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Katzung
Antimicrobial Therapy
| Question | Answer |
|---|---|
| Gram positive aerobes cocci cluster | staphylococci |
| Gram + aerobe cocci pairs | S. pneumoniae |
| Gram + aerobe cocci chains | group and viridans streptococci |
| Gram + aerobe cocci pairs & chains | Enterococcus sp. |
| Gram + aerobe bacilli | bacillus sp. coryneobacterium sp, listeria monocytogenes, nocardia sp. |
| Gram - aerobe cocci | moraxella catarhalis, neisseria gonorrhoeae, neisseria meningitidis, haemophilus influenza |
| Gram - aerobe bacilli | E. coli, Enterobacter sp, citrobacter, Klebsiella sp, Proteus sp, Serratia, Salmonella, Shegella,Acintobacter, Helicobacter, Psuedomonas aeruginosa |
| Anaerobes above diaphram | peptococcus sp, petostreptococcus sp, prevotella, veillonella, actinomyces |
| Anaerobes below diaphram | clostridium perfringes, tetani, difficile bacteroides fragilis, disastonis, ovatus, thetaiotamicron, fusobacterium |
| atypical bacteria | legionella pneumophila, mycoplasma pneumonia/hominus, chlamydia pneumoniae/trachomatis |
| Spirochetes | treponema pallidum(syphilus), borrelia burgdorferi (Lyme) |
| bacteria in mouth | peptococcus, peptostreptococcus, actinomyces |
| bacteria of skin/soft tissue | S. aureus, S. pyogenes, S. epidermidis, Pasturella |
| bacteria in bone/joints | S. aureus, S. epidermidis, Streptococcus, N. gonorrhoeae, Gram-neg rods |
| bacteria in abdomen | E. coli, proteus, klebsiella, enterococcus, bateroides |
| bacteria in urinary tract | E. coli, Proteus, Klebsiella, enterococcus, Staph saphrophyticus |
| bacteria in upper respiratory | S. pneumoniae, H. influenza, M. catarrhalis, S. pyrogenes |
| bacteria in lower respiratory tract | S. pneumoniae, H influenza, K pneumonia, legionella pneumonophilia, mycoplasma, chlamydia |
| hospital acquired lower respiratory tract | K. pneumoniae, P. aeroginosa, Enterobacter sp, Serratia sp., S. aureus |
| Meningitis | S. pneumoniae, N. meningitidis, H. influenza, Group B strep, E. coli, Listeria |
| MIC | minimum inhibitory concentration, lowest concentration of antibiotic that inhibits growth of bacteria, antibiotic conc. in body fluid must be greater than MIC |
| bacteriostatic | stops growth of bacteria, limits spread of infection while immune system attacks pathogen |
| bacteriocidal | kills bacteria |
| factors improve antibiotic cross BBB | lipid soluble, small size, low protein binding, inflammation of BBB open passage of BBB to allow antibiotic to pass |
| Concentration dependent killing antibiotic | aminoglycosides (gentamycin, tobramycin, amikacin); Fluoroquinolones (Cipro, levofloxin, moxifloxin)Once a day dose. also have post-antibiotic effect. |
| Time-dependent killing antibiotic | B-lactams (PCN, cephalosporin), glycopeptides, macrolides, clindamycin; must doses to maintain dose above MIC |
| beta-lactamase | reside in perplasmic space of bacteria; deactivates beta lactam ring of penicillin; only nafcillin is resistant |
| Which penicillin has greatest activity against gram + organisms, gram - cocci, and non-beta lactamase anaerobes? | Penicillin G, Pen VK |
| Antibiotic resistant to staphylcoccal beta lactamase and active against staphylcocci, streptococci only? | Nafcillin, Oxacillin, Methicillin; Nafcillin is IV only; Give po med 1 hr before or after food. Mostly used for staph infections, except MRSA, obviously. |
| Extended spectrum penicillin, with improved gram - activity, but susceptible to beta lactamase? | Ampicillin, Amoxicillin. Amoxicillin is best po aminopenicillin inactivated by beta-lactamase |
| PBP | penicillin binding protein thatreside in bacteria cytoplasmic membrane and cross link peptidoglycan layer (which is part of cell wall); binding site of PCN that stops bacterial cell wall growth and kills bacteria |
