Clinical Uses and Adverse Effects

Question 1

• Clinical uses
  Effective agent against Pseudomembranous colitis
  Drug of choice for resistant infections such as MRSA and MRSE
• Adverse effect
  Red Man Syndrome

Answer 1

vancomycin

Question 2

Its only use is for topical application to skin, wounds, or mucous membranes.

Answer 2

bacitracin

Question 3

It is used as a second-line drug in the
treatment of tuberculosis.

Answer 3

cycloserine

Question 4

• Clinical Uses
  Because of their toxicity and poor distribution to tissues, the polymyxins were used primarily topically and rarely for systemic infections.
  Clinically useful member is Polymyxin E
  (colistin) and Polymyxin B.

Answer 4

polymyxins

Question 5

• Clinical uses
  Used most widely against gram-negative
  enteric bacteria or when there is suspicion of sepsis. Poor bioavailability, hence, IM
  administration.
  The group includes streptomycin, neomycin, kanamycin, amikacin, gentamicin, tobramycin, sisomicin, netilmicin, arbekacin, and dibekacin. Spectinomycin is an aminocyclitol antibiotic (related to aminoglycosides)
• Adverse effects
  All are potentially ototoxic, vestibulotoxic and nephrotoxic, although to different degrees.

Answer 5

aminoglycosides

Question 6

• Clinical uses
  Widest or broadest spectrum among the
  antibiotics and susceptible against gram-
  positive and gram-negative bacteria & are
  drugs of choice in infections caused by
  rickettsiae, Anaplasma, Bartonella,
  chlamydiae, and Mycoplasma pneumoniae. Include tetracycline, doxycycline,
  minocycline, demeclocycline.
• Adverse effects
  Avid chelators of metals, contraindicated in children, Fanconi-like syndrome, renal
  failure, ototoxicity, and phototoxicity.

Answer 6

tetracyclines

Question 7

• Clinical Uses
• Tigecycline, the only agent, is the 9-tert-
  butyl-glycylamido derivative of minocycline.
• Tigecycline is active against a broad
  spectrum of gram-positive and gram-
  negative pathogens.
• Compared with the tetracyclines, it is more active against MRSA and S epidermidis, drug-susceptible and drug-resistant S pneumoniae, and enterococci.

Answer 7

glycylcyclines

Question 8

• Clinical Uses
  Substitutes for penicillins in persons with
  hypersensitivity.
  Clinically useful agents include erythromycin, azalides (clarithromycin and azithromycin).
  The ketolide, Telithromycin, is semisynthetic
  derivative of erythromycin.
• Adverse effects
  Drug fever, mild GI upsets. Cholestatic
  hepatitis in erythromycin estolate. Cardiac
  arrhythmias in azithromycin.
  Erythromycin, Clarithromycin, Azithromycin

Answer 8

macrolides

Question 9

• Clinical Uses
  Clindamycin and lincomycin are clinically
  useful agents.
  Active against Bacteroides species and other anaerobes infection.
  Effective for skin and soft tissue infections.
• Adverse effects
  Prominent as a cause of antibiotic-
  associated colitis caused by C. difficile.

Answer 9

lincosamides

Question 10

• Clinical Uses
  Its spectrum is similar to those of the
  tetracyclines.
  Extensively useful for treatment of typhoid fever.
  It is bacteriostatic against Salmonella typhi, but has bactericidal activity against the three important encapsulated organisms that cause meningitis: Haemophilus influenzae, Streptococcus pneumoniae, and Neisseria meningitidis.
• Adverse effects
  Gray baby syndrome, bone marrow
  suppression (aplastic anemia)

Answer 10

chloramphenicol

Question 11

• Clinical Uses
  Linezolid and tedizolid are useful agents.
  Most frequently used to treat pneumonia, bacteremia, and skin and soft tissue infections caused by vancomycin-resistant staphylococci and enterococci.
• Adverse effects
  Reversible thrombocytopenia

Answer 11

oxazolidinones

Question 12

• Clinical Uses
  Quinupristin–dalfopristin (Synercid) is an
  injectable streptogramin antibiotic consisting of a 30:70 mixture of two semisynthetic derivatives of pristinamycin (a group B streptogramin) and dalfopristin (a group A streptogramin).
  The two components act synergistically to inhibit a wide spectrum of gram-positive
  bacteria, including methicillin-resistant
  staphylococci, VRE, and penicillin resistant pneumococci.

Answer 12

streptogramins

Question 13

• Clinical Uses
  Effective in urinary tract infections.
  Treatment of sexually transmitted diseases (N. gonorrhoeae and C. trachomatis).
  Control lower respiratory infections caused by infection with H. influenzae. Enteritis caused by salmonellae, shigellae, or campylobacters.
• Adverse effects
  Occurrence of tendinitis in adults resulting in tendon rupture, and phototoxicity.
• Ends with “-floxacin”

Answer 13

quinolones and fluoroquinolones

Question 14

• Clinical Uses
  Active in vitro against some gram-positive and gram-negative cocci, some enteric bacteria, mycobacteria, chlamydiae, and poxviruses.
  Some clinically useful agents include rifampin, rifabutin, rifaximin, and rifapentine.
• Adverse effects
  Rifampin imparts a harmless orange color to urine, sweat, and contact lenses.

Answer 14

rifamycins

Question 15

• Clinical Uses
  Active against gram-negative and gram-
  positive bacteria, chlamydiae, nocardiae, and protozoa.
  Prontosil red, silver sulfadiazine, The “soluble” sulfonamides (trisulfapyrimidines, sulfisoxazole), sulfamethoxypyridazine, sulfamethoxazole (SMZ)
• Adverse effects
  Erythema multiforme. Stevens-Johnson syndrome. Toxic epidermal necrolysis. Contraindicated in G6PD Deficiency, hemolysis, and jaundice.

Answer 15

sulfonamides

Question 16

Clinical Uses
Clinically combined with sulfonamides to
treat urinary tract infections, shigellosis, and salmonellosis and infections with other gram-negative bacterial infections and in pneumocystis pneumonia.
* Adverse effects
Megaloblastic anemia

Answer 16

trimethoprim, pyrimethamine, trimetrexate

Question 17

• Clinical Uses
  Used in combination with other antimycobacterial agents (especially ethambutol or rifampin) to reduce the emergence of resistant tubercle bacilli.
• Adverse effects
  Patients receiving INH excrete pyridoxine in excessive amounts, which results in peripheral neuritis.

Answer 17

isoniazid (INH)

Question 18

• Clinical Uses
• Used in combination with other antimycobacterial agents to reduce the emergence of resistant tubercle bacilli.
• Adverse effects
  The most common side effects are visual disturbances (red-green visual disturbance): reduction in visual acuity, optic neuritis, and perhaps retinal damage.

Answer 18

ethambutol

Question 19

• Clinical Uses
  Used in combination with other antimycobacterial agents to reduce the emergence of resistant tubercle bacilli.
• Adverse effects
  The major adverse effects of pyrazinamide are hepatotoxicity (most hepatotoxic among anti-TB drugs), nausea, vomiting, hypersensitivity, and hyperuricemia.

Answer 19

pyrazinamide