Macrolides, Tetracyclines, Aminoglycosides, and Fluoroquinolones

The macrolides, lincosamides, and tetracyclines are primarily ___________ (inhibit bacterial growth) drugs and may be __________ (kill bacteria), depending on the drug dose or _________ (microorganism capable of producing disease).

Glycopeptides, aminoglycosides, and fluoroquinolones are __________ drugs.

Drugs from these groups are used as penicillin substitutes, especially in individuals who are allergic to penicillin.

___________ is the drug frequently prescribed if the patient has a hypersensitivity to penicillin.

Macrolides, including azithromycin (Zithromax), clarithromycin (Biaxin), and erythromycin (E-Mycin), are called __________________.

the first macrolide

__________ bind to the 50S ribosomal subunits and inhibit protein synthesis.

Gastric acid destroys erythromycin in the stomach; therefore, acid-resistant salts are added to erythromycin (e.g., ethylsuccinate, stearate, estolate) to decrease dissolution (breakdown in small particles) in the stomach. True or False?
True False

___________ is the drug of choice for the treatment of mycoplasmal pneumonia and Legionnaire’s disease.

_________ is clarithromycin in a once-a-day extended-release tablet to be taken for 7 days.

_____________ is frequently prescribed for upper and lower respiratory infections, STIs, and uncomplicated skin infections.

Macrolides are excreted in bile, feces, and urine. Because only a small amount is excreted in urine, renal insufficiency is not a contraindication for macrolide use. True or False?
True False

Side effects and adverse reactions to macrolides

_____________ may develop as a side effect of azithromycin.

____________ can occur when erythromycin and azithromycin are taken in high doses with other hepatotoxic drugs, such as acetaminophen (high doses), phenothiazines, and sulfonamides.

Erythromycin should not be taken with clindamycin or lincomycin because
they compete for receptor sites. True or False?
True False

To avoid severe toxic effects, erythromycin should not be used with other macrolides. True or False?
True False

Macrolides can increase serum levels of these drugs

The first extended macrolide group developed after the introduction of erythromycin was _____________, which has been effective against many bacterial infections.

Elimination of extended macrolide group is via ___________.

Common side effects of clarithromycin and azithromycin

Monitor patient for liver damage resulting from prolonged use and high dosage of macrolides such as azithromycin. Signs of liver dysfunction include elevated liver enzyme levels and jaundice. True or False?
True False

In taking macrolides, teach patient to report any evidence of _____________ (a secondary infection resulting from
drug therapy), such as stomatitis or vaginitis.

In taking macrolides, tell patient to report onset of loose stools or diarrhea. ____________________ should be ruled out.

examples of lincosamides

Which among the two is more widely prescribed than the other because it is active against most gram-positive organisms, including Staphylococcus aureus and anaerobic organisms? It is not effective against gram-negative bacteria (e.g., Escherichia coli, Proteus, Pseudomonas). Clindamycin or lincomycin?

Side effects and adverse reactions to clindamycin and lincomycin

Severe adverse reactions to clindamycin and lincomycin

Clindamycin and lincomycin are incompatible with aminophylline, phenytoin (Dilantin), barbiturates, and ampicillin. True or False?
True False

_______________, a glycopeptide bactericidal antibiotic, is used against drug-resistant S. aureus and in cardiac surgical prophylaxis for individuals with penicillin allergies. S

Vancomycin has become ineffective for treating ____________.

______________________ is a combined antibacterial used to treat life-threatening vancomycin-resistant enterococci (VREF) infections.

_________________, a glycopeptide, treats selected gram-positive bacteria and skin infections. This drug is a semisynthetic derivative of vancomycin, with bactericidal action against MRSA.

Vancomycin may cause ______________ and ____________.

______________ results in damage to the auditory or vestibular branch of cranial nerve VIII. Such damage can result in permanent hearing loss (auditory branch) or temporary or permanent loss of balance (vestibular branch).

Side effects of vancomycin

Too rapid an IV injection of vancomycin can cause a condition known as
_____________________. Characterized by red blotching of the face, neck, and chest, this is a toxic effect rather than an allergic reaction.

_______________ can mask ototoxicity when taken with vancomycin.

The first drug in Ketolides is _______________, which is used for adults 18 years of age and older to treat mild to moderate community-acquired pneumonia.

Side effects and adverse reactions to telithromycin

Telithromycin may also lead to an exacerbation of ________________.

