antimicrobials Flashcards
1
Q
Penicillin G
MOA:
PK:
Allergy:
Anaphylaxis
A
first generation beta-lactamase sensitive penicillin
MOA: beta lactam, bacteriacidal
PK: 90% renal tubular excretion.
Allergy in 10% of pop.
anaphylaxis is 0.004 to 0.04%,
mortality in 10%
2
Q
Amoxicillin
Class:
MOA:
A
2nd generation beta-lactamase sensitive PCN
MOA: beta-lactam bactericidal
3
Q
Ampicillin
MOA:
Pk:
A
2nd generation beta-lactamase sensitive PCN
MOA: beta-lactam, bactericidal
Pk: 50% excreted unchanged by the kidney 6 hours after dose
In the anesthesia cart!
4
Q
Carbenicillin
class:
SE:
A
3rd generation beta-lactamase sensitive PCN
Unique! r/t lots of SE
- High sodium load (30-40 mg) -> caution in CHF
- Hypokalemia
- Metabolic Alkalosis
- Prolonged bleeding time despite normal platelet count also needs renal dose.
5
Q
carbenicillin is avoided in CHF r/t
A
high sodium load, 30-40 mg
6
Q
beta-lactamase resistant PCNs are affective against
A
staph aureus
but otherwise are narrow spectrum agents
7
Q
Nafcillin
class:
Pk:
Excretion:
A
beta-lactamase resistant PCN!
- Good for staph aureus, otherwise narrow spectrum
penetrates the CNS 80%
secreted in BILE!
GOOD FOR RENAL!
8
Q
PCN for patients renal dysfunction:
A
Nafcillin
beta-lactamse resistant PCN
80% secreted in bile
9
Q
Dicloxacillin
class:
A
beta-lactamase resistant PCN
10
Q
Oxacillin
class:
A
beta-lactamase resistant PCN
11
Q
Unasyn [ampicillin/sulbactam]
A
beta-lactamase sensitive / beta-lactamase resistant PCN
12
Q
amoxicillin/clavulanic acid [augmentin]
A
beta-lactamase sensitive / beta-lactamase resistant PCN
13
Q
ticarcillin/clavulanic acid [timentin]
A
beta-lactamase sensitive / beta-lactamase resistant PCN
14
Q
pipercillin/tazobactam [zosyn]
A
beta-lactamase sensitive / beta-lactamase resistant PCN
15
Q
Cephalosporin MOA:
A
Cephalosporins also have a beta-lactam ring,
so function by binding to pencillin binding proteins,
inhibiting transpeptidase, and
activating autolysins.
16
Q
Cephalosporins are usually excreted
A
via renal route
**exception = ceftriaxone
17
Q
Bleeding Concerns with Cephalosporins:
A
cefoperazone, cefotetan, ceftriaxone
These inhibit the conversion of vitamin K to active form, inhibits factors 2, 4, 10 and prothrombin.
18
Q
Cefuroxime
class:
A
2nd generation cephalosporin
DOES cross placenta
19
Q
Cefoxitin
class
A
2nd genration cephalosporin
20
Q
Cefemetazole
class
SE:
A
2nd generation cephalosporin
Anta-abuse agent
21
Q
Cefotetan
Class:
SE:
Interacts:
A
2nd generation cephalosporin
r/f bleeding
- r/t inhibits conversion of vitamin K to active form
- Antabuse drug!!!
- Interacts with anti-plt / anti-coag drugs
22
Q
Ceftazidime
Class:
A
3rd generation cephalosporin
23
Q
Cefotaxime
Class:
A
3rd generation cephalosporin
24
Q
Ceftriaxone
Class:
Pk:
SE:
Interacts:
A
3rd generation cephalosporin
- Has some renal excretion but significant liver metabolism Longest e1/2 time of cephalosporins
- R/F bleeding r/t inhibits conversion of vitamin K to active form
- Interacts with anti-platelet drugs / anti-coags
- FORMS PRECIPITATES WITH CALCIUM - fatal, neonates
25
Cefepime
Class:
Pk:
Coverage:
generation **4 cephalosporin**.
* broadest spectrum activity against gram +, gram -,
* **_crosses BBB_**,
* activity against anaerobes.
* $$expensive
26
Ceftaroline
Class:
Either *5th* or *3rd* generation cephalosporin.
