29 Antibacterial drugs Flashcards

(84 cards)

1
Q

29.01 BETA-LACTAM ANTIBIOTICS

Penicillins - actions

A

bactericidal
interfere with cell wall synthesis in dividing bacteria

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2
Q

29.01 BETA-LACTAM ANTIBIOTICS

Penicillins - MOA

A

bind to and inhibit the enzyme that cross-links the peptide chain of the newly formed ‘building block’ to the peptidoglycan cell wall backbone

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3
Q

29.01 BETA-LACTAM ANTIBIOTICS

Penicillins - types of penicillins

A

beta-lactamase resistant (methicillin, flucloxacillin, temocillin), broad spectrum (ampicillin, amoxicillin), extended spectrum (piperacillin, ticarcillin)

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4
Q

29.01 BETA-LACTAM ANTIBIOTICS

Penicillins - abs/distrib/elim

A

oral absorption varies
can also be given IM or IV
pass into all body fluids
cross the placenta but not the blood-brain barrier unless the meninges are inflamed
excreted in the urine (blocked by probenecid)

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5
Q

29.01 BETA-LACTAM ANTIBIOTICS

Penicillins - clinical uses

A

bacterial meningitis - benzylpenicillin
skin, bone and joint infections - flucloxacillin
animal bites - co-amoxiclav
pharyngitis - phenoxymethylpenicillin
otitis media, bronchitis, pneumonia - amoxicillin
syphilis - procaine, or benzathine penicillin
endocarditis - benzylpenicillin (with aminoglycoside)
infections with Pseudomonas aeruginosa - piperacillin, ticarcillin

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6
Q

29.01 BETA-LACTAM ANTIBIOTICS

Penicillins - adverse effects

A

hypersensitivity reactions (rashes, urticaria, angioedema, fever, arthralgia, anaphylaxis)

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7
Q

29.02 BETA-LACTAM ANTIBIOTICS

Cephalosporins and cephamycins: ceftriaxone, cefotaxime, cefuroxime - actions

A

bactericidal
interfere with cell wall synthesis in dividing bacteria

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8
Q

29.02 BETA-LACTAM ANTIBIOTICS

Cephalosporins and cephamycins: ceftriaxone, cefotaxime, cefuroxime - MOA

A

bind to and inhibit the enzyme that cross-links the peptide chain of the newly formed ‘building blocks’ to the peptidoglycan cell wall backbone

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9
Q

29.02 BETA-LACTAM ANTIBIOTICS

Cephalosporins and cephamycins: ceftriaxone, cefotaxime, cefuroxime - abs/distrib/elim

A

some cephalosporins given orally, but most given IM or IV
pass into all body fluids
excreted in the urine (blocked by probenecid)
excretion mostly via kidneys, but 40% of ceftriaxone is eliminated in the bile

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10
Q

29.02 BETA-LACTAM ANTIBIOTICS

Cephalosporins and cephamycins: ceftriaxone, cefotaxime, cefuroxime - clinical use

A

septicaemia - cefotaxime, cefuroxime
pneumonia caused by susceptible organisms, meningitis - ceftriaxone, cefotaxime
biliary tract infections, urinary tract infections, sinusitis - cefadroxil

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11
Q

29.02 BETA-LACTAM ANTIBIOTICS

Cephalosporins and cephamycins: ceftriaxone, cefotaxime, cefuroxime - resistance

A

some pneumococci, meningococci and gonococci have decreased sensitivity

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12
Q

29.02 BETA-LACTAM ANTIBIOTICS

Cephalosporins and cephamycins: ceftriaxone, cefotaxime, cefuroxime - adverse effects

A

hypersensitivity reactions (rashes, urticaria, angioedema, fever, arthralgia, anaphylaxis)
GIT disturbances
rarely: hepatitis and cholestatic jaundice

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13
Q

29.03 BETA-LACTAM ANTIBIOTICS

Carbapenems: imipenem, meropenem, ertapenem - actions

A

bactericidal
interfere with cell wall synthesis in dividing bacteria

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14
Q

29.03 BETA-LACTAM ANTIBIOTICS

Carbapenems: imipenem, meropenem, ertapenem - MOA

A

bind to and inhibit the enzyme that cross-links the peptide chain of the newly formed ‘building blocks’ to the peptidoglycan cell wall backbone

