Antibiotics Overview
- Cell Wall Inhibitors
 - Penicillins
 - Cephalosporins
 - Monobactams
 - Glycopeptides
 - Carbapenems (Imipenem & Meropenem)
 - Beta-Lactamase Inhibitors
 - Protein Synthesis Inhibitors
 - Aminoglycosides
 - Macrolides
 - Clindamycin
 - Tetracyclines
 - Linezolid
 - Chloramphenicol
 - Fluoroquinolones
 - Sulfonamides
 
Penicillin
- Gram Positive
 - Spirochetes
 - Bind PBPs
 - Block Transpeptidase Cross-linking of Cell Wall
 - Activate Autolytic Enzymes
 - Bactericidal
 - Hypersensitivity Reactions
 - Hemolytic Anemia
 - Beta-lactamase Sensitive
 
Aminopenicillin Mechanisms
- Broader Spectrum
 - Ampicillin
 - Amoxicillin
 - Beta-Lactamase Sensitive
 - Combine with Clavulanic Acid
 - Hypersensitivity Reactions
 - Ampicillin Rash
 - Pseudomembranous Colitis
 - Diarrhea
 
Aminopenicillin Uses
- Ampicillin
 - Amoxicillin
 - Shigella
 - Haemophilus influenzae
 - Salmonella
 - Listeria
 - Enterococci
 - Proteus mirabilis
 - E. coli
 - Helicobacter pylori
 - Streptococcus pneumoniae
 - Streptococcus agalactiae
 
Ampicillin and Amoxicillin
- Aminopenicillin
 - Broad Spectrum Penicillin
 - Gram-Positive and Some Gram-Negative Infections
 - Rash
 - Ampicillin Rash in EBV
 - Diarrhea
 - Pseudomembranous Colitis
 - Allergic Reaction
 - No Effect Against Staph Aureus
 - Often Combined with Beta-Lactamase Inhibitor
 
Beta-Lactamase Inhibitors
- Often Combined with Penicillin Antibiotics
 - Clavulanic Acid
 - Sulbactam
 - Tazobactam
 
Antipseudomonal Penicillins
- Ticarcillin
 - Carbenicillin
 - Piperacillin
 - Same Mechanism as Penicillin
 - Extended Spectrum
 - Pseudomonas and Gram-Negative Rods
 - Combine with Beta Lactamase Inhibitor
 - Clavulanic Acid
 - Tazobactam
 - Hypersensitivity Reactions
 
Cephalosporins Overview
- Beta Lactam Drug
 - Inhibits Cell Wall Synthesis
 - Bactericidal
 - Meningitis
 - MRSA
 - Hypersensitivity Reactions
 - Vitamin K Deficiency
 - Disulfiram Like Reaction with Alcohol
 - Increased Nephrotoxicity of Aminoglycosides
 - Extended Spectrum Beta Lactamase
 
1st Generation Cephalosporin
- Cefazolin
 - Cephalexin
 - Proteus mirabilis
 - E. coli
 - Klebsiella
 - Gram-Positive Cocci
 
2nd Generation Cephalosporin
- Cefoxitin
 - Cefaclor
 - Cefuroxime
 - Proteus mirabilis
 - E. coli
 - Klebsiella
 - Gram-Positive Cocci
 - Haemophilus influenzae
 - Enterobacter
 - Neisseria
 - Serratia marcescens
 
3rd Generation Cephalosporin
- Cefotaxime
 - Ceftriaxone
 - Cefdinir
 - Ceftazidime
 - Pseudomonas
 - Serious Gram-Negative Bacteria Resistant to Other Beta-Lactams
 
4th Generation Cephalosporin
- Cefepime
 - Increased Activity Against Gram-Positive Infections and Pseudomonas
 
5th Generation Cephalosporin
- Beta-Lactam
 - Resistant Bacteria
 - Broad Spectrum Gram-Positive and Gram-Negative
 - Ceftobiprole
 - Has Pseudomonas Coverage
 - Ceftaroline
 - No Pseudomonas Coverage
 
Imipenem and Meropenem (Carbapenems)
- Carbapenems
 - Broad-spectrum Antibiotic
 - Bactericidal
 - Gram Positive and Gram Negative Infections
 - GI Distress
 - Suprainfections
 - Seizures
 - Penicillin Allergy
 - IV or IM Route
 - Imipenem Combined with Cilastatin
 
