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174 PART 4 Antifungal Drugs What They’re Good For Amphotericin B formulations remain the drugs of choice for cryptococcal meningitis and serious forms of some other fungal infections, such as those caused by dimorphic fungi and some molds. Because of their broad spectrum, they are also a reasonable choice if fungal infection is suspected but the infecting organism is not known, as in febrile neutropenia. Their use in candidiasis and aspergillosis has de clined with the availability of newer, safer agents. Don’t Forget! Double-check that dose of amphotericin B; which formulation are you using?
Antifungal Antimetabolites 28 Agent: flucytosine (5-FC) Flucytosine has a mechanism of action that is distinct from that of other antifungals in that it is an antimetabolite that interferes with DNA synthesis. Flucytosine was originally investigated as an oncology drug, but it was found to be significantly more active against fungi than against human cancer cells. The primary role of flucytosine is in combination therapy with amphotericin B formulations for cryptococcal disease. Because of its toxicity and relative lack of efficacy, it is rarely used for other infections. Mechanism of Action Flucytosine is deaminated inside fungal cells to 5-fluorouracil, which is further converted into metabolites that interfere with both protein and DNA synthesis. Spectrum Good: in combination with amphotericin B: Cryptococcus neoformans, most species of Candida Moderate: monotherapy: Cryptococcus neoformans, most species of Candida Poor: molds, Candida krusei
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Antibiotics Simplified third EDITIO
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Contents Acknowledgments Introducti
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Contents v Chapter 28: Antifungal A
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Acknowledgments Our thanks go to th
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x Introduction ■■ How to Use Th
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New to the Third Edition The Third
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The Wonderful World of Microbiology
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chapter 1 Microbiology 5 More like
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chapter 1 Microbiology 7 Influenza
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chapter 1 Microbiology 9 Bacilli An
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chapter 1 Microbiology 11 Gram-nega
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chapter 1 Microbiology 13 Cocci Aer
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General Approach to Infectious Dise
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chapter 2 Infectious Diseases 17 Th
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chapter 2 Infectious Diseases 19 Su
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chapter 2 Infectious Diseases 21 al
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Antibiotic Pharmacokinetics 3 The t
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chapter 3 Pharmacokinetics 25 Table
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chapter 3 Pharmacokinetics 27 can b
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chapter 3 Pharmacokinetics 29 becau
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chapter 3 Pharmacokinetics 31 Table
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34 PART 1 Antibiotic Therapy No vis
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36 PART 1 Antibiotic Therapy Table
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38 PART 1 Antibiotic Therapy done i
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Adverse Consequences of Antibiotic
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chapter 5 Adverse Consequences 43 f
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chapter 5 Adverse Consequences 45 U
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Antibacterial Drugs Part 2
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50 PART 2 Antibacterial Drugs to be
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52 PART 2 Antibacterial Drugs is ne
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54 PART 2 Antibacterial Drugs Spect
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Antistaphylococcal Penicillins Agen
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Aminopenicillins Agents: amoxicilli
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chapter 6 Beta-Lactams 61 Don’t F
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64 PART 2 Antibacterial Drugs Adver
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66 PART 2 Antibacterial Drugs enhan
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68 PART 2 Antibacterial Drugs good
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70 PART 2 Antibacterial Drugs Cefaz
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72 PART 2 Antibacterial Drugs ■
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Third-Generation Cephalosporins Age
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chapter 6 Beta-Lactams 79 biliary e
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82 PART 2 Antibacterial Drugs but o
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84 PART 2 Antibacterial Drugs bind
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Carbapenems Agents: imipenem/cilast
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chapter 6 Beta-Lactams 89 and thus
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94 PART 2 Antibacterial Drugs Mecha
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96 PART 2 Antibacterial Drugs as be
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98 PART 2 Antibacterial Drugs Spect
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chapter 9 Aminoglycosides 103 equal
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Aminoglycosides 9 Agents: gentamici