| Staphylococci | Gram + aerobe cocci, causes infection in skin/soft tissue, bone/joint, hospital acquired pneumonia. Killed by beta-lactam compounds, and vancomycin |
| beta-lactam compounds | penicillins, cephalosporins, monobactams, carbapenems, B-lactamase inhibitors |
| PCN that are acid-stable; can be given po? | Penicillin V, dicloxacillin, amoxicillin |
| S. pneumoniae | Gram positive aerobe cocci in pairs; URI,community acquired pneumonia, meningitis |
| What is the difference between gram + and gram - bacteria? | peptidoglycan layer (unique to bacteria)is thicher in Gram + bacteria. Gram - bacteria have a lipid bilayer not present in gram + bacteria. |
| What is the mechanism of methicillin resisitance? | Altered PBP (penicillin-binding protein); found in staph, pneumococci, enterococci |
| Enterococcus species | Gram positive aerobe cocci in pairs/chains; cause UTI, abd infections |
| What type of PCN are formulated for delayed absorption? | benzathine and procaine pcn. IM injection for B-hemolytics strep (10 day conc.) Benzathine PenG treat strep throat(1.2 million), syphilis (2-4 million weekly x 3) |
| What is preferred oral PCN? | Amoxicillin (amino-pcn;best bioavailability) Penicillin V is oral form but should not be give with food & has narrow spectrum (QID.) |
| List Penicillinase-resistant penicillin | methicillin, nafcillin,oxacillin Gram +: methicillin susceptible S. aureus, group streptococci, viridans strep. |
| List Aminopenicillins | Ampicillin, Amoxicillin; Increase to Gram negative (Proteus mirabilis, Salmonella, Shigella, some E. coli, BL-H. influenza) |
| What penicillin class is only active against resistant gram-negative aerobes | Carboxypencillins (Carbenicillin, ticarcillin) |
| Ureidopenicillins | piperacillin, azlocillin; good activity with anaerobes,Kleibsiella pneumoniae, combo with pseudomonas aerugionosa outside of urinary tract |
| What is the purpose of combination therapy | Beta lactamase inhibitors (clavulanic acid, sulbactam, tazobactam) extends penicillin. Ex: Unasyn, Zosyn, augmentin, timentin |
| What cephamycins are active against anaerobes | 2nd generation cephamycins; cefoxitin, cefotetan, cefmetazole (anaerobe: Bacteroides fragilis) |
| What is the most common first generation cephalosporin? | Cefazolin; commonly used in surgical prophylaxis |
| What is 1st generation cephalosporin? | cefazolin, cephalexin |
| what is included with 2nd generation cephalosporin? | cephamycins, carbaphems, cefuroxime Cephamycins: cefoxitin, cefotetan, cefmetazole |
| What is 1st generation cephalosporin active against? | Gram +: meth-susc S. aureus, pcn-susc S. pneumoniae, group/viridans strep, E. coli, K. pneumoniae, P. mirabilis |
| What is 2nd generation cephalosporin active against? | Gram +:meth-susc S. aureus, pcn-susc. S. pneumoniae, group/viridans streptococci Gram - : E. coli, K. pneumoniae, P. mirabilis, H. influenza, M catarrhalis, Neisseria sp. ANAEROBES: Bacteroides fragilis |
| What has the best activity against gram + aerobes including S. pneumoniae? | Ceftriaxone, cefotaxime |
| What is significant for 3rd generation cephalosporin? | expanded gram-negative activity; work against resistance organisms |
| What 3rd gen cephalosporin is active against pseudomonas aeruginosa? | ceftazidime, cefoperazone |
| What bacteria produce beta-lactamase | H. influenza, K. pneumoniae, some species of E. coli, staph. aureus & neisseria, Enterobacter sp |
| List 3rd generation cephalosporins | cefdinir, cefixime, cefoperazone, cefotaxime, ceftazidime, ceftibuten, ceftriaxone |
| What generation of cephalosporin pass the BBB? | 3rd gen, (ceftriaxone, cefotaxime) ROCEPHIN (ceftriaxone) is a 3rd generation cephalosporin. Means it can be used to treat meningitis. |
| Significance of 4th generation cephalosporin | extended spectrum activity, same as Gram + 3rd generation & pseudomonas aeruginos, enterobacter sp. (mix of ceftriaxone and ceftazidime) |
