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Pharmacotherapy of Infectious Diseases 
A Case-Based Approach 
Pneumonia 
Anas Bahnassi PhD 
Pharmacotherapy of Infectious Diseases 
Anas Bahnassi 2014 
A Case-Based Approach
Pharmacotherapy of Infectious Diseases 
A Case-Based Approach 
Introduction 
•Community Acquired Pneumonia (CAP) 
–Common and serious disease. 
–80% of cases can be treated at home. 
–Mortality rate for patients requiring hospitalization is 8-10%, and can increase to 40% to those requiring ICU. 
–Clinical presentation of CAP does not allow for and etiological diagnosis. 
–Many organisms can be 
Anas Bahnassi 2014
Pharmacotherapy of Infectious Diseases 
A Case-Based Approach 
Common pathogens in CAP: 
Pneumonia treated on ambulatory basis 
Streptococcus pneumoniae 
Mycoplasm pneumoniae 
Haemphilus Influenzae 
Chlamydophila pneumoniae 
Respiratory viruses 
Moraxelia catarrhalis 
Anas Bahnassi 2014 
Pneumonia requiring hospital admission 
Streptococcus pneumoniae 
Chlamydophila pneumoniae 
Haemphilus Influenzae 
Lagionella supp. 
Aspiration 
G –ve. Bacilli 
Mixed etiology 
Respiratory viruses 
Mycoplasm pneumoniae 
Pneumonia requiring ICU admission 
Streptococcus pneumoniae 
Staphylococcus aureus 
Lagionella supp. 
G –ve. Bacilli 
Haemphilus Influenzae
Pharmacotherapy of Infectious Diseases 
A Case-Based Approach 
Goals of Therapy 
•Assess severity of pneumonia. 
•Eradicate infecting pathogen. 
•Relieve symptoms. 
–Fever, cough, pleuritic chest pain, sputum, dyspnea. 
•Promptly recognize and minimize complications. 
–Metastatic infection, empyema, cavitation, pneumothorax, septic shock, respiratory failure, worsening of comorbid condition (IHD, DM). 
•Provide end-of-life care if emerges. 
Anas Bahnassi 2014 
Empyema is a collection of pus in the space between the lung and the inner surface of the chest wall (pleural space). Pneumothorax: collapsed lung.
Pharmacotherapy of Infectious Diseases 
A Case-Based Approach 
Investigations 
•History and PI with particular attention to: 
–Symptoms: 
•Cough, SOB, pleuritic chest pain, hemoptysis, sputum, fever, chills, headache, confusion, …. 
–History of recent travel and other risk factors like: 
•Smoking, alcohol, comorbid illnesses. 
–Physical findings: 
•Objective measurements: 
–Vital signs: RR≥30 is the most sensitive and specific sign. 
–Oxygenation status: If O2 saturation is ≤ 92% then perform arterial blood gas. 
–Chest radiograph: consider a CT scan if radiograph is negative. 
Anas Bahnassi 2014
Pharmacotherapy of Infectious Diseases 
A Case-Based Approach 
Investigations 
•Laboratory testing: 
–Electorlytes, Glu, BUN, Cr, CBC, differential WBC. 
–Blood cultures. 
–Sputum culture from the lower respiratory tract. 
–Urine for Legionella antigens. 
–Rapid test for flu. 
–Serological studies. 
–Nucleic acid amplification. 