**_MRSA_** coverage
27
Aztreonam
MOA:
Pk:
Excreted by:
SE:
class: **monobactam**
MOA: has a **beta-lactam ring**
* but only binds to _GRAM NEGATIVE_ bacteria
* Very resistant to beta-lactimase
**Pk:**
* Penetrates CSF
**Excreted**
* unchanged by **kidney !!**
Biggest SE
* **GI superinfection**
28
Erythromycin
Clarithromycin
Azithromycin
are:
macrolides
29
**macrolides**
MOA:
metabolism:
excreted:
**MOA:** bind to 50S subunit and therefore are _bacteriostatic_, *can be bactericidal in large concentration*
**Metabolized** by CYP450 - **CYP3A4**
**Excreted** in BILE
30
_Macrolides_ are very good against:
**ATYPICAL** pathogens:
Community Aquired Pneumonia
Legionella Pneumophila
Pertussis
Acute Diptheria
Chlamydial Infections
Bacterial Endocaridits
**_Limited_ activity against anaerobes**
31
biggest concern with macrolides
r/f for **QT prolongation**, dysrythymias
## Footnote
**especially when prescribed with CYP3A4 inhibitors**
32
_Clindamycin_
## Footnote
**Class:**
**MOA:**
**Used for:**
**Metabolized by:**
**Excreted by:**
Clindamycin:
## Footnote
**Class:** Linomycin
**MOA:** Binds to 50S sub-unit, so also _bacteriostatic_
**Most Commonly Used:** for female GU surgery
**Metabolized By:** liver
**Excreted**: mostly in bile
33
SE of Clindamycin
1. pseudomembranous colitis
2. 6% C. Diff
3. Blood Dyscrasia
**4. Muscle weakness -\>**
* Prolonged *pre* and *post* junctional effects NMJ
* *_Not antagonized_* by anticholinesterase or calicum
anti-cholinesterase = acteylcholinesterase inhibitor
34
Profound NMB with **clindamycin**
is NOT reversed with calcium or neostigmine
neostigmine = acetylcholinesterase inhibitor/anticholinesterase
35
Decrease dose in clindamycin with
**severe LIVER** disease
36
_Vancomycin_
## Footnote
**class:**
**MOA:**
**PharmacoK:**
**excretion:**
_vancomycin_
**class:** glycopeptide
**MOA:** Depletes cell of precursors for cell wall
* *slow bacteriacidal*
**PharmacoK:**
* poorly absorbed via GI route,
* slow CSF penetration unless active infalmmation.
**Excretion:** 90% excreted unchanged kidneys
37
Vancomycin is a good choice for
**MRSA coverage**!
Good choice for **PCN allergy**
serious staph infections
**surgery with prosthetic devices**
**CSF**/shunt related infections
bacterial endocarditis
Severe C. Diff
38
Amikacin
Gentamycin
Neomycin
class:
**aminoglycosides**
39
_Aminoglycosides_
## Footnote
**MOA**
**Excretion**
_Aminoglycosides:_
## Footnote
**MOA:** bind to 30S subunit and block initiation of protein synthesis - BACTERICIDAL
**excretion:** 100% renal
40
Skeletal Muscle Weakness with aminoglycosides
Aminoglycoside inhibit the pre-junctional release of acetylcholine and decrease post-synaptic sensitvity to the neurotansmitter
**_Potentiaton of NDNMB_**
* paralysis is usually reversible with calcium gluconate or neostigmine (acetylcholinesterase inhibitor)
41
amikacin + PCN
is C/I because amikacin can antagonize the effects of PCN
42
_Zyvvox_
**MOA**
Zyvvox
**MOA: I**nhibits bacterial protein synthesis by inhibiting formation of functional ribosome unit 23.
_BACTERIOSTATIC_
43
_Zyvvox Coverage:_
_Zyvvox_
## Footnote
Gram positive pathogens
*Not active against gram negative*
**Active against resistant bacteria such as _MRSA_ and _VRE_**
Expensive $$
44
Zyvox is ***contraindicated***
_Zyvvox is contraindicated for_
1. PKU patients
* Formualted with phenylalanine
2. SSRIs
* Zyvvox is a weak MAO-I, increase r/f serotonin syndrome
3. Meperidine
* Zyvvox is a weak MAO-I, increase r/f serotonin syndrome
4. Ephedrine
* zyvvox is a weak MAO-I, increase r/f HTN crisis
45
Zyvvox acts as a weak ...
