Summary For Antibiotic For

USMLE Exam
DR.Paul

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Also you should remember this..

+Sulfonamides compete for albumin with:

Bilirrubin: given in 2°,3°T, high risk or indirect hyperBb and

kernicterus in premies
Warfarin: increases toxicity: bleeding

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* Beta-lactamase (penicinillase) Suceptible:

Natural Penicillins (G, V, F, K)

Aminopenicillins (Amoxicillin, Ampicillin)
Antipseudomonal Penicillins (Ticarcillin, Piperacillin)

* Beta-lactamase (penicinillase) Resistant:

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Oxacillin, Nafcillin, Dicloxacillin

3°G, 4°G Cephalosporins
Carbapenems
Monobactams
Beta-lactamase inhibitors

* Penicillins enhanced with:

Clavulanic acid & Sulbactam (both are suicide inhibitors, they

inhibit beta-lactamase)
Aminoglycosides (against enterococcus and psedomonas)

* Aminoglycosides enhanced with Aztreonam

* Penicillins: renal clearance EXCEPT Oxacillin & Nafcillin (bile)

* Cephalosporines: renal clearance EXCEPT Cefoperazone &

Cefrtriaxone (bile)

* Both inhibited by Probenecid during tubular secretion.

* 2°G Cephalosporines: none cross BBB except Cefuroxime

* 3°G Cephalosporines: all cross BBB except Cefoperazone bc is

highly highly lipid soluble, so is protein bound in plasma, therefore it
doesn’t cross BBB.

* Cephalosporines are “LAME“ bc they do not cover this

organisms

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L isteria monocytogenes
A typicals (Mycoplasma, Chlamydia)
M RSA (except Ceftaroline, 5°G)
E nterococci

* Disulfiram-like effect: Cefotetan & Cefoperazone (mnemonic)

* Cefoperanzone: all the exceptions!!!

 All 3°G cephalosporins cross the BBB except Cefoperazone.
All cephalosporins are renal cleared, except Cefoperazone.
Disulfiram-like effect

* Against Pseudomonas:

3°G Cef taz idime (taz taz taz taz)

4°G Cefepime, Cefpirome (not available in the USA)
Antipseudomonal penicillins
Aminoglycosides (synergy with beta-lactams)
Aztreonam (pseudomonal sepsis)

* Covers MRSA: Ceftaroline (rhymes w/ Caroline, Caroline the 5°G

Ceph), Vancomycin, Daptomycin, Linezolid, Tigecycline.

* Covers VRSA: Linezolid, Dalfopristin/Quinupristin

* Aminoglycosides: decrease release of ACh in synapse and act as

a Neuromuscular blocker, this is why it enhances effects of muscle
relaxants.

* DEMECLOCYCLINE: tetracycline that’s not used as an AB, it is

used as tx of SIADH to cause Nephrogenic Diabetes Insipidus
(inhibits the V2 receptor in collecting ducts)

* Phototoxicity: Q ue S T ion?

Q uinolones
Sulfonamides
T etracyclines
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* p450 inhibitors: Cloramphenicol, Macrolides (except
Azithromycin), Sulfonamides

* Macrolides SE: Motilin stimulation, QT prolongation, reversible

deafness, eosinophilia, cholestatic hepatitis

* Bactericidal: beta-lactams (penicillins, cephalosporins,

monobactams, carbapenems), aminoglycosides, fluorquinolones,
metronidazole.

* Baceriostatic: tetracyclins, streptogramins, chloramphenicol,

lincosamides, oxazolidonones, macrolides, sulfonamides, DHFR
inhibitors.

* Pseudomembranous colitis: Ampicillin, Amoxicillin, Clindamycin,

Lincomycin.

* QT prolongation: macrolides, sometimes fluoroquinolones

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