Antimicrobial therapy Flashcards Preview

Microbiology > Antimicrobial therapy > Flashcards

Flashcards in Antimicrobial therapy Deck (175):
1

Antimicrobial therapy - groups

1. Cell wall synthesis
2. Folic acid synthesis
3. DNA topoisomerases
4. Damage DNA
5. mRNA synthesis
6. Protein synthesis
7. daptomycin

2

Antimicrobial therapy - Cell wall synthesis drugs - divided to

1. Peptidogylcan synthesis drugs
2. Peptidoglycan cross linking

3

Antimicrobial therapy - peptidoglycan cross linking - Groups and drugs

1. Penicillinae sensitive penicillins (amoxillin, ampicillin, Penicillin G and V)
2. Penicillinase-resistant penicillins (Dicloxacillin, Nafcillin, Oxacillin, Methcillin)
3. Antipseudomonals (Piperacillin, Ticarcillin)
4. Cephalosporins (I-V)
5. Carbapenems (Doripenem, Ertapenem, Imipenem, Meropenem)
6. Monobactams (Aztreonam)

4

Antimicrobial therapy - Penicillinae sensitive penicillins - drugs

1. amoxillin
2. ampicillin
3. Penicillin G and V

5

Prototype β-lactam antibiotics

Penicillin G and V

6

Penicillin G vs V

Penicillin G --> IV and IM form
Penicillin V --> Oral

7

Penicillin G and V - mechanism of action

D-Ala-Ala analog --> Bind penicillin-binding proteins (transpeptidas) --> blocks trasnpeptisase cross linking of peptidoglycan in cell wall --> inhibits cell wall synthesis --> Activate autolytic enzyme
BACTERICIDAL

8

Penicillin G and V - clinical use

gram + cocci and robs, gram (-) cocci, spirochetes:
1. gram (+) organisms (S. pneumoniae, S.pygoenes, Actinomyces)
2. gram (-) cocci (mainly N. meningitidis)
3. spirochetes (mainly T. pallidum)

9

Penicillin G and V - toxicity

1. Hyperesensitivity reactions
2. Hemolytic anemia

10

Penicillin G and V - resistance

Penicillinae in bacteria (a type of β-lactamase) cleaves β-lactam ring

11

aminopenicillins - drugs

1. amoxillin
2. ampicillin

12

aminopenicillins (amoxicillin, ampicillin) - mechanism of action

same as penicillin but WIDER SPECTRUM

13

aminopenicillins (amoxicillin, ampicillin) - clinical use

extended spectrum penicillin:
1. H. infl 2. H. pylori 3. E. coli
4. Listeria 5. Proteus 6. Salmonella
7. Shigella 8. Entetococci
MNEMONIC : HHELPSS + enterococci

14

aminopenicillins (amoxicillin, ampicillin) - toxicity

1. hypersensitivity reactions
2. rash
3. pseudomembranous colitis

15

aminopenicillins (amoxicillin, ampicillin) - mechanism of resistance

penicillinase in bacteria (a type of β-lactamase) cleaves β-lactams ring--> combine with clavulanic acid

16

Penicillinase-resistant penicillins - drugs

1. Dicloxacillin
2. Nafcillin
3. Oxacillin
4. Methcillin

17

Penicillinase-resistant penicillins - mechanism of action

same as penicillin
NARROW SPECTRUM AND PENICILLINASE RESISTANT

18

Penicillinase-resistant penicillins - mechanism of penicillinase resistance

Bulky R group blocks blocks access of β-lactase to lactam ring

19

Penicillinase-resistant penicillins - drugs and clinical use

1. Dicloxacillin2. Nafcillin 3. Oxacillin 4. Methcillin
S. aureus (except MRSA)

20

MRSA - mechanism of resistance

altered penicillin binding protein target site

21

Penicillinase-resistant penicillins - toxicity

1. hypersensitivity reactions
2. interstitial nephritis

22

Antipseudomonals - drugs

Piperacillin, Ticarcillin

23

Antipseudomonals - mechansism of action

same as penicillin
Extended spectrum

24

Antipseudomonals - clinical use

1. psudomonas spp and gram-negative robs
2. gram (-) robs

25

Antipseudomonals - toxicity

hypersensitivity reaction

26

Antipseudomonals - resistance

susceptible to penicillinase --> use with β-lactamase

27

β-lactamase inhibitors - drugs

1. clavulanic acid
2. sulbactam
3. tazobactam

28

β-lactamase inhibitors - use

often added to penicillin antibiotics to protect the antibiotic from destruction by β-lactamase (penicillinase)