| Example of 4th generation cephalosporin | cefipime |
| Why choose cefipime over ceftazidime? | cefipime covers pcn-rst strep, enterobacter |
| What percentage of pt have cross-allergy to cephalosporin from pcn | 5-10% (if allergy to pcn shouldn't receive cephalosporin.) |
| Monobactam | Aztreonam; NO activity against gram + or anaerobes. Can receive aztreonam pneumonia, sepsis, meningitis if allergic to pcn |
| What does Carbapenems NOT cover | Carbapenems do not cover MRSA, VRE, coagulase-negative staph, C. diff, S. maltophilia, Nocardia |
| MECHANISMS OF RESISTANCE FOR BETA-LACTAMS | 1. beta-lactamase enzymes 2. alteration in PBPs cause < binding 3. alteration of outer cell membrane < penetration |
| MECHANISM OF ACTION FOR BETA-LACTAMS | 1. interfer with cell wall synthesis by binding to PBP 2. inhibit of PBP inhibit peptidoglycan synthesis BACTERIOCIDAL TIME-DEPENDENT KILLING |
| PHARMACOKINETICS OF B-LACTAMS | 1. food usually affects absorption 2. Wide distribution 3. usually eliminated by kidney 4. usually short half-life (except ceftriaxone) |
| What is the best orally absorbed b-lactams | Pen VK > Pen G amoxicillin > ampicillin |
| What Beta-lactam passes BBB | 3rd & 4th gen Cephalosporins meropenem aztreonam |
| What b-lactams are eliminated by liver | Nafcillin oxacillin ceftriaxone cefoperazone |
| What is the mechanism of hypersensitivity to Beta-lactams? | antibodies to penicillin or metabolic by-products |
| What Beta-lactams does not display cross sensitivity? | aztreonam |
| Adverse effects of Beta-lactams | neuro: irritable, jerking, confusion, seizures (esp in > dose w renal insufficiency) Leukopenia, neutropenia, thrombocytopenia with therepy > 2 wks. GI (N/V/D, > LFTs, C. diff) Interstitial Nephritis (nafcillin, methicillin) phlebitis, hypokalemia, |
| Cephalosporin specific adverse effects | MTT side chain: cefamandole, cefotetan, cefmetazole, cefoperazone, molalactam) Hypoprothrombinemia (< Vit K bacteria in gut) Ethanol intolerance |
| Mechanism of action: Vancomycin | inhibit cell wall synthesis-at site different than b-lactams Binds to D-ala-D-ala portion of cell wall precursor BACTERICIDAL (except Enterococcus) TIME DEPENDENT KILLING |
| What does Vanco not work against? | Gram Negative aerobes or anaerobes |
| when is Vancomycin given PO? | only po for c. diff colitis |
| How dose Vancomycin? | TBW instead of IBW Wide distribution (variable CSF) Renal dosing necessary-kidney elimination |
| Mechanism of resistance for Vancomycin? | Modification of D-alaD-ala binding site to D-lactate Plasmid-mediated change in permeability of drug |
| Adverse effects of Vancomycin? | Red-man syndrome nephro/ototoxic neutropenia, thrombocytopenia thrombophlebitis |
| Inhibitors of cell wall synthesis | B-lactams: pcn, cephalosporin, monbactams, carbapenems Vancomycin |
| Inhibitors of protein synthesis | tetracycline, aminoglycosides, macrolides, clindamycin, streptogrammins, oxazolidinones, glycylcyclines |
| Inhibitors of nucleic acid function or synthesis | Fluoroquinolones |
| Inhibitors of metabolism | Sulfonamides, Trimethoprim |
| Tetracyclines | demeclocyclines doxycycline minocycline tetracycline |
| Mechanism of action for Tetracycline | Inhibit protein synthesis by reversibly binding to 30S ribosome (inhibit binding of t-RNA to acceptor (A) site on mRNA) BACTERIOSTATIC |
| SPECTRUM OF ACTIVITY : TETRACYCLINE | Broad Spectrum: Gram + aerobes (s. aureus-MSSA) S. pneumoniae (PSSP), some group/veridan strep, bacillus sp, listeria sp, nocardia sp. Gram - aerobes: H. influnzae, H. ducreye, C. jejuni, H. pylori. Anaerobes (mouth). Misc bacterial |
| Pharmacokenitics of Tetracycline | TIME-DEPENDENT Doxycycline/minocycline-best F (90%) Interact with Mg/Ca (di-trivalent cations) Widely distributed-not CSF |
| What tetracycline does not need renal dose adjustments? | Doxyclycline, Minocycline |
