The Guilt Button:
CrCl > 80: 1 gm IM or IV q 24 h.
CrCl 80-50: 1 gm IM or IV q 24 h.
CrCl 50-10: 7.5 mg/kg q 24 - 48 h IM or IV.
CrCl < 10: 7.5 mg/kg IM or IV 2x / wk.
Hemodialysis:
Peritoneal dialysis:
abnormal LFT's, eosinophilia, hypokalemia, injection site pain, nephrotoxicity, ototoxicity, urticaria, maculopapular rash.
Important drug interactions: increased ototoxic or nephrotoxic potential with other drugs with this effect.
Rants and Screeds:
Pearls:
Treatment of choice:
Mycobacterium tuberculosis (second line drug).
Don't use for:
Class:
CrCl > 80: 5-6 gm q 4 h iv.
CrCl 80-50: 5-6 gm q 4 h iv.
CrCl 50-10: 2-3 g q 6 h iv.
CrCl < 10: don't give it.
Hemodialysis: 750 mg - 2 g iv after.
Peritoneal dialysis: 2 g q 6 - 12 h iv.
Important drug interactions:
Rants and Screeds:
Pearls:
Treatment of choice:
Don't use for: almost a drug of historical interest, it has been superseded by ticarcillin, then mezlocillin, and then pipericillin.
Class: penicillin
CrCl > 80: 382 - 764 mg q 6 h po.
CrCl 80-50: no data.
CrCl 50-10: no data.
CrCl < 10: no data.
Hemodialysis: no data.
Peritoneal dialysis: no data.
Important drug interactions:
Rants and Screeds:
Pearls:
Treatment of choice:
Use for: the odd Pseudomonas UTI that is resistant to cipro.
Don't use for:
Class: penicillin.
CrCl > 80: 70-mg loading dose should be administered on Day 1, followed by 50 mg qd IV. Rifampin reduces caspofungin concentrations by 30%. Patients on rifampin should receive 70 mg of caspofungin qd.
CrCl 80-50: No dosage adjustment is necessary.
CrCl 50-10: No dosage adjustment is necessary.
CrCl < 10: No dosage adjustment is necessary.
However, do need to decrease dose for liver failure.
Hemodialysis:
Peritoneal dialysis:
facial swelling, fever, headache, increased lft's, thrombophlebitis, nausea, vomiting, pruritus, rash.
Important drug interactions:
carbamazepine, cyclosporine, dexamethasone, efavirenz (decreases caspofungin blood levels), nelfinavir (decreases caspofungin blood levels), nevirapine (decreases caspofungin blood levels), phenytoin, rifampin (Rifampin reduces caspofungin concentrations by 30%. Patients on rifampin should receive 70 mg of caspofungin qd.), tacrolimus.
Rants and Screeds:
Pearls:
Treatment of choice:
Aspergillus (salvage therapy) and Candida. Prophylaxis for neutropenic fever.
Don't use for:
urinary tract infections, cryptococcus, zygomyces.
Class: echinocandidan.
CrCl > 80: 250 - 500 mg po q 8 h.
CrCl 80-50: 250 - 500 mg po q 8 h.
CrCl 50-10: 250 - 500 mg po q 8 h.
CrCl < 10: 250 - 500 mg po q 8 h.
Hemodialysis: 250 - 500 mg after dialysis.
Peritoneal dialysis:na
Important drug interactions:
Rants and Screeds:
Pearls:
Treatment of choice:
Cellulitis, Otitis media, Pneumonia, Sinusitis, UTI.
Don't use for:
Class: second generation cephalosporin.
CrCl > 80: 500 - 1000 mg po q 12 - 24 h.
CrCl 80-50: 500 - 1000 mg po q 12 - 24 h.
CrCl 50-10: 500 mg po q 12 - 24 h.
CrCl < 10: 500 mg q 36.
Hemodialysis: 500 - 1000 mg after.
Peritoneal dialysis: no data.
Important drug interactions:
Rants and Screeds:
Pearls:
Treatment of choice:
Pharyngitis - streptococcal, Pneumonia, Bronchitis, COPD exacerbation, Cellulitis, Pneumonia.
Don't use for:
Class: first generation cephalosporin.
CrCl > 80: 500 mg - 2 g q 4 - 8 h iv.
CrCl 80-50: 500 mg - 2 g q 6 h iv.
CrCl 50-10: 500 mg - 2 g q 8 h iv.
CrCl < 10: 500 mg - 1 g q 12 h iv.
Hemodialysis:
Peritoneal dialysis:
Important drug interactions:
Heparin coagulation abnormalities due to a direct effect on prothrombin time or vitamin k production . Warfarin hypoprothrombinemia and/or prolonged bleeding time.
Rants and Screeds:
Pearls:
Treatment of choice:
Arthritis, Osteomyelitis, Peritonitis, Pneumonia, surgical prophylaxis.
