ID questions

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nafcillin

nafcillin

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which drugs cover pseudomonas? any easy way to remember which ones they are?

Which drugs cover anaerobes and which kinds of infections are you most likely to see anaerobes?
 
I better not be doing your homework!

Antipseudomonals:

Aminoglycosides
Cephalosporins: Ceftazidime, Cefepime, & Ceftobiprole
Penicillins: Ticarcillin (Timentin), Piperacillin (Zosyn), Carbenicillin
Penems: Meropenem, Imipenem, Doripenem
Quinlones: Mostly all cover it..marginally.

I'm doing this by memory..so may have left a few out.

Anaerobic infection? Where do they usually live? Gut? Look up Bacteroides fragilis.. and Clostridium species. Go to IDSA website and look up GI and Abdominal infections. Also Diabetic foot.
 
ItsOverZyvox said:
I
Quinlones: Mostly all cover it..marginally.
Click to expand...

I learned Cipro was the only anti-pseudomonal quinolone.

I just looked in Sanford and Cipro is the only (+). However, (+) means >60% susceptibility - IDSA says 80%.

Both moxi and levo were +/-
 
nope, not doing my homework - I'm out of school and practicing. I just have a hard time remembering these important ID things. thanks!
 
njac said:
I learned Cipro was the only anti-pseudomonal quinolone.

I just looked in Sanford and Cipro is the only (+). However, (+) means >60% susceptibility - IDSA says 80%.

Both moxi and levo were +/-
Click to expand...

Are you questioning me grasshopper? Well...why do you suppose they call cipro the "only" antipseudomonal? Hint... look at the indication.

Then again, look at the antibiogram..you'll notice that pseudomonal coverage between Levo and Cipro are more similar than different.
 
nafcillin said:
nope, not doing my homework - I'm out of school and practicing. I just have a hard time remembering these important ID things. thanks!
Click to expand...

alrighty then!
 
ItsOverZyvox said:
Quinlones: Mostly all cover it..marginally.
Click to expand...

Not Moxi! Cipro is about the only one I see used for this.

The institution where I did my hospital rotations switched from Cipro/Levo to Cipro/Moxi, only using Cipro for pseudomonas and UTIs.
 
Glycerin said:
Not Moxi! Cipro is about the only one I see used for this.

The institution where I did my hospital rotations switched from Cipro/Levo to Cipro/Moxi, only using Cipro for pseudomonas and UTIs.
Click to expand...


Do you know why that hospital switched to Cipro/Moxi?
 
Glycerin said:
Because the moxi reps came in and twisted their arms until they cried "Uncle!" :meanie:

Levo is more expensive than moxi. 😀
Click to expand...

No.. Moxi only has one strength.. and it costs $10 to $12 on contract and $35 non contract.

Levo 250mg costs around $5 to $7.. 500mg costs $7 to $12 and 750mg costs less than 500mg.. IVs.. so if you average it out..there is not a whole lot of difference in cost between Levo and Moxi..

So, try again. Why did that hospital switch to Moxi/cipro.. wanna be resident?
 
ItsOverZyvox said:
No.. Moxi only has one strength.. and it costs $10 to $12 on contract and $35 non contract.

Levo 250mg costs around $5 to $7.. 500mg costs $7 to $12 and 750mg costs less than 500mg.. IVs.. so if you average it out..there is not a whole lot of difference in cost between Levo and Moxi..

So, try again. Why did that hospital switch to Moxi/cipro.. wanna be resident?
Click to expand...

Well, they did mention the cost savings, and maybe it had to do with whatever contract they had.

Moxi instead of levo provides better anaerobic coverage and there is no renal dosing adjustment necessary with moxi.
 
Glycerin said:
Well, they did mention the cost savings, and maybe it had to do with whatever contract they had.

Moxi instead of levo provides better anaerobic coverage and there is no renal dosing adjustment necessary with moxi.
Click to expand...

But you couldn't use Moxi on patients with both CAP and UTI where you can with Levo.. and do you really want to use Moxi for anaerobic infxns?

And renal dosing with Levaquin saves money...you lose out on cost savings opportunity with moxi because you don't renal dose it.

So try again...why did they switch to Moxi/Cipro from Levo?
 
