Cephalosporins Overview
- Beta lactam drug
- Inhibits cell wall synthesis
- Bactericidal
- Hypersensitivity reactions
- Vitamin K Deficiency
- Disulfiram like reaction with Alcohol
- Increased Nephrotoxicity of Aminoglycosides
1st Generation Cephalosporin
- Cefazolin
- Cephalexin
- Proteus mirabilis
- E. coli
- Klebsiella
- Gram-Positive Cocci
2nd Generation Cephalosporin
- Cefoxitin
- Cefaclor
- Cefuroxime
- Proteus mirabilis
- E. coli
- Klebsiella
- Gram-Positive Cocci
- Haemophilus influenzae
- Enterobacter
- Neisseria
- Serratia marcescens
3rd Generation Cephalosporin
- Cefotaxime
- Ceftriaxone
- Cefdinir
- Ceftazidime
- Pseudomonas
- Serious Gram-Negative Bacteria Resistant to Other Beta-Lactams
4th Generation Cephalosporin
- Cefepime
- Increased Activity Against Gram-Positive Infections and Pseudomonas
5th Generation Cephalosporin
- Beta-Lactam
- Resistant Bacteria
- Broad Spectrum Gram-Positive and Gram-Negative
- Ceftobiprole
- Has Pseudomonas Coverage
- Ceftaroline
- No Pseudomonas Coverage
Protein Synthesis Inhibitors
- 30S inhibitors
- Aminoglycosides
- Tetracyclines
- 50S inhibitors
- Chloramphenicol
- Clindamycin
- Erythromycin
- Lincomycin
- Linezolid
Linezolid (Zyvox)
- Oxazolidinone Antibiotic
- Binds 23S rRNA of 50S Subunit
- Inhibits Protein Synthesis
- Gram-Positive Organisms
- MRSA
- VRE (Vancomycin Resistant Enterococci)
- Bone Marrow Suppression
- Decreased Platelet Count
- Peripheral Neuropathy
- Lactic Acidosis
- Serotonin Syndrome
- Avoid Tyramine Containing Foods
Clindamycin
- Bacteriostatic
- Binds 50S Ribosomal Subunit
- Blocks Translocation
- Anaerobic Infections above the Diaphragm
- Aspiration Pneumonia
- Lung Abscess
- Can Cause Pseudomembranous Colitis
Aminoglycosides
- Gentamicin
- Neomycin for Bowel Surgery Prep
- Amikacin
- Tobramycin
- Streptomycin
- Bactericidal
- Inhibit Formation of Initiation Complex
- Cause Misreading of mRNA
- Require O2 for Uptake
- Resistance by Transferase Enzymes
- Acetylation
- Phosphorylation
- Adenylation
- Gram-Negative Rod Infections
- Synergistic with B-Lactam Antibiotics
- Nephrotoxicity Especially When Used with Cephalosporins
- Ototoxicity Especially When Used with Loop Diuretics
- Teratogen
Macrolides
- Bacteriostatic
- Bind to 23S rRNA of 50S Subunit
- Inhibit Protein Synthesis by Blocking Translocation
- Erythromycin
- Azithromycin
- Clarithromycin
- Gram-Positive Cocci
- Atypical Pneumonia
- Chlamydia
- Resistance by Methylation of 23S rRNA Binding
Macrolides Side Effects
- Diarrhea
- Prolonged QT Interval
- P450 Inhibitor
- Cholestatic Hepatitis
- Skin Rash
- Eosinophilia
Neomycin Sulfate
- Aminoglycoside Antibiotic
- Topical Infection
- Intestinal Surgery Prophylaxis
- Ototoxicity
- Nephrotoxicity
- Rash
- Blood Dyscrasias
- GI Superinfection
Penicillin
- Gram Positive
- Spirochetes
- Bind PBPs
- Block Transpeptidase Cross-linking of Cell Wall
- Activate Autolytic Enzymes
- Bactericidal
- Hypersensitivity Reactions
- Hemolytic Anemia
- Beta-lactamase Sensitive
Ampicillin and Amoxicillin
- Aminopenicillin
- Broad Spectrum Penicillin
- Gram-Positive and Some Gram-Negative Infections
- Rash
- Diarrhea
- No Effect Against Staph Aureus
- Often combined with Beta Lactamase Inhibitor
- Allergic Reaction
Aminopenicillin Mechanisms
- Broader Spectrum
- Ampicillin
- Amoxicillin
- Beta-Lactamase Sensitive
- Combine with Clavulanic Acid
- Hypersensitivity Reactions
- Ampicillin Rash
- Pseudomembranous Colitis
Aminopenicillin Uses
- Ampicillin
- Amoxicillin
- Shigella
- Haemophilus Influenzae
- Salmonella
- Listeria
- Enterococci
- Proteus Mirabilis
- E. Coli
Beta-Lactamase Inhibitors
- Often Combined with Penicillin Antibiotics
- Clavulanic Acid
- Sulbactam
- Tazobactam
Aztreonam
- Monobactam
- Resistant to beta lactamases
- Binds to penicillin binding protein (PBP)
- Inhibit cell wall synthesis
- No Activity on Gram-Positives or Anaerobes
- Gram-Negative Rods
- Non allergenic to penicillin
- Synergistic with aminoglycosides
Tetracycline Drug Names and Indications
- Demeclocycline
- Minocycline
- Doxycycline
- Fecally Eliminated
- Can be Used in Renal Failure
- Antidiuretic Hormone Antagonist
- Chlamydia
- Rickettsia
- Borrelia burgdorferi
- Helicobacter Pylori
- Mycoplasma Pneumonia
