ANTIBIOTICS

INDICATIONS

ADVERSE EFFECTS

CONTRAINDICATION

DRUG-DRUG Interaction

Aminoglycosides Inhibit protein synthesis

* Bactericidal * treats serious infections due to Gram (-) aerobic bacilli * alternative if penicillin is contraindicated *short term IM/IV use for Gram (-) *Pseudomonas, AIDS *Hepatic coma, GI normal flora NOT used for > 7-10 days *milder form, suppress GI bacteria preop. hepatic coma, skin wounds *short term IM/IV use *ocular infections

Amikacin Gentamicin Kanamycin Neomycin Netilmicin Tobramycin

1. CNS a.ototoxicity -deafness b. vestibular paralysis c. confusion d.depression e. numbness f. disorientation g. tingling/weakness 2. Nephrotoxicity 3. Depressed bone marrow 4. GI effects 5. Cardiac effect 6. Allergy to aminoglycosides

1. allergy to drug 2. renal / hepatic disease 3. preexisting hearing loss 4. active infection with herpes or mycobacterium 5. myasthenia gravis 6. parkinsonism 7. lactation 8. pregnancy

1. Diuretics = ototoxicity, nephrotoxicity neurotoxicity 2. Anesthetics = neuromuscular blockade & paralysis 3. synergistic effect with a. penicillins b. cephalosporins c. carbenicillin d. ticarcillin

ANTIBIOTICS Cephalosporins Interfere w/ cellwall-building 1 - Generation Cephalexin Cephradine Cefadroxil 2nd - Generation *Cefaclor *Cefuroxime *Loracarbef
st

INDICATIONS * Bactericidal & Bacteriostatic

ADVERSE EFFECTS 1. GI Tract a. nausea b. vomiting c. diarrhea d. anorexia e. colic f. flatulence 2. Pseudomembranous colitis ( dangerous ) a. violent, bloody diarrhea b. abdominal pain 3. CNS a. headache b. dizziness c. lethargy d. paresthesia 4. Nephrotoxicity 5. Superinfections 6. Phlebitis (IV) = local abscess at site of IM injection

CONTRAINDICATION 1. Allegy to cephalosporins & penicillins 2. Renal failure 3. Pregnancy 4. Lactation

DRUG-DRUG Interaction 1. Aminoglycosides = nephrotoxicity 2. Oral Anticoagulant = bleeding gum bleeding easy bruising 3. Alcohol = disulfiram-like reaction 72 H after discontinuation Disulfiram = drug used in alcoholism tx creating sensitivity to alcohol & produces extreme discomfort if alcohol is ingested * refrain using alcohol for 72 H after drug is stopped

Gram (+) Gram(-) ( PEcK) Proteus mirabilis Escherichia coli Klebsiella pneumonia ( HENPEcK ) Haemophilus influenza Enterobacter aerogenes Neisseria sp. Proteus mirabilis Escherichia coli Klebsiella pneumonia ( HENPEcKS ) Haemophilus influenza Enterobacter aerogenes Neisseria sp. Proteus mirabilis Escherichia coli Klebsiella pneumonia Serratia marcescens

3rd Generation Ceftazidime *Cefixime (OD) *Cefdinir *Ceftriaxone Cefotaxime Cefpodoxime Ceftibuten (OD) *Ceftizoxime

ANTIBIOTICS 4th Generation Cefepime Fluoroquinolone Interfere w/ the action of DNA enzymes inside the cell Ciprofloxacin Enoxacin Grepafloxacin Levofloxacin

INDICATIONS Gram (-) & Gram (+) Cephalosporin-resistant Staphylococcus & Pseudomonas aerugenosa * new class of broad spectrum activity * has a unique way of disrupting bacterial activity * Gram (-) * UTI, RTI. Skin Infections * most widely used fluoroquinolone * UTI and STDs * community- acquired RTI & UTI * RTI, UTI, skin & sinus infections preferred IV for severe infections * URTI & UTI * drug of choice for preop/postop prophylaxis for UTI after transurethral or transrectal prostate biopsies * ONLY for Tx of various UTI=G(-) * RTI, UTI & pelvic inflammatory diseases (PID) Ocular diseases * community acquired pneumonia * respiratory, inta-abdominal, UTI, gynecologic, skin infections

