Bacterial Classification and Characteristics Quiz

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Questions and Answers

What is the primary distinguishing feature of Gram-positive bacteria compared to Gram-negative bacteria?

Thicker layer of peptidoglycan (correct)

Presence of flagella

Different shape

Absence of cell membrane

Which enzyme is responsible for the production of peptidoglycan in bacterial cell walls?

Lysozyme

Peptidase

Transpeptidase (correct)

Cellulase

Which of the following correctly classifies bacteria based on their oxygen requirements?

Anaerobic bacteria require oxygen to grow.

Aerobic bacteria cannot survive in oxygen-rich environments.

Aerobic bacteria thrive in oxygen-poor environments.

Anaerobic bacteria can produce foul-smelling pus. (correct)

What characteristic makes Gram-negative bacteria more resistant to antibacterial drugs?

Complex cell wall structure Signup and view all the answers

Which of the following bacteria are classified as opportunistic pathogens?

All of the above Signup and view all the answers

What is the primary distinction of bactericidal drugs that exhibit concentration-dependent killing?

The rate of killing increases with higher peak drug concentrations. Signup and view all the answers

Which of the following antibiotics is classified as bacteriostatic?

Clindamycin Signup and view all the answers

What class of antibiotics demonstrates time-dependent killing?

Beta-lactams Signup and view all the answers

How is selective toxicity significant in the use of antibiotics?

It ensures the drug is toxic to microbes while sparing human cells. Signup and view all the answers

What is an important consideration when determining antibiotic therapy for mixed infections?

Combination therapy may be required to address multiple bacterial species. Signup and view all the answers

In the context of antibiotic therapy, what does the term 'narrow spectrum' imply?

The drug is effective against a limited range of microorganisms. Signup and view all the answers

Why is it crucial to maintain adequate blood levels of antibiotics during treatment?

To sustain antimicrobial activity above the minimum bactericidal concentration. Signup and view all the answers

Which of the following represents a hallmark of bactericidal antibiotics?

They kill bacteria directly instead of just inhibiting their growth. Signup and view all the answers

What is the primary function of beta-lactamase inhibitors?

To bind to the active site of beta-lactamases, preventing antibiotic resistance Signup and view all the answers

Which of the following is an example of a beta-lactamase inhibitor?

Clavulanic acid Signup and view all the answers

Which generation of cephalosporins is least effective against Gram-negative bacteria?

1st Generation Signup and view all the answers

What mechanism do cephalosporins primarily use to exert their antibacterial effect?

Inhibition of cell wall synthesis Signup and view all the answers

Which cephalosporin generation is specifically noted for reaching therapeutic levels in cerebral spinal fluid (CSF)?

3rd Generation Signup and view all the answers

How are beta-lactam antibiotics typically administered when used with beta-lactamase inhibitors?

In combination with beta-lactamase inhibitors Signup and view all the answers

Which of the following cephalosporins has both Gram-positive and Gram-negative activity?

Cefipime Signup and view all the answers

Why is dose reduction necessary for cephalosporins in patients with renal impairment?

Because they are fully excreted unchanged in urine Signup and view all the answers

What is a common side effect of beta-lactam antibiotics?

Diarrhea Signup and view all the answers

Which cephalosporin is administered orally and has a dosing schedule of 250-500mg every 6 hours?

Cephalexin Signup and view all the answers

What is the recommended timing for taking antacids in relation to food?

1 hour before or 2 hours after food Signup and view all the answers

Why should tetracyclines be avoided in pregnant women and children younger than 8 years?

They can cause discoloration of permanent teeth Signup and view all the answers

What is a serious adverse effect associated with Clindamycin use?

Antibiotic-associated colitis Signup and view all the answers

In which situations is Chloramphenicol primarily reserved for use?

Life-threatening infections like typhoid fever and meningitis Signup and view all the answers

What property does Minocycline possess that may impact patients while on treatment?

Can interfere with balance Signup and view all the answers

What is the primary mechanism of action of aminoglycosides?

Inhibit protein synthesis at the 30s ribosome Signup and view all the answers

What adverse effect is commonly associated with high plasma levels of vancomycin?

Hearing loss Signup and view all the answers

In which circumstance is oral vancomycin typically administered?

Managing pseudomembranous colitis Signup and view all the answers

Which condition contraindicates the use of aminoglycosides due to increased risk of toxicity?

