antibiotic classes Flashcards
Name the major classes of ABX (6)
Betalactams, Fluoroquinalones, Macrolides, Tetracyclines, Lincomycins, Sulfonamides
Name the “Miscellaneous” classes/ABX (7)
Nitrofurantoin, Metronidazole, Rifamycin, Aminoglycosides, Vancomycin, Linezolid, Daptomycine
3 Subdivisions of Penicillins
Penicillin G derivatives, Anti-Staphylococcal Penicillins, Extended Spectrum Penicillins
2 Subclasses of Betalactams
Penicillin deritatives and cephalosporins
Pen G derivatives (4)
Pen G, Pen C, Ampicillin, Amoxicillin
Pen G works on:
Most GP, susceptible staphylococcus and streptococcus pyogenes, enterococcus (GP), [limited GN]
4 indications for use of Pen G derivatives (Amp, Amox, Pen G, Pen V)
- Uncomplicated OTM (Amoxicillin)
- pre-partum group beta strep prophylaxis (Amp)
- Sub-acute Bacterial Endocarditis prophylaxis (Pen V)
- H. pylori (amox)
Anti-Staphylococcus Pen drugs (5)
Dicloxacillin, Cloxacillin, Nafcillin, Methicillin
What is MRSA due to? (resistance)
overuse of penicillins, mainly anti-staph
Methicillin Resistant Staph Aureus
4 indications for anti-staph penicillins
- coagulase neg staph
- MSSA
- Beta-lactamase producing strep
- bacterial endocarditis
(infx d/t susceptible strains of staphylococcus)
What is a broadened spectrum agent?
it utilizes an “add on” beta lactamase inhibitor that is added onto the penicillin
3 broad spectrum Penicillins
Augmentin, Unasyn, Zosyn
4 “super” penicillins (broad spec and extended spec)
Ticarcillin, mezlocillin, azlocillin, piperacillin
What are the Super pens good for?
Both BL and non-BL GP & GN, some anaerobes
*serious infections, hospital setting, all IV
3 (negative) things to think about when using Penicillins:
- secreted by kidneys: look at renal function!
- high rates of hypersensitivity (anaphylaxis)
- increasing BL resistance
3 indications for penicillins in general:
- pediatric indications (amoxicillin)
- Specific indications (UTIs that that don’t respond to bactrim)
- inpatient indications (broadened spectrum, serious infxn)
Cephalosporin 1st generation drugs (3)
cefazolin, cephalexin, cefadroxil
Cephalosporin 2nd generation drugs (2)
Cefoxitin, Cefuroxime
Cephalosporin 3rd generation drugs (2)
ceftriaxone, cefpodoxime
Cephalosporin 4th generation drugs (1)
cefipime
what are 1st gen cephalosporins good for? (2)
most non-BL producing GP, non-BL producing GN aerobes
alternative to pen G for pediatrics, SSTs
what are 2nd gen cephalosporins good for? (2)
GN, GP (slightly less than 1st gen), anaerobes
clean-contaminated surgeries
what are 3rd gen cephalosporins good for? (2)
GP, GN
severe OTM, CAP, NOT prophylaxis in surgery d/t no anaerobic coverage
what are 4th gen cephalosporins good for?
GP, GN (better BL-producing organism resistance than 3rd gen)
*limited to clinically serious infections (inpatient)
Fluoroquinalones (5)
Ciprofloxacin, Ofloxacin, Levofloxacin, Moxifloxacin, Gtifloxacin (-“ofloxacins”)
2 good things about FQs
- available in both IV and Po; and dosing conversion in 1:1
- broad spec; good for empirical tx of common comm. acquired infxns
4 clinical issues with FQs
- not useful for CNS infxns
- reduced absorption with cations (can not take with antacids)
- not for pregnant or kiddos (bone growth issues)
- growing resistance
- not good for pt’s with impaired renal function (dose and check CrCl frequently)
What are FQs good for treating?
- Staphylococcus, GN
- minimal activity against streptococcus (Levo and Moxi are the exceptions) and anaerobes (moxifloxacin is the exception)
3 Macrolide ABXs
Erythromycin, Azythromycin (zithromax), clarithromycin (biaxin)
What are macrolides good at getn’?
susceptible GP, atypical coverage (mycoplasma, legionella, chlamydia)
clinical indications of Macrolides
CAP
atypical pneumonia (mycoplasma, legionella)
chlamydia
susceptible URIs
clinical issues with macrolides
- resistance: take home: DO NOT use macrolide if pt has recent hx of macrolide use
- emerging resistance of streptococcus
Tetracyclines (4)
tetracycline
doxycycline
minocycline
tigecycline
what are tetracyclines used to treat?