Anas Bahnassi 2014
Pharmacotherapy of Infectious Diseases 
A Case-Based Approach 
CURB-65 
Anas Bahnassi 2014
Pharmacotherapy of Infectious Diseases 
A Case-Based Approach 
Anas Bahnassi 2014
Pharmacotherapy of Infectious Diseases 
A Case-Based Approach 
Anas Bahnassi 2014
Pharmacotherapy of Infectious Diseases 
A Case-Based Approach 
Initial Management of CAP 
Anas Bahnassi 2014 
CAP diagnosed based on History, PE, Findings, chest X-ray 
PSI is for guidance not to replace clinical judgment 
< 90 and not hypo- oxynated 
> 90 treat in hospital 
Otherwise healthy, no use of antibiotics for 3 months, and no other risk factor use macrolide or doxycycline po 
Co-morbidities , lung or kidney disease, risk factors then respiratory fluroquinolone *po, or Amox HD or Amox/Clav + Macrolide No Erythromycin alone 
Treat at home 
*moxifloxacin, levofloxacin. Gemifloxacin is not approved for CAP
Pharmacotherapy of Infectious Diseases 
A Case-Based Approach 
Initial Management of CAP 
Anas Bahnassi 2014 
CAP diagnosed based on History, PE, Findings, chest X-ray 
PSI is for guidance not to replace clinical judgment 
> 90 treat in hospital 
(Respiratory Fluroquinolone po/iv or B- lactam po/iv )+ Macrolide po/iv 
Antipnumococcal, antipsudomonal B- lactam*+ one of the followings: 
•Ciprofloxacin 
•Aminoglycoside + Macrolide 
•Aminoglycoside + Ciprofloxaxin 
Ward 
B-lactam iv + (Macrolide iv or respiratory fluroquinolone iv) 
ICU 
ICU 
S.aregunesa 
* Cefepime or imipenem or meropenem or piperacillin/tazopactam
Pharmacotherapy of Infectious Diseases 
A Case-Based Approach 
Antibiotic Treatment Recommendations 
Anas Bahnassi 2014 
Class 
Drug 
Dose 
ADR 
Comments 
Cost 
Amino- glycosides 
Gentamicin 
Conventional: 
1.5mg/kg DBW Q8H iv Extended: 
4-6mg/kg DBW Once iv 
Nephro/ Ototoxicity 
Do not permeate pulmonary tissue very well. 
Exhibit conc. dependent bacterial killing and postantibiotic effect 
Co-administration with vancomycin or loop diuretics may increase the risk of nephro/ototoxicity 
$ 
Tobramycin 
Conventional: 
1.5mg/kg DBW Q8H iv Extended: 
4-6mg/kg DBW Once iv 
$ 
In obese patients >30 of ideal body weight (IBW) use dosing body weight (DBW) instead of total body weight (TBW) to prevent overdosing. DBW=0.4 (TBW-IBW) 
Ideal body weight in (kg) Males: IBW = 50 kg + 2.3 kg for each inch over 5 feet. Females: IBW = 45.5 kg + 2.3 kg for each inch over 5 feet.
Pharmacotherapy of Infectious Diseases 
A Case-Based Approach 
Antibiotic Treatment Recommendations 
Anas Bahnassi 2014 
Class 
Drug 
Dose 
ADR 
Comments 
Cost 
Fluro- quinolones 
Cipro- floxacin 
PO: 500- 750mg BID 
IV: 400mg Q12H 
GI upset, HA, dizziness, photo- sensitivity, hepatitis. Avoid in children: Cartridge toxicity. 
Cipro is not a 1st line agent for CAP. 
Cipro available in suspension. 
Decreased absorption with antacids, metals, and sucrafate. 
Cipro may decrease theophylline or cyclosporin elimination. 
 Levo 750 BID X5d is equivalent to 500 BID X10d. 
May increase warfarin effect. 
Avoid in class Ia and III arrhythmia patients or prolonged QT intervals 
Can switch from iv to po 
$ 
Levo- floxacin 
PO: 500mg Q24H X10 days. or 750mg Q12H X5 days. 
IV: 500mg Q24H 
$ 
Moxi- floxacin 
400mg Q24H po/iv`
Pharmacotherapy of Infectious Diseases 
A Case-Based Approach 
Antibiotic Treatment Recommendations 
Anas Bahnassi 2014 
Class 
Drug 
Dose 
ADR 
Comments 
Cost 
Glyco- peptides 
Vanco- mycin 
1g Q12H iv 
Nephro/ ototoxicity 
Infusion related ADRs may increase with shorter infusion times 
For MRSA pneumonia. 
Increase risk of nephrotoxicity when co- administered with aminoglycosides. 
$$$$ 
Ketolides 
Telithro-mycin 
800mg daily X7-10 days 
Diarrhea, nausea, vomiting, elevated liver enzymes, hepatotoxicity. 
Can not be considered as a first line. 
Hepatotoxicity can be fatal. 