Myasthenia Gravis Signup and view all the answers

What is a common pharmacokinetic property of aminoglycosides?

Elimination unchanged in the urine Signup and view all the answers

How should macrolides be administered to avoid pain?

Slow intravenous infusion in diluted solution Signup and view all the answers

Which of the following is NOT an example of an aminoglycoside?

Azithromycin Signup and view all the answers

What is the primary reason for conducting Therapeutic Drug Monitoring (TDM) with aminoglycosides?

To minimize toxicity due to renal impairment Signup and view all the answers

Which of the following best describes the antibacterial activity of macrolides?

Bacteriostatic for most organisms Signup and view all the answers

What is the recommended administration method for vancomycin to avoid 'Red man' syndrome?

Dilute and infuse slowly over an hour Signup and view all the answers

What type of bacteria are naturally resistant to penicillins?

Gram-negative bacteria Signup and view all the answers

Which mechanism allows bacteria to pump out antibiotics before they can be effective?

Efflux pumping of the antibiotic Signup and view all the answers

What is one reason that contributes to the development of antibiotic resistance in bacteria?

Globalized travel Signup and view all the answers

What does the term 'cross resistance' refer to?

Resistance to antibiotics with similar actions Signup and view all the answers

Which of the following describes the process of inactivation of an antibiotic?

Enzymatic breakdown of antibiotic molecules Signup and view all the answers

What is the role of porins in bacterial cell membranes regarding antibiotic resistance?

They are removed to reduce antibiotic permeability Signup and view all the answers

Which condition increases the likelihood of developing antibiotic resistance in patients?

Inadequate treatment of infections Signup and view all the answers

How do bacteria modify their target for antibiotics?

By altering the structure of the target site Signup and view all the answers

Study Notes

Introduction to Antimicrobial Treatment

The use of antimicrobial agents, such as antibiotics, aims to eliminate the infecting microorganism from the body.
However, the agents may also harm the host, necessitating careful consideration of potential side effects and interactions.
Different types of microorganisms, including bacteria, fungi, viruses, and parasites, can cause infections.
Infections can cause harm depending on the microbe and the severity of infection (e.g. local or systemic).

Topic Objectives

Students will be able to define an infection and list the common microorganisms that infect humans.
Students will be able to describe the infection process.
Students will be able to list the modes of transmission of various infections.
Students will be able to define common terminologies used when discussing infections.

What is an Infection?

An infection occurs when microorganisms (bacteria, fungi, viruses, or parasites) enter the human body and multiply.
If the infection causes harmful effects on the body, it's considered a disease.

What Happens in an Infection?

Infections may or may not produce noticeable signs or symptoms.
Infections confined to a specific area of the body are called local infections.
Infections spreading throughout the body are called systemic infections.

Patterns of Infection

Mixed infection- several microbes simultaneously infect the location.
Primary infection- an infection that develops in a healthy individual.
Secondary infection- an infection that develops in an existing infection.
Acute infection- rapid-onset, short-duration effects
Chronic infection- prolonged, persistent effects

Infectious Disease Process

Infectious agents, susceptible hosts, reservoirs, modes of transmission, portals of entry and exit are critical elements of infectious disease.

CHAIN of INFECTION

Infectious agent or pathogen
Reservoir
Portal of exit
Mode of transmission
Portal of entry
Susceptible host

Infectious Agent/Pathogen

Microorganisms (bacteria, viruses, fungi, protozoa, parasites) that can cause diseases.

Reservior

Animate sources (humans, animals, insects)
Inanimate sources (soil, water, food, medical equipment)
Pathogens need appropriate environmental conditions to survive (food, oxygen, water, temperature, pH, light).

Living Reservoirs

Carrier - a person who shelters a pathogen and unknowingly spreads it to others (may or may not be affected by the microbe).
Asymptomatic carrier - an individual who carries the agent but does not exhibit symptoms (e.g. incubation carriers, convalescent carriers, chronic carriers).
Passive carrier- contaminated healthcare provider transfers the pathogen to patients.

Living Reservoirs (continued)

Individuals at risk for carrying microbes without showing symptoms.

Portal of Exit/Entry

Skin and mucous membranes
Respiratory tract
Urinary tract
Gastrointestinal tract
Reproductive tract
Blood

Modes of Transmission

Contact (direct & indirect)
Droplet
Airborne
Vehicles
Vectors

Susceptible Host

Susceptibility- the degree of resistance to infection.
Factors influencing susceptibility include: age, nutritional status, chronic disease history, immunity, genetics, and personal hygiene.

