13.1. Apart from vancomycin, list three antibiotics that have activity against hospital acquired methicillin resistant staphylococcus aureus (MRSA).
13.2 List an example of each of the three main classes of systemic antifungal agents.
13.3. Briefly outline the dosing adjustment and the monitoring necessary in patients with septic shock for each of the following drug groups in patients with moderate to severe renal dysfunction (without dialysis)
a) Aminoglycosides
b) Fluoroquinolones
c) Beta Lactams
d) Carbapenems
e) Glycopeptides
13.1. Apart from vancomycin, list three antibiotics that have activity against hospital acquired methicillin resistant staphylococcus aureus (MRSA).
• Linezolid
• Talavancin
• Streptogramins (not currently available in Australia)
• tigecycline
13.2 List an example of each of the three main classes of systemic antifungal agents.
• Polyenes e.g. Amphotericin B
• Azoles e.g. Fluconazole
• Echinocandins e.g. caspofungin, andulafungin, micafungin
13.3. Briefly outline the dosing adjustment and the monitoring necessary in patients with septic shock for each of the following drug groups in patients with moderate to severe renal dysfunction (without dialysis)
a) Aminoglycosides
b) Fluoroquinolones
c) Beta Lactams
d) Carbapenems
e) Glycopeptides
Aminoglycosides |
High initial dose and monitor trough concentrations. Extend interval. May be necessary to decrease dose and monitor with MIC data |
Fluoroqinolones |
Reduce frequency but maintain dose. |
Beta Lactams |
Can reduce dose OR frequency |
Carbapenems |
As for Beta Lactams |
Glycopeptides |
High dosing on day one dose |
A good article on the antibiotic management options for MRSA lists the following substances:
So, really, we are spoilt for choice. MRSA in general is discussed in greater detail in the Required Reading section
As for the antifungal drugs, in brief summary:
Antifungal pharmacology is explored in luxurious detail by Russell E. Lewis in his 2011 article for the Mayo Clinic Proceedings. Some of this detail has been condensed into a summary of antifungal pharmacology, available in the Required Reading section,
Question 13.3 very closely resembles Question 15.2 from the second paper of 2013, and will receive no further attention here.
Holt, S., and K. Moore. "Pathogenesis and treatment of renal dysfunction in rhabdomyolysis." Intensive care medicine 27.5 (2001): 803-811.
Welte, Tobias, and Mathias W. Pletz. "Antimicrobial treatment of nosocomial meticillin-resistantStaphylococcus aureus (MRSA) pneumonia: current and future options." International journal of antimicrobial agents 36.5 (2010): 391-400.
Lewis, Russell E. "Current concepts in antifungal pharmacology." Mayo Clinic Proceedings. Vol. 86. No. 8. Elsevier, 2011.