"Super Gram Positive" Antibiotics'

Question 1

What 4 organisms do “Super Gram (+)” drugs cover?

Answer 1

1. MRSA
2. Coagulase (-) staph
3. Streptococci
4. Enterococcus

Question 2

What is the MOA for Vancomycin?

Answer 2

inhibits cell wall synthesis in Gram (+) –> different than D-Ala-D-Ala

• Bactericidal

Question 3

What are 4 possible side-effects of Vancomycin use? (RONB)

Answer 3

Red Man Syndrome - due to histamine release
Ototoxicity (reversible vs aminoglycosides)
Nephrotoxicity (ATN)
Bone Marrow Suppression (Leukopenia > Thrombocytopenia)

Question 4

What are 4 major medications that fall into the “Super Gram (+)” category?

Answer 4

1. Vancomycin
2. Daptomycin
3. Linezolid
4. Ceftaroline

Question 5

What is the MOA of Linezolid?

Answer 5

50s subunit inhibitor = Bacteriostatic

Question 6

What is the brand-name of Linezolid?

Answer 6

Zyvox

Question 7

Besides Gram (+) organisms, what additional organism is Linezolid useful against?

Answer 7

Tuberculosis (acid-fast = no gram staining)

Question 8

What is the bioavailability of Linezolid vs Vancomycin when given orally?

Answer 8

Linezolid = 100% bioavailability

Vancomycin = reduced bioavailability

Question 9

What are 6 possible side-effects from Linezolid use? (BSMPOB)

Answer 9

Bone Marrow Suppression (Thrombocytopenia)
Serotonin Syndrome (MAOI)
Mitochondrial Toxicity (metabolic acidosis)
Peripheral Neuropathy
Optic Neuritis
Blindness

Question 10

What is the MOA of Daptomycin?

Answer 10

forms transmembrane channels and depolarizes cell = RAPIDLY bactericidal

Question 11

Can Daptomycin be used for pneumonia, similar to Vancomycin and Linezolid?

Answer 11

NO! –> no effect in lung parenchyma due to inactivation by SURFACTANT

Question 12

What are 3 possible side-effects of Daptomycin use? (MPG)

Answer 12

Muscle Toxicity (myalgia/rhabdomyolysis)
Peripheral Neuropathy
GI side-effects