1. Nafcillin, Methicillin, Oxacillin
    Penicillinase resistant penicillins

    Active against penicillinase producing Staph. Drug of choice for Staphylococcal dz.

    Worthless for garm neg bac, and MRSA

    Stable in acid: absorbed in GI tract

    Severe infection requires injection
  2. Penicillin V, Potassium
    Natural Penicillin

    Good oral abosrption. Treats group AB hemolytic Strep gram pos and neg cocci.

    Anaerobes are susceptible

    Watch renal fxn in neonates/infants
  3. Penicillin G
    Natural Penicillins

    • Used for: Group AB hemolytic strep.
    • Gram neg and gram pos cocci

    Anaerobes are susceptible

    Unstable in gastric acid: poor oral absorption

    Special considerations: neonates/infants: renal fxn
  4. Ampicillin

    • Aminopenicillins
    • Broad spectrum
    • used for URI, L. monocytogenes in immunocompromised. Gram negh

    Resisitant: H. influenzae, N. Gonorrhoeae, enterobacteriaceae

    Interferes w/ oral contraceptives
  5. Piperacillin
    • Antipseudomonal PUN
    • Up activity against pseudomonal, enterobacter and proteus. Activfe against Klebsiella
    • Up gram neg coverage

    Resistance to PCNG impries resistance to these drugs

    Serious, pseudomonal require additional aminoglycoside.

    Reserved for severe, hospital acquired gam neg bacteria
  6. All Penicillins
    Adverse rxn: maculopapular rash

    Uticarial rash, stevens-johnson syndrome

    Serum sickness, bronchospasm angioedema

    Toxicity: rare. Watch for bone

    Marrow depression granupocytopenia, hepatitis, impaired pt fxn, lethargy, confusion, seizures superinfections
  7. Cephalexin
    1st gen cephalosporin

    Gram pos coverage w/ gram pos cocci, less gram neg coverage; oral anaerobes are covered

    Not active against enterococcus, MRSA, MRSA or VRE

    Cefadroxil- better PO absorption, BID
  8. Cefuroxime
    • 2nd gen cephalosporin
    • low gram pos coverage
    • hih gram neg coveragers (e. coli, klebsiella)

    • Resistant to Beta lactamases
    • useful for H. influenzae, N. meningitidis and pneumococcal meningitis

  9. Cefotoxin
    2nd gen cephalosporin/ bacteroides

    Better anaerobic coverage including B. fragilis

  10. Cefuroxime axefil

    2nd gen cephalosporins

    More active against H. Influenzae and M. Catarrhalis

    are given PO
  11. Ceftriaxone
    3rd gen cephalosporin

    Decreased gram pos, much better gam neg, esp Beta lactamase

    Penetrates CSF


    Not for: Listeria mono, MRsA, VRE, injected, once daily, good for penicillinase- gonococcus also empiric for meningitis in noncompromised due to H. influenza, S. pneum, N. meningitis, gram neg bacilli
  12. Ceftazidime
    Injectable 3rd gen cephalosporin

    more active against pseudomonas

    Penetrates CSF

    DOC w/ aminoglycoside for meningitidis by pseudomonas
  13. cefdinir
    oral 3rd gen cephalosporin

    More active against enterobacteriaceae and B-lactamase producing H. influ and N. gonorrhea
  14. Cefixime
    oral 3rd gen cephalosporin

    BID dose

    Enterobacteriaceae, B-lactamase, H. influenzae, and N. gon
  15. Cefepime
    4th gen injected cephalosporin

    Enterobacteriaceae resistant to other cephalos

    Good antipseudomonal

    Excellent CSF
  16. Ceftobiprole
    4th gen injected cephalosporin

    Designed for MRSA penicillin binding protein, active against MRSA
  17. Imipenem/ cilastin
    IV or IM


    Cilastin inhgibits renal tubular dipeptidase (degrades imipenem)

    Imipenem: ery broad gram pos cocci-not MRSA

    Enterobacteriaseae, pseudomonas, B. fragilis, acinetobacter

    For severe UTI, lower RTI, intraabol, gynecologic, skin, bone, joint, severe mixed nosocomial

