ID

Pennicillins, Cephalosporins, Carbapenems, Monobactams

Penicillins, Cephalosporins, Carbapenems, Monobactams, Vancomycin, Telavancin, Fosfomycin

Tetracyclines, Macrolides, Lincosamides, Streptogramins, Aminoglycosides, Linezolids

Polymyxin, Daptomycin

Rifampin, Rifaximin, Fluoroquinolones, Metronidazole

Sulfonamides, Trimethoprim

Isoniazid, Ethambutol

• Natural penicillins
• Aminopenicillins
• Antipseudomonal penicillins
• Antistaphylococcal pennicillins

Augment

Unasyn

Zosyn

• penicillin G (IV, IM)
• penicillin V (oral, IM)

• Gram +
• interstitial nephritis
• anaphylaxis
• beta-lactamase inactivation
• Take penicillin V (oral) on empty stomach
• renal elim
• high dose seizure

irreversible suicide-inhibition of transpepitidase enzyme

• ampicillin (IV, PO)
• amoxicillin (PO)

• Gram +, little more Gram -
• beta lactamase inactivation
• renal elamination
• high dose seizure

piperacillin (IV)

• Gram +, even more Gram -
• beta lactamase inhibition
• renal elimination
• high dose seizure

• nafcillin (IV)
• dicloxacillin (PO)

• staphlococcus
• poor activity against non-staph
• not staphlococcal beta-lactamase vulnerable
• hepatic elimination
• Take dicloxacillin on empty stomach

• cephalexin (PO)
• cefazolin (IV)

Gram + >> Gram -

• renal excretion
• seizure
• anaphylaxis

• cefuroxime (IV, PO)
• cefoxitin (IV)

Gram - ~ Gram +

• renal excretion
• seizure
• anaphylaxis

• ceftriaxone (IV) (BILIARY)
• ceftazidime (IV)
• cefdinir (PO)
• cefixime (PO)

Gram - >> Gram +

• renal excretion
• seizure
• anaphylaxis

cefepime (IV)

broad spectrum

• renal excretion
• seizure
• anaphylaxis

ceftaroline (IV)

• broad spectrum
• not susceptible to MRSA b-lactamases

• renal excretion
• seizure
• anaphylaxis

• ertapenem INVANZ
• meropenem MERREM
• imipenem/cilastatin PRIMAXIN

• broad spectrum
• not vulnerable to beta-lactamases
• inhibit lactamases, but also induce them
• poor chemical stability
• inactivated by renal dehydropeptidase 1

inactivates imipenem

renal dehydropeptidase inhibitor

aztreonam (IV, inh for CF)

• Gram - only
• not vulnerable to beta-lactamase
• renal elimination

• vancomycin (IV, PO - GI infect)
• telavancin (IV)

binds to terminus of growing peptidoglycan peptides

• Gram +
• not beta-lactamase inactivated (no b-lactam ring)
• renal elimination
• Maintain adequate hydration

• complete full therapy course
• may decrease OC efficacy - use back up
• GI upset
• seizure - cephs
• anaphylaxis - cephs
• fatal colitis - cell wall inhibitors

• dicloxacillin - anti-staph penicillin
• azithromycin, erythromycin - macrolides
• clindamycin - lincosamides
• quinupristin/dalfopristin - streptogamins
• linezolids
• rifampin, rifaximin - rifamycins
• ciprofloxacin, moxifloxacin, levofloxacin - fluoroquinolones
• metronidazole
• isoniazid
• doxycycline

fosfomycin (PO)

inhibits enolpyruvate transferase which blocks the formation of cell wall acetylmuramic acid (NAM)

• broad spectrum
• not beta-lactam susceptable (no b-lactam)
• renal elimination
• maintain adequate hydration
• powder that must be dissolved in cold water and taken immediately

cross links polypeptide chains in peptidoglycan cell walls for structure to keep the cell from lysing

methacillin resistant staph aureus has a MecA gene that encodes a form of transpeptidase that is poorly inhibited by beta-lactams

is a resistance form where the bacteria has produced an enzyme to break down drugs with a beta-lactam ring. the beta-lactamase can use water to regenerate itself and release the drug with an inactivated open beta lactam ring

• clavulanate
• tazobactam
• sulbactam

bacteria and drugs can be VULNERABLE or RESISTANT to each other.

• penicillins
• cephalosporins
• carbapenems

block dihydropteroate synthetase (sulfonamide) or dihydropteroate reductase (trimethoprim) which blocks the production of tetrahydrofolic acid, purines, and ultimately the production of DNA, and RNA

• rifampin
• rifaximin

binds and inhibits RNA polymerase

Inhibits DNA gyrase and blocks mRNA production

breaks apart DNA

Cell membrane disrupter

detergent disruption of OUTER then INNER membrane, causes cell lysis

calcium dependent detergent disruption of INNER membrane causing cell lysis

• Staphlococcus aureus
• Staphlococcus epidermidis

Anaerobes: Peptococcus, Peptostreptococcus

Streptococcus pneumoniae

• Streptocuccus pyogenes
• Group B Strept
• Viridans Streptococcus
• Enterococcus

