Antimicrobials Ii

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Sulfonamide

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Inhibits Dihydropteroate synthase

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Sulfonamide

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Indicated for Gram (+) and Gram (-) organism, nocardia, chlamydia trachomatis, some protozoa, some enteric bacteria

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Sulfonamide

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Poor against anaerobes

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Sulfonamide

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Pseudomonas aeruginosa is intrinsically resistant

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Sulfonamide

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May stimulate growth if Rickettsia

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Sulfonamide

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Absorbed from the stomach and small intestine

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Sulfisoxazole and sulfamethoxazole

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Oral Absorbable Sulfonamide

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Sulfisoxazole and Sulfamethoxazole

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Used almost exclusively to treat urinary tract infections, respiratory tract infections

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Sulfadiazine in combination with pyrimethamine

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First line treatment of acute toxoplasmosis

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Sulfadoxine with pyrimethamine

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Used as second line treatment of malaria

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Sulfasalazine

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Oral Nonabsorbable Sulfonamide

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Sulfasalazine

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Widely used in ulcerative colitis, enteritis and other inflammatory bowel disease

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Sodium sulfacetamide

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Topical Sulfonamide

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Sodium sulfacetamide

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Opthalmic solution or ointment effective in treatment of bacterial conjunctivitis and as adjunctive therapy for trachoma

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Malfenide acetate

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Used topically but can be absorbed from burn sites

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Mafenide acetate

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Adverse effect: Metabolic acidosis

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Silver sulfadiazine

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Less toxic topical sulfonamide

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Silver Sulfadiazine

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Preferred to prevention of infection of burn wounds

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Sulfonamide

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Cross allergenic

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Sulfonamide

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May manufest as fever skin rash, exfoliative dermatitis, photosensitivity, urticaria

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Sulfonamide

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Steven-Johnson syndrome

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Sulfonamide

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Hematopoietic disturbances

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Sulfonamide

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Contraindicated in 1st trimester and 3rd trimester

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Sulfonamide

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Hepatitis, Polyarteritis nodosa and psychosis

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Sulfonamide

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May precipitate in urine producing crytalluria

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Trimetoprim

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Selectively inhibits bacteri dihydrofolic acid reductase

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Pyrimethamine

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Selectively inhibits protozial dihydrofolic acid reductase

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Oral Trimetophrim

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Used to treat acute urinary tract infections

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Oral Trimetophrim-Sulfamethoxazole

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Used for P. carinii pneumonia, Shigellosis, systemic salmonella infections, urinary tract infections, prostatitis

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Oral Trimetophrim-Sulfamethoxazole

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For S. aureus (MRSA and MSSA)

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Oral Trimetophrim-Sulfamethoxazole

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For respiratory tract pathogens

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IV TMP-SMZ

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Drug of choice for moderately severe to severe P. carinii pneumonia

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Fluoroquinolones

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Synthetic fluorinated analogs of Nalidixic acid

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Fluoroquinolines

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Has low synthetic level and useful only in the treatment of lower UTI

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Fluoroquinolones

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Block bacterial DNA synthesis by inhibiting bacterial topoisomerase II and topoisomerase IV

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Fluoroquinolones

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Active against atypical pneumonia and intracellular pathogen

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Levofloxacin, Gemifloxacin, Gatifloxacin, Moxifloxacin

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Respiratory Fluoroquinolone

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Fluoroquinolones

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Oral absorption is impaired by divalent and trivalent cations (antacids)

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Glomerular Filtration and Tubular Secretion

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Excretion of Fluoroquinolines

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Trovafloxacin, Moxifloxacin

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Nonrenal Fluoroquinolone

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Gemifloxacin

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Renal and Nonrenal Fluoroquinolone

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Gatifloxacin

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Highest oral bioavailability Fluoroquinolone

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Sparfloxacin

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Longest half life Fluoroquinolone

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Fluoroquinolone

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Effective in urinary tract infection caused by P. aeruginosa

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Fluoroquinolone

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Bacterial diarrhea

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Ciprofloxacin

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Drug of choice for prophylaxis and treatment of anthrax

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Ciprofloxacin and Levofloxacin

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Chlamydial urethritis or cervitis

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Ciprofloxacin, Levofloxacin, or Moxifloxacin

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Used for tuberculosis and atypical mycobacterial infection

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Ciprofloxacin, Levofloxacin, or Moxifloxacin

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Suitable for eradication of meningococci from carriers

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Ciprofloxacin, Levofloxacin, or Moxifloxacin

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For prophylaxis of infection for neutropenic cancer patients

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Fluoroquinolone

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Elevated levels of Theophylline

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Fluoroquinolone

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Nausea, vomiting, diarrhea, photosensitivity

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Fluoroquinolone

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Damage growing cartilage and cause arthropathy contraindicated in pregnancy

