-
Penicillin V
- Beta-lactam - inhibits transpeptidation
- Broad-spec agains G pos; Nisseria and some anarobes
- Hypersensitivity rxns
-
Methicillin
- Penicillinase-resistant penicillin
- Good for beta-lactamase producing G pos coccal infx
- Resistance from failure to bind PBPs
-
Ampicillin
- Extended range penicillin
- First penicillin effective against G neg strains
- Active against E. coli, P. mirabilis, H. infleunzae, Salmonella, Shigella, and Neisseria
- "I am extended"
-
Ticarcillin
- Anti-Pseudomonal Penicillins
- Carboxylated derivative of ampicillin
- Works on P. aeruginosa, Proteus, and Enterobacter
- "Pseudo-cars have tail pipes"
-
Cefazolin
- First generation cephalosporin
- Narrow spec
- Surgical prophylaxis
- Active against Staph and Strep
-
Cefotetan
- Second generation cephalosporin
- Anarobes; use as prophylaxis during intra-abdominal surgery
- Crosses BBB
-
Ceftazidine
- Third generation cephalosporin
- Good penetration of CNS, bone, lungs, urinary tract
- Indicated primarily for multidrug-resistant G neg infx, particularly those by P. aeruginosa
-
Cefipime
- Fourth generation cephalosporin
- Works better on G pos than 3rd gen
- Beta-lactamase resistant
-
Imipenem
- Carbapenem
- Extremely broad spec
- rapidly hydrolyzed in renal tubule dipeptidase, give with cilastin
- IV only
- Not resistant to Beta-lactamase
- Seizures and renal toxicity
-
Aztreonam
- Monobactam
- Works best on G neg
- Little cross-allergenicity with other beta-lactams
-
Vancomycin
- Glycopeptide
- Binds to D-ala-D-ala to prevent transglycosylation and transpeptidation
- No effect on G neg
- Static for cocci; cidal for rods
- IV only
- Use for pseudomembranous colitis or enterocolitis
- no cross-allergenicity
- Red man syndrome - hypersensitivity rxn
- Resistance by changing D-ala
-
Daptomycin
- Lipopeptide
- Inhibits cell membrane potential - forms membrane channels in a calcium-dependent manner leading to rapid depolarization
- Use for complicated skin infx and endocarditis by aerobic G pos
- Good for antibiotic-resistant G pos
- synergizes with oxacillin against MRSA
- IV only
-
Cilastin
- Renal tubule dipeptidase inhibitor
- Give with imipenem
-
Clavulanate
- Suicide inhibitor of beta-lactamase
- give wtih amoxicillin = Augmentin; with ticarcillin = Timentin
-
Linezolid
- Oxazoladinone
- Binds to 50S and prevents formation of the intiation complex
- Bacteriostatic against G pos
- Inhibits MAO; thrombocytopenia, anemia, myelosuppression
-
Tetracycline
- Binds 30S ribosomal subunit and prevents binding of the aminoacyl-tRNA during protein synthesis
- Broad spec against G pos, neg, anaerobic and aerobic; especially good against all rickettsiae
- Adverse effects: pseudomembranous colitis, tooth discoloration, bone deformation, renal and hepatic toxicity, photosensitivity - not for kiddos
-
Tigecycline
- Binds to 30S on the ribosome and inhibits binding of the aminoacyl-tRNA
- Good for tetracycline-resistant organisms
- bacteriostatic against G pos and neg
- IV only
- TetX = resistance
- Not for children, infants, pregnant or nursing women
- Drug interactions with warfarin and OCPs
-
Streptomycin
- Binds the 30S subunit irreversibly inhibiting protien synthesis
- 3 mechanisms of action:
- 1) interference with formation of the initiation complex
- 2) misreading -> bacteriocidal
- 3) premature termination through dissociation
- Bacteriocidal against G neg
- Inactive against anaerobes
- IM or IV -> post antibiotic effect
- Synergy with beta-lactams
- ototoxicity, nephrotoxicity, NM blockade
-
Chloramphenicol
- Not used in US
- Binds reversibly to 50 S subunit
- Broad spec
- Adverse effects: normocytic anemia (erythroid suppression of bone marrow), idiosyncratic blood dyscrasias, gray baby syndrome
- interacts with CYP3A4
-
Erythromycin
- Macrolide
- Binds 50S subunit and inhibits the translocation step
- Wide distribution throughout the body except CSF
- Interacts with a wide variety of liver p450s
-
Clindamycin
- Lincosamide
- Binds to P and A sites in the 50S subunit
- Bacteriostatic primarily against G pos cocci
- effective against anaerobes
- Does not reach CNS (but will get to bone)
- Can lead to pseudomembranous colitis
-
Streptogramins
- Type A - induces a conformational change in the 50S subunit
- Type B - binds 50S subunit and inhibits translocation
- Effective against G pos
- Use often reserved for VRE or multiple-drug resistant G pos organisms
- IV only
-
Telithromycin
- 50S subunit binding, similar to macrolides
- G pos and neg bacilli and cocci; mycobacteria
- Use reserved for community-acquired pneumonia from S. pneumoniae
- CRITICAL ADVERSE EFFECT: Liver toxicity and failure
- Potent inhibitor of CYP3A4
-
Nitrofurantoin
- Multiple mechanisms of action: DNA damage, binding and inhibition of ribosomal proteins, inhibition of other bacterial enzymes
- USE ONLY FOR UTI
- distribution only to the bladder where drug is concentrated in the urine
- hemolytic anemia with G6PD
-
Sulfisoxazole
- Sulfonamides
- Structural analog and competitive inhibitor of PABA at dihydropteroate synthase -> inhibits folic acid synthesis
- Bacteriostatic
- Resistance = decreased permeability, active efflux, increased production of PABA, decreased sensitivity of synthase
-
Trimethoprim
- Benzylpyrimidine
- Selective inhbitor of bacterial isoform of dihydrofolate reductase
- Broad spec
- Broad distribution, crosses BBB
- AE: Megaloblastic anemia, leukopenia, granulocytopenia
-
Ciprofloxacin
- Fluoroquinolones
- Inhibition of bacterial DNA gyrase (topoisomerase II)
- Mostly G neg, some G pos
- Imparied by dairy products, antacids, and supplements containing divalent and trivalent cations
- Not recommended for use in pregnancy, nursing mothers, or children due to potential cartilage damage
- Increases levels of theophylline
-
Levofloxacin
- Fluoroquinolone
- Inhibits DNA gyrase
- Don't take with milk or supplements
- Good for prostatitis
- Don't use in pregnancy, nursing, or children
- Interacts with theophylline
-
Metronidazole
- Nitroimidazole
- Inhibits DNA replication -> DNA strand breaks
- Used primarily for anaerobes, can be used for C. diff
- AE: seizures and peripheral neuropathy after prolonged therapy, leukopenia
- Interacts with barbituates which induce liver enzymes
- Interferes with alcohol metabolism (disulfuram-like rxn)
-
Rifampin
- Rifamycins
- Inhibits bacterial RNA synthesis -> non-covalently binds to beta subunit of DNA-dependent RNA polymerase
|
|
