1. Macrolides
1.1. inhibit bacterial protein synthesis
1.1.1. bind to 50S ribo subunit
1.1.1.1. preventing movement of ribo along mRNA
1.1.1.2. can't effect human protein synthesis
1.1.1.3. resistance by pumping out of cell or changing subunit shape
1.2. can be bactericidal or bacteriostatic depending on dose or target org
1.2.1. usually bacteriostatic
1.3. whopping cough, legionnaires disease, streptococcus, H. influenzae, Mycoplasma pneumoniae and Chlamydia
1.4. newer macrolides have longer half-lives and cause less GI irritation
1.5. considered one of the safest antibiotic cases
1.6. should be taken on empty stomach
1.6.1. food decreases ab
1.6.2. have enteric coating
1.6.3. do not take with fruit juice
1.7. met by liver and excreted in bile
1.7.1. decrease hepatic met of other drugs
1.7.1.1. drug-drug interactions
1.7.1.2. pot. toxicity
1.7.2. not given to pt. with hepatic disease
1.8. careful with taking other med and supplements
1.9. Erythromycin (Eryc)
1.9.1. inactivated by stomach acid therefore enteric coated
1.9.2. effective against most gram +
1.9.3. given to ppl who are allergic or penicillin-resistant infections
1.9.4. widely distro
1.9.5. partly met by liver
1.9.6. mostly excreted in bile, small amount in urine
1.9.7. short half life
1.9.8. admin with glass of water on empty stomach
2. Fluoroquinolones
2.1. 4 gen
2.2. all gen against gram -, later gen gram + too
2.3. affect DNA synthesis
2.3.1. inhib DNA gyrase and topoisomerase IV
2.4. mostly used as alt to other antibiotics
2.5. well ab orally
2.5.1. some can be taken with food
2.5.2. multvit or supplements + NO
2.5.3. antacids and ferrous sulfate decrease ab
2.6. given once or twice a day
2.7. adverse effects
2.7.1. dysrhythmias
2.7.2. liver failure
2.7.2.1. careful with pt with liver dysfunction
2.7.3. CNS effects (dizziness, headache, sleep disturbances)
2.7.4. affects cartilage dev
2.7.4.1. careful with children
2.7.4.2. don't give to preg women
2.7.4.3. refrain from physical exercise
2.7.5. photo phobia can occur
2.8. use to treat against bio terrorism bac
2.8.1. Bacillus anthracis, Yersinia pestis, Francisella tularensis, Brucella melitensis
2.9. serum levels btw PO admin and IV admin are the same
2.9.1. easy transition from IV to PO treatment
2.10. careful with pt. with epilepsy, cerebral arteriosclerosis or alchholisum
2.11. excreted by the kidneys
2.11.1. careful with pt. with renal dysfunction
2.11.2. encourage pt. to drink water
2.12. interact with warfarin
2.12.1. increase anti coagulation effects
2.13. Ciprofloxacin (cipro)
2.13.1. 2nd gen
2.13.2. inhib DNA gyrase
2.13.2.1. affects DNA repair and mexico
2.13.3. more effective against gram -
2.13.4. rapidly ab orally
2.13.4.1. can also be IV
2.13.5. widely distro
2.13.6. met by liver
2.13.7. 50% excreted unchanged in urine
2.13.8. half life of 4h
2.13.9. GI side effects
2.13.9.1. can be taken with food
3. inhib DNA synthesis
4. Sulfonamides
4.1. wide spectrum for gram + and gram -
4.2. inhib folic acid
4.3. used in combination with other antibio for treating UTI
4.4. classified by how ab and excreted
4.4.1. sulfsoxazole and sulfamethoxazole
4.4.1.1. rapid ab and excretion
4.4.2. sulfasalazine
4.4.2.1. poor ab
4.4.2.1.1. stays in alimentary canal to treat infections
4.4.3. sulfadiazine
4.4.3.1. topical
4.5. careful with hematological disorders
4.6. careful with renal crystalluria
4.7. preg , lactating, child younger then 2 is a NONO
4.7.1. cause jaundice
4.8. risk of Stevens-Johnson syndrome
4.8.1. connected with hypersensitivity to sulfonamides
4.8.2. skin abnormality
4.9. void exposure to direct sunlight
4.10. take oral does with full glass of water
4.11. increase fluid intake
4.12. Trimethoprim-Sulfamethoxazole
4.12.1. Combination used to treat UTI
4.12.2. both inhib bac met of folic acid
4.12.3. well ab orally
4.12.3.1. admin with glass of water
4.12.4. partly met by liver
4.12.5. less then 40% excreted in urine unchanged
4.12.6. half life is 6-12h
4.12.7. common adverse effect
4.12.7.1. skin rash
4.12.7.2. nausea/vomiting
4.12.7.3. careful of pt. with renal disorders
4.12.7.4. check blood work periodically
5. Inhb bac met of folic acid
6. Penicillin
6.1. From fungus Penicillim
6.2. beta-lactam ring structure attacks cell wall
6.2.1. beta-lactamase/penicillinase = resistance
6.2.2. weakens cell wall, water enters
6.3. Oxacillin and cloxacillian are penicillinase-resistant penicillins
6.4. Most effective against gram +, few have gram - bacteria
6.5. Most narrow spectrum
6.6. Widely distro
6.7. Rapidly excreted thru kidneys
6.7.1. Need a lower dose with pt. with impaired renal function
6.8. Most have short half lives (30min)
6.9. Allergy most common side effect
6.10. Superinfection can occur: antibiotic-ass. pseuodomembranous colitis
6.10.1. Clostridium difficile
6.11. With most, take a full glass of water 1h before or 2h after meals (increase ab)