To remember all of that ID stuff I highly recommend the book "Clinical Microbiology Made Incredibly Simple." It saved my rear on our ID therapeutics exam.
 
ItsOverZyvox said:
Are you questioning me grasshopper? Well...why do you suppose they call cipro the "only" antipseudomonal? Hint... look at the indication.

Then again, look at the antibiogram..you'll notice that pseudomonal coverage between Levo and Cipro are more similar than different.
Click to expand...

You should be proud that I'm questioning you!

Go read the job offer thread and give us advice there!
 
ItsOverZyvox said:
No.. Moxi only has one strength.. and it costs $10 to $12 on contract and $35 non contract.

Levo 250mg costs around $5 to $7.. 500mg costs $7 to $12 and 750mg costs less than 500mg.. IVs.. so if you average it out..there is not a whole lot of difference in cost between Levo and Moxi..

So, try again. Why did that hospital switch to Moxi/cipro.. wanna be resident?
Click to expand...

Moxi got an indication for intraabdominal as monotherapy.
 
ItsOverZyvox said:
But you couldn't use Moxi on patients with both CAP and UTI where you can with Levo.. and do you really want to use Moxi for anaerobic infxns?

And renal dosing with Levaquin saves money...you lose out on cost savings opportunity with moxi because you don't renal dose it.

So try again...why did they switch to Moxi/Cipro from Levo?
Click to expand...

Who do I get to play tonight...Ortho-McNeil or Schering-P drug rep? :meanie:

And what are we talking about re: UTI...pseudomonas or E.coli, etc.
 
firefighter9015 said:
To remember all of that ID stuff I highly recommend the book "Clinical Microbiology Made Incredibly Simple." It saved my rear on our ID therapeutics exam.
Click to expand...

my GF uses it for med school. The picture of the pilli makes me ROFL. The pictures are so ridiculous you remember it
 
ItsOverZyvox said:
Are you lost?
Click to expand...

Lost?

No...just joking that a response would be different based on which "drug rep" you asked...

Everything from anaerobic coverage/aspiration pneumonia/C. diff outbreak costs, yada yada.

UTI comment had to do with ruling out Moxiflox. Which isn't necessarily applicable with E. Coli/enterococcus, but if we're talking psuedomonas empiric/formulary decisions, then forget about it, it's a non-issue.


Posted via Mobile BlackBerry Device
 
SpirivaSunrise said:
Lost?

No...just joking that a response would be different based on which "drug rep" you asked...

Everything from anaerobic coverage/aspiration pneumonia/C. diff outbreak costs, yada yada.

UTI comment had to do with ruling out Moxiflox. Which isn't necessarily applicable with E. Coli/enterococcus, but if we're talking psuedomonas empiric/formulary decisions, then forget about it, it's a non-issue.


Posted via Mobile BlackBerry Device
Click to expand...

What kind of person types this much on a blackberry. And I only get this type of response from students who aren't sure of the answer..

But what kind of institution would make this sort of drastic formulary change based on how to treat UTI??
 
ItsOverZyvox said:
What kind of person types this much on a blackberry. And I only get this type of response from students who aren't sure of the answer..

But what kind of institution would make this sort of drastic formulary change based on how to treat UTI??
Click to expand...

Exactly; you wouldn't...I didn't read the wholet hread and just thought you were talking strictly coverage. Avelox/UTI would just be an interesting conversation point for pseudomonas...but forget it if w'ere talking formulary.

I'm at a meeting, and bored...and have fast thumbs.


Posted via Mobile BlackBerry Device
 
SpirivaSunrise said:
Exactly; you wouldn't...I didn't read the wholet hread and just thought you were talking strictly coverage. Avelox/UTI would just be an interesting conversation point for pseudomonas...but forget it if w'ere talking formulary.

I'm at a meeting, and bored...and have fast thumbs.


Posted via Mobile BlackBerry Device
Click to expand...

You give up so easily... and what kind of company has a meeting at 9:20pm??????
 
In other news, received my AJHP today and promptly noticed the preview ad for ceftobiprole:

"In an uncertain environment....