Zyvvox acts as a **_weak MAO-I_** and should be avoided with: **SSRIs, meperidine, ephedrine.**
46
cephalosporin adverse effects
**Allergy in 10%**
* (cross sensitivity 1% to PCN)
**Bleeding!**
* Inhibits conversion of vitamin K to active form, inhibits factors 2,4,10 and prothrombin
* Cefotetan, Ceftriaxone, Cefperazone
**Thrombophlebitis at IV site**
**Hemolytic Anemia**
**R/F Superinfection** (C. Diff)
47
routes of administration for cephalosporins
1st and 2nd = PO/oral and IV 3rd, 4th = generally administered IV
48
cephalosporins that cross placenta:
cefazolin
49
cephalosporins that cross BBB
cefuroxime, 3rd gen (ceftazidime, cefotaxmie, ceftriaxone) 4th generation: cefepime
50
cephalosporin of choice in renal failure
ceftriaxone
51
gram + activity in cephalosporins
basically of them
52
gram - activity in cephalosporins
generation 3 and 4
53
activity against anaerobes in cephalosporins
generation 3 and 4
54
beta-lactamase susceptibility in cephalosporins
decreases as you get to broader generations.
55
monobactams
aztreonam
56
aztreonam is a good in PCN/Cephalosporin allergy
because it does not have either side ring but DOES have a beta-lactam ring. BUT! only works on gram negative
57
Beta-Lactamase Resistance PCNs
Nafcillin \* best
Oxacillin
Dicloxacillin
58
Beta-Lactam Sensistive/Beta-Lactam Resistant Combinations
Ampicllin/Sulbactam "Unasyn"
Amoxicllin/Clavulanic Acid "Augmentin"
Ticarcillin/Clavulanic Acid "Timentin"
Pipercillin/Tazobactam "Pipercillin"
59
Aztreonam with PCN allergy
_Safe!_
*Has a _beta-lactam ring_*, but does not have iether side ring found in *PCN* or *cephalosporins* so good for allergy with either.
But only works on gram-negative bacteria.
60
Macrolide SE:
**QT prolongation**
**Severe N/V** with IV infusion
May slow gastric emptying, increase r/f **aspiration**
**Cholestatic Hepatitis**
IV assocaited with tinnitus
Thrombophlebitis
61
CYP3A4 inhibitors
Verapamil
Diltiazem
Protease Inhibitors
Azole Antifungals
will prolong actions of macrolides, **increase r/f QT prolongation *dramatically***
62
Macrolide drugs:
Erythromycin
Azithromycin
Clarithromycin
63
Azithromycin is notable because of its
class: macrolide
## Footnote
**E1/2T = 68 hours.**
64
_Vancomycin_
Dose:
Administration:
Vancomycin:
**Dose: 10 - 15 mg/kg over 60 minutes**
12 hours of therapeutic plasma concentration
IV administration over **60 minutes**
65
Vancomycin SE:
Thrombophlebitis
Nephrotoxicity ("Rare")
Otoxicity (\>30mcg/mL)
Hypersensitivity
Severe Hypotension / Red Man Syndrome (rapid adminstration)
Immune Mediated Thrombocytopenia and Bleeding (Rare)
66
Nephrotoxicity with Vanco:
**Usually occurs as the result of combined effect.**
## Footnote
Vancomycin + aminoglycoside in compormised pt (DMII, decreased Cr Clearance)
Or
Vancomycin + other nephrotoxic drug.
67
Vancomycin + Aminoglycoside
_Synergistic effect based on two MOA._
**Vanco:** slowly deprives bacterial cells of precursors for cell walls
**Aminoglycosides:** Bind to 30S ribosome subunit and block the intiation of protein synthesis in bacterial cells
_Synergism but **increased risk** for nephro/ototoxicity_
68
Aminoglycosides SE
_Aminoglycosides SE_
_*Crosses* the placenta_ -\> **cause ototoxicity in fetus**
_*Ototoxicity* -_
* especially with diuretics, mannitol, vancomyci
_*Nephrotoxicity*_
* esp with amphotericin B, cyclosporine, etracrynic acid, vancomyin, NSAIDs
*_Skeletal Muscle Weakness_*
* Inhibit the prejunctional release of Acetylcholine and decrease post-synaptic sensitivity to the neurotransmitter
69
Gentamicin
_Aminoglycoside._
## Footnote
**Broader spectrum:** does pleural, ascitic, synovial infections
Toxic Level = \>9mcg/mL
Levels should be monitored.