The Infection Process

Infection has four key stages:
- Incubation period- from initial exposure to first symptom. The infection agent is multiplying but the damage is not significant enough to produce symptoms.
- Prodromal stage- vague feelings of discomfort.
- Invasion period- multiplication at higher levels that produce many symptoms.
- Convalescence period- decrease in symptoms as the host responds to the infection.

Major Factors in the Development of an Infection

True pathogens- able to cause disease in healthy individuals with normal immune defenses (e.g., influenza virus, plague bacillus, malaria).
Opportunistic pathogens- cause disease when the host's defenses are compromised (e.g., Pseudomonas sp., Candida albicans).
Virulence- the severity of the disease depends on this factor.

How to Break the Infection Chain?

Identification of infectious agent and appropriate treatment
Potential hosts and carriers practice proper hygiene, sanitation, and equipment disinfection.
Covering mouth and nose when coughing or sneezing.
Proper handwashing
Use of PPE

How to Break the Infection Chain (cont)

Handwashing, isolation of infected patients, and disinfection/sterilization
Aseptic technique, proper catheter care/wound care
Treatment of underlying disease and immunizations.

Antimicrobial Therapy

Therapeutic goal- removing the infecting microorganisms from tissues.
Chemicals destroy microbes, but can harm the host.

Modern Chemotherapy

Paul Ehrlich introduced the concept of chemotherapy, using chemicals for treating diseases.
Ehrlich envisioned drugs that target parasites but weren't toxic to humans.

First Antibiotic

Penicillin G was discovered in 1929 by Alexander Fleming.
Penicillin was clinically tested and produced in the 1940s.
Fleming observed that Penicillium fungus made an antibiotic, Penicillin, which killed S. aureus.

In 1944, Waksman isolated streptomycin and other agents like chloramphenicol, tetracyclines, and erythromycin from soil samples.

Oxford University Group and Penicillin

In 1939, Florey and his colleagues at Oxford University re-isolated penicillin.

Antibiotics

Chemicals produced by microorganisms (bacteria, fungi, actinomyces) suppress or destroy other microorganisms.
Some are created via chemical synthesis or semisynthesis.

How to Achieve Therapeutic Goal?

Organism must be susceptible to the drug.
Drug concentrations of the antibiotic must reach the infection site.
Sufficient drug levels must be maintained at the infected site.
Host defenses help clear the infection.

Types of Antimicrobial Agents

Antibacterial agents (antibiotics)
Antifungals
Antivirals
Antiprotozoans
Antihelmintics

Clinical Uses of Antimicrobial Agents

Empirical therapy or initial therapy. The antimicrobial should cover all likely pathogens until microorganisms are identified. May be needed in serious infections before lab results come.
Definitive therapy or pathogen-directed therapy. Once the causative microbe is identified, this method utilizes definitive antimicrobial therapy with a narrow-spectrum, low-toxicity agent to complete the course.
Prophylactic or preventive therapy (e.g., surgery, recurrent infections)

Antimicrobial Regimen Selection

Confirming the presence of infection
Identifying the pathogen
Selecting rational antimicrobial therapy
Monitoring therapeutic response

Classification of Antibacterials

Antibiotics can be categorized based on structure and mechanism of action to help understand how antibiotics work on microorganism.

Bacterial Classification, Shape & Oxygen Requirements

Bacteria are single-celled organisms in various shapes.
Classified by cell wall (Gram-positive/Gram-negative).
Classified by shape (cocci, bacilli, spirilli).
Classified by oxygen requirements (aerobic/anaerobic).

How Bacteria Cause Disease

Many bacteria act as opportunistic pathogens, harming the host when conditions allow their growth.
Some bacteria release toxins that harm the host cells.
Bacteria can release toxins that damage host cells and disrupt cell membranes. Some gram-negative bacteria produce toxic components in the cell walls.

Principles of Antibacterial Action

Must kill harmful bacteria without damaging the host cells.
Must target bacterial cell structures different from eukaryotic human cells (selective toxicity).

Bacteriostatic vs. Bactericidal

Bacteriostatic- inhibits bacterial growth. Host defenses kill the bacteria.
Bactericidal- kills bacteria. Bacteria cannot replicate once the antibiotic is removed.

