Professional Documents
Culture Documents
Anti Microbial Notes
Anti Microbial Notes
INHIBITORS OF
PEPTIDOGLYCAN
CROSS LINKING
Names
-lactams
penicillins,
cephalosporins,
carbapenems
Mechanism
Bind PBPs (transpeptidases),
block cross-linking of
peptidoglycan activation of
autolytic enzymes. Bactericidal
Bugs
Resistance
Toxicity
Hypersensitivity with a range of
manifestations urticarial skin rash is
common, but anaphylaxis is possible
1. IgE mediated rapid onset,
anaphylaxis, angioedema,
laryngospasm
2. IgM and IgG antibodies fixed to
cells vasculitis, neutropenia,
positive Coombs test
3. Immune complex formation
vasculitis, serum sickness (fever,
urticaria, proteinuria, arthralgia,
lymphadenopathy 5-10 days after
starting the drug), interstitial
nephritis
4. T cell mediated urticarial and
maculopapular rashes, Sevens
Johnson syndrome
Notes
Most are eliminated
through the kidney
except nafcillin and
oxacillin are eliminated in
bile (N and O say NO to
the kidney!)
Same
Penicillin G
Streptococci
S pneumo - resistance
Meningococci
Treponema pallidum
Actinomyces
Penicillinase a type of
lactamase
Hemolytic anemia
monobactam aztreonam
-LACTAM:
PENICILLINS
Bacteriocidal
Penicillin V
Streptococci and oral
pathogens
Amino-penicillins =
-lactamase-sensitive
penicillins
Ampicillin
Amoxicillin better
oral bioavailability
Same
HELPSS kill enterococci!
Gram positives
Gram postive cocci not
staph
Listeria (ampicillin)
Enterococci
-lactamase-resistant
penicillins
Anti-psuedomonals
Oxacillin
Nafcillin
Dicloxicillin
Methicillin
Ticarcillin
Piperacillin
Same
Same
lactamase inhibitors
Clavulanic acid
Sulbactam
Tazobactam
LACTAM CEPHALOSPORINS
Bacteriocidal
Cefazolin
Cephalexin
2nd generation
Cefoxitin
Cefaclor
Cefuroxime
3rd generation
Ceftriaxone
Cefotaxime
Ceftazidime
th
4 generation
Cefepime
Ceftriaxone
meningitis, gonorrhea,
and community acquired
pneumonia. Largely
elimated in bile.
Ceftazidime
pseudomonas
th
5 generation
Ceftaroline
CARBAPENEMS
Bactericidal
Imipenem
Meropenem
Ertapenem
Doripenem
IV ONLY
MONOBACTAMS
Bactericidal
IV ONLY
INHIBITORS OF
PEPTIDOGLYCAN
SYNTHESIS
VANCOMYCIN
Bactericidal
TETRACYCLINES
Bacteriostatic
No cross-allergenicity with
penicillins or cephalosporins!
Vancomycin
Drug inactivation by
acetylation,
phosphorylation, or
adenylation
Gentamicin
Neomycin
Amikacin
Tobramycin
Streptomycin
Tetracycline
Doxycycline
Minocycline
PROTEIN SYNTHESIS
INHIBITORS 50S
SUBUNIT
Wide spectrum
Gram positive cocci
Gram negative rods including pseudomonas
(ertapenem has
pseudomonas coverage)
Anaerobes
Aztreonam
Doesnt cover
psuedomonas
Amino acid
modification D-ala Dala D-ala D-lactate
Borrelia burdorferi
Mycoplasma pneumonia
Rickettsia and chlamydia
(reaches high intracellular
concentrations)
Acne
Doxycycline prostatitis,
reaches high concentrations
Minocycline
meningococcus carrier
states
Nephrotoxicity
Ototoxicity
Hypotension
Thrombophlebitis
Red man syndrome diffuse
flushing. Prevent with antihistamines
and slow infusion rate
Renal elimination
Nephrotoxicity especially
when mixed with
cephalosporins
Neuromuscular blockade
Ototoxicity
Teratogen
Synergistic with
lactams for enterococci
(penicillin G or ampicillin)
and pseudomonas
(extended spectrum)
Neomycin for bowel
surgery
GI distress
Discoloration of teeth & inhibition
of bone growth in kids
Photosensitivity
Contraindicated in pregnancy
Superinfections candidiasis,
colitis
Doxycycline has fecal elimination