A new era in antibiotic therapy"

Coming soon from Ortho McNeil

Oh the pretty colors, I bet the reps are going to be HOT and armed with "educational materials"

Anybody know what the brand name of this bad boy is going to be?
 
straight off wikipedia, the drug reference of choice for pharmacy students


Ceftobiprole (brand name Zeftera) is a next generation cephalosporinantibiotic with activity against methicillin-resistant Staphylococcus aureus, penicillin-resistant Streptococcus pneumoniae, Pseudomonas aeruginosa, and Enterococci.[2][3][4] It was discovered by Basilea Pharmaceutica[5] and was developed by Johnson & Johnson Pharmaceutical Research and Development.[6] It has been shown to be statistically non-inferior to the combination of vancomycin and ceftazidime for the treatment of skin and soft tissue infections.
 
bigpharmD said:
straight off wikipedia, the drug reference of choice for pharmacy students


Ceftobiprole (brand name Zeftera) is a next generation cephalosporinantibiotic with activity against methicillin-resistant Staphylococcus aureus, penicillin-resistant Streptococcus pneumoniae, Pseudomonas aeruginosa, and Enterococci.[2][3][4] It was discovered by Basilea Pharmaceutica[5] and was developed by Johnson & Johnson Pharmaceutical Research and Development.[6] It has been shown to be statistically non-inferior to the combination of vancomycin and ceftazidime for the treatment of skin and soft tissue infections.
Click to expand...


Well well well...then why don't we use Vanco ($15 per day of TX) + Ceftazidime ($15 per day of tx) instead of $160 to $200 per day of Ceftobiprole????

Somebody convince me..
 
SpirivaSunrise said:
What are you, on sarcasm receptor blocker?

Yeay...finally, I get to go home.


Posted via Mobile BlackBerry Device
Click to expand...

oooooh.. I like that. SRB!!! Make that ZRB.. Zarcasm Receptor Blocker!

Get off your ZRB!!!
 
ID was never my strong point. . . (I am more into cardio/geriatric/antipsychotics). Can you explain to me why Cipro is sooo much better than Levo maybe with the exception of respiratory pneumonia? Thanks a bunch.

Seriously, I learn all of my ID from you zyvox (with the exception of why zpacks suck. . . that i know). My school just go through ID without factoring the costs. I am even worse in ID.

I observed that most of the pharmacists I work with (Hospital and retail) dont know their ID except general coverages of antibiotics. I also noticed that a lot of pharmacists are not strong on the oncology side either.
 
Aznfarmerboi said:
ID was never my strong point. . . (I am more into cardio/geriatric/antipsychotics). Can you explain to me why Cipro is sooo much better than Levo maybe with the exception of respiratory pneumonia? Thanks a bunch.
Click to expand...

Well, I'm answering one of my questions no one answered. Cipro, considered one of the earlier generation of quinolones tends to have a slight better coverage against Pseudomonas. So, cipro has an indication for Nosocomial pneumonia while other quinlones don't. But cipro's coverage against streptococcus pneumoniae isn't quite so good where Levo and Moxi usually have 100% sensitivity. So Cipro is a No No for community acquired pneumonia while good for Nosocomial.

But in real practice, I would never recommend Cipro for HAP or VAP.

Now.. pneumonia is usually "respiratory." :meanie:
 
ItsOverZyvox said:
Well, I'm answering one of my questions no one answered. Cipro, considered one of the earlier generation of quinolones tends to have a slight better coverage against Pseudomonas. So, cipro has an indication for Nosocomial pneumonia while other quinlones don't. But cipro's coverage against streptococcus pneumoniae isn't quite so good where Levo and Moxi usually have 100% sensitivity. So Cipro is a No No for community acquired pneumonia while good for Nosocomial.

But in real practice, I would never recommend Cipro for HAP or VAP.

Now.. pneumonia is usually "respiratory." :meanie:
Click to expand...


Moxi=no renal adjustment
 
KARM12 said:
Hence no renal adjustment -- doesn't concentrate in the urine like other FQs
Click to expand...

Oh yeah? Then how come Trovafloxacin with 6%-9% renal clearance was used for UTI while we can't use Moxi with 20% renal clearance?

Are you saying Moxi's renal concentration isn't high enough to treat simple UTI with E. Coli? What say you resident?
 
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