70
Amikacin
_Aminoglycoside_
Very little abx resistance yet.
Do not use with PCN (may antagonize effects)
71
Neomycin
_Aminoglycosides_
## Footnote
Topical treatment for skin, eye, mucous membrane infections
Allergy Risk: 6-8%
Adjunct therapy to hepatic coma (decreases ammonia concentrations)
Adminsitered to **decrease bacteria in intestine before GI surgery**
**Most nephrotoxic**
72
Zyvvox SE:
1. Thrombocytopenia
2. GI affects (diarrhea/nausea)
3. Rare: optic / peripheral neuropathy
73
Fluoroquinolone Agents:
_Flouroquinolones:_
Ciprofloxacin
Levofloxacin
Moxifloxacin
74
_Flouroquinolones:_
**MOA:**
**Excretion:**
Flouroquinolones:
## Footnote
**MOA:** Inhibits DNA gyrase and topoisomerase, prevents bacterial replication.
**Excretion:** Renal excretion!
75
Fluoroquinolones SE:
Fluoroquinolones SE:
**1. QT prolongation**
2. Nasuea
**3. C. Diff superinfection**
4. CNS disturbances
5. Opportunistic Candida
6. Rashes
7. Phototoxicity (severe sunburn)
**8. Muscle Wakness in _Myasthenia Gravis pts_**
9**. Tendinitis and Achilles Tendon rUPTURE**
* due to extracellular cartilage matrix weakning
* high risk \>65 y/o
* avoid IV drug in \<18 y/o
76
Flouroquinolones Drug Interactions
Fluoroquinolones Drug Interactions:
## Footnote
CYP450 interactions: increase levels of theophylline, warfarin, tinidazole
77
Fluoroquinolones are contraindicated with
Myasthenia Gravis patients
Cause increased muscle weakness in these patients.
78
Fluroquinolnes wiht the highest risk of adverse SE
Moxifloxacin
79
_Sulfonamides_
## Footnote
**MOA**
**Pharmacokinetics:**
_Sulfonamides_
**MOA:** Prevent normal bacterual use of para-aminobenzoic acid [PABA] by bacteria to synthesize folic acid.
* **Bacteriostatic**
**Pharmacokinetics:** Portion of drug is acetylated by liver and other is renally excreted
80
_Sulfonamides:_ Clincal Uses
_Sulfonamides:_ Clincal Uses
## Footnote
1. UTI
2. Inflammatory Bowel Disease
3. **Burns**
4. PCP prophylaxis with HIV+
81
_Sulfonamides SE_
_Sulfonamides SE_
## Footnote
Skin Rash -\> Anaphylaxis
Steven-Johnson's Syndrome (more common c PCP/HIV+)
Photosensitivity
Allergic Nephritis
_Drug Fever_
**Hepatotoxicity**
Acute Hemolytic Anemia
**Thrombocytopenia**
**Increase effect of PO anti-coagulant**
82
_Metronidazole_
## Footnote
**MOA:**
**Pharmacokinetics:**
_Metronidazole_
**MOA:**? -\> ***Bacteriacidal***
**Pharmacokinetics:**
* Well absorbed orally and widely distributed in tissue inlcuding *_CNS_*
83
_Metronidazole SE:_
_Metronidazole SE:_
## Footnote
Dry Mouth
Metallic Taste
Nausea
Avoid Alcohol: Antabuse Drug
Rare: Neuropathy and pancreatitis
84
_Metronidazole is used for:_
_Metronidazole is used for:_
## Footnote
**Anaerobic *gram negative*** bacilli and clostridium
**_Reccomended for pre-op prophylaxis for colorectal surgery_**
CNS infections
Abdominal and pelvic sepsis
Psuedomembraneous Colitis (**C. Diff**)
Endocarditis
85
Anti**_myco_**bacterial Agents
Anti**_myco_**bacterial Agents
## Footnote
1. Isoniazid
2. Rifampin
3. Ethambutol
4. Pyrazinamide
86
_Isoniazid_
## Footnote
**class:**
**MOA:
Note:**
_Isoniazid:_
## Footnote
**class:** Mycobacterial agent
**MOA:** Bacteriostatic agent, becomes bacteriacidal if cells are dividing.
**Note:** NAT2 fast vs slow acetylators.
Anesthesi: check LFTs
87
Antimycobacterial Agents are used for
1st line treatment against TB
Used in combinatino (3 or 4 agents) for 2 months
Followed by a minimum of 4 months on therapy with 2 agents.