CHLORAMPENICOL
Bacteriostatic
Chloramphenicol
st
Clindamycin
Blocks peptidyltransferase,
which transfers amino acid from A
site to P site and catalyzes peptide
bond. Acts at the 50s subunit
Meningitis H influenza, N
meningitidis, S pneumo
Rocky mountain spotted
fever (Rickettsia rickettsi)
Drug inactivation by
acetyltransferase
encoded by plasmids
Azithromycin
Clarithromycin
Erythromycin
Same as clindamycin
(macroslides). Bind to the 23S
rRNA of the 50s subunit
Atypical pneumonias
mycoplasma (including
avium), chlamydia, legionella
STDs chlamydia
Gram positive cocci
streptococcal infections in
patients allergic to penicillin
MACROLIDES
Bacteriostatic
Methylation of target
site on 23S rRNA
prevents drug binding
MACRO:
Motility issues
Arrhythmia by QT
Acute cholestatic hepatitis
Rash
eOsinophilia
serum concentration of
theophyllines, oral anticoagulants
Can cause serotonin syndrome
Clarithromycin
combine with
metronidazole and PPI in
triple therapy for H pylori
Azithromycin
prophylaxis in AIDS for
Mycobacterium avium
(CD4 < 50)
LINEZOLID
Bacteriostatic (usually)
Linezolid
Very rare
STREPTOGRAMINS
Bacteriostatic alone,
Bacteriocidal together
Quinupristin
Dalfopristin
Inactivating enzymes,
efflux
Sulfamethoxazole
Sulfisoxazole
Sulfadiazine
Sulfasalazine
Altered enzyme,
uptake, or PABA
synthesis
Hypersensitivity
Hemolysis if G6PD deficient
Nephrotoxicity
tubulointerstitial nephritis
Photosensitivity
Displace bilirubin and other
drugs from albumin e.g.,
warfarin; kernicterus in infants
and pregnancy
Stevens Johnson syndrome
Sulfasalazine ulcerative
colitis
Altered dihydrofolate
reducatase
TRIMETHOPRIM
Bacteriostatic
Trimethoprim
Gram positives
Gram negatives
Nocardia
Chlamydia
Triple sulfas or Bactrim for
UTI
Usually combined w/
trimethoprim to avoid resistance
Bactrim:
UTIs
Leukopenia
Granulocytopenia
UTIs
Prophylaxis in AIDS for
pneumocystis pneumonia
(CD4 < 200)
DNA TOPOISOMERASES
FLOUROQUINOLONES
Bactericidal
Ciprofloxacin
Norfloxacin
Levofloxacin
Oflofloxacin
Sparfloxacin
Moxifloxacin
Gemifloxacin
Enoxacin
Mutation in DNA
gyrase
(topoisomerase II)
encoded by
chromosome.
More common
GI upset
Superinfections
Skin rashes
Headache, dizziness
Rare
Tendonitis, tendon rupture (esp
> 60 yrs, taking prednisone), leg
cramps, myalgias
QT
Nalidixic acid
DAMAGES DNA
METRONIDAZOLE
Bacteriocidal
Antiprotozoal
ANTIMYCOBACTERIAL
DRUGS
ISONIAZID
Metronidazole
Protozoa giardia,
entamoeba, trichomonas,
Gardnerella (gram variable
rod)
Use with PPI and
clarithromycin for triple
therapy against H Pylori
Anaerobes below the
diaphragm
Isoniazid
Clindamycin for
anaerobes above the
diaphragm
RIFAMYCINS
Rifampin
Rifabutin
TB
Leprosy delays
resistance to dapsone
Enzyme alteration
4 Rs of Rifampin
1. RNA polymerase
inhibitor
Pyrazinamide
ETHAMBUTOL
Ethambutol
Acidifies intracellular
environment by conversion to
pyrazinoic acid effective in
acidic pH of phagolysosome,
where TB engulfed by
macrophages is found
carbohydrate polymerization
of mycobacterium cell wall by
blocking arabinosyltransferase
dangerous)
In HIV, rifabutin is better because
< P450 stimulation rifAMPin
amps up P450s but rifaBUTin
does not
TB
Hyperuricemia
Hepatotoxicity
TB
2. Ramps up microsomal
P450
3. Red/orange body fluids
4. Rapid resistance if
used alone
Antifungal Drugs
Drug Class
POLYENES
Names
Amphotericin
B
Mechanism
Binds ergosterol and forms membrane
pores leakage of electrolytes.