    N/V, hypersensitive- cross w/ pen and up LFT
  18. Meropenem
    Similar to imipenem- not sensitive to renal tubular dipeptidase

    Less active against gram pos cocci

    Limited use
  19. Ertapenem
    Same as Meropenem

    Less gram pos cocci than imipenem

    Limited use
  20. Doripenem
    Same as meropenem and entapenem but w/ resistance by pseudomonas

    Limited use
  21. Aztreonam

    Monobactams- similar to aminoglycosides

    Mostly gram neg- aerobic

    gram pos/anerbobes resist

    Great for enterobacteriaceae, also pseudomonas, H. flu, N. gon

    OK in Penicillin allergy, phlebitis, eosinophilia
  22. Teicoplanin
    Like vanc

    T1/2 is 100hrs

    Van A enterococci resist

    Hypersensitivity, ototoxicity
  23. Vancomycin
    Ototoxicity, nephrotox-caution w/ aminoglycosides: anaphylaxis, red neck flush w/ rapid....


    Binds d-alanyl-d-dlanine terminus of peptidoglycan precursors

    Inhibits earlier strep than B-lactams

    Rapid bactericidal in growing cells

    Bacteriostatin for enterococci

    Resist: modified enzyme modifies peotidoglycan-plasmid

    For gram pos, MRSA, 2nd line C. Dif,

    Most enterobacci, bas S. pyogenesw, S. pneumo (?)
  24. Macrolides
    Binds 5OS ribo

    Gram pos= 100x etter acumulate

    inhibits peptide bond formation by inhibiding translocation from A to P site


    Resist: plasmid-down permeability, efflux pump, methylate enzymes 50S, esterase hydroxyzes drug

    For: gram pos cocci, not staph, enterococcus gram pos bacillus, mycoplasma=DOC

    Gram neg bacilli= H. influ, H. Ducreyi, C. jejuni, J. pylori

    DOC= legionella, B. pertussis
  25. Erythromycin

    Poorly absorbed, worse w/ food, destroyed by acid

    No Bb cross, and metab by liver

    DOC: M. pneumo, C. diptheriae, C. pneumo, B. pertussis, H. ducreyi

    Also- clamydiae, C. Trachomatis for strep, C. tetani, T. pallidum preggo w/ PCN allergy


    Prolong QT, transient auditory

    Inhibit P455, CYP 3A4= Up benzao, cyclosporine, carbametepine, steroids
  26. Clarithromycin

    rapid absorb, big first pass

    DOC Myco avium intracellular complex
  27. Azithromycin

    rapid absorb, stable in acid

    Take on empty stomach

    T1/2= 68rh

    Single lg dose for C. trachomatis

    Also best macrolide for H. influ URI
  28. Telithromycin

    Slight better spectrum, no food interfere, Major 3A4 metabolizer

    No in kids less than 12

    GI, NV, Diarrhea, Up LFT, prolong QT
  29. Clindamycin
    Oral lincosamide

    Binds 50S, bacteriostatin similar to macrolides

    Gram pos cocci Strep and non-MRSA Staph

    Better anerobe coverage than macrolides

    • C. Perfingen, peptostrepto, peptococcus, propionbac, Bacteroides
    • Also-protozoal

    For: anaerobic infect fecal spill, pelvic abscess topical acne, bact vaginosis perotinitis gram pos cocci

    GI, superinfection, rash common, STI's
  30. Chloramphenicol
    binds 50S prevents amino-acid containing end of aminoacyl tRNA binding to A site


    resist: chloramphenicol acetyltransferase, Down perm, mutate 50S

    • For: gastroenteritis- Salmonella and syph
    • Meningitidis- H. influ, N. men, S. pneumoRickettsial dz if TCN sensitive, Brucellosis 2nd to TCN

    Heme tox- anemia, leukopenia, thrombo, N/V common, inhibits P450 and Pheny, anaplastic anemia, gray baby syndrome, inhibit mitochondrial respiration
  31. Quinupristin (30) and Dalfopristin (70)
    • Synercid
    • Streptogamins