Telithromycin: Atorvastatin, Lovastatin, Simvastatin, Itraconazole, Ketoconazole. 
Digoxin levels. 
Contraindicated with ergot, pimozide and disopyramide.
Pharmacotherapy of Infectious Diseases 
A Case-Based Approach 
Antibiotic Treatment Recommendations 
Anas Bahnassi 2014 
Class 
Drug 
Dose 
ADR 
Comments 
Cost 
Linco- semides 
Clindamycin 
300-450mg Q6H po 
600mg Q8H iv 
Diarrhea 
C.Difficile 
For suspected aspiration provide anareobic coverage 
$ 
Macro- lides 
Azithromycin 
Adults 
500mg on day 1 then 250 on days 2-5 
Lower GI effects than Eryth. 
Azi QD X5days = Ery QID X10days. 
More effective than clarithro-mycin for H.influenzae. 
$$ 
Clarithromycin 
500mg BID X10d 
Or 
1g ER QD X10d 
Contraindicated with pimozide. 
Rifampin  Conc. 
Warfarin levels. 
Conc. of CYP3A4 susbtrates (statins/digoxin) 
$$ 
Erythromycin 
500mg QID po 
GI upset 
$
Pharmacotherapy of Infectious Diseases 
A Case-Based Approach 
Antibiotic Treatment Recommendations 
Anas Bahnassi 2014 
Class 
Drug 
Dose 
ADR 
Comments 
Cost 
Nitro- imidazole 
Metronidazole 
500mg po/iv Q12H 
Vertigo, HA, Ataxia, GI, taste change 
Avoid alcohol until 48h after the last dose 
(disulfram-like reaction) 
$ 
Oxazolidi- none 
Linezolide 
600mg po/iv Q12H 
GI, HA, dose and time dependent bone marrow suppression, peripheral neuropathy. 
Preferred agent for MSRA –pneumonia. 
 Risk of serotonin toxicity with concurrent use of serotonergic drugs. 
$$
Pharmacotherapy of Infectious Diseases 
A Case-Based Approach 
Antibiotic Treatment Recommendations 
Anas Bahnassi 2014 
Class 
Drug 
Dose 
ADR 
Comments 
Cost 
Carba- penems 
Ertapenam 
1g daily iv 
Anaphylaxis, diarrhea, HA, increased seizure risk. 
Indicated for S.pneumonia (penicillin- susceptible), H.influenzae. M. Catarrhalis. 
$$$ 
Impenem 
500 mg Q6H iv 
Hypotension, nausea with rapid infusion, seizure activity with high levels. 
Antipseudomonal for patients with high risk for P. aeruginosa. 
$$$$ 
Meropenam 
1g Q8H iv 
Less than Impenem. 
$$$$
Pharmacotherapy of Infectious Diseases 
A Case-Based Approach 
Antibiotic Treatment Recommendations 
Anas Bahnassi 2014 
Class 
Drug 
Dose 
ADR 
Comments 
Cost 
Carba- penems 
Ertapenam 
1g daily iv 
Anaphylaxis, diarrhea, HA, increased seizure risk. 
Indicated for S.pneumonia (penicillin- susceptible), H.influenzae. M. Catarrhalis. 
$$$ 
Impenem 
500 mg Q6H iv 
Hypotension, nausea with rapid infusion, seizure activity with high levels. 
Antipseudomonal for patients with high risk for P. aeruginosa. 
$$$$ 
Meropenam 
1g Q8H iv 
Less than Impenem. 
$$$$
Pharmacotherapy of Infectious Diseases 
A Case-Based Approach 
Antibiotic Treatment Recommendations 
Anas Bahnassi 2014 
Class 
Drug 
Dose 
ADR 
Comments 
Cost 
Cephalo- sporins 
Cefazolin 
1st generation 
1-2g Q8H iv 
Hyper- sensitivity 
$-$$ 
Cefaclor 
2nd generation 
250mg TID po 
$ 
Cefprozil 
2nd generation 
500mg BID po 
$ 
Cefotaxime 
3rd generation 
1-2g Q8H iv 
Can be used hepatobilliary disease. 
$$- $$$ 
Cefepim 
4th generatrion 
1-2g Q12H 
Antipseudomonal for patients with high risk for P. aeruginosa. 
$$$$
Pharmacotherapy of Infectious Diseases 
A Case-Based Approach 
Antibiotic Treatment Recommendations 
Anas Bahnassi 2014 
Class 
Drug 
Dose 
ADR 
Comments 
Cost 
Penicillins 
Penicillin V K 
300mg TID- QID po 
Anaphylaxis 
GI distress 
Diarrhea. 
