- Bind to penicillin binding proteins and inhibit cell wall synthesis causing cell death

Natural Penicillins - Penicillin VK + G Aminopenicilins - Ampicillin - Amoxicillin Penicillinase-resistant Penicillin - Dicloxacillin, - Nafcillin, - Oxacillin, - Methacillin Extended-spectrum Penicillins - Ticarcillin/clavulanate - Piperacillin/tazobactam B-Lactamase Inhibitors - Clavulanate - Tazobactam - Sulbactam

- Dicloxacillin, - Nafcillin, - Oxacillin, - Methacillin

Spectrum: - Staph + Strep Uses: - DRUG OF CHOICE for B-lactamase producing staph - Cellulitis + Endocarditis

- Ticarcillin/clavulanate - Piperacillin/tazobactam

Spectrum: - Gram (+), Staph + Strep - Gram (-): Enterobacteriaceae - Anaerobes: Bacteroides Uses: - Nosocomial PNA, intra-abdominal infections - Skin and soft tissue infections

Adverse Effects - Similar effects to PCN - Cefotetan (2nd): - MTT side chain → hypoprothrombinemia + bleeding + disulfiram like reaction Other: - Earlier generations = better gram (+) coverage - Later generations = better gram -coverage - Use in caution w/ pts who have PCN allergy

- Cephalexin – oral - Cefazolin – IV

Spectrum: - SPEcK: - Strep (+), Proteus, E. coli, Kleb Uses: - Mild skin / soft tissue inf

Antibiotics Flashcards by Arton Azizi

Beta-Lactams MOA?

Bind to penicillin binding proteins and inhibit cell wall synthesis causing cell death

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Beta-Lactams Drugs?

Natural Penicillins
- Penicillin VK + G

Aminopenicilins

Ampicillin
Amoxicillin

Penicillinase-resistant Penicillin

Dicloxacillin,
Nafcillin,
Oxacillin,
Methacillin

Extended-spectrum Penicillins

Ticarcillin/clavulanate
Piperacillin/tazobactam

B-Lactamase Inhibitors

Clavulanate
Tazobactam
Sulbactam

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Natural Penicillins?

Penicillin VK + G

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Penicillin VK + G

Spectrum:

Streptococcus pyogenes
Treponema Pallidum

Uses:

Pharyngitis,
Erysipelas,
Syphillis

Other:
- Probenicid ↓ the renal tubular secretion of PCNs co-administration causes ↑ abx serum levels

OC interaction:
- Rifampin ↓ levels of ethinyl estradiol and norethindrone by ↑ metabolism thru liver enzymes

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Aminopenicilins?

Ampicillin

- Amoxicillin

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Ampicillin

- Amoxicillin

Uses:

URI
DRUG OF CHOICE for susceptible Enterococcal infections
Skin inf, UTI, CAP, lymphadenitis (Augmentin)

Adverse Effects:
- GI upset / Diarrhea (especially augmentin)

MC w/ ampicillin and in nearly all pts w/ mono:
Maculopapular/urticarial rash
Anaphylaxis + Angioedema

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Penicillinase-resistant Penicillin?

Dicloxacillin,
- Nafcillin,
- Oxacillin,
- Methacillin

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Dicloxacillin,
- Nafcillin,
- Oxacillin,
- Methacillin

Spectrum:
- Staph + Strep

Uses:

DRUG OF CHOICE for B-lactamase producing staph
Cellulitis + Endocarditis

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Extended-spectrum Penicillins

Ticarcillin/clavulanate

- Piperacillin/tazobactam

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Ticarcillin/clavulanate

- Piperacillin/tazobactam

Spectrum:

Gram (+), Staph + Strep
Gram (-): Enterobacteriaceae
Anaerobes: Bacteroides

Uses:

Nosocomial PNA, intra-abdominal infections
Skin and soft tissue infections

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B-Lactamase Inhibitors

Clavulanate
- Tazobactam
- Sulbactam

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Clavulanate
- Tazobactam
- Sulbactam

Other: Booster

-Enhances antimicrobial activity against certain B-lactamase producing orgs, extending the abx antimicrobial spectrum

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Cephalosporins

Adverse Effects
- Similar effects to PCN

Cefotetan (2nd):
- MTT side chain → hypoprothrombinemia + bleeding + disulfiram like reaction

Other:

Earlier generations = better gram (+) coverage
Later generations = better gram -coverage
Use in caution w/ pts who have PCN allergy

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1st Generation Cephalosporins?

Cephalexin – oral

- Cefazolin – IV

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Cephalexin – oral

- Cefazolin – IV

Spectrum:

SPEcK:
Strep (+), Proteus, E. coli, Kleb

Uses:
- Mild skin / soft tissue inf

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2nd Generation Cephalosporins?

Cefuroxime – oral

Cefoxitin – IV

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Cefuroxime – oral

Cefoxitin – IV

Spectrum:

HM-SPEcK:
Haemophilus flu, Moraxella,
Strep (+), Proteus, E. coli, Kleb

Uses:
- Cefoxitin: anaerobic coverage i.e. bacteroides

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3rd Generation Cephalosporins?

