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Vancomycin: indications

only serious g(+) infections--MRSA, staph meningitis, C.diff

Vancomycin: mechanism and side effects (four)

similar to pens--inhibits peptidoglycan construction-->bactericidal

side effects: nephrotoxic, ototoxic, thrombophlebitis, "red man syndrome"

Bacitracin: indications and route of admin

gram (+) cocci eye and skin infections-->topical admin

Bacitracin: mechanism

similar to pens; interferes with regeneration of lipid carriers in peptidoglycan synthesis by blocking dephosphorylation

3 members of quinolone family

ciprofloxacin, norfloxacin, and ofloxacin

Quinolones: mechanism, route of admin

inhibits DNA gyrase (topoisomerase II)-->bactericidal
given PO

Quinolones: side effects (two) and contraindications (what type of pts)

side effects: n/v/d, can have suprainfections with streptococci and candida
Contraindicated in pts < 18 yrs and > 60 yrs for cartilage damage (tendinitis and tendon rupture); also in preg and nursing mothers

Quinolones: 2 mechanisms for drug resistance

1. gyrase mutation
2. decreased permeability of drug through porins

Quinolones: 8 indications

1. UTI by multi-drug resistant bacteria
2. gastroenteritis (by shigella, salmonella, E.coli, helicobacter)
3. osteomyelitis and soft tissue infections (not routine)
4. intraabdominal and respiratory tract infections (not routine)
5. gonococcal infections
6. chlamydia
7. prophylaxis for traveler's diarrhea
8. pseudomonas

Which quinolone is particularly anti-pneumoncoccal?

ofloxacin--has closely related levofloxacin and moxifloxacin which are also "respiratory" quinolones

Macrolides: 4 members

erythromycin, azithromycin, clarithromycin, and spectinomycin

Macrolides: mechanism

binds to 50S ribosome to inhibit aminoacyl translocation-->bacteriostatic

Macrolides: drug resistance

plasmid-mediated gene encodes alternate protein on 50S ribosome

Erythromycin: indications (ten)

1. DOC in community-acquired pneumonia (includes S. pneumoniae, Legionella, M. pneumoniae)
2. Treponema if pens allergy
3. Ureaplasma
4. Chlamydia (esp during preg)
5. Helicobacter
6. Listeria
7. Neisseria
8. Bordetella pertussis
9. Campylobacter
10. Gram pos: Pneumococci, Streptococci, Staphylococci, C. diphtheriae (eliminate carrier state)

Similar spectrum as pen G

Azithromycin: indications (two)

1. chlamydia
2. H. influenzae

Clarithromycin: indications (two)

1. H. pylori (in combo with amoxicillin + PPI)
2. H. influenzae

Spectinomycin: indications

GU gonorrhea if pens allergy or if gonorrhea is pens-resistant

Clindamycin: indications

B. fragilis infections, also Strep, Staph, and pneumococcal infx

Clindamycin: mechanism and route of admin

inhibits protein synthesis

Clindamycin: side-effects (two)

1. suprainfection by C. difficile
2. hepatotoxicity

Metronidazole: indications (three)

Bacteriodes, Clostridia, and Pseudomembranous colitis

Metronidazole: mechanism and route of admin

inhibits DNA synthesis-->bactericidal
oral; IV available

Metronidazole: side effects (two)

1. minor GI and CNS disturbances
2. Interferes with EtOH metabolism--disulfram-like effect-->decreases activity of aldehyde dehydrogenase, so aldehyde toxicity

Polymyxins: indications and mechanism

topical for eye and ear with bacitracin or neomycin
binds to phosphatidyl ethanolamine--detergent-like activity

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