Updated: 2/28/2021

Antibiotics

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  • Snapshot
    • A 45-year-old woman presents to urgent care for a large abscess on her forearm. She had fallen and scraped herself a few days ago with subsequent erosions and increasing redness and warmth of the area. Today, she noticed some drainage of pus. A wound culture was sent, and she is started on a cephalosporin for soft tissue infection.
  • Introduction
    • Drugs
      • see below
    • Clinical use
      • bacterial infections
    • Cell Wall Synthesis Inhibitors
        • Penicillins
        • (Bactericidal: inhibits bacterial cell wall synthesis via competitive inhibition of the transpeptidase enzyme)
        • Class
        • Name of Drug(s)
        • Indications
        • Penicillin
        • Penicillin G
        • Aqueous (crystalline) penicillin G
        • Procaine penicillin G
        • Benzathine penicillin G
        • Penicillin V
        • S. pnuemoniae
        • S. pyogenes (group A strep)
        • N. meningitidis
        • T. pallidum
        • L. monocytogenes
        • A. israelii
        • P. multocida
        • Aminopenicillins
        • Ampicillin
        • Amoxicillin
        • ↑ gram-negative coverage
        • Enterococci (group D strep)
        • All others listed above
        • Penicillinase-resistant penicillins
        • Methicillin
        • Nafcillin
        • Oxacillin
        • Cloxacillin
        • Dicloxacillin
        • Penicillinase-producing S. aureus
        • All others listed above
        • Antipseudomonal penicillins
        • Carbenicillin
        • Ticarcillin
        • Piperacillin
        • P. aeruginosa
        • Anaerobic bacteria
        • All others listed above
        • Cephalosporins
        • (Bactericidal: inhibits bacterial cell wall synthesis via competitive inhibition of the transpeptidase enzyme)
        • Class
        • Name of Drug(s)
        • Indications
        • 1st generation
        • Cefazolin
        • Cephalexin
        • Gram-positives
        • Some gram-negatives
        • Skin infection prophylaxis
        • 2nd generation
        • Cefoxitin
        • Cefaclor
        • Cefuroxime
        • Gram-positives
        • Improved gram-negative coverage
        • Anaerobes
        • 3rd generation
        • Ceftriaxone
        • Cefotaxime
        • Ceftazidime
        • Serious gram-negative infections
        • Meningitis
        • Pseudomonas
        • 4th generation
        • Cefepime
        • Same coverage as cephalosporins + expanded Pseudomonas coverage + expanded gram-positive coverage
        • 5th generation
        • Ceftaroline
        • Expanded gram-positive and gram-negative coverage, non-suitable coverage of Pseudomonas
        • Other Cell Wall Inhibitors
        • Class
        • Name of Drug(s)
        • Indications
        • Vancomycin
        • (bactericidal: inhibits bacterial cell wall synthesis by disrupting peptioglycan cross linking)
        •  Vancomycin
        • MRSA
        • Patients with PCN or ceph allergies
        • S aureus
        • S epidermidis
        • C. difficile
        • Beta-lactamase inhibitors
        • (beta-lactamse inhibitors that  prevent the degradation of beta-lactam antibiotics)
        • Clavulanic acid
        • Sulbactam
        • Tazobactam
        • Gram-positive
        • S. aureus
        • S. epidermis
        • Gram-negative
        • E. coli
        • Klebsiella
        • Carbapenems
        • (Inhibits bacterial cell wall synthesis)
        • Imipenem (+ cilastatin)
        • Meropenem
        • Doripenem
        • Ertapenem
        • Broadest activity of any antibiotic (does NOT cover MRSA, Mycoplasma, and some Pseudomonas)
        • Aztreonam
        • (inhibits bacterial cell wall synthesis)
        •  Aztreonam
        • Gram-negative rods
        • Aerobes
        • Difficult-to-treat hospital-acquired infections
        • Polymyxins
        • Polymyxin B
        • Polymyxin E
        • Topical gram-negative infections
        • Bacitracin
        •  Bacitracin
        • Topical gram-positive infections
    • Protein Synthesis Inhibitors
        • Anti-30S Ribosomal Subunit
        • Class
        • Name of Drug(s)
        • Indications
        • Aminoglycosides
        • (bactericidal)
        • Gentamicin
        • Neomycin
        • Amikacin
        • Tobramycin
        • Streptomycin
