UTI drugs
Sulfa drugs
Nitrofurantoin
Fluoroquinolones (cipro and levofloxacin)
Flucytosine ===> 5-FU
Methenamine (don’t mix with sulfa – requires low pH, but low pH for sulda ===> crystals in your pee)
Add more??
Combine with sulfa for sequential inhibition
trimethoprim
Forms crystals in urine at low pH (and what is the most soluble form of this drug?)
Sulfonamides! Sulfisoxazole is most solube!
Oral or IV use for MRSA
Tedizolid
IV only for MRSA
Dalbavancin
Oral for vancomycin resistant; most broad spectrum for vanco resistant bugs
Linezolid
IV only for vancomycin resistant; side effects are arthralgia and myalgia
Quinupristin/Dalfopristin
So well absorbed by GI that presence of food doesn’t effect absorption
Clindamycin
Inhibits protein synthesis by 1)blocking peptide bond formation and 2) inhibiting the tRNA binding to 50S subunit
Retapamulin
side effects include blurred vision, altered taste perception, severe hepatotoxicity; reserved only for severe respiratory infections
telithromycin
Mostly treats G+, some G-, used for penicillinase-producing bacteria & mycoplasma
Erythromycin
CSF distribution, conjugated with glucuronic acid (thus not used in infants!), must determine toxic anemia from aplastic anemia!
Chloramphenicol
such a broad spectrum that it poses risk for superinfection. treatment can cause discoloration of teeth and phototoxicity
Tetracyclines
“best” overall tetracycline that can be given oral or parenterally
doxycycline
best tetracycline for preggers (isn’t excreted in titty juice as easily)
oxytetracycline
Treats pseudomonas and klebsiellas that didn’t respond to penicillins or cephalosporins – often side effects ototoxicity, blocks NMJs, irreversible kidney damage… often resistance due to biofilms
Aminoglycosides
Name of 3rd generation cephalosporins (they go to CNS)
Cefotaxime & Cefixime
Which 2 UTI drugs should not be taken at same time?
Methenamine & Sulfas… Methanamines are only soluble at low pH, but at low pH sulfa drugs are less solube and can form crystals
pt. has brown urine after seeing a different doctor for an unknown infection… what antibiotic is the pt likely taking?
nitrofurantoin
Inhibits RNA polymerase, don’t need to modify for renal insufficiency, teratogenic, and increased metabolism of anti-coagulants (oh… and it causes orange pee)
Rifampin
These nucleic acid synthesis inhibitors should be avoided in patients under age 17 to avoid cartilage damage
Fluoroquinolones (ciprofloxacin and levofloxacin)
the most (not only) well absorbed (orally) anti-fungal drug
terbinafine
this family of anti-fungals inhibit cytochrome p450 enzymes thus prolonging the half-life of any other drug patient might be taking!
-“azoles”
drug of choice for fungal meningitis
Fluconazole
low pH helps to absorb these 2 anti-fungals
ketoconazole & itraconazole
2 members of the polyene anti-fungal group
nystatin & amphotericin B
Treat pseudomonas (narrow spectrum G-) of the eye, skin, and mucous membranes with this drug
Polymixins
Topical use only… BUT can be used in GI to decrease bowel flora prior to surgery
polymixins
This B-lactam drug is VERY broad spectrum (G+, G-, anaerobes) but would be useless without co-infusion with______ (aka 2 answers to this question)
Carbapenems
Cillistatin
Name the 4 B-lactam containing drugs
1) penicillins
2) cephalosporins
3) carbapenems
4) monobactram
topical use only… narrow spectrum G+, thus usually mixed in ointments with aminoglycosides and polymixin (G-‘s)
Bacitracin
Only to be used if bugs resistant to other drugs (ie penicillin resistant)… toxicity can cause hearing loss and kidney damage
Vancomycin
Name the topical use only drugs (4 of em)
1) Retapamulin
2) bacitracin
3) Polymixin
4) Nystatin
Use these drugs to treat anaerobes (4ish)
1) pipercillin
2) clindamycin
3) Imepenem / Carbapenem
4) 3rd gen cephalosporins (cefotaxime & cefixime)
CNS drugs (5 + 2 only during meninges inflammed)
1) 3rd gen cephalosporins
2) Fluconazole (anti-fungal)
3) 5-FU (flucytosine)
4) Chloramphenicol
5) Sulfa Drugs
*Vanco & penicillins during meningitis