ABXSH4-macrolides Flashcards
Macrolides
MOA: inhibit protein synthesis by binding 50S ribosomal subunit
Watch for QT prolongation
• erythromycin: GI upset ( can use if patient allergic to PCN for strep, syphilis, gonorrhea
• clarithromycin ( biaxin ) -metallic taste
•azithromycin - empty stomach
-chlamydia/ N. Gonorrhea: 1 G single dose ( For gonorrhea we gave ceftriaxone 250 mg IM plus 1 gram azithromycin )
MAC ( mycobacterium avian complex ) prophylaxis : 1200 mg once weekly- for HIV when CD4 ≤50
Fidamoxicin ( Dificid ) - indicated for C. diff
- Telithromycin ( Ketek ) - CAP ( liver failure DSC ) : was not a macrolide. A ketolide
Clarithromycin
Biaxin , Biaxin XL ( XL form with food )
Group A strep, sinusitis, CAP, MAC
Dont refrigerate suspension
DDI: 3a4 and 1a2 inhibitor
( increases levels of digoxin, carbamazepine, simvastatin, theophylline, INR )
QT prolong
Azithromycin
Pregnancy category B
Zithromax
Zpak: 6 of the 250 mg
Tri-pak: 3 500mg tabs
Take suspension : on empty stomach. Comes in suspension for kids.
DOC for otitis media is amoxicillin, if you fail amoxicillin give Augmentin, and if PCN allergy can give azithromycin
Can give for CAP
give IV over 1 hour.
Opthalmic formulation in refrigerator
SE: hearing loss ( IV ), QT prolongation, does not inhibit p450, dont take with antacids, GI
Fidaxomicin
Dificid
Indication: C. Difficile only ( not well aborbed so oral just works for c diff )
Preg B
MOA: inhibit RNA synthesis by inhibiting RNA polymerases. Bactericidal against C. Diff
Tetracyclines
MOA: inhibits protein synthesis. Binds to 30s subunit of bacterial ribosome. Blocks tRNA to the mRNA ribosome complex
Spectrum : broad spectrum bacteriostatic w/activity against aerobic gram positive and gram negative bacteria and atypical pathogens ( mycoplasma and chlamydia )
Also can use for syphilis if PCN allergy
Different tetracyclines
Doxycycline ( vibramycin , adoxa, acticlat, doryx MPC, Oracea( only indicated for rosacea. Low dose not for antibacterial effect but to reduce redness ) ) :
-CAP, bronchitis
-Lyme disease ( minimum of Lyme disease ) , rosacea, PID,
-Doryx MPC ( delayed release ) : decreased exposure in upper GI
-if RENAL IMPAIRMENT, Then recommend doxycycline
Minocycline:
-acne , prosthetic joint infection
-watch for hepatoxicity, lupus, dizziness
-solodyn and ximino ( er forms to decrease dizziness for patient )
Tetracycline ( sumycin )
-empty stomach
-Chronic bronchitis, acute exacerbation; PUD
Dont give tetracycline less than 8. Also Pregnancy category D. Teeth discoloring
Chloramphenicol
Used mostly in other countries
MOA: binds to the bacterial 50S ribosomal submit and inhibits protein synthesis.
-bone marrow toxicity /supression
-absolutely cant give to kids. Gray baby syndrome. Can’t excrete the drug.
Clindamycin
( Cleocin )
Clinda, Linda this girl is so positive. Covers gram positive and all anaerobes ( no gram ( - ) )
SE: #1 cause of C. Diff
Pseudomembranous colitis
IV/IM/ PO / Soln
Lincomycin
Lincocin
IV / IM only
Clindamycin and lincomycin should never be given with erythromycin. ( consider antagonistic )
Metronidazole
Flagyl
MOA: disruption of bacterial DNA synthesis
Spectrum: B fragilis, giardia, C diff
Contraindicated in 1st trimester, then considered preg category B
SE: disulfiram reaction ( avoid alcohol 3 d caps/ER )
Darkens urine, metallic taste, GI upset
DDI: increases INR with warfarin ( 2c9 inhibitor )
Scenario: if patient is taking metronidazole for bacterial vaginosis, recommend vaginal clindamycin instead IF patient on warfarin
Dosage forms: IV ( protect from light) ( refrigerate : crystals may from , just re-dissolve on warming room temp ( recall mannitol)
NS dilution : metroNidazole
Secnidazole
Solosec
Indications: fishy Odor vaginal discharge, in reproductive age women : BACTERIAL Vaginosis
What was first line? Metronidazole : BAC to the metro 500 mg or vaginal gel
- other drugs you can use : clindamycin oral or 2%cream vaginally 7d
-then you can use secnidazole ( or tinidazole ) :
- benefit of secnidazole 2 gram single dose ( packet sprinkle on applesauce ( dont chew ). Consume mixture within 30 mins
No hepatic or renal
Adverse : HA , GI
Nitrofurantoin
Macrobid ( look for RENAL if CrCl < 60 dont give Nitrofurantoin )
Furadantin ( suspension ), macrodantin( 50-100 mg po Q6H x 3 to 7 d w/food ) , macrobid
Spectrum: all UTI gram negatives except pseudomonas and proteus ( Kl/B)
Pregnancy category B: except do not give after 38 weeks of pregnancy
-DO not use in infant <1 month
Dose: macrobid : 100 mg po BID w/food 7d
SE: discorlation of urine ( brown ) hepatic reactions, peripheral neuropathy , pulmonary toxicity
Fosfomycin
Monurol
Indication: simple uncomplicated UTI in women
- one 3 gram packet simple dose ( dissolve in 1/2 cup of water )
DDI : metoclopramide decreases urinary excretion
Oxazolidinones
MOA: 50 s bacterial ribosomal subunit / Gram +
- Linezolid ( zyvox ) : oral ( comes in an oral suspension too but dont shake gently turn good 21 days ) and IV / BID
- Tedizolid ( sivextro ) : oral and IV / QD
Linezolid:
Spec: VRE, MRSA, other gram ( + ) //// DOES NOT COVER gram ( - )
Dose: 600 mg q 12 hours
SE: THrombocytopenia, check CBC. Peripheral and optic neuropathy ( monitor vision if on it >3 months ) linez👀lid
DDI: slight MAOI
Preg: C
Premade in NS
Tedizolid ( sivextro) :
Prodrug binds to 50s ribosomal subunit
spec: skin ifx ( gram + ) , staph ( MRSA ) strep, & enterococcus faecalis
You make this one so remember in NS ( recall: daptomycin, cubicin , Unasyn, ampicillin, metronidazole)
Common SE: GI, dizziness, thrombocytopenia, MAOI, and if on long period check eyes
No RENAL or hepatic dose adjustment
Synercid
( Quinupristine / Dalfopristin )
MOA: inhibits protein synthesis
Spectrum: VRE, MRSA, other gram ( + ) ( covers E. faecium only)
( recall : linezolid, tedizolid, daptomycin, tigecycline, cover both VRE ( e faecalis and E faecium )
SE: venous irritation, arthralgia, myalgia