88
_Rifampin_
## Footnote
**class:**
**MOA:**
**SE:**
_Rifampin_
## Footnote
**Class:** Mycobacterial Agents
**MOA:** bacteriacidal
**SE:** Hepato-renotoxicity, thrombocyopenia
89
_Ethambutol_
**Class**
**SE**
_Ethambutol_
**Class:** Mycobaterial Agents
**SE**: Optic neuritis
* prone with low BP -\> r/f optnic neuritis higher
90
_Pyrazinamide_
## Footnote
**Class:**
**SE:**
_pyrazinamide_
## Footnote
**Class:** mycobaterial agent
**SE:** Heptoxicity
91
Risk for hepatoxicty with mycobaterial agents increases
with acetaminophen or ETOH
92
_Amphotericin B_
## Footnote
**Class:**
**MOA:**
**Pharmacokinetics:**
_Amphotericin B:_
**Class:** Anti-Fungals
**MOA:** Binds to ergosterol in fungal membrane to form pores, altered membrane permeability leakage of cellular contents.
**Pharmacokinetics:**
* ***Slow renal excretion***, 80% of patients tx with drug have renal impairment - usually reversible.
* Poor PO absorption, given IV
93
_Amphotericin B_
Clincal Uses:
_Amphotericin B_
## Footnote
**Clincal Uses:** Yeast and fungi
94
_Amphotericin B_
SE:
_Amphotericin B:_
"ampho-terrible"
SE:
*Fevers, chills, dyspnea*, **hypotension**
**Impaired hepatic function**
Hypokalemia
Allergic Rxns
Seizure
Anemia
**Thrombocytopenia**
**Nephrotoxic**
95
_Acyclovir:_
**Class:**
**Uses:**
**SE:**
_Acyclovir_
**Class:** Anti-viral Drug
**Uses:** Tx Herpes
**SE:**
* Thrombophlebitis
* HA with IV infusion
* May cause **renal damage if infused *rapidly***
96
_Interferon B_
## Footnote
**Class:**
**MOA:**
**Uses:**
_Interferon B:_
## Footnote
**Class:** Anti-viral, recombinant DNA
**MOA:** Bind to receptors on host cell membranes and induce the production of enzymes that inhibit viral replication -- degradation of viral mRNA, enhance tumorcidal activites of macrophages
**Uses**: Hep B, Hep C, MS pts.
97
_Interferon B_
SE
_Interferon B:_
**SE:**
* **Flu like symptoms**
* Hematological toxicity
* Decreased mental concentration
* Development of ***autoimmune conditions***
* Depression
* Irritability
* Rashes
* Alopecia
* **Changes in CV, thyroid, hepatic function**
98
_HIV Fusion/Entry Inhibitors:_
## Footnote
**Class:**
**MOA:**
**Interferes with:**
_HIV Fusion/Entry Inhibitors:_
**Class:** Anti-Retroviral
**MOA:** Blocks the fusion/entry of virus into cells, blocks CCR5/CXCR4 proteins.
**Intereferes with:** metabolism/clearance of *_midazolam._*
99
_Zidovudine:_
**Class:**
**MOA:**
**SE:**
Zidovudine:
**Class:** Nucleoside Reverse Transcriptase Inhibitors - antiretrovirals
**MOA:** Blocks the actions of reverse transcriptase
**SE:**
* Nausea
* Diarrhea
* **Myalgia**
* Increase LFTs
* Pancreatitis
* Peripheral Neuropathy
* **Renal Toxicity**
* Marrow Suppresion
* Anemia
* Lactic Acidosis
* **Inhibition of CYP450**
100
_Zidovudine_
## Footnote
+ corticosteroids
+ succinylcholine
Zidovudine:
## Footnote
_+ Corticosteroids_ = Severe myopathy, including respiratory muscle dysfunction
_+ Succinylcholine_ = myalgia x 2.