Bacteriostatic and Bactericidal agents

List of bacteriostatic and bactericidal agents.

Concentration Dependent Vs Time-Dependent Killing

Concentration-dependent killing: the rate and extent of killing increase with rising drug concentration (e.g. aminoglycosides, fluoroquinolones, metronidazole).
Time-dependent killing: bactericidal activity continues as long as the plasma concentration is above the minimum bactericidal concentration (MIC) (e.g., beta-lactams, vancomycin, macrolides, tetracyclines).

Selective Toxicity and Spectrum of Activity

Selective toxicity- drugs toxic to microorganisms but not to human cells.
Narrow spectrum: effective against limited microorganisms
Broad spectrum: effective against many microorganisms

Principles of Antimicrobial Selection

Match drug to the bug
Consider the spectrum of the drug
Consider combination therapy
Consider infection site/administration

Principles of Antimicrobial Selection and Administration: Maintain Adequate Blood Levels

Many antibiotics need regular dosing to maintain sufficient blood levels.
Oral doses often require an empty stomach.

Principles of Antimicrobial Selection and Administration: Antibiotic Combinations

Combinations of antibiotics which act via different mechanisms may be synergistic (e.g., enhance antibiotic effectiveness) or antagonistic (oppose each other's effects).
Necessary in treating mixed infections (more than one bacterial species).
Combinations can discourage antibiotic resistance.
Combine only when indicated.

Empiric Therapy

Administration of antibiotics based on the practitioner's best guess of the infecting pathogens to avoid treatment delay.

Definitive Therapy

Antibiotics given based on results from culture and sensitivity tests.
A narrow-spectrum drug with minimal toxicity is utilized.

Prophylactic Antibiotic Therapy

Antibiotic use to prevent infection before anticipated exposure, such as pre-operative surgery.

Superinfection

Secondary infection that arises during the treatment of another infection.
Occurs when the antibiotic destroys normal flora, creating conditions for another infection to flourish.

Examples of Superinfections

Yeasts and fungal infections
Diarrhea due to disruption of normal intestinal bacteria.

Organism Sensitivity

A laboratory test confirms the drug's toxicity to the specific microorganism causing the infection.

Culture and Sensitivity Testing of Bacteria

Isolate bacteria from infection site and culture them.
Apply antibiotic-soaked discs to the plate.
Clear area around the disc indicates sensitivity.
The clear area's size reflects the antibiotic's effectiveness against that specific bacteria.

Classification of Antibacterials (continued)

Classification of antibiotics typically based on chemical structure and mechanism of action (examples).

Chemical Classification of Antibacterials

List of antibiotics categorized by chemical agents (examples).

Mechanisms of Action of Antibiotics

Inhibition of cell wall synthesis
Inhibition of protein synthesis
Inhibition of nucleic acid synthesis
Injury to plasma membrane
Inhibition of essential metabolite synthesis

Modes of Antimicrobial Action

Visual representation demonstrating the impact of antibiotics on bacterial processes (cell wall, nucleic acids, protein synthesis, etc.).

Inhibition of Cell Wall Synthesis

Most bacteria have cell walls for protection against osmotic pressure.
Peptidoglycans are linked by transpeptidase to form a rigid structure.
Inhibiting this process prevents bacteria from creating new walls, leading to cell rupture and death.
Examples of drugs include penicillins, cephalosporins, and vancomycin.

Inhibition of Protein Synthesis

Antibiotics target bacterial ribosomes to prevent protein production, necessary for growth and cell division.
Examples of drugs include tetracyclines, aminoglycosides, and macrolides.

Inhibition of Nucleic Acid Synthesis

Drugs disrupt the enzymes involved in DNA replication and transcription.
Examples of drugs include rifampicin and fluoroquinolones.

Inhibition of Essential Metabolite Synthesis

Bacteria synthesize essential molecules like folic acid.
Antibiotic drugs block the synthesis of these molecules needed for bacterial growth.
Examples of drugs include sulfonamides and trimethoprim.

Injury to Cell Membrane

Antibiotics can dissolve bacterial membranes, increasing permeability.
Cell contents leak out, leading to microbial death.
Example: Polymyxin B.

Inhibitors of Cell Wall Synthesis (beta-lactams)

Penicillins, cephalosporins, and carbapenems belong to this group.
The β-lactam ring is crucial for their antibacterial activity.

