Antibacterial New Deck Flashcards
Natural Penicillins
Penicillin G and Penicillin V
MOA: PBPs
T: Mainly gram positive
AS: includes N. Meningitidis, T. Palladium
R: Mycoplasma and any B-lactamase producer (Staph aureus)
ROA: IV (G), oral (V)
CA: (G) syphilis, strep infections, susceptible pneumococci; (V) strep throat, mild/moderate infection upper respiratory/skin
AE: hypersensitivity, GI, seconday infections
C: B-lactam allergies
Repository Penicillins
Penicillin G Procaine, Penicillin G Benzathine
MOA: PBPs
T: mainly gram positive
AS: includes N. meningitidis, T. Pallidum
R: myoplasma & any that produce B-lactamase (staph aureus)
ROA: IM
CA: Penicillin G Benzathine: syphilis, rheumatic fever prophylaxis
AE: hypersensitivity, GI, secondary infections
C: B-lactam allergies
Extended-Spectrum Penicillins
Amoxicillin and Ampicillin
MOA: PBPs
T: gram positive and some gram negatives
AS: H. influenzae, H. pylori, E. coli, Listeria, P. Mirabilis, Samonella, Shigella
R: mycoplasma, any that produce B-lactamase (staph aureus)
ROA: Amoxicillin mainly oral; Ampicillin oral/IV/IM
CA: mild/moderate infections (URI, UTI, skin)
AE: hypersensitivity, GI, maculopapular rash, secondary infections
C: B-lactam allergies
Antistaphylococal Penicillins
Dicloxacillin, Oxacillin, Methicillin, Nafcillin
MOA: PBPs
T: gram positive
AS: B-lactamase resistant
R: Mycoplasma, MRSA/VRSA
ROA: Dicloxacillin oral; Oxacillin IV; Methicillin not FDA approved, Nafcillin IV
CA: B-lactamase producing staphylococci
AE: hypersensitivity, GI, secondary infections; Oxacillin hepatitis; Methicillin interstital Nephritis; Nafcillin neutropenia
C: B-lactam allergies
Antipseudomonal Penicillins
Carbenicillin, Piperacillin, Ticarcillin
MOA: PBPs
T: Gram positive and Gram negative
AS: includes P. aeruginosa
R: Mycoplasma and any B-lactamase producer (staph aureus)
ROA: IV; Carbenicillin IV/oral
CA: P. aeruginosa, moderate-severe GN infections (febrile neutropenia)
AE: hypersensitivity, GI, secondary infections
C: B-lactam allergies
Cephalosporins 1st Generation
Cefazolin and Cephalexin
MOA: PBPs
T: mainly Gram positive
AS: P. mirabilis, E. coli, K. pneumoniae
R: Listeria, Legionella, Chlamydia, Mycoplasma, Acinetobacter, MRSA
ROA: Cefazolin parenteral only, Cephalexin oral
CA: penicillin G substitute; Cefazolin surgical prophylaxis
AE: hypersensitivity, superinfections
C: B-lactam allergies (partial cross-reactivity)
Cephalosporins 2nd Generation
Cefaclor, Cefoxitin, Cefotetan, Cefamandole
MOA: PRPs
T: Gram positive and some Gram negatives
AS: H. influenzae, Enterobacter, Neisseria, P. mirabilis, E. coli, Klebsiella pneumoniae, Serratia maracens
R: Listeria, Legionella, Chlamydia, Mycoplasma Acinetobacter, MRSA
ROA: Paraenteral only except Cefaclor is oral
CA: mild-moderate infections, sinusitis, otits media, and lower respiratory infections
AE: hypersensitivity, superinfections; Cefotetan/Cefamandole hypoprothrombinemia and disulfram-like reactions
C: B-lactam allergies (parital cross-reactivity)
Cephalosporins 3rd Generation
Ceftriaxone, Cefaperazone, Cefotaxine, Ceftazidime, Cefixime
MOA: PRPs
T: extended Gram negative coverage
AS: highly active against Enterobacteriacae, Neissera, H. influenzae, and possible pneumococci
R: Listeria, Legionella, Chlamydia, Mycoplasma, Acinetobacter, MRSA
ROA: Parenteral only except Cefixime is oral
CA: mild-severe gram negative infections (otitis, meningitis, and pseudomonas)
AE: hypersensitivity, superinfections; Cefaperazone hypoprothombinemia, Disulfiram-like reactions
C: B-lactam allergies (partial cross-reactivity)
Cephalosporin 4th Generation
Cefipime
MOA: PBPs
T: broad specturm
AS: increased activity against Pseudomonas aeruginosa
R: Listeria, Leigonella, Chlamydia, Mycoplasma, Acinetobacter, MRSA
ROA: parenteral only
CA: complicated susceptible infections (UTI, febrile neutropenia, intra-abdominal)
AE: hypersensitivity, superinfections
C: B-lactam allergies (parital cross-reactivity)
Cephalosporin 5th Generation
Ceftaroline
MOA: PBPs
T: Gram negative & some gram positives
AS: MRSA
R: Pseudomonas
ROA: Parenteral only
CA: complicated skin/soft tissue infections due to MRSA especially if GN also present
AE: hypersensitivity, superinfection
C: B-lactam allergies (partial cross-reactivity)
Carbapenems
Imipenem and Meropenem
MOA: PRPs
T: broad spectrum
AS: Gram positive, Gram negative, Aerobes, Anaerobes including P. aeruginosa
R: carbapenemase producing organisms (Enterobacteriaceae & carbepenem resistant Klebsiella & MRSA)
ROA: parenteral only
CA: restricted to emperic therapy of serious infections
AE: GI, rash; Imipenem nephrotoxic (combined with cilastatin), CNS toxicity (seizures)