29

Cephalosporins - drugs

1st generation --> cefazolin, cephalexin
2nd generation --> cefoxitin, cefaclor, cefuroxamine
3rd generation --> ceftriaxone, cefotaxime, ceftazidime
4th generation --> cefepime
5th generation --> ceftraroline

30

Cephalosporins - mechanism of action

β- lactam drugs that inhibit cell wall synthesis but are less susceptible to penicillinases - BACTERICIDAL

31

organisms typically not covered by Cephalosporins?

mnemonic: LAME
Listeria, Atypicals (Chlamydia, Mycoplasma) MRSA, Entrococci
exception. Ceftaroline (5th) covers MRSA

32

1st generation cephalosporins - drugs and clinical use

cefazolin, cephalexin
1. gram + cocci
2. Proteus
3. E. coli
4. Klebsiella
cefazolin used prior to surgery to prevent S. aureus wound infection

33

cefazolin used prior to surgery to

prevent S. aureus wound infection

34

2nd generation - drugs and clinical use

cefoxitin, cefaclor, cefuroxamine
1. like 1st generation (gram + cocci, proteus, E.coli, Klebsiella)
2. H. infuenzae
3. Enterobacter aerogenes
4. Neisseria spp
5. Serratia marcescens

35

3rd generation - drugs and clinical use

ceftriaxone, cefotaxime, ceftazidime
serious gram (-) infections resistant to other β-lactams
- ceftriaxone --> meningitis, gonnorrhea, disseminated Lyme disease
- Ceftazimide --> Pseudomonas

36

4th generation - drugs and clinical use

cefepime
gram (-) organism, with high activity against Pseudomonas
2. gram (+)

37

5th generation - drugs and clinical use

ceftaroline
1. broad gram (+)
2. borad gram (-)
INCLUDING MRSA
DOES NTO COVER PSEUDOMONAS

38

Cephalosporins - toxicity

1. hypersensitivity reactions
2. autoimmune hemolytic anemia
3. disulfiram-like reaction
4. vitamin K deficiency
5. exhibit cross-reactivity with penicillins
6. Increases aminoglycosides mediated nephrotoxicity

39

Cephalosporins - mechanise of resistance

structural change in penicillin-binding proteins (transpeptidase)

40

Carbapenems - drugs

1. Imipenem
2. Meropenem
3. Doripenem (newer)
4. Ertapenem (newer)

41

Carbapenems - mechanism of action

broad spectrum, β-lactamase-resistant β-lactam
ALWAYS ADMINISTRATED WITH CILASTATIN (inhibitor of renal dehydropeptidase I) to decrease inactivation of drug in renal tubule --> meropenem is stable to cilastatin

42

cilastatin - mechansim of action

inhibitor of renal dehydropeptidase I

43

Carbapenems - clinical use

1. Gram (+) cocci
2. Gram (-) robs
3. anaerobes
WIDE spectrum but significant side effects limit use of life threatening infection or after other drugs have failed
Ertapenem has limited pseudomonas coverage

44

Carbapenems - toxicity

1. GI distress
2. skin rash
3. CNS toxicity (seizurs) at high plasma levels (less risk with meropenem)

45

Monobactams - drugs

Aztreonam

46

Monobactams (Aztreonam) - mechansim of action

Bind penicillin-binding proteins 3 (transpeptidas) --> blocks trasnpeptisase cross linking of peptidoglycan in cell wall --> inhibits cell wall synthesis --> Activate autolytic enzyme
LESS SUSCEPTIBLE TO β-lactamases

