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Antimicrobials Day 2


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1st generation cephalosporins: PEcK
cefazolin, cephalexin (G+ cocci, Proteus, E.coli, Klebsiella)
2nd generation cephalosporins; treat which bacteria: (HEN PEcKS)
cefoxitin, cefaclor, cefuroxime (G+ cocci, H.influenza, Enterobacter, Neisseria, Proteus, E.coli Klebsiella, Serratia)
3rd generation cephalosporins:
ceftriaxone, cefotaxime, ceftazidime (serious G- infections resistant to other beta lactams; meningitis)
* ceftazidime = Pseudomonas
* ceftriaxone = gonorrhea
4th generation cephalosporins:
cefepime, cefpiramide (Pseudomonas, G+)
Toxicities of cephalosporins:
1) cross hypersensitivity with penicillins in 10% of patients!!
2) inc. nephrotoxicity of aminoglycosides
3) disulfiram like rxn wtih ETOH
Which antimicrobial is:
- resistant to B-lactamase
- inhibit cell wall synthesis
- synergistic with aminoglycosides
- no cross hypersensitivity with penicillins
aztreonam - for Klebsiella, Pseudomonas, Serratia (no effect on G+ or anaerobes!)
What can you give penicillin-allergic patients & those with renal failure who can't take aminoglycosides?
What do you always give with imipenem to dec. its inactivation by the kidney?
What is imipenem good for?
G+ cocci, G- rods, anaerobes, drug of CHOICE for Enterobacter!
Toxicities of imipenem/cilastatin, meropenem?
GI, skin rash, seizures at high plasma levels
How do bacteria become resistant to vancomycin?
cell wall AA change of D-ala D-ala --> D-ala D-lac (sneaky buggers)
What is vancomycin used for?
serious G+ multidrug-resistant critters like S. aureus and C. dificile
Vancomycin toxicities?
nephro, ototoxicity, thrombophlebitis, diffuse red flushing (prevent by pretreat with antihistamnes and slower infusion)
* well tolerated drug
What are 5 aminoglycosides? (recall: bactericidal, 30S)
streptomycin, gentamicin, tobramycin, neomycin, amikacin
Aminoglycosides need ___ for uptake, therefore ineffective against ___ bacteria.
O2, anaerobic
What are aminoglycosides good for?
severe G- rod infections, synergy with B-lactams
Toxicities of aminoglycosides:
nephro, ototoxocity w/loop diuretics, TERATOGEN!
* recall: use aztreonam
Name 3 other tetracyclines:
doxycycline, demeclocycline, minocycline
Which tetracycline acts as an ADH antagonist (makes you pee)?
demeclocycline - used as diuretic in SIADH
If you are on tetracycline, you cannot eat:
milk, antacids, or iron-containing things because the cations will prevent drug absorption in the gut
Toxicities of tetracycline:
teeth discoloration and inhibiton of bone growth in kids, GI distress, photosensitivity! CONTRAINDICATED in pregnancy!
What are the 3 macrolides? (ACE)
azithromycin, erythromycin, clarithromycin
What are tetracyclines used for? (10)
V.cholera, acne, Chlamydia, Ureaplasma, Urealyticum, Mycoplasma, Tularemia (bunnies and ticks), H.pylori, Borrelia, Rickettsia
Macrolides bind to the ___S rRNA of the ___ ribosome subunit.
23S, 50S
Macrolides: bactericial or bacteriostatic?
What are macrolides used for?
URI, pneumonia, STD, strep infxn in patients allergic to penicillin, Mycoplasma, Legionella, Chlamydia, Neisseria
Toxicities of macrolides:
GI discomfort, acute cholestatic hepatitis, eosinophilia, skin rash, inc. serum theophyllines & oral anticoagulants (warfarin)
Chloramphenicol is used for meningitis caused by: (3)
H.influenza, S.pneumonia, N.meningitidis
Toxicities of chloramphenicol:
aplastic anemia, gray baby syndrome in preemies
Clindamycin is good for ___ infections caused by: (2)
anaerobic, Bacteroides fragilis and Clostridium perfringens (anaerobes above the diaphragm)
Clindamycin can unfortunately lead to ___ which is due to overgrowth of ___.
pseudomembranous colitis, C. dificile

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