Polymyxins, Chloramphenicol, Clindamycin, Metronidazole, Fidaxomycin, Urinary Agents

Colistimethate and polymyxin B.

Polymyxins act as cationic detergents, damaging the bacterial cytoplasmic membrane, causing leakage of intracellular substances and cell death.

Enterobacter spp., E.coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa.

<p>Warnings: Dose-dependent nephrotoxicity and neurotoxicity. Notes: It is a prodrug converted to colistin, and its use with other nephrotoxic medications should be avoided.</p> Signup and view all the answers

<p>Respiratory paralysis from neuromuscular blockade, Nephrotoxicity, Neurotoxicity (dizziness, tingling, numbness, paresthesia, vertigo)</p> Signup and view all the answers

<p>Reversibly binds to the 50S subunit of the bacterial ribosome inhibiting protein synthesis</p> Signup and view all the answers

<p>Boxed warning for serious and fatal blood dyscrasias (aplastic anemia, pancytopenia - may be irreversible), Gray syndrome with high serum levels, Monitoring CBC at baseline and every 2 days during therapy, LFTs, renal function, serum drug concentrations</p> Signup and view all the answers

<p>It covers Gram-positives, Gram-negatives, anaerobes and atypical organisms.</p> Signup and view all the answers

<p>Dizziness, tingling, numbness, paresthesia, vertigo</p> Signup and view all the answers

<p>Chloramphenicol reversibly binds to the 50S subunit of the bacterial ribosome</p> Signup and view all the answers

<p>Serious and fatal blood dyscrasias (aplastic anemia, pancytopenia - may be irreversible)</p> Signup and view all the answers

<p>CBC at baseline and every 2 days during therapy, LFTs, renal function, serum drug concentrations</p> Signup and view all the answers

<p>The risks associated with the use of polymyxins include dose-dependent nephrotoxicity and neurotoxicity. These risks are managed by monitoring renal function and electrolytes for nephrotoxicity, and by being vigilant for symptoms such as dizziness, headache, tingling, oral paresthesia, and vertigo for neurotoxicity.</p> Signup and view all the answers

<p>Colistimethate sodium is a prodrug that is converted to colistin, the active form. Its dose should be carefully assessed, as it can be represented in units of colistimethate sodium, mg of colistimethate sodium, or mg of colistin base activity.</p> Signup and view all the answers

<p>Polymyxins cover Gram-negative bacteria, including Enterobacter spp., E.coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa. However, they do not cover Proteus spp.</p> Signup and view all the answers

<p>Polymyxins are primarily used for multidrug-resistant (MDR) Gram-negative pathogens in combination with other antibiotics. It is important to consider the risk of toxicities and to avoid their use with other nephrotoxic medications.</p> Signup and view all the answers

<p>Polymyxins act as cationic detergents that damage the bacterial cytoplasmic membrane, causing leaking of intracellular substances and cell death. They cover Gram-negative bacteria such as Enterobacter spp., E.coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa.</p> Signup and view all the answers

<p>Colistimethate sodium is a prodrug that is converted to colistin, the active form. It should be carefully assessed for dose representation, as it can be represented in units of colistimethate sodium, mg of colistimethate sodium, or mg of colistin base activity. Avoid use with other nephrotoxic medications.</p> Signup and view all the answers

<p>The risks associated with the use of polymyxins include dose-dependent nephrotoxicity and neurotoxicity. These risks are managed by monitoring renal function and electrolytes for nephrotoxicity, and by being cautious of neurotoxic effects such as dizziness, headache, tingling, oral paresthesia, and vertigo.</p> Signup and view all the answers

<p>Polymyxins are used primarily for MDR Gram-negative pathogens in combination with other antibiotics due to the risk of toxicities. They provide coverage for Gram-negative bacteria, but their use in combination therapy helps to enhance efficacy and reduce the risk of resistance development.</p> Signup and view all the answers

<p>The potential neurotoxic effects of Polymyxin B Sulfate include dizziness, tingling, numbness, paresthesia, and vertigo. These effects can result in respiratory paralysis from neuromuscular blockade, which is a life-threatening complication.</p> Signup and view all the answers

<p>Serious and potentially fatal side effects associated with Chloramphenicol include serious and fatal blood dyscrasias (aplastic anemia, pancytopenia - may be irreversible) and Gray syndrome with high serum levels, leading to circulatory collapse, cyanosis, acidosis, abdominal distention, myocardial depression, coma, and death. Monitoring recommended during Chloramphenicol therapy includes complete blood count (CBC) at baseline and every 2 days during therapy, liver function tests (LFTs), renal function, and serum drug concentrations.</p> Signup and view all the answers