47

Monobactams (Aztreonam) - 2 special characteristics

1. no cross-allergenicity with penicillins
2. Synergistic with aminoglycosides

48

Monobactams (Aztreonam) - clinical use

1. Gram (-) robs ONLY (no anaerobesm no gram (+))
For penicillin allergic patients and those with renal insufficiency who cannot tolerate aminoglycosides

49

Monobactams (Aztreonam) - side effects

usually nontoxin --> occasional GI upset

50

Monobactams (Aztreonam) - β-lactamases

less susceptible

51

Carbapenems (Doripenem, Ertapenem, Imipenem, Meropenem) - β-lactamases

resistant

52

Antimicrobial therapy - Cell wall synthesis drugs - divided to

1. Peptidogylcan synthesis drugs
2. Peptidoglycan cross linking

53

Antimicrobial therapy - Cell wall synthesis drugs - groups and drugs

glycopeptides:
1. Bacitracin
2. Vancomycin

54

Vancomycin - mechanism of action

inhibits cell wall peptidoglycan formation by binding D-ala D-ala portion of cell wall precursors
BACTERICIDAL
not susceptible to β-lactamases

55

Vancomycin - clinical use

gram (+) bugs only:
serious Multidrug resistance organisms, including:
- MRSA
- S. epidermidis
- Clostiridium difficle (oral)
- Enterococcus species

56

Vancomycin - toxicity

well tolerated
1. nephrotoxicity
2. ototoxicity
3. thrombophlebitis
4. red man syndrom (diffuse flushing)

57

red man syndrom - appearance, caused by, solution

- diffuse flushing
- it is caused by vancomycin
- pretreatment with antihistamines and slow infusion rate

58

Vancomycin - mechanism of resistance

occurs in bacteria via amino acid modification of D-ala D-ala to D-ala D-lac

59

Antimicrobial therapy - DNA topoisomerases - drugs

Fluroroquinolones: (-FLOXACIN) + enoxacin
1. CIPRO-
2. NOR-
3. LEVO-
4. O-
5. MOXI
6. GEMI-
7. ENOXACIN

60

Fluroroquinolones - drug that i not -floxacin

enoxacin

61

Fluroroquinolones - mechanism of action

inhibit prokaryotic enzymes topoisomerase II (DNA gyrase) and topoisomerase IV
BACTERICIDAL

62

Fluororoquinolones - clinical use

1. gram (-) robs of urinary and GI tracts (including Pseudomonas)
2. Neisseria
3. some gram (+)

63

Fluororoquinolones - toxicity

1. GI upset
2. superinfections
3. skin rash
4 .headache/dizziness
5. leg cramps and myalgias (less commonly)
6. Prolonged QT
7. tendonitis or tendon rupture (if >60 or prednisone)
8. contraindicated in pregnancy, nursing mothers, children under eighteen --> possible damage to cartilage

64

Fluororoquinolones - mechanism of resistance

1. chromosome encoded mutation in DNA gyrase
2. plasmid mediated resistance
3. efflux pumps

65

Antimicrobial therapy - damage DNA drug

metronidazole

66

metronidazole - mechanism of action

Forms toxic free radical metavolites in the bacterial cell that damage DNA.
BACTERICIDAL, ANTIPROTOZOAL

67

metronidazole - clinical use

1. Giardia
2. Entamoeba
3. Trichomonas vaginalis
4. Garndenella vaginalis
5. Anaerobes (Bacteroides, C. difficile)
6. H. pylori

68

metronidazole - adverse effects

1. Disulfiram-like reaction (severe flushing, tachycardia, hypertension) with alcohol
2. headache
3. metallic taste

69

Daptomycin - mechanism of action

lipopeptide that disrupt cell membrane of gram (+) cocci

70

Daptomycin - clinical use

1. S. aureus SKIN infection (esp MRSA)
2. bacteremia
3. endocarditis
4. VRE

71

Daptomycin to pneumonia

not used --> avidly binds to and is inactivated by surfactant

72

Daptomycin - toxicity

1. Myopathy
2. rhabdomyolysis

73

Antimicrobial therapy - protein synthesis - divisions and drugs

50S --> 1. Chloramphenicol 2. Clindamycin 3. Linezolid 4. Macrolides 5. Streptogramins
30S --> 1. aminoglycosides 2. Tetracyclines

