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