Many questions are written to assess your clinical application of the material from the textbook, in real-world scenarios.
Chapter 24: Drugs used in treating infectious diseases (p. 692-760) SEE DRUG CHART BELOW
Know the following for each drug class (penicillins, cephalosporins, fluoroquinol...
Many questions are written to assess your clinical application of the material from the textbook, in real-world
scenarios.
Chapter 24: Drugs used in treating infectious diseases (p. 692-760) SEE DRUG CHART BELOW
Know the following for each drug class (penicillins, cephalosporins, fluoroquinolones, lincosamides, macrolides,
sulfonamides, trimethoprim, nitrofurantoin, lipoglycopeptides):
• • Spectrum of coverage for various organisms
• • Pharmacodynamics
• • Pharmacokinetics
• • Pharmacotherapeutics
• • Clinical indications & dosing
• • ADRs
• • Monitoring
• • Patient education
Antimicrobial resistance
Treatment of Group A and Group B beta
streptococci Cross sensitivity with cephalosporins
Category Bacteriocidal or What do they Pharmacokineti Pregnancy Adverse
Bacteriostatic Treat? cs Category? Safe in
(Indications) pediatrics?
Safe in Lactation?
Penicillins Bacteriocidal; Pcn - Treat Absorption – - Catergory B - Hyp
(PCN and Amoxicillin) inhibits synthesis aerobic and gram from GI tract, - Safe in y
of bacterial cell positive. Red depends on lactation - Sup
wall Book recommends agent, ph of - Safe in nn
Used in tx bact. URI, penicillin for stomach/intesti pediatrics - GI
pharyngitis strep, otitis Group ne, presence of - Does not distu
media, sinusitis, pna, STI, A beta streptococci food; high cross BBB s
wound infx & for Group doses can cause unless - Ras
B beta streptococci GI inflammatio (ma
due to low upset/diarrhea n lar)
resistance - Cha
Distribution – rena
Aminopcn – treat varies in func
gram posivite protein n
, anaerobes and binding, well infe
gram negative distributed, - Seiz
(MSSA, strep, inflammation abili
H.flu, E.coli, enhance - Dec
Klebsiella, distribution, oral
Neisseria crosses cont
meningitides); placenta/breast ves
amoxicillin, milk effe
ampicillin; - Inte
combined with Metabolism – neph
betalactamase minimal metab i
inhib except for
nafcillin/oxacill * Severe, ty
Pcnase-resistant – in allergic reac
(pcnase staph, to cephalosp
strep, MSSA); not Excretion – carbapenem
effective against primarily beta-lactama
MRSA; cloxacillin, unchanged in inhibitors m
dicloxacillin, urine, caution contraindica
methicillin, in renal penicillins.
nafcillin, oxacillin insufficiency
(increase half
Antipseudomonal – life)
gramneg bacilli
(pseudo
aeruginosa,
enterbacter,
morganella);
piperacillin,
ticarcillin
Cephalosporins – 1st Bactericidal First gram pos Absorption In pregnancy d/t - GI
Generation and limited gram oral, GI tract, increase fluid distu
(Cephalexin) & Increase in gram neg; doesn’t enter rate of shorter half life, (C.d
2nd Generation neg up the CSF, staph aureus, absorption lower serum levels - Alte
(Cefuroxime) generations and strep, pna/resp infx delayed by and larger Vd bloo
3rd Generation decreases in gram (cephalexin, food, IM – clott
cefazolin) Lactation safe
(ceftriaxone) & pos. absorbed by g
4th Generation muscle Pediatrics in - Com
Treat surgical Second gram +
(cefepime) neonates immature with
and H. flu, more
prophylaxis, resp potent, broader Distribution renal fx causes (disu
1st – narrow spectrum tract infx, strep spectrum, widely increased half life rxn
5th – broad spectrum pharyngitis/sinusi distributed to and accumulation; flush
gonorrhea, resp
tis, CAP, skin, most tissue, kids – varies by dizz
infx (cefaclor
soft tissues, variation in drug n/v,
(CAP),
bones/joints, UTI cefziroxine) protein prob
(2nd line for kids), binding, m
STI Third some penetration - Nep
gram + and -, not CSF varies by ty
active against generation - Sup
MRSA, effective nn