Penicillins

Inhibit bacterial enzymes that crosslink peptidoglycans.
Bactericidal.
Effective against dividing cells only.
High therapeutic index (safe for humans).

Examples of Penicillins

Benzylpenicillin, phenoxymethylpenicillin, ampicillin, amoxicillin, bacampicillin, and cloxacillin are examples of penicillins.
Oral penicillins are generally best taken with an empty stomach to avoid reduced absorption due to food.

Pharmacokinetics of Penicillins

Some penicillins are destroyed by gastric acid — not suitable for oral use.
Bound to plasma proteins, not efficiently crossing the blood-brain barrier but can reach CNS if meninges are inflamed.
Excreted by kidneys; probenecid may delay excretion to prolong effect.

Penicillin Allergy

Allergic response to penicillin may range from mild skin rash to severe anaphylaxis. May also be allergic to other beta-lactam drugs like cephalosporins.
Allergic reaction possibility increases with repeated exposure.

Adverse Effects of Penicillins

Common adverse effect- allergic reactions.
Other adverse effects- diarrhea and neutropenia, neurologic problems with overdose.

Drug Interactions of Penicillins

Synergistic with aminoglycoside antibiotics.
May reduce effectiveness of oral contraceptives.

Bacterial Resistance to Penicillins

Bacteria produce β-lactamases to break open the β-lactam ring in penicillins, rendering them inactive.
Bacteria can also modify penicillin-binding proteins (PBPs).
Reduced permeability of the cell membrane can also reduce antibiotic action on bacterial cells and their subsequent lysis.

Beta-Lactamases

Enzymes that break the β-lactam ring of penicillin, making it ineffective.
Some bacteria produce these beta-lactamases resulting in resistance to beta-lactam type antibiotics.

Beta-Lactamase Inhibitors

Drugs that bind to beta-lactamases and prevent them from destroying the β-lactams.
Examples: Clavulanic acid, sulbactam, tazobactam

Penicillin/Cephalosporin-Beta-Lactamase Combinations

Drug preparations combine a β-lactam with a beta-lactamase inhibitor (examples and trade names).

Cephalosporins

Derived from fungi.
Similar structure and mechanism of action to penicillins (inhibit cell wall synthesis).
First-generation drugs do not reach therapeutic levels in cerebrospinal fluid (CSF). Important for treating meningitis.

Mechanism of Action of Cephalosporins

Inhibit cell wall synthesis via binding to penicillin-binding proteins (PBP).
Bactericidal.
Time-dependent killing – Maintain drug levels above MIC.

Pharmacokinetics of Cephalosporins

Widely absorbed and distributed in most body fluids, including placenta and breast milk.
Excreted in urine; dose adjustments needed in renal impairment.
First-generation do not reach good levels in CSF; 2nd- and 3rd-generation drugs reach good levels and are especially important in treating meningitis

Classification of Cephalosporins

Categorized based on spectrum of activity; newer generations have wider Gram-negative antibacterial activity with some less Gram-positive activity.

Examples of Cephalosporins

A table of 1st, 2nd, 3rd, and 4th generation cephalosporins, showing their routes and dosage information.

Major Differences between Cephalosporin Generations

Table summarizing the activities against Gram-negative bacteria, resistance to beta-lactamases, and distribution to CSF.

Clinical Uses of Cephalosporins

Broad spectrum and safety profile for infections.
Earlier generations are common in community-acquired infections.
Later generations help treat Gram-negative bacteria infections, such as hospital-acquired or complicated infections.

Adverse Effects of Cephalosporins

Common adverse effects- allergic reactions (cross-allergy with penicillin).
Prolonged high doses can cause blood disorders in some patients, such as diarrhea, pain at injection sites, and nephrotoxicity.

Mechanisms of Bacterial Resistance

Mechanisms by which bacteria develop resistance to cephalosporins:
Destruction of the β-lactam ring by β-lactamases.
Altered affinity of cephalosporins for their target site.
Decreased penetration of cephalosporins to its target site.

Carbapenems

Another beta-lactam group.
Broad-spectrum, resistant to beta-lactamases.
Often a last resort in treating infections (e.g., septicemia, intra-abdominal infections).
Examples: Imipenem, meropenem.

