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Protozoans Entamoeba histolytica Giardia lambia Toxoplasmosis gondii Trichomonas vaginalis Plasmodium species

Pathogenic Fungi Candida albicans Histoplasma capsulatum Coccidioides immitis Blastomyces dermatitidis Cryptococcus neoformans Pneumocystis jirovecii

Acid-Fast bacilli Mycobacterium tuberculosis Mycobacterium bovis Mycobacterium leprae

Spirochetes Treponema pallidum

Gram Positive Cocci Staphylococcus aureus Streptococcus pyogenes, Streptococcus pneumoniae Enterococcus faecalis

Gram Positive Bacilli Bacillus anthracis Corynebacterium diphtheria Clostridium botulinum Clostridium perfringens Clostridium tetani Clostridium difficile

Gram Negative Cocci Neisseria gonorrhoeae Neisseria meningitidis

Gram Negative Bacilli Escherichia coli Enterobacter aerogenes Proteus mirabilis Salmonella enterica Klebsiella species

Drugs  Sulfonamides o Trimethoprim (Trimpex, Proloprim) o Co-trimoxazole (Septra, Bactrim) o Silver sulfadiazine (Silvadene Cream) o Mafenide (Sulfamylon) o Sulfacetamide (Blephamide) o Sulfasalazine (Azulfidine)

Inhibitors of Folate Metabolism Useful For  Urinary tract infections (UTI) o Co-trimoxazole  Alternative for some pneumonias  Inflammatory Bowel Disease Agents o Sulfasalazine (Azulfidine)

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Side Effects Sulfa class allergic reactions (5%) Hemolytic anemia in G-6-PD deficiency Can cause aplastic anemia (rare)

 Inhibitors of Cell Wall Synthesis Useful For Beta-Lactam Antibiotics  Gram positive organisms o Penicillin’s  Gram negative cocci  Naturals o Neisseria gonorrhoeae  Penicillin G o Neisseria meningitidis  Pen G benzathine or procaine (Bicillin)  Treponema pallidum (syphilis)  Penicillin V (Veetids)  Extended spectrums  Anti-Staph o Otitis o UTI  Methicillin (Staphcillin) o Dental Prophylaxis  Cloxacillin  Nafcillin  Weaknesses  Oxacillin o Staphylococcus aureus  Extended Spectrum o Gram negative rods/bacilli  Ampicillin o Polycillin o Amcil o Omnipen  Amoxicillin o Larotid o Polymox o Amoxil  Anti-Psuedomonal  Carbenicillin (Geocillin)  Mezocillin (Mezlin)  Piperacillin (Pipracil)  Ticarcillin (Ticar) Drugs    Side Effects Hypersensitivity (5% incidence) o Rash o Angioedema o Anaphylaxis Diarrhea Nephritis (esp. methicillin) .

Kefzol)  Cephalexin (Keflex)  Cefadroxil (Duracef)  2nd Generation Cephalosporins  Cefamandole (Mandol)  Cefoxitin (Mefoxin)  Cefaclor (Ceclor)  Cefotetan (Cephotan)  Cefmetazole (Zefazone)  Loracarbef (Lorabid)  3rd Generation Cephalosporins  Cefoxatine (Claforan)  Ceftizoxime (Cefizox)  Ceftriaxone (Rocephin)  Cefoperazone (Cefobid)  Cefexime (Suprax)  4th Generation Cephalosporins  Cefepime (Maxipine) o Carbapenems o Monobactams Inhibitors of Cell Wall Synthesis Useful For  1st Generation o Gram + active agents  2nd Generation o Better gram negative coverage  3rd Generation o Better gram neg o Better for CNS sepsis  4th Generation o Better beta-lactamase resistance     Side Effects 1-2% allergic reaction Allergic cross-reactivity with Pens: 5-15% Disulfiram-like effect o Cefamandole o Cefaperazone Bleeding due to anti-vitamin K action Not in slides Not in slides  Drugs Non-Beta Lactams o Vancomycin (Vancocin)  Teicoplanin (Targocid) o Bacitracin (ointment. Polysporin) o Fosfomycin (Monurol) o Cycloserine (Seromycin)    Inhibitors of Cell Wall Synthesis Useful For Vancomycin o Synergistic with aminoglycosides o Enterococcus o Resistant staph and strep o Clostridium dificle Fosfomycin (Monurol) o UTI treatment Cycloserine (Seromycin) o Active against TB & gram negatives Side Effects . Drugs Beta-Lactam Antibiotics o Cephalosporins  1st Generation Cephalosporins  Cephalothin (Keflin)  Cefazolin (Ancef. Neosporin.