Don't use for:
Class: second generation cephalosporin.
CrCl > 80: 500 mg - 2.0 g q 8 h iv.
CrCl 80-50: 500 mg - 2.0 g q 8 h iv.
CrCl 50-10: 500 mg - 1.0 g q 8 - 12 h iv.
CrCl < 10: 500 mg - 1.0 g q 18 - 24 h iv.
Hemodialysis: 250 mg - 500 mg after dialysis. I prefer 2 gram dose if it is 48 hours before the next dialysis and 3 grams if it is 72 hours before the next dialysis. Prevents underdosing.
Peritoneal dialysis: na
Important drug interactions:
cefazolin may produce hypoprothrombinemia and increase the anticoagulant effect of warfarin.
Rants and Screeds:
Pearls:
when combined with probenecid, can use one a day and is an excellent method for treating outpatient cellulitis (better than ceftiaxone).
Treatment of choice:
streptococci of all types and methicillin susceptible S. aureus. Arthritis, Cellulitis, Cholangitis, Cholecystitis, Endocarditis - treatment and prophylaxis, Epididymitis, genital infections, Gonorrhea, Meningitis, Osteomyelitis, perinatal streptococcal disease prophylaxis, pneumococcal Pneumonia, Prostatitis, Bronchitis, COPD exacerbation, Pneumonia, Sepsis, surgical prophylaxis, Tetanus, UTI.
Don't use for:
Class: first generation cephalosporin.
Updated 3/28/7.
CrCl > 30: 300 mg po q 12 h.
CrCl < 30: 300 mg po qd.
Hemodialysis:
Peritoneal dialysis:
Important drug interactions:
antacids and iron decrease absorption.
Rants and Screeds:
Pearls:
Treatment of choice:
bronchitis - acute and chronic, Cellulitis, Otitis media, Pharyngitis / tonsillitis - streptococcal, Pneumonia, Sinusitis, Vaginitis.
Don't use for:
Class: second generation cephalosporin.
CrCl > 80: 0.5 - 2 gm iv q 8 - 12 h.
CrCl 80-50: 0.5 - 2 gm iv q 12 - 24 h.
CrCl 50-10: 0.5 - 2 gm iv q 24 h.
CrCl < 10: 250 mg - 500 mg iv q 25 h.
Hemodialysis: 250 mg after dialysis.
Peritoneal dialysis: 1 - 2 gm iv q 48 h.
encephalopathy, myoclonus, and seizures when you don’t alter dose for CrCl.
Important drug interactions:
Rants and Screeds:
Pearls:
Compared to other third generation cephlosporins, there may be incrased death rates (), perhaps due to MIC cutoff's being incorrect. Turns out that sensitive should be less than 8 ug/ml, not equal to 8 ug/ml (PubMed).
Treatment of choice:
Pseudomonas and Enterobacter are often sensitive to this agent when resistant to all others. Arthritis, Cellulitis, Neutropenic fever, Intra abdominal infections, Meningitis, Osteomyelitis, Peritonitis - dialysis-related, Pneumonia, Pyelonephritis, UTI.
Don't use for:
I remain unenthusiastic about using this drug for staph, despite it being a so called 4th generation cephalosporin. It violates the MMPVIIAHTBTM principal.
Class: fourth generation cephalosporin.
CrCl > 80: 400 mg po q 24 h.
CrCl 80-50: 400 mg po q 24 h.
CrCl 50-10: 300 mg po q 24 h.
CrCl < 10: 400 mg po q 48 h.
Hemodialysis: no change.
Peritoneal dialysis: no change.
Important drug interactions:
Rants and Screeds:
Pearls:
Treatment of choice: N. gonorrhoea.
any thing you would use a third generation cephalosporin for. Bronchitis, Gonorrhea, Otitis media, Pneumonia, Salmonella infections, Shigella, UTI, Whipples disease.
Don't use for:
Class: third generation cephalosporin.
CrCl > 80: 1 - 2 g iv q 6 - 12 h.
CrCl 80-50: 1 - 2 g iv q 12 h.
CrCl 50-10: 1 - 2 g iv q 16 - 24 h.
CrCl < 10: 1 -2 g iv q 48 h.
Hemodialysis:
Peritoneal dialysis:
increase in prothrombin time.
Important drug interactions:
Rants and Screeds:
Pearls:
Treatment of choice:
Appendicitis, Cellulitis, Cholangitis, Cholecystitis, chronic Bronchitis, Intra abdominal infections, PID, Peritonitis, Pneumonia, surgical prophylaxis (its main use), UTI.
Don't use for:
Class: second generation cephalosporin.
CrCl > 80: 1 - 2 g iv q 6 - 12 h.
CrCl 80-50: 1 - 2 g iv q 6 - 12 h.
CrCl 50-10: 1 - 2 g iv q 6 - 12 h.
CrCl < 10: 1 - 2 g iv q 6 - 12 h.