Vancomycin

Glycopeptide antibiotic used for serious gram-positive bacterial infections when other choices fail.
Treatment of choice for methicillin-resistant Staphylococcus aureus (MRSA).
MOA- Inhibit cell wall synthesis at a site different from beta-lactams.

Pharmacokinetics of Vancomycin

Poorly absorbed from the gastrointestinal tract (oral).
Widely distributed in tissues; excreted by kidneys.
Time-dependent killing, therapeutic drug monitoring (TDM) required in renal failure.

Adverse Effects of Vancomycin

Serious adverse effects- ototoxicity (tinnitus, deafness), nephrotoxicity (at high plasma levels).
Rapid IV administration may cause vasodilation and hypotension (red man syndrome).
Other side effects: fever, rash, injection site pain.

Inhibition of Protein Synthesis

Antibiotic list example of drugs that inhibit protein synthesis.

Aminoglycosides

Inhibit protein synthesis in ribosomes by binding to 30S ribosomes.
Bactericidal, concentration-dependent killing.
Used for specific bacterial infections.

Pharmacokinetics of Aminoglycosides

Usually given intravenously or intramuscularly.
Eliminated primarily in urine; regular monitoring crucial in patients with renal impairment.
Poor penetration into cerebrospinal fluid (CSF).

Adverse Effects of Aminoglycosides

Ototoxicity, nephrotoxicity are common side effects and increase with high dose or extended duration;
Neuromuscular blockade.
Other potential side effects: rash, hemolytic anemia, bleeding.

Examples of Aminoglycosides

Gentamicin, tobramycin, streptomycin, neomycin, netilmicin, amikacin, framycetin are Aminoglycosides.

Drug Interactions of Aminoglycosides

Penicillin interactions decrease aminoglycoside effectiveness.
Caution is needed to avoid interactions with other nephrotoxic drugs.

Macrolides

Broad-spectrum antibiotics targeting bacterial 50S ribosomal subunits to inhibit protein synthesis.
Mostly bacteriostatic, but can be bactericidal at high concentrations.
Examples: erythromycin, azithromycin, clarithromycin

Examples of Macrolides

Erythromycin (base, stearate, ethylsuccinate, estolate)
Azithromycin
Clarithromycin

Pharmacokinetics of Macrolides

Gastric acid destroys erythromycin, acid-resistant salts needed for oral absorption.
Food typically does not impact absorption of acid-resistant macrolides.
Excreted in bile, feces, and urine; renal impairment is rarely a contraindication

Adverse Effects of Macrolides

Common adverse effects- gastrointestinal (GI) disturbances (nausea, vomiting, diarrhea, abdominal cramps).
Hepatotoxicity is possible at high doses.
Reversible effects with drug discontinuation.

Interactions of Macrolides

Can inhibit the metabolism of other medications.
Can reduce serum levels of other drugs, including anticoagulants, other antimicrobials, and CNS/muscle relaxant drugs.
Antacids may decrease azithromycin levels.

Mechanism of Resistance of Macrolides

Active efflux pumps actively export the macrolide out of bacterial cells
Altered target sites within bacterial ribosomes, making the binding site less attractive for macrolides.

Tetracyclines

Broad-spectrum antibiotics that bind to bacterial 30S ribosomal subunits, inhibiting protein synthesis.
Bacteriostatic.
Selectively taken up by bacterial transport systems.

Examples of Tetracyclines

Tetracycline, minocycline, doxycycline.

Pharmacokinetics of Tetracyclines

Usually given orally; IM injections are painful, IV for severe infection.
Absorption impacted by calcium, iron, or magnesium salts, or antacids—taken on an empty stomach.
Widely distributed, including placental transfer.
Primarily excreted in urine.

Adverse Effects of Tetracyclines

Gastrointestinal disturbances (nausea, vomiting, diarrhea).
Photosensitivity (protective clothing and sunblock advised).
Discoloration of permanent teeth (contraindicated in pregnant women and children <8 years old).
Possible vestibular disturbances (minocycline).

Other Inhibitors of Protein Synthesis

Drugs targeting protein synthesis via diverse mechanisms.
Clindamycin- similar spectrum to erythromycin; commonly for joint infections, dental infections, or serious intra-abdominal infections.
Chloramphenicol- broad spectrum, but reserved for life-threatening infections. (Serious adverse effect- "gray baby syndrome"). (eye and ear drops, systemic use can cause bone marrow damage)
(Other inhibitors of protein synthesis discussed in detail.)