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15
Q

29.03 BETA-LACTAM ANTIBIOTICS

Carbapenems: imipenem, meropenem, ertapenem - abs/distrib/elim

A

given by IV infusion
pass into all body fluids including the CSF
inactivated by renal enzymes so must be given with cilastatin which inhibits the relevant enzymes

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16
Q

29.03 BETA-LACTAM ANTIBIOTICS

Carbapenems: imipenem, meropenem, ertapenem - clinical use

A

broad spectrum: active against gram-positive, gram-negative and anaerobic bacteria
not active against MRSA
used to treat severe polymicrobial hospital-acquired infections, e.g. septicaemia, pneumonia, complicated urinary infections

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17
Q

29.03 BETA-LACTAM ANTIBIOTICS

Carbapenems: imipenem, meropenem, ertapenem - adverse effects

A

GIT disturbances, rashes, injection site reactions

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18
Q

29.04 BLOCKERS OF PEPTIDOGLYCAN SYNTHESIS

Glycopeptides: vancomycin, teicoplanin - actions

A

inhibits bacterial cell wall peptidoglycan synthesis

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19
Q

29.04 BLOCKERS OF PEPTIDOGLYCAN SYNTHESIS

Glycopeptides: vancomycin, teicoplanin - MOA

A

inhibit the synthesis of the cell wall in sensitive bacteria
these drugs are slowly bactericidal for dividing microorganisms
impair the permeability of the bacterial cell membrane and RNA synthesis

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20
Q

29.04 BLOCKERS OF PEPTIDOGLYCAN SYNTHESIS

Glycopeptides: vancomycin, teicoplanin - abs/distrib/elim

A

given IV
vancomycin plasma half-life ~8h
vancomycin given orally for treatment of Clostridium difficile

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21
Q

29.04 BLOCKERS OF PEPTIDOGLYCAN SYNTHESIS

Glycopeptides: vancomycin, teicoplanin - clinical use

A

vancomycin used in a wide range of serious infections, including septicaemia, and treatment of MRSA

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22
Q

29.04 BLOCKERS OF PEPTIDOGLYCAN SYNTHESIS

Glycopeptides: vancomycin, teicoplanin - adverse effects

A

hypersensitivity reactions, ototoxicity and nephrotoxicity
phlebitis at infusion site

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23
Q

29.04 BLOCKERS OF PEPTIDOGLYCAN SYNTHESIS

Glycopeptides: vancomycin, teicoplanin - special notes

A

daptomycin is a relatively new lipopeptide antibacterial with similar spectrum to vancomycin
used for treatment of MRSA
telavancin is also active against MRSA with longer duration of action than vancomycin

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24
Q

29.05 BACTERIAL PROTEIN SYNTHESIS BLOCKERS

Tetracyclines: doxycycline, tetracycline, oxytetracycline - actions and MOA

A

interfere with bacterial protein synthesis by competing with tRNA for the A site of the ribosome and reversibly inhibiting its binding to the mRNA codons in the 30S subunit

