Other Antibiotics

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  1. Fluoroquinolones
    • Drugs: ciprofloxacin, levofloxacin, gatofloxican, moxifloxican
    • Mechanism: inhibition of DNA gyrase (gram negative) and topoisomerase (gram positive) by binding DNA enzyme complexes
    • Pharmacokinetics: Excellent oral bioavailability, may be impaired by divvalent cations in antacids
    • Distribution: High volume of distribution, not recommended for bacterial meningitis
    • Elimination: Mostly renal, dosage adjustment for low creatine clearance
    • Adverse effects: nausea, vomiting, diarrhea, photosensitivity; May damage growing cartilage (not used in < 18), tendinitis; small risk of long QT syndromes
    • Drug Interactions: Chelated by di/trivalent cations (antacids, vitamins, dairy products)
    • Clinical use: Gram negative aerobes (enterpbacteriaceae); newer versions act better than older versions at treating S. Pneumoniae, community acquired pnuemonia
  2. Metronidazole
    • Nitroimidazole
    • Mechanism: Enters bacteria via passive diffusion, reductive process creates free radicals that disrupt DNA and stop protein synthesis
    • Restricted to anaerobic bacteria and protazoa
    • Pharmacokinetics: Oral admin, large volume of distribution, high CSF levels, liver metabolism
    • Adverse rxn: High levels of nausea/vomiting, disulferam like rxn with alcohol
    • Clinical: gold standard anaerobic agent, best for gram negative like B. Fragilis, drug of choice for C. Diff
  3. Rifampin
    • Mechanism: Inhibits bacterial RNA polymerase
    • Pharmacokinetics: Liver metabolism, orange tinge to bodily fluids
    • Adverse rxn: Hepatotoxicity, inducer of hepatic enzymes, including glucocorticosteroids, birth control, etc...
    • Use: TB, N. Meningiditis and S. Aureus
  4. Sulfonamides
    • Mechanism: comete with PABA for DHPS, inhibiting folate synthesis
    • Bacteriostatic
    • Only effective in organisms that synthesize own folate
    • Can be used alone in Nocardia infection
    • Most allergenic of all antibiotics; diffuse maculopapular rash, higher risk in HIV+ people, Steven Johnson's toxic epidermal necrolysis
  5. TMP/SMZ
    • Mechanism: DHFR inhibitor + sulfonamide action
    • Bactericidal
    • Excreted unchanged by kidney, not indicated for meningitis
    • Indications: UTIs, PCP, enterobacteriaceae
  6. Nitrofurantoin
    • Used for UTIs
    • Only oral formulation, low serum tissue concentrations but adequate urine concentrations
    • Not effective for UTIs with proteus
    • Peripheral neuropathy, pulmonary fibrosis with prolonged use
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Other Antibiotics
2011-11-26 21:33:57
Other Antibiotics

Other Antibiotics
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