Pharm - Micro - Clinical Uses
Terms
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- Bactericidal for gram positive cocci, gram positive rods, gram-negative cocci, and spirochetes.
- Penicillin
- S. aureus (except MRSA; resistant because of altered penicillin-binding protein target site).
- Methicillin, nafcillin, dicloxacillin
- certain gram-positive bacteria and gram-negative rods (Haemophilus influenzae, E. coli, Listeria monocytogenes, Proteus mirabilis, Salmonella, enterococci).
-
Ampicillin, amoxicillin
Coverage: ampicillin/amoxicillin HELPS kill enterococci - Pseudomonas spp. and gram-negative rods; susceptible to penicillinase; use with clavulanic acid.
-
Ticarcillin, carbenicillin, piperacillin
TCP: Takes Care of Pseudomonas -
gram-positive cocci, Proteus mirabilis, E. coli, Klebsiella
pneumoniae. -
Cephalosporins
1st generation (cefazolin, cephalexin)––
PEcK - gram-positive cocci, Haemophilus influenzae, Enterobacter aerogenes, Neisseria spp., Proteus mirabilis, E. coli, Klebsiella pneumoniae, Serratia marcescens.
-
2nd generation (cefoxitin, cefaclor, cefuroxime)––
2nd generation––HEN PEcKS -
serious gram-negative infections resistant to other
β-lactams; meningitis (most penetrate the blood-brain
barrier).
Examples: _________ for Pseudomonas;
__________ for gonorrhea. -
3rd generation (ceftriaxone, cefotaxime, ceftazidime)––
ceftazidime for Pseudomonas
ceftriaxone for gonorrhea -
↑ activity against
Pseudomonas and gram-positive organisms. - 4th generation (cefepime, cefpiramide)
- Gram-negative rods- Klebsiella spp., Pseudomonas spp., Serratia spp. No activity against gram-positives or anaerobes. For penicillin-allergic patients and those with renal insufficiency who cannot tolerate aminoglycosides.
- Aztreonam
-
Gram-positive cocci, gram-negative rods, and
anaerobes. Drug of choice for Enterobacter. - Imipenem/cilastatin, meropenem
- Used for serious, gram-positive multidrug-resistant organisms, including S. aureus and Clostridium difficile (pseudomembranous colitis).
- Vancomycin
-
Severe gram-negative rod infections. Synergistic with
β-lactam antibiotics. Neomycin for bowel surgery. -
Aminoglycosides
Gentamicin, Neomycin, Amikacin, Tobramycin,
Streptomycin. (GNATS) -
Vibrio cholerae, Acne, Chlamydia, Ureaplasma, Urealyticum, Mycoplasma pneumoniae, Tularemia, H. pylori, Borrelia burgdorferi (Lyme disease),
Rickettsia. -
Tetracyclines - Tetracycline, doxycycline, demeclocycline, minocycline.
VACUUM THe BedRoom. - URIs, pneumonias, STDs––gram-positive cocci (streptococcal infections in patients allergic to penicillin), Mycoplasma, Legionella, Chlamydia, Neisseria.
-
Macrolides-
Erythromycin, azithromycin, clarithromycin. -
Meningitis (Haemophilus influenzae, Neisseria meningitidis, Streptococcus pneumoniae).
Conservative use owing to toxicities. - Chloramphenicol
-
Treat anaerobic infections (e.g., Bacteroides fragilis,
Clostridium perfringens).
Treats anaerobes above the diaphragm - Clindamycin
- Gram-positive, gram-negative, Nocardia, Chlamydia. Triple sulfas or SMX for simple UTI.
-
Sulfonamides-
Sulfamethoxazole (SMX), sulfisoxazole, triple sulfas, sulfadiazine. -
recurrent UTIs, Shigella,
Salmonella, Pneumocystis carinii pneumonia. - Trimethoprim with Sulfonimides (TMP-SMX)
- Gram-negative rods of urinary and GI tracts (including Pseudomonas), Neisseria, some gram-positive organisms.
-
Fluoroquinolones-
Ciprofloxacin, norfloxacin, ofloxacin, sparfloxacin, moxifloxacin, gatifloxacin, enoxacin (fluoroquinolones), nalidixic acid (a quinolone). -
Anaerobic infection below the diaphragm.
Giardia, Entamoeba, Trichomonas, Gardnerella vaginalis, anaerobes (Bacteroides, Clostridium). Used with bismuth and amoxicillin (or tetracycline) for “triple therapy†against H. pylori. -
Metronidazole
GET on the Metro! - Resistant gram-negative infections.