    • Quinupristin: conformational change=Up quin effect
    • Bacteriostatic= E. faecium, others killed
    • For: gram pos cocci, MRSA, VRE, E. faecium, MDR Pneumococci

    Atypicals- M. pneumo, C. pneumo, Legionella

    CYP3A4 metab- inhibits

    Infusion site pain, arthralgias, myalgias,, and up LFT
  32. Linezolid
    Oxalidinone- bind 50S

    • Bacteriostatic- Staph and Enterococci
    • Kills-Strep

    • For: gram pos staph, strep, MRsa, VRE, E. faecium, S. pyogenes, bind skin infect.
    • Oral
    • Not CYP metab,=-MAO

    • GI, HA, N/V, diarrhea, myelosuppress thrombocytopenia, anemia
    • Interacts w/ MAO inhibitors and adrenergic agonists
  33. Mupirocin

    From pseudomonas fluorescens

    Binds bac Bolencyl-tRNA synth

    Highly active aghainst Staph, MRSA, most strep.

    Usually topically for MRsa carrier in Strep

    Ant. Nares(?)
  34. Tigecycline
    Better activity against MRSA and VRE

    Used empirically for complicatd skin infxns caused by MRSA and intrabol(?) infxns
  35. Minocycline
    propionibacterium acnes

    Metabolized by liver

    vestibular tox
  36. Doxicycline

    DOC: borrelia, mycoplasma, ureaplasma, urealyticum, chlamydiae, rickettsiae

    Metabolism induced by barbituates/phenytoin

    photosensitivity, Not preggo, not less than 8yrs
  37. Tetracycline
    Tetracycline binds 30S

    DOC: rickettsiae, chlamydiae, borellia, mycoplasma, ureaplasma


    Not- preggo, less than 8yo
  38. Tobramycin
    Better than gent for pseudomonas
  39. Gentamycin

    Nosocomial pneumonia- empiric for hospital acquired mulit-resist gram neg aerobes, some kleb and pseudomonas are resistant

    • Pseudomonal sepsis
    • enterococcal infections
    • topical-ocular

    • Nephrotox-renal prox tubule
    • Ototox: cochlear=25% Starts high then goes low. Tinnitus, vestibular tox=HA leading to vertigo
  40. Aminoglycosides
    Diffused through aq pore in outer membrane grm neg acive transport across cytoplasmic membrane

    Binds 30S ribo of polysomes

    Interfere w/ initiation and synth, block furtyher translation, premature term, misread RNA and destruction of cytoplasmic memb and death

    Resist: fail permeation, low affinity for ribo, enzyme inactivation

    For: gram neg aerobic bacilli, very little gram pos

    w/ b lactam or vanc for sneitive strep
  41. Prophylaxis w/ isoniazid
    6 months

    300 mg adults

    900 my 2X week

    10mg/kg for kids
  42. TB w/ Upped level resist, or Disseminating TB, or TB meningitis, or TB w/ AIDS
    Isoniazid, rifampin, pyrazinamide, ethambutol

    9-12 months or more

    At least 2 drugs continue once done susceptibility testing
  43. Treat TB in Urea, w/ low drug resist, or elderly
    Isoniazid and rifampin 6 months and pyrazinamide first 2 months

    Or, Iso, rifam, streptomycin for 9 months
  44. Clofazimine
    Alt. to sulfones if dapsone resistant strains or pt is intolerant

    M. Leprae
  45. Dapsone
    Similar to sulfonamides most likely inhibits folate synth


    For: M. leprae, several years w/ rifampin, must monitor and much support

    Bad, hemolysis, methemeglobinemia, GI, allergic
  46. Rifampin
    Binds to DNA dependent RNA poly and inhibits RNA synth in Mycobacteria


    Also: M. leprae w/ dapsone

    Urine and body fluids= orange rash, thrombocytopenia, nephritis, down liver fxn w/ isoniazid
  47. Streptomycin
    • Mostly for extracellular tubercle forms.
    • poor cell penetration, crosses BBB

    For: iv DRUG W/ LIFE THREATENING meningitis tuberculosis and disseminating Dz

    Ototox, nephrotox, CAUTION
  48. Pyrazinamide
    Inactive at neutral pH

    Bactericidal at slightly acidic pH

    Resist alone but not w/ isoniazid

    Impair liver fxn

    Used only in combos
  49. Ethambutol
    • Good oral, good CSf
    • Fast resistane if alone