$ 
Penicillin G 
2MU Q4H iv 
$ 
Amoxicillin 
500mg TID po 
GI distress 
Diarrhea. 
Consider HD if patient is with drug resistant S.pneumoniae risk factors 
$ 
Amox/Clav 
500/125 TID po 
or 
875/125 BID po 
$$ 
Rifamycin 
Rifampin 
300mg BID po 
Rash, orange discoloration of body fluids, GI upset, liver toxicity, hematologic effects 
Never use as a single agent for CAP 
CYP inducer.
Pharmacotherapy of Infectious Diseases 
A Case-Based Approach 
Antibiotic Treatment Recommendations 
Anas Bahnassi 2014 
Class 
Drug 
Dose 
ADR 
Comments 
Cost 
Sulfo- namides 
SMX/TMP 
800/160mg BID po 
GI, rash, Stevenson- Johnson’s syndrome 
May  effects of sulfonylurea and warfarin. 
Caution with G6PD deficiency and impaired renal and hepatic function. 
$ 
Tetracyclins 
Doxycycline 
100mg BID on 1st day then 100mg once 
GI, photosensitivity 
Fe/antacids  absorption. 
Alcohol. Barbiturates, phenytoin, rifampin, carbamazepin  levels. 
$
Pharmacotherapy of Infectious Diseases 
A Case-Based Approach 
Empiric Treatments for Adults 
Anas Bahnassi 2014
Pharmacotherapy of Infectious Diseases 
A Case-Based Approach 
Empiric Treatments for Adults 
Anas Bahnassi 2014
Pharmacotherapy of Infectious Diseases 
A Case-Based Approach 
Empiric Treatment in Children 
Anas Bahnassi 2014
Pharmacotherapy of Infectious Diseases 
A Case-Based Approach 
Prevention Measures 
•Smoking cessation. 
•Influenza vaccine. 
•Pneumococcal vaccine. 
•Chin down posture reduce the chance of aspiration both before and during the swallow. 
•Follow-up chest radiographs for smokers. 
Anas Bahnassi 2014
Pharmacotherapy of Infectious Diseases 
A Case-Based Approach 
Pharmacotherapy: Infectious Diseases: Anas Bahnassi PhD 
abahnassi@gmail.com 
http://www.twitter.com/abpharm 
http://www.facebook.com/pharmaprof 
http://www.linkedin.com/in/abahnassi 
Anas Bahnassi 2014

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Pneumonia

  • 1. Pharmacotherapy of Infectious Diseases A Case-Based Approach Pneumonia Anas Bahnassi PhD Pharmacotherapy of Infectious Diseases Anas Bahnassi 2014 A Case-Based Approach
  • 2. Pharmacotherapy of Infectious Diseases A Case-Based Approach Introduction •Community Acquired Pneumonia (CAP) –Common and serious disease. –80% of cases can be treated at home. –Mortality rate for patients requiring hospitalization is 8-10%, and can increase to 40% to those requiring ICU. –Clinical presentation of CAP does not allow for and etiological diagnosis. –Many organisms can be Anas Bahnassi 2014
  • 3. Pharmacotherapy of Infectious Diseases A Case-Based Approach Common pathogens in CAP: Pneumonia treated on ambulatory basis Streptococcus pneumoniae Mycoplasm pneumoniae Haemphilus Influenzae Chlamydophila pneumoniae Respiratory viruses Moraxelia catarrhalis Anas Bahnassi 2014 Pneumonia requiring hospital admission Streptococcus pneumoniae Chlamydophila pneumoniae Haemphilus Influenzae Lagionella supp. Aspiration G –ve. Bacilli Mixed etiology Respiratory viruses Mycoplasm pneumoniae Pneumonia requiring ICU admission Streptococcus pneumoniae Staphylococcus aureus Lagionella supp. G –ve. Bacilli Haemphilus Influenzae
  • 4. Pharmacotherapy of Infectious Diseases A Case-Based Approach Goals of Therapy •Assess severity of pneumonia. •Eradicate infecting pathogen. •Relieve symptoms. –Fever, cough, pleuritic chest pain, sputum, dyspnea. •Promptly recognize and minimize complications. –Metastatic infection, empyema, cavitation, pneumothorax, septic shock, respiratory failure, worsening of comorbid condition (IHD, DM). •Provide end-of-life care if emerges. Anas Bahnassi 2014 Empyema is a collection of pus in the space between the lung and the inner surface of the chest wall (pleural space). Pneumothorax: collapsed lung.