ADVERSE EFFECTS

CONTRAINDICATION

DRUG-DRUG Interactions

1. CNS a. headache b. dizziness c. insomnia d. depression 2. GI effects a. nausea / vomiting b. diarrhea c. dry mouth 3. Immunologic effects a. bone marrow depression 4. fever 5. rash 6. photosensitivity = serious adverse effect that can cause severe skin reactions = avoid sun and UV light exposure = use protective clothing & sunscreens

1. allergy to drug 2. Pregnancy 3. Lactation 4. Renal dysfunction 5. Seizures

1. therapeutic effect Fe salts Sucralfate Mineral supplements Antacids * if drug combination is needed, take it 4 H separately 2. Drugs that QT interval or cause torsades de pointes severe to fatal cardiac rxn ( quinidine, procainamide, amiodarone, sotalol, bepridil, erythromycin, terfenadine, astemizole, cisapride, pentamidine, tricyclics, phenothiazines) 3. Theophylline = theophyline level 4. NSAIDs = risk to CNS effects

Lomefloxacin

Norfloxacin Ofloxacin

Sparfloxacin Trovafloxacin Alatrofloxacin

ANTIBIOTICS Macrolides Interfere with protein synthesis Erythromycin

INDICATIONS *prophylaxis for endocarditis before dental procedure in px w/ vulvular heart disease allergic to penicillin * ocular infections * acne vulgaris * 1st developed macrolide GOOD alternative to patients allergic to penicillin * drug of choice in: a. Legionnaires disease b. Corynebacterium diphtheria c. Syphylis d. Mycoplasmal pneumonias e. Chlamydial infections f. Ureaplasma mild to moderate respiratory disease urethritis / otitis media in adults pharyngitis / tonsillitis children expensive oral agent respiratory infections skin, sinus & maxillary infections * one day dosing Lower Respiratory Tract Infection Skin infections Pharyngitis . tonsillitis

ADVERSE EFFECTS 1. GI tract a. abdominal cramps b. anorexia c. diarrhea d. vomiting e. pseudomembranous colitis 2. Neurological Effects a. confusion b. abnormal thinking c. uncontrollable emotions 3. Hypersensitivity Rxn. 4. Superinfections

CONTRAINDICATION 1. allergy to macrolides 2. (+) viral, fungal or mycobacterium infection of the eye ( ocular prep ) 3. hepatic dysfunction 4. lactation 5. pregnancy

DRUG-DRUG Interactions 1. Digoxin = serum level 2. effects ( so, dose ) oral anticoagulants theophylline carbamazepine corticosteroids 3. Cycloserine = serum level risk of renal toxicity 4. Astemizole = fatal cardiac arrhythmias DRUG-FOOD Interaction 1. Food = oral absorption of oral macrolides * give on empty stomach, 1 H before or at least 3-4 H after meals with a full glass of water

Azythromycin

Clarithromycin

Dirithromycin

ANTIBIOTICS Monobactam disrupts bacterial cell wall synthesis

INDICATIONS * unique structure among antibiotics * UTI Skin Intra-abdominal Gynecological infections Septicemia * Gram (-) enterobacteria NO EFFECT on Gram (+) or anaerobic bacteria * SAFE alternative in px allergic to penicillin and cephalosporins * 1st antibiotic introduced for clinical use * selective toxicity * Streptococcal infections a. pharyngitis c. scarlet fever b. tonsillitis d. endocarditis * Pneumococcal infections * Staphylococcal infections * Fusospirochetal infections * Rat bite fever * Diphtheria * Anthrax * Syphilis * Uncomplicated gonococcal disease