• small: Listeria
• Large and anaerobic: Clostridium

• Neisseria meningititis
• Neisseria gonorrhoeae

• Escherichia coli
• Klebsiella
• Proteus
• Serratia
• Pseudomonas
• Acinetobacter
• Citrobacter
• Enterobacter

Anaerobe: Bacteroides

• Haemophilus influenzae
• Moraxella catarrhalis

• MSSA Methacillin sensitive Staph aureus
• MRSA Methicillin resistant Staph aureus

• Staph epidermidis (plastic)
• Staph saprophyticus

• E. Coli
• Klebsiella
• Proteus

• Serratia
• Pseudomonas
• Acinetobacter
• Citrobacter
• Enterobacter

• tetracyclines
• macrolides
• lincosamides
• streptogramins
• aminoglycosides
• linezolid

• tetracycline (PO, IV)
• doxycycline (PO, IV)

binds reversibly to 30S subunit of bacterial ribosome and blocks tRNA from docking -> inhibits protein synthesis

• broad spectrum
• avoid dairy, Fe, or Ca
• photosensitivity
• take with full glass of water

• erythromycin (PO, IV)
• azithromycin (PO, IV)

binds to 50S subunit of bacterial ribosome and blocks formation of elongation complex -> inhibits protein synthesis

• Gram +, Gram -
• Take with food if GI upset
• hepatic elimination
• QT prolongation
• inhibits CYP3A4

clindamycin (PO, IV)

binds to bacterial ribosome 50S and blocks protein elongation

• Gram +
• diarrhea
• take with full glass of water
• hepatic elination
• [severe fatal colitis]

• quinupristin (IV)
• dalfopristin (IV)
• quinupristin + dalfopristin SYNERCID

dalfopristin increases binding of quinupristin to the bacterial 50S ribosomal subunit and blocks elongation

• Gram +
• myalgia and flu-like symptoms
• hepatic elimination (t50 = 0.85hr)

• gentamicin
• tobramycin
• amikacin
• neomycin

• bind to ribosome and blocks proof reading -> incorporation of wrong AAs
• must be activily transported into cells
• Gram - (enteric)
• HA, dizzines, tinnitis
• Ototoxic (irrevers)
• Neprhotoxic (revers)
• Cell wall inhibitors increase penetration

linezolid (PO)

binds to unique site on bacterial ribosome 50S and inhibits the formation of initiation complex -> inhibits protein synthesis

• Gram +
• hepatic elimination
• lots of GI upset
• Gently mix oral solution before admin
• No MAOIs within 2 weeks
• Avoid tyramine foods
• Bone marrow suppression
• Serotonin Syndrome

• polymixin B
• polymixin E
• (top, Otic, Opth, IM, IV)

detergent disruption to OUTER then inner cell membrane -> causes lysis

• Gram -
• renal excretion
• Opth - redness, itching
• Otic - accumulation (use spariningly)
• Muscle pain, [nephrotoxicity], [IM/IT/IV hospital use only], [pregnant]

daptomycin (IV)

calcium-dependent detergent disruption to INNER cell membrane

• Gram + only
• renal elimination
• rhabdomyolysis (CPK monitoring)

• rifampin (PO, IV)
• rifaximin (unabsorbed PO form)

inhibits bacterial RNA polymerase -> blocks RNA synthesis

• Gram +, mycobacteria
• hepatic elimination
• take on empty stomach with full glass of water
• avoid alcohol
• Orange body fluids (stains contacts)

• ciprofloxacin (PO, IV)
• moxifloxacin (PO, IV)
• levofloxacin (PO, IV)

inhibits bacterial DNA gyrase/topoisomerase and prevents relaxation of supercoiled DNA -> blocks DNA replication and protein synthesis

• Gram +, Gram - (broad spectrum)
• hepatic, renal elimination
• photosensitivity
• hypo/hyperglycemia diabetics
• QT prolongation
• [Tendon inflammation/rupture]
• damages growing cartilage
• CNS effects
• no dairy, Fe, Ca

metronizadole (PO, IV)

fragments DNA and blocks DNA synthesis and protein synthesis

• Gram -
• hepatic elimination
• N, HA, taste disturbance
• alcohol within 3 days (disulfiram like reaction)
• GI upset - take with food, milk
• contact MD c numbness/tingling [peripheral neuropathy]

sulfamethoxazole (PO, IV)

• Broad spectrum, Gram +, Gram -
• renal elimination -> active metabolites UTIs

• Sulfa allergies
• photosensitivity
• maintain adequate hydration
• jaundice, haemolytic anemia

• GI upset
• OC backup
• complete whole therapy

isoniazid (PO)

inhibits mycobacterial fatt acid synthesis, blocks cell wall synthesis

mycobacteria

• hepatic elimination
• take on empty stomach 1-2 hours after meal
• avoid tyramine foods
• avoid alcohol, acetaminophne
• peripheral neuropathy = take VitB6

fatal hepatitis

ethambutol (PO)

inhibits mycobacterial fatt acid synthesis, blocks cell wall synthesis

mycobacteria

renal elimination

• take with food
• dizziness, disorientation, drowsiness
• optic neuritis = need eye exams

pyrazinamide (PO)

MOA unknown

TB active only

• hepatic elimination
• need regular medical followups
• nausea, loss of appetite
• hepatitis
• gout exacerbations