Bugs
This is the most common opportunistic respiratory infection in patients with AIDS. It typically occurs in patients with a CD4 count <200 who are not receiving ART or appropriate prophylaxis.
What is Pneumocystis jirovecii pneumonia (formerly called Pneumocystis carinii pneumonia or PCP)?
This class of antibiotics are primarily used for Gram - bacteria but may be used for Gram + synergy. They often require monitoring of drug levels and have potential to cause nephrotoxicity and ototoxicity.
What are aminoglycosides?
(Extra points to name at least 3.)
Strenotrophomonas maltophilia is a multidrug-resistant gram-negative bacillus that is an opportunistic pathogen associated with high morbidity and mortality in immunocompromised patients. This is the drug of choice for treatment.
What is TMP-SMX?
This antibiotic has been known to cause a disulfiram-like reaction if alcohol is used while on the medication.
What is metronidazole (Flagyl)?
This is an appropriate treatment duration of amoxicillin for acute otitis media in a 3 year old child with an intact tympanic membrane and no history of recurrent AOM.
What is 5-7 days?
Ampicillin is used as part of empiric meningitis treatment in adults >50 and neonates as well as immunocompromised patients to cover for this bug?
What is Listeria monocytogenes?
Aztreonam is often reserved for use in patients with severe penicillin allergy. It comes in IV and inhaled formulations and is only active against gram negative bacteria. What class does Aztreonam belong to?
What is a monobactam?
Sometimes referred to as “monkey-cillin”, this carbapenem (unlike its classmates) does NOT cover Acinetobacter, Pseudomonas or Enterococcus (“APE”).
What is Ertapenem (Invanz)?
This medication used commonly to treat UTIs and SSTIs should be used with caution in patients with a G6PD deficiency. Hyperkalemia is also a concern in elderly patients and patients with poor renal function.
What is trimethoprim-sulfamethoxazole?
2020 Vancomycin guidelines recommend this goal AUC/MIC for most clinical situations to optimally manage serious MRSA infections.
What is 400-600?
95% of seafood associated mortality is related to this organism.
What is Vibrio vulnificus?
Vancomycin is a member of this class of antibiotics which now also includes dalbavancin and oritavancin which are single dose regimens for skin infections. Also includes telavancin (Vibativ) approved for HAP/VAP and complicated skin and skin structure infections.
What are glycopeptides?
Aspergillus species are ubiquitous in nature but patients with cystic fibrosis or those receiving corticosteroids are at increased risk of invasive infection. This antifungal is often consider the drug of choice for Aspergillus infections. It is available IV and PO and requires drug level monitoring (troughs) to ensure efficacy/avoid toxicity.
What is voriconazole (VFend)?
This Gram + agent risks interactions with tyramine containing foods, SSRIs and MAOis. Beware of thrombocytopenia as well is irreversible peripheral neuropathy and optic neuritis which are associated with durations of therapy greater than 28 days.
What is linezolid (Zyvox)?
This urinary agent comes in two different formulations and is in the 2019 Beers list. Long term use in elderly patients may be associated with an increased risk of hepatic and pulmonary toxicity and peripheral neuropathy.
What is nitrofurantoin?
“Cat scratch disease” or “Cat scratch fever” typically characterized by self-limiting regional lymphadenopathy is mostly caused by this?
What is Bartonella henselae?
These bactericidal agents exhibit concentration-dependent killing. They can used for a variety of different infections but come with Boxed Warnings for tendon rupture, peripheral neuropathy and CNS effects. Avoid in patients with a history of myasthenia gravis.
What are fluoroquinolones?
Abbreviated TDF/FTC, this antiretroviral is the preferred regimen for PrEP in most patients.
What is Truvada (tenofovir disoproxil fumarate and emtricitabine)?
Commonly used as part of “triple therapy” this antibiotic can cause QT prolongation and has the potential for a slew of drug-drug interactions (with common medications such as Lipitor, Xarelto, CCBs) as a major CYP3A4 substrate and a strong inhibitor of CYP3A4.
What is clarithromycin?
(Bonus points for what is included in triple therapy)
This THIRD generation cephalosporin has activity against Pseudomonas aeruginosa.
What is ceftazidime?
These aerobic Gram-negative rods are part of the Enterobacteriaceae family, have 4 groups and are a common cause of bacterial diarrhea worldwide.
What is Shigella? (S. dysenteriae, S. flexneri, S. boydii, S. sonnei)
Cephalosporins are beta-lactam antibiotics and have 5 generations based on their antimicrobial activity and resistance to B-lactamase. Name a second generation ORAL option.
What is cefuroxime (Ceftin)?
Carbapenem-resistant Acinetobacter has become a threat in the US and caused an estimated 700 deaths in 2017. If resistant to first line agents, name one agent that may be one of your limited options.
What is colistin, polymyxin B, minocycline or tetratcycline?
This antifungal medications is available IV and PO but has excellent PO bioavailability. Serious (and sometimes fatal) hepatic toxicity has occurred.
What is fluconazole?
The use of extended infusions of piperacillin/tazobactam optimizes the probability that drug concentrations will remain above the minimum inhibitory concentration (MIC) for an appropriate period of time. The infusion will be run over this many hours.
What is 4 hours?