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25
29.05 BACTERIAL PROTEIN SYNTHESIS BLOCKERS Tetracyclines: doxycycline, tetracycline, oxytetracycline - abs/distrib/elim
given orally, absorption impaired by milk and by calcium, magnesium and iron preparations
26
29.05 BACTERIAL PROTEIN SYNTHESIS BLOCKERS Tetracyclines: doxycycline, tetracycline, oxytetracycline - clinical use
doxycycline is drug of choice for chlamydial, rickettsial and brucella infections effective in most chest infections, including mycoplasma and Haemophilus influenzae used in acne, sinusitis, prostatitis, syphilis, Lyme disease and prevention/treatment of malaria demeclocycline is used in inappropriate secretion of ADH causing hyponatraemia (different action from its antibacterial effect)
27
29.05 BACTERIAL PROTEIN SYNTHESIS BLOCKERS Tetracyclines: doxycycline, tetracycline, oxytetracycline - adverse effects
staining of the teeth, GIT disturbances, anorexia, flushing, tinnitus rare: hepatotoxicity, pancreatitis, hypersensitivity reactions
28
29.05 BACTERIAL PROTEIN SYNTHESIS BLOCKERS Tetracyclines: doxycycline, tetracycline, oxytetracycline - special notes
tetracyclines should not be given to children or pregnant or breastfeeding women
29
29.06 BACTERIAL PROTEIN SYNTHESIS BLOCKERS Aminoglycosides: gentamicin, streptomycin, amikacin, tobramycin, neomycin - actions
inhibit bacterial protein synthesis
30
29.06 BACTERIAL PROTEIN SYNTHESIS BLOCKERS Aminoglycosides: gentamicin, streptomycin, amikacin, tobramycin, neomycin - MOA
cause misreading of the mRNA message due to abnormal codon:anticodon recognition with the production of abnormal proteins
31
29.06 BACTERIAL PROTEIN SYNTHESIS BLOCKERS Aminoglycosides: gentamicin, streptomycin, amikacin, tobramycin, neomycin - abs/distrib/elim
given IM or by slow IV injection or infusion can be given intrathecally renal excretion
32
29.06 BACTERIAL PROTEIN SYNTHESIS BLOCKERS Aminoglycosides: gentamicin, streptomycin, amikacin, tobramycin, neomycin - clinical use
infections with staphylococci (with a beta-lactam antibiotic), streptococci, enterococci, gram-negative bacilli (including Pseudomonas aeruginosa) used for septicaemia, meningitis, pyelonephritis, endocarditis, pneumonia
33
29.06 BACTERIAL PROTEIN SYNTHESIS BLOCKERS Aminoglycosides: gentamicin, streptomycin, amikacin, tobramycin, neomycin - adverse effects
dose-related ototoxicity and nephrotoxicity GIT disturbances, rash, blood disorders can occur ↑ototoxicity with loop diuretics ↑effect of neuromuscular blockers
34
29.07 BACTERIAL PROTEIN SYNTHESIS BLOCKERS Amphenicols: chloramphenicol - actions
inhibit bacterial protein synthesis
35
29.07 BACTERIAL PROTEIN SYNTHESIS BLOCKERS Amphenicols: chloramphenicol - MOA
inhibit transpeptidation
36
29.07 BACTERIAL PROTEIN SYNTHESIS BLOCKERS Amphenicols: chloramphenicol - abs/distrib/elim
given orally or by IV injection or infusion enters CSF and CNS inactivated in the liver excreted in the urine also available as eye drops
37
29.07 BACTERIAL PROTEIN SYNTHESIS BLOCKERS Amphenicols: chloramphenicol - clinical use
used mainly for life-threatening Haemophilus influenzae infections, for meningitis resistant to penicillin (or patients with severe penicillin allergy) and for typhoid used topically for bacterial eye infections
38
29.07 BACTERIAL PROTEIN SYNTHESIS BLOCKERS Amphenicols: chloramphenicol - adverse effects
dose-related bone marrow depression ‘grey baby’ syndrome in neonates who lack the relevant inactivating enzyme: circulatory collapse, flaccidity, vomiting aplastic anaemia in a few genetically predisposed individuals
39
29.08 BACTERIAL PROTEIN SYNTHESIS BLOCKERS Macrolides: erythromycin, clarithromycin, azithromycin - actions
inhibit bacterial protein synthesis
40