| What tetracycline is available in IV and PO form | Doxycycline |
| What tetracycline is excreted unchanged in urine | demeclocycline tetracycline (also the F = 60-80%) |
| Mechanism of resistance for tetracycline | 1. decreased permeability 2. efflux 3. ribosomal protective proteins 4. enzymatic inactivation |
| What tetracycline does not exhibit cross resistance? | Minocycline |
| Adverse effects of tetracycline | GI: n/v/d, p. colitis hypersensitivity photosensitivity hepatotoxicity deposit on bone/teeth-not for children < 8, or pregnant women |
| Who should not receive tetracycline? | children < 8 and pregnant women (due to deposits on bone/teeth) |
| Aminoglycosides | Gentamycin, tobramycine, amikacin, streptomycin |
| Mechanism of action: Aminoglycosides | inhibit protein synthesis (30S ribosome) Bacteriocidal Post-antibiotic effect |
| Spectrum of activity Aminoglycosides | G +: most S. auerus, coagulase - staph viridans strep, enterococcus G-: E. coli, K. pneumo, proteus, morganella, providencia, serratia, salmonella, shigella, p. aeruginosa. Mycobacteria: tuberculosis, atypical |
| How is aminoglycosides used to treat endocarditis | Use aminoglycoside with other agent for Gram+ coverage-amino. has little gram + coverage |
| What aminoglycoside has better coverage for pseudomonas aeruginosa | Amikacin > tobramycin > gentamycin |
| What aminoglycoside treats tuberculosis | streptomycin |
| What aminoglycoside is used for atypical bacterial infections. | streptomycin or amikacin |
| Pharmacokinetics of Aminoglycosides: | CONCENTRATION dependent killing Poor PO absorption Distribute in ECF-not CSF. Dose on IBW half-life dependent on renal function |
| How does renal function affect aminoglycosides? | normal renal function 2/5-4hrs. prolonged in impaired renal function |
| Mechanism of resistance- Aminoglycosides | 1. alt. in uptake-< penetration 2. modifying enzymes, -poor binding to ribosome 3. alt in ribosome binding site |
| Adverse effects of aminoglycosides? | nephrotoxicity-reversible ototoxicity-irreversible |
| Compare difference of ototoxicity among different aminoglycosides? | vestibular-dizziness, vertigo, ataxia: Streptomycin, gentamycin, tobramycin Auditory: tinnitus, < hearing: amikacin, netilmicin, gentamycin |
| Macrolides | erythromycin, clarithromycin,azithromycin |
| mechanism of action of macrolides | inhibit protein synthesis (50S) BACTERIOSTATIC -except at high doses may be bacteriocidal to susceptible organisms |
| Macrolide spectrum of activity | gram + aerobes: MSSA, PSSP, group/viridans strep, bacillus sp., corynebacterium sp. Gram - aerobes: h. influenza, M. cattahalis, neisseria sp upper airway anaerobes ATYPICAL BACTERIA! |
| What does macrolides not work against? | No enterobacteriaceae activity |
| What macrolides has best activity against Gram + aerobes? | erythromycin, clarithromycin |
| What macrolide does not work against H. influenzae? | Erythromycin does not work against H. influenzae |
| Pharmacokinetics of macrolides | erythromycin require EC for oral absorption; ester (salts) improve Erythomycin absorption clarithromycin absorb regardless of food azithromycin-food affects absorption Hepatically eliminated cross-sensitivity among all macrolides |
| What macrolide required dose adjustment for kidney function? | Clarithromycin |
| What are the half-lives of Macrolides | 1.4 hrs for Erythromycin, 3-7 hrs for clarithromycin, 68 hrs for azithromycin |
| Mechanism of resistance for macrolides | 1. active efflux 2. altered taget sites |
| Adverse effects of Macrolides | GI: n/v/d, dyspepsia-most common w/erythro. cholestatic hepatitis (> 1-2 wk of erythromycin) thrombophlebitis-IV erythro, azithro ototoxicity, prolonged QT, allergy |
| Ketolides | Telithromycin |
| Mechanism of action of telithromycin | Inhibits protein synthesis by binding to 2 sites on 50S CONCENTRATION DEPENDENT BACTERIOCIAL (S. pneumoniae) |