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chapter 9 Aminoglycosides 103 equal
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Tetracyclines and Glycylcyclines 10
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chapter 10 Tetracyclines 107 admini
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Macrolides and Ketolides 11 Agents:
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chapter 11 Macrolides and Ketolides
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Oxazolidinones 12 Agent: linezolid
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chapter 12 Oxazolidinones 115 What
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118 PART 2 Antibacterial Drugs Spec
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Nitrofurans and Fosfomycin 14 Agent
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Page 143 and 144: Cyclic Lipopeptides 16 Agent: dapto
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Page 150 and 151: 136 PART 2 Antibacterial Drugs What
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Page 163 and 164: Antimycobacterial Drugs 21 ■■ I
Page 165: chapter 21 Antimycobacterial Drugs
Page 168 and 169: 154 PART 3 Antimycobacterial Drugs
Page 175 and 176: Pyrazinamide 24 Agent: pyrazinamide
Page 177 and 178: Ethambutol 25 Agent: ethambutol (EM
Page 179: Antifungal Drugs Part 4
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Page 185 and 186: Polyenes 27 Agents: amphotericin B,
Page 187: chapter 27 Polyenes 173 1.5 mg/kg/d
Page 191: chapter 28 Antifungal Antimetabolit
Page 195 and 196: Fluconazole The introduction of flu
Page 197: chapter 29 Azoles 183 • The high
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Page 203 and 204: Voriconazole The introduction of vo
Page 205 and 206: chapter 29 Azoles 191 ■■ Import
Page 207 and 208: Posaconazole Posaconazole is the ne
Page 209: chapter 29 Azoles 195 inhibitors lo
Page 212 and 213: 198 PART 4 Antifungal Drugs Spectru
Page 215: Antiviral Drugs Part 5
Page 218 and 219: 204 PART 5 Antiviral Drugs The unde
Page 221 and 222: Anti-Herpes Simplex Virus and Varic
Page 223: chapter 32 Anti-HSV and VZV Agents
Page 226 and 227: 212 PART 5 Antiviral Drugs Spectrum
Page 229 and 230: Neuraminidase Inhibitors 34 Agents:
Page 231: chapter 34 Neuraminidase Inhibitors
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Page 236 and 237: 222 PART 5 Antiviral Drugs Spectrum
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224 PART 5 Antiviral Drugs What The
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226 PART 5 Antiviral Drugs Adverse
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228 PART 5 Antiviral Drugs • NNRT
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230 PART 5 Antiviral Drugs The drug
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232 PART 5 Antiviral Drugs • The
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Integrase Inhibitors Agents: ralteg
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chapter 35 Antiretroviral Drugs 237
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240 PART 5 Antiviral Drugs from hea
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242 PART 5 Antiviral Drugs Spectrum
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244 PART 5 Antiviral Drugs option f
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246 PART 5 Antiviral Drugs Think of
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248 PART 5 Antiviral Drugs ribaviri
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250 PART 5 Antiviral Drugs administ
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Hepatitis B Nucleoside Analogs 39 A
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Antiparasitic Drugs Part 6
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258 PART 6 Antiparasitic Drugs Tabl
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Quinolines 41 Agents: chloroquine,
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chapter 41 Quinolines 263 majority
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Atovaquone 42 Agents: atovaquone, a
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chapter 42 Atovaquone 267 Don’t F
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270 PART 6 Antiparasitic Drugs Adve
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Pentamidine 44 Agent: pentamidine P
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chapter 44 Pentamidine 275 as appro
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278 PART 6 Antiparasitic Drugs Spec
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Appendix 1 Selected Normal Human Fl
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Appendix 2 Spectrum of Activity A N
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284 appendix 2 and thus less likely
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286 appendix 2 Table A-2 Clinically
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Appendix 3 Empiric Regimens for Com
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290 appendix 3 Infection Common Pat
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292 appendix 3 Infection Common Pat
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294 Index Amoxicillin/clavulanate,
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296 Index Broad-spectrum antibacter
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298 Index Combivir, 221 Community-a
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300 Index Eukaryotes, 5, 203 Extend
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302 Index HIV (continued) anti-herp
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304 Index Minimum bactericidal conc
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306 Index PEG. See Polyethylene gly
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308 Index Pseudomonas (continued) P
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310 Index Sustained virologic respo
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