Imipenem
- Resistant to Beta-Lactamases
 - Broad Spectrum
 - Anaerobes
 - Gram-Negative Rods
 - Gram-Positive Cocci
 - Must Administer with Cilastatin
 - Cilastatin is Inhibitor of Renal Dehydropeptidase I
 - Diarrhea
 - Skin Rash
 - Seizures
 - Meropenem
 - Stable to Dehydropeptidase I
 - Reduced Risk of Seizures (Non-Seizure Causing)
 
Aztreonam
- Monobactam
 - Resistant to Beta-Lactamases
 - Binds to Penicillin-Binding Protein (PBP)
 - Inhibit Cell Wall Synthesis
 - Bactericidal
 - No Activity on Gram-Positives or Anaerobes
 - Gram-Negative Rods
 - Cystic Fibrosis
 - Non Allergenic to Penicillin
 - Synergistic with Aminoglycosides
 - GI Upset
 - Pain at Injection Site
 
Vancomycin Mechanism
- Bacteriostatic and Bactericidal
 - Gram-Positive
 - Inhibits Cell Wall Mucopeptide
 - Binds to D-ala D-ala
 - Resistance with Change to D-ala D-lac
 - Staphylococcus aureus
 - Orally for Clostridium difficile
 - Enterococci
 
Vancomycin Side Effects & Toxicity
- Thrombophlebitis
 - Nephrotoxicity
 - Ototoxicity
 - Diffuse Flushing Called Red Man Syndrome
 - Prevent with Antihistamine
 - Prevent with Slow Infusion
 
Daptomycin (Cubicin)
- Lipopeptide Antibiotic
 - Disrupts Cell Membrane
 - Causes Rapid Depolarization
 - Gram-Positive Cocci
 - MRSA
 - Myopathy
 - Rhabdomyolysis
 - Allergic Pneumonitis
 - Inactivated by Surfactant
 - Not Used (Avoid) for Pneumonia
 
Polymyxins
- Cationic
 - Act Like Detergents
 - Bind to Cell Membranes of Bacteria
 - Disrupt Their Osmotic Properties
 - Resistant Gram-Negative Infections
 - Neurotoxicity
 - Renal tubular necrosis
 
Protein Synthesis Inhibitors
- 30S inhibitors
 - Aminoglycosides
 - Tetracyclines
 - 50S inhibitors
 - Chloramphenicol
 - Clindamycin
 - Erythromycin
 - Lincomycin
 - Linezolid
 
Aminoglycosides
- Gentamicin
 - Neomycin for Bowel Surgery Prep
 - Amikacin
 - Tobramycin
 - Streptomycin
 - Bactericidal
 - Inhibit Formation of Initiation Complex
 - Cause Misreading of mRNA
 - Require O2 for Uptake
 - Gram-Negative Rod Infections
 - Synergistic with B-Lactam Antibiotics
 
Aminoglycosides Side Effects and Resistance
- Nephrotoxicity Especially When Used With Cephalosporins
 - Ototoxicity Especially When Used With Loop Diuretics
 - Teratogen
 - Neuromuscular Blockade
 - Resistance By Transferase Enzymes
 - Acetylation
 - Phosphorylation
 - Adenylation
 
Neomycin Sulfate
- Aminoglycoside Antibiotic
 - Topical Infection
 - Intestinal Surgery Prophylaxis
 - Hepatic Encephalopathy
 - Ototoxicity
 - Nephrotoxicity
 - Rash
 - GI Superinfection
 - Neuromuscular Blockade
 - Pregnancy
 
Tetracycline Mechanism
- Binds to 30 S to Prevent Attachment of Aminoacyl tRNA
 - Limited CNS Penetration
 - Divalent Cations Inhibit Absorption
 - Must Not Take with Milk, Antacids, Iron
 
Tetracycline Drug Names and Indications
- Demeclocycline
 - Minocycline
 - Doxycycline
 - Fecally Eliminated
 - Can be Used in Renal Failure
 - Antidiuretic Hormone Antagonist
 - Chlamydia
 - Rickettsia
 - Borrelia burgdorferi
 - Helicobacter Pylori
 - Mycoplasma Pneumonia
 
Tetracycline Toxicities
- Inhibition of Bone Growth in Children
 - Teratogen
 - Discoloration of Teeth
 - Photosensitivity
 - GI Distress
 
Tigecycline (Tygacil)
- Glycylcycline Antibiotic
 - Binds 30S Subunit
 - Inhibits Protein Synthesis
 - Severe Infections
 - Broad Spectrum Coverage
 - Anaerobic & Multidrug-Resistant Organisms
 - Deep Tissue Penetration
 - GI Distress
 - Severe Nausea and Vomiting
 - 2nd Line Agent
 
