ANTIBIOTICS CHEAT SHEET by AREEBA HUMAYUN.pdf

ANTIBIOTICS CHEAT SHEET by AREEBA HUMAYUN X=No ac...

ANTIBIOTICS CHEAT SHEET by AREEBA HUMAYUN X=No activity against […]=that activity along with … ✓ = Cover MRSA CLASS DRUGS SPECTRUM and USE/DRUG OF CHOICE MOA ADRs Natural Penicillin Penicillin G: benzyl penicillinPenicillin V Gram+ cocci, Gram+ bacilli, Gram- cocci, Spirochetes Syphilis: Treponema palidum Gas gangrene Clostridium perfringens Inhibit transpeptidation or Anti-staphylococcal penicillin Methicillin Nafcillin Oxacillin Dicloxacillin Penicillinase producing Staphylococci, MSSA. MRSA identification test cross-linkage (last step) Extended spectrum penicillin Ampicillin Amoxicillin [Pen. G.] Gram- Bacilli → exposure of osmotically Hypersensitivity, Diarrhea, Penicillin Amoxicillin/Clavulanic acid Ampicillin: Enterococcal, Respiratory inf. Gram+ bacillus Listeria monocytogenes less stable membrane. Nephritis, Hematologic toxicities, Broad spectrum+β-lactamase inhibitor Ampicillin/sulbactam (Co-Amoxiclav) Amoxicillin: prophylactically by dentist- bacterial endocarditis Cell lysis by: Neurotoxicity Anti-Pseudomonal penicillin Piperacillin Ticarcillin Pseudomonas aeruginosa, Gram- bacilli. X Klebsilla 1. Osmotic pressure Beta Lactams Bactericidal + β-lactamase inhibitor → Pipercillin/tazobactam Ticarcillin/Clavulanic acid Penicillinase producing Enterobacteriaceae and Bacteroides sp. 2. Activation of auto-lysins st Cross-sensitivity: penicillin-1st gen CELL WALL SYNTHESIS INHIBITORS 1 generation Cefazolin Cefalexin Cefadroxil Cefradine Good gram+, moderate gram- Proteus mirabilis, E.coli, K.pneumoniae. Covers MRSA 2 nd generation Cefaclor Cefoxitin Cefotetan Cefuroxime Moderate gram+, good gram- : Enterobacter aerogenes, Neisseria sp. Cefotetan/Cefoxitin anaerobe Bacteroides fragilis too Hypersensitivity reactions: 3rd generation Cefixime Cefotaxime Ceftriaxone Ceftazidime Weak gram+, good gram- Bacilli, enteric org, S. marcescens. Ceftriaxone/Cefotaxime: Meningitis, Ceftazidime: P. aeruginosa Same as penicillins anaphylaxis, skin rash, Extended gram+, good gram- Streptococci, staphylococci (only methicillin susceptible) and granulocytopenia, fever, hemolytic Cephalosporins 4th generation Cefepime IV Cefpirome gram- Enterobacter, P. mirabilis, K. pneumoniae, E. coli, P. aeruginosa anemia. Renal toxicity: interstitial nephritis, tubular necrosis, Broad gram+. MRSA. Complicated skin and skin structure infection, Community acquired Pneumonia [3rd gen gram-] Binds PBP2a MRSA, PBP2x Local irritation: pain--IM, Advanced generation Ceftaroline fosamil ✓ X P.aeruginosa ESBL Streptococcus pneumoniae thrombophlebitis--IV Aerobes: gram- Enterobacteriaceae, P. aeruginosa X gram+, anaerobes. Non-toxic but phlebitis, skin rash, Monobactams Aztreonam Bind PBPs. Resistant to β -lactamase except ESBLs. Safe in penicillin allergy. abnormal LFTs. β -lactamase producing gram+, gram-, anaerobes, P. aeruginosa. Enter Gram- through porins → Eosinophilia, neutropenia, Carbapenems Imipenem/Cilastatin Meropenem Doripenem Ertapenem Ertapenem: X P. aeruginosa, Enterococcus sp., Acinetobacter sp. permanently acylate PBPs Imipenem: N/V/D, ↑dose: seizures - Sepsis+endocarditis caused by MRSA Bactericidal Gram+, Non β lactam - Enterococcal carditis (vanco+gentamicin) 1. inhibit cell wall phospholipid synthesis MDR: MRSA, Fever, chills, flushing, phelebitis Others ✓ Vancomycin (glycopeptide) - Meningitis by highly penicillin resistant pneumococcus (vanco+cefotaxime, ceftriaxone, rifampin) 2. inhibits Peptidoglycan polymerization fosfomycin enterococci - Antibiotic associated colitis - Clostridium difficile diarrhea IV reconstitute 125mg PO 4X/d 10day by preventing transglycosylation step Bacitracin Gram+. Interfere with dephosphorylation in cycling of lipid carrier that transfers peptidoglycan subunits to growing wall. Nephrotoxic systemically, use topical on surface lesion CELL MEMBRANE Colistin (polymyxin) ✓ Daptomycin (cyclic lipopeptide) Bactericidal Bacteriostatic. Gram+, gram-, protozoa, Acne. Chlamydia inf. (doxycycline). Rickettsiae: rickettsialpox, Bind 30s subunit → GI discomfort, effect calcified tissues, growth Tetracyclines Tetracycline Oxytetracycline Doxycycline Minocycline spirochetes, mycobacteria, atypical sp. Q fever, Rocky Mountain spotted fever, murine/epidemic/scrub typhus no protein synthesis stunting, tooth discoloration, Hepato+Phototoxicity -Mycin streptomyces Streptomycin Tobramycin Kanamycin Neomycin Paromomycin Aerobic gram- bacilli MDR P. aeruginosa, K. pneumonia, Enterobacter sp Bactericidal 30s TDM. Nephrotoxicity, ototoxicity, PROTEIN SYNTHESIS INHIBITORS Aminoglycosides -Micin Kanamycin, streptomycin: X Serratia, P. aeruginosa Prevent assembly of ribosomal apparatus, inhibit Amikacin Gentamicin Netilmicin Verdamicin paralysis, skin rash micromonospores - Enterococcus faecalis, enterococcus faecium infective endocarditis (+β-lactam) binding of 30s to 50s or cause 30s to miss-read code Glycylcyclines Tigecycline ✓ - - Bacteriostatic - Erythromycin: [pen