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45 Cards in this Set

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levofloxacin, moxifloxacin
Fluoroquinolones
Inhibit DNA synthesis by inhibiting DNA gyrase → “CIDAL”
Enhanced gram-positive activity, anaerobes [moxifloxacin]
Clinical uses: pneumonia, UTIs, travelers diarrhea [cipro], osteomyelitis [great bone penetration], “mixed” infections [moxifloxacin]
Nitromidazoles
Metronidazole [Flagyl] PO, IV
How it works: Bactericidal; Taken up by anaerobic bacteria, disrupts DNA structure → cell death
Spectrum of activity: Gram-positive and gram-negative anaerobes ONLY
Clinical uses: Drug of choice for C. difficile diarrhea; used for anaerobic infections, bacterial vaginosis, trichomoniasis, Crohn’s disease
Side effects: GI, metallic taste, drug-induced seizures, peripheral neuropathy [rare], disfulfiram reaction with alcohol
Cell-wall synthesis inhibitors
Beta-lactams [penicillins, cephalosporins, carbapenems, monobactams]
Glycopeptides [vancomycin]
Penicillin Facts
Excreted by tubular secretion and can be blocked by probenecid
Dosage adjustment for renal insufficiency [exceptions?]
Generally well-tolerated
GI [diarrhea], rash
Can give rise to allergic reactions - immediate, accelerated and late
Most important adverse effect – hypersensitivity
Fluoroquinolones
Side effects: GI, CNS [dizziness, seizures], Achilles tendon rupture
Severe cases of hyperglycemia with gatifloxacin [Tequin] – no longer manufactured
Drug interactions: CYP450 inhibitor [cipro to greatest extent], antacids, iron
Not to be used in children < 18 yo
Have been used in patients with cystic fibrosis without sequelae
Protein synthesis inhibitors
Tetracyclines, Aminoglycosides, Fluoroquinolones
Macrolides, Chloramphenicol, Clindamycin
Folate Antagonists (Trimethoprim-Sulfonamides
Sulfonamides block incorporation of PABA
Trimethoprim blocks dihydrofolate reductase enzyme
Spectrum of activity: Gram-positive, gram-negative bacteria; no activity against Group A streptococcus
Agents: Sulfadiazine, sulfasalazine, sulfamethoxazole- trimethoprim [Bactrim]
Commonly used for UTIs
Trimethoprim/Sulfamethoxazole
Folate antagonists
nflammatory bowel disease, UTIs, acute otitis media, Pneumocystis carinii pneumonia [AIDS], some MRSA infectionsI
Side effects: Rash, GI, thrombocytopenia
Not to be used in patients with G-6-P-D deficiency
Sulfadiazine, sulfasalazine, sulfamethoxazole- trimethoprim
First line agent in treatment of tuberculosis
Rifamycins:Rifabutin & Rifampin
Extremely active against gram-positive cocci
Moderate gram-negative activity (NOT Pseudomonas aeruginosa)
Cephalosporin Facts
General rules of spectrum of activity:
As you move from 1st through 4th generation
“Lose” gram-positive activity and “gain” gram-negative activity
Cross BBB better
No cephalosporin covers enterococcus – intrinsic resistance
Metronidazole
Nitromidazoles
Dose adjusted for severe liver impairment

Major side effects: Metallic taste, disulfiram reaction, drug-induced pancreatitis, drug-induced seizures

