Carbepenems –

Renal dehydropeptidase I covert imipenem into

neurotoxic metabolites that can cause seizures.
Thus it is inhibited using cilastatin.

Teicoplanin and telavancin – other glycopeptide derivatives

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Thrombophlebitis – pus accumulation in portal vein  symptoms: fever, increased ALT & AST, pain.
Vancomycin infusion reaction (red-man syndrome) – if drug is infused rapidly  destroys our muscle  releases histamine
(IgE is not elevated)  anti-histamine
Vanocomycin kills infection  bacterial products will be dispersed  APCs  lymph nodes  B-cells proliferation will be too
much = enlarged lymph nodes (paracortex). Symptoms: fever, chills, hyperventilation, lymphadenopathy. If untreated 
 septic shock + multisystem failure. T and B-cell will be aggressive  release cytokines (TNF, IL-1, IL-6)  TNF suppresses
heart contractility – heart collapse.

Cannot be first choice – cuz it’s a radical drug  can give radical side effect Bacterial – 30/50/70

Humans – 40/60/80

 It can cross the placenta and BBB

 Inactivated by hepatic glucuronosyltransferase (not resistancy) – DON’T give if person have liver failure
 Not effective against chlamydia
 Backup drug for severe infections caused by salmonella
 Used for anaerobes like bacteroides fragilis
Adverse effect / toxicity –
 GI disturbances  irritation + superinfections (like candidiasis – presented as white painful lesions can be deployed in
esophagus
 Bone-marrow  two main conditions:
o Inhibition of RBCs maturation= megaloblastic anemia (RBCs increase in size)  decreased circulating RBCs =
dose-dependent; reversible
o Aplastic anemia  bleeding, infections, and hypoxia = irreversible; fatal
 Gray baby syndrome  decreased RBCs  cyanosis, and cardiovascular collapse (Hypoxia in lungs (vasoconstriction of
vessels)  increased lung resistance  hypertrophy of the heart - right side). They are deficient in hepatic
glucuronosyltransferase.
 Drug interaction – chloramphenicol inhibits hepatic drug metabolizing enzymes  increases the elimination half-lives
of drugs including phenytoin, tolbutamide, and warfarin (anticoagulant)  side-effects

Effective against intracellular pathogens

First choice for rickettsia

Doxycycline is used in patients allergic

to penicillin; it helps with leptospirosis
It stops cartilage development  problem with joints

 In case of meningitis  this drug will be useless

 If person have ulcers/GERD  they will take antacids // iron-containing preparations  used in patient with anemia
 Tetracycline treats for GI ulcers caused by helicobacter pylori
 Doxycycline treats lyme disease
 Meningococcal carrier state minocycline
  Demeclocylcine  inhabits renal actions of ADH (which acts on V2 receptors) – used in management in patients with
ADH secreting tumors

 Acute cholestasis hepatitis – right upper quadrant pain

 Prolonged QT because the drug destroys potassium channels. Other names – torsade de pointes or polymorphic
ventricular tachycardia. Symptoms - rapid chest palpitation fixed by Mg sulfate.
Patient have constipation because of diabetes  so we usually use M3 agonist, but if the patient has asthma we don’t use it
instead we can use macrolides – since it increases motility.