Tetracycline Mechanism
- Binds to 30 S to Prevent Attachment of Aminoacyl tRNA
- Limited CNS Penetration
- Divalent Cations Inhibit Absorption
- Must Not Take with Milk, Antacids, Iron
Tetracycline Toxicities
- Inhibition of Bone Growth in Children
- Teratogen
- Discoloration of Teeth
- Photosensitivity
- GI Distress
Tigecycline (Tygacil)
- Glycylcycline Antibiotic
- Binds 30S Subunit
- Inhibits Protein Synthesis
- Severe Infections
- Broad Spectrum Coverage
- Anaerobic & Multidrug-Resistant Organisms
- Deep Tissue Penetration
- GI Distress
- Severe Nausea and Vomiting
- 2nd Line Agent
Vancomycin Mechanism
- Bacteriostatic and Bactericidal
- Gram-Positive
- Inhibits Cell Wall Mucopeptide
- Binds to D-ala D-ala
- Resistance with Change to D-ala D-lac
- Staphylococcus aureus
- Orally for Clostridium difficile
- Enterococci
Vancomycin Side Effects & Toxicity
- Thrombophlebitis
- Nephrotoxicity
- Ototoxicity
- Diffuse Flushing Called Red Man Syndrome
- Prevent with Antihistamine
- Prevent with Slow Infusion
Fluoroquinolones Antibiotics
- -floxacin
- Inhibits Topoisomerase II & IV
- Bactericidal
- Gram-negative Rods
- Pneumonia
- Gastrointestinal Infections
- Urinary Tract Infection
- Genital Infections
- Levofloxacin
- Ciprofloxacin
- Has Pseudomonas Coverage
- Avoid Polyvalent Cations
Fluoroquinolones Toxicities
- Diarrhea
- Skin Rash
- Headache
- Tendon Rupture in Adults
- Myalgias in Kids
- Damage to Cartilage
- Teratogen
- QT Prolongation
Daptomycin (Cubicin)
- Lipopeptide Antibiotic
- Disrupts Cell Membrane
- Causes Rapid Depolarization
- Gram-Positive Cocci
- MRSA
- Myopathy
- Rhabdomyolysis
- Peripheral Neuropathy
- Inactivated by Surfactant
- Not Used (Avoid) for Pneumonia
Sulfonamides Mechanisms
- Bacteriostatic
- Gram-Positive
- Gram-Negative
- Nocardia
- Chlamydia
- PABA antimetabolites
- Inhibit dihydropteroate synthase
- Sulfamethoxazole
- Sulfisoxazole
- Sulfadiazine
Sulfonamides Side Effects
- Hypersensitivity
- Nephrotoxicity
- Photosensitivity
- Kernicterus in Infants
- Displaces Warfarin from Albumin
- Hemolysis with G6PD Deficiency
Sulfa Drug Allergies
- Sulfasalazine
- Sulfonylureas
- Thiazide Diuretics
- Acetazolamide
- Furosemide Diuretic
- Celecoxib
- Probenecid
Trimethoprim
- Bacteriostatic
- Inhibits Bacterial Dihydrofolate Reductase
- Causes Sequential Block of Folate Synthesis
- Used in Combination with Sulfamethoxazole
- Combination Used For Recurrent Urinary Tract Infections
- Shigella
- Salmonella
- Pneumocystis Jiroveci Pneumonia
- Decrease in Red and White Blood Cells
- Alleviated with Leucovorin Rescue
Metronidazole
- Bactericidal
- Forms Free Radical Toxic Metabolites
- Damages DNA
- Giardia lamblia
- Entamoeba Histolytica
- Trichomonas
- Gardnerella
- Anaerobes
- Metallic taste
- Disulfiram like Reaction with Alcohol
Imipenem
- Resistant to Beta-Lactamases
- Broad Spectrum
- Anaerobes
- Gram-Negative Rods
- Gram-Positive Cocci
- Must Administer with Cilastatin
- Cilastatin is Inhibitor of Renal Dehydropeptidase I
- Diarrhea
- Skin Rash
- Seizures
- Meropenem
- Stable to Dehydropeptidase I
- Reduced Risk of Seizures (Non-Seizure Causing)
Chloramphenicol
- Bacteriostatic
- Inhibits 50S Peptidyltransferase Activity
- Meningitis
- Rocky Mountain Spotted Fever in Pregnant Women
- Anemia
- Aplastic Anemia
- Gray Baby Syndrome due to Decreased UDP-Glucuronyl Transferase
- Resistance Caused by Plasmid Encoded Acetyltransferase
Polymyxins
- Cationic
- Act Like Detergents
- Bind to Cell Membranes of Bacteria
- Disrupt Their Osmotic Properties
- Resistant Gram-Negative Infections
- Neurotoxicity
- Renal tubular necrosis
HIV Prophylaxis Medications
- CD4+ < 200
- TMP-SMX
- Pneumocystis Pneumonia
- CD4+ < 100 Susceptible to Toxoplasma Gondii
- CD4+ < 50
- Mycobacterium Avium and Intracellulare
- Azithromycin If Delayed Therapy
Hydroxychloroquine
- Immunosuppressant
- Malaria
- Rheumatoid Arthritis
- Systemic Lupus Erythematosus (SLE)
- Porphyria Cutanea Tarda
- Cardiotoxicity
- Retinopathy
- Ophthalmological Exams
Macrolides
- End in "-thromycin"
- Bacteriostatic
- Alternative for Penicillin Allergy
- Respiratory Infections
- Pneumonia
- QT Prolongation and Sudden Death
- C.Diff Overgrowth
- GI Distress
- Slow IV Infusion