Antimicrobials vancomycin

Amphotericin B, cephalosporins, penicillins, minocycline, nitrofurantoin, sulfonamide antimicrobials, and vancomycin... 

Allopurinol, barbiturates, carbamazepine, cephalosporins, cyclophosphamide, ethambutol, fluconazole, ibuprofen, lamotrigine, macrolides, nitrofurantoin, penicillins, phenytoin, propranolol, quinolones, sulfonamide antimicrobials, sulindac, tetracyclines, thiazides, valproic acid, and vancomycin... 

Albumin, aminophylline, aspirin, heparin, insulin, metoclopramide, NSAIDs, muromonab-CD3 (OKT3), opiates, penicillins, propafenone, quinidine, senna, sulfonamide antimicrobials, and vancomycin... 

P-lactam antimicrobials, erythromycin, nitrofurantoin, rifampin, sulfonamide antimicrobials, and vancomycin 0 Diuretics (all classes), NSAIDs... 

The patient was admitted to the hospital with a presumptive diagnosis of health care-associated pneumonia (based on the recent hospitalization). He received intravenous hydration with normal saline, 5 L oxygen via face mask, an insulin infusion to control his glucose, and empirical antimicrobial therapy with piperacillin-tazobactam 2.25 g intravenously every 6 hours and vancomycin 1 g intravenously every 24 hours. All other medications are continued with the exception of the diabetes medications. 

High-dose penicillin G traditionally has been the drug of choice for the treatment of pneumococcal meningitis. However, due to increases in pneumococcal resistance, the preferred empirical treatment now includes a third-generation cephalosporin in combination with vancomycin.13 All CSF isolates should be tested for penicillin and cephalosporin resistance by methods endorsed by the CLSI. Once in vitro sensitivity results are known, therapy may be tailored (Table 67-3). Patients with a history of type I penicillin allergy or cephalosporin allergy may be treated with vancomycin. Treatment should be continued for 10 to 14 days, after which no further maintenance therapy is required. Antimicrobial prophylaxis is not indicated for close contacts. 

Dexamethasone therapy may reduce antibiotic penetration, so antimicrobial drug dosing may have to be increased (especially vancomycin) to achieve adequate CSF levels. Serum levels of vancomycin should be measured and doses titrated to ensure adequate CNS concentrations. Evaluate whether intraventricular or intrathecal antibiotics are indicated. 

Correct timing of antibiotic administration is imperative to preventing SSI. The National Surgical Infection Prevention Project recommends infusing antimicrobials for surgical prophylaxis within 60 minutes of the first incision. Exceptions to this rule are fluoroquinolones and vancomycin, which can be infused 120 minutes prior to avoid infusion-related reactions.1 No consensus has been reached on whether the infusion should be complete prior to the first incision. However, if a proximal tourniquet is used, antibiotic administration should be complete prior to inflation. 

Cefazolin or cefuroxime are appropriate for prophylaxis in cardiothoracic and vascular surgeries. In the case of 3-lactam allergy, vancomycin or clindamycin are advised. Debate exists on the duration of antimicrobial prophylaxis. The National Surgical Infection Prevention Project cites data that extending prophylaxis beyond 24 hours does not decrease SSI rates and may increase bacterial resistance.1 American Society of Health-System Pharmacists guidelines from 1999 allow for the continuation of prophylaxis for up to 72 hours.22 Duration of therapy should be based on patient factors and risk of development of an SSI. SSIs are rare after cardiothoracic operations, but the potentially devastating consequences lead some clinicians to support longer periods of prophylaxis. 

Verify the patient s allergy history and the type of reaction experienced. Attempt to discern between true allergy and adverse event. (3-Lactam-allergic patients may receive clindamycin, vancomycin, or other antimicrobials. Crossreactivity between penicillin allergy and cephalosporins is low but cephalosporins should be avoided in patients with a history of anaphylaxis to penicillins. 

Prophylactic antimicrobials should be started within an hour of the first incision to optimize patient outcomes. Exceptions to this include vancomycin and fluoroquinolones. 

Montecalvo MA Ramoplanin A novel antimicrobial agent with the potential to prevent vancomycin-resistant enterococcal infection in high-risk patients. J Antimicrob Chemother 2003 51(suppl 3) 31—35. 

Penicillin antibiotics must be used with caution because some strains of Bacillus anthracis possess an enzyme that inactivates penicillin. Other antimicrobial agents can be used as alternatives if the listed drugs are unavailable or in short supply. These include erythromycin, imipenem, clindamycin, vancomycin, and chloramphenicol.3... 

Bozdogan B., R. Leclerq, A. Lozniewski, and W. Weber (1999). Plasmid-mediated coresistance to streptogramins and vancomycin in Enterococcus faecium HM1032. Antimicrobial Agents and Chemotherapy 43 2097-2098. 

Hiramatsu K., H. Hanaki, T. Ino, K. Yahuta, T. Oguri, and F.C. Tenover (1997). MethiciUin-resistant Staphylococcus aureus chnical strains with reduced vancomycin susceptihihty. Journal of Antimicrobial Chemotherapy 40 135-136. 

Tenover F.C., L.M. Weigel, P.C. Appelbaum, L.K. McDougal, J. Chaitram, S. McAllister, N. Clark, G. Killgore, C.M. O Hara, L. Jevitt, J.B. Patel, and B. Bozdogan (2004). Vancomycin-resistant Staphylococcus aureus isolate from a patient in Pennsylavania. Antimicrobial Agents and Chemotherapy 48 275-280. 

The answer is b. (Hardman, p 1128.) Tetracycline is one of the drugs of choice in the treatment of Rickettsia, Mycoplasma, and Chlamydia infections. The antibiotics that act by inhibiting cell-wall synthesis have no effect on Mycoplasma because the organism does not possess a cell wall penicillin G, vancomycin, and bacitracin will be ineffective. Gentamicin has little or no antimicrobial activity with these organisms. 

The use of an antagonistic antimicrobial combination does not preclude other potential beneficial interactions. For example, rifampin may antagonize the action of anti-staphylococcal penicillins or vancomycin against staphylococci. However, the aforementioned antimicrobials may prevent the emergence of resistance to rifampin. 

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