<p>Chloramphenicol reversibly binds to the 50S subunit of the bacterial ribosome, inhibiting protein synthesis. It covers Gram-positives, Gram-negatives, anaerobes, and atypical organisms.</p> Signup and view all the answers

<p>The boxed warnings for Polymyxin B Sulfate include nephrotoxicity (dose-dependent) and neurotoxicity (dizziness, tingling, numbness, paresthesia, vertigo) that can result in respiratory paralysis from neuromuscular blockade. Other nephrotoxic drugs can enhance the nephrotoxic effects, and it is important to consider potential drug interactions with these drugs (refer to the Aminoglycoside section).</p> Signup and view all the answers

<p>Clindamycin is a lincosamide that reversibly binds to the 50S subunit of the bacterial ribosome, inhibiting protein synthesis. It covers most anaerobes and Gram-positive bacteria, including some community-associated MRSA, but it does not cover Enterococcus or Gram-negative pathogens.</p> Signup and view all the answers

<p>The boxed warning for clindamycin (Cleocin) is colitis (C. difficile), and the warning is severe or fatal skin reactions (SJS/TEN/DRESS).</p> Signup and view all the answers

<p>Clindamycin (Cleocin) is commonly used for purulent and non-purulent skin infections and serves as a beta-lactam alternative for dental abscesses.</p> Signup and view all the answers

<p>An induction test (D-test) should be performed, and a flattened zone between the disks (positive D-test) indicates inducible clindamycin resistance, signaling that clindamycin should not be used.</p> Signup and view all the answers

<p>Clindamycin is a lincosamide which reversibly binds to the 50S subunit of the bacterial ribosome inhibiting protein synthesis. It covers most anaerobes and Gram-positive bacteria (including some community-associated MRSA). It does not cover Enterococcus or Gram-negative pathogens.</p> Signup and view all the answers

<p>An induction test (D-test) should be performed on S.aureus that is susceptible to clindamycin but resistant to erythromycin; a flattened zone between the disks (positive D-test) indicates inducible clindamycin resistance and clindamycin should not be used.</p> Signup and view all the answers

<p>Clindamycin (Cleocin) BOXED WARNING: Colitis (C. difficile). Clindamycin (Cleocin) WARNING: Severe or fatal skin reactions (SJS/TEN/DRESS).</p> Signup and view all the answers

<p>Common uses: purulent and non-purulent skin infections, beta-lactam alternative for dental abscesses.</p> Signup and view all the answers

<p>The D-test is important to detect inducible clindamycin resistance. A positive result, indicated by a flattened zone between the disks, suggests that clindamycin should not be used.</p> Signup and view all the answers

<p>The use of clindamycin (Cleocin) is associated with severe or fatal skin reactions such as SJS/TEN/DRESS, which require monitoring and immediate discontinuation of the medication if suspected.</p> Signup and view all the answers

<p>Clindamycin covers most anaerobes and Gram-positive bacteria, including some community-associated MRSA, but it does not cover Enterococcus or Gram-negative pathogens.</p> Signup and view all the answers

<p>Clindamycin is commonly used as an alternative to beta-lactam for dental abscesses and is suitable for treating both purulent and non-purulent skin infections.</p> Signup and view all the answers

<p>Metronidazole and related drugs</p> Signup and view all the answers

<p>Bacterial vaginosis, trichomoniasis, giardiasis, amebiasis, C.difficile, and used in combination regimens for intra-abdominal infections</p> Signup and view all the answers

<p>Tinidazole is structurally related to metronidazole but has limited activity to protozoa (giardiasis, amebiasis), trichomoniasis, and bacterial vaginosis organisms</p> Signup and view all the answers

<p>Possibly carcinogenic based on animal data</p> Signup and view all the answers

<p>Pregnancy (1st trimester), use of alcohol or propylene glycol-containing products during treatment or within 3 days of treatment discontinuation (disulfiram reaction), use of disulfiram within the past 2 weeks</p> Signup and view all the answers

<p>Metronidazole (Flagyl): Metallic taste, Secnidazole (Solosec): Vulvovaginal candidiasis</p> Signup and view all the answers

<p>Metronidazole is a weak inhibitor of CYP3A4 and CYP2C9</p> Signup and view all the answers