ADVERSE EFFECTS * mild 1. GI effects a. nausea / vomiting b. GI upset c. diarrhea 2. Hepatic enzyme 3. Inflammation 4. Phlebitis 5. Discomfort on site of injection 6. Allergy / anaphylaxis 1. GI Tract a. nausea / vomiting b. diarrhea c. abdominal pain d. glossitis/stomatitis e. gastritis f. furry tongue 2. Superinfections 3. Pain / inflammation on injection site 4. Hypersensitivity rxn 5. Anaphylaxis shock death

CONTRAINDICATION 1. allergy to aztreonam 2. Hx of acute allergic reactions to penicillins or cephalosporins 3. Renal dysfunction 4. Hepatic dysfunction 5. Pregnancy 6. Lactation 1. allergy to penicillin, cephalosporins or other allergens ( dose ) 2. Renal disease 3. Pregnancy 4. Lactation

DRUG-DRUG Interactions

Aztreonam

Penicillins & Penicillinase Resistant Interfere with cell wall synthesis Penicillin Penicillin G Penicillin V Extended Spectrum Penicillin Amoxicillin Ampicillin Bacampicillin

1. Tetracycline = effect of penicillin 2. Parenteral aminoglycosides = no aminoglycosides effect

ANTIBIOTICS Penicillase Resistant Cloxacillin Nafcillin Oxacillin Dicloxacillin Sulfonamides Inhibit folic acid ( block PABA ) synthesis needed for purine / pyrimidine ( precursor of DNA abd RNA ) Sulfadiazine Sulfa Methoxazole Sulfisoxazole

INDICATIONS

ADVERSE EFFECTS

CONTRAINDICATION

DRUG-DRUG Interactions

Inexpensive and effective treatment for UTI & Trachoma * Gram (-) & Gram (+) Chlamydia trachomatis ( trachoma = leads to blindness ) Nocardia ( nocardiasis brain abscess & pneumonia) H. influenza E. coli ( UTI / STD ) Proteus mirabilis

1. GI Effects a. nausea / vomiting b. diarrhea c. abdominal pain d. anorexia e. stomatitis f. hepatic injury 2. Renal Effects nephrotic syndrome toxic nephrosis a. crystalluria b. hematuria c. proteinuria 3. CNS Effects 4. Bone marrow depression 5. Dermatologic effects 6. Hypersensitivity

1.allergy to sulfa drugs, sulfonylureas or thiazide diuretics 2. Pregnancy ( kernicterus ) 3. Lactation ( kernicterus, diarrhea & rash ) 4. Renal disease / stones

1. Antidiabetic drugs = ( hypoglycemia ) a. Tolbutamide b. Tolazamide c. Glyburide d. Glipizide e. acetohexamide f. chlorpropamide 2. Cyclosporine = risk of nephrotoxicity

* drug of choice for severe infections & tx of meningococcal infection * recommended by Center for Disease Control & Prevention for STDs * prophylaxis for recurrent otitis media

ANTIBIOTICS Sulfasalazine ( Aspirin )

INDICATIONS Ulcerative colitis Chrons disease Rheumatoid arthritis

ADVERSE EFFECTS

CONTRAINDICATION

DRUG-DRUG Interactions

Cotrimoxazole Sulfamethoxazole Otitis media Bronchitis + Trimethoprim UTI Pneumonitis ( Pneumocystis carnii ) = serious problem in AIDS patients Tetracyclines * developed as semi- synthetic * has 4 rings inhibit protein synthesis Demeclocycline Doxycycline Minocycline * Ophthalmia neonatorum Acne vulgaris Minor skin infections * can be toxic to human in conc. * use if penicillin is contraindicated * Travellers diarrhea STDs * drug of choice : Meningococcal carriers uncomplicated GU/gyne infections * adjunct tx in Acute intestinal amebiasis

