Antibiotics+-+Part+II+-+Chapter+39

= FIGHTING BACK WITH ANTIBIOTICS = =﻿ = =What Are Multi Drug Resistant Organisms? = ﻿  Multidrug-resistant organisms are bacteria that are resistant to one or more classes of antimicrobial drugs. These include: MRSA- Methicillin-resistant Staphylococcus Aureus VRE- Vancomycin-resistant Enterococcus ESBLs- Extended-spectrum beta-lactamase producing organisms KPC- Klebsiella pneumoniae carbapenemase producing organisms Why Worry So Much? Infected patients may become untreatable if the bacteria forms a resistance. Resistance is occuring with even the strongest antibiotics. For Example: A patient is admitted with a KCP producing organism infection. The only ABX treatment options are tigecycline and colistimethate. Some Multi Drug Resistant Organisms become resistant to these ABXs, making the patient untreatable. Such organisms are spread through contact = ** ﻿HAND HYGEINE ** Infected patients are placed on contact isolation.

So You've Got the "Big Bug" Now What? Let's Talk about your options.........

1) AMINOGLYCOSIDES Fighting In the RED Corner representing a group of potent, natural and semisynthetic bactericidal antibiotics:

 AMIKACIN GENTAMYCIN TOBRAMYCIN NEOMYCIN

<span style="color: #0000ff; font-family: Impact,Charcoal,sans-serif; font-size: 140%;">Fighting in the BLUE corner is gram negative bacteria ran by Captain //E. Coli// and his multi drug resistant organisms <span style="color: #0000ff; font-family: Impact,Charcoal,sans-serif; font-size: 140%;">Joining in the fight are gram positive bacteria including Enterococcus and //S. Aureus//

<span style="color: #ff0000; font-family: Impact,Charcoal,sans-serif; font-size: 140%;">Providing synergistic assistance For the Red Corner:

<span style="color: #ff0000; font-family: Impact,Charcoal,sans-serif; font-size: 140%;">Beta-Lactam (These medications are given first to break down the cell wall and allowing the Aminoglycoside to fight the ribosomes inside) <span style="color: #ff0000; font-family: Impact,Charcoal,sans-serif; font-size: 140%;">Vancomycin <span style="color: #ff0000; font-family: Impact,Charcoal,sans-serif; font-size: 140%;">Aminoglycosides use the synergistic help when the blue corner brings out its gram positive bacteria fighters, sadly they just can't win that fight alone

<span style="color: #ff0000; font-family: Impact,Charcoal,sans-serif; font-size: 140%;">Training Hard: How to Fight Like an Aminoglycoside

<span style="color: #ff0000; font-family: Impact,Charcoal,sans-serif; font-size: 140%;">Prevents the protein synthesis of the bacteria by binding to the 30S Ribosome of the bacteria <span style="color: #ff0000; font-family: Impact,Charcoal,sans-serif; font-size: 140%;">Once Aminiglycosides enter the bacteria's ribosomes, the fight begins <span style="color: #ff0000; font-family: Impact,Charcoal,sans-serif; font-size: 140%;">These meds pack a punch so hard you can feel it after they stop working- Post Antibiotic effect <span style="color: #ff0000; font-family: Impact,Charcoal,sans-serif; font-size: 140%;">Aminoglycoside (Neomycin) is often used as a prophylaxis for surgery of the abdomen and GI tract to prevent enteroccocal bacteremia <span style="color: #ff0000; font-family: Impact,Charcoal,sans-serif; font-size: 140%;">In order to bring their 'A' game, aminoglycosides must be given parenterally because they have such poor absorption when taken PO <span style="color: #ff0000; font-family: Impact,Charcoal,sans-serif; font-size: 140%;">Neomycin, however is an exception to that rule and can be given

<span style="font-family: Impact,Charcoal,sans-serif; font-size: 140%;">Aminoglycosides are known to cause adverse effects in patients. These effects include ototoxicity and nephrotoxicity. Due to the occurence of these adverse effects the duration of treatment with these drugs should be kept as short as therapeuticaly possible.

<span style="color: #ff6700; font-family: Impact,Charcoal,sans-serif; font-size: 140%;">Nephrotoxicity occurs in 5-25% of patients and is detected in urinary casts which are visible reminents of destroyed renal cells, proteinuria, increased BUN and serum creatinine. A renal functions test should be monitored throughout treatment. Nephrotoxicity is usually reversible.

<span style="color: #00ff00; font-family: Impact,Charcoal,sans-serif; font-size: 140%;">Ototoxicity occures less frequently but it is rarely reversible. It causes permanent hearing loss. tinnitus, feeling of fullness in the ears. It is believed that this is due to damage of CN VIII.