29.08 BACTERIAL PROTEIN SYNTHESIS BLOCKERS Macrolides: erythromycin, clarithromycin, azithromycin - MOA
macrolides inhibit bacterial protein synthesis by an effect on ribosomal translocation they bind to the same 50S subunit of the bacterial ribosome as chloramphenicol and clindamycin and any of these drugs may compete if given concurrently
41
29.08 BACTERIAL PROTEIN SYNTHESIS BLOCKERS Macrolides: erythromycin, clarithromycin, azithromycin - abs/distrib/elim
given orally or by IV infusion (IV injection can cause thrombophlebitis) erythromycin half-life 1.5h widely distributed but does not enter brain or CSF
42
29.08 BACTERIAL PROTEIN SYNTHESIS BLOCKERS Macrolides: erythromycin, clarithromycin, azithromycin - clinical use
for pneumococcal and streptococcal infections in patients allergic to penicillin for chlamydial and mycoplasma infections for infections of the skin and respiratory tract (syphilis, diphtheria, prostatitis, whooping cough, campylobacter enteritis) azithromycin is more effective against Haemophilus influenzae and may be more active against Legionella clarithromycin is effective against H. influenzae and Mycobacterium avium-intracellulare and may also be useful in leprosy and against Helicobacter pylori
43
29.08 BACTERIAL PROTEIN SYNTHESIS BLOCKERS Macrolides: erythromycin, clarithromycin, azithromycin - adverse effects
GIT disturbances less frequent: allergic reactions, cholestatic jaundice
44
29.08 BACTERIAL PROTEIN SYNTHESIS BLOCKERS Macrolides: erythromycin, clarithromycin, azithromycin - special notes
concomitant use of statins with clarithromycin is contraindicated statins are extensively metabolised by CYP3A4 and concomitant treatment with clarithromycin increases their plasma concentration, which increases the risk of myopathy, including rhabdomyolysis
45
29.09 BACTERIAL PROTEIN SYNTHESIS BLOCKERS Lincosamide: clindamycin - actions
inhibit bacterial protein synthesis
46
29.09 BACTERIAL PROTEIN SYNTHESIS BLOCKERS Lincosamide: clindamycin - MOA
inhibits the translocation of the tRNA (with its attached peptide) from the A site to the P site
47
29.09 BACTERIAL PROTEIN SYNTHESIS BLOCKERS Lincosamide: clindamycin - abs/distrib/elim
given orally or by IM injection or IV infusion half-life 2.5h widely distributed, entering abscesses but does not penetrate brain or CSF concentrated in bone metabolised in liver to give active metabolite, excreted in urine
48
29.09 BACTERIAL PROTEIN SYNTHESIS BLOCKERS Lincosamide: clindamycin - clinical use
effective against streptococci, penicillin-resistant staphylococci and many anaerobes (except Clostridium difficile) used for lung abscesses, and for bone, joint, skin and soft tissue infections
49
29.09 BACTERIAL PROTEIN SYNTHESIS BLOCKERS Lincosamide: clindamycin - adverse effects
GIT disturbances, skin rashes, jaundice, pseudomembranous colitis
50
29.10 ANTIBIOTICS AFFECTING TOPOISOMERASE Quinolones: ciprofloxacin, levofloxacin, ofloxacin, norfloxacin, moxifloxacin, nalidixic acid - actions
interfere with bacteria DNA function
51
29.10 ANTIBIOTICS AFFECTING TOPOISOMERASE Quinolones: ciprofloxacin, levofloxacin, ofloxacin, norfloxacin, moxifloxacin, nalidixic acid - MOA
inhibits DNA gyrase (aka topoisomerase II) - the enzyme that produces the supercoil in the chromosome that is essential for transcription and replication
52
29.10 ANTIBIOTICS AFFECTING TOPOISOMERASE Quinolones: ciprofloxacin, levofloxacin, ofloxacin, norfloxacin, moxifloxacin, nalidixic acid - abs/distrib/elim
given orally, well absorbed accumulate in several tissues, concentrated in phagocytes aluminium and magnesium antacids interfere with absorption only ofloxacin crosses blood-brain barrier ciprofloxacin and norfloxacin eliminated partly by hepatic P450 metabolism and partly by renal excretion ofloxacin is excreted in urine
