Macrolides

Question 1

Macrolides kinetic

Answer 1

• Needs salt to survive acid
• Less absorption with food
• Distribution everywhere good (azithro better penetration)

Question 2

Macrolides clearance

Answer 2

• Erythro & Clarithro: Hepatic & Renal
• Azithro: slow & unchanged Renal

Question 3

Macrolides spectrum

Answer 3

1. Erythro: Broad, gr + - cocci, some gr - like legionella & campylobacter
2. Azithro & Clarithro: like Erythro, Azithro in Gonorrhea instead of Ceftriaxone & Syphillis instead of Pen G, Clarithro on H.pylori

Question 4

Macrolides MOA

Answer 4

50s

Question 5

Macrolides Resistance

Answer 5

Esterase Enzymes
Cross-resistance

Question 6

Erythro clinical use

Answer 6

• instead of Pen G in allergy
• Corine bacterium, Campylo, Chlamydia, Legionella
• Gr + cocci
• Ineffective on MRSA but effective on penicillinase making staph

Question 7

Azithro & Clarithro use

Answer 7

Azithro:
* Like erythro, longer half life
* Better on H.inf & Neisseria
* Chlamydia trachomatis
* 4d for CAP

Clarithro:
* M.avium & H.pyloti treatment & prophylaxis

Question 8

Fidaxomicin use

Answer 8

• Aerobic gr + & anaerobics
• C.difficile (effective as vanco)
• Inj.

Question 9

Macrolides side effects

Answer 9

• GI
• Erythro: motility up, skin & eosinophili rash
• Acute cholestatic hepatitits in acetolate salt of erythro (esp in pregnancy)
• Hepatic enzyme inhibition (anti coagulation, anti convulsive & digoxin) in erythro & clarithro NOT azithro

Question 10

Telithromycine

Group, MOA, Spectrum, Use, Clearance, Side effect

Answer 10

• Ketolides
• like macrolides 50s
• very broad
• CAP, oral daily
• Biliary & renal
• Heart & hepatic, 3A4 inhibition like erythro

Question 11

Telithromycine

Group, MOA, Spectrum, Use, Clearance, Side effect

Answer 11

• Ketolides
• like macrolides 50s
• very broad
• CAP, oral daily
• Biliary & renal
• Heart & hepatic, 3A4 inhibition like erythro

Question 12

Clindamycin

Group, MOA, Spectrum, Use, Side effect

Answer 12

• Lincosamides
• like Macrolides
• Mostly on gr + (gr- innate resistance)
• Use:
  1. Severe anaerobics e.g. bacteroids
  2. Replacement for gr+ cocci
  3. Endocarditis prevention
  4. P.jirovecii, with pyrimethamine for Toxoplasmosis
  5. Stomach infections: + AGs / + Cephs
• C.difficile superinfection & Pseudomembrane collitis

Question 13

Other pr synthesis inhibitors

Answer 13

1. Mupirocin
2. Streptogramins
3. Oxazolidinones