<span style="color: #e407e3; font-family: Impact,Charcoal,sans-serif; font-size: 140%;">!!!!!!!!!!!!!!!!!!!Whenever a patient is on an Aminoglycoside monitor peak and trough levels!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

= =

<span style="color: #000080; font-family: 'Arial Black',Gadget,sans-serif; font-size: 140%;">2) QUINOLONES
=<span style="color: #000080; font-family: 'Arial Black',Gadget,sans-serif; font-size: 140%; line-height: 0px; overflow-x: hidden; overflow-y: hidden;">﻿ =

<span style="color: #000080; font-family: Arial,Helvetica,sans-serif; font-size: 140%; line-height: 0px; overflow-x: hidden; overflow-y: hidden;">Quinolones kill gram-negative, and some susceptible gram-positive organisms. They destroy the bacteria by   <span style="color: #000080; font-family: Arial,Helvetica,sans-serif; font-size: 140%; line-height: 0px; overflow-x: hidden; overflow-y: hidden;">altering its DNA. Currently available Quinolone antibiotics include the following: <span style="color: #000080; font-family: Arial,Helvetica,sans-serif; font-size: 140%; line-height: 0px; overflow-x: hidden; overflow-y: hidden;">- Norfloxacin <span style="color: #000080; font-family: Arial,Helvetica,sans-serif; font-size: 140%; line-height: 0px; overflow-x: hidden; overflow-y: hidden;">- Ciprofloxacin <span style="color: #000080; font-family: Arial,Helvetica,sans-serif; font-size: 140%; line-height: 0px; overflow-x: hidden; overflow-y: hidden;">-Levofloxacin <span style="color: #000080; font-family: Arial,Helvetica,sans-serif; font-size: 140%; line-height: 0px; overflow-x: hidden; overflow-y: hidden;">-Moxifloxacin <span style="color: #000080; font-family: Arial,Helvetica,sans-serif; font-size: 140%; line-height: 0px; overflow-x: hidden; overflow-y: hidden;">Let's take a closer look at these antibiotics! <span style="font-family: Arial,Helvetica,sans-serif;"> <span style="font-family: arial,helvetica,sans-serif;">

GI: nausea, constipation, flatulence, heartburn, diarrhea, oral candidiasis, dysphagia. Integumentary: rash, pruritis, urticaria, flushing. Other: ruptured tendons + tendonitis, fever, chills, blurred vision, tinnitus. ||
 * ** Antibiotic  **  ||  **  Indications  **  ||  **  Adverse Effects  **  ||
 * ** Norfloxacin ** ||  Urinary tract infections, prostatitis, STDs  ||  CNS: Headache, dizziness, fatigue, insomnia, depression, convulsions.
 * ** Ciprofloxacin ** ||  Anthrax, UTIs, STDs, typhoid fever, slected nosocomial pneumonias  ||^   ||
 * ** Levofloxacin ** ||  Respiratory infections, UTIs, prophylaxis in transrectal/transurethral prostate surgical procedures  ||^   ||
 * ** Moxifloxacin ** ||  Resiratory and skin infections, anaerobic infections  ||^   ||

<span style="color: #ff0000; font-family: Arial,Helvetica,sans-serif;">3) ﻿OTHER ANTIBIOTIC TREATMENTS THAT DO NOT FALL INTO THE PREVIOUSLY MENTIONED CATEGORIES INCLUDE:

 * ** ANTIBIOTIC ** ||  ** INDICATIONS **  ||  ** ADVERSE EFFECTS **  ||
 * **Linezolid (Zyvox)** ||  To treat infections associated with VRE, skin infections caused by MRSA  ||  headache, nausea, vomiting, diarrhea  ||
 * **Quinupristin/Dalfopristin (Synercid)** ||  To treat VRE infections and skin infections caused by MRSA  ||  Arthralgias, myalgias and pain, inflammation and edema at IV site.  ||
 * **Vancomycin (Vancocin, Vancoled)** ||  **Antibiotic of choice** for treatment of MRSA and other serious gram-positive infections.  ||  Ototoxicity, nephrotoxicity, red man syndrome  ||
 * **Daptomycin (Cubicin)** ||  Treats complicated skin and soft tissue infections caused by MRSA, VRE and other gram-positive bacteria  ||  Hypotenstion, hypertension, headache, dizziness, rash, GI discomfort, renal failure  ||
 * **Colistimethate (Coly-Mycin)** ||  One of the only drugs available to treat KPC.  ||  Serious adverse effects including renal failure, paresthesia, vertigo, impairment of speech  ||

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