| Spectrum of activity of telithromycin | Gram + aerobe: S. pneumoniae!!, MSSA, group/viridan strep, listeria Gram -: N. meningitis, moraxella, H. influenzan, aeromonas, e. coli Atypical: chlamydia, mycoplasma, legionella |
| Pharmacokinetics of telithromycin (ketolide class) | absorp:rapid, incomplete, food no effect distributtion-lungs eliminate-hepatic-no renal dosage necessary |
| Adverse effects of telithromycin | n/v/d, abd pain hepatotoxicity-why not used much CNS (ha, insomnia, visual dist. transient loc) prolong QT Resp. Failure esp. w Myasthenia Gravis |
| Clindamycin mechanism of action | inhibit protein synthesis-50S bind in close proximity to macolides-competitive inhibition bacteriostatic; bacteriocidal in high doses w susceptible organism |
| Spectrum of activity-clindamycin | MSSA PSSP group/viridan strep anaerobes ABOVE the diaprham pneumocystis carinii, toxopasmosis gondii, malaria |
| Pharmacokinetics of clindamycin | F=90%, food minimal affect Tissue and bone distribution time dependent dosing-half life 2/5-3 hr |
| Clindamycin Mechanism of resisitance | 1. altered target site 2. active efflux? |
| erm gene | alters binding site on ribosome creates resistance to macrolides, clindamycin, Synercid |
| mef gene | encodes efflux pump pumps out macrolides |
| Adverse effect of clindamycin | GI:n/v/d, dyspepsia C. diff-worst offender-require tx w metronidazole hepatotoxicity-rare, elevated trasaminase rare allergy |
| Streptogramins | quinupristin/dalfopristin 30:70 ratio (Synercid) only one available active against gram - VRE |
| Mechanism of action-Synercid | Inhibit protein synthesis-50S (early & late stages) BACTERIOSTATIC (cidal-to some) |
| Spectrum of activity | mostly Gram + (MSSA, MRSA, coag - staph, PRSP, strep, enterococcus faecium only,corynebacterium, bacillus, listeria, actinomyce clostridium (x c. diff), pepto/peptostreptococcus Limited gram- aerobes-neisseria, moraxella atypical-mycoplasma, legionella |
| Pharmacokinetics of Synercid | Time-dependent activity IV route only distribute-lungs, gallbladder, bile > blood low CSF Liver metabolized-bile elimination No renal dosing required |
| Mechanisms of resistance Synercid | alt. ribosome binding site enzymatic inactivation |
| Synercid adverse effects | venous irritation-central line preferred GI: n/v/d myalgia, arthralgia rash hyperbilirubinemia |
| BLACK BOX WARNING OF TELITHROMYCIN | RESPIRATORY FAILURE IN MYASTHENIA GRAVIS |
| Oxazolidinones mechanism of activity | Linezolid Inhibit protein synthesis: 50S, near surface interface of 30S which causes inhibition of 70S BACTERIOSTATIC |
| Spectrum of activity of oxazolidinones | MRSA, VRE, coag-staph, s. pneumo (PRSP) strep, enterococcus faecium/faecalis, bacillus, listeria, clostridium (ex c. diff), p. acnes, peptostreptococcus not much gram - atypical: mycoplasma, chlamydia, legionella |
| Oxazolidinones (linezolid) phamacokinetics | time dependent 100 % bioavailable, IV/PO 30% CSF, renal/nonrenal elimination, no RI adjustment needed |
| Mechanism of resistance for oxazolidinones | alt in ribosome binding-rare cross resistance to other protein synthesis inhibitors unlikely |
| Adverse effects of linezolid | GI-n/v/d headache thrombocytopenia-therapy > 2 wks, rtn to nml when therapy stopped |
| Glycylcyclines (tigecycline) mechanism of activity | inhibits protein TRANSLATION by binding to 30S and blocking tRNA into A site of ribosome BACTERIOSTATIC |
| Spectrum of activity of tegecycline | BROADEST Spectrum (except no pseudomonas) Gram +, Gram-, anaerobes |
| Tigecycline pharmacokinetics | TIME DEPENDENT activity IV only 71-89% protein binding lung, skin, gallbladder penetration no extensively metabolized 33% kidney excretion/ 59% biliary/fecal excretion |
| Tigecycline resistance | none to date |
| Tigecycline adverse effects | diarrhea nausea vomiting acute pancreatitis-rare |