  • 5. Pharmacotherapy of Infectious Diseases A Case-Based Approach Investigations •History and PI with particular attention to: –Symptoms: •Cough, SOB, pleuritic chest pain, hemoptysis, sputum, fever, chills, headache, confusion, …. –History of recent travel and other risk factors like: •Smoking, alcohol, comorbid illnesses. –Physical findings: •Objective measurements: –Vital signs: RR≥30 is the most sensitive and specific sign. –Oxygenation status: If O2 saturation is ≤ 92% then perform arterial blood gas. –Chest radiograph: consider a CT scan if radiograph is negative. Anas Bahnassi 2014
  • 6. Pharmacotherapy of Infectious Diseases A Case-Based Approach Investigations •Laboratory testing: –Electorlytes, Glu, BUN, Cr, CBC, differential WBC. –Blood cultures. –Sputum culture from the lower respiratory tract. –Urine for Legionella antigens. –Rapid test for flu. –Serological studies. –Nucleic acid amplification. Anas Bahnassi 2014
  • 7. Pharmacotherapy of Infectious Diseases A Case-Based Approach CURB-65 Anas Bahnassi 2014
  • 8. Pharmacotherapy of Infectious Diseases A Case-Based Approach Anas Bahnassi 2014
  • 9. Pharmacotherapy of Infectious Diseases A Case-Based Approach Anas Bahnassi 2014
  • 10. Pharmacotherapy of Infectious Diseases A Case-Based Approach Initial Management of CAP Anas Bahnassi 2014 CAP diagnosed based on History, PE, Findings, chest X-ray PSI is for guidance not to replace clinical judgment < 90 and not hypo- oxynated > 90 treat in hospital Otherwise healthy, no use of antibiotics for 3 months, and no other risk factor use macrolide or doxycycline po Co-morbidities , lung or kidney disease, risk factors then respiratory fluroquinolone *po, or Amox HD or Amox/Clav + Macrolide No Erythromycin alone Treat at home *moxifloxacin, levofloxacin. Gemifloxacin is not approved for CAP
  • 11. Pharmacotherapy of Infectious Diseases A Case-Based Approach Initial Management of CAP Anas Bahnassi 2014 CAP diagnosed based on History, PE, Findings, chest X-ray PSI is for guidance not to replace clinical judgment > 90 treat in hospital (Respiratory Fluroquinolone po/iv or B- lactam po/iv )+ Macrolide po/iv Antipnumococcal, antipsudomonal B- lactam*+ one of the followings: •Ciprofloxacin •Aminoglycoside + Macrolide •Aminoglycoside + Ciprofloxaxin Ward B-lactam iv + (Macrolide iv or respiratory fluroquinolone iv) ICU ICU S.aregunesa * Cefepime or imipenem or meropenem or piperacillin/tazopactam
  • 12. Pharmacotherapy of Infectious Diseases A Case-Based Approach Antibiotic Treatment Recommendations Anas Bahnassi 2014 Class Drug Dose ADR Comments Cost Amino- glycosides Gentamicin Conventional: 1.5mg/kg DBW Q8H iv Extended: 4-6mg/kg DBW Once iv Nephro/ Ototoxicity Do not permeate pulmonary tissue very well. Exhibit conc. dependent bacterial killing and postantibiotic effect Co-administration with vancomycin or loop diuretics may increase the risk of nephro/ototoxicity $ Tobramycin Conventional: 1.5mg/kg DBW Q8H iv Extended: 4-6mg/kg DBW Once iv $ In obese patients >30 of ideal body weight (IBW) use dosing body weight (DBW) instead of total body weight (TBW) to prevent overdosing. DBW=0.4 (TBW-IBW) Ideal body weight in (kg) Males: IBW = 50 kg + 2.3 kg for each inch over 5 feet. Females: IBW = 45.5 kg + 2.3 kg for each inch over 5 feet.
