Pharm 4.01 Antibiotics-Cell wall, Nucleic Acid Biosynthesis, Membrane Potential

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Vancomycin

Bacteriostatic against Gram+ cocci Bactericidal for Gram+ rods Including penicillinase producers and methicillin-resistant strains Not effective against Gram- Last resort for some strains of C. difficile Binds D-Ala-D-ALA terminus of the murine monomer (substrate) Red Man syndrome

Teicoplanin (Glycopeptide)

Structured around a heptapeptide with covalently linked side chains with sugar additions Extended half-life elimination Once daily dosing, fewer side effects No pain or tissue necrosis after intramuscular injection No ototoxicity

Penicillin G

β-Lactams Bactericidal, require actively growing infection Inhibition by binding the enzyme Penicillins Natural Penicillins Common feature is the 6-aminopenicillanic acid nucleus composed of a thiazolide ring fused to a β-lactam ring Most active penicillins against Gram+ Only 1/3 of oral dose absorbed Add procaine or benzathine to delay absorption from IM injection site Add probenecid to delay elimination

Penicillin V (Beta lactam, natural penicillin)

Common feature is the 6-aminopenicillanic acid nucleus composed of a thiazolide ring fused to a β-lactam ring Acid stable form with better absorption after oral administration

Methicillin (Penicillinase-resistant penicillin)

Resists β-lactamase produced by S. aureus and S. epidermidis Gram+ only Resistance related to failure to bind to penicillin binding proteins Not given orally

Cloxacillin

β-Lactams Bactericidal, require actively growing infection Inhibition by binding the enzyme Penicillinase-Resistant Penicillins Resist β-lactamase produced by S. aureus and S. epidermidis Gram+ only

Amoxicillin (Extended range penicillin)

First penicillins effective against Gram- For E.coli, P. mirabilis, H. influenzae, Salmonella, Shigella, Neisseria More completely absorbed after oral admin than ampicillin

Ampicillin

β-Lactams Bactericidal, require actively growing infection Inhibition by binding the enzyme Extended Range Penicillins First penicillins effective against Gram- For E.coli, P. mirabilis, H. influenzae, Salmonella, Shigella, Neisseria

Carbenicillin Ticarcillin

β-Lactams Bactericidal, require actively growing infection Inhibition by binding the enzyme Anti-Pseudomonal Penicillins (2) Carboxylated derivatives extend range of ampicillin to P. aeruginosa, indole positive Proteus, and Enterobacter

Pipercillin

β-Lactams Bactericidal, require actively growing infection Inhibition by binding the enzyme Anti-Pseudomonal Penicillins N-acyl derivatives

Cefazolin

β-Lactams Bactericidal, require actively growing infection Inhibition by binding the enzyme Cephalosporins Similar basic structure and mode of action to the penicillins Can cause bleeding due to bleeding disorders or Vitamin K deficiency First Generation Narrow spectrum, against Staph and Strep Surgical prophylaxis Not effective for MRSA

Cefuroxime

β-Lactams Bactericidal, require actively growing infection Inhibition by binding the enzyme Cephalosporins Similar basic structure and mode of action to the penicillins Can cause bleeding due to bleeding disorders or Vitamin K deficiency Second Generation Increased action against Gram- like E. coli and Proteus Decreased action against Gram+ Effective for H. influenzae and K. pneumoniae For community acquired pneumonia

Cefotetan Cefoxitin (2nd generation cephalosporins)

Increased action against Gram- like E. coli and Proteus Decreased action against Gram+ B. fragilis and other anaerobes Prophylaxis during intra-abdominal surgery (2)

Loracarbef

β-Lactams Bactericidal, require actively growing infection Inhibition by binding the enzyme Cephalosporins Similar basic structure and mode of action to the penicillins Can cause bleeding due to bleeding disorders or Vitamin K deficiency Second Generation Increased action against Gram- like E. coli and Proteus Decreased action against Gram+ • Sometimes classes as a carbacephem

Ceftriazone (3rd generation cephalosporin)

Good penetration of CNS, bone, lungs, urinary tract High activity against Gram- • Choice for N. gonorrhea and B. burgdorferi

Ceftazidime Cefoperazone (Third generation cephalosporins)

Good penetration of CNS, bone, lungs, urinary tract High activity against Gram- • For multidrug-resistant Gram- infections, such as P. aeruginosa (2)

Cefepime

β-Lactams Bactericidal, require actively growing infection Inhibition by binding the enzyme Cephalosporins Similar basic structure and mode of action to the penicillins Can cause bleeding due to bleeding disorders or Vitamin K deficiency Fourth Generation • Better against Gram+ because of resistance to β-lactamases

Imipenem

β-Lactams Bactericidal, require actively growing infection Inhibition by binding the enzyme Carbapenems Extremely broad spectrum Resistant to β-lactamases, not resistant to metallo-β-lactamases Given in combination with cilastatin, a dipeptidase inhibitor

Meropenem

Extremely broad spectrum Less susceptible to hydrolysis by renal tubule dipeptidase Less nephrogenic

Aztreonam

β-Lactams Bactericidal, require actively growing infection Inhibition by binding the enzyme Monobactams Excellent against Gram-, poor against Gram+ Can be used instead of aminoglycoside The only one that does not show cross-allergenicity with other β-lactam antibiotics

Sulfisoxazole Sulfamethoxazole (Sulfonamides)

Broad spectrum Structural analogs and competitive antagonists of PABA at dihydropteroate synthase (2)

Trimethoprim (Benzylpyrimidine)

Broad Spectrum Selective inhibitor of bacterial dihydrofolate reductase

Daptomycin (Cubicin)

Antibiotics Spectrum: For complicated skin and skin structure infections Retains activity against resistant Gram+ Binds to membranes and forms membrane channels in a Ca2+ dependent manner Pharmacokinetics: IV only Excreted by kidney Does not cross blood-brain barrier

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