| FLUOROQUINOLONES mech. of action | inhibit bacterial topoisomerase (need for DNA synthesis (DNA gyrase, Topoisomerase IV) BACTERIOCIDAL/ POST ANTIBIOTIC EFFECTS. |
| DNA gyrase | removes excess positive supercoiling in DNA helix Gram neg target for fluoroquinolones |
| Topoisomerase IV | essential for seperation of interlinking daughter DNA molecules Gram + target for fluoroquinolones |
| Spectrum of activity for fluoroquinolones | Excellent Gram - aerobes, & atypical bacteria limited gram + aerobes, no anaerobe resistance develop against p. aeruginosa other bacteria: mycobacterium tuberculosis, bacillus anthracis |
| Pharmacokinetics of fluoroquinolones | CONCENTRATION DEPENDENT KILLING Good bioavail p oral, food can delay peak extensive distribution, min CSF renal/hepatic elimination |
| Range of distribution for fluoroquinolones | prostate, liver, lung, skin/soft tissue, bone urinary tract cipro> levofloxacin > gatifloxacin |
| Fluoroquinolones Mechanism of resistance | 1. alt target sites-chomosomal mutations in genes that encode DNA gyrase/topoisomerase IV 2. alt cell wall permeability-< porin expression 3. efflux 4. cross-resistance between FQs |
| Adverse effects fo fluoroquinolones | GI: n/v/d, dyspepsia CNS: ha, agitation, insomnia, dizziness, rare hallucination/seizures hepatotoxicity-> LFTs QT prolongation |
| Metronidazole mechanism of action | inhibit DNA synthesis by prodrug, toxicity against anaerobic bacteria, ferredoxin cause cell death BACTERIOCIDAL |
| Metronidazole spectrum of activity | anaerobe bacteria:bacteroides, fusobacterium, prevotella, clostridium, h. pylori anaerobic protozoa: trich, entamoeba, giardia, gardnerella vaginalis |
| Pharmacokinetic of Metronidazole | IV/PO F=90%, food not interfer does penetrate CNS metabolize by liver |
| Resistance to metronidazole | documented, but uncommon impaired oxygen scavenging ability-oxygen impairs activation of met. altered ferrodoxin levels-< transcription of ferrodoxin gene |
| Adverse effects of metronidazole | n/v, stomatitis, metallic taste peripheral neuropathy, seizure, encaphalopathy-caution w preexisting CNS disulfiram reaction with ETOH ingestion |
| TMP-SMX | trimethoprim-sulfamethoxazole (Bactrim or Septra) INhibitor of metabolism |
| Machanism of action TMP-SMX | inhibit folinic acid sythesis which is necessar for microbial production of DNA Sulfamethoxazole: inhibit dihydropteraoate synthesis (inhibit PABA into folic acid) Trimethoprim: inhibit dihydrofolate reductase- ALONE-bacteriostatic. TOGETHER-bacterioci |
| TMP-SMX spectrum of activity | gram+: s. pneumoniae, s. aureus, s. pyogenes, nocardia. NO ANAEROBE activity. Lots of Gram-: acinobacter, enterobacter, e coli, k. pneumoniae, proteus, salmonella, shigella, haemophilus sp., N. gonorrhea, stenotrophomonas maltophilia. TX of choice for PCP |
| Pharmacokinetic of TMP-SMX | TIME DEPENDENT ACTIVITY F=90%, IV/PO Distribute urine, prostate, CSF renal adjustment required renal/hepatic elimination |
| TMP-SMX resistance | point mutation in dihydropteroate synthase and/or altered production/sensitivity of dihydrofolate reductase slow progression b/c combo drug E. coli, Klebsiella, proteus, H. influenzae |
| Adverse reaction TMP-SMX | GI: n/v, glossitis hematologic-leukopenia, thrombocytopenia, eosinophilia may require d/c of med Steve-Johnson's syndrome hypersensitivity CNS: h/a, aseptic meningitis, seizures crystalluria |
| Nitrofurantoin | Urinary antiseptic bacteriostatic, bacteriocidal Alt. when E. coli resistant to TMP-SMX and FQs |
| Pharmacokenitics of nitrofurantoin | well absorped PO, metabolized and excreted quickly-no systemic action. Contraindicated for significant renal insufficiency. Urinary pH affect drug activity |
| Side effects of nitrofurantoin | anorexia, n/v neuropathy, hemolytic anemia w/glucose-5 phosphate dehydrogenase deficiency |
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