20 Questions
What is the minimum risk of Clostridium difficile (Cl.diff) enterocolitis associated with?
Tetracyclines
What is a contraindication for Tetracyclines?
Children under 8 years old
What is a side effect of Tetracyclines in about 1 in 20 patients?
Photosensitivity
What is the spectrum of Glycylcyclines?
VRE, MRSA, VRSA, BGN, atypical, anaerobic
What is an indication for Glycylcyclines?
Complicated skin/soft tissue infections
What is a representative of Glycylcyclines?
Tygecycline
What is the mechanism of action of Oxazolidinones in inhibiting bacterial protein synthesis?
Binding to the 50S subunit of the ribosome
What is the FDA pregnancy category for Oxazolidinones?
C
Which of the following is NOT an indication for Oxazolidinones?
Endocarditis
What is a potential side effect of Oxazolidinones that can be reversible?
Reversible cytopenias
What is the mechanism of action of Tetracyclines in inhibiting bacterial protein synthesis?
Inhibiting the elongation phase of protein synthesis
What is the FDA pregnancy category for Tetracyclines?
D
Which of the following is an indication for Tetracyclines?
Uncomplicated pneumonia
What is a precaution to be taken when using Oxazolidinones?
Avoiding foods containing tyramine
What is the mechanism of action of macrolides?
Binding to ribosomal 50S subunit
What is the FDA pregnancy category of Erythromycin?
C
Which of the following organisms is not typically covered by macrolides?
Pseudomonas aeruginosa
What is the first-line treatment for atypical pneumonia caused by Chlamydia?
Doxycycline
Which macrolide is used to treat toxoplasmosis during pregnancy?
Spiramycin
What is the indication for macrolides in the treatment of MAC infections?
Treatment and prophylaxis
Study Notes
Oxazolidinones
- Inhibits bacterial protein synthesis by binding to 50S subunit of the ribosome
- Representatives: Linezolid IV/PO, Tedizolid IV
- Spectrum: GP (same as …) + Mycobacterium TB, MRSA, VRSA, VISA, VRE, PRP
- Indications: HA Pneumonia, skin/soft tissue infections, bone infections, arthritis, Mycobacterium tuberculosis MDR
- Not indicated for endocarditis
- Adverse Reactions: MAOI – serotoninergic syndrome, reversible cytopenias (> 28 days), optic and peripheral neuropathies – irreversible (> 28 days), lactic acidosis (mitochondrial toxicity)
Tetracyclines
-
Inhibits bacterial protein synthesis - elongation phase - subunit 30S
-
Representatives: tetracycline, doxycycline PO/IV, minocycline
-
Spectrum: GPC (MRSA), GNB (Legionella, H.influenzae), Borrelia, atypical (Mycoplasma, Ureaplasma, Chlamydia), Bartonella, Coxiella, Plasmodium
-
Indications: Uncomplicated pneumonia/acute exacerbations of COPD, Vaginal infections with Chlamydia, Mycoplasma, Ureaplasma, Prophylaxis + treatment of malaria (P.falciparum), Prophylaxis + treatment of Lyme disease, Coxiella burnetti endocarditis, Rickettsioses – Q fever
-
Absorption is Minocycline Summary
- Spectrum: MRSA, Legionella, H. influenzae, Borrelia, atypical pathogens, Bartonella, Coxiella, and Plasmodium
- Indications: Uncomplicated pneumonia, COPD exacerbations, vaginal infections, malaria prevention/treatment, Lyme disease prevention/treatment, Coxiella burnetti endocarditis, and Rickettsioses (Q fever)
- Absorption reduced by: Calcium salts, dairy products, antiacids, aluminium/magnesium complexes, or iron supplements
- Adverse Reactions: (not specified)
by concomitant administration of calcium salts, dairy products, antiacids, aluminium or magnesium complexes, or iron supplements
-
Adverse Reactions: Hepatic cytolysis, hyperbilirubinemia, low PT, Contraindicated in children < 8 years/pregnant women (brown coloration of teeth), Photosensitivity (1 of 20 patients), Nausea and vomiting, Pancreatic toxicity, vertigo, ataxia (Tygecycline)
Glycylcyclines
- Representative: Tygecycline IV
- Spectrum: VRE, MRSA, VRSA, BGN (Acinetobacter spp., Stenotrophomonas maltophilia – inconstant, NOT Pseudomonas), atypical, anaerobic (Cl.diff, Bacteroides)
- Indications: Severe infections caused by GNB MDR (associated with polymyxins), Complicated skin/soft tissue infections, Intraabdominal sepsis, Cl.Diff enterocolitis – salvation therapy, associated with Vancomycin, or when the patient needs ABT after the onset of Cl.diff enterocolitis
Macrolides
- Inhibits protein synthesis by binding to ribosomal 50S subunit
- Representatives: Erythromycin PO, Clarithromycin PO/IV, Azythromycin PO/IV, Spiramycin PO – toxoplasmosis during pregnancy
- Spectrum: Bartonella henselae, Bordetella pertussis, GN Cocobacilli : Moraxella, Haemophilus, Helicobacter pylori, GNB, Legionella pneumophila, Atypical, Mycoplasma pneumoniae/hominis, Ureaplasma urealyticum, Chlamydia, MAC – I line
- Indications: Whooping cough (Bordetella pertussis), Severe acne, MAC – treatment + prophylaxis (I line), Toxoplasmosis during pregnancy
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