Chapter 20 Drug Therapy PDF - Wolters Kluwer

Chapter 20 Drug Therapy With Tetracyclines, Sulfonamides, and Urinary Antiseptics  Older, broad-spectrum bacteriostatic Tetracyclines and Rarely used for systemic infections Sulfonamides oDue to antimicrobial resistance oDevelopment...

Chapter 20 Drug Therapy With Tetracyclines, Sulfonamides, and Urinary Antiseptics  Older, broad-spectrum bacteriostatic Tetracyclines and Rarely used for systemic infections Sulfonamides oDue to antimicrobial resistance oDevelopment of more effective/less toxic medications Urinary antiseptics oUsed only in UTIs 2 Copyright © 2025 Wolters Kluwer. All rights reserved.  Effective against wide range of gram(+) and Tetracyclines #1 gram(−) microbes Not usually the drug of choice Widely distributed into most body tissues and fluids Older medications are excreted mainly in urine. oDoxycycline eliminated in urine and feces oMinocycline eliminated mainly by liver but also in urine 3 Copyright © 2025 Wolters Kluwer. All rights reserved.  Tetracycline (Prototype) Tetracyclines #2 Doxycycline (Vibramycin) Eravacycline (Xerava) Demeclocycline Minocycline (Minocin) Omadacycline (Nuzyra) Sarecycline (Seysara) Tigecycline (Tygacil) 4 Copyright © 2025 Wolters Kluwer. All rights reserved.  Bacteriostatic against wide range of gram(+) Sulfonamides #1 and gram(−) microbes Increasing resistance, decreasing efficacy Susceptibility should be documented by culture and sensitivity testing. Some can be used in the treatment of systemic infections. oOthers exert only local effects. 5 Copyright © 2025 Wolters Kluwer. All rights reserved.  Trimethoprim–sulfamethoxazole (Bactrim) Sulfonamides #2 oPrototype Mafenide (Sulfamylon) Sulfadiazine Sulfasalazine (Azulfidine) Silver sulfadiazine (Silvadene) 6 Copyright © 2025 Wolters Kluwer. All rights reserved.  Is the following statement True or False? Question #1 Tetracyclines and sulfonamides are older bacteriostatic medications that are rarely used for systemic infections. 7 Copyright © 2025 Wolters Kluwer. All rights reserved.  True Answer to Question #1 Rationale: Tetracyclines and sulfonamides are older, broad-spectrum bacteriostatic medications that are rarely used for systemic infections because of microbial resistance and the development of more effective or less toxic drugs. 8 Copyright © 2025 Wolters Kluwer. All rights reserved.  May be bactericidal because of local effects Urinary produced by high concentration levels in renal Antiseptics tubules and urine Not used for systemic infections oDo not attain therapeutic plasma levels 9 Copyright © 2025 Wolters Kluwer. All rights reserved.  Tetracyclines Mechanisms of oPenetrate microbial cells, inhibiting protein Action synthesis Sulfonamides oHalt multiplication of new bacteria oDo not kill mature, fully formed bacteria 10 Copyright © 2025 Wolters Kluwer. All rights reserved.  Is the following statement True or False? Question #2 Phenazopyridine is an antimicrobial used in the treatment of UTIs. 11 Copyright © 2025 Wolters Kluwer. All rights reserved.  False Answer to Question #2 Rationale: Phenazopyridine is not an antimicrobial medication; it is administered to relieve pain associated with UTIs not to treat UTIs. 12 Copyright © 2025 Wolters Kluwer. All rights reserved.  Drug of choice in specific infections Tetracycline oCholera, Rocky Mountain spotted fever, Indications for syphilis, typhus, H. pylori, etc. Use Useful in animal bites, Lyme disease Chlamydia infections, adjunct in STD treatment, prophylaxis/treatment of anthrax Long-term acne treatment, substitute for penicillin in hypersensitivity 13 Copyright © 2025 Wolters Kluwer. All rights reserved.  Severe UTIs caused by E. coli, Proteus, Sulfonamide Klebsiella organisms Indications for P. jirovecii pneumonitis Use In combination to treat chronic bronchitis Ulcerative colitis, other uncommon infections Topically oPrevention of burn wound infections oOcular and other soft tissue infections 14 Copyright © 2025 Wolters Kluwer. All rights reserved.  Urinary antiseptics are used only for UTIs. Urinary Antiseptic Nitrofurantoin (Macrobid) Indications for Phenazopyridine (Pyridium) Use Trimethoprim 15 Copyright © 2025 Wolters Kluwer. All rights reserved.  Tetracyclines Contraindications oPatients with kidney failure for Use oPregnant females oChildren aged