101
**_NRTIs_**
Interact with:
Alter Metabolism/Clearance of:
**_NRTIs_**
Interact with:
* **Anticonvulsants:** phenytoin
* **Antifungals:** ketoconazole, dapsone
* **Alcohol**
* **H2 Blocker:** Cimetidine
Alter Metabolism/Clearance of:
* Opiates: **Methadone**
102
_Delavirdine_
## Footnote
**Class:**
**CYP450:**
Delavirdine
## Footnote
**Class:** NNRTI, anti-retroviral
**CYP450:** Inhibits - increases concentrations of sedatives, antiarrthymics, warfarin, Ca-Channel Blockers
103
_Nevirapine:_
## Footnote
**Class:**
**CYP450:**
_Nevirapine:_
## Footnote
**Class:** NNRTIs - antiretroviral
**CYP450:** induces! opposite of other drugs in class.
104
_NNRTIs_
## Footnote
**Interact with:**
**Prolong half life/effects of:**
_NNRTIs_
**Interact with:**
* **Anti-coagulant:** warfarin
* **Anticonvulsants:** carbamezapine, phenytoin, phenobarbital
* **Anti-TB drug:** Rifampin
* **Herbal:** St. John's Wort
**Prolong half life/effects of:**
* **Sedatives:** diazepam, midazolam, triazolam
* **Opiates:** fentanyl, meperidine, methadone
105
_Protease Inhibitors_
## Footnote
**MOA:**
_Protease Inhibitors:_
## Footnote
**MOA:** Impair polypeptide chains of new viral DNA from ever forming. (HIV)
106
_Ritonavir_
**Class:**
**SE:**
_Ritonavir:_
**Class:** Protease-Inhibitors, anti-retroviral
**SE:**
* Hyperlipidemia
* Glucose Intolerance
* Abnormal Fat distribution
* Altered LFTs
* **Aging of the CV system**
* **_Inhibit CYP450_**
107
108
_Ritonavir_ and life-threatening interactions:
_Ritonavir_ and life-threatening interactions:
**Meperidine**
**Amiodarone**
**Diazepam**
109
_Protease Inhibitors:_
## Footnote
**Interact With:**
**Porlong Half-Life/Effect Of:**
_Protease Inhibitors:_
**Interact With:**
* **Anti-coagualant:** warfarin
* **Anticvonulsants:** Carbamezapine, phenytoin, phenobarbital
* **Antidepressants**: Sertraline
* **Calcium Channel Blockers:**
* **Anti-TB:** Rifampin
* **Herbal:** St. John's Wort
* **Immunosuppressant:** Cyclosporine
**Porlong Half-Life/Effect Of:**
* **Antidysrhytmics:** amiodarone, digoxin, quindine
* **Sedatives:** diazepam, midazolam, triazolam
* **Opiates:** fentanyl, meperidine, methadone
* **Local Anesthetic**: Lidocaine
110
_Safe ABX for prengnacy:_
_Safe ABX for pregnancy_
(no known SE)
**PCNs**
**Cephalosporins**
**Erythromycin**
111
_Caution ABX in pregnancy:_
_Caution ABX in pregnancy:_
## Footnote
**Aminoglycosides (ototoxicity)**
**Clindamycin (colitis risk in mom)**
112
_Contraindicated in Pregnancy:_
_Contraindicated in Pregnancy:_
## Footnote
**Metronidazole**
**Tetracylines (teeth - until age 8)**
**Fluoroquinolones**
**Trimethorphin (folic acid pathway)**
113
HIV tx during pregnancy
HIV tx during pregnancy
_1st Trimester:_
* Does not need to take HAART if asymptomatic.
_2nd Trimester:_
* women with HIV should recieve at least AZT, appropirate HAART additions.
_3rd Trimester / Labor and Delivery:_
* HAART c AZT even for asymptomatic mothers.
* During L/D: IV AZT for mom and
* PO AZT for baby q 6 hours for 6 weeks.
114
Disulfuram Rxns with Cephalosporins
+ ETOH:
## Footnote
**Cephazolin**
**Cefmetazole**
**Cefotetan**
**Cefoperzone**
115
Monobactam Coverage
Gram Negative Only
Very beta-lactamse resistant
Does Cross BBB
116
_Fluoroquinolones:_
## Footnote
**Uses**
_Fluoroquinolones:_
**Uses**
1. complicated GI/GU infections
2. TB
3. URI
4. Anthrax
* Enteric Gram Negative Bacilli and Mycobacterium*
117
macrolids increase the serum concentrati on:
theophylline
warfarin
cyclosporine
methylprednisone
digoxin
