Potential for drug interactions dosing in renal

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Potential for drug interactions Dosing in renal dysfunction ClCr < 50-60 adjust interval +/- dose of: Penicillins (not nafcillin, oxacillin) Cephalosporins (not ceftriaxone) Doripenem Aztreonam Vanc Aminoglycosides Misc. Agents TMP/SMX (generally avoid) Fluconazole Acyclovir Ganciclovir Most nucleoside RTIs Avoid (nephrotoxic) Amphotericin B No dose adjustment required Ceftriaxone Nafcillin Clindamycin Metronidazole Macrolides Tetracyclines Rifampin Isoniazid Drugs Interactions Cleared by CYP 450 Statins, cyclosporine, benzos, theophylline, anticonvulsants, Oral hypoglycemics Inhibit CYP 450 Macrolides (erythromycin/clarithromycin) Azoles (fluconazole, itraconazole) Protease inhibitors Ciprofloxacin Induce CYP 450 Rampin Rifabutin Oral contraceptives Decreased with rifampin and nafcillin +/- others Warfarin Effect and INR profoundly increased by Bactrim Metronidazole Erythromycin/clarithromycin which agent doesn't our dose adjustment if Crclc 50 Erythromycin macrolide
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Significant increase with Fluconazole, +/- ciprofloxacin/levofloxacin Decreased by: Rifampin/Rifabutin Multivalent cations Decreases absorption of: FQs Tetracyclines Cefpodoxime Adverse Effects Penicillin allergy Fully cross reactive with other penicillins May cross react with cephalosporins/carbapenems 10% w/ first generation; 1-2% to 3rd Not cross reactive with aztreonam Anaphylaxis is not for a lifetime Penicillin skin testing widely available Sulfa allergy Other sulfonamides Antibiotics generally safe but: Rash: almost any of them Diarrhea, C. diff colitis: all of them Nephrotoxicity Aminoglycosides Amphotericin Photosensitivity FQs Tetracycline relatively contraindicated in pregnancy AGs, FQs, tetracyclines, fluconazole, ribavirin Preventing Use of Antibiotics Verify diagnosis and need for antibiotics Consider other causes of symptoms Remember: antibiotics don’t work against viruses Vaccinate at risk patients Wash hands Skin/Soft Tissue Infections Including MRSA Guidelines update ABSSSI - acute bacterial skin and skin structure infections cSSTI - complicated skin and skin structure infection SSTI - skin and skin structure infection Most antibiotics with gram-positive activity are included which agent decreases INR Rifampin Pt has penicillin allergy Dr prescribes cephalosporin what do you do Common SE of Doxycycline photosensitivity
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Vast majority of SSTIs not gram-neg. surgical wounds infections and animal bites are exceptions ABSSSI-new rules from FDA ABSSSI will be nomenclature to describe SSTIs Must be one of the following Cellulitis/erysipelas Wound infection Major cutaneous abscess Each of these must possess a minimum lesion size of 75 cm2 Impetigo/Ecthyma
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  • Fall '19
  • Tetracycline, UTI, Ceftriaxone

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