Antibacterials Flashcards
Natural Penicillins:
Mechanism of Action
Gram+
Gram-
Other
Adverse Effects
Comments
Minimal
Inhibitors of cell wall synthesis
Streptococcus #Enterococcus (esp E. faecalis)
Treponema pallidum
(Syphilis)
#Mouth anaerobes
#Hypersensitivity #Seizures (high doses)
-Have lost utility against
Staphylococci (due to β-lactamase)
-Only cidal against Enterococcus when combined with aminoglycoside
- Streptococcus spp. are uniformly susceptible, with exception of some S pneumoniae isolates
Aminopenicillins:
Drug(s)
Mechanism of Action
Gram+
Gram-
Other
Adverse Effects
Ampicillin/Amoxicillin
Inhibitors of cell wall synthesis
Streptococcus
Enterococcus (espE. faecalis)
Listeria monocytogenes
Escherichia.coli, Proteus mirabilis, Haemophilus influenzae (but resistance is common due to B-lactamase)
Treponema pallidum
(Syphilis)
#Lyme
#Hypersensitivity #Seizures (high doses)
Aminopenicillins + Beta-lactamase Inhibitors:
Drug(s)
Mechanism of Action
Gram+
Gram-
Other
Adverse Effects
Ampicillin+ Sulbactam
Amoxicillin+Clavulanate
Inhibitors of cell wall synthesis
Streptococcus
Enterococcus (espE. faecalis)
methicillin-sensitive Staphylococcus
aureus (MSSA)
Escherichia.coli, Proteus mirabilis, Haemophilus influenzae (but resistance is common due to B-lactamase)
B-lactamase producing strains of H. influenzae, some strains of Klebsiella spp., E coli.
Treponema pallidum
(Syphilis)
#Lyme
Excellent anaerobic activity (including Bacteroides fragilis)
#Hypersensitivity #Seizures (high doses) #Diarrhea
Penicillinase Resistant Penicillins:
Drug(s)
Mechanism of Action
Gram+
Gram-
Other
Adverse Effects
Comments
None
Nafcillin/Oxacillin
Dicloxacillin
Inhibitors of cell wall synthesis
EXCELLENT MSSA (drugs of
choice)
Streptococcus
#Hypersensitivity #Seizures (high doses) Hepatotoxicity (oxacillin) and interstitial nephritis (nafcillin)
- “Penicillinase” is β-lactamase that hydroyzes penicillins but not these agents
- Unique due to hepatic elimination, so no dosing adjustments necessary in renal insufficiency
Extended Spectrum Penicillin + Beta-lactamase Inhibitor:
Drug(s)
Mechanism of Action
Gram+
Gram-
Other
Adverse Effects
Comments
Ticarcillin+Clavulanate
Piperacillin+Tazobactam
Inhibitors of cell wall synthesis
EXCELLENT MSSA (drugs of
choice)
Streptococcus
Enterococcus (esp E. faecalis)
Broad-spectrum activity, including Pseudomonas
Treponema pallidum
(Syphilis)
Mouth anaerobes
Excellent anaerobic activity (including Bacteroides fragilis)
#Hypersensitivity #Seizures (high doses) #Diarrhea
1st Generation Cephalosporins:
Drug(s)
Mechanism of Action
Gram+
Gram-
Other
Adverse Effects
Comments
oral anaerobes
Cefazolin
Cephalexin
Cefadroxil
Inhibitors of cell wall synthesis
MSSA
Streptococcus
E. coli, Klebsiella
#Hypersensitivity #Seizures (high doses)
Uses: skin and soft tissue infections
2nd Generation Cephalosporins:
Drug(s)
Mechanism of Action
Gram+
Gram-
Other
Adverse Effects
Comments
Cefuroxime
Cefaclor
Cefprozil
*Cefoxitin
Inhibitors of cell wall synthesis
MSSA, Streptococci
- Poor MSSA
- Streptococcus
E. coli, Klebsiella
H. influenzae
#oral anaerobes *Moderate B. fragilis
#Hypersensitivity #Seizures (high doses)
3rd Generation Cephalosporins:
Drug(s)
Mechanism of Action
Gram+
Gram-
Other
Adverse Effects
Comments
oral anaerobes
Ceftibuten Cefdinir Cefpodoxime Ceftriaxone Cefotaxime Cefixime *Ceftazidime **Ceftaroline
Inhibitors of cell wall synthesis
MSSA
Streptococcus
*Poor MSSA, Streptococcus
**Only β-lactam with activity against MRSA, excellent against Streptococcus
Broad, not Pseudomonas
- Broad, including Pseudomonas
- *Broad, not Pseudomonas
#Hypersensitivity #Seizures (high doses)