Unfortunately also binds cholesterol to a
lesser degree toxicity
Poor penetration into CNS combine w/
flucytosine for cryptococal meningitis
Use
Serious, systemic mycoses
Cryptococcus neoformans,
candida +/- flucytosine for
meningitis
Mucor
Aspergillis
Blastomyces, coccidiodes
histoplasma
Resistance
Low ergosterol
content in cell
membranes
TRIAZOLES
Fluconazole
Ketoconazole
Clotrimazole
Miconazole
Itraconazole
Voriconazole
PYRIMIDINES
Flucytosine
ECHINOCANDIN
S
Caspofungin
Micafungin
Anidulafungin
Terbinafine
TERBINAFINE
Dermatophytes
GRISEOFULVIN
Dermatophytes
Griseofulvin
Toxicity
Caused by cholesterol binding:
Fever & chills
Hypotension
Nephrotoxicity because GFR - w/
hydration
Hypomagnesemia, hypokalemia in
most pts altered permeability of renal
tubules
Arrhythmias
Anemia - renal EPO
IV phlebitis
Resistance is
fast if used solo
GI upset
Flushing from histamine release
Dermatophytoses especially
onychomycosis = fungal infection of
finger/toe nails
GI upset
Headaches
Hepatotoxicity
Taste disturbance
Teratogenic
Carcinogenic
Confusion
warfarin and P450 metabolism
Notes
Give intrathecally for fungal
meningitis
Give w/ K+ and Mg
2+
Drug Class
Inhibit
release of
viral
progeny
Name
Zanamivir
Oseltamivir
Mechanism
Inhibit influenza neuraminidase to release of progeny
virus
Use
Influenza A and B
(orthomyxyviruses)
Inhibit
nucleic acid
synthesis
Ribavarin
RSV
Chronic Hep C
Acyclovir
Famcyclovir
Valacyclovir
Gancicyclovi
r
Inhibit viral
protein
synthesis
Foscarnet
Cidofovir
Interferon
1. CMV retinitis in
immune compromised
patients
2. HSV resistant to
acyclovir
Same as foscarnet
1. Chronic Hep B and Hep
C
2. Condyloma
acuminatum
3. Kaposi sarcoma
4. Renal cell carcinoma,
hairy cell leukemia,
malignant melanoma
Resistance
Toxicity
Hemolytic anemia
Severe teratogen makes sense
b/c human cells use IMP
dehydrogenase to make GMP
Must be adequately hydrated!
Risk of obstructive crystalline
nephropathy and acute renal
failure!
Notes
Amantidine and
rimantidine used to inhibit
influenza uncoating no
longer used b/c of
resistance
Renal toxicity
More toxic to host enzymes than
acyclovir:
Leukopenia
Neutropenia
Thrombocytopenia
Nephrotoxicity
Nephrotoxicity coadminister
with probenicid and IV saline to
Neutropenia
Myopathy
Valgancyclovir is a prodrug
with better
Drug class
Nucleoside
Reverse
Transcriptase
Inhibitors
Drug Names
Nucleosides:
Lamivudine
Stavudine
Zidovudine
Emtricitabine
Didanosine
Abacavir
Mechanism
Competitive inhibition of nucleotide binding to reverse
transcriptase terminates DNA chain (lacks 3 OH group)
Use
CHOOSE 2 for part 1
of triple therapy
Toxicity
Bone marrow suppression
reverse with G-CSF and EPO!
Peripheral neuropathy
Nucleosides lactic acidosis
Nucleotides rash
Zidovudine anemia
Didanosine - pancreatitis
Rash
Hepatotoxicity
Efavirenz CNS symptoms and rash,
avoid in pregnancy
Delavirdine avoid in pregnancy
Hyperglycemia
GI intolerance nausea, diarrhea
Lipodystrophy
Notes
Choose 2, then use with 2 out of 3:
NNRT, protease inhibitor, integrase
inhibitor
Nucleotide:
Tenofovir
Non-nucleoside
Reverse
Transcriptase
Inhibitors
Efavirenz
Nevivirapine
Delavirdine
Protease
Inhibitors
-navir
Atazanavir
Darunavir
Fosamprenavir
Indinavir
Lopinavir
Ritonavir
Saquinavir
Integrase
Inhibitor
Raltegravir
Fusion
Inhibitor
Enfuvirtide
Maraviroc
Nephropathy
Hematuria - idinavir
Hypercholesterolemia
Psuedomonas
Bug
Treatment
th
rd
Ticarcillin, pipercillin, cefepime 4 generation, ceftazidime 3
generation, aminoglycosides, others?
MRSA
VRE
Notes
PROTOZOA
Toxoplasmosis
Trypanosoma brucei
Trypanosoma cruzi
Nifurtimox
Leishmaniasis
Sodium stibogluconate
PLASMODIA
Plasmodium vivax, ovale, malariae
Chloroquine.
If life threatening quinidine in the US, quinine elsewhere, or artesunate
Plasmodium falciparum
Artemether/lumefantrine or atovaquone/proguanil
If life threatening quinidine in the US, quinine elsewhere, or artesunate
HELMINTHS
Nematodes (round worms): Enterobius vermicularis (pinworm), ascaris
lumbricoides (giant roundworm), ancylostoma duodenale
Praziquantel
10