<p>PO dosing is 2 gram single dose</p> Signup and view all the answers

<p>Metronidazole and related drugs are indicated for the treatment of bacterial vaginosis, trichomoniasis, giardiasis, amebiasis, and C. difficile infections, as well as for use in combination regimens for intra-abdominal infections.</p> Signup and view all the answers

<p>Metronidazole and related drugs carry a boxed warning for being possibly carcinogenic based on animal data.</p> Signup and view all the answers

<p>Contraindications for metronidazole and related drugs include pregnancy in the 1st trimester, use of alcohol or propylene glycol-containing products during treatment or within 3 days of treatment discontinuation (disulfiram reaction), and the use of disulfiram within the past 2 weeks.</p> Signup and view all the answers

<p>Side effects of metronidazole and related drugs include metallic taste (for metronidazole), and vulvovaginal candidiasis (for secnidazole).</p> Signup and view all the answers

<p>The dosing for Secnidazole (Solosec) is a 2-gram single dose.</p> Signup and view all the answers

<p>The related drugs in the metronidazole class include Tinidazole (Tindamax) and Secnidazole (Solosec).</p> Signup and view all the answers

<p>The IV:PO ratio for metronidazole is 1:1.</p> Signup and view all the answers

<p>Metronidazole is a weak inhibitor of CYP3A4 and CYP2C9.</p> Signup and view all the answers

<p>Metronidazole and related drugs</p> Signup and view all the answers

<p>Effective for bacterial vaginosis, trichomoniasis, giardiasis, amebiasis, C.difficileand is used in combination regimens for intra-abdominal infections</p> Signup and view all the answers

<p>1:1</p> Signup and view all the answers

<p>Possibly carcinogenic based on animal data</p> Signup and view all the answers

<p>Pregnancy (1st trimester), use of alcohol or propylene glycol-containing products during treatment or within 3 days of treatment discontinuation (disulfiram reaction), use of disulfiram within the past 2 weeks</p> Signup and view all the answers

<p>PO dosing is 2 gram single dose</p> Signup and view all the answers

<p>Tinadazole (Tindamax), Secnidazole (Solosec)</p> Signup and view all the answers

<p>Metranidazole (Flagyl): Metallic taste, Secnidazole (Solosec): Vulvovaginal candidiasis</p> Signup and view all the answers

<p>Fidaxomicin (Dificid) inhibits RNA polymerase, resulting in inhibition of protein synthesis and cell death. It is used for C. difficile infections.</p> Signup and view all the answers

<p>Rifaximin (Xifaxan) inhibits bacterial RNA synthesis by binding to bacterial DNA-dependent RNA polymerase. It covers E. coli.</p> Signup and view all the answers

<p>Travelers' diarrhea: PO: 200 mg TID x 3 days; Reduction of hepatic encephalopathy recurrence: PO: 550mg BID; Irritable bowel syndrome w/diarrhea (IBS-D): PO: 550 mg TID x 14 days.</p> Signup and view all the answers

<p>Fidaxomicin (Dificid) inhibits RNA polymerase, resulting in inhibition of protein synthesis and cell death. It is used for C. difficile infections.</p> Signup and view all the answers

<p>Rifaximin (Xifaxan) inhibits bacterial RNA synthesis by binding to bacterial DNA-dependent RNA polymerase. It covers E. coli.</p> Signup and view all the answers

<p>Travelers' diarrhea: PO: 200 mg TID x 3 days; Reduction of hepatic encephalopathy recurrence: PO: 550mg BID; Irritable bowel syndrome w/diarrhea (IBS-D): PO: 550 mg TID x 14 days</p> Signup and view all the answers

<p>Fidaxomicin (Dificid) inhibits RNA polymerase, resulting in inhibition of protein synthesis and cell death. It is used for C. difficile infections.</p> Signup and view all the answers

<p>Travelers' diarrhea: PO: 200 mg TID x 3 days, Reduction of hepatic encephalopathy recurrence: PO:550mgBID, Irritable bowel syndrome w/diarrhea (IBS-D): PO: 550 mg TID x 14 days</p> Signup and view all the answers

<p>Rifaximin covers E. coli and is not effective for systemic infections (&lt; 1% absorption)</p> Signup and view all the answers

<p>Fosfomycin inhibits bacterial cell wall synthesis by inactivating the enzyme pyruval transferase, critical in the synthesis of cell walls. It covers E.coli (including ESBLs) and E. faecalis (including VRE). A single-dose regimen is used for uncomplicated UTI (cystitis only).</p> Signup and view all the answers

