Erythromycin contraindicated for preexisting liver ds Telithromycin needs

Erythromycin contraindicated for preexisting liver ds

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Erythromycin-contraindicated for preexisting liver ds; Telithromycin needs dosage adjustment in severe renal impairment—no altered AUC for hepatic impairment Pregnancy B; safe in children ADRs Dose-related GI Sx: n/v, abdominal pain, cramping, diarrhea; Skin: urticaria, bullous eruptions, eczema, Stevens-Johnson syndrome; reversible hearing loss; hyperkinesia, dizziness, agitation in children Drug interaction s Cyclosporine, most statins, rivaroxaban, theophylline, carbamazepine, select benzo, colchicine, DGX, warfarin; Tourette Syndrome—pimozide w/ macrolides may cause prolonged QT intervals; aluminum, MG antacids delay absorption Clinical use & dosing CAP: initial empirical therapy in healthy older children (>age of 5), adolescent, adults w/o cardiopulmonary dz, no antibiotics in the past 3 mo advanced-generation macrolide ( azithromycin for 3 days or clarithromycin 500mg bid for 7-14 days ) no improvement in 48-72 hr switch to respiratory Fluoroquinolones STI: 1g azithromycin single dose for nongonococcal urethritis & cervicitis; recurrent or no improvement, metronidazole 2 g single dose if persistent, re-eval for STI Chancroid: 1 g of azithromycin as the first line Tx; alternatives erythromycin 500mg qid for 7 days Peptic Ulcer Dz (PUD) Endocarditis Prophylaxis Indication: prosthetic heart valves, previous infective endocarditis,
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certain pt w/ congenital heart dz, cardiac transplant pt w/ valve regurgitation who undergo manipulation of gingival tissue or periapical region of teeth Exacerbation of Chronic Bronchitis Rational Drug Selection Alternatives in PCN allergic pts Erythromycin: more GI effects (taking w/ a full glass of water), risk of cholestatic jaundice; history of cardiac arrhythmia or QT prolongation Monitoring Reversible hearing loss occurs in 36 hr to 8 days after tx and recover 1-14 days of discontinuation Fidaxomicin (Dificid) MOA Macrocyclic abx; approved in Tx of CDI; inhibits RNA synthesis; rare resistance Pharmacokin etics Taken w/ or w/o food; metabolized in intestine, excreted in feces Contraindicati on Use caution if macrolide allergy; pregnancy B Clinical use & dosing Recurrent CDI reduced 200mg bid for 10 d; higher cost Oxazolidinones MOA inhibitors of bacterial ribosomal protein synthesis Linezolid (Zyvox) Pharmaco- kinetics/ dynamics most effective against aerobic gram-positive bacteria; resistance- uncommon but enterococci & S. aureus (previous linezolid exposure) No dosage adjustment needed for impaired hepatic or renal function; clearance is altered by age Contra- indication Concurrent, within 2 wk of MAOIs; myelosuppression (anemia, leucopenia, pancytopenia, and thrombocytopenia)—disappears if discontinues; lactic acidosis; > 28 day use—peripheral neuropathy & optic neuropathy; Pregnancy C; approved for use in children from birth ADRs Diarrhea, HA, nausea, CDI Clinical use CAP for susceptible strains of S. pneumoniae or aureus only--600mg bid for 10-14 days Uncomplicated skin & skin structure infections: not the first line Vancomycin-Resistant Enterococcus faecium Infections: no more than 28 day course Rational Drug selection
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  • Spring '14
  • Henrikson,J
  • Clostridium difficile, Renal function

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