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Antibiotic drugs
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- 2. Antibiotic Mechanism of Action Inhibition of Bacterial CellWall Synthesis Inhibition of Bacterial Nucleic acid synthesis Inhibition of Bacterial Folic Acid Synthesis Inhibition of Bacterial Protein Synthesis Vancomycin Imipenem/Meropenem Penicillins Aztreonam Cephalosporins Trimethoprim Sulfonamides Pyrimethamine Fluoroquinolones Rifampin Macrolides Aminoglycosides Chloramphenicol Tetracyclines Streptogramins Clindamycin Linezolid
- 3. Beta-lactam Antibiotics “-cillin” •Inhibits cell wall synthesis. Cell dies by lysis. • Penicillins (types) • Natural penicillins • Penicillinase-resistant penicillins • Aminopenicillins • Extended-spectrum penicillins • Carboxypenicillins • Ureidopenicillins
- 4. Penicillins - Points •First ABT on market • Tx: URI, skin • Decreases effectiveness of oral contraceptives – use a condom. • Decreases effectiveness of Coumadin. • Not compatible w/Aminoglycosides (Gentamicin) • Reduces effect of Tetracyclines • Take on empty stomach w/ 8 oz. H2O.
- 5. Cephalosporins • Broader inspectrum than PCN • Ancef, Keflex, Rocephin • Tx: Staph infections • Don’t give with PCN/PCN allergy • Stable against beta-lactamases. • Categorized by generation • I. Surgical prophylaxis, upper resp. infections, ear infections • II. Abdominal/ colorectal prophylaxis surgeries • III. Bacteria meningitis • IV. Complicated urinary tract infections, uncomplicated skin infections Trade Names I. Keflex II. Ceftin III. Rocephin IV. Maxipime
- 6. Carbapenems “-penem” • Imipenem/meropenem •Broad spectrum – mixed aerobic/anaerobic • Extended-spectrum beta-lactamases (ESBLs) • #1 concern = drug sensitivity • Avoid with known/likely C. difficile • Risk: Seizures • Nephrotoxicity/neurotoxicity/immunomodulation • Monitor for abscess/inflammation/phlebitis/rash • Monitor liver function • May lead to superinfection Carbapenem-Resistant Enterobacteriaceae (CRE)
- 7. Monobactams • Aztreonam (onlyone available in U.S.) • Treats: UTI, dermal infection, septicemia, intra-abdominal, gynecologic infections. • Moderately severe systemic infections and urinary tract infections • Admin IV or IM • Contraindicated in pregnancy
- 8. Beta-lactamase inhibitors • Adjuncttherapy only - not useful alone • Amoxicillin/Clavulanic acid (Augmentin)
- 9. Sulfonamides • Target folicacid synthesis. • Inhibit dihydropterate synthetase (enzyme) • May blood glucose levels • Avoid sun exposure • Classifications • Rapid absorption/excretion • Poor absorption • Rapid absorption/slow excretion • Topical
- 10. Tetracyclines • Doxycycline/Minocycline • Derivedfrom soil mold • Broad spectrum (Gram +/-) • Bacteriostatic • 90-100% bioavailable • Decrease effectiveness PCN G & OBC (oral birth control) • Take on empty stomach w/ 8 oz. H2O. • Report black, furry tongue
- 11. Aminoglycosides “-micin,-mycin” • Gentamicin(Peak: 5-10 mcg/mL) • Tx: Septicemia, infective endocarditis • Narrow-spectrum • Bactericidal • Gram-negative bacteria • Neomycin • Tx: Cirrhosis • Nephrotoxicity/Ototoxicity • GFR & serum creatinine
- 12. MacROlides “-Romycin” • Erythromycin-Safest ABT available • Azithromycin “Z-pack” • Bacteriostatic/bactericidal • Very effective against staph. aureus • Better patient compliance • Avoid sun / Take on empty stomach • AVOID in patients with cirrhosis/hepatitis
- 13. Quinolones/Fluoroquinolones “-floxacin” • Cipro/Levaquin •Bactericidal • Tx: UTIs, STDs, GI, abd, respiratory, bone/joint, soft tissue • Orally, parenterally, topically • Avoid/limit caffeine • Excreted by kidneys • No antacids within 4 hours • Monitor urine pH • Increase fluids 2-3L/day • Admin IV slowly – may drop B/P.
- 14. Lincosamides • Clindamycin • Tx:bacterial/protozoan pathogens • Hypersensitivity is rare • Good alternative for PCN allergy/tolerance • Nasty side effect: Pseudomembranous colitis (2-9 days)
- 15. Vancomycin • Bacteriocidal • IV– serious nonresponsive infections (MRSA) • Contraindicated in pregnancy • Nephrotoxic • Peak/Trough – 80-100 mg/mL *Red man’s syndrome* -infusing too quickly
- 16. Oxazolidinones • Linezolid (synthetic) •Oral/IV • Tx: VRE/MRSA • Avoid foods containing tyramine • No breastfeeding • Avoid caffeine & ETOH • Serious CNS reaction – Serotonin Syndrome • Excreted in urine
- 17. Anti-infective drugs – Resistantinfections • Streptogramins • Quinupristin/Dalfopristin – Syndercid • IV admin • Tx: resistant VRE, MRSA • Excreted via bile/feces
- 18. Antitubercular drugs • Isoniazid(INH) • Prophylaxis/combo with other anti-TB meds • Food interferes with absorption • ETOH increases chance liver damage • Antacids interfere with absorption • Rifampin • Drug of choice: Pulmonary TB – combo drug • Use additional contraception • Caution with alcoholics