<p>The dosing regimen for Nitrofurantoin for uncomplicated UTI is 100 mg BID x 5 days.</p> Signup and view all the answers

<p>The contraindications for Nitrofurantoin include renal impairment (CrCI &lt; 60mL/min*), previous history of cholestatic jaundice/hepatic dysfunction, and pregnancy (at term).</p> Signup and view all the answers

<p>The warnings associated with Nitrofurantoin include optic neuritis, hepatotoxicity, peripheral neuropathy, pulmonary toxicity, and hemolytic anemia (use caution in patients with G6PD deficiency).</p> Signup and view all the answers

<p>The key features of Nitrofurantoin include being the drug of choice for uncomplicated UTI, contraindicated when CrCI &lt; 60 mL/min, and having different dosing regimens for Macrobid (BID) and Macrodantin (QID).</p> Signup and view all the answers

<p>Mupirocin (Bactroban Nasal) is a topical antimicrobial ointment used to eliminate Staphylococci (MRSA) colonization of the nares.</p> Signup and view all the answers

<p>Inhibits bacterial cell wall synthesis by inactivating the enzyme pyruval transferase, critical in the synthesis of cell walls.</p> Signup and view all the answers

<p>It covers E.coli (including ESBLs) and E. faecalis (including VRE).</p> Signup and view all the answers

<p>3 grams PO x 1, mixed in 3-4 oz of cold water</p> Signup and view all the answers

<p>It is a bacterial cell wall inhibitor.</p> Signup and view all the answers

<p>It covers E. coli, Klebsiella, Enterobacter, S.aureus, and Enterococcus (VRE).</p> Signup and view all the answers

<p>Renal impairment (CrCI &lt; 60mL/min*), previous history of cholestatic jaundice/hepatic dysfunction, pregnancy (at term).</p> Signup and view all the answers

<p>Optic neuritis, hepatotoxicity, peripheral neuropathy, pulmonary toxicity, hemolytic anemia (use caution in patients with G6PD deficiency).</p> Signup and view all the answers

<p>It is a topical antimicrobial ointment used to eliminate Staphylococci (MRSA) colonization of the nares.</p> Signup and view all the answers

<p>pyruval transferase</p> Signup and view all the answers

<p>100 mg BID x 5 days</p> Signup and view all the answers

<p>Renal impairment (CrCI &lt; 60mL/min*), previous history of cholestatic jaundice/hepatic dysfunction, pregnancy (at term)</p> Signup and view all the answers

<p>Optic neuritis, hepatotoxicity, peripheral neuropathy, pulmonary toxicity, hemolytic anemia (use caution in patients with G6PD deficiency)</p> Signup and view all the answers

<p>Nitrofurantoin</p> Signup and view all the answers

<p>topical antimicrobial ointment used to eliminate Staphylococci (MRSA) colonization of the nares</p> Signup and view all the answers

<p>Drug of choice for uncomplicated UTI</p> Signup and view all the answers

<p>E.coli (including ESBLs) and E. faecalis (including VRE)</p> Signup and view all the answers

<p>Fosfomycin inactivates the enzyme pyruval transferase</p> Signup and view all the answers

<p>Nitrofurantoin covers E. coli, Klebsiella, Enterobacter, S.aureus, and Enterococcus (VRE)</p> Signup and view all the answers

<p>3 grams PO x 1, mixed in 3-4 oz of cold water</p> Signup and view all the answers

<p>Renal impairment (CrCI &lt; 60mL/min*), previous history of cholestatic jaundice/hepatic dysfunction, pregnancy (at term)</p> Signup and view all the answers

<p>Optic neuritis, hepatotoxicity, peripheral neuropathy, pulmonary toxicity, hemolytic anemia (use caution in patients with G6PD deficiency)</p> Signup and view all the answers

<p>Fosfomycin covers E. coli (including ESBLs) and E. faecalis (including VRE)</p> Signup and view all the answers

<p>Mupirocin is used to eliminate Staphylococci (MRSA) colonization of the nares</p> Signup and view all the answers

<p>Drug of choice for uncomplicated UTI, contraindicated when CrCI &lt; 60 mL/min, dosing Macrobid is BID, Macrodantin is QID, take with food to prevent nausea, cramping, can discolor the urine (brown)</p> Signup and view all the answers