GP &GN areobes, anaerobes
clinical indications for tetracyclines? (4)
rickettsial infxns (lyme, RMSF) chlamydia alternative (doxy) secondary infxns to acne vulgarus (mino) serious infections (+ sensitivity to Tige)
clinical issues of tetracyclines (2)
contraindicated for pregnant and kiddos (bone growth)
bad for GI flora
Lincomycins (1)
clindamycin
what does clindamycin treat? (2)
GP aerobes
anaerobes!!
clinical indications for clindamycin?
Gut/GI/GU anaerobic infections GP infections (streptococcus, staphylococcus that are sensitive)
clinical issues with clindamycin?
BAD for GUT (enterocolitis is a major side effect)
resistance with GP
Sulfonamide abx (6)
sulfamethoxazole trimethoprim SMX/TMP (Bactrim) sulfaisoxazole sulfadiazine silver sulfadiazine (silvadene)
Spectrum of coverage for Sulfa drugs (2):
GP and GN
clinical indications for sulfa drugs (4)
pediatric URI
PCP pneumonia (for immunocompramised pts=bactrim)
bacterial infections secondary to burns (topical)
ocular infections
clinical issues with sulfa:
resistance
SEVERE side effects (rash, anemias, SJS)
Nitrofurantoin indication:
alternative for uncomplicated UTI (d/t GN aerobes liek E. coli, klebsiella, proteus)
clinical issues with nitrofurantoins:
-not good for pt’s with impaired renal function (not toxic, just doesn’t work)
Metronidazole indications:
antiprotozoal (trichamonas) and antimicrobial anaerobic species (helicobacter, bacteroides, c. Diff)
antibiotic Rifamycin in class
rifampin
spectrum of activity/ indications for rifampin (3):
susceptible GP (a few GN)
TB (mycobacterial) in combo with other agents
meningitis (goes in CNS rapidly)
draw backs of rifampin:
hepatotoxic
numerous drug interactions
resistance
makes you pee orange… but who really cares?
Aminoglycosides (4):
gentamicin
tobramycin
spectinomycin
amikacin
spectrum of activity for aminoglycosides:
GN aerobic
synergistic effect on GN infections that are tough to tx
bad things about aminoglycosides (2):
renal and ototoxic (hearing loss)
Vancomycin is structurly similar to….
aminogylcosides
mode of administration of vancomycin:
IV only (unless treating a GI infection)
spectrum of activity for vancomycin (3)
GP
MRSA!!!!
Metronidazole resistant c. Diff
clinical issues with Vancomycin
oto and renal toxic
Antibiotic in oxalininone class:
linezolid (zyvox)
spectrum of activity for zyvox (3)
GP aerobes
MRSA!!
VRE!!
(primarily used for inpatients with MRSA/VRE)
drawbacks of zyvox/linezolid
$$$$$$
significant drug/food interactions (seritonin, caetcholamines, cheese and wine)
Daptomycin spectrum of activity/ indication
MRSA! MSSA/anti-staphylcoccal VRE (?) most GP (indicated for serious GP infections of hospitalized pts; bacteremia, SSTs)
drawbacks of Daptomycin
only IV, too big and complicated
$$$$- reserved for pts that are not responding to other tx
not indicated for pts w/ pneumonia, even if caused by MRSA
Daptomycin : the good things
VERY bacericidal
benign side effect profile
what are bactericidal abx dependent on?
concentation
what are bacteriostatic abx dependent on?
time/host dependent (the pt’s immune system needs to be functioning)
bacteriostatic classes (5):
(MALTS) Macrolides Amineogylcosides Lincomycins Tetracyclines Sulfonamides
Bactericidal classes/drugs (5):
Betalactams Fluoroquinolones Vancmycin Rifamycin daptomycin
What ABX treat gram Neg? (1 drug, 2 classes)
Cipro (only FQ for GN), Aminoglycocides, nitrofurantoin
What Abxs treat both GN and GP? (4 drugs, 3 classes)
piperacillin, ticarcillin, rifampin, metronidazole
2nd-4th gen cephalosporins
FQ
Sulfonamides
which ABX treat gram positive?(4 classes/sub classes, 4 drugs)
Pen G, Anti-Staph, 1st gen Cephalosporins, tetracyclines
clindamycin, zyvox, daptomycin, vancomycin