Hemodialysis: dose after dialysis
Peritoneal dialysis:
hypoprothrombinemia with increase in protime.
Important drug interactions:
heparin, warfarin due to hypoprothrombinemia with increase in protime.
Rants and Screeds:
Pearls:
Treatment of choice:
any thing you would use a third generation cephalosporin for. Cellulitis, Cholangitis, Cholecystitis, Gonorrhea, Intra abdominal infections, PID, Peritonitis, Pneumonia, Meningitis, ocular infections, Osteomyelitis, Otitis media, peritoneal dialysis, Peritonitis, proteus mirabilis infections, Pneumonia, Sepsis, UTI.
Don't use for:
Class: third generation cephalosporin.
CrCl > 80: 500 mg - 2 gm iv q 8 - 12 h.
CrCl 80-50: 500 mg - 2 gm iv q 8 - 12 h.
CrCl 50-10: 500 mg - 2 gm iv q 12 -24 h.
CrCl < 10: 500 mg - 2 gm iv q 24 h.
Hemodialysis: 500 mg - 2 gm after dialysis.
Peritoneal dialysis:
Important drug interactions:
Rants and Screeds:
Pearls:
Treatment of choice:
any thing you would use a third generation cephalosporin for. Abdominal hysterectomy, Arthritis, Brain abscess, Cellulitis, Endocarditis, Endometritis, Flavobacterium infections, Gonorrhea, Intra abdominal infections, Lyme Disease, Meningitis, Osteomyelitis, PID, Peritonitis, Pneumonia, Salmonella infections, Sepsis, surgical prophylaxis, UTI, ventriculitis.
Don't use for:
Class: third generation cephalosporin.
CrCl > 80: 1-2 gm iv q 12 h.
CrCl 80-50: 1-2 gm iv q 12 h.
CrCl 50-10: 1-2 gm iv q 24 h.
CrCl < 10: 1-2 gm iv q 48 h.
Hemodialysis: 25 % on non hemo days, 50% on hemo days.
Peritoneal dialysis:
hypoprothrombinemia with increase in protime.
Important drug interactions:
heparin, warfarin due to hypoprothrombinemia with increase in protime.
Rants and Screeds:
no clinical indication for real infections, its major use is surgical prophylaxis.
Pearls:
Treatment of choice:
Arthritis, Cellulitis, cesarean section, Diverticulosis/itis, Endometritis, Gonorrhea, Intra abdominal infections, intrapelvic cellulitis, Osteomyelitis, PID, pelvic peritonitis, Pneumonia, surgical prophylaxis, Pharyngitis, UTI.
Don't use for: does not cover the 'dot' group of Bacteroides.
Class: second generation cephalosporin.
CrCl > 80: 1-2 gm q 6-8 h iv.
CrCl 80-50: 1-2 gm q 8-12 h iv.
CrCl 50-10: 1-2 gm q 12-24 h iv.
CrCl < 10: 500 mg - 1 gm q 12-48 iv.
Hemodialysis: 1-2 g after hemo.
Peritoneal dialysis:
Important drug interactions:
Rants and Screeds:
Pearls:
Treatment of choice:
a second generation with reasonable anaerobic coverage. Arthritis, Cellulitis, Diverticulosis/itis, Endometritis, Intra abdominal infections, Osteomyelitis, PID, surgical prophylaxis, UTI.
Don't use for:
Class: second generation cephalosporin.
CrCl > 80: 0.1 - 0.4 g po q 12 h.
CrCl 80-50: 0.1 - 0.4 g po q 12 h.
CrCl 50-10: 0.1 - 0.4 g po q 24 h.
CrCl < 10: 0.1 - 0.4 g po q 24 h.
Hemodialysis: 0.1 -0.4 g po 3x per week.
Peritoneal dialysis:
Important drug interactions:
antacids and H2 blockers will decrease absorption.
Rants and Screeds:
Pearls:
Treatment of choice:
Bronchitis, Cellulitis, Cystic fibrosis, Gonorrhea, Otitis media, Pharyngitis, Pneumonia, Sinusitis, UTI.
Don't use for:
Class: cephalosporin.
CrCl > 80: 250 - 500 mg q 12 - 24 h po.
CrCl 80-50: 250 - 500 mg po q 12 - 24 h po.
CrCl 50-10: 125 - 250 mg po q 12 - 24 h po.
CrCl < 10: 125 - 250 mg po q 12 - 24 h po.
Hemodialysis:
Peritoneal dialysis:
Important drug interactions:
Rants and Screeds:
Pearls:
Treatment of choice:
Bronchitis, Cellulitis, Osteomyelitis, Otitis media, Pharyngitis, Pneumonia, Sinusitis, tonsillitis,
Don't use for:
Class: cephalosporin.
CrCl > 80: 1 - 2 g iv q 8 - 12 h iv.
CrCl 80-50: 1 - 2 g iv q 8 - 12 h iv.
