Drugs for the Treatment of Pneumonia and Pertussis, 1/22/2013
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| Drug class and mechanism of action: Azithromycin, Clarithromycin | Macrolides, Protein Synthesis inhibitors acting at the 50S ribosomes
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| Drug class and mechanism of action: Ciprofloxacin, Levofloxacin, Moxifloxocin | Fluoroquinolones, Bacterial DNA synthesis blockers (DNA gyrase, Topoisomerase IV inhibitors)
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| Drug class and mechanism of action: Doxycycline | Tetracyclines, Protein synthesis inhibitors acting at the 30S ribosomes
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| Drug class and mechanism of action: Ampicillin, Amoxicillin | Extended-Specrtum Penicillin, Cell wall synthesis inhibitors
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| Drug class and mechanism of action: Ticarcillin, Piperacillin | Antipseudomonal penicillin, Cell wall synthesis inhibitors (Inhibits crosslinking by way of PBPs)
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| Drug class and mechanism of action: Imipenem, Meropenem | Carbapenems (B-Lactam), Cell wall synthesis inhibitor
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| Drug class and mechanism of action: Sulbactam, Tazobactam, | Beta Lactamase inhibitors, Bind to B-lactamase and inactivate the enzyme
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| Drug class and mechanism of action: Trimethoprim+Sulfamethoxazole | Antifolates, Inhibit folate production in bacteria which is needed for nucleic acid synthesis
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| Drug class and mechanism of action: Cetriaxone, Ceftazidime, Cefotaxime, CCefdinir | 3rd gen cephalopsorin, Cell Wall synthesis inhibitors
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| Drug class and mechanism of action: Cefepime | 4th gen cephalosporin, Cell wall synthesis inhibitor
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| Drug class and mechanism of action: Tobramycin, gentamycin, | Aminoglycoside, Binds to 30S and 50S ribosomes to prevent the 70S complex
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| Drug class and mechanism of action: Aztreonam | Beta-lactam, Blocks peptidoglycan crosslinking in cell wall
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| Macrolide Toxicities | GI effects, Hepatotoxicity (primarily seen with erythromycin estolate), Prolonged QT
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| Fluoroquinolones Adverse effects | Increased incidence of tendon rupture and tendonitis (Do not give for pregnant, nursing or children), Prolonged QT (Do not give in hypokalemia or QT problems)
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| Tetracyclines are cleared by the | Metabolically so you don't have to worry about renal failure!
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| Do not take a tetracycline with | Anything that will increase the stomach pH
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| Why can't you give a tetracycline to a child? | It chelates with calcium and stains teeth brown and leaves bone rings
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| Tetracycline Adverse effects | GI, Bones/teeth, Liver toxicity, Tissue hyperpigmentation, Photosensitization, Risk of pseudomembranous colitis
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| Precautions for Tetracyclines | Do not give to pregnant patients, children under the age of 8 and always use skin protection and DO NOT TAN
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| Avoid a Carbapenem if | An CNS lesion is present, renal insufficiency, Penicillin allergy
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| Bactrim adverse effects | Allergies, Anemia, Kernicterus/encephaolopathy
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| If you are allergic to Pens, you are more likely to be allergic to | Cephalosporins and Carbapenems
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| What is the mechanism of action for a Beta lactamase inhibitor | They bind to the B-lactamase and inactivate the enzyme
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| What is the role of a B-lactamase inhibitor in anitmicrobial therapy? | The extend "penicillin drugs" spectrum against lactamase producers (Staphs and Klebsiella)
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| Why is imipenem always used in combination with cilastatin? | To prevent rapid breakdown in the kidneys
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| First line treatment in Community-aquired pneumonia for outpatients with no comorbities and no recent antibiotic use | Macrolide (Azithromycin or Clarithromycin)
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Doxycycline
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| If local macrolide-resistant pneumonia is high,treatment in Community-aquired pneumonia for outpatients with no comorbities or recent antibiotic use | Fluoroquinolone
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| First line treatment in Community-aquired pneumonia for outpatients with comorbities or recent antibiotic use | Fluoroquinolone (Levofloxacin or moxifloxacin)
OR
Amoxicillan+Macrolide(or Doxycycline)
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| Preferred treatment for hospital acquired pneumonia | Fluoroquinolone
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3rd gen Cephalosporin+Macrolide(or Doxycycline)
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| If MRSA is a concern in the treatment, add | Vanc or linezolid
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| For an ICU patient, what is the preferred pneumonia treatment? | Combination of Antipseudomonal B-lactam (cephalosporin, meropenem, or aztreonam[if patient is allergic to B-lactam]), Fluoroquinolones (Ciprofloxacin/Levoflaxacin), and Aminoglycosides(Gentamycin)
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| Doxycyline is not used in which cases | Severe
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| If Pseudomonas is a concern (pulmonary complications), administer | Ciprofloxacin
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| Treatment of Pertussis for newborn | Azithromycin
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| Treatment of Pertussis over 1 month old | Macrolide(Azithromycin), alternate could be Bactrim
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