    Fen adverse

    Good for TB, Kansasii, and many atypicals

    W/ isoniazid
  50. Isoniazid
    primary for TB

    Inhibits synth of mycolic acid

    Hits cell wall

    Cidal for active growers, static at low dose

    Not for atypical Mycos

    Good for tuberculosis and Kansasii

    Fast and slow acetylator in liver

    CNS/PNS- pyridoxal phos deficiency inhibits metab of diphenylhydantoin

  51. Sulfadoxine and pyrinethamine
    Sulfadoxine= long acting

    Pyrimethamine= parasite dihydrofolate reductase inhibition

    For: P. falciparum
  52. Sulfamethoxazole and Trimethorprim
    Gram pos/neg

    • Sulfamethoxazole- PABA anolog
    • Inhibits dihydropteric acid synth. prevents folic acid

    Trimethorprim- inhibits dihydrofolate reductase


    For: AIDS pneumocystis, jirovecii in up dose UTI

    Parasitic if the combo abose is given

  53. Moxifloxacin
    • 3rd gen
    • Once daily

    For: low RTI only

    May prolong QT, less photo, no inhibit theophylline
  54. Gemifloxacin
    3rd gen once daily

    For: community acquired pneumo and bronchitis, PCN-resist Strep pneumo

    Rash, inhibits theophylline
  55. Levofloxacin
    3rd gen

    Levo or ofloxacin- once daily

    For: low RTI, skin, bone, joint, gastroenteritis, GUTI, pen resist strep pneum

    Less CNS, no theophylline inhibit
  56. Lomefloxacin
    2nd gen

    For: low RTI, skin, bone, joint, gastroenteritis, GUTI

    Photosensitivity, NOT inhibit theophylline, CNS, NSAIDS
  57. Oflxacin
    Racemic 2nd gen

    for: low RTI, skin, bonde, joint, gastroenteritis, GUTI

    CNS stim- anxiety hallucinate,

    Theophylline, NSAIDS, insomnia
  58. Ciprofloxacin
    2nd gen fluoroquinolone

    More potent gram neg

    Better gram pos strep faecalis, staph aureus MRSA


    For: low RTI, skin, bone, joint, gastroenteritis, GUTI

    Interact w/ theophylline and NSAIDS
  59. Norfloxacin
    oral 1st gen

    • For: GUTI, UTI, STD, gonococcus, prostatic-ecoli
    • Pseudomonas=resist

    inhibits theophylline metab CYP1A2

  60. Fluoroquinolones
    inhibits DNA gyrase- Topoiso IV and II

    Resist: mutate gyrase, down perm,

    Quinolones: gram neg only

    Flouroquinolones: great gram neg, gram pos, strep paecalis, staph w/ MRSA, intracellular-chlamydia, mycoplasmin, legionella, brucella, mycobacterium

    Poor against anaerobes and S. pneumo

    Good oral but not w/ Ca2+ and MG2+

    GI, photo, CNS, seizure, Connective tiss, endocrine

    Not- preggo or young child: Not-antacids, NSAIDS, inhibit theophylline metab
  61. Misoprostol
    Synth. analog of PGE,

    PG down acid secreation and Up mucus and up bicarb

    ASA down PG synth= ulcer

    For: NSAID ulcers

    Not: preggo= uterine contract
  62. Metronidazole
    H. pylori w. resistance
  63. Clarithromycin and amoxicillin
    PPI + clarith and amox


    PPI + bismuth and tetraycline and metronidazole (for resistance)

    10-14 days, ulcer cure
  64. Bismuth subsalycilate
    up mucosal secreation

    Coats ulcer

    Causes H. pylori detachment and lysis

    No antacid effect
  65. Aluminum compounds
    Storage issues

    Up mucus secreation

    Phosphate epletion

    bad: binds to tetracycline and constipate
  66. Calcium carbonate
    Potent, good for women (Tums)

    CA2+ may produce intense and long HCl rebound
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