Macrolides
- Bacteriostatic
 - Bind to 23S rRNA of 50S Subunit
 - Inhibit Protein Synthesis by Blocking Translocation
 - Erythromycin
 - Azithromycin
 - Clarithromycin
 - Gram-Positive Cocci
 - Atypical Pneumonia
 - Chlamydia
 - Resistance by Methylation of 23S rRNA Binding
 
Macrolides Side Effects
- Diarrhea
 - Prolonged QT Interval
 - P450 Inhibitor
 - Cholestatic Hepatitis
 - Skin Rash
 - Eosinophilia
 
Clindamycin
- Bacteriostatic
 - Binds 50S Ribosomal Subunit
 - Blocks Translocation
 - Anaerobic Infections above the Diaphragm
 - Aspiration Pneumonia
 - Lung Abscess
 - Can Cause Pseudomembranous Colitis
 
Linezolid (Zyvox)
- Oxazolidinone Antibiotic
 - Binds 23S rRNA of 50S Subunit
 - Inhibits Protein Synthesis
 - Gram-Positive Organisms
 - MRSA
 - VRE (Vancomycin Resistant Enterococci)
 - Bone Marrow Suppression
 - Decreased Platelet Count
 - Peripheral Neuropathy
 - Lactic Acidosis
 - Serotonin Syndrome
 - Avoid Tyramine Containing Foods
 
Chloramphenicol
- Bacteriostatic
 - Inhibits 50S Peptidyltransferase Activity
 - Meningitis
 - Rocky Mountain Spotted Fever in Pregnant Women
 - Anemia
 - Aplastic Anemia
 - Gray Baby Syndrome due to Decreased UDP-Glucuronyl Transferase
 - Resistance Caused by Plasmid Encoded Acetyltransferase
 
Fluoroquinolones Antibiotics
- -floxacin
 - Inhibits Topoisomerase II & IV
 - Bactericidal
 - Gram-negative Rods
 - Pneumonia
 - Gastrointestinal Infections
 - Urinary Tract Infection
 - Genital Infections
 - Levofloxacin
 - Ciprofloxacin
 - Has Pseudomonas Coverage
 - Avoid Polyvalent Cations
 
Fluoroquinolones Toxicities
- Diarrhea
 - Skin Rash
 - Headache
 - Tendon Rupture in Adults
 - Myalgias in Kids
 - Damage to Cartilage
 - Teratogen
 - QT Prolongation
 
Metronidazole
- Bactericidal
 - Forms Free Radical Toxic Metabolites
 - Damages DNA
 - Giardia lamblia
 - Entamoeba Histolytica
 - Trichomonas
 - Gardnerella
 - Anaerobes
 - Metallic taste
 - Disulfiram like Reaction with Alcohol
 
Sulfonamides Mechanisms
- Bacteriostatic
 - Gram-Positive
 - Gram-Negative
 - Nocardia
 - Chlamydia
 - PABA antimetabolites
 - Inhibit dihydropteroate synthase
 - Sulfamethoxazole
 - Sulfisoxazole
 - Sulfadiazine
 
Sulfonamides Side Effects
- Hypersensitivity
 - Nephrotoxicity
 - Photosensitivity
 - Kernicterus in Infants
 - Displaces Warfarin from Albumin
 - Hemolysis with G6PD Deficiency
 
Sulfa Drug Allergies
- Sulfasalazine
 - Sulfonylureas
 - Thiazide Diuretics
 - Acetazolamide
 - Furosemide Diuretic
 - Celecoxib
 - Probenecid
 
Trimethoprim
- Bacteriostatic
 - Inhibits Bacterial Dihydrofolate Reductase
 - Causes Sequential Block of Folate Synthesis
 - Used in Combination with Sulfamethoxazole
 - Combination Used For Recurrent Urinary Tract Infections
 - Shigella
 - Salmonella
 - Pneumocystis Jiroveci Pneumonia
 - Decrease in Red and White Blood Cells
 - Alleviated with Leucovorin Rescue
 
HIV Prophylaxis Medications
- CD4+ < 200
 - TMP-SMX
 - Pneumocystis Pneumonia
 - CD4+ < 100 Susceptible to Toxoplasma Gondii
 - CD4+ < 50
 - Mycobacterium Avium and Intracellulare
 - Azithromycin If Delayed Therapy