legionella. helicobacter. some gram neg Chlamydia. Doxy. mycoplasma Treponema. dairy products. Erythrocin) o Azithromycin (Zithromax) o Clarithromycin (Biaxin) o Telithromycin (Proteck)     Protein Synthesis Inhibitors Useful For Good gram + coverage. diptheria Safe in pregnancy & pediatrics    Side Effects GI upset (motilin like effects) o Cramps/nausea common side effects Liver toxicity CYP 450 3A inhibitor  toxic effects . antacids o All contraindicated:  Pregnancy & children (age < 814)  Dental enamel dysplasia & discoloration  Dental caries and cavities  Growth inhibition. bone deformity o Beware of photosensitivity!!  Especially TCN. demeclocycline  Avoid sun or double up on sunscreen  Can burn easier  Reduces latency to burn by ½ to 2/3  Drugs Bacteriocidal Agent o Aminoglycosides  Streptomycin (“Strep”)  Amikacin (Amikin)  Gentamicin (Garamycin)  Tobramycin (Nebcin)  Neomycin (Neosporin et al)   Protein Synthesis Inhibitors Useful For Widely used in gram negative infections Rarely used as single agents o Usually combined with gram + effective agent     Side Effects Parenterals: poorly absorbed from GI tract All are potentially ototoxic All are potentially nephrotoxic Toxicity increased by loop diuretics o Most potent to shed sodium o Reduce fluid volume Drugs  Macrolides o Erythromycin (EES. Drugs Broad Spectrum Bacteriostatic Agents o Tetracyclines  Tetracycline (TCN)  Doxycycline (Vibramycin)  Minocycline (Minocin)  Demeclocycline (Declomycin)  Oxytetracycline (Terramycin)  Methacycline (Rondomycin) Others o o o o  Protein Synthesis Inhibitors Useful For Broad spectrum bacteriostatic agents o More effective against gram pos than gram neg o Chlamydia species o Mycoplasma pneumoniae o Acne vulgaris (anti inflammatory) o Some protozoal infections   Chloramphenicol (Chloromycetin) Lincomycins Spectrogramins Oxazolidinones Side Effects Tetracyclines o Oral absorption reduced by food.

chlamydia Legionella Some mycobacteria (TB. o Colfazamine o Rifampin Mycobacterium tuberculosis o Isoniazid (INH) o Rifampin (Rifadin. headache) Liver toxicity: trovafloxacin Photosensitivity: lomefloxacin Fluoroquinolones damage growing cartilage Don’t use <18 years of age o Exceptions: serious resistant infections Avoid (if possible) use during pregnancy Tendon rupture   Drugs Mycobacterium leprae o Dapsone. ureaplasma. diarrhea) CNS symptoms (dizziness. avium) Anaerobes         Side Effects GI symptoms (nausea. Rimactane) o Ethambutol (Myambutol) o Streptomycin o Pyrazinamide o Aminosalicyclic sodium (Paser) o Ethionamide (Trecator-SC) o Cycloserine (Seromycin)  Anti-Mycobacterium Agents Useful For Battling Leprosy (Hansen’s Disease) o Works best w/ triple drug treatment Tuberculosis Treatment o Two or more drugs based on sensitivity studies o Duration of treatment varies from 4-7 months  Longer in selected cases  Side Effects  Isoniazid (INH) o Toxicity:  Peripheral Neuritis (paresthesia)  Pyridoxine (B6) insufficiency  Hepatitis/Hepatotoxicity  Age linked o The older you are the greater the risk  Means no ethanol while under RX  Drug Interactions .Drugs  Fluoroquinolones  Gram negative efficacy only o Norfloxicin (Noroxin)  Gram + activity added o Ciprofloxin (Cipro) o Enoxacin (Penetrex) o Lomefloxacin (Maxaquin) o Levofloxacin (Levaquin) o Ofloxacin (Floxin)  Augmented anti-staphylococcal activity o Gatifloxacin (Tequin) o Moxifloxacin (Avelox) o Sparfloxacin (Zagam) o Trovafloxacin (Trovan)       Inhibitors of Nucleic Acid Useful for Norfloxicin (Noroxin) o People with frequent UTI Gonorrhea Mycoplasma.

duration. depression o Flu-like syndromes o Marrow suppression o Hepatic toxicity Ribavirin o Hemolytic anemia (10-20%) . fetus o Long latency o Serious problem in immunocompromised patients:  Retinits  Enchephalitis Hepatitis Viruses o Types A. others o Chronic infection (B.C) Interferon o Immune cell produced cytokines which… o Are anti-viral and anti-neoplastic because… o They activate key immune system components:  Macrophages  Natural killer cells  Antigen presentation to T cells   Side Effects Well tolerated o Many >10 years acyclovir suppression Famciclovir o Oncogenic o Testictular toxicity   Ganciclovir o Myelosupression o Additive with anti-HIV drugs Cidofovir o Renal toxicity (dose dependent)    Interferon o Neuropsychiatric  Contraindicated in psychosis. B. severity of recurrent outbreaks Battling CMV o Very common (60-80%) o Can infect embryo. recurrences common o Severe infection possible in immunocompromised patients Battling Varicella-Zoster Virus (VZV) o Chickenpox o Zoster (“herpes zoster”) o Dangerous in immunocompromised hosts For HSV & VZV: o Reduce symptoms of primary infection For HSV: o Reduce frequency. C.C) o Liver failure. Drugs Anti-HSV & VZV Agents o Acyclovir (Zovirax): oral & IV o Famciclovir (Famvir): oral o Valacyclovir (Valtrex): oral o Foscarnet (Foscavir): IV o Penciclovir (Denavir): topical o Trifluridine (Viroptic): topical       Anti-CMV Agents o Ganciclovir (Cytovene) o Cidofovir (Vistide) o Foscarnet (Foscavir) o Fomivirsen (Vitravene) o Valfanciclovir (Valcyte)  Anti-Hepatitis Agents o Lamivudine (Epivir) o Adefovir (Hepsera) o Interferon alfa-2a (Roferon)  2b (Intron)  N3 (Alferon) o Ribavirin (Rebetol/Virazole)   Antivirals Useful For Battling Herpes Simplex o Type I: “Oral” Type II: “Genital” o Primary Infections often terrible  Teratogenic in early pregnancy  Potentially fatal to newborns o Latency. hepatoma (B.

