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236 PART 5 Antiviral Drugs Adverse Effects Musculoskeletal: Raltegravir has been associated with increases in creatine phosphokinase. Most of these cases have been asymptomatic; clinically evident myositis or rhabdomyolysis is rare. ■■ Important Facts • Cobicistat isn’t an antiviral, but rather a “pharmacokinetic enhancer”: much like ritonavir, it is used to “boost” the concentrations of other drugs. In this case, it enhances the blood levels of elvitegravir. In fact, right now elvitegravir is ONLY available in combination with cobicistat (and tenofovir and emtricitabine). Thus, concerns for drug interactions for the combination elvitegravir product are similar to those for ritonavir-boosted protease inhibitors. In contrast, raltegravir has few documented drug interactions, a considerable advantage over many antiretrovirals. • Like the NNRTIs, the INSTIs have a low genetic barrier to resistance, such that they would be less “forgiving” of imperfect adherence than a PI-based regimen. What They’re Good For These drugs have been studied both as add-ons for patients with drug-resistant HIV and as initial therapy in treatment-naïve patients. Don’t Forget! Pretty much the only drug raltegravir has an interaction with is the anti-TB drug rifampin. Rifampin is a potent inducer of drug-metabolizing
chapter 35 Antiretroviral Drugs 237 enzymes, and its co-administration with many HIV drugs reduces their serum levels below the effective range. Thus, seeing rifampin on the profile of a patient receiving antiretrovirals is a huge red flag and warrants investigation to make sure the patient’s antiretroviral therapy is adequate.
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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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chapter 14 Nitrofurans and Fosfomyc
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Cyclic Lipopeptides 16 Agent: dapto
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chapter 16 Cyclic Lipopeptides 131
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136 PART 2 Antibacterial Drugs What
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140 PART 2 Antibacterial Drugs Don
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144 PART 2 Antibacterial Drugs Beca
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146 PART 2 Antibacterial Drugs asso
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Antimycobacterial Drugs 21 ■■ I
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chapter 21 Antimycobacterial Drugs
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154 PART 3 Antimycobacterial Drugs
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Pyrazinamide 24 Agent: pyrazinamide
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Ethambutol 25 Agent: ethambutol (EM
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Antifungal Drugs Part 4
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168 PART 4 Antifungal Drugs When th
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Polyenes 27 Agents: amphotericin B,
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chapter 27 Polyenes 173 1.5 mg/kg/d
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Antifungal Antimetabolites 28 Agent
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chapter 28 Antifungal Antimetabolit
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Fluconazole The introduction of flu
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chapter 29 Azoles 183 • The high
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Page 203 and 204: Voriconazole The introduction of vo
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Page 207 and 208: Posaconazole Posaconazole is the ne
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Page 215: Antiviral Drugs Part 5
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Page 221 and 222: Anti-Herpes Simplex Virus and Varic
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Page 229 and 230: Neuraminidase Inhibitors 34 Agents:
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Page 244 and 245: 230 PART 5 Antiviral Drugs The drug
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Page 249: Integrase Inhibitors Agents: ralteg
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Page 262 and 263: 248 PART 5 Antiviral Drugs ribaviri
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Page 267 and 268: Hepatitis B Nucleoside Analogs 39 A
Page 269: Antiparasitic Drugs Part 6
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Page 275 and 276: Quinolines 41 Agents: chloroquine,
Page 277 and 278: chapter 41 Quinolines 263 majority
Page 279 and 280: Atovaquone 42 Agents: atovaquone, a
Page 281: chapter 42 Atovaquone 267 Don’t F
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Page 287 and 288: Pentamidine 44 Agent: pentamidine P
Page 289: chapter 44 Pentamidine 275 as appro
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Page 294 and 295: Appendix 1 Selected Normal Human Fl
Page 296 and 297: Appendix 2 Spectrum of Activity A N
Page 298 and 299: 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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