        • Severe gram-negative infections
        • Aerobes only
        • Tetracycline
        • (bacteriostatic)
        • Tetracycline
        • Doxycycline
        • Minocycline
        • Demeclocycline
        • Chlamydia
        • Rickettsia
        • Bacteria without peptidoglycan cell walls
        • Spirochetes
        • V. cholerae
        • H. pylori
        • Anti-50S Ribosomal Subunit
        • Class
        • Name of Drug(s)
        • Indications
        • Macrolides
        • Erythromycin
        • Azithromycin
        • Clarithromycin
        • Outpatient URI, LRI
        • Atypical pneumonia
        • STDs
        • Gram-positive cocci
        • Chloramphenicol  
        • (bacteriostatic)
        •  Chloramphenicol
        • H. influenzae
        • Bacterial meningitis
        • Brain abscess
        • Bacteroides fragilis
        • Clindamycin 
        • (bacteriostatic)
        • Clindamycin
        • Anaerobes above the diaphragm
        • Female GU
        • TSS
        • Linezolid
        • (variable)
        • Linezolid
        • Resistant gram-positives (MRSA, VRE)
        • can cause serotonin syndrome
        • Streptogramins
        • Quinupristin
        • Dalfopristin
        • VRE
        • GAS and S. aureus skin infections
        • Note: bacteriocidal when used together
    • DNA Synthesis Inhibitors
        • Fluoroquinolones
        • (Bactericidal: inhibit DNA gyrase enzyme, inhibiting DNA synthesis)
        • Class
        • Name of Drug(s)
        • Indications
        • 1st generation
        • Nalidixic acid
        • Gram-negative UTIs
        • 2nd generation
        • Ciprofloxacin
        • Norfloxacin
        • Enoxacin
        • Ofloxacin
        • Levofloxacin
        • Gram-negative UTIs
        • Gram-negative GI tract
        • Pseudomonas
        • 3rd generation
        • Gatifloxacin
        • As above + gram-positives
        • 4th generation
        • Moxifloxacin
        • Gemifloxacin
        • As above + gram-positives + anaerobes
        • Other DNA Inhibitors
        • Class
        • Name of Drug(s)
        • Indications
        • Metronidazole
        • (bacteridical: metabolic byproducts disrupt DNA)
        •  Metronidazole (Flagyl)
        • Bacteria AND protozoa
        • Anaerobes below the diaphragm
        • C. difficile
        • H. pylori
    • RNA Synthesis Inhibitors
        • Class
        • Name of Drug(s)
        • Indications
        • Rifampin 
        • (bactericidal: inhibits RNA transcription)
        • Rifampin
        • TB
        • Leprosy
        • H.influenzae prophylaxis
        • Antistaphylococcal
    • Mycolic Acids Synthesis Inhibitors
        • Class
        • Name of Drug(s)
        • Indications
        • Isoniazid
        • Isoniazid
        • TB
        • Latent TB
    • Folic Acid Synthesis Inhibitors
        • Class
        • Name of Drug(s)
        • Indications
        • Sulfonamides
        • Sulfamethoxazole (SMX)
        • Sulfisoxazole
        • Sulfadiazine
        • Respiratory (S. pneumoniae, H. influenzae)
        • GI (enterics)
        • UTIs
        • PCP and T. gondii
        • Trimethoprim 
        • Trimethoprim
        • Respiratory (S. pneumoniae, H. influenzae)
        • GI (enterics)
        • UTIs
        • PCP and T. gondii
        • Pyrimethamine 
        • Pyrimethamine
        • Malaria
        • T. gondii
    • Miscellaneous   
        • Drugs
        • Mechanism of Action
        • Indications and Side Effects
        • Pyrazinamide
        • Uncertain mechanism: potentially accumulates in cells dsirupting membrane potential and fatty acid synthesis
        • Part of RIPE therapy for TB
        •  Can cause hyperuricemia and hepatoxicity
        • Ethambutol
        • Inhibits arabinosyltransferase (inhibiting production of mycobacterium cell wall)
        • Part of RIPE therapy for TB and used for M. avium-intracellulare
        •  Can cause optic neuropathy (red-green color blindness)
        • Daptomycin
        • Lipopeptide that disrupts cell membrane
        • Multi-resistant gram-positives such as MRSA and VRE
        •  Can cause myopathy (elevated CK and rhabdomyolysis
        •  Ineffective in lung infections as drug cannot distinguish between surfactant lipid layer and bacterial membranes, thus is sequestered in surfactant

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