74

Antimicrobial therapy - protein synthesis - mechanism of action

specifically target smaller bacterial ribosome (70S=30S+50S), leaving human ribosome (80S) unaffected

75

Aminoglycosides - drugs

1. Gentamycin
2. Neomycin
3. Amikacin
4. Tobramycin
5. Streptomycin

76

Aminoglycosides - mechanism of action

- irreversible inhibition of initiation complex through binding of the 30S subunit
- mRNA misreading
- Block translocation
BACTEROCIDAL /REQUIRE O2 FOR UPTAKE

77

Aminoglycosides - clinical use

1. severe gram (-) rob infection
2. Synergistic with β-lactam antibiotics
3. Neomycin for bowel surgery

78

Aminoglycosides - side effects

1. nephrotoxicity (worse with cephalosporins)
2. Neuromascular blockage
3. Ototoxicity (esp with loop diuretics)
4. Teratogen

79

Aminoglycosides - ototoxicity espc with

loop diuretics

80

Aminoglycosides - mechanism of resistance

Bacterial tranferase enzymes inactivate the drug by acetylation, phosphorylation, or adenylation

81

Tetracyclines - drugs

-CYCLINE
- tetracycline
- doxycycline
- minomycline

82

Tetracyclines - mechanism of action

bind 30S (A-site tRNA binding) and prevent attachment of aminoacyl-tRNA
BACTERIOSTATIC
LIMITED CNS PENETRATION

83

Tetracyclines - cns

limited penetration

84

doxycycline - special characteristic

it is fecally eliminated and can be used in patients with renal failure

85

Tetracyclines - co-administrations

do not take tetracyclines with milk (Ca2+), antiacids (Ca2+ or Mg2+), pr iron-containing preparations --> divalent cations inhibit drug's absorption in the gut

86

Tetracyclines - clinical use

1. Borrelia bugdorferi
2. M. pneumoniae
3. Rickettsia
4. Chlamydia
5. acne
6. Ehrichiosis/Anaplasmosis
7. Q fever

87

Tetracyclines - effective against Rickettsia and chlamydia because of

their ability to accumulate intracellulary

88

Tetracyclines - renal failure

doxycycline is fecally eliminated and can be used in patients with renal failure

89

Tetracyclines - toxicity

1. GI distress
2. discoloration of teeth and inhibition of bone growth in children
3. photosensitivity
4. Contraindicated in pregnancy

90

Tetracyclines - mechanism of resistance

decreased uptake or increased efflux out of bacterial cells by plasmid-encoded transport pumps

91

Antimicrobial therapy - protein synthesis - 30S inhibitors (and bactericidal or bacteriostatic)

1. Aminoglycosides (bactericidal)
2 Tetracyclines (bacteriostatic)

92

chloramphenicol - mechanism of action

block peptidyltranferase at 50S ribosomal subunit
Bacteriostatic

93

chloramphenicol - clinical use

1. meningitis (H. infl, N. meningitis, S. pneumoniae)
2. Rocky Montain spoted fever (R. ricketsi)
Limited use owing to toxicities but often still used in developing countries (low cost)

94

chloramphenicol - toxicity

1. anemia (dose dependent)
2. aplastic anemia (dose independent)
3. gray baby syndrome

95

chloramphenicol - gray baby syndrome - mechanism

in premature infants because they lack liver UDP-glucuronyl tranferase

96

chloramphenicol - mechanism of resistance

plasmid-encoded acetyltranferase inactivates the drug

97

Clindamycin - mechanism

blocks peptide transfer (translocation) at 50S ribosomal subunit.
BACTERIOSTATIC

98

Clindamycin - clinical use

1. anaerobic infections in aspiration pneumonia, lung abscess, oral infection
2. invasive A streptococcal infection
3. Gardenella vaginalis