CrCl 50-10: 1 - 2 g iv q 12 - 24 h iv.
CrCl < 10: 500 mg iv q 24 - 48 h iv.
Hemodialysis: 1 gm load then 1 g after dialysis.
Peritoneal dialysis: 500 mg q 24 h iv or 250 mg/2L dialysate.
Important drug interactions:
Chloramphenicol is antagonistic.
Rants and Screeds:
not as good against E. coli as cefotaxime.
Pearls:
Treatment of choice:
Pseudomonas. Arthritis, Brain abscess, bronchiectasis, Cellulitis, Cystic fibrosis, E. coli infections, Neutropenia and fever, gynecologic infections, Intra abdominal infections, Meliodosis, Meningitis, ophthalmic infections, Osteomyelitis, Otitis media, Peritonitis, PID, Pneumonia, Sepsis, UTI.
Don't use for:
Class: third generation cephalosporin.
CrCl > 80: 200- 400 mg q 12 - 24 h po.
CrCl 80-50: 200 - 400 mg po q 12 -24 h po.
CrCl 50-10: 200 - 400 mg po q 24 h po.
CrCl < 10: 100 mg q 24 h po.
Hemodialysis: 400 mg after dialysis po.
Peritoneal dialysis: 200 mg q 24 h po.
Important drug interactions:
increase in pH will increase absorption.
Rants and Screeds:
Pearls:
Treatment of choice:
Bronchitis, Diarrhea-bacterial, gynecologic infections, Otitis media, Pharyngitis, Pneumonia, UTI.
Don't use for:
Class: cephalosporin.
CrCl > 80: 1 - 3 g q 6 - 8 h iv.
CrCl 80-50: 0.5 - 1.5. g q 8 h iv.
CrCl 50-10: 250 mg - 1 g iv q 24 h iv.
CrCl < 10: 500 mg q 24 h iv.
Hemodialysis: dose after dialysis.
Peritoneal dialysis: 3 g q 48 h iv.
Important drug interactions:
Rants and Screeds:
Pearls:
Treatment of choice:
Arthritis, bacteremia, Cellulitis, Endocarditis, Escherichia coli infections, Gonorrhea, gynecologic infections, Haemophilus influenzae infections, Intra abdominal infections, Klebsiella pneumoniae infections, Meningitis, Osteomyelitis, PID, Pneumonia, Proteus indole positive infections, Providencia stuartii infections, Salpingitis, Sepsis, Serratia infections, surgical prophylaxis, UTI.
Don't use for:
Class: third generation cephalosporin.
CrCl > 80: 1 - 2 g iv q 12 - 24 h.
CrCl 80-50: 1 - 2 g iv q 12 - 24 h.
CrCl 50-10: 1 - 2 g iv q 12 - 24 h.
CrCl < 10: 1 - 2 g iv q 12 - 24 h
Hemodialysis:.
Peritoneal dialysis:
cholestatic hepatitis and the formation of ceftriaxone gall stones, the worlds most expensive. Usually seen at high doses.
Important drug interactions: increases cyclosporine levels.
When combined with intravenous calcium in neontes it can lead to death. Importance of this reaction in adults is not known as of 10/3/7.
Rants and Screeds:
I wonder which is more expensive: ceftriaxone gallstones or crixivan kidney stones?
Pearls:
Treatment of choice:
abdominal hysterectomy, Arthritis, Bronchitis, Brucella infections, Cellulitis, Brucella, Cystic fibrosis, Endocarditis , endocervical Gonorrhea, Epididymitis, Escherichia coli infections, Gonorrhea, Haemophilus influenzae infections and nasopharyngeal carriers, intra-abdominal infections, Intra abdominal infections, Lyme Disease, Meningitis, Moraxella catarrhalis infections, Neisseria meningitidis pharyngeal carriers, Neutropenic fever, Osteomyelitis, Otitis media, Peritonitis, PID, Pneumonia, Proctitis, Proteus, Providencia stuartii infections, Relapsing Fever, Salmonella infections , Sepsis, Serratia infections, sexual assault, Shigella infections, shunt infections, surgical prophylaxis, syphilis, Typhoid fever, UTI, vaginal hysterectomy,
Don't use for:
Class: third generation cephalosporin.
CrCl > 80: 500 mg IV q 8 h.
CrCl 80-50:
CrCl 50-10:
CrCl < 10:
Hemodialysis:.
Peritoneal dialysis:
Important side effects: nausea and taste change.
Important drug interactions:
Rants and Screeds:
Pearls:
Treatment of choice:
Use for: Staphylococcus aureus esp MRSA It has a high affinity for penicillin-binding protein PBP2a, the major determinant of methicillin resistance in staphylococcal species. Ceftobiprole has an MIC90 of 0.5 mg/mL for methicillin-susceptible S. aureus and an MIC90 of 2 mg/mL for MRSA.
Don't use for:
Class: cephalosporin.