6.11.1. Oral penicillin G is inactivated with acidic fruit juice
6.12. Penicillin G Potassium
6.12.1. inactivated by penicillinase
6.12.2. streptococci, pneumococci, staphylococci, gonorrhea and syphilis
6.12.3. Not well absorbed orally
6.12.3.1. given IM or Iv
6.12.4. 60% protein bound
6.12.5. anaphylaxis is most serious side effect
6.12.6. may decrease effectiveness of oral contraceptives
7. Destroys Cell Walls
8. Cephalosporins
8.1. beta-lactam ring structure attacks cell wall
8.1.1. inhibit cell wall synthesis
8.2. allergy most common adverse side effect
8.3. sometimes prescribed for pt. who are allergic to penicillin
8.3.1. 5-10% of pt. have hypersensitivity to both
8.4. Almost all eliminated by kidneys
8.5. cause pain at IM sites
8.6. thrombophlebitis can occur when given IV
8.7. 4 generations
8.7.1. Gen 1
8.7.1.1. beta-lactamase ring
8.7.2. Gen 2
8.7.2.1. more resistant
8.7.2.2. broader spectrum
8.7.3. Gen 3
8.7.3.1. longer duration of action
8.7.3.2. broader spectrum
8.7.3.3. resistant to beta-lactamase
8.7.3.4. Can enter CSF
8.7.4. Gen 4
8.7.4.1. more organisms with resistance to previous gen
8.7.4.2. Can enter CSF
8.8. for gram - and pt. with hypersensitivity to penicillin
8.9. careful with NSAIDS, cephalosporins increase platelet inhibition
8.10. superinfection can occur: pseudomembranous colitis
8.10.1. cultured dairy can help suppress superinfections
8.11. avoid alcohol use
8.11.1. produces disulfiram-like state
8.12. Cefotaxime (Claforan)
8.12.1. Gen 3
8.12.2. broad spectrum against gram -
8.12.3. serious infections of lower resp tract, CNS, genitourinary system, bones, and joints, blood infections
8.12.4. not ab thru GI
8.12.4.1. IV or IM
8.12.5. wide distro, partly met by liver, 50% excreted unchnaged by kidneys
8.12.6. interacts with probenecid
8.12.6.1. decreased renal elimination of the drug
9. Tetrocyclines
9.1. extracted from Strptomyces soil microorg
9.2. selectively inhibit bac protein synthesis
9.2.1. bind to 30S bac ribo
9.2.1.1. aa can't be added to polypeptide chain
9.2.1.2. means they can't attack human protein synthesis, high concentration had toxic effects
9.3. broadest spectrum of any antibiotic
9.3.1. gram - and +
9.4. large number of resistant bac strains
9.4.1. prevent tetracyclines from building up in cell
9.4.2. Ribo changes shape
9.5. Rocky Mountain spotted fever, typhus, cholera, Lyme disease, ulcers, chlamydial infections
9.6. take on empty stomach to increase ab
9.6.1. iron and milk supplements big no
9.6.2. food and dairy decrease ab by 50%
9.6.3. magnesium-containing laxatives and antacids also a no
9.7. Superinfection can occur: pseudomembranous colitis
9.7.1. Clostridium difficile
9.7.2. Candida albicans
9.7.2.1. oral and perineal hygiene important
9.8. Can cause hepototoxicity
9.8.1. careful with liver disease
9.9. can cause photosensitivity
9.10. decreases effectiveness of oral contraceptives
9.11. do not save, toxic effects after expiration date
9.12. take at least 2h before/after taking lipid lower drugs
9.13. Tetracycline
9.13.1. given orally
9.13.2. short half life
9.13.2.1. need to be given often
9.13.3. mostly ab
9.13.4. widely distro
9.13.5. excreted unchanged in urine
9.13.6. take with full glass of water to decrease esophageal and GI irritation
9.13.7. admin antacids 1-3h before/after
9.13.8. admin antilipidemic agents 2h before
9.13.9. can cause superinfections
10. Inhibits protein synthesis
11. Aminoglycosides
11.1. mostly restricted to TB treatment b/c of high resistance
11.2. aerobic gram - bac, mycobacteria, protozoans,
11.3. inhib protein synth
11.3.1. cause synth of abnormal protein
11.4. polar compound
11.4.1. oral dose is not absorbed
11.4.1.1. given orally for parasitic infections and sterilize bowls for surgery
11.4.2. parenterally given
11.4.3. can't enter human cells
11.4.4. can cross placenta
11.4.4.1. causes hearing loss
11.4.5. build up in renal tissue
11.4.5.1. nephrotoxicity
11.5. bac resistance happens quickly
11.5.1. degrades antinbiotic
11.5.2. mut ribo
11.5.3. give one large dose/day = greater bacteriocidal effect
11.5.4. given with penicillin
11.6. excreted through kidneys
11.6.1. binds to tissue tightly, can take up to 20 days to clear
11.6.1.1. post-antibiotic effect
11.6.2. builds up in renal tissue
11.6.2.1. nephrotoxicity
11.6.2.1.1. drug builds up, more toxic effects
11.7. can cause damage to hearing and balance
11.7.1. cumulative damage
11.8. inhib release of acetylcholine at synapses
11.8.1. when given other drugs that effect acetylcholine release = apnea, prolonged m. paralysis
11.9. Gentamicin (Garamycin)
11.9.1. urinary, respiratory, neurological or Gi infections
11.9.2. IM or IV
11.9.2.1. well ab
11.9.3. widely distributed
11.9.4. excreted in urine mostly
11.9.4.1. unchanged
11.9.4.2. careful with kidney disease
11.9.5. half life 2 to 4h