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Toronto Notes 2019 A Simplified Look at Antibiotics Infectious Diseases ID47 Epidemiology
• inHIV-positivepatientsstartingART,IRSreportedtoaffect~10%
Investigations
• IRSisadiagnosisofexclusion
• ruleoutdrugreaction,medicationnon-adherence,drugresistance
Treatment
• continueARVtherapyinHIV-positivepatientswithmild-moderatesymptoms,butconsider discontinuation if symptoms are life-threatening or potentially irreversible
• treatunderlyinginfection;initiatetreatmentforsomeinfectionspriortoARVinitiation
• considerstartingcorticosteroids/NSAIDstodecreaseinflammatoryresponse
A Simplified Look at Antibiotics
• generaloverview,seeTable31,ID49formoredetails 1. Penicillins
Penicillin G (IV)/Penicillin V (PO)
(most Streptococcus, N. meningitidis, many oral anaerobes except B. fragilis)
Ampicillin (IV)/Amoxicillin (PO)
+ Enterococcus faecalis
Amoxicillin-clavulanate
+β-lactamase producing organisms including anaerobes
Cloxacillin
+ MSSA butStreptococci
Piperacillin
+ Pseudomonas
Figure 19. Penicillins
2. Cephalosporins (PO/IV)
Piperacillin/tazobactam
+β-lactamase producing organisms including anaerobes
• 1stgeneration:cephalexin/cefazolin(mostlyGP,someGN)orcefadroxil
• 2ndgeneration:cefuroxime/cefprozil(someGPandsomeGN,*anaerobes)
• 3rdgeneration:cefixime/cefotaxime,ceftriaxone(goodStreptococcalcoverage,mostlyGN),and
ceftazidime (no GP, mostly GN, Pseudomonas)
• 4thgeneration:--/cefepime(mostGP,mostGN,Pseudomonas),ceftaroline(forMRSA)
3. Aminoglycosides (GN aerobic bacilli + Pseudomonas) • gentamicin
• tobramycin
• amikacin
4. Macrolides (GP, Haemophilus, and atypical bacteria [Legionella, Chlamydophila, Mycoplasma]) • erythromycin
• clarithromycin
• azithromycin
5. Fluoroquinolones (GN – although resistance becoming a huge problem)
• ciprofloxacin(+Pseudomonas)
• norfloxacin(forspontaneousbacterialperitonitis(SBP)prophylaxis)
• “respiratory”fluoroquinolones(someGP,GN,“atypicals”,Legionella,Mycoplasma,Chlamydophila,
Mycobacteria)
■ levofloxacin
■ moxifloxacin (has some anaerobic coverage)
6. Carbapenems (broad coverage: GP, GN, and anaerobes)
• imipenem(+Pseudomonas)
• meropenem(+Pseudomonas) • ertapenem