Updated 6/02/8.
CrCl > 80: 750 mg - 1.5 g q 12 h iv.
CrCl 80-50: .750 - 1.5 g q 12 h iv.
CrCl 50-10: .750 - 1.5 g q 12 h iv.
CrCl < 10: 250 mg iv q 24 h iv.
Hemodialysis: 750 mg after dialysis.
Peritoneal dialysis:
Important drug interactions:
Rants and Screeds:
Pearls:
Treatment of choice:
Arthritis, Bronchitis, Cellulitis, Gonorrhea, Haemophilus influenzae infections, Lyme Disease, maxillofacial infections, Meningitis (but don't use it for meningitis), Moraxella catarrhalis infections, Osteomyelitis, Otitis media, PID, Pharyngitis/tonsillitis, Pneumonia, Sinusitis, surgical prophylaxis, UTI.
Don't use for:
Class: second generation cephalosporin.
CrCl > 80: 125 - 500 mg q 12 h po.
CrCl 80-50: 125 - 500 mg q 12 h po.
CrCl 50-10: 125 - 500 mg q 8 - 12 po.
CrCl < 10: 750 mg q 24 h po
Hemodialysis:
Peritoneal dialysis:
Important drug interactions:
Rants and Screeds:
Pearls:
Treatment of choice:
Bronchitis, Cellulitis, Gonorrhea, Impetigo, Lyme Disease- early, Otitis media, Pharyngitis/tonsillitis, Sinusitis, .UTI
Don't use for:
Class: second generation cephalosporin.
CrCl > 80: 250 mg - 1000 mg q 6 h po.
CrCl 80-50: 250 mg - 1000 mg q 6 h po.
CrCl 50-10: 250 mg - 1000 mg q 8-12 h po.
CrCl < 10: 250 mg - 1000 mg q 24- 48 h po.
Hemodialysis: 250 mg - 1000 mg after dialysis.
Peritoneal dialysis: na
Important drug interactions:
Concomitant cephalexin and cholestyramine reduces cephalexin absorption.
Rants and Screeds:
Pearls:
As you double the oral dose, you double the serum levels. Many patients tolerate 1 gm po qid (peak of 32 ug/ml) and may remove the need for iv rx of mild to moderate cellulitis.
Treatment of choice:
streptococci of all types and methicillin susceptible S. aureus. Bronchitis, Cellulitis, Cystic fibrosis, dental prophylaxis, Diverticulosis/itis, Lyme Disease-, Osteomyelitis, Otitis media, Peritonitis, Pharyngitis, Pneumonia, Prostatitis, Sinusitis, UTI.
Don't use for:
Class: first generation cephalosporin.
CrCl > 80: 500 mg - 2 g q 4 - 6 h iv.
CrCl 80-50: 500 mg - 2 g q 4 - 6 h iv.
CrCl 50-10: 1-1.5 g q 6 h iv.
CrCl < 10: 500 mg q 8 h iv.
Hemodialysis: 500 mg - 2 g after dialysis.
Peritoneal dialysis: na
Important drug interactions:
Rants and Screeds:
Pearls:
Treatment of choice:
streptococci of all types and methicillin susceptible S. aureus. Arthritis, Cellulitis, Pneumonia, Osteomyelitis, surgical prophylaxis, UTI.
Don't use for:
Class: first generation cephalosporin.
CrCl > 80: 500 mg - 2.0 g q 4 - 6 h iv.
CrCl 80-50: 500 mg - 2.0 g q 6 h iv.
CrCl 50-10: 500 mg - 2.0 g q 8 h iv.
CrCl < 10: 500 mg - 2.0 g q 12 h iv.
Hemodialysis: 7.5 - 15 mg/kg before, then q 12 h.
Peritoneal dialysis: na
Important drug interactions:
Rants and Screeds:
Pearls:
Treatment of choice:
Cellulitis, Endocarditis, Pneumonia, Osteomyelitis, Peritonitis, preoperative prophylaxis, UTI.
Don't use for:
Class: first generation cephalosporin.
CrCl > 80: 250 mg - 1.0 g q 6 h.
CrCl 80-50: 250 mg - 1.0 g q 6 h.
CrCl 50-10: 500 mg q 6 h.
CrCl < 10: 250 mg q 12 h.
Hemodialysis: 250 mg before, then q 36 - 48 h.
Peritoneal dialysis: 500 mg q 6 h.
Important drug interactions:
Rants and Screeds:
Pearls:
Treatment of choice:
appendectomy, Cellulitis, Furuncles, Osteomyelitis, Otitis media, Streptococcus pneumoniae pneumonia, Pneumonia, surgical prophylaxis, Pharyngitis, UTI.
Don't use for:
Class: first generation cephalosporin.
CrCl > 80: 250 - 750 mg po q 6 h po or 250 mg iv q 6 h.
