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MOA: Inhibit ribosomal protein synthesis
aminoglycosides
clindamycin
macrolides
tetracyclines
MOA: Inhibit folate (thus RNA purines)
sulfonamides
trimethoprim
MOA: Inhibit DNA synthesis
fluoroquinolones
MOA: Inhibit cell wall synthesis
Beta-lactams
(PCNs, cephs, carben, aztreo)
vancomycin
Clinical Uses:
Streptocococcal infections
Syphilis
Dental infections
Natural PCNs
PCN G potassium
PCN G sodium
Pen VK
Narrow spectrum of activity:
strept pyogenes
strept viridans
non beta-lactam staph aureus
mouth flora, gram + anaerobes
clostridia perfingens
neisseria meningitidis
pasteurella
spirochetes- treponema pallidum
Natural Penicillins
Natural PCN
Long acting
syphilis
strep throat
Benzathine pcn (Bicillin LA)
Natural PCN
pnuemococcal pneumonia
procaine pcn (Wycillin)
Nafcillin (Unipen)
Oxacillin
Dicloxacillin (Diclox)
Antistaph PCNs
Penicillinase-Resistant PCNs
Clinical Uses
acute otitis media
acute bacterial sinusitis
bronchitis
prophylaxis against endocarditis before dental procedures
Aminopenicillins:
Ampicillin
Amoxicillin
Extended-release form of amoxicillin
tx for tonsillitis or pharayngitis or strep throat
amoxicillin (Moxatag)
amoxicillin/clavulanic acid
Augmentin (beta-lactamase inhibitor)
Ampicillin/sulbactam
Unasyn (beta-lactamase inhibitor)
Ticarcillin/clavulanic acid
Timentin (beta-lactamase inhibitor)
Piperacillin/tazobactam
Zosyn (beta-lactamase inhibitor)
Amoxicilin/clavulanic acid (Augmentin)
Ampicillin/sulbactam (Unasyn)
Ticarcillin/clavulanic acid (Timentin)
peperacillin/tazobactam (Zosyn)
Beta-lactamase inhibitors
Haemophilus influenza
Proteus
Klebsiella
E. Coli
Moraxella catarrhalis
N. gonnorrhea
Staph aureus
Bacteroides
Beta lactamase producing organisms
treat intra-abdominal infections
aspiration pneumonia
mixed soft tissue and bone infections
beta-lactamase inhibitors:
Augmentin
Unasyn
Timentin
Zosyn
Clinical Uses:
refractory: otitis media, sinusitis
bite wounds
amoxicillin/clavulanic (Augmentin)
Clinical uses
CAP (in combo with a macrolide)
intra-abdominal infections
ampicillin/sulbactam (Unasyn)
Clinical Uses:
pseudomonas coverage
aspiration pneumonia
severe intra-abdominal infections
mixed infections
Ticarcillin/clavulanic (timentin)
Piperacillin/tazobactam (Zosyn)
MOA: inhibit cell wall synthesis
Bactericidal
Cephalosporins
4 generations of cephalosporins
4th generation are better for gram (-) or (+)
4th genaration is better gram negative (-)
cephalosporins
MTT side chain:
cefamandole, cefoperazone, cefotetan, cefmetazole
increase risk of bleeding and disulfiram reaction
1st generation cephalosporin
DOC for:
skin and skin structure infections (cellulitis, impetigo)
surgical prophylaxis
Cefazolin (Ancef, Kefzol)
spectrum of activity:
staph aureus (including beta-lactamase producing strains
streptococcus
poor CNS penetration
1st gen cephalosporins
cefoxitin (Mefoxin)
cefuroxime (Zinacef or Ceftin)
cefotetan (Cefotan)
cefonicid (Monocid)
cefaclor (Ceflor)
cefprozil (Cefzil)
2nd genaration cephalosporins
most potent cephalosporins against anaerobes
cefoxitin (Mefoxin)
cefotetan (Cefotan)
increased gram negative coverage
H flu, Neisseria, Moraxella, E. Coli, Klebsiella, Proteus
2nd generation cephalosporins
2nd generation cephalosporin
Good for CAP
cefuroxime
  • cefotaxime (Claforan)
    cefoperazone (Cefobid)
    ceftazidime (Fortaz)
    cefibuten (Cedax)
    cefdinir (Omnicef)
    cefpodoxime (Vantin)
    ceftriaxone (Rocephin)
    cefixime (Suprax)
    cefditoren (Spectracef)
3rd generation cephalosporins
cephalosporins: what generation?
increased negative coverage
no anaerobic coverage
3rd generation cephalosporins
3rd gen cephalosporin
excellent CSF penetration
DOC meningitis 2g q 12 hrs
ceftriaxone
3rd gen ceph: what drug?
good pseudomonas coverage
excellent gram negative coverage
ceftazidime
4th generation ceph
good for pseudomonas
gram negative coverage
Cefepime (Maxipime)
other name for carbapenems
gorilla-cillins
gorilla-cillins
MOA: inhibit cell wall synthesis
bactericidal
carbapenems
imipenem/cilastatin (Primaxin)
meropenem (Merrem)
ertapenem (Invanz)
doripenem (Doribax)
carbapenems
broad spectrum
Bactericidal
mixed infections
severe nosocomial infections
good gram positive
good gram negative
anaerobes
carbapenems
the only carbapenem that doesn't cover pseudomonas
ertapenem (Invanz)
carbapenems may lower seizure threshold specially which one?
imipenem
Monobactam
MOA:
inhibit cell wall synthesis
bactericidal
Gram (-) coverage only
pseudomonas
aztreonam (Azactam)
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