C: B-lactam allergies (partial cross-reactivity)
Monobactams
Aztreonam
MOA: PRPs
T: aerobic Gram negative rods only
AS: P. aeruginosa resistant to B-lactamase
R: mycoplasma & gram positive
ROA: parenteral
CA: UTI, lower respiratory infections, other GN infections
AE: relatively nontoxic
C: little cross-reactivity with other B-lactams
Vancomycin
Vancomycin (glycopeptide)
MOA: D-Ala-D-Ala terminus
T: Gram positive only
AS: multidrug resistant organisms (MRSA, Enterococci, PRSP, C. difficile)
R: VRSA, VRSP, and virtually all GN
ROA: Parenteral (or oral for C. difficile)
CA: serious infections caused by resistant GP organisms and for pts severely allergic to penicillin
AE: nephrotoxicity, ototoxicity, Red man syndrome
C:
Daptomycin
Daptomycin (glycopeptide)
MOA: cell membrane insertion of lipid tail
T: Gram positive only
AS: MRSA/VRSA, Enterococci, VRE
R: pneumonia (inactivated by surfactant)
ROA: parenteral
CA: serious infections caused by resistant GP, complicated skin/structure infections
AE: myopathy/rhabodomyolysis
C:
Bacitracin
Bacitracin (Miscellaneous)
MOA: PRPs
T: Gram positive
AS:
R:
ROA: mainly topical
CA: skin infections and burns
AE: topical irritation (nephrotoxicity when given systemically)
C:
Fosfomycin
Fosfomycin (Miscellaneous)
MOA: inhibits enolpyruvate transferase
T: broad spectrum
AS:
R:
ROA: oral
CA: uncomplicated lower UTI’s
AE:
C:
Beta-Lactamase Inhibitors
Clavulanic Acid/Clavulanate, Sulbactam, Tazobactam
MOA: PRPs inhibition
T:
AS: combined with B-lactam antibiotics to enhance antimicrobial spectrum
R:
ROA: oral; Sulbactam/Tazobactam also parenteral
CA:
AE:
C:
Tetracyclines
Doxycycline, Minocycline, Tetracycline
MOA: 30S ribosomal subunit
T: broad spectrum
AS: intracellular organisms (Rickettsia & Chlamydia)
R: most exhibit some sort of resistance
ROA: oral, parenteral
CA: Empiric treatment of PNA, Lyme disease, Acne, Roseaca, Chlamydia, Syphilis
AE: GI distress, discoloration of teeth, inhibition of bone growth in children, photosensitivity, superinfections
C: pregnancy and children under 8
Glycylcyclines
Tigecycline (Tetracycline)
MOA: 30S ribosomal subunit
T: broad spectrum
AS: multi-drug resistant organisms (MRSA/VRSA/VRE)
R:
ROA: parenteral
CA: complicated skin, soft tissue, and intestinal infections due to resistant bacteria
AE: GI distress, discoloration of teeth, inhibition of bone growth in children, phosensitivty, superinfection
C: pregnancy, children under 8
Aminoglycosides
Amikacin, Gentamicin, Neomycin, Streptomycin
MOA: 30S ribosomal subunit
T: aerobic gram negative rods
AS: aerobes only
R: anaerobes
ROA: Parenteral except Neomycin is topical and oral
CA: Amikacin/Streptomycin combination for empiric therapy of serious infections; Gentamicin combination with Vancomycin for emperic therapy of serious infection (septicemia, endocarditis); Neomycin component of triple antibiotic ointment or orally for hepatic encephalopathy
AE: nephrotoxicity, ototoxicity; Neomycin only nephrotoxicity when given orally
C: pregnancy (Neomycin only when given systemically)
Macrolides
Azithromycin, Clarithromycin, Erythromycin, Telithromycin
MOA: 50S ribosomal subunit
T: Gram positive and some gram negative
AS:
R:
ROA: oral; Azithromycin/Erythromycin also given by IV
CA: atypical PNAs, GP cocci, URI, soft tissue infections, STD’s for penicillin allergic pts; Telithromycin not used in minor illnesses
AE: GI motility issues, QT prolongation, rash eosinophilia; Clarithromycin/Erythromycin inhibit CYP; Telithromycin fatal hepatotoxicity, myasthenia gravis exacerbation, visual disturbances
C: statins for Clarithromycin/Erythromycin/Telithromycin
Streptogramins
Dalfoprisitin + Quinupristin
MOA: 50S ribosomal subunit (seperate sites)
T: Gram positive only
AS: includes VRSA and VRE
R: E. faecalis is intrinsically resistant
ROA: parenteral
CA: severe infections caused by multi-drug resistant Staphylococci or VRE
AE: infusion-related irrita tion/arthralgias/myalgias, hyperbilireubinemia, inhibits CYP
C:
Clindamycin
Clindamycin (Lincosamide)
MOA: 23S of 50S ribosomal subunit
T: primarily gram positive anaerobes
AS: anaerobes (Bacteriodes, Clostridium perfringens)
R:
ROA: oral, parenteral
CA: anaerobic infections (especially above diaphragm, aspiration PNA), skin/soft tissue infections
AE: Pseudomembranous colitis
C:
Linezolid
Linezolid (Lincosamide)
MOA: 23S portion of 50S ribosomal subunit
T: Gram positive only
AS: MRSA, VRSA, VRE, and bacteria resistant to other drugs
R:
ROA: oral, parenteral
CA: severe infetions caused by multi-drug resistant GP
AE: bone marrow suppresion, peripheral neuropathy, Serotonin syndrome (inhibitor of MAO)
C: adrenergic and serotonergic drugs