2. Definitions
Antimicrobial
Substance that kills or inhibits the growth of
microorganisms like bacteria, fungi and protozoa
Antibacterial
Substance that kills or inhibits the growth of bacteria
Bacteriostatic
Inhibits the growth or reproduction of bacteria
Bactericidal
Acts by killing bacteria
3. Definitions
URI LRI
AOM CAP
ABS HAP
Pharyngitis
CDAD PCP
Pseudomembranous colitis MAC
Cellulitis Bacterial vaginosis UTI
4. General Antibiotic Counseling Tips
Most important: Take all antibiotics until they are gone!!
Why...?
General side effects: N/V/D and yeast infections (women)
What can you recommend to your patients?
Take with food (drug permitting)
OTC anti diarrhea meds (except when?)
Probiotics?
5. General Antibiotic Counseling Tips
Usual length of therapy is 5 to 14 days
Some are less, some are more
When will they feel better?
Exception: azithromycin
So what about oral contraceptives?
Very controversial...
6. General Antibiotic Counseling Tips
Allergies
Your first question for the patient when they say
they have an allergy... ????
Penicillin allergies are very common
and come in 3 varieties:
Immediate (30-60 minutes)
Accelerated (1-72 hours)
Delayed (>72 hours)
What should the patient look for and do??
7. General Storage and Administration
Shake suspensions well before each use
Watch out for those that need to be refrigerated
Check the stability of the drug after reconstitution vs.
the length of therapy
Tablets- cool, dry place
What if they miss a dose?
8. Beta-lactams
Penicillins and Cephalosporins
Mechanism and Site of Action
Penicillin binding
proteins in the
bacterial cell wall
and inhibits cell
wall synthesis
Bactericidal
9. Beta-lactams
Penicillins
Penici!in VK, amoxicillin, amoxici!in/clavulanat"
Tablets, chewable tablets, capsules, suspension
Brand names: Veetids, Amoxil, Augmenti#
Indications : Pharyngitis, AOM, ABS, CAP, UTIs, cellulitis
Special administration:
PCN- without food Dosing is usually BID-QID
Amox- with or without
Amox/clav- with food
10. Beta-lactams
Cephalosporins
Cephalexin, cefuroxime, cefdinir
Tablets, capsules, suspensions
Brand names: Keflex, Ceftin, Omnicef
Indications: Cellulitis, gonorrhea, AOM, ABS
Special administration:
Most are ok with or without food, Dosing usually
some suspensions vary BID -QID
Cefdinir - Not with antacids or iron
containing supplements
11. Beta-lactams
Side effects: N/V/D, yeast infections
N/V/D is especially common with clavulanate
So why do we use it?
Allergic reactions
What does a penicillin allergy mean for cephalosporins?
What does a cephalosporin allergy mean for
penicillins?
Rash vs. Anaphylaxis
12. Sulfonamides
Mechanism and Site of Action
Competes with enzyme required for
folate synthesis in bacterial cell and
slows cell cycle
Bacteriostatic
13. Sulfonamides
Sulfamethoxazole/Trimethoprim
Tablets, suspension SS and DS
Brand name: Bactrim, Septra, Sulfatrim
Indications: uncomplicated UTIs, AOM, PCP
Special administration:
Best taken with food
Full glass of water Dosing usually BID
Suspension should not be refrigerated
14. Sulfonamides
Side effects: N/V/D
Sun sensitivity, dizziness, rash
Allergies: urticaria, Stevens-Johnson Syndrome
Should not be used in pregnant women >38 weeks, lactating
women or infants <2 months
Drug interactions: methotrexate, warfarin, rosiglitazone
15. Macrolides
Mechanism and Site of Action
50S ribosome subunit
Binds ribosome and inhibits
protein biosynthesis
Bacteriostatic
16. Macrolides
Azithromycin, erythromycin, clarithromycin
Tablets, suspensions, (ophthalmic)
Brand name: Zpak, Ery-Tab, Biaxin
Indications: CAP, URI/LRI, chlamydia, MAC, (conjunctivitis)
Special administration:
Best without food, but Dosing: Azithromycin-QD
okay Clarithromycin-BID
Erythromycin- BID-QID
Azithromycin-antacids
Clarithromycin and erythromycin-grapefruit