53
29.10 ANTIBIOTICS AFFECTING TOPOISOMERASE Quinolones: ciprofloxacin, levofloxacin, ofloxacin, norfloxacin, moxifloxacin, nalidixic acid - clinical use
active against gram-positive organisms, particularly effective against gram-negative bacteria used for: infections of the urinary tract, GIT and bones and joints, respiratory tract infections not caused by pneumococci, gonorrhoea and septicaemia caused by sensitive organisms
54
29.10 ANTIBIOTICS AFFECTING TOPOISOMERASE Quinolones: ciprofloxacin, levofloxacin, ofloxacin, norfloxacin, moxifloxacin, nalidixic acid - adverse effects
major safety concerns regarding tendon damage, aortic dissection, gait disturbance, neuropathies infection with Clostridium difficile, GIT upsets, headache, dizziness, rashes clinically important interaction between ciprofloxacin and theophylline which can lead to theophylline toxicity in asthmatics
55
29.10 ANTIBIOTICS AFFECTING TOPOISOMERASE Quinolones: ciprofloxacin, levofloxacin, ofloxacin, norfloxacin, moxifloxacin, nalidixic acid - special notes
avoid them in older patients, patients with renal damage/impairment or organ transplant risk of tendon injury increased if also on steroids - avoid combined use of these agents
56
29.11 BLOCKERS OF FOLATE SYNTHESIS/ACTION Sulfonamides and trimethoprim - actions
bacteriostatic both sulfonamides and trimethoprim interfere with bacterial folate metabolism and thus with DNA synthesis
57
29.11 BLOCKERS OF FOLATE SYNTHESIS/ACTION Sulfonamides and trimethoprim - MOA
sulfonamides competitively inhibit the enzyme dihydropteroate synthetase trimethoprim inhibits dihydrofolate reductase and thus the conversion of folate to tetrahydrofolate
58
29.11 BLOCKERS OF FOLATE SYNTHESIS/ACTION Sulfonamides and trimethoprim - abs/distrib/elim
given orally or by IV infusion sulfa drugs pass into inflammatory exudates, but are inactive in the presence of pus
59
29.11 BLOCKERS OF FOLATE SYNTHESIS/ACTION Sulfonamides and trimethoprim - clinical use
co-trimoxazole (sulfamethoxazole and trimethoprim combined) is used for pneumocystis pneumonia, toxoplasmosis and nocardiosis, urinary infections, acute exacerbations of chronic bronchitis trimethoprim alone is used for prostatitis, and for urinary and respiratory infections sulfonamides with pyrimethamine are used for drug-resistant malaria and toxoplasmosis
60
29.11 BLOCKERS OF FOLATE SYNTHESIS/ACTION Sulfonamides and trimethoprim - adverse effects
GIT upsets, rashes very rare but serious: Stevens-Johnson syndrome, blood dyscrasias, toxic epidermal necrolysis, photosensitivity, hepatitis, crystalluria trimethoprim - folate deficiency with resultant megaloblastic anaemia is possible with long-term treatment
61
29.12 OTHER ANTIBACTERIAL DRUGS Metronidazole
antiprotozoal agent, but also active against anaerobic bacteria and some streptococci effective in the treatment of pseudomembranous colitis and serious anaerobic infections avoid alcohol, due to dilsulfiram-like action
62
29.12 OTHER ANTIBACTERIAL DRUGS Nitrofurantoin
synthetic compound active against range of gram-positive and gram-negative organisms damages bacterial DNA given orally, rapidly absorbed from GIT, rapidly excreted by kidneys clinical use in treatment of urinary tract infections
63
29.12 OTHER ANTIBACTERIAL DRUGS Quinupristin and dalfopristin - actions
streptogramins - inhibit bacterial protein synthesis individually, exhibit only modest bacteriostatic activity, but combined as an IV injection they are active against many gram-positive bacteria
64
29.12 OTHER ANTIBACTERIAL DRUGS Quinupristin and dalfopristin - clinical use
