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Ampicillin, amoxicillin (aminopenicillins)

Haemophilus influenzae, E. coli, Listeria monocytogenes, Proteus mirabilis, Salmonella, enterococci

Ampicillin, amoxicillin (aminopenicillins)

Hypersensitivity rxns, rash, pseudomembranous colitis

Methicillin, nafcillin, dicloxacillin (penicillinase-resistant penicillins)

S. aureus

Methicillin, nafcillin, dicloxacillin (penicillinase-resistant penicillins)

Hypersensitivity reactions, *interstitial nephritis

Ticarcillin, carbenicillin, piperacillin

Pseudomonas spp and GNR. Susceptible to penicillinase, use with clavulanic acid (beta-lactamase inhibitor)

Cefazolin, cephalexin

Proteus mirabilis, E. Coli, Klebsiella pneumoniae

Cefoxitin, cefaclor, cefuroxime

Haemophilus influenzae, Enterobacter aerogenes, Neisseria spp., Proteus mirabilis, E. coli, Klebsiella pneumoniae, Serratia marcescens

Ceftriaxone, cefotaxime, ceftazidime

Serious gram-negative infections resistant to other beta-lactams; meningitis (most penetrate BBB).

Ceftazidime

Pseudomonas

Ceftriaxone

Gonnorrhea

Cefepime

Increased activity against pseudomonas and gram-positive organisms

Cephalosporins

Hypersensitivity reactions. Cross-hypersensitivity with penicillins in 5-10%.

Cephalosporins

Increased nephrotoxicity of aminoglycosides

Cephalosporins

Disulfiram-like reaction with ethanol

Aztreonam

Synergistic with aminoglycosides

Aztreonam

No cross-allergenicity with penicillins. Binds PBP3

Aztreonam

Gram-negative rods - Klebsiella spp., Pseudomonas spp., Serratia spp.

Aztreonam

No activity against gram-positives or anaerobes

Aztreonam

For penicillin-allergic patients and those with renal insufficiency who cannot tolerate aminoglycosides

Aztreonam

Usually non-toxic. Occassional GI upset.

Imipenem

Broad-spectrum, beta-lactamase-resistant carbapenem.

Imipenem

Always administered with cilastatin (inhibitor of renal dihydropeptidase I) to decrease inactivation in renal tubules.

Imipenem

Gram-positive cocci, gram-negative rods, and anaerobes.

Imipenem

Drug of choice for enterobacter

Imipenem

Significant side effects limit use to life-threatening infections, or after other drugs have failed.

Meropenem

Reduced risk of seizures. Stable to dihydropeptidase I

Imipenem

GI distress, skin rash, and CNS toxicity (seizures) at high plasma levels.

Vancomycin

Inhibits cell wall mucopeptide formation by binding D-ala D-ala portion of cell wall.

Vancomycin

Bactericidal. Resistance occurs with amino acid change of D-ala D-ala to D-ala D-lac

Vancomycin

Used for serious, gram-positive multidrug-resistant organisms, including S. aureus and Clostridium difficile

Vancomycin

Nephrotoxicity, Ototoxicity, Thrombophlebitis

Vancomycin

Diffuse flushing - preventable by pretreatment with antihistamines and slow infusion rate

Vancomycin

Generally well tolerated. Does not have many problems.

Aminoglycosides

30S inhibitor

Tetracyclines

30S inhibitor

Chloramphenicol

50S inhibitor

Clindamycin

50S inhibitor

Erythromycin

50S inhibitor

Lincomycin

50S inhibitor

Linezolid

50S inhibitor

Aminoglycosides (Gentamycin, Neomycin, Amikacin, Tobramycin)

Bactericidal. Inhibit formation of initiation complex and cause misreading of mRNA.

Aminoglycosides (Gentamycin, Neomycin, Amikacin, Tobramycin)

Require O2 for uptake. Ineffective against anaerobes.

Aminoglycosides (Gentamycin, Neomycin, Amikacin, Tobramycin)

Severe gram-negative rod infections. Synergistic with beta-lactam antibiotics.

Neomycin

Bowel surgery

Aminoglycosides (Gentamycin, Neomycin, Amikacin, Tobramycin)

Nephrotoxicity (especially when used with cephalosporins)

Aminoglycosides (Gentamycin, Neomycin, Amikacin, Tobramycin)

Ototoxicity (especially when used with loop diuretics)

Aminoglycosides (Gentamycin, Neomycin, Amikacin, Tobramycin)

Teratogen

Tetracycline, doxycline, demeclocycline, minocycline

Bacteriostatic; bind to 30S and prevent attachment of aminoacyl-tRNA; limited CNS penetration.

Doxycycline

Fecally eliminated and cannot be used in patients with renal failure. Must NOT take with milk, antacids, or iron-containing preparations because divalent cations inhibit its absorption in the gut.

Tetracycline, doxycline, demeclocycline, minocycline

Vibrio cholera

Tetracycline, doxycline, demeclocycline, minocycline

Acne

Tetracycline, doxycline, demeclocycline, minocycline

Chlamydia

Tetracycline, doxycline, demeclocycline, minocycline

Ureaplasma

Tetracycline, doxycline, demeclocycline, minocycline

Urealyticum

Tetracycline, doxycline, demeclocycline, minocycline

Mycoplasma pneumoniae

Tetracycline, doxycline, demeclocycline, minocycline

Tularemia

Tetracycline, doxycline, demeclocycline, minocycline

H. pylori, Borrelia burgdorferi, Rickettsia

Tetracycline, doxycline, demeclocycline, minocycline

GI distress, discoloration of teeth and inhibition of bone growth in children, photosensitivity.