17. Macrolides
Side effects: N/V/D, yeast infections
Clarithromycin: metallic taste, sun sensitivity
Azithromycin: normal side effects, especially
in high single-dose regimens
Potential for QTc prolongation with all
Drug interactions: all are P450 inhibitors and substrates
Some key drugs to watch for: warfarin, digoxin,
amiodarone, statins
Clarithromycin worst offender for DDIs
18. Fluoroquinolones
Mechanism and Site of Action
Inhibits DNA replication &
transcription by binding enzymes in
the bacterial cell
Bactericidal
19. Fluoroquinolones
Ciprofloxaci", levofloxacin, moxifloxacin
Tablets, suspension
Brand names: Cipro, Levaquin, Avelox
Indications: Pyelonephritis , UTIs, CAP, ABS
Cipro- anthrax post exposure prophylaxis
Special administration:
With or without food - separate Dosing is QD-BID
antacids, iron, MVTs and dairy
20. Fluoroquinolones
Side effects: N/V/D, yeast infections
Sun sensitivity, headache, dizziness, dyspepsia
Increased blood sugar in DM
RARE- tendon toxicity
Drug interactions:
Cipro and caffeine
Warfarin
22. Tetracyclines
Tetracycline, doxycycline, minocycline Tablets, capsules
Brand names: Sumycin, Vibramycin, Minocin
Indications: acne, skin infections, STDs, (respiratory infections)
Special administration:
Doxycycline and minocycline- Tetracycline- without
with or without food food
All with a full glass of water Dosing is usually BID-QID
and sit up for 30 minutes
Patients should never use
Avoid antacids, iron, MVT and expired medication
dairy
23. Tetracyclines
Side effects: N/V/D, yeast infections
Sun sensitivity, headache, indigestion, teeth discoloration
Should not be used in children <8 or pregnant women
Drug interactions:
Doxycycline and warfarin
24. Lincosamides
Mechanism and Site of Action
50S ribosome subunit
Binds ribosome and inhibits
protein biosynthesis
Bacteriostatic
25. Lincosamides
Clindamycin
Capsules, suspension, topical
Brand name: Cleocin
Indications : anaerobic upper GI infections, bacterial
vaginosis, topical for acne
Special administration:
Full glass of water Dosing usually TID
With or without food
26. Lincosamides
Side effects: N/V/D, yeast infections
Diarrhea- higher risk for C. difficile associated
diarrhea and Pseudomembranous colitis (Black
Box)
Use of probiotics
Drug interactions: very few!!
27. Nitroimidazoles
Mechanism and Site of Action
Absorbed into anaerobic and
protozoal cells where converted into
toxic compound that causes loss of
helical DNA structure and strand
breakage
Bactericidal
28. Nitroimidazoles
Metronidazole
Tablets, topical (vaginal)
Brand name: Flagyl
Indications: anaerobic lower GI infections, C. difficile
associated diarrhea, bacterial vaginosis
Special administration:
Take with food or milk
(except ER) Dosing usually TID
Disulfiram-like reaction (BID-QID)
with alcohol
29. Nitroimidazoles
Side effects:
Metallic taste, discolored/dark urine, dysuria, dry mouth
Should not be used in pregnant women in the first trimester
Drug interactions: lithium
30. Nitrofurantoin
Mechanism and Site of Action
Inhibition of acetyl CoA
interfering with the
metabolism of carbohydrates
in susceptible bacteria
Bacteriostatic
31. Nitrofurantoin
Nitrofurantoin
Capsules
Brand names: Macrobid and Macrodantin
Indications: uncomplicated UTIs, and UTI prophylaxis
Special administration:
Take with food Dosing is usually BID
32. Nitrofurantoin
Side effects:
N/V/D, flatulence, headache, discoloration of urine
Shouldn't be used in renal impairment, low/no
systemic absorption
Drug interactions:
Magnesium salts decrease effectiveness
34. Feedback!
Please take out a 1/2 sheet of paper and respond to these
questions:
1) What was the most useful information you learned today?
2) What questions remain about my lecture material?
3) What constructive feedback do you have for me? I can take it!