_______________, isolated from Streptomyces aureofaciens in 1948, were the first broad-spectrum antibiotics effective against gram-positive and gram-negative bacteria and many other organisms—mycobacteria, rickettsiae, spirochetes, and chlamydiae, to name a few.

Tetracyclines are not effective against S. aureus (except for the newer tetracyclines), Pseudomonas, or Proteus. They can be used against _____________.

Tetracycline in combination with metronidazole and bismuth subsalicylate
is useful in treating ______________, a bacterium in the stomach that can cause a peptic ulcer.

For years, oral and topical tetracycline has been used to treat severe _____________. Low doses are usually prescribed to minimize the toxic effect of the drug.

Tetracycline resistance has increased in the treatment of pneumococcal and gonococcal infections; therefore tetracyclines are not as useful in treating these infections. True or False?
True False

Because IM administration of tetracycline causes pain on injection and tissue irritation, this route of administration is seldom used. The _______ route is used to treat severe infections.

______________ (sunburn reaction) may occur in persons taking tetracyclines, especially demeclocycline (Declomycin).

(Tetracycline) _______________ can cause damage to the vestibular part of the inner ear, which may result in difficulty maintaining balance.

______________ results when tetracycline is given in high doses with other nephrotoxic drugs.

Because tetracycline can disrupt the microbial flora of the body, _________________ (secondary infection resulting from drug therapy) is another adverse reaction that might result.

prevent absorption of tetracycline from the GI tract

inhibit tetracycline absorption

Lipid-soluble tetracyclines (doxycycline and minocycline) are actually
better absorbed from the GI tract when taken with milk products and food. True or False?
True False

_____________ is an antibiotic in a category called glycylcycline, a synthetic analogue of the tetracyclines. This drug acts by blocking protein synthesis in bacterial cells, resulting in a bacteriostatic action.

Advise patient to check expiration date on bottle of tetracycline; out-of-date tetracycline can be toxic. True or False?
True False

Female patients who are contemplating pregnancy can still take tetracycline because it has no teratogenic effect. True or False?
True False

Oral contraceptives may be less effective when given concurrently with tigecycline. Warfarin levels may be increased and may lead to bleeding when taken with tigecycline. True or False?
True False

________________, derived from the bacterium Streptomyces griseus in 1944, was the first aminoglycoside available for clinical use and was used to treat tuberculosis. Because of its ototoxicity and the bacterial resistance that can develop, it is infrequently used today.

Despite its toxicity, streptomycin is the drug of choice to treat __________ and __________________.

_____________ are for serious infections. These cannot be absorbed from the GI tract and cannot cross into the cerebrospinal fluid.

IV aminoglycosides can be given with penicillins and cephalosporins but should not be mixed together in the same container.When combinations of antibiotics are given IV, the IV line is flushed after each antibiotic has been administered to ensure that the antibiotic was completely delivered. True or False?
True False

Serious adverse reactions to aminoglycosides

In taking aminoglycosides, check for __________________. Aminoglycosides can cause ototoxicity.

The mechanism of action of _____________ is to interfere with the enzyme DNA gyrase, which is needed to synthesize bacterial deoxyribonucleic acid (DNA). Their antibacterial spectrum includes bactericidal action on both gram-positive and gram-negative organisms.

the earliest derivatives of the fluoroquinolone group, prescribed primarily for urinary tract infection caused by common gram-negative organisms such as E. coli

This group of antibiotics is useful in the treatment of urinary tract, bone, and joint infections; bronchitis; pneumonia; gastroenteritis; and gonorrhea.

synthetic antibacterials related to nalidixic acid

(Fluoroquinolone) _______________ is used primarily to treat respiratory problems, such as community-acquired pneumonia, chronic bronchitis, acute sinusitis, urinary tract infections, and uncomplicated skin infections.

(Fluoroquinolone) _____________ is available for once-a-day oral and parenteral dosing. This drug is prescribed to treat the same infections other fluoroquinolones are effective against.

Moxifloxacin is more active than levofloxacin against S. pneumoniae. True or False?
True False

____________ is an FDA-approved antibiotic in the category of lipopeptides. It acts by binding to the bacterial membrane and causing rapid depolarization of its membrane potential, inhibiting protein, DNA, and RNA synthesis. This action results in bacterial cell death.

_________________ was discovered in 1947 and has a bacteriostatic action by inhibiting bacterial protein synthesis. Because of the toxic effects of chloramphenicol, including blood dyscrasias related to bone
marrow suppression, it is used only to treat serious infections.