I: BACKGROUND & ANTIBACTERIALS BY DRUG CLAS 5 URINARY AGENTS FOSFOMYCIN Inhibits bacterial cell wall synthesis by inactivating the enzyme pyruval transferase, which is critical in the synthesis of cell walls. It covers E. coli (including ESBLs) and E. faecalis (including VRE ). A single -dose regimen is used for uncomplicated UTI (cystitis only ). DRUG DOSING SAFETY/ SIDE EFFECTS / MONITORING Fosfomycin ( Monurol ) Female, uncomplicated UTI 3 grams PO x 1, mixed in 3 - 4 oz of cold water SIDE EFFECTS Headache, diarrhea, nausea 1packet granules = 3 grams See lab interactions, storage requirements and renal dosage information near the end of this chapter. NITROFURANTOIN Nitrofurantoin is a bacterial cell wall inhibitor. It is used for uncomplicated UTI (cystitis only) . It covers E. coli, Klebsiella, Enterobacter, S. aureus , and Enterococcus (VRE ). SAFETY/ SIDE EFFECTS / MONITORING DRUG DOSING Nitrofurantoin ( Macrobid , Macrodantin , Furadantin ) Macrodantin: Capsule, suspension PO: 50-100 mgQIDx 3-7 days; 50-100 mg QHS for prophylaxis Macrobid: PO: lOOm BIDx 5 days ^ The macrocrystal formulation ( Macrobid ) dissolves more slowly and is given BID CONTRAINDICATIONS Renal impairment (CrCI < 60 mL/min* ) inadequate urine concentrations and risk for accumulation of neurotoxins; previous history of cholestatic jaundice / hepatic dysfunction, pregnancy (at term) WARNINGS Optic neuritis, hepatotoxicity, peripheral neuropathy, pulmonary toxicity, hemolytic anemia (use caution in patients with G6PD deficiency) SIDE EFFECTS Gl upset (take with food), headache, rash, brown urine discoloration (harmless) . 'Per package labeling. Some sources (e.g. Beer's Criteria ) recommend use if CrCI > 30 mL / min. See lab interactions , storage requirements and renal dosage information near the end of this chapter. KEY FEATURES OF NITROFURANTOIN urug or cnoice Tor uncomplicated UTI See the ID II chapter for a discussion on use in pregnancy Do not use Contraindicated when CrCI < 60 mL/min Dosing Macrobid is BID Macrodantin is QID Counseling Take with food to prevent nausea, cramping Can discolor the urine (brown) TOPICAL DECOLONIZATION MUPIROCIN NASAL OINTMENT Mupirocin is a topical antimicrobial ointment used to eliminate Staphylococci ( MRSA ) colonization of the nares. See the Common Skin Conditions chapter for a discussion regarding topical mupirocin use for infected skin lesions. DRUG Mupirocin Nasal ( Bactroban Nasal ) 1g tubes DOSING SAFETY/ SIDE EFFECTS / MONITORING Decolonization: SIDE EFFECTS Headache, burning, localized irritation, rhinitis, pharyngitis Yi tube in each nostril BID x 5 days See lab interactions , storage requirements and renal dosage information near the end of this chapter. 168 RxPrep Course Book | RxPrep © 2019, RxPrep © 2020 SUMMARY TABLES DRUGS OF CHOICE /ACTIVE DRUGS FOR SPECIFIC PATHOGENS Community-associated methicillinresistant Staphylococcus aureus (CA MRSA ) skin & soft tissue infections (SSTIs) SMX/ TMP Doxycycline, minocycline Clindamycin* Linezolid VRE (E. faecium) Daptomycin Carbapenem-resistant Gram-negative rods (CRE) Linezolid Ceftazidime/Avibactam Quinupristin/ Dalfopristin Colistimethate, polymyxin B Tigecycline Cystitis only: nitrofurantoin, fosfomycin, doxycycline Bacteroides fragilis Metronidazole Beta- lactam /beta-lactamase inhibitor For more severe SSTIs requiring IV treatment or hospitalization (cover MRSA and Streptococci ) Vancomycin (consider using alternative if MIC 2 ) Linezolid, tedizolid Ceftazidime/Avibactam Cefepime Tigecycline Ceftazidime Others (reduced activity): clindamycin, moxifloxacin Daptomycin Ceftolozane/Tazobactam Ceftaroline Carbapenems (except ertapenem) Telavancin Ciprofloxacin, levofloxacin Oritavancin Aztreonam Dalbavancin Aminoglycosides Quinupristin/ Dalfopristin Colistimethate, polymyxin B Tigecycline Acinetobacter baumannii Nosocomial MRSA Vancomycin (consider using alternative if MIC > 2) Linezolid Daptomycin (not in pneumonia) Rifampin (select infections, never used alone) Telavancin VRE (E. faecalis ) Pen G or ampicillin Linezolid Daptomycin Carbapenems C. difficile Infection Vancomycin (oral) Fidaxomicin Metronidazole Atypical Organisms Azithromycin, clarithromycin Carbapenems (except ertapenem) Doxycycline, minocycline Ampicillin/ Sulbactam Quinolones Minocycline HNPEK Beta- lactam / beta- lactamase inhibitor Tigecycline Quinolones SMX/ TMP Amoxicillin (if beta-lactamase negative) . Colistimethate polymyxin B Extended spectrum beta- lactamase producing Gram-negative rods (ESBL GNR) - E. coli , K . pneumoniae , P. mirabilis Carbapenems Tigecycline Ceftolozane/Tazobactam Cystitis only: nitrofurantoin, fosfomycin, Ceftazidime/Avibactam doxycycline . Pseudomonas aeruginosa Piperacillin/Tazobactam Cefotetan cefoxitin Cephalosporins (except 1st generation) Carbapenems SMX/ TMP Aminoglycosides Quinolones Cefepime (high - dose) Aminoglycosides Cystitis only: fosfomycin 'A D-tcst must be performed before using clindamycin. n /n 22 | INFECTIOUS DISEA 5E 5 I: BACKGROUND & ANT 18 ACTERIALS BV DRUG CLASS STORAGE REQUIREMENTS: LIQUID ORAL ANTIBIOTICS REFRIGERATION REQUIRED AFTER RECONSTITUTION Penicillin VK Cefaclor Cefadroxil Ampicillin Cefpodoxime Ceftibuten Amoxicillin/Clavulanate ( Augmentin ) Cefprozil Vancomycin oral ( Firvanq ) Cephalexin ( Keflex ) Cefuroxime Valganciclovir (Valcyte)' Cefdinir (formerly Omnicef ) Ciprofloxacin (Cipro) Acyclovir (Zovirax )' Azithromycin Levofloxacin ( Levaquin) Fluconazole ( Diflucan)' Clarithromycin ( Biaxin ) - bitter taste, REFRIGERATION RECOMMENDED Amoxicillin - improves taste DO NOT REFRIGERATE Clindamycin (Cleocin) - thickens, may crystallize Posaconazole ( Noxafil )' thickens /gels Linezolid ( Zyvox ) Voriconazole (Vfend )' Doxycycline (Vibramycin) Sulfamethoxazole /Trimethoprim (Sulfatrim ) Nystatin* STORAGE REQUIREMENTS: IV ANTIBIOTICS Most IV medications are refrigerated ; the list below represents a few that are not. DO NOT REFRIGERATE Metronidazole (Flagyl ) Sulfamethoxazole/Trimethoprim (Sulfatrim) Moxifloxacin ( Avelox ) Acyclovir ( Zovirax )' * Discussed - refrigeration causes crystallization in the ID III chapter. DRUG- LABORATORY INTERACTIONS RENAL DOSE ADJUSTMENTS Some antimicrobials can cause abnormalities in laboratory values, necessitating a change in treatment (e.g., a positive Coombs test in combination with bleeding indicates that a patient could be experiencing drug- related hemolysis and the antibiotic should be discontinued ). Some medications can interfere with the result of the test, even if there are no clinical effects (e.g., daptomycin can cause a falsely elevated INR , but does not cause bleeding). In other cases, a drug should not be started in patients with certain laboratory test results (e.g., primaquine in patients with G6 PD deficiency ) . Many antibiotics are cleared through the kidneys and require dose adjustments based on renal function. This includes most beta - lactams and quinolones. See Key Drugs Guy for antibiotics that do not require renal adjustment, See the Learning Lab Values & Drug Monitoring chapter for a complete list of drugs (antibiotics and other drugs) that interfere with lab tests. Refer to the Anemia chapter for a complete discussion on hemolytic anemia and drugs that can cause hemolysis and /or should be avoided with G 6PD deficiency. NO RENAL DOSE ADJUSTMENT REQUIRED Others: KEY DRUGS Antistaphylococcal penicillins (e.g , . dicloxacillin, nafcillin) n Ceftriaxone Clindamycin Doxycycline Chloramphenicol Fidaxomicin Select tetracyclines (e.g., eravacycline, seracycline omacycline) . Quinupristin/ Dalfopristin Rifaximin Rifampin* Macrolides (azithromycin and erythromycin only) Tedizolid Metronidazole Tigecydine Moxifloxacin Tinidazole Linezolid Vancomycin (PO only) This agent is discussed in the ID II chapter. . RxPrep Course Book | RxPrep © 2019 RxPrep © 2020 SPECIAL REQUIREMENTS TAKE WITH / WITHOUT FOOD Most antibiotics can be taken with food to decrease Gl upset; except these drugs, which are different. Take within one hour of finishing a meal: amoxicillin ER Take on an empty stomach: ampicillin oral capsules and suspension, ceftibuten suspension, levofloxacin oral solution, penicillin VK, rifampin*, isoniazid’, itraconazole solution’, voriconazole’ 1:1 IV TO ORAL DOSING For these drugs, the oral and IV dose is the same. Levofloxacin, moxifloxacin Doxycycline, minocycline Sulfamethoxazole/ Trimethoprim Linezolid, tedizolid Metronidazole Fluconazole*, isavuconazonium’, posaconazole’ (oral tablets and IV), voriconazole’ LIGHT PROTECTION DURING ADMINISTRATION See the Learning IV Medications chapter for a complete list of drugs (including antibiotics and other drugs) that require specific light protection. Doxycycline Micafungin’ Pentamidine’ DILUENT COMPATIBILITY REQUIREMENTS See the Learning IV Medications chapter for a complete list of drugs (including antibiotics and other drugs) that require specific diluents. Compatible with dextrose only Dalbavancin, oritavancin Pentamidine* Quinupristin/ Dalfopristin Sulfamethoxazole/Trimethoprim Amphotericin B * (conventional, Abelcet , Ambisome) Compatible with saline only Ampicillin Ampicillin/Sulbactam Ertapenem Daptomycin (Cubicin RF - see the daptomycin drug table for reconstitution requirements prior to dilution) Compatible with NS/ LR only Caspofungin* Daptomycin (Cubicin ) * These drugs are discussed in the ID ll - IV chapters. . Lactatad Klng*r 22 | INFECTIOUS DISEASES I: BACKGROUND & ANTIBACTERIALS BY DRUG CLASS PATIENT COUNSELING ALL ANTIBIOTICS Antibiotics only treat bacterial infections. They do not treat viral infections, such as the common cold. Skipping doses or not completing the full course of treatment can i the effects, cause the infection to return, and increase the likelihood that this medication will not work for you in the future. If your symptoms worsen , contact your healthcare provider. Many antibiotics can cause rash. If you experience a rash, contact your healthcare provider. Many antibiotics can cause GI upset. Taking the medication with food can help, but some antibiotics need to be taken on an empty stomach. Measure liquid doses carefully using the measuring device /syringe that comes with the medication. Ask your pharmacist if you do not have one. Household spoons should not be used, as they often do not deliver the correct dose. Contact your healthcare provider if you have watery diarrhea several times a day, with or without abdominal cramping. This can occur during treatment, or weeks after the antibiotic treatment has finished. You should not self treat with anti -diarrheal medication. Some oral liquid and chewable dosage forms contain phenylalanine. Let your healthcare provider know if you have phenylketonuria (inability to metabolize phenylalanine). BETA- LACTAM ANTIBIOTICS Amoxicillin Products Amoxicillin can be taken with or without food. Amoxicillin ER is taken within 1 hour of finishing a meal. Augmentin is taken with food to T what your body absorbs and 1 stomach upset. Suspensions should be refrigerated (especially important for Augmentin ). Cephalexin ( Keflex ) , Cefuroxime, Cefdinir (formerly Omnicef ) Cephalexin: take this medication by mouth , with or without food , every six hours. The suspension should be refrigerated . Cefuroxime: take this medication by mouth, with food, every 12 hours. The suspension should be refrigerated. Cefdinir: can be taken with or without food. The suspension should not be refrigerated. Penicillin VK Take this medication by mouth one hour before or two hours after a meal , usually every six hours. The suspension should be refrigerated. QUINOLONES Antacids, didanosine (Videx ) , sucralfate ( Carafate ) , bile acid resins, magnesium, aluminum, calcium, iron , zinc and multivitamins can bind to quinolones and prevent them from working properly. Take: - i Ciprofloxacin two hours before or six hours after these drugs. J Levofloxacin two hours before or two hours after these drugs. J Moxifloxacin four hours before or eight hours after these drugs. Dairy products can decrease how well these antibiotics work. Avoid consuming calcium - rich foods (dairy products) with the dose. Drink plenty of fluids to prevent crystals from forming in the urine. This medication can cause tendon inflammation ( tendinitis) or tendon rupture. It is rare, but if you hear or feel a pop, or notice pain /swelling in the back of the ankle (Achilles) , shoulder, hand or other site, stop the medication and contact your healthcare provider immediately. This occurs more frequently if you are age > 60 years, have had an organ transplant, or use steroid medications, such as prednisone. This medication can increase your risk for seizures. This is rare, but you should not take this medication if you have a history of seizures. Other effects include restlessness, anxiousness, trouble sleeping/ nightmares, lightheadedness, dizziness, headaches or depression. This medication can make your skin more sensitive to the sun, and you can burn more easily. Use sunscreen, wear protective clothing and avoid sun exposure. Do not take this medication if you have myasthenia gravis. Breathing problems can occur. This medication can cause weakness or tingling/ painful sensations in the arms and legs. If this occurs, contact your healthcare provider immediately. If you use blood sugar - lowering medications, your blood sugar may get unusually low. Check your blood sugar level more frequently and treat low blood sugar if it occurs. . RxPrep Course Book | RxPrep 02019 RxPrep © 2020 Ciprofloxacin (Cipro) Do not use this medication if you take a different medication