Department of Emergency Medicine

UMEM Educational Pearls

Title: Broad spectrum antibiotics for multidrug resistant bacteria

Category: Toxicology

Keywords: antibiotics, imipenem, meropenem, doripenem, ertapenem, colistin, amikacin, multiresistant (PubMed Search)

Posted: 2/4/2010 by Ellen Lemkin, MD, PharmD
Click here to contact Ellen Lemkin, MD, PharmD

CARBAPENENEMS

  • Broadest spectrum of activity of all classes
  • Imipenem has slightly better gm + activity; lowers seizure threshold
  • Meropenem has slightly better gm - activity
  • Ertapenem does not cover Pseudomonas
  • Doripenem has the most activity against Pseudomonas
  • May use in PCN allergic patients (cross reactivity lower than previously thought)

TIGECYCLINE

  • Has broad coverage, but does not cover Pseudomonas
  • Bacteriostatic; derivative of tetracycline
  • Does NOT require renal dosing
  • Higher mortality in VAP than other agents; do not use for intra-abdominal infections (poss higher risk of perforation)

AMIKACIN

  • Has antipseudomonal activity
  • Used in combination with other agents for MDR (multi-drug resistant) bacteria
  • Causes nephrotoxicity and ototoxicity

COLISTIN

  • Bacteriocidal against many MDR gram - bacteria
  • Not active against Proteus, Provincia, Burkholderia, Neisseria, or Serratia
  • Nephrotoxicity and ototoxicity reported

References


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