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2004 Pocket Book of Infectious Disease Therapy by John G. Bartlett

By John G. Bartlett

Designed to supply easy accessibility to the factors with which to struggle infectious ailment through targeting choice, right doses, expenses, and unwanted side effects of antimicrobial brokers, the 2004 notebook of Infectious sickness treatment attracts generally from options made via the facilities for ailment regulate, the scientific Letter, the yankee health facility Formulary provider, and the AMA's Drug reviews. Tabular fabric has been up to date to incorporate all newly authorized antibiotics, in addition to new ideas for administration.

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Nephrotoxicity is usually reversible Vestibular and auditory damage: related to dose and duration, only risk is advanced age (AAC 1987;31:1383)—note dizziness, vertigo, roaring, tinnitis, high tone hearing loss; ototoxicity is irreversible Fever, rash, blurred vision, neuromuscular blockage especially with myasthenia or Parkinson's—may be reversible with calcium salts, paresthesias, hypotension, allergic reactions—usually caused by sulfites in some preparations Aminosalicylic acid (PAS) GI intolerance Liver damage; allergic reactions, thyroid enlargement, hepatotoxicity Acidosis, vasculitis, hypoglycemia (diabetes), hypokalemia, encephalopathy, decreased prothrombin activity, myalgias, renal damage, gastric hemorrhage Amoxicillin + clavulanic acid Similar to amoxicillin—see penicillins Amphotericin B (Fungizone) Fever (maximal at 1 hr) and chills (at 2 hr)—prevent/reduce with hydrocortisone, ibuprofen, ASA, acetaminophen, meperidine Renal tubular acidosis—dose dependent and usually reversible in absence of prior renal damage and dose <3 g, reduce with hydration and sodium Hypomagnesemia, nausea, vomiting, metallic taste, headache Hypotension, rash, pruritus, blurred vision, peripheral neuropathy, convulsions, hemorrhagic gastroenteritis, arrhythmias, diabetes insipidus, hearing loss, pulmonary edema, anaphylaxis, acute hepatic failure, eosinophilia, leukopenia, thrombocytopenia, delirium (especially with intrathecal use) supplementations Hypokalemia Anemia (treat severe anemia with erythropoietin) Phlebitis and pain at injection site (add 1,000 units heparin to infusions) GI intolerance, electrolyte abnormalities Amphotericin B lipid complex and liposomal (Amphotec Abelcet AmBisome) Chills and fever during infusion; infusion-related side effects and nephrotoxicity are significantly less compared with amphotericin B(Amphotec > Abelcet > AmBisome) (CID 2000;31:1155) Dose-related nephrotoxicity (substantially less than with amphotericin B; Abelcet > Amphotec > AmBisome) Ampicillin + sulbactam (Unasyn) Similar to those for ampicillin alone—see penicillins Atovaquone (Mepron) Rash—20%; rash requiring discontinuation—4%; GI intolerance—20%; diarrhea—20% Nausea, vomiting, mild diarrhea; headache in comparative trial for PCP—9% required discontinuation because of side effects vs 24% with sulfatrimetho-prim; 7% vs 21% with IV pentamidine Atovaquone + proguanil (Malarone) Abdominal pain—20%, nausea—12%, vomiting—20%, headache—10%, diarrhea—8% Dizziness—5%, increased transaminases Hypotension, anaphylaxis Fever, elevated aminotransferases (generally mild), abdominal pain Azithromycin (Zithromax) GI intolerance (4%), diarrhea, nausea, abdominal pain, vaginitis Reversible hearing loss (more common with 500 mg × 30–90 days); erythema multiforme; increased transaminase; C.

C Obese patients: use calculated lean body weight plus 40% of excess fat. d Patients who are oliguric or anuric: use CCr of 5–8 mL/min. 2. MAYO CLINIC GUIDELINES (Mayo Clin Proc 47:519, 1999) a. 5–15 mg/kg. 3 kg (height in inches–60 inches). 4 (actual weight in kg -IBW). b. Maintenance dose: Cockcroft-Gault equation. 3. MONITORING: Measure peak levels at 1 hr after start of 20- to 30-min infusion. Goal with q8h dosing is 5–10 Cg/mL for gentamicin and tobramycin or 20–40 Cg/mL for amikacin; peak levels when using low doses of gentamicin or tobramycin for synergy vs staph, strep or enterococcus is 3 Cg/mL.

A. Elderly patient: Serum creatinine may be deceptively low (with danger of overdosing) because of reduced muscle mass. b. Pregnancy, ascites, and other causes of volume expansion: GFR may be increased (with danger of underdosing) in third trimester of pregnancy and patients with normal renal function who receive massive parenteral fluids. c. Obese patients: Use lean body weight. d. Renal failure: Formulas assume stable renal function; for patients with anuria or oliguria assume creatine clearance (CCr) of 5–8 mL/min.

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