Silver sulfadiazine cream:

DOC for prevention of colonization at burn sites

What are advantages of trimethoprim-sulfamethoxazole (TMP-SMX) combo?

- synergistic:  broader spectrum inhibition of bacterial folic acid synthesis than achieved using either agent alone

- bactericidal:  TMP may be bactericidal or bacteriostatic

- DOC for UTIs due to susceptible strains of G- enterics

- preferred DOC for ampicillin-resistant Shigella

- DOC for acute exacerbation of chronic bronchitis

- CA-MRSA

- skin reactions:  rash and urticaria are common; rare incidence of Steve-Johnson Syndrome (SJS) and exfoliative dermatitis

- increased pharmacological effects of sulfonylureas and warfarin; displacement from albumin binding sites by SMX

- increased toxicity with methotrexate:  increased risk of bone marrow suppresion with concomitant antimetabolite or antifolate therapy; additive or synergistic interaction with TMP

- Nalidixic acid

- Norfloxacin

- Nitrofurantoin

- G- bactericidal urinary tract antiseptic

- ineffective vs. Pseudomonas, anaerobes, G+ aerobic cocci

What is the clinical use for Nalidixix acid?

What is

 Norfloxacin used for?

- Broad-spectrum flouroquinolone only for UTI

- Increases activity vs. G-, including Pseudomonas 

What is the activity of

 Norfloxacin?

- Bactericidal

- Most G- and G+ aerobes

- Ineffective vs. mycobacteria, Mycoplasma, Chlamydia, anaerobes, and spirochetes

What is the FDA-approved indications of

 Norfloxacin?

What are the kinetics (food and drug interactions) of

 Norfloxacin?

- food decreases absorption; take 1 hr before or 2 hours after meals

- DI: aluminum or magnesium-containing antacids, bismuth salts, iron and zinc products, and sucralfate significantly impair absorption

What are the ADRs of

 Norfloxacin?

- dizziness, headache

- arthopathy in immature animals, c/i in pregnancy and children < 18

- CNS overstimulation: tremor

DOC for vanc resistant E. faecium (VREF) UTI

- dose related nausea and vomiting; use macrocrystalline form, take with food

- acute hemolytic anemia:  susceptible groups are G6PD defic

- pulmonary --> chronic:  continuous long-term treatment

- peripheral neuropathy

- exertional cough, dyspnea, interstitial fibrosis

-residual effects in 70% even after d/c

- Ciprofloxacin

- Ofloxacin

3rd generation cephalosporin

- ceftriaxone:  125 mg IM

- cefixime:  400 mg po

- PRSP

- DRSP

- atypicals (chlamydia, mycoplasma) and legionella

- Bacteriocidal, concentration dependent

- broad spectrum fluoroquinolones

Divalent/trivalent metal cations contained in Mg/Al antacids, didanosine (a magensium in buffer component), iron supplements, sucalfate, zinc supplements, bismuth subsalicylate

- Class interaction

Ciprofloxacin

- inhalational, cutaneous, and prophylaxis

**remember doxycycline was also a DOC for anthrax

ciprofloxacin

**norfloxacin is also a treatment for UTI caused by P. aeruginosa.

Ciprofloxacin

**DOC for rickettsial infections (Rocky Mountain spotted fever, typhus): doxycycline

- headache, dizzy, lightheadedness

- overstimulation (tremor)

- arthropathy and osteochonodrosis (relatively c/i in pregnancy and in children < 18

-photosensitivity

-tendon rupture

- Take on an empty stomach

- Avoid products containing divalent and trivalent cations (sucralfate and didanosine) for 2 hours before and after dosing

- non gon urethritis (NGU) due to C. trachomatis

**Preferred DOC is Azithromycin

- increased G+ activity, e.g.vs PRSP

- increased and enhanced atypical coverage

- increased anaerobic coverage

- once-daily

- usual dosing intervals are q24h in normal renal function

Moxifloxacin and levofloxacin

**alternate DOC is azithromycin

- B. fragilis and other bacteroides

- C. diff AAPMC

- Metronidazole is still currently recommended, higher doses (750 mg BID) may be considered

- PO Vancomycin should be used for relapses when Metronidazole has failed

- Bacitracin is no longer used