CrCl 80-50: no change
CrCl 50-10: no change
CrCl < 10: no change
Hemodialysis: no change
Peritoneal dialysis: no change
aplastic anemia in 1in 40,000 cases. Idiosyncratic: aplastic anemia. Dose related: cytopenias, grey baby.
Important drug interactions:
antagonistic with both penicillin and cephalosporins, rifampin will decrease chloramphenicol levels by 90%. Other drugs with potential interactions include acetaminophen , chlorpropamide, cyanocobalamin, cyclophosphamide, cyclosporine, dicumarol, entacapone, fosphenytoin, glimepiride, iron, live typhoid vaccine, methotrexate, phenobarbital, phenytoin, rifampin, rifapentine, tacrolimus.
Rants and Screeds:
Pearls:
Treatment of choice:
meningitis when type 1 allergic reaction to penicillins.
It is the secondary agent for bioterrorism from
Anthrax: 50 to 100 milligrams/kg/day divided every 6 hours ,
Plague: pneumonic plague 25 milligrams/kilogram every 6 hours for 10 days,
Tularemia: 15 milligrams/kilogram every 6 hours for 14 to 21 days.
Don't use for:
Class:
CrCl > 80: 600 mg base (1000 mg chloroquine phosphate) PO, then 300 mg base (500 mg salt) 6 hr later, and again on days 2 and 3.
CrCl 80-50:
CrCl 50-10:
CrCl < 10:
Hemodialysis:
Peritoneal dialysis:
EKG changes, , decrease in hearing, long term can lead to retinal degeneration and blindness as well as many other side effects.
Important drug interactions: WITH THE EXCEPTION OF antacids and kaolin, which decrease absorption, ALL OF THE FOLLOWING WILL INCREASE THE QT and could lead to cardiac death: antipsychotics, arsenic trioxide, astemizole, aurothioglucose, bepridil, chloral hydrate, chloroguanide, cimetidine, cisapride, clarithromycin, class i antiarrhythmic agents, class ia antiarrhythmic agents, class iii antiarrhythmic agents, cotrimoxazole, cyclosporine, dolasetron, droperidol, enflurane, erythromycin, erythromycin/sulfisoxazole, fluconazole, fluoxetine, foscarnet, gemifloxacin, halofantrine, halothane, isoflurane, isradipine, kaolin, levomethadyl, levothyroxine, lidoflazine, mefloquin, mesoridazine, octreotide, pentamadine, phenothiazines, pimozide, praziquantal, probucol, spiramycin, sulfamethoxazole, telithromycin, terfenadine, thioridazine, tricyclic antidepressants, trimethoprim, vasopressin, venlafaxine, ziprasidone, zolmitriptan.
Rants and Screeds:
Pearls:
Treatment of choice:
Don't use for:
Class: 4-aminoquinoline derivative.
CrCl > 55: 5 mg/kg q wk x 2. Probenecid may be administered at 2 grams 3 hr prior and one gram administered at 2 hr after and again at 8 hr after each cidofovir infusion (for a total of 4 grams). Probenecid may increase over all toxicity.
Contraindicated with CrCl < 55 or creat > 1.5 or > 100 mg proteinuria. 1
Hemodialysis:
Peritoneal dialysis:
nephrotoxic, neutropenia, uveitis and Fanconis.
Important drug interactions:
avoid other nephrotoxins (aminoglycosides, pentamadine).
Rants and Screeds:
Pearls:
Treatment of choice:
CMV, acyclovir resistant Herpes simplex (one time dose).
Don't use for:
Class: acyclic nucleoside phosphonate
CrCl > 80: 250 - 750 mg q 12 h po or 200 - 400 mg q 12 h iv.
CrCl 80-50: 250- 750 mg q 12 h po or 200 - 400 mg q 12 h iv.
CrCl 50-10: 250 - 500 mg q 12 h po or 200 - 400 mg q 12-24 h iv
CrCl < 10: 250 - 500 mg q 18 h po or 200 - 400 mg q 18 - 24 h iv.
Hemodialysis: 250 - 500 mg q 24 h.
Peritoneal dialysis: 250 - 500 mg q 24 h.
like all quinolones, can affect the QT interval. All variety of neuropsychiatric side effects; not recommended for children, adolescents, and pregnant or lactating women due to arthropathy; perhaps achillies tendon rupture.
Important drug interactions:
Ca, Mg, Fe, and Sulcralfate will markedly inhibit po absorption. Antidiabetic agents, azlocillin, calcium, corticosteroids, cyclosporine, didanosine, duloxetine, dutasteride, fosphenytoin, indomethacin, iron, methotrexate, metoprolol, olanzapine, phenytoin, probenecid, propranolol, rifapentine, ropinirole, ropivacaine, sucralfate, teicoplanin, theophylline, tizanidine, warfarin, zinc.
