Bacterial Pneumonia

Question 0

Macrolides

Erythromycin, Clarithromycin, Azithromycin

Answer 0

bac. pneumo
-“-thromycin”
Effective against
-H. influenzae (azithromycin)
-H. pylori (clarithromycin)
-erythromycin=don’t use for MSSA, MRSA
MOA
-inhibition of protein metabolism
-reversibly binds to 50s subunit of bacterial ribosome inhibiting RNA-dep protein synthesis
ADE
-erythromycin (+side effect)=acts as a motilin receptor agonist in the gut and gallbladder which has a prokinetic effect
-gastrointestinal intolerance (nausea, vomiting, abdominal pain, diarrhea)
-hepatitis
-azithromycin=INC QT interval
-erythromycin via IV=thrombophlebitis
Drug interactions
-CYP 3A4 inhibition (hepatic enzymes)(*clarithromycin is less potent inhibitor)

Question 1

Fluoroquinolones

Levafloxacin, Moxifloxacin, Gemifloxacin

Answer 1

bac. pneumo
-“-floxacin”
Effective against
-S. pneumo (most effective w/ all)
-H. influenzae
-Legionella
-Mycoplasma pneumo
-moxifloxacin=don’t use for MSSA or MRSA but good for S. pneumo
-don’t use for E.coli or Ps. aerug
MOA
-inhibits nucleic acid synthesis
-activates DNa gyrase and topoisomerase IV and promotes cleavage of DNA
ADE (mostly for levofloxacin)
-Moxifloxacin: hepatic metabolism, low urine levels, QT interval side effects
-renal dysfunction
-tendinitis and tendon rupture
-peripheral neuropathy
-hypersensitivity rx
-C. diff associated diarrhea
-prolongation of QT intervals (cause v.tach or torsades de pointes)
-MSK disorders in kids
-blood glucose disturbances
Drug interactions
-multivalent cation containing products (antacids, metal cation (zinc or iron)) (separate by 2 hours)
-Warfarin- effects will be enhanced
-Antidiabetic agents=carefully monitor blood glucose (levofloxacin)
-Class IA and Class III antiarrhythmics (*moxifloxacin)
-Peds=only used in post anthrax exposure, otherwise stay away

Question 2

B-lactam antibiotics

Answer 2

bac. pneumo
- ceftriaxone, cefotaxime, ceftaroline
- ampicillin/sulbactam
- ertapenem