  • 13. Pharmacotherapy of Infectious Diseases A Case-Based Approach Antibiotic Treatment Recommendations Anas Bahnassi 2014 Class Drug Dose ADR Comments Cost Fluro- quinolones Cipro- floxacin PO: 500- 750mg BID IV: 400mg Q12H GI upset, HA, dizziness, photo- sensitivity, hepatitis. Avoid in children: Cartridge toxicity. Cipro is not a 1st line agent for CAP. Cipro available in suspension. Decreased absorption with antacids, metals, and sucrafate. Cipro may decrease theophylline or cyclosporin elimination.  Levo 750 BID X5d is equivalent to 500 BID X10d. May increase warfarin effect. Avoid in class Ia and III arrhythmia patients or prolonged QT intervals Can switch from iv to po $ Levo- floxacin PO: 500mg Q24H X10 days. or 750mg Q12H X5 days. IV: 500mg Q24H $ Moxi- floxacin 400mg Q24H po/iv`
  • 14. Pharmacotherapy of Infectious Diseases A Case-Based Approach Antibiotic Treatment Recommendations Anas Bahnassi 2014 Class Drug Dose ADR Comments Cost Glyco- peptides Vanco- mycin 1g Q12H iv Nephro/ ototoxicity Infusion related ADRs may increase with shorter infusion times For MRSA pneumonia. Increase risk of nephrotoxicity when co- administered with aminoglycosides. $$$$ Ketolides Telithro-mycin 800mg daily X7-10 days Diarrhea, nausea, vomiting, elevated liver enzymes, hepatotoxicity. Can not be considered as a first line. Hepatotoxicity can be fatal. Telithromycin: Atorvastatin, Lovastatin, Simvastatin, Itraconazole, Ketoconazole. Digoxin levels. Contraindicated with ergot, pimozide and disopyramide.
  • 15. Pharmacotherapy of Infectious Diseases A Case-Based Approach Antibiotic Treatment Recommendations Anas Bahnassi 2014 Class Drug Dose ADR Comments Cost Linco- semides Clindamycin 300-450mg Q6H po 600mg Q8H iv Diarrhea C.Difficile For suspected aspiration provide anareobic coverage $ Macro- lides Azithromycin Adults 500mg on day 1 then 250 on days 2-5 Lower GI effects than Eryth. Azi QD X5days = Ery QID X10days. More effective than clarithro-mycin for H.influenzae. $$ Clarithromycin 500mg BID X10d Or 1g ER QD X10d Contraindicated with pimozide. Rifampin  Conc. Warfarin levels. Conc. of CYP3A4 susbtrates (statins/digoxin) $$ Erythromycin 500mg QID po GI upset $
  • 16. Pharmacotherapy of Infectious Diseases A Case-Based Approach Antibiotic Treatment Recommendations Anas Bahnassi 2014 Class Drug Dose ADR Comments Cost Nitro- imidazole Metronidazole 500mg po/iv Q12H Vertigo, HA, Ataxia, GI, taste change Avoid alcohol until 48h after the last dose (disulfram-like reaction) $ Oxazolidi- none Linezolide 600mg po/iv Q12H GI, HA, dose and time dependent bone marrow suppression, peripheral neuropathy. Preferred agent for MSRA –pneumonia.  Risk of serotonin toxicity with concurrent use of serotonergic drugs. $$
  • 17. Pharmacotherapy of Infectious Diseases A Case-Based Approach Antibiotic Treatment Recommendations Anas Bahnassi 2014 Class Drug Dose ADR Comments Cost Carba- penems Ertapenam 1g daily iv Anaphylaxis, diarrhea, HA, increased seizure risk. Indicated for S.pneumonia (penicillin- susceptible), H.influenzae. M. Catarrhalis. $$$ Impenem 500 mg Q6H iv Hypotension, nausea with rapid infusion, seizure activity with high levels. Antipseudomonal for patients with high risk for P. aeruginosa. $$$$ Meropenam 1g Q8H iv Less than Impenem. $$$$