Rants and Screeds:
Pearls:
Treatment of choice:
the dreaded Pseudomonas.
anything gram negative. GI decontamination, Anthrax - postexposure prophylaxis and treatment, Arthritis ,
bone marrow transplantation - prophylaxis, Bronchitis, Cat scratch fever, Cellulitis, Chancroid, Cholangitis, Cholecystitis, Cholera, Conjunctivitis, Cystic fibrosis, Endocarditis, Enterobacter, Gonorrhea, Helicobacter pylori - triple therapy, infectious Diarrhea, Intra abdominal infections, Klebsiella infections, Mediterranean Spotted Fever, meningitis - multidrug-resistant, Mycobacterium non-tuberculous and tuberculosis, Meningococcus, Neutropenic fever, nongonococcal Urethritis, Osteomyelitis, Otitis externa, Otitis media - chronic, Peritonitis, Plague, Pneumonia, Proteus, Providencia, Pseudomonas, rhinoscleroma, Rickettsia infections, Salmonella carriers and infections, Serratia, Shigella Sinusitis, Staphylococcus aureus (but don't do it), Stenotrophomonas, Streptococcus pneumoniae (but don't do it), chronic bacterial Prostatitis, Tularemia, Typhoid fever, UTI, Yersinia enterocolitica infections.
Don't use for: anything round and purple, say Streptococci or Staphylococcus.
Class: quinolone.
CrCl > 80: 250 - 500 mg q 12 h po.
CrCl 80-50: 250 - 500 mg q 12 h po.
CrCl 50-10: 250 - 500 mg q 24 h po.
CrCl < 10: 250 - 500 mg q 24 h po.
Hemodialysis: 250 - 500 mg q 24 h po.
Peritoneal dialysis: 250 - 500 mg q 24 h po.
Important drug interactions: alprazolam, antipsychotics, astemizole, atazanavir, atorvastatin, bepridil, bromocriptine, carbamazepine, chloral hydrate, chloroquine, cilostazol, cisapride, class i antiarrhythmic agents, class ia antiarrhythmic agents, class iii antiarrhythmic agents, colchicine, conjugated estrogens, cotrimoxazole, cyclosporine, delavirdine, diazepam, digoxin, disopyramide, dolasetron, droperidol, efavirenz, eletriptan, enflurane, ergot derivatives, erlotinib, erythromycin, erythromycin/sulfisoxazole, esterified estrogens, estradiol, estriol, estrone, estropipate, eszopiclone, fentanyl, fluconazole, fluoxetine, foscarnet, gemifloxacin, halofantrine, halothane, hexobarbital, imatinib, isoflurane, isradipine, itraconazole, lansoprazole, levomethadyl, lidoflazine, lovastatin, mefloquin, mesoridazine, methylprednisolone, midazolam, nevirapine, octreotide, pentamadine, phenothiazines, phenytoin, pimozide, prednisone, probucol, quinidine, rifabutin, rifapentine, ritonavir, saquinavir, sildenafil, simvastatin, spiramycin, sulfamethoxazole, tacrolimus, telithromycin, terfenadine, theophylline, thioridazine, tolterodine, triazolam,
tricyclic antidepressants, trimethoprim, valproic acid, vasopressin, venlafaxine, verapamil, warfarin, zidovudine, ziprasidone, zolmitriptan.
Rants and Screeds:
Pearls:
Treatment of choice:
Anthrax, Bacillary angiomatosis, Borrelia burgdorferi infections, Bronchitis, Cat scratch fever, Cellulitis, cryptosporidiosis, Endocarditis prophylaxis, erythrasma, Helicobacter pylori, Haemophilus, Legionella, Mediterranean Spotted Fever, Moraxella catarrhalis, Mycobacterium, Mycoplasm pneumoniae, Otitis media, Pertussis, Pharyngitis, Pneumonia, Sinusitis , Streptococci (all) infections, Toxoplasma encephalitis, Ureaplasma urealyticum.
Don't use for:
Class: macrolide.
CrCl > 80: 150 mg - 900 mg q 6 -8 iv or po.
CrCl 80-50: no change
CrCl 50-10: no change
CrCl < 10: no change
Hemodialysis: no change
Peritoneal dialysis: no change
#1 cause of C. difficile colitis. May be. quinolones are driving C. difficile of late.
Important drug interactions:
atracurium, cisatracurium, cyclosporine, doxacurium, erythromycin, erythromycin/sulfisoxazole, gallamine, kaolin, metocurine, mivacurium, pancuronium, pipecuronium, rocuronium, tubocurarine, vecuronium.
Rants and Screeds:
Pearls:
30% of bacteroides are now resistant.
Treatment of choice:
use to decrease toxin production in all forms of Toxic Shock Syndrome.
Acne, Anaerobes, Anthrax, Babesia microti, bacterial Endocarditis prophylaxis, Bacterial vaginosis, bacteroides infections, Diverticulosis/itis, Endometritis, Intra abdominal infections, intraocular infections, Microsporidia, PID, peridonitis, Pneumocystis prophylaxis, and treatment, Staphylococcus aureus, Staphylococcus, coag negative, Streptococci, surgery prophylaxis, Toxoplasma.
