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Chapter 19: Miscellaneous Antibxs


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List 3 important qualities of the fluoroquinolones?
1. Safe
2. Oral absorption
3. Penetrate extremely well into tissues
What is the fluoroquinolone mechanism of action?
Think "flock of sinners" -- "gyrating": inhibition of DNA gyrase
What are the adverse effects of ciprofloxacin?
Can cause seizures in patients with renal insufficiency or when combined with NSAIDs
Describe fluroquinolone drug levels in the stool and kidneys?
Enterohepatic circulation and then excretion via kidney leads to high levels in both stool and kidneys
What are the clinical uses of fluoroquinolones?
Gram (-)s!
1. multi-resistant pseudomonas aeruginosa
2. Enterobacteriaceae
3. Complicated UTIs
4. Gram (-) facultative intracellular organisms - Legionella, Salmonella, Mycobacterium, etc
5. Chronic osteomyelitis caused by Staph aureus
Vancomycin covers which bugs? Makes it the opposite coverage of which drug? Which nasty bugs in particular?
Covers all gram (+)s! Opposite of aztreonam.
2. Multi-resistant Staph epidermidis
3. Enterococcus (strep faecalis)
A rapid infusion of vancomycin can cause which adverse effect?
Nonimmunologic release of histamine: Red Man syndrome
Why is vancomycin effective in C dif treatment?
Not absorbed orally, so when taken orally, cruises down the GI tract to kill C dif.
Sulfa drugs - mechanism of action?
Competitively inhibits production of TH4 by bacteria.
Sulfamethoxazole is often given with which drug?
Describe the absorption and excretion of sulfa drugs?
Oral absorption.
Excretion in urine - good for UTIs.
Which people often have adverse effects on TMP/SMX?
AIDS patients.
What are the clinical uses of TMP/SMX?
Think of the mnemonic: TMP S
T - respiratory TREE: strep pneumo, H flu
M- MOUTH (GI tract): gram (-)s like Shigella, Salmonella, and E coli
P - PEE (GU tract): infections by the E coli and other enterics
S - SYNDROME (AIDS): Pneumocystis carinii and other protozoan prevention (prophylaxis)

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