#Ceftriaxone unique for non-renal elimination #Ceftriaxone/cefotaxime gold- standard for community-acquired meningitis, N. gonorrhea, neuro Lyme
4th Generation Cephalosporins:
Drug(s)
Mechanism of Action
Gram+
Gram-
Other
Adverse Effects
None
Cefepime
Inhibitors of cell wall synthesis
MSSA
Streptococcus
Broad activity , including Pseudomonas
#Hypersensitivity #Seizures (high doses)
Monobactams:
Drug(s)
Mechanism of Action
Gram+
Gram-
Other
Adverse Effects
Comments
None
Aztreonam
Inhibitors of cell wall synthesis
None
Good, including Pseudomonas
#Hypersensitivity #Seizures (high doses)
Safe to use in patients with severe allergic reactions to other beta- lactams (like penicillin)
Carbapenems:
Drug(s)
Mechanism of Action
Gram+
Gram-
Other
Adverse Effects
Comments
Imipenem/Cilastatin
Meropenem
Doripenem
*Ertapenem
Inhibitors of cell wall synthesis
Streptococcus
MSSA
Enterococcus faecalis
*No Enterococcus
Excellent, including Pseudomonas
*Doesn’t cover Pseudomonas
Anaerobes, including excellent B. fragilis
#Hypersensitivity #Seizures (high doses) Imipenem- ↑ incidence of seizures in pts with ↓ renal function & or hx of seizures
Glycopeptide:
Drug(s)
Mechanism of Action
Gram+
Gram-
Other
Adverse Effects
Comments
None
Vancomycin
Inhibitors of cell wall synthesis
Streptococcus
MRSA/MRSE
Enterococcus
Not VRE
C. difficile
Rash and hypotension with rapid IV administration (Red Man’s syndrome)
Nephrotoxicity (mostly with high doses or in combination with aminoglycosides)
Neutropenia, allergy (rare)
Used exclusively for gram- positive infections (IV) and C. difficile-associated diarrhea (PO)
- Old drug, but resistance amongst staph/strep is rare
- At UPMC, ~80% of Enterococcus faecium is VRE (vancomycin- resistant), as is ~20% of E. faecalis
Fosfomycin:
Mechanism of Action
Gram+
Gram-
Other
Adverse Effects
Comments
None
Inhibitors of cell wall synthesis
Streptococcus
Staphylococcus
Enterococcus
E. coli & others
Not pseudomonas
- Only available in USA as single- dose oral regimen for acute cystitis in females
- First line option due to increasing E coli resistance to other agents (TMP/SMX, quinolones)
TMP/SXM:
Mechanism of Action
Gram+
Gram-
Other
Adverse Effects
Comments
Inhibitors of DNA & RNA synthesis
S. aureus
S. epi
Most MRSA & MRSE
Poor streptococcus
Most gram- including Stenotrophomonas maltophilia
EXCEPT
Pseudomonas
Nocardia
Pneumocystis jiroveci (PCP) (fungus)
Toxoplasma gondii (protozoa) NOT
B. fragilis or other anaerobes
- Skin rash (3-4%): from mild reactions that resolve with continuation to Stevens-Johnson (rare)
- Renal: TMP inhibits secretion of creatinine and may lead to mild (~10%) elevations of serum creatinine
- Hyperkalemia
- Acute tubular necrosis
- Acute interstitial nephritis
- Hematological: neutropenia, thrombocytopenia (rare)
- Many uses, including urinary tract, gastrointestinal, skin, pneumocystis (both treatment and prophylaxis), toxoplasmosis, nocardiosis
- Monitor for increase in INR when used concomitantly with warfarin (drug interaction)
- Dosing based on Trimethoprim component
Rifampin:
Mechanism of Action
Gram+
Gram-
Other
Adverse Effects
Comments
Inhibitors of DNA & RNA synthesis
Staph/Strep
No enterococcus
Not used as monotherapy
N. meningitidis (prophylaxis only)
M. tuberculosis
- Orange-red discoloration of tears, sweat, urine, etc
- Gastrointestinal
- Hepatotoxicity: from mild, transient elevations in bilirubin to fulminant hepatitis (rare)
- MANY drug-drug interactions
- Utilized almost exclusively in combination due to rapid emergence of resistance when utilized alone
- Uses: Tuberculosis, staphylococcal endocarditis, infections of prosthetic materials