the better it works Side Effects . Drugs Anti-Influenza Agents o Prophylactic agents against influenza A  Amantadine (Symmetrel):  Rimantadine (Flumadine) o Neuraminidase inhibitors  Zanamivir (Relenza)  Oseltamivir (Tamiflu)    Antivirals Useful for Battling Influenza Amantadine/Rimantadine o Allergies and asthma o Some help with symptoms in first 24-48 hours o Best at prevention  Patients allergic to vaccine (eggs)  70-90% effective o Mode of action uncertain  May block viral attachment Neuraminidase Inhibitor o Preventive and shorten the duration o Prevention (prophylaxis)  70-80% effectiveness o Reduce symptoms/severity  Reduce illness duration by 1-4 days  The earlier it’s started.

Blastomyces Fluconazole (Diflucan) o 1st choice for cryptococcal meningitis o GYN use: single dose for vaginitis Nystatin (Mycostatin) o “Swish & swallow” for oral candida o Alternative is clotrimazole troches  Side Effects Amphotericin B o Toxic: low therapeutic index o Fever. Fever. Headache o Elevated Liver Enzymes o Epidermal Reactions  Toxic Epidermal Necrolysis  Stevens-Johnson Syndrome Protease Toxicity o Diarrhea. chills (preventable) o Hypotensive crisis o Anemia o Thrombophlebitis . abdomen) o Hyperglycemia & hyperlipidemia   Drugs Superficial Agents o Clotrimazole (Lotrimin) o Miconazole (Monistat) o Econazole (Spectazole) o Nystatin (Mycostatin) o Grieseofulvin (Grifulvin) Systemic/Subcutaneous o Amphotericin B (Amphotec) o Fluconazole (Diflucan) o Flucytosine (Ancobon) o Itraconazole (Sporanox o Ketoconazole (Nizoral) o Terbinafine (Lamasil)    Antifungals Useful For Amphotericin B o Potent against Candida. Nausea. 3TC)  Didanosine (Videx.Drugs  Anit – HIV o Nucleoside Reverse Transcriptase Inhibitors  Zidovudine (Retrovir. lorazepam. ddC)  Stavudine (Zerit. AZT)  Zalcitabine (Hivid. Cryptococcus. AZT) o Drug Interactions (esp. acetoaminophen NNRTI Toxicity o Rash. Histoplasma. Coccidioides. indomethacin. AZT)  Cimetidine. fatigue. d4T)  Lamuvudine (Epivir. headache o Drug Interactions  Elevated liver enzymes o Lipodystrophy  Redistribution of fat (to back. Integrase inhibitor  Antivirals Useful For HIV Treatment o Multi-drug combinations o Usually 3 drugs o More effective o Less risk of drug resistance o Highly Active AntiRetroviral Therapy (HAART)    Side Effects NRTI Toxicity o Pancreatitis o Renal Impairment o Peripheral neuropathy o Bone marrow toxicity (esp. ddi)  Abacavir (Ziagen)  Tenofovir (Viread) o Nonnucleoside RT Inhibitors  Nevirapine (Viramune)  Delavirdine (Rescriptor)  Efavirenz (Sustiva) o Protease Inhibitors  Saquinavir (Invirase)  Ritonavir (Norvir)  Ritonavir/lopinavir (Kaletra)  Indinavir (Crixivan)  Nelfinavir (Viracept)  Amprenavir (Agenerase) o Nucleotide Inhibitors o Fusion inhibitor.

Antiprotozoals Drugs  Antiprotozoal Drugs o Metronidazole (Flagyl) o Chloroquine (Aralen) o Artemisinin Useful For  Metronidazole (Flagyl) o All but Plasmodium o Protozoal infections o Anaerobic infections o Abscesses o Pseudomembraneous colitis o Bacterial vaginosis  Chloroquine (Aralen) o Plasmodium o Amebic liver abscess  Artemisinin o Plasmodium Side Effect  Metronidazole (Flagyl) o Generally safe o Nausea. metalic taste. dizziness o Disulfiram (Antabuse)-like reaction possible  Avoid ethanol .