Anti-microbial pharamocology??

the honest truth is, until you are in the clinical year, antimicrobials will not make sense. in fact, afterwards, they still won't make much sense. there is absolutely no logical schema to use. you just gotta learn by experience. unsatisfying.

You should know what types of bugs each class covers and should be able to determine the bugs that may be present in certain pathologies such as community acquired pnemonia, bowel perf or gsw casuing leak of anaerobes etc. These are things that were on step 1 for me, not hugely represented, but present nevertheless. I feel the indications for antimicrobials will be mostly based on understanding the patient and the side-effect, and when to avoid the drug, i.e., don't give Levaquin to kids as quinolones will break your bones etc. If you know general indications, you should be able to get the few q's that make you hone in on which specific pathologies MOST commonly are treated by which drug. I would just make a quick reference notecard or something. Hope that helps.

Medical Microbiology Made Ridiculously Simple...I found that really useful.
As you said, there really isn't any logical explanation for that stuff but MMRS has some ridiculous pictures that help you remember things.

This may help: http://www.nfid.org/pdf/id_archive/antibiotictherapy.pdf

Think of it in terms of bacteriocidal vs bacteriostatic and what you're hoping to accomplish by giving the antibacterial agent..

Usually until you know the bug you are treating you cover empirically with something like Zosyn, which has gram (+) and (-) and anaerobe coverage. Throw in some Vancomycin for MRSA.

Once you know the bug, you narrow therapy with an antibiotic that will cover the bug based on your hospital's C/S.

Some places like to double cover Pseudo too. Like Gent and Zosyn. Cefepime is a good choice too.

J DUB said:

Usually until you know the bug you are treating you cover empirically with something like Zosyn, which has gram (+) and (-) and anaerobe coverage. Throw in some Vancomycin for MRSA.

Once you know the bug, you narrow therapy with an antibiotic that will cover the bug based on your hospital's C/S.

Some places like to double cover Pseudo too. Like Gent and Zosyn. Cefepime is a good choice too.

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Ugh, brand names

Try to get your hands on Kaplan Pharm videos. The guy is pretty on point and aims to minimize memorization. All of antimicrobials comes up to about 4 hours of video time, so its decently concise. Its worth a shot IMO.

Hi,
When on rotations, seek a Pharmacy intern or student, we are usually good with ID coverage and the good ones can identify which abx would be the cheapest most effective to use . Another solution:

The Sanford Antomicrobial guide will help, also get Tarascon Pharmacopeia pocket book if you are interested. Epocrates helps but Lexicomp is more through soruce. There are only a few bugs that show up again and again P. Aeruginsa ( and other SPACE coverage), high resistance patterns in quinolones, different types of MRSA etc. If you know which organisms dont really stain (Legionella (-), Listeria(+), fungus, viral chalmydia etc.) and when they show up in Hospital/ Community aquired pneumonia (and what are the top 5) w/ what compelling indications that helps.

What helps the most is knowing which PCN and Cephs are anti pseudonomal, which can cover MSSA, CA-MRSA and hospital MRSA, what medications will help with atypicals, resistance patterns (ie Zpak, Septra). Klebsiella and Ecoli most common ESBL producers, know what will get it.

Page 186 in the SAnford guide for example will tell you which drugs are renally cleared and which are not.

Cephalosporins are in the 5th generation now (Ceftobiprole and didnt cover enteroccocus before) with different coverage and effects (for example Cefortetan has an MTT group which can be for alcoholics and patients on Warfarin)


I also went to Cal and did a double in MCB G&D and Public Health mgmt. How about Cal ripping ther Twerps a new one this week? 52-13 NICE! I think we can take down USC this year.

Let me know if you have questions. Be glad to help

NRAI2001 said:

We ve covered general kinetics & pharmodynamics as well as autonomics, diuertics, cardiac pharm so far and they all are pretty straight forward...but I having trouble with anti-microbials..

I ve memorized the general mechanisms and adverse effects of all the classes (penicillins, cephalosporins, carbapenems, flouroquinolons, aminoglycosides...etc); BUT I guess I dont have a much of a "BIG PICTURE" idea of when to use which drug?? Like when would you choose to use a penicillin vs. cephalosporin vs. sulfonamide....etc

If anyone has any free time or wants to do a little self review your advise would be greatly appreciated

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