Exam 4 - Antibiotic Mayhem Flashcards by Cameron Niswander

Cell Wall Synthesis Inhibitors and Mechanism of Action

Penicillins - Stage 3 CW
Cephalosporins - Stage 3 CW
Vancomycin - Stage 2 CW
All are bactericidal

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Penicillin Antibiotics (6)

Penicillin G - narrow spectrum (IV/IM)
Penicillin V - narrow spectrum (oral)
Dicloxacillin - penicillinase resistant (+MSSA)
Amoxicillin+Clavulanate (extended+ßlac inhibitor)
Ampicillin (extended)
Piperacillin-Tazobactam (anti-pseudomonal, IV only)

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Penicillin Excretion and Adverse Reactions

Renal excretion - dose adjustment
Anaphylaxis (Type I, rare) - switch to Macrolides
Rash (common) - Cephalosporins OK
Extended spec: superinfection (CDAD)

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Cephalosporin Antibiotics

1st Gen: Cefazolin (IV/IM), Cephalexin (oral)

3rd Gen: Ceftriaxone (parenteral only, good CNS)

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Cephalosporin Excretion and Adverse Reactions

Renal excretion - dose adjustment

3rd Gen: superinfection (CDAD)

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Vancomycin

Poor oral
Renal excretion
AR: Redman syndrome, oto/renal toxicity
Must monitor Cp levels

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Protein Synthesis Inhibitors and Mechanisms of Action (4)

Macrolides - 50S subunit (23S rRNA)
Tetracyclines - 30S subunit
Clindamycin - 50S subunit
Aminoglycoside - 30S subunit (-CIDAL)
Most are bacteriostatic

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Macrolides Antibiotics and Absorption

Azithromycin
Erythromycin (inhibit P450)
Clarithromycin (inhibit P450)
Good oral and IV

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Macrolides - Adverse Reactions

GI upset (esp Ery)
DDI - P450 inhibition (Ery and Clar)

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Macrolides - Coverage

Used if penicillin hypersensitivity

+Atypical

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Tetracycline Antibiotics and Elimination

Doxycycline - oral, biliary excretion
Tetracycline - oral, renal excretion
Crosses placenta

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Tetracyclines Adverse Reactions

Abnml bone/tooth development (Ca2+ chelation)
n/v, diarrhea (tetra>doxy)
Fungal superinfection
DDI - metal cations in stomach

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Tetracyclines - Coverage

Broad version of Macrolides

Expanded to G- (including bacteroides)

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Clindamycin - absorption, elimination, adverse reactions

Oral, IV
Hepatobiliary excretion
Bone penetration
Severe diarrhea/pseudomembranous colitis (C. Diff)

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Aminoglycosides absorption, elimination, use, adverse reactions

parenteral only
Renal excretion
G- aerobes
AR: Oto/renal toxicity
Must monitor Cp levels

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Inhibitors of DNA Function and Mechanisms of Action

Fluoroquinolones - DNA gyrase
Nitrofurantoin - reduced, damage DNA
Metronidazole - reduced, interfer w/ DNA function
Sulfamethoxazole+trimethoprim - folate metabolism
BACTERICIDAL

Fluoroquinolone Antibiotics - absorption and exrection

Ciprofloxacin - renal
Levofloxacin - renal
Moxifloxacin - hepatic
Oral or IV

Fluoroquinolone adverse reactions

Superinfections (CDAD)

DDI - antacids, decrease absorption

Fluoroquinolone coverage

G- including pseudomonas (except Moxi)

Atypical

Nitrofurantoin

Urinary antiseptic (rapid kidney excretion)
UTI tx (especially if TMP-SMX resistance)
AR: GI upset

Metronidazole absorption, excretion, use, AR

oral
hepatic exrection
covers anaerobic bacteria (necessary for activation)
Antabuse reaction - inhibits aldehyde dehyrdogenase
(avoid EtOH or n/v, HA, flushing)
Candidal superinfection

Sulfamethoxazole+trimethoprim MOA and absorption

Bacteriostatic if used alone
Bactericidal if combo
Oral and IV

SMX/TMP AR

kernicterus in neonates

Hypersensitivity skin reactions

Pregnancy concern

Doxycycline
Aminoglycosides
TMP-SMX
Fluroquinolones (arthropathies)

Not PO

Aminoglycosides Pip-Taz Vancomycin Ceftriaxone

Covers pseudomonas

Aminoglycosides PIP-Taz Ceftriaxone FQ - Ciprofloxacin, Levofloxacin

Covers C. Diff

Metronidazole | Vancomycin

Select for C. Diff

Amox-clav Clindamycin Fluroquinolones Ceftriaxone

DQ-CRIMES

Doxycycline: non-renally eliminated Quinolones: ciprofloxacin (renal) but inhibitor of P450 Clindamycin: non-renally eliminated Rifampin Isoniazid Metronidazole: EtOH - inhibition of aldehyde metabolsim Erythromycin-like: inhibitior of P450 (A-OK) Sulfonamides: N-acetylated to more lipid soluble (renal crystalluria)

Most G+ Cocci coverage

Penicillin Clindamycin Macrolides FQ - Levofloxacin

Strep pyo/pneumo coverage

Amoxicillin

MSSA coverage

``` Enzyme resistance 1st gen cephalosporins Amox-clav Clindamycin Macrolides ```

MRSA coverage

``` Altered target resistance Doxycycline TMP-SMX Clindamycin Vancomycin (IV) ```

Neisseria gon/men coverage

Ceftriaxone (good CNS penetration)

Most G- rods/E. Coli coverage

Aminoglycosides Nitrofurantoin Amoxicillin (/Clav) 1st gen Cephalosporin

Most anaerobes coverage

penicillins PIP-Taz Clindamycin

Bacteroides coverage

Pip-Taz | Clindamycin

Atypical coverage

Macrolides | Doxycycline