Immune hemolytic anemiawithin 2 3 wk of initiation discontinue until

Immune hemolytic anemiawithin 2 3 wk of initiation

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Immune hemolytic anemia—within 2-3 wk of initiation, discontinue until determining etiology; C. diff infection Clinical use & dosing Exacerbation of Chronic Bronchitis: PCN is the first line; mild-moderate dz related to S. pneumoniae, H. influenzae, and M. catarrhalis for 5-10 days Acute Otitis Media: AMX failed, Ceftriaxone 50mg/kg IM or IV once daily for 3 days; For PCN allergy, cefdinir, cefuroxime, high-dose cefpodoxime recommended Sinusitis: 2 nd & 3 rd gen not recommended; for PCN allergy, tx a combination of cefixime & clindamycin Pharyngitis: PCN V is the first choice for group A strep; 1 st gen (cephalexin, cefadroxil) as alternatives, for 10-day course UTI: Cephalexin, cefpodoxime, cefixime for the second line therapy if allergic to sulfa, fluoroquinolones; cystitis & Urethritis for 3 days, uncomplicated pyelonephritis for 14 days; children for 10 d; infant and children w/ febrile UTI receive parenteral ABX for the first 24 hr or until afebrile (Ceftriaxone, cefotaxime) STIs: 250mg Ceftriaxone IM, 400mg Cefixime PO—recommended abx for cervicitis, urethritis, pharyngitis, proctitis d/t N. gonorrhoeae; ceftriaxone— chancroid (250mg), throughout syphilis (1g IM for 10 d), PID (25mg + Doxy 100mg daily for 14 d); epididymo-orchitis 25mg + Doxy 100mg daily for 10 d); Gonococcal conjunctivitis in adults (1g IM once + saline lavage of eye) Skin & tissue infections: 1 st gen (commonly cephalexin) is the first line tx of primary & secondary skin infection (cellulitis, erysipelas, impetigo, traumatic wound infection, surgical incision infection); other first line: dicloxacillin, AMX/Clavulanate, clindamycin MRSA: TMP/SMX, Doxy, Clindamycin; cat bite ( Pasteurella multocida and/or S. aureus) —AMX/Clavulanate, cefuroxime 500mg bid Community-Acquired Pn: First line Tx—macrolides in adults, high dose AMX in
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children < 5 y/o; combine macrolide with cephalosporin (cefpodoxime, cefuroxime, or parenteral ceftriaxone followed by cefpodoxime) (off label) Endocarditis Prophylaxis prior to surgery in pt w/ rheumatic heart dz Early Lyme Dz (erythema migraines)—cefuroxime 500mg bid for 21 d; facial nerve and arthritis involved; 2g ceftriaxone daily for 14-28 da Rational drug selection 1 st Gen may be used in most PCN allergic individuals 2 nd Gen: Cefaclor—more susceptible to beta-lactamase (not for otitis media tx) Palatability—Cefixime suspension > cefuroxime (less expensive) Monitorin g Superinfection, C. diff infection—diarrhea is common but distinguish if just side effect; hemolytic anemia (sx of tiredness, weakness, yellow skin, eyes)— CBC w/ indices; For prolonged use, BUN/CCr periodic monitoring needed; cefotetan affects clotting (PT) & disulfiram reaction (abd cramping, facial flushing, HA, hypotension, palpitation, SOB, sweating, tachycardia, vomiting if exposed to alcohol) Education Take w/ food or milk to avoid stomach irritation except for Ceftibuten on empty stomach or 1 hr prior or 2 hr after meals ADRs For severe diarrhea, report first; for mild diarrhea, take absorbent antidiarrheal agents Fluoroquinolones MOA Interfere with bacterial enzymes required for the synthesis of bacterial DNA;
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  • Spring '14
  • Henrikson,J
  • Clostridium difficile, Renal function

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