against Metabolism - Ren
pseudomonas, less hepatic c dy
metabolism – exte
freq dosing,
insignificant half
crosses BBB with
inflammation - Ana
Excretion
y rx
p d
gi
ceph
, (ceftriaxone, excreted by - Prob
omnicef (CAM) kidney i
conc
Fourth broad n of
spectrum of - Loo
activity, good diur
for c
organisms that incr
developed risk
resistance to earlier neph
generation y
cephalos, strep,
staph, doesn’t
penetrate CSF
(cefepime,
maxipime)
Glycopeptides Bacteriocidal Inhibits cell wall Absorption – Pregnancy Side effect
(Vancomycin – gram positive synthesis and poor absorption - Category B - Irrit
narrow spectrum disrupts from GI tract, (oral) tissu
(Vancocin)) membrance barrier IV rapidly - Category C an
(telavancin (Vibativ)- used to function; affects absorbed; (parenteral) bloo
tx HAP or CAP when vanc RNA synthesis vanc:52-56% - Must do intim
fails) protein bound; pregnancy - Red
Vanc: C.diff, and telavancin: test prior to synd
staph enterocolitis 90% protein telavancin (fac
bound use tors
Telavancin: Lactation min
complicated skin Distribution – - Excreted in infu
infections widely breast milk Adverse Eff
distributed; Pediatrics - Nep
penetrates CSF - Hospitalized - Tran
patients otot
Metabolism – only with - Hyp
primarily given serious e vit
IV; bypasses illness - Phle
first pass i
inje
Excretion –
oral vanc
(feces); Iv vanc
(renally via
glomerular
filtration);
telavancin
(primarily
urine)
Macrolides Bactericidal or Inhibits gram + Absorption – Cautions - GI u
(Erythromycin, bacteriostatic and few gram - well absorbed - Prolongs (esp
Clarithromycin, depending on in duodenum QT eryt
Azithromycin, dirithromycin, concentration; - Liver )
telithromycin) reversibly binds Distribution – impairment - Sev
to 50S ribosome distribute - Clarithromy expl
unit, preventing readily to body cin: wate
protein synthesis tissues, enters - CrCl diar
of bacteria; CSF when <30ml/min - Acu
alkaline – meninges are requires chol
inactivated by inflamed dosage to be hepa
, acid; halved - Rash
Metabolism – Pregnancy eosi
metabolized in - Erythromyci - Met
liver, n: cat B Inte
erythromycin, - Clarithromy esp
heavily cin: cat C eryt
metabolized by - Azithromyci - Prol
CYP3A4 n: cat B QT
Lactation synd
Excretion – - Safe mali
excreted in Pediatrics arrth
feces and urine, - Safe over
caution with age 6 Interactions
clarithromycin months - Colc
increased renal - War
excretion
- Digo
incr
effe
Lincosamides Bacteriostatic in First line tx in Absorption – Cautions - GI s
(clindamycin - Cleocin) usual doses; MRSA, primarily good oral - Asthma - Dizz
suppresses gram +, some absorption - Severe vert
protein synthesis anaerobic allergies - C.di
– binds to 50S pathogens Distribution – - Severe serio
subunit of the highly protein renal/liver
bacterial bound impairment
ribosome Pregnancy
Metabolism – - Category B
metabolized in - Okay for 3rd
liver trimester
Lactation
Excretion – - Present in
excreted in bile breast milk
and urine – weigh
risk/benefit
Pediatrics
- Severe infx
only
Quinolones Bactericidal for Broad spectrum; Absorption – Cautions - GI
(Levofloxacin, DNA gyrase extensive gram -; well absorbed - Renal - CNS
Ciprofloxacin, Moxifloxacin) (needed to later generations after PO admin, dysfunction: - Pho
synthesize increased activity IV and oral can cause - Skin
bacterial DNA) against gram +; similar serum increase - Sup
only moxifloxacin concentration half-life nn
has activity against with - Mus
anaerobic bacteria; Distribution – majority of l eta
PO and IV widely drug - Ren
formulations; distributed; excreted - Diab
resistance already high tissue, unchanged - Seri
occurring from urinary in urine s
inappropriate use prostate, sinus - CrCl effe
and lung <50mL/min: dysr
penetration; adjust t
variable protein dosage
binding; - Cautious in
moderately patients
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