99

metronidazole vs clincamycin according to clinical use

treats anaerobic infection below diaphragm with metronidazole and above diaphragm with clindamycin

100

Clindamycin - toxicity

1. pseudomembranous colitis
2. fever
3. diarrhea

101

Oxalinezolid - drugs

Linezolid

102

Linezolid - mechanism of action

it inhibits protein synthesis by binding to 50S subunit and preventing formation of the initiation complex

103

Linezolid - clinical use

gram (+) species MRSA and VRE

104

Linezolid - toxicity

1. bone marrow suppression (esp thrmbocytopenia)
2. peripheral neuropathy
3. seretonin syndrome

105

Linezolid - mechanism of resistance

point mutation of ribosomal RNA

106

Macrolides - drugs

1. Azythromycin
2. Clarithromycin
3. Erythromycin

107

Macrolides - mechanism of action

bind to the 23S rRNA of the 50S ribosomal subunit
--> inhibit protein synthesis by blocking translocation
BACTERIOSTATIC

108

Macrolides - clinical use

1. Atypical pneumonias (Mycoplasma, chlamydia, legionalla
2. STI (chlamydia)
3. Gram (+) cocci (streptococcal infections in patients allergic to penicillin)
4. B. pertusis

109

Macrolides - resistance

methylation of 23S rRNA-binding site prevents binding of drug

110

Macrolides - side effects

1. GI uspet 2
2. Arrhytmia (long QT)
3. Acute cholestatic hepatitis
4. Rash
5. eosinophilia
6. increased serum levels of theophyllines, oral anticoagulants
7. inhibit P-450 (clarithromycin and erythrmicycin)
8. contraindicated in pregnancy (embryotoxic)

111

macolides - P-450

clarithromycin and erythrmicycin inhibit P-450

112

Antimicrobial therapy - protein synthesis - divisions and drugs (bactericidal or bacteriostatic)

50S --> 1. Chloramphenicol (bacteriostatic) 2. Clindamycin (bacteriostatic) 3. Linezolid (variable) 4. Macrolides (bacteriostatic) 5. Streptogramins
30S --> 1. aminoglycosides (bactericidal 2. Tetracyclines (bacteriostatic)

113

Streptogramins - drugs

1. Dalfopristin
2. Quinupristin

114

Antimicrobial therapy - Folic acid synthesis - drugs

1. Sulfonamides: a. sulfadiazine b. sulfamethoxazole (SMX)
c. sulfisoxazole
2. Trimethoprim (or pyrimethamine)
3. dapsone

115

Tetrahydrofolic acid (THF) synthesis pathway

PABA + Pteridine --> Dihydropteroic acid (Dihydropteroate syntase) --> Didhydrofolic acid -->
Tetrahydrofolic acid (THF) (Dihydrofolate reductase)

116

Tetrahydrofolic acid (THF) can give rise to

1. Purines (DNA, RNA)
2. Thymidine (DNA)
3. Methionine (Protein)

117

Trimethoprim - mechanism of action

inhibits bacterial dihydrofolate reductase
BACTERIOSTATIC

118

dihydrofolate reductase - action

Didhydrofolic acid -->
Tetrahydrofolic acid (THF)

119

Trimethoprim - clinical use

in combination with sulfonamides (TMP-SXM) --> seqential block of folate syntesis -->
1. UTI 2. Shigella 3. Salmonella 4. P. jorovecii (treatment and prophyaxis) 5. toxoplasmosis prophylaxis

120

Trimethoprim - toxicity

1. megaloblastic anemia
2. leukopenia
3. granulocytopenia
MAY ALLEVIATE WITH SUPPLEMENTAL FOLINIC ACID

121

Tetrahydrofolic acid (THF) synthesis pathway - PABA?

