Antimicrobial Drugs

Antimicrobial Drugs

1. Works on Cell Wall

   • Peptidoglycan cross-linking inhibition= no wall synthesis
     • Penicillinase Resistant
       • Naficillin
         • Staph. Aureus; except MRSA
         • Interstitial Nephritis
       • Oxacillin
       • Dicloxacillin
       • Aztreonam
         • Gram NEG RODS ONLY!!
       • Vancomycin
         • Gram POSITIVE ONLY! Multi-drug resistant organisms
           • MRSA, Enterococci, & C.diff
         • RED MAN SYNDROME (diffuse flushing) Nephrotoxicity, Ototoxiicity, Thrombophlebitis
     • NOT resistant to B-lactamase
       • Penicillin (B-lactam)
         • 1.Gram + organisms w/ no B-lactamase, 2.Neisseria M. 3.Treponema Pallidum
         • Hemolytic Anemia
       • Ampicillin/AmOxicillin
         • EXTENDED SPECTRUM: 1.H.influenzae 2.E.coli 3.Listeria M. 4.Proteus Mirabilis 5.Salmonella 6.Shigella
         • Pseudomembranous Colitis
       • +Clavulanic Acid/ Tazobactam/ Sulbactam (B-lactamase inhibitor)
       • Ticarcillin/ Piperacillin
         • Pseudomonas
       • Cephalosporins
         • First Generation
           • Cefazolin/cephalexin
             • Prior to surgery for Staph a.
             • 1. ProteusM. 2.E.coli 3.Klebsiella
         • Vit K deficiency
         • 2nd generation
           • Ceftriaxone
             • Meningitis and Gonorrhea
           • Ceftiazidime
             • Pseudomonas

2. Protein Synthesis Inhibitors

   • 30S inhibitors
     • Aminoglycosides
       • Gentomycin Neomycin Streptomycin
       • Nephrotoxicity Ototoxicity NM blockage
     • Tetracyclines
       • Tetracycline Deoxycycline
         • Borrelia Burgdorferi M.pneumonia Rickettsia Chlamydia
         • Teeth discoloration Bone growth inhibition Photosensitivity
   • 50S inihibitors
     • Chloramphenicol
       • MENINGITIS (H.influenza, N. meningitis, Strep. pneum)
         • Anemia Pancytopenia
     • Erythromycin Azithromycin
       • Atypical pneumonias (Mycoplasma & LEGIONELLA= Eryth #1) Chlamydia Strep infections in pencillin allergy
       • Motility problems Arrythmia Cholestatic hepatits Rash Eosinophilia
     • Clindamycin
       • Pseudomembranous colitis; ASPIRATION PNEUMONIA (alcoholics) = works against oral anaerobes & G+ aerobes (S.pneum) ; and oral infections w/ mouth anaerobes
         • Treats anaerobes ABOVE the diaphragm vs Metronidazole that works BELOW

3. Others:

   • Isoniazid (INH)
     • Myco. TB (& prophylaxis)
       • Neurotoxicity (due to similar structure to B6)
   • Rifampin
     • Mycob. TB
       • ORANGE Urine
   • TMP-SMX
     • (Trimethoprim- Sulfamethoxazole)
       • HIV prophylaxis Hx of recurrent UTI's
   • TB Treatment
     • Prophylaxis
       • Isoniazid
     • Active infection treatment drugs
       • Isoniazid
       • Rifampin
       • Ethambutol
       • Pyrazinamide
         • Only one that works best in LOW pH and INTRACELLULARLY
       • I/E work on the cell wall. Rif- inhibits DNA- dependent RNA polymerase Pyra-kills intracellularly
   • '-floxacin' (Fluroquinolones)
     • Inhibit DNA gyrase & topoisomerase IV
       • G- rods of urinary and GI tracts; Neisseria
         • DONT take with ANTACIDS!! GI upset; Superinfections; TENDONITIS; Tendon rupture; Myalgias
   • Metranidazole
     • Forms free radicals in the bacteria
       • Treats ANAEROBIC infections BELOW the diaphragm; Giardia; Entamoeba; Trichomonas; Gardnerella vaginalis; and H.pylori (+clarithromycin & PPI)
         • Disulfiram-like rxn w/ alcohol; METALLIC TASTE