Oxytetracyclin

1. GI tract a. nausea / vomiting b. diarrhea c. abdominal pain d. glossitis e. dysphagia 2. Fatal hepatotoxicity 3. Skeletal effects = damage to bones & teeth 4. Dermatologic effects a. photosensitivity b. rash 5. Superinfection 6. Local effects = pain / stinging with topical or ocular application 7. Hemolytic anemia

1. allergy to tetracyclines or tartrazine (oral prep) 2. Pregnancy ( bones & 3. Lactation teeth ) 4. Children < 8 yrs old 5. Renal dysfunction 6. Hepatic dysfunction 7. Ophthalmic prep. in fungal, mycobacterial viral ocular infections

ANTIBIOTICS

1. Penicillin G = effect 2. Oral contraceptive = effect = use additional birth control drug 3. Methoxyflurane = risk of nephrotoxicity 4. Digoxin toxicity 5. absorption of tetracycline if taken with: a. Calcium salts b. Magnesium salts c. Zinc salts d. Aluminum salts e. Bismuth salts f. Iron ( Fe ) g. Urinary alkalinizers h. Charcoal * take on an empty stomach or 1 H before or 2 H after meals

INDICATIONS Antimyco Bacterial Antituberculosis = tx must be continued for 6mons to 2 yrs 1st Line Drugs Isoniazid =affects mycolic acid coating Rifampicin = alters DNA & RNA activities Ethiomide = prevents cell division Rifapentine = alters DNA & RNA activities Mycobacteria = group of bacteria causing tuberculosis & leprosy = acidfast bacteria = mycolic acid, outer coat protecting them from disinfectants & allows them to survive for a long period of time = slow-growing bacteria ( so need to be treated for several years before it can be eradicated ) Tuberculosis ( Mycobacterium tuberculosis ) = leading cause of death due to infectious disease in the world * Antituberculosis drugs are always used in COMBINATION to : 1. affect various stages 2. emergence of resistant strains

ADVERSE EFFECTS 1. CNS effects a. neuritis b. dizziness c. headache d. malaise e. drowsiness f. hallucinations 2. GI effects a. nausea / vomiting b. anorexia c. stomach upset d. abdominal pain 3. Rifampicin, Rifapentine & Rifabutin = cause discoloration of body fluids: urine sweat tears = orange-tinged urine, sweat & tears stain clothing & = permanently stain contact lens 4. Hypersensitivity Rxn.

CONTRAINDICATION 1. allergy to these agents 2. severe renal failure 3. severe hepatic failure 4. severe CNS dysfunction 5. Pregnancy * If antituberculous regimen is necessary during pregnancy, use in combination : a. Isoniazid ( INH ) b. Ethambutol ( EMB ) c. Rifampicin

DRUG-DRUG Interactions 1. Rifampicin + INH = liver toxicity 2. Quinidine Metoprolol Propranolol Corticosteroids Oral contraceptives Oral anticoagulants Oral antidiabetic Digoxin Theophylline Methadone Phenytoin Verapamil Cyclosporine Ketoconazole = metabolism and drug effectiveness

ANTIBIOTICS

ADVERSE EFFECTS 2nd Line Drugs Ethambutol = inhibits cellular metabolism Pyrazinamide = bactericidal & bacteriostatic 3rd Line Drugs Capreomycin Cycloserine = inhibits cell wall synthesis

ANTIBIOTICS

INDICATIONS Leprostatic Leprosy / Hansens Disease ( Mycobacterium leprae ) = disfiguring skin lesions & destruction of the respiratory tract = worldwide health problem Dapsone = mainstay of leprosy treatment = inhibits folate synthesis Clofazimine = binds to bacterial DNA sites Thalidomide = hypnotic drug * Leprosy * P. carnii pneumonia in AIDS patients * Brown recluse spider bites *Useful in Dapsone-resistant leprosy

ADVERSE EFFECTS

* use for a condition that occurs after treatment for leprosy

Mycobacterium Avium-Complex ( MAC ) ( M. intracellulare ) = seen in immunocompromised patients ( AIDS )

10

11