Para-aminobenzoic acid

122

Tetrahydrofolic acid (THF) synthesis pathway

PABA + Pteridine --> Dihydropteroic acid (Dihydropteroate syntase) --> Didhydrofolic acid -->
Tetrahydrofolic acid (THF) (Dihydrofolate reductase)

123

Antimicrobial therapy - Folic acid synthesis - drugs

1. Sulfonamides: a. sulfadiazine b. sulfamethoxazole (SMX)
c. sulfisoxazole
2. Trimethoprim (or pyrimethamine)

124

Sulfonamides - drugs

a. sulfadiazine
b. sulfamethoxazole (SMX)
c. sulfisoxazole

125

Sulfonamides - mechanism of action

PABA antimetobolites (analog) inhibit dihydropteroate synthase
BACTERIOSTATIC (BACTERICIDAL when combined with trimethoprim)

126

Sulfonamides - clinical use

1. Gram-positives
2. Gram-negatives
3. Nocardia
4. Chlamydia
5. simple UTI (TRIPLE SULFAS or SMX)

127

Sulfonamides - toxicity

1. hypersensitivity 2. G6PD hemolysis
3. nephrotoxicity (tumbulointestinal nephritis)
4. photosensitivity 5. kernicterus (infants)
6. displace other drug from albumin (eg. warfarin)

128

Sulfonamides displaces other drugs from albumin - example

warfarin

129

Sulfonamides - nephrotoxicity?

tumbulointestinal nephritis

130

Sulfonamides - mechanism of resistance

1. altered enzyme (bacterial dihydropteroate syntase)
2. decreased uptake
3. increased PABA synthesis

131

Dapsone mechanism of action and side effects

similar to sulfonamides, but structurally distinct agent
Hemolysis if G6PD deficiency

132

Dapsone clinical use

1. Leprosy (leptromatous and tuberculoid)
2. Pneumocystis jorovecii prophylaxis

133

botulism treatment

antitoxin

134

pseudomembranous colitis - treatment

metronidazoleo or oral vancomycin
For recurrent cases, consider repeating prior regimen, fidaxomicin, or fecal microbiota transplant

135

Listeria monocytogenes - treatment

1. gastroenteritis is self limited
2. ampicillin in infants, immunocompromised, and the elderly as empirical treatment of meningitis

136

actinomyces vs Nocardia according to treatment

MNEMONIC: SNAP --> Sulfa - Nocardia / Actinom - Penicillin
Acinomyces --> penicillin
Nocardia --> sulfonamides

137

C. tetani - therapy

Prevent with tetanus vaccine
treat with antitoxin +/- vaccine booster and diazepam (for muscle spasms)

138

neisseria gonococci vs neisseria meningitis - treatment

neisseria gonococci --> ceftriaxone + (azithromycin or doxycycline) for possible chlamydial coinfection
neisseria meningitis --> ceftraxone or penicillin G

139

neisseria gonococci vs neisseria meningitis - prevention

neisseria gonococci --> condoms (for STD), erythromycin ointment (neonatal transmision)
neisseria meningitis --> Rifampin, ciprofloxacin or ceftriaxone prophylaxis in close contacts

140

H. influenza - treatment/prophylaxis

1. mucosal infection --> amoxicillin +/- clavulanate
2. meningitis --> ceftriaxon.
prophylaxis --> rifampin

141

Legionella - treatment

macrolide or quinolone

142

Pseudomonas aeroginosa - treatment

1. extended spectrum β-lactams (eg piperacillin, ticarcillin, cafepime)
2. Carbapenems (eg imipenem, meropenem)
3. Monobactams (eg aztreonam)
4. Fluoroquinolones (eg ciprofloxacin)
5. Aminoglycosides (eg. gentamycin, tobramicin)
6. For multidrug resistant stains --> colistin, polymyxin B

143

typhoid fever - treatment

ceftriaxone or flouroquinolone

144

Helicobacter pylori - treatment

MC initial treatment:
PROTON PUMP INHIBITOR + CLARITHROMYCIN + AMOXICILLIN (or metronidaxzole if penicillin allergy)

