Chapter 17: Anti-Ribosomal Antibiotics
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- What are the anti-ribosomal antibiotics?
- buy AT 30S, CELL at 50S: Aminoglycosides, Tetracycline, Chloramphenicol, Erythromycin, Linezolid, cLindamycin
- Which anti-ribosomal drug cannot be absorbed orally?
- aminoglycosides
- What are the adverse effects of chloramphenicol?
- 2 types of bone marrow depression and "gray baby syndrome"
- What are the clinical uses of chloramphenicol?
- 1. bacterial meningitis when cause unknown and patient can't tolerate penicillins; 2. young kids and pregnant women with Rocky Mountain spotted fever who can't be treated with tetracycline
- Where is chloramphenicol widely used?
- 3rd world countries because of the broad spectrum coverage
- What makes chloramphenicol unique?
- it's the "chlorine" that kills all (almost) all germs; gram +, gram -, and even anaerobes are susceptible (can kill bacteroides fragilis)
- What bugs are targeted by clindamycin?
- ANAEROBES! and gram +
- What is the DOC for penetrating wounds to the abdomen?
- clindamycin for the anaerobes and aminoglycosides for the aerobic gram - bacteria
- What is the DOC for infections of the female genital tract, esp. after septic abortions?
- clindamycin; its oral preparation and vaginal cream are alternatives to metronidazole for the treatment of bacterial vaginosis
- What is the key problem with clindamycin?
- pseudomembranous colitis caused by clostridium difficile (CLindamycin and CLostridium)
- How is pseudomembranous colitis treated?
- vancomycin or metronidazole
- What are the clinical uses and toxicity of linezolid?
- C: new agent to fight resistant gram + bugs; T: headache and GI upset
- What are the clinical uses of erythromycin?
- community-acquired pneumonias that do NOT require hospitalization: s. pneumoniae, mycoplasma pneumoniae, chlamydia trachomatis; also, gram + bacteria and legionella
- What is used in patients with streptococcal and staphylococcal infections who are sensitive to penicillin?
- erythromycin
- What is the DOC for Legionnaire's disease?
- erythromycin ("a wreath" omycin)
- What are some side effects from erythromycin?
- it's considered a very safe drug! 1. abdominal pain from peristalsis stimulation; 2. rare cholestatic hepatitis (swallow a "wreath")
- What are the 4 macrolide antibiotics?
- CARE: clarithromycin, azithromycin, roxithromycin, erythromycin
- How are the CAR macrolides different from erythromycin?
- Show promise in covering severe staph infections, H. influenza, and even some atypical mycobacteria (Mycobacterium avium-intracellulare, MAI)
- What can be used as an alternative to doxycycline for treatment of chlamydial non-gonococcal urethritis?
- azithromycin
- Compare tetracycline and doxycycline.
- They have the same clinical use, but doxycycline is better absorbed since it doesn't chelate with cations in the diet. IV tetracycline is no longer available.
- What are the 4 clinical uses of doxycycline?
- Fights things a soldier would get in the "TET offensive": 1. VDs by chlamydia trachomatis; 2. walking pneumonia by mycoplasma pneumoniae; 3. animal and tick-borne diseases caused by brucella and rickettsia; 4. good for acne, too!
- Doxycycline's side effects?
- 1. GI irritation, nausea; 2. phototoxic dermatitis; 3. renal and hepatic toxicity; 4. discolored teeth and depressed bone growth
- How are the aminoglycosides often used?
- Since they must diffuse across the cell wall, they are used with penicillins
- Clinical use of aminoglycosides?
- aerobic gram-negative enteric organisms and kills the terrible pseudomonas aeruginosa
- What are the 6 aminoglycosides?
- "TANNGS": Tobramycin, Amikacin, Neomycin, Netilmicin, Gentamicin, Streptomycin
- What is streptomycin?
- Oldest aminoglycoside in the family; many bugs are resistant to it.
- Use of gentamicin?
- A lot of GENeral use in the "GENeral" hospital; most commonly used of the aminoglycosides; combined with penicillins for in-hospital infections. Many bacterias are resistant to it.
- Use of tobramycin?
- The "COBRA" to fight the Terrible pseudomonas aeruginosa.
- Use of amikacin?
- Has broadest spectrum of the AGs and is good for hospital-acquired infections.
- Use of neomycin?
- Broad coverage, but too toxic; good only for skin infections.
- Use of netilmicin?
- Preoperative coverage before GI surgery.
- Side effects of aminoglycosides?
- 8th cranial nerve toxicity (vertigo, hearing loss); renal toxicity; neuromuscular blockade. To remember, remember "a mean guy" boxing to the head, the kidney, and then a KO.
- How is spectinomycin administered?
- Intramuscular injection.
- What is the clinical use of spectinomycin?
- Gonorrhea caused by neisseria gonorrhoeae as an alternative to penicillin and tetracycline (doxycycline) since many strains are resistant to these bugs.
- What are 3 ways to treat gonococcal ureathritis?
- 1. ceftriaxone with doxycycline (to get the chlamydia trachomatis that is often involved); 2. quinolone antibiotics (ciprofloxacin, ofloxacin) with doxycycline; 3. spectinomycin wiht doxycycline.