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Antibiotics Review
1
Learning Objectives:
1. Review Mechanism of Action of Select antibiotics
2. Learn Clinical Applications of Antibiotics
3. General Side Effects of Select Antibiotics
Antibiotics Review
Inhibitor of Cell-Wall Synthesis
Pencillins
MOA:
- Binds PBP
- Inhibit transpeptidations
-Inhibits Lactams
Mechanism of Resistant:
- B-lactamases
-Structural change in PBPs: MRSA
- Change in Porin structure
Sub-groups and Antimicrobial
- Pencillin G and Pencilin V = T. Palldium
- Methicillin, nafcilloin, and Oxacillin = S. aureus
- Amoxicillin and Ampicillin
- Gram + cocci: Listeria
- Gram -: E. coli, HI, and H. pyori
- Ticarcillin, Piperacillin, Azlocillin, and Carbencillin
1. Anti-pseudomonal pencillins
Cephaosporins
1st Gen: Cefazolin and Cephalexin
- Gram + and Some Gram - coverage
- Surgical Prophylaxis
2nd Gen: Cefotetan, Cefaclor, and Cefuroxime
- Better Gram - Coverage
3rd Gen: Ceftriaxone, Cefotaxime, Cefdinir, etc.
- Empirical Management of sepsis and meningitis
- Broad Spectrum
- No activity against LAME
4th Gen: Cefepime
- IV
- Beta-lactamase resistant
Imipenem and Meropenem
- Spectrum: Gram + cocci and Gram - rods
- In hospital agents for empiric use in severe life threatening infections
Pharmacokinetics:
1. Imipenem w/ Cilastatin
Side effects:
1. GI
2. Drug fever
3. SZ= Imipenem
Quinolones: Norfloxacin, Ciprofloxacin, and Ofloxacin
MOA
Activity and Clinical Use
- Broad spectrum
SE:
1. Phototoxicity
2. Tendon rupture
3. Increase QT intervals
4. SZ
Bacteial Protein Synthesis
Macrolides: Erthromycin, Azithromycin, and Clarithromycin
Activity and Clinical uses: Wide spectrum
1. Gram + Cocci
2. Atypicals: Chlamydia, Mycoplasma, Legionella pneumophila, C. Jejuni, and MAC
Pharmoacokinetics: Inhibits cytochrome P450s
Tetracyclines: Doxycycline, Minocycline, Demelocycline
SE: GI and Deafness
Activity and Clinical use:
1. Bascteriostactic
2." Broad spectrum" antibiotic with good activoty vs. chlamydial and Mycoplasmal species, H. pylori, Rickettsia, B. burgorferi, Brucell, Vibrio, and Treponema
Pharmacokinetics: Kidneys and Liver(Doxycycline)
Side effects:
1. Tooth enamel dysplasia
2. Photoxicity
Aminoglycosides:Gentamicin, Torbamycin, Streptomycin
- Activity and Clinical uses: Bactercidal, accumulate IC via an O2-dependent uptake- anaerobes are innately resistant
- Spectrum: Gram - rods, and are often used in combination w/ cell inhibitors for synergistic actions caused by enterococci and P. aeruginosa
- Pharmokietics: Dosage dependent on GFR
Side effects:
1. Nephrotoxicity: ATN
2. Ototoxicity
3. Neuromuscular blockade
4. Contact Dermatitis