- Polymyxins
- Mycobacterium tuberculosis. The only agent used as solo prophylaxis against TB.
- Isoniazid (INH)
- Mycobacterium tuberculosis; delays resistance to dapsone when used for leprosy. Used for meningococcal prophylaxis and Haemophilus influenzae type B.
- Rifampin
-
prophylaxis:
Meningococcal infection - Rifampin (drug of choice), minocycline
-
prophylaxis:
Gonorrhea - Ceftriaxone
-
prophylaxis:
Syphilis - Benzathine penicillin G
-
prophylaxis:
Recurrent UTIs - TMP-SMX
-
prophylaxis:
Pneumocystis Carinii pneumonia - TMP-SMX (drug of choice), aerosolized pentamidine
-
prophylaxis:
Endocarditis with surgical or dental procedures - Penicillins
-
Used for wide spectrum of systemic mycoses.
Cryptococcus, Blastomyces, Coccidioides,
Aspergillus, Histoplasma, Candida, Mucor
(systemic mycoses). Intrathecally for fungal
meningitis; does not cross blood-brain barrier. - Amphotericin B
- “Swish and swallow†for oral candidiasis (thrush); topical for diaper rash or vaginal candidiasis.
- Nystatin
- Systemic mycoses. Fluconazole for cryptococcal meningitis in AIDS patients and candidal infections of all types (i.e., yeast infections). Ketoconazole for Blastomyces, Coccidioides, Histoplasma, Candida albicans; hypercortisolism.
- Fluconazole, ketoconazole, clotrimazole, miconazole, itraconazole, voriconazole
- Used in systemic fungal infections (e.g., Candida, Cryptococcus).
- Flucytosine
- Invasive aspergillosis.
- Caspofungin
- Used to treat dermatophytosis (especially onychomycosis)
- Terbinafine
- Oral treatment of superficial infections; inhibits growth of dermatophytes (tinea, ringworm).
- Griseofulvin
- Prophylaxis and treatment for influenza A; Parkinson’s disease.
- Amantadine
- Inhibit influenza neuraminidase.
- Zanamivir, oseltamivir
- RSV, chronic hepatitis C.
- Ribavirin
- HSV, VZV, EBV. Mucocutaneous and genital herpes lesions. Prophylaxis in immunocompromised patients.
- Acyclovir
- CMV, especially in immunocompromised patients.
- Ganciclovir
-
CMV retinitis in immunocompromised patients
when ganciclovir fails; acyclovir-resistant HSV. - Foscarnet
-
6 NUCLEOSIDE Reverse transcriptase
inhibitors -
Zidovudine (AZT), didanosine (ddI), zalcitabine (ddC),
stavudine (d4T), lamivudine (3TC), abacavir. -
3 NON-NUCLEOSIDE Reverse transcriptase
inhibitors - Nevirapine, delavirdine, efavirenz.
- Protease Inhibitors
-
Saquinavir, ritonavir, indinavir, nelfinavir, amprenavir.
Never (navir) tease a protease inhibitor - chronic hepatitis B and C, Kaposi’s sarcoma.
- IFN-α
- MS
- IFN-β
- NADPH oxidase deficiency
- IFN-γ
- Onchocerciasis
-
Ivermectin
(rIVER blindness treated with IVERmectin) - Nematode/roundworm (e.g., pinworm, whipworm) infections.
- Mebendazole/thiabendazole
- Giant roundworm (Ascaris), hookworm (Necator/Ancylostoma), pinworm (Enterobius).
- Pyrantel pamoate
- Trematode/fluke (e.g., schistosomes, Paragonimus, Clonorchis) and cysticercosis.
- Praziquantel
- Cestode/tapeworm (e.g., Diphyllobothrium latum, Taenia species) infections except cysticercosis.
- Niclosamide
- Leishmaniasis.
- Pentavalent antimony
- Malaria.
- Chloroquine, quinine,mefloquine, atovaquone,proguanil
- Latent hypnozoite (liver) forms of malaria (Plasmodium vivax, P. ovale).
- Primaquine
- Pneumocystis carinii pneumonia prophylaxis.
- TMP-SMX, pentamidine
- Chagas’ disease, American trypanosomiasis (Trypanosoma cruzi).
- Nifurtimox
- African trypanosomiasis (sleeping sickness).
- Suramin