Cefpodoxime – oral

Ceftriaxone – IV

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Cefpodoxime – oral

Ceftriaxone – IV

Spectrum:
 MESH:
  - Moraxella
  - Enterobacteriaceae (-)
  - Strep PNA (+)	
  - H. flu

Uses:

CAP,
otitis media,
URI

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4th Generation Cephalosporins?

Cefepime – IV

Ceftaroline – IV

Cefepime – IV

Ceftaroline – IV

Spectrum:
- Gram (+), (-), anaerobes

Uses:
- Nosocomial infections

Carbapenems

MOA:

Binds to PCN binding protein
- Inhibits cell wall synthesis
- Cell Death

Spectrum:
- Srep, Staph, Listeria, Gram (-), Anarobes, Pseudomonas (Except Entrapenem)

Uses:

DRUG OF CHOICE for infections caused by ESBLs (extended spectrum beta lactamases)
UTI, Resp inf, Skin tissue, Bone

Side Effects:
- N/V , Seizures

Other:

Cross sensitivity w/ PCN allergy
Renal done adjustment

Fosomycin

Spectrum
Gram (-) + (+) coverage

Uses:
- UTIs in women

Other:
- One-time 3 gram dose

Bacitracin

Uses:

Topical use ONLY
Surface skin lesions, irrigation of wounds + joints

Other:
- Highly nephrotoxic when administered IV

Cycloserine

Spectrum: - Gram (+) + (-) coverage Uses - MC resistant TB Other: - Serious adverse effects: HA, tremors, acute psychosis

Tetracycline, Minocycline, Doxycycline

Spectrum: - S. PNA, S. Pyogens, Atypicals Uses - Respiratory infections + CA-MRSA

Macrolides Erythromycin, Clarithromycin, Azithromycin

``` Spectrum: ASH - Atypicals - Strep, - H. flu, ``` Uses: - CAP Other: - Alternative for PCN allergies

Clindamycin

Spectrum: - Anaerobes, CA-MRSA Uses: - Skin, soft tissue and anaerobic infections CA-MRSA Other: -Alternative for dental prophylaxis in PCN allergies

Vancomycin (IV)

Spectrum - Gram (+) Uses: - MRSA

Linezolid (PO)

Spectrum: - Gram (+) Uses: - Resistant infecitons i. e. MRSA or Vancomycin resistant E. faecium

Aminoglycosides Gentamicin, Tobramycin, Amikacin

Spectrum: - Gram (-) bacilli Other: - Benefits of extended interval dosing

Sulfonamides

Uses: - UTI - Sulfamethoxazole-trimethoprim = 1st line for CA-MRSA, PCP tx + px

Fluoroquinolones (floxin) - Cipro - Oflo - Norflo

Spectrum: - Gram (-) enterobacteriaceae Uses: - Complicated + uncomplicated UTIs

Fluoroquinolones (floxin) - Levo - Moxi, - Gati optho only*

``` Spectrum: MESH-P - Moraxella catarrhalis - Enterobacteriaceae, - S. PNA, - H. flu, - Pseudomonas (Levo) ``` Uses: - Similar to 2nd generation +: CAP + URI Other: - * Moxi NOT used for UTIs

Metronisazole

Spectrum: - Protozoa + anaerobes-Bacteroides group, C. dif Uses: - Intra-abdominal, - gynecologic infections - Pseudomembranous colitis d/t C. dif

Nitrofurantoin

Uses | - UTI

Infection

The isolated organisms are form the specimen and causing the infection

Colonization

The isolated organisms are from the specimen, but are NOT causing symptoms

Contamination

The isolated organisms came from the patients’ skin or the environment

Minimum inhibitory concentration MIC

The lowest antimicrobial concentration that prevents visible growth of an organism

Susceptible

You can get enough drug into the patient to treat the infection (MIC < attainable serum levels)

Intermediate

You may not be able to get enough drug into the pt to treat the infection unless the drug is safe enough to give in high doses or the drug concentrates exceptionally well at the infection site (MIC = attainable serum levels)

Resistant

You cannot get enough drug into the pt to treat the infection (MIC > attainable serum levels)

Drug factors (examples)

Antimicrobial spectrum, cost, routes of admin, DIs, efficacy, safety

Patient factors (examples)

``` Age, hepatic/renal impairment, allergies, pregnancy, cost, route of admin, DIs, compliance ```

Intrinsic resistance

Naturally occurring resistance (i.e. drug cannot penetrate org cell wall)

Acquired resistance

A normally sensitive organism becomes resistant

Mechanisms of acquired resistance

Detoxifying enzymes, alteration in abx target site, decreased cellular accumulation of antibiotics

Daptomycin

MOA: - Cell wall or membrane activity Spectrum: - Similar to Vanco + VRE & VRSA Uses: - Skin, Soft tissue, Bacteremia, Endocarditis, NOT PNA Side Effects: - Inj site rxn, Fever, chills, N/V, muscle. cramps + weakness Other: - Renal Dose adj - Monitor CPK