Vancomycin, Aminoglycosides, Macrolides, Tetracyclines, Quinolones, Miscellaneous

Question 1

Vancomycin

Answer 1

• MOA: Inhibits bacterial cell wall synthesis
• G+ cocci: MRSA, Strep, Enterococcus
• G- bacilli: Listeria, Corynebacterium
• Other: Clostridium, Actinomyces
• Indications: MRSA, Severe/refractory C. diff colitis
• Dosage forms: MRSA slow IV infusion, C.diff oral
• PK’s: Not aborbed by GI tract or metabolized by liver
• Must monitor levels

Question 2

Vancomycin Adverse Effects

Answer 2

• Hyperemia (red man syndrome)
  
  • With rapid infusion or high doses
  • Avoid slow infusion (1-2 hrs)
  • Pretreat with antihistamine
• Fever/chills
• Thrombophlebitis at injection site
• Ototoxicity/nephrotoxicity
  
  • Associated w/toxicity of drug
    
    • Renal impairment in elderly
  • Especially w/aminoglycosides
• Resistance emerging

Question 3

Vancomycin ALTERNATIVES

Answer 3

• For use against MRSA*
• Daptomycin
  
  • DNA/RNA inhibitor
  • Not for pneumonia treatment
• Televancin
  
  • Inhibits bacterial cell wall synthesis
  • Not for VRE
• Linezolid
  
  • Inhibits bacterial protein synthesis

Question 4

Aminoglycosides

Answer 4

• Prototype: Gentamycin
• Streptomycin, Kanamycin, Amikacin, Tobramycin (opthalmic), Neomycin (topical)
• MOA: Inhibit bacterial protein synthesis
• Indications: G-, G+ enterococcus, M. Tuberculosis
• Routes: IM, IV, Opthalmic, Topical
• Adverse effects: Ototoxicity, nephrotoxicity, neuromuscular paralysis
• Must be monitored