ANTIBIOTICS

SARAH DYAB
 OUTLINES
• Antibiotics: Mechanism of action, uses
and side effects.
• Empirical antibiotics .
• Source of infection and appropriate
antibiotic choice.

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MECHANISMS OF ACTION

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 B LACTAMS
• Inhibit cell wall synthesis by blocking peptidoglycan crosslinking

• CNS penetration

- Only when meninges are inflamed

- Exceptions: ceftriaxone and aztreonam always have good CNS penetration.

• Route of elimination - Primarily renal (via tubular secretion)

• General adverse effects

- Hypersensitivity reactions

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CLASSIFICATIONS

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PENICILLINS
TYPE AMINOPENICILLINS NATURAL PENICILLINASE
PENICILLINS RESISTANT

NAMES AMOXICILLIN –ORAL PENICILLIN G –IV Nafcillin , Dicloxacillin

AMPICILLIN –IV/IM PENICILLIN V - Oxacillin
ORAL
USE -Gram-positive aerobes -Gram-positive aerobes (esp. -Gram-negative rods,
-Gram-negative rods Streptococcus pyogenes, especially Pseudomonas
• Most effective against: Streptococcus pneumoniae) -Anaerobes (e.g., Bacteroides
H. pylori -Gram-negative cocci (esp. fragilis)
H. influenzae Neisseria meningitidis) -Gram-positive aerobes: not
E. coli - Actinomyces effective against S. viridans
Listeria monocytogenes
Proteus mirabilis
Salmonella
Shigella
Enterococci
Spirochetes

Adverse effects Diarrhea -Hypersensitivity reactions hypersensitivity reactions

Pseudomembranous colitis -Hemolytic anemia positive
Hypersensitivity reactions -Direct Coombs test
Drug-induced rash -Drug-induced interstitial
Possibly acute interstitial nephritis
nephritis -Seizures 6
 Cephalosporins

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Cephalosporins
• Adverse effects

• Cross-reactivity in patients with penicillin allergies

• Autoimmune hemolytic anemia (AIHA)

• Vitamin K deficiency.

• Disulfiram-like reaction, especially when consumed with alcohol (flushing,

tachycardia, hypotension)

• Increases nephrotoxic effect of aminoglycosides when administered together

with cephalosporins
• Neurotoxicity (can lower seizure threshold)

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 CARBAPENEMS
• Examples : IV imipenem (combined with cilastatin) , IV meropenem ,IV Adverse effects :
ertapenem ,IV doripenem.
• Secondary fungal
• Clinical use • CNS toxicity: can lower seizure
1. Broad-spectrum antibiotics with intrinsic beta-lactamase resistance threshold at high concentrations
2. Gram-positive cocci (except for MRSA and Enterococcus faecalis and (highest risk –imipenem)
faecium • Gastrointestinal upset
3. Gram-negative rods, including Pseudomonas aeruginosa (except • Rash
ertapenem which has limited activity against Pseudomonas) • Thrombophlebitis
4. Anaerobes

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Monobactams
• Effective against gram-negative bacteria only ,including nosocomial • Adverse effects :rare
Pseudomonas, H. influenzae, and N. meningitidis • GI upset
• Injection reactions
• Alternative for penicillin-allergic patients • Rash
• Can be used as an alternative to aminoglycosides for patients with renal
insufficiency because it is synergistic with aminoglycosides
• Broad-spectrum coverage in combination with vancomycin or
clindamycin

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AMINOGLYCOSIDES

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FLOROQUINILONES

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 TETRACYCLINS
Mechanism of action:

bind 30S subunit → aminoacyl-tRNA is blocked from

binding to ribosome acceptor site → inhibition of
bacterial protein synthesis (bacteriostatic effect)

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 Macrolides

Mechanism of action:

bind to 23S ribosomal RNA molecule of the

50S subunit → blockage of translocation → inhibition
of bacterial protein synthesis; bacteriostatic effect

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Sulfonamides and diaminopyrimidine

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 Empirical antibiotic treatment

The term “empiric therapy” refers to antibiotics that are administered during the period prior to the
receipt of blood culture and antibiotic susceptibility test results, whereas the term “definitive therapy”
refers to the antibiotic therapy given subsequent to receipt of these results.

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Central Nervous System Infections

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Intra-abdominal Infections
Dysenteric Diarrhea (other than C. difficile)

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C-DIFF INFECTION

Fidaxomicin 200 mg PO every 12 hours for 10 days

Vancomycin 125 mg PO every 6 hours for 10 days

Metronidazole 500 mg PO every 8 hours for 10 days

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Fulminant CDI
Vancomycin 500 mg PO
Metronidazole 500 mg IV every 8 hours for 10 days
Vancomycin 500 mg in 100 mL normal saline PR every 6
hours

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Pneumonia, Community Acquired

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Pneumonia, Community Acquired

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Pneumonia, healthcare-associated

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Community Acquired Sepsis

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Complicated UTI
•all urinary tract infections in immunocompromised patients, males, and
those associated with fevers, stones, sepsis, urinary obstruction,
catheters, or involving the kidneys are considered complicated
infections.

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Community-acquired pyelonephritis/complicated UTI, hospitalized patient

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Community-acquired pyelonephritis/complicated UTI, outpatient

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Healthcare-Associated Urinary Tract Infection: UTI

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