Tetracycline, doxycline, demeclocycline, minocycline

Contraindicated in pregnancy

Macrolides (Erythromycin, azithromycin, clarithromycin)

Inhibit protein synthesis by blocking translocation. Bind to 23S rRNA of 50S ribosome. Bacteriostatic.

Macrolides (Erythromycin, azithromycin, clarithromycin)

URIs, pneumonias, STDs

Macrolides (Erythromycin, azithromycin, clarithromycin)

Gram-positive cocci (streptococcal infections in patients allergic to penicillin)

Macrolides (Erythromycin, azithromycin, clarithromycin)

Mycoplasma, legionella, Chlamydia, Neisseria

Macrolides (Erythromycin, azithromycin, clarithromycin)

Prolonged QT interval

Macrolides (Erythromycin, azithromycin, clarithromycin)

GI discomort (most common cause of noncompliance)

Macrolides (Erythromycin, azithromycin, clarithromycin)

Acute cholestatic hepatitis, eosinophilia, skin rashes.

Macrolides (Erythromycin, azithromycin, clarithromycin)

Increased serum concentration of theophyllines, oral anticoagulants

Chloramphenicol

Inhibits 50S peptidyltransferase activity. Bacteriostatic.

Chloramphenicol

Meningitis (Haemophilus influenzae, Neisseria meningitidis, Streptococcus pneumoniae) Conservative use owing to toxicities.

Chloramphenicol

Anemia (does-dependent), aplastic anemia (dose independent)

Chloramphenicol

Gray baby syndrome (in premature infants because they lack liver UDP-glucuronyl transferase).

Clindamycin

Blocks peptide bond formation at 50S ribosomal subunit. Bacteriostatic.

Clindamycin

Treat anaerobic infections (e.g. Bacteroides fragilis, Clostridium perfringens)

Clindamycin

Pseudomembranous colitis, fever, diarrhea

Sulfonamides (Sulfamethoxazole SMX, sufisoxazole, sulfadiazine)

PABA antimetabolites inhibit dihydropteroate synthetase. Bacteriostatic.

Sulfonamides (Sulfamethoxazole SMX, sufisoxazole, sulfadiazine)

Gram-positive, gram-negative, Nocardia, Chlamydia.

Sulfonamides (Sulfamethoxazole SMX, sufisoxazole, sulfadiazine)

Simple UTI

Sulfonamides (Sulfamethoxazole SMX, sufisoxazole, sulfadiazine)

Hypersensitivity reactions, hemolysis of G6PD deficient

Sulfonamides (Sulfamethoxazole SMX, sufisoxazole, sulfadiazine)

Nephrotoxicity (tubulointerstitial nephritis), photosensitivity, kernicterus in infants, displace other drugs from albumin (e.g. Warfarin)

Trimethoprim

Inhibits bacterial dihydrofolate reductase. Bacteriostatic.

Trimethoprim

Used in combination with sulfonamides causing sequential block of folate synthesis.

TMP-SMX

Recurrent UTIs, Shigella, Salmonella, Pneumocystis jiroveci pneumonia

Trimethoprim

Megaloblastic anemia, leukopenia, granulocytopenia (may alleviate with supplemental folinic acid)

Fluoroquinolones (ciprofloxacin, norfloxacin, ofloxacin, sparfloxacin, moxifloxacin, gatifloxacin, enoxacin, nalidixic acid - a quinolone)

Inhibit DNA gyrase (topoisomerase II) Bactericidal

Fluoroquinolones (ciprofloxacin, norfloxacin, ofloxacin, sparfloxacin, moxifloxacin, gatifloxacin, enoxacin, nalidixic acid - a quinolone)

Must not be taken with antacids

Fluoroquinolones (ciprofloxacin, norfloxacin, ofloxacin, sparfloxacin, moxifloxacin, gatifloxacin, enoxacin, nalidixic acid - a quinolone)

Gram-negative rods of urinary and GI tracts (including pseudomonas), Neisseria, some gram-positive organisms.

Fluoroquinolones (ciprofloxacin, norfloxacin, ofloxacin, sparfloxacin, moxifloxacin, gatifloxacin, enoxacin, nalidixic acid - a quinolone)

GI upset, superinfections, skin rashes, HA, dizziness.

Fluoroquinolones (ciprofloxacin, norfloxacin, ofloxacin, sparfloxacin, moxifloxacin, gatifloxacin, enoxacin, nalidixic acid - a quinolone)

Contraindicated in pregnant women and children d/t cartilage damage. Tendonitis and tendon rupture in adults. Leg cramps and myalgias in kids.

Metronidazole

Forms toxic metabolites in the bacterial cell that damage DNA. Bactericidal, antiprotazoal.

Metronidazole

Giardia

Metronidazole

Entamoeba

Metronidazole

Trichomonas

Metronidazole

Gardnerella vaginalis

Metronidazole

Anaerobes (Bacteroides, Clostridium)

Metronidazole

Used with bismuth and amoxicillin for "triple therapy" against H. pylori.

Metronidazole

Disulfiram-like reaction with alcohol; HA, metallic taste

Polyyxins (Polymyxin B, polymyxin E)

Bind to cell membranes of bacteria and disrupt their osmotic properties. Cationic, basic proteins that act like detergents.

Polyyxins (Polymyxin B, polymyxin E)

Resistant gram-negative infections

Polyyxins (Polymyxin B, polymyxin E)

Neurotoxicity, acute renal tubular necrosis

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