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Fluoroquinolone

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Excreted in breast milk

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Fluoroquinolone

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Can cause peripheral neuropathy and QT prolongation

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Metronidazole

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Potent antibacterial activity against anaerobes, including Bacteroides and Clostridium species

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Metronidazole

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Once taken up by anaerobes, it is nonezymatically reduced by reacting with reduced ferredoxin

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Metronidazole

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Has IV, oral, suppository, vaginal gel preparations

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Metronidazole

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Used for vaginitis, Clostridium difficile and brain abscess

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Metronidazole

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Peripheral neuropathy, seizures, tea-colored urine, disulfram-like effect, metallic taste

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Muciprocin

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Inhibits staphylococcal isoleucyl tRNA synthase

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Muciprocin

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For topical treatment of minor skin infections, such as impetigo

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Muciprocin

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Topical application over large infected areas, such as decubitus y

ulcers or open surgical wounds

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Polymixin B

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Acts as cationic detergent

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Polymixin B

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Disrupt bacterial cell membranes, bind and inactivate endotoxin

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Polymixin B

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Topical ointments are mixed with Bacitracin and/or Neomycin

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Fidamoxin

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Narrow-spectrum, macrocyclic antibiotic

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Fidaxomicin

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As effective as oral vancomycin

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Nitrofurantoin

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Rapid intracellular conversion to highly reactive intermediates by bacterial reductase

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Nitrofurantoin

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Antagonizes the action of Nalidixic acid

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Methamine mandelate and hippurate

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Excreted unchanged

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Methamine mandelate and hippurate

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Urinary aseptics used to suppress abd not to treat UTI

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Methamine mandelate and hippurate

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Not given together with sulfonamide because it forms and insoluble compound

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Quinolone

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Drug of Choice for Shigella

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Proton Pump inhibitor + amoxicillin + clarithromycin

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Drug of Choice for Helicobacter pylori

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Tetracycline

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Drug of choice for Vibrio cholera

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Penicillin

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Drug of choice for Streptococcus pneumoniae

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Penicillin, Clindamycin

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Drug of choice for Streptococcus pyogenes

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Penicillin + aminoglycosides

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Drug of choice for Streptococcus agalactiae

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Penicillin

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Drug of choice for B-lactamase negative Staphylococcus aureus

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Penicillinase-resistant penicillin

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Drug of choice for B-lactamase positive Staphylococcus aureus

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Vancomycin

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Drug of choice for Methicillin-resistant Staphylococcus aureus

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Penicillin + aminoglycosides

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Drug of choice for Enterococcus species

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Vancomycin

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Drug of choice for Bacillus species

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Ampicillin + aminoglycosides

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Drug of choice for Listeria species

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Sulfadiazine, TMP-SMZ

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Drug of choice for Nocardia species

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Penicillin, clindamycin

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Drug of choice for Gram-positive anaerobes

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Metronidazole

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Drug of choice for Clostridium difficile

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Tetracycline, azithromycin

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Drug of choice for Chlamydia trachomatis

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Tetracycline, erythromycin

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Drug of choice for Clostridium pneumoniae

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Tetracycline

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Drug of choice for Chlamydia psittaci

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Penicillin

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Drug of choice for Leptospira

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Penicillin

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Drug of choice for Treponema

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Vancomycin+ceftriaxone

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Drug of choice for Acute bacterial endocarditis

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Penicillin+gentamycin

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Drug of choice for subacute bacterial endocarditis

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Vancomycin + ceftriaxone

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Drug of choice for septic arthritis

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Amoxicillin

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Drug of choice for acute otitis media sinusitis

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Penicillinase resistant penicillin, 1st gen cephalosporin

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Cellulitis

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Ampicillin + 3rd gen cephalosporin

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Drug of choice for Meningitis in neonates

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Ceftriaxone or cefotaxime + vancomycin

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Drug of choice for meningitis in children

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Ceftriaxone, cefotaxime

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Drug of choice for meningitis in adult

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Metronidazole + 3rd gen cephalosporin , piperacillin/tazobactam

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Drug of choice for peritonitis due to ruptured viscus

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Macrolide, amoxicillin, tetracycline

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Drug of choice for adult community acquired pneumonia

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Vancomycin + 3rd gen cephalosporin or piperacillin/tazobactam or imipenem or metropenem

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Drug of choice for septicemia

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Ampicillin or penicillin

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Drug of choice for Group B streptococcal infection

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Rifampicin, ciprofloxacin or ceftriaxone

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Drug of choice for meningococcal infection

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Amoxicillin

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Drug of choice for otitis media

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Azithromycin

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Drug of choice for pertussis

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Benzathine penicillin

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Drug if choice for rheumatic fever

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Trimethoprim-sulfamethoxazole

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Drug of choice for UTI