145

Lyme disease - treatment

1. doxycycline
2. ceftriaxone

146

how to prevent congenital syphilis

treat mother early in pregnancy, as placental transmission occurs after first trimester

147

patients with + culture of Streptococcus agalactiae -->

receive intrapartum penicillin for prophylaxis

148

Gardnerella vaginalis - treatment

metronidazole or clindamycin

149

Typhus treatment

all vector-borne illness - rash common and rash rare diseases --> doxycycline

150

Q fever treatment

all vector-borne illness - rash common and rash rare diseases --> doxycycline

151

Chlamydia - treatment

azythromycin (favored because in time treatment) or doxycycline

152

Lymphogranuloma venereum - treatment

doxycycline

153

Mycoplasma pneumoniae - treatment

macrolides, doxycycline, or fluoroquinolone

154

antimicrobial prophylaxis - high risk for endocarditis and undergoing surgical or dental procedures

amoxicillin

155

antimicrobial prophylaxis - exposure to gonorrhea

ceftriaxone

156

antimicrodial prophylaxis -history of reccurent UTIs

TMP-SMX

157

antimicrobial prophylaxis - exposure to meningococcal infection

ceftriaxone, ciprofloxacin or rifampin

158

antimicrodial prophylaxis - Pregnant woman carrying group B strep

Penicillin G

159

antimicrobial prophylaxis - prevention of gonococcal conjuctivitis in newborn

Erythomycin oitment

160

antimicrobial prophylaxis - prevention of postsurgical infection due to S. aureus

Cefazolin

161

antimicrobial prophylaxis - prophylaxis of strep pharyngitis in child with prior rheumatic fever

Benzathine penicillin G
or
oral penicillin V

162

antimicrobial prophylaxis - Exposure to syphilis

Benzathine penicillin G

163

antibiotic for bowel surgery

neomycin

164

Antibiotics to avoid in pregnancy (and why)

1. Sulfonamides --> Kernicterus
2. Amniglycosides --> Ototoxicity
3. Fluoroquinolones --> Cartilage damage
4. macrolides --> embryotoxic
5. tetracyclines --> DIscolored teeth, inhibiton of growth
6. Chloramphenicol --> Gray babe syndrome
7. Griseofluvin --> teratogenic
8. Ribavirin (antiviral)

165

non bacterial antibiotics to avoid in pregnancy

1. Griseofluvin --> teratogenic
2. Ribavirin (antiviral)

166

antibiotic that causes kernicterus if used during pregnancy

Sulfonamides

167

Treatment of highly resistant bacteria

MRSA: vancomycin, daptomycin (esp skin), linezolid, tigecycline, ceftaroline
VRE: linezolid and streptogramins (quinupristin, dalfopristin)
Multidrug-resistant P. aeruginosa: polymixins B and E (Colistin)
Multidrug-resistant Acinetobacter baumannii: polymixins B and E (Colistin)

168

Treatment of MRSA

vancomycin, daptomycin (esp skin), linezolid, tigecycline, ceftaroline

169

treatment of VRE

linezolid and streptogramins (quinupristin, dalfopristin)

170

treatment Multidrug-resistant P. aeruginosa

polymixins B and E (Colistin)

171

treatment of Multidrug-resistant Acinetobacter baumannii

polymixins B and E (Colistin)

172

antibiotics - prophylaxis in HIV patients (and why)

CD4 under 2 hundred --> TMP-SMX (pneumocysts)
CD4 under 1 hundred --> TMP-SXM (pneumocysts and toxoplasmosis)
CD4 under fifty --> Azithromycin or clarythromycin (M. avium complex)

173

antibiotics - prophylaxis in HIV patients (and why) - under 2 hundred

TMP-SMX (pneumocysts)

174

antibiotics - prophylaxis in HIV patients (and why) - under 1 hundred

TMP-SXM (pneumocysts and toxoplasmosis)

175

antibiotics - prophylaxis in HIV patients (and why) - under fifty

Azithromycin or clarythromycin (M. avium complex)