DOC for C. difficile colitis
Excellent bone penetration
Clindamycin, they bind 50S
Fluoroquinolones
Metronidazole
Excellent activity against gram-negative anaerobes (B. fragilis) and gram-positive anaerobes (Clostridium sp.)
Sulfadiazine, sulfasalazine, sulfamethoxazole- trimethoprim
Folate Antagonists (Trimethoprim-Sulfonamides
Sulfonamides block incorporation of PABA
Trimethoprim blocks dihydrofolate reductase enzyme
Spectrum of activity: Gram-positive, gram-negative bacteria; no activity against Group A streptococcus
Commonly used for GI surgical prophylaxis and abdominal infections
Second Generation: Group 2 (Cephamycins)
Very useful in “mixed “ infections
-Lactam/-Lactamase Inhibitor Combinations
Most common side effect: GI (diarrhea)
DOC for enterococcus
Ampicillin
Methicilin IV
Oxacillin
Nafcillin
Cloxacillin
Dicloxacillin PO
DOC for MSSA infection

Dose adjusted for severe hepatic impairment

Cross BBB adequately
Widely used for uncomplicated cellulitis, surgical prophylaxis
First generation Cefazolin
Cephalexin
Cefadroxil
DOC for MSSA infection
Penicillinase -Resistant penicillins
Methicilin IV
Oxacillin
Nafcillin
Cloxacillin
Dicloxacillin PO
High Na content
Ticarcillin,Carboxypenicillins
Poor CSF penetration
Cefazolin
Cephalexin
Cefadroxil
First generation
• Bacteriostatic
– Inhibit growth and reproduction of bacteria without killing them
– Examples: tetracyclines, sulfonamides
Oral absorption decreased by di- and trivalent cations (milk, antacids, sucralfate
Doxycycline
Minocycline
Tetracycline
Useful in “mixed” infections
Imipenem/cilastatin
Meropenem
Ertapenem
Doxycycline
Minocycline
Tetracycline
Acne,
respiratory tract infections,
Lyme disease, STD,
select
Good substitute for aminoglycosides in patients at risk for toxicity
Aztreonam
• Bactericidal
– “Destroy bacteria”
– Cause bacterial cell death
– Examples: beta-lactams, vancomycin, aminoglycosides
Doxycycline
Minocycline
Tetracycline
Major toxicity: GI, phototoxicity

Minocycline: associated with vertigo

Doxycycline: hepatic
: Dose adjusted for liver dysfunction
Ceftriaxone, cefoperazone:
Most broad spectrum agents available
Carbapenems
• Broadest spectrum β-lactam class
Imipenem/cilastatin
Meropenem
Polymicrobial coverage all in one agent
Useful in “mixed” infections
Ampicillin/sulbactam
Amoxicillin/clavulanic acid
Ticarcillin/clavulanic acid
Piperacillin/tazobactam
-Lactam/-Lactamase Inhibitor Combinations
Carboxypenicillins
Carbenicillin
Ticarcillin
-Lactam/-Lactamase Inhibitor Combinations
Imipenem/cilastatin
Meropenem
Useful in “mixed” infections
Piperacillin
Azlocillin
Mezlocillin IV
Ureidopenicillins
Very active against MSSA, strep
Group 1
Cefaclor
Cefuroxime
– Drug of choice for MRSA
Vancomycin
Less activity against MSSA,
2 group Cephamycins)
Cefoxitin
Cefotetan
Cefmetazole
Gram-positive activity ONLY
Vancomycin
Clindamycin
Penicillinase -Resistant penicillins
Very good against atypical pathogens
Doxycycline
Minocycline
Tetracycline
2.Erythromycin
Clarithromycin
Azithromycin
Dirithromycin
3Fluoroquinolones
Telithromycin
Macrolides/ they bind 50S Ketolides
Limit use to resistant S. pneumoniae
Erythromycin
Clarithromycin
Azithromycin
Dirithromycin
toxicity
Major toxicity: GI upset (major)(erythromycin), drug interactions

Azithromycin, erythromycin: hepatic elimination

Clarithromycin
Metallic taste

Visual disturbances, liver failure
Clindamycin
Good alternative for cellulitis in PCN-allergy
Excellent bone penetration
Major toxicity: GI, pseudomembraneous colitis
Dose adjusted for hepatic dysfunction
Used in higher doses for gram-positive toxic shock syndromes