Antimicrobials

Question 1

Pentamidine

Answer 1

PCP, leishmania, Trypanosoma brucei

Question 2

Anti-pseudomonal drugs

Answer 2

Some penicilins, cephalosporins, aminoglycosides, fluoroquinolones:

• Ticarcillin, carbenecillin, piperacillin
• Ceftazidime and Cefepime
• Amikacin, Gentamicin, Tobramicin
• Ciprofloxacin, Levofloxacin
• Aztreonam
• Imipenem/cilastatin, Meropenem

Question 3

Antiviral transcriptase inhibitors: which require viral kinase?

Toxicities?

Answer 3

• Require viral kinase:
  
  • Acyclovir - HSV thymidine kinase - crystalline nephropathy
  • Ganciclovir - CMV UL97 kinase - bone marrow suppression (due to CMV tropism?)
  • Famciclovir (prodrug, converted to penciclovir) - HSV thymidine kinase
• Require host kinase:
  
  • all cyclovirs after viral kinase phosphorylation
  • HIV nucleoside analogues - zidovudine, emtricitabine, etc.
  • HIV nucleotide analogues - tenofovir, cidofovir.
• Does not require phosphorylation: foscarnet
• UL97- CMV and thymidine kinase- HSV (HIV associated):
  
  • ​foscarnet, cidofovir
  • both have renal toxicity

Question 4

What is the Jarisch-Herxheimer reaction?

Answer 4

Sepsis-like sx due to massive death of immune-evading or intracellular bacteria.

Classicaly, upon PCN administration to a syphilis-sufferer.

Also, borreliosis aka tick-borne relapsing fever, Rickettsial infx.