  • 18. Pharmacotherapy of Infectious Diseases A Case-Based Approach Antibiotic Treatment Recommendations Anas Bahnassi 2014 Class Drug Dose ADR Comments Cost Carba- penems Ertapenam 1g daily iv Anaphylaxis, diarrhea, HA, increased seizure risk. Indicated for S.pneumonia (penicillin- susceptible), H.influenzae. M. Catarrhalis. $$$ Impenem 500 mg Q6H iv Hypotension, nausea with rapid infusion, seizure activity with high levels. Antipseudomonal for patients with high risk for P. aeruginosa. $$$$ Meropenam 1g Q8H iv Less than Impenem. $$$$
  • 19. Pharmacotherapy of Infectious Diseases A Case-Based Approach Antibiotic Treatment Recommendations Anas Bahnassi 2014 Class Drug Dose ADR Comments Cost Cephalo- sporins Cefazolin 1st generation 1-2g Q8H iv Hyper- sensitivity $-$$ Cefaclor 2nd generation 250mg TID po $ Cefprozil 2nd generation 500mg BID po $ Cefotaxime 3rd generation 1-2g Q8H iv Can be used hepatobilliary disease. $$- $$$ Cefepim 4th generatrion 1-2g Q12H Antipseudomonal for patients with high risk for P. aeruginosa. $$$$
  • 20. Pharmacotherapy of Infectious Diseases A Case-Based Approach Antibiotic Treatment Recommendations Anas Bahnassi 2014 Class Drug Dose ADR Comments Cost Penicillins Penicillin V K 300mg TID- QID po Anaphylaxis GI distress Diarrhea. $ Penicillin G 2MU Q4H iv $ Amoxicillin 500mg TID po GI distress Diarrhea. Consider HD if patient is with drug resistant S.pneumoniae risk factors $ Amox/Clav 500/125 TID po or 875/125 BID po $$ Rifamycin Rifampin 300mg BID po Rash, orange discoloration of body fluids, GI upset, liver toxicity, hematologic effects Never use as a single agent for CAP CYP inducer.
  • 21. Pharmacotherapy of Infectious Diseases A Case-Based Approach Antibiotic Treatment Recommendations Anas Bahnassi 2014 Class Drug Dose ADR Comments Cost Sulfo- namides SMX/TMP 800/160mg BID po GI, rash, Stevenson- Johnson’s syndrome May  effects of sulfonylurea and warfarin. Caution with G6PD deficiency and impaired renal and hepatic function. $ Tetracyclins Doxycycline 100mg BID on 1st day then 100mg once GI, photosensitivity Fe/antacids  absorption. Alcohol. Barbiturates, phenytoin, rifampin, carbamazepin  levels. $
  • 22. Pharmacotherapy of Infectious Diseases A Case-Based Approach Empiric Treatments for Adults Anas Bahnassi 2014
  • 23. Pharmacotherapy of Infectious Diseases A Case-Based Approach Empiric Treatments for Adults Anas Bahnassi 2014
  • 24. Pharmacotherapy of Infectious Diseases A Case-Based Approach Empiric Treatment in Children Anas Bahnassi 2014
  • 25. Pharmacotherapy of Infectious Diseases A Case-Based Approach Prevention Measures •Smoking cessation. •Influenza vaccine. •Pneumococcal vaccine. •Chin down posture reduce the chance of aspiration both before and during the swallow. •Follow-up chest radiographs for smokers. Anas Bahnassi 2014
  • 26. Pharmacotherapy of Infectious Diseases A Case-Based Approach Pharmacotherapy: Infectious Diseases: Anas Bahnassi PhD abahnassi@gmail.com http://www.twitter.com/abpharm http://www.facebook.com/pharmaprof http://www.linkedin.com/in/abahnassi Anas Bahnassi 2014