combination used to treat serious gram-positive infections unresponsive to other antibacterials, e.g. MRSA, skin and soft tissue infections, hospital-acquired pneumonia, vancomycin-resistant Enterococcus faecium
65
29.12 OTHER ANTIBACTERIAL DRUGS Aztreonam
monobactam - resistant to most beta-lactamases given by injection with plasma half-life 2h effective only against gram-negative aerobic bacilli (Pseudomonas species, Neisseria meningitidis and Haemophilus influenzae)
66
29.12 OTHER ANTIBACTERIAL DRUGS Polymyxin B, colistimethate
polymyxins - cationic detergent properties and disrupt bacterial outer cell membrane selective bactericidal action on gram-negative bacilli, especially Pseudomonas and coliform organisms
67
29.12 OTHER ANTIBACTERIAL DRUGS Fosfomycin
phosphonic acid acts against many gram-positive and gram-negative organisms used for treatment of urinary tract infections
68
29.13 ANTIMYCOBACTERIALS FOR TUBERCULOSIS Isoniazid
nicotinic acid derivative given orally, well absorbed passes into CSF and tuberculous lesions acetylated in liver adverse effects: GIT disturbances, hypersensitivity reactions, peripheral neuritis (with high doses, pyridoxine prophylaxis required)
69
29.13 ANTIMYCOBACTERIALS FOR TUBERCULOSIS Rifampicin - actions
bactericidal effective against most gram-positive and many gram-negative bacteria
70
29.13 ANTIMYCOBACTERIALS FOR TUBERCULOSIS Rifampicin - abs/distrib/elim
given orally, widely distributed excreted in urine and bile
71
29.13 ANTIMYCOBACTERIALS FOR TUBERCULOSIS Rifampicin - clinical use
apart from tuberculosis - leprosy, prophylaxis for meningococcal meningitis, and Haemophilus influenzae also used (combined with other drugs) for brucellosis, endocarditis, legionnaires’ disease, serious staphylococcal infections
72
29.13 ANTIMYCOBACTERIALS FOR TUBERCULOSIS Rifampicin - adverse effects
GIT disturbances, skin eruptions, liver damage orange tint to saliva, sweat and tears
73
29.13 ANTIMYCOBACTERIALS FOR TUBERCULOSIS Ethambutol
bacteriostatic given orally, well absorbed adverse effects: optic neuritis (dose-related) - colour vision should be monitored before and during prolonged treatment
74
29.13 ANTIMYCOBACTERIALS FOR TUBERCULOSIS Pyrazinamide
bacteriocidal given orally, well absorbed adverse effects: GIT disturbances, increases plasma urate, malaise, liver damage
75
29.13 ANTIMYCOBACTERIALS FOR TUBERCULOSIS Capreomycin
inhibits protein synthesis given IM adverse effects include renal and auditory nerve damage
76
29.13 ANTIMYCOBACTERIALS FOR TUBERCULOSIS Cycloserine
broad-spectrum antibiotic - inhibits bacterial cell wall synthesis given orally, penetrates CSF adverse effects mainly on CNS
77
29.13 ANTIMYCOBACTERIALS FOR TUBERCULOSIS Streptomycin
aminoglycoside antibiotic - inhibits bacterial protein synthesis given IM adverse effects: ototoxicity and nephrotoxicity
78
29.14 ANTIMYCOBACTERIALS FOR LEPROSY Dapsone - action and MOA
sulfonamide-like, may inhibit folate synthesis
79
29.14 ANTIMYCOBACTERIALS FOR LEPROSY Dapsone - abs/distrib/elim
given orally plasma half-life 24-48h
80
29.14 ANTIMYCOBACTERIALS FOR LEPROSY Dapsone - clinical use
tuberculoid leprosy (and dermatitis herpetiformis) resistance increasing
81
29.14 ANTIMYCOBACTERIALS FOR LEPROSY Dapsone - adverse effects
haemolysis of red blood cells, methaemoglobinaemia, anorexia, nausea and vomiting, fever, allergic dermatitis, neuropathy
82
29.14 ANTIMYCOBACTERIALS FOR LEPROSY Clofazimine - action and MOA
a dye MOA thought to involve action on DNA of leprosy bacilli anti-inflammatory activity
83
29.14 ANTIMYCOBACTERIALS FOR LEPROSY Clofazimine - abs/distrib/elim
given orally plasma half-life can be 8 weeks
84
29.14 ANTIMYCOBACTERIALS FOR LEPROSY Clofazimine - adverse effects
skin and urine can develop a reddish colour and leprosy lesions a blue-black discolouration GIT disturbances, headaches