called tizanidine ( Zanaflex ). The liquid suspension should not be refrigerated. Levofloxacin ( Levaquin ) Take this medication once daily, with or without food. The suspension is taken one hour before or two hours after eating. The liquid formulation should not be refrigerated . MACROLIDES Azithromycin (Zithromax ) Common dosing is two tablets on day 1, followed by one tablet daily on days 2 - 5. The tablets and immediate release oral suspension can be taken with or without food. The suspension should be stored at room temperature and should not be refrigerated. Clarithromycin ( Biaxin ) Common side effects include abnormal ( metallic) taste, diarrhea and GI upset. The tablets and oral suspension are taken twice daily, with or without food or with milk. Biaxin XL tablets should be taken with food. The liquid suspension should not be refrigerated. TETRACYCLINES Doxycycline (Vibramycin , Others) This medication can make your skin more sensitive to the sun , and you can burn more easily. Use sunscreen , wear protective clothing and avoid the sun. Take with a full glass of water and stay upright for 30 minutes to avoid GI irritation. Minocycline ( Minocin, Solodyn ) Take this medication with or without food, 1- 2 times daily. Swallow the tablet or capsule whole with a full glass of water to decrease GI irritation. Do not use this medication if you are pregnant, if you could become pregnant, or if you are breastfeeding. SULFAMETHOXAZOLE AND TRIMETHOPRIM ( BACTRIM ) Do not use this medication if you have an allergy to sulfa. Take with a full glass of water to prevent crystal formation in the urine. Take with or without food. If stomach upset occurs, take with food or milk. Do not use this medication if you are pregnant, if you could become pregnant, or if you are breastfeeding. This medication can make your skin more sensitive to the sun, and you can burn more easily. Use sunscreen , wear protective clothing, and avoid the sun. Shake the suspension prior to use. The suspension should not be refrigerated and it should be protected from light. CLINDAMYCIN (CLEOCIN ) Take by mouth, with or without food, 3 - 4 times a day. Take with a full glass of water to avoid GI irritation. The liquid suspension should not be refrigerated. METRONIDAZOLE ( FLAGYL ) Common side effects include nausea and an unusual ( metallic) taste in the mouth. Do not use any alcohol products while using this medication , and for at least three days afterward. Immediate- release tablets and capsules may be taken with food to minimize stomach upset. This medication should be taken twice daily, 1 - 2 hours before, or 4 - 6 hours after antacids, vitamins, magnesium, calcium, iron , zinc, dairy products, or bismuth subsalicylate. Oracea should be taken on an empty stomach (one hour before or two hours after meals) . Do not use this medication if you are pregnant, if you could become pregnant, or if you are breastfeeding. The liquid suspension should not be refrigerated. T7** 22 | INFECTIOUS DISEASES I. BACKGROUND & ANTIBACTERIALS BY DRUG CLASS NITROFURANTOIN ( MACRODANTIN , MACROBID ) Take this medication with food to help it get into the body and i side effects. Swallow the medication whole. Nausea and headache may occur. This medication can cause your urine to turn dark yellow or brown in color. This is a harmless, temporary effect and will disappear when the medication is stopped. Dark brown urine can be a sign of liver damage. Seek immediate medical attention if you notice dark urine with any of the following: persistent nausea or vomiting, pale stools, unusual fatigue or if your skin and whites of your eyes become yellow. This medication can cause very serious ( possibly fatal ) lung problems. This is rare, but can occur within the first month of treatment or after long-term use of the drug (generally for 6 months or longer ). Seek immediate medical attention if you develop symptoms of lung problems, including: persistent cough, chest pain, shortness of breath / trouble breathing, joint /muscle pain or bluish/ purplish skin. 774 MUPIROCIN OINTMENT ( BACTROBAN NASAL ) 1 GRAM TUBE Place Vi the ointment from the tube into one nostril and the other V2 into the other nostril. Press the nostrils at the same time and let go; do this many times (for about 1 minute) to spread the ointment into the nose. Wash your hands after use. The most common side effects are burning and itching. Select Guidelines/References Guidelines available at the Infectious Diseases Society of America website (www.idsociety.org)