Do NOT try to pop/squeeze or lance the abscess6.Cellulitis:a.Group A strep is most common pathogen…treat with penicillins, dicloxicillin, cephalexin (small agent)b.Do NOT culture cellulitis, worry about group A strep and staph aureus IF there is an abscess and drainage…also worry if its those pathogens is pt is an IV drug user, has penetrating traumas, colonization with MRSA or if there is MRSA elsewhere on their bodyc.If these are the cases then use COMBO therapy Bactrim+B-lactam, Tetracycline + B-Lactam, can also use clindamycin (one of the last ones) otherwise the BIG Guns—vancomycin or daptomycin 7.Impetigo 8.Lymphagitis
a.Spreads quickly and associated with puncture wound or bite, most common pathogen is group A strep, treat with penicillin 9.
Antibiotic Classes:1. Tetracyclines:a.Do not use in children <8 yrs old or pregnant or nursing women.b.Absorption with divalent cations and dairy supplements (calcium, antacids, iron, zinc) need to space out by at least 2 hrs)c.Do not take food with Tetracycline bc decreases absorption by 50% but can take with Doxy and mino since it only decreases it by 20%d.Very hard on GI tract …need to take with a full glass of water because it can cause burning of the esophaguse.These are bacteriostatic drugs and can cause photosensitivity up to 3 weeks after course of therapyf.Minocycline can cause vertigog.Hepatotoxicity can occur with IV and these drugs can also cause teeth staining and affect bone development also intracranial hypertension (if pt has worst headache ever tell them to get to ER immediately)2. Fluoroquinolonesa.Get EKG for pts who are already on OTc meds or if they are arrthymaticb.Reacts with divalent cations (okay to take with food but not just straight diary like yogurt)c.Causes photosensitivity mainly Cipro and Levo (< 3-5%) but NOT moxid.Can cause tendinitis so only use if have to e.Can cause anorexia due to CNS activity and is very lipophilic f.Can use in kids but want to use as last line g.If using to treat pseudomonas NEVER use Cipro or Levo alone need to do combo therapy h.Respiratory quinolones are Moxi and Levo because they both cover Strep and get absorbed in the respiratory tract3.Aminoglycosides (Gentamicin, Tobramycin, Amikacin-last line)a.Need to use these agents in COMBO therapy because they do not get achieved MIC unless in UTI because they are super concentrated in the urineb.Can cause nephrotoxicity…it will eventually happen if long term so you want to use in short durations because they get transported to the proximaltubules and affect other drugs/ions absorptionc.They loveee water ..nephrotoxicity is usually reversible but Ototoxicity is usually IRREVERSIBLE and can lose hearingd.Vestibular toxicity (vertigo) due to neuromuscular blockade by inhibiting Ca+
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- Spring '14
- Staphylococcus aureus, clindamycin, osteomyelitis, Methicillin-resistant Staphylococcus aureus