Don't use for:
Class: macrolide.
CrCl > 80: 50 mg q d.
CrCl 80-50:
CrCl 50-10:
CrCl < 10:
Hemodialysis:
Peritoneal dialysis:
in eye: dryness, burning, itching, irritation and conjunctival and corneal pigmentation and skin pigmentation.
Important drug interactions:
antacids (decreases clofazamine), fosphenytoin and phenytoin (decreases fosphenytoin and phenytoin)
Rants and Screeds:
Pearls:
Treatment of choice:
used in multidrug rx of leprosy.
M. chelonae, M. abscessus, and M. avium-intracellulare.
Don't use for:
Class:
CrCl > 80: suck one 10 mg tab 5x day. They don't taste all that bad.
CrCl 80-50:
CrCl 50-10:
CrCl < 10:
Hemodialysis:
Peritoneal dialysis:
Important drug interactions:
Rants and Screeds:
Pearls:
Treatment of choice:
Candida thrush and esophagitis.
Don't use for:
Class:
CrCl > 80: 500 - 1000 mg q 6 h po.
CrCl 80-50: 500 - 1000 mg q 6 h po.
CrCl 50-10: 500 - 1000 mg q 6 h po.
CrCl < 10: 500 - 1000 mg q 6 h po.
Hemodialysis: 500 - 1000 mg q 6 h po.
Peritoneal dialysis:500 - 1000 mg q 6 h po.
Important drug interactions:
Rants and Screeds:
Pearls:
Treatment of choice:
staphylococcus and streptococcus.
Don't use for:
Class: penicillin.
CrCl > 80: 2.5-5 mg/kg/day IM or IV in 2 to 4 divided doses, maximum 5 mg/kg/day. 1 million units bid inhaled has been used to treat multidrug resistant pneumonia (PubMed).
CrCl 80-50: 75% of the normal dose.
CrCl 50-10: 50% of the normal dose.
CrCl < 10: 25% of the normal dose.
Hemodialysis:
Peritoneal dialysis:
neurotoxic ( confusion, muscle weakness, visual disturbances, vertigo, paraesthesia, neuropathy) and nepthrotoxic.
Important drug interactions: alcuronium, amikacin, atracurium, cisatracurium, doxacurium, fazadinium, gallamine, hexafluorenium, metocurine, mivacurium, pancuronium, pipecuronium, rapacuronium, rocuronium, tubocurarine, vecuronium.
INHALED COLISITN CAN KILL or cause ARDS.
Rants and Screeds:
Pearls:
may be using more of it as resistance rates keep on going up.
Treatment of choice:
aerobic gram negative rods including Acinitobacter, Citrobacter, Haemophilus influenzae, Enterobacter, Escherichia coli, Klebsiella, Morganella morganii, Pseudomonas aeruginosa, Salmonella, Shigella, Stenotrophomonas maltophilia, Yersinia pseudotuberculosis.
Don't use for:
Pseudomonas mallei, Burkholderia cepacia, Proteus species, Providencia species, Serratia species, Edwardsiella species, and Brucella species are all resistant to colistin.
Class: detergent.
Updated 10/4/7.
CrCl > 80: 1 po bid.
CrCl 80-50:
CrCl 50-10:
CrCl < 10:
Hemodialysis:
Peritoneal dialysis:
cytopenias.
Important drug interactions: see each drug.
Rants and Screeds:
Pearls:
Treatment of choice:
Don't use for:
Class: nucleoside reverse transcriptase inhibitors.
CrCl > 80: 250 - 500 mg po bid, usually the lower dose.
CrCl 80-50:
CrCl 50-10:
CrCl < 10:
Hemodialysis:
Peritoneal dialysis:
mostly neurologic including absence seizures, catatonia, coma, confusion, dysarthria, headache, hyperreflexia, irritability, nervousness, paranoia, paresis, psychosis, somnolence, tonic-clonic seizures, tremor, twitching, vertigo, visual disturbances.
Important drug interactions:
Concomitant use of cycloserine and ethionamide or cycloserine and isoniazid can increase CNS toxicity.
Rants and Screeds:
Pearls:
Treatment of choice:
second line for tuberculosis.
Don't use for:
Class:
-Table of Contents- -Antibiotic Index- -Bug Index- -Disease Index- -Comparison of Antibacterials- -Comparison of Antifungals-
References:
All dosing for renal function is from the source: Bennet et. al. (1)
1. PDR
Version 4.1 Released 07/20/08
Warning: There may be errors or mistakes. Use at your own risk, If you find mistakes, bad links, or even porr speling, or, most importantly, you looked for a topic and could not find it, let me know at mcrislip@pusware.com
Copyright 2005-2008 Mark Crislip MD www.pusware.com