Pharmacology Of Bacterial Infections: Cell Wall Synthesis

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PEP analogues that inhibit synthesis of NAM formation from NAG

Used for gram (-) infx: E. coli, Klebsiella, serratia, clostridia

Side effects: headache, diarrhea, nausea

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fosfomycin and fosmidomycin

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Inhibitors of alanine racemase and D-Ala D-Ala synthetase

Used for M. tuberculosis and M. avium infections

Side effects: siezures, somnolence, peripheral neuropathy, and psychosis

Contraindications: epilepsy, depression, anxiety, psychosis, severe renal insufficiency, alcohol abuse

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Cycloserine

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inhibitors of dephosphorylation of batoprenol (blocks the ferry)

Used for cutaneous and eye infections; C. difficil or vancomycin resistant enterococci

side effects: nephrotoxicity, neurotoxicity, bone marrow suppression, contact dermatitis, blurred vision, red eye

Contraindication: coadmin. with nephrotoxic agents or neuromuscular blocking agents

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Bacitracin

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inhibitors of murein polymer synthesis

used for MRSA (IV) and C. difficil (oral)

side effects= neutropenia, ototoxicity, nephrotoxicity, anaphylaxis, red-man syndrome, fever, hypersensitivity rash

contraindications: solutions containing dextrose

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vancomycin and teicoplanin

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inhibitors of polymer crosslinking

used for S. areus and S. pyogenes, oral anaerobes, N. meningitidis, clostridia, syphilis, Yaws, leptospirosis, rheumatic fever

Side effects: seizures, pseudomembranous enterocolitis, eosinophilia, hemolytic anemia, neuropathy, acute interstitial nephritis, anaphylaxis, rash, fever, Jarisch Herxheimer rxn (syph)

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Penicillin G and V

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Beta-lactamase penicillins

used for skin and soft tissue infections or systemic infx with beta lactamase producing MRSA

side effects: diarrhea, nausea, vomiting, pseudomembranous enterocolitis, hepatitis (o), interstitial nephritis, phlebitis (n)

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oxacillin, cloxacillin, dicloxacillin, nafcillin,methicillin

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broad spectrum penicillins with positively charged side chains

used for enterococcal infx and Listeria meningitis, uncomplicated ENT infx, endocarditis prophylaxis, H. pylori infx, beta lactamase producing organisms, anaerobes

side effects; rash, nausea, vomiting, diarrhea

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ampicillin, amoxicillin, amoxicillin/clavulanic acid, ampicillin/sulbactam

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beta lactamase sensitive penicillins with broad spectrum use

used primarily for P. aeruginosa infx, also for hospital acquired pneumonia (G-)

side effects: rash, nausea, vomiting, diarrhea

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carbenicillin, ticarcillin, piperacillin, mezlocillin

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First generation cephalosporins

used for P. mirabilis, E. coli, Klebsiella pneumoniae, skin/soft tissue infx, and surgical prophylaxis

side effects: pseudomembranous enterocolitis, leukopenia, thrombocytopenia, hepatotoxicity, nasea, vomiting, diarrhea, rash

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cefazolin and cephalexin

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Second generation cephalosporins

used for H. influenzae, enterobacter, neisseria, P. mirabilis, E. Coli, K. pneumoniae

side effects: disulfiram-like reaction with alcohol; block synthesis of Vit K coags

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cefuroxime, cefotetan, cefoxitin

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Third generation cephalosporins; Highest CNS penetration

Used for n. gonorrhoeae, borrelia burgdorferi, H. influenzae, enterobacteriaceae, P. aeruginosa

side effects: cholestatic hepatitis

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cefotaxime, ceftizoxime, ceftriaxone, cefperazone, ceftazidime

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fourth generation cephalosporin

used for enterobacteriaceae, neisseria, H. influenzae, P. aeruginosa, and (G+)

side effects: production of erythrocyte auto antibodies w/o hemolysis

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cefepime

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monobactam with no G+ coverage

used for G- bacteria and in penicillin allergic patients

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aztreonam

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inhibitor of polymer crosslinking

used for G+ and G- except MRSA, VRE, and Legionella

side effects: seizures if used in high levels (i and m)

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ertapenam, imipanem, meropenem

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Decreases arabinogalactan synthesis

used for mycobacterium species

side effects: optic neuritis, blindness, peripheral neuropathy, neutropenia, thrombocytopenia, hyperuricemia, mania, nausea, vomiting

contraindications: optic neuritis, patients unable to report visual changes, coadministration with antacids

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ethambutol

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prodrug that must be converted to its active form; targets (FAS1)

used for mycobacterium

side effects: anemia, hepatotoxicity, arthralgias, hyperuricemia (asymptomatic)

contraindications: acute gout and severe hepatic dysfunction

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Pyrazinamide

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inhibitor of mycolic acid synthesis (FAS2)

can inhibit Cytochrom P450

used for mycobacterium

side effects: hepatitis, neuro toxicity, systemic lupus erythematosus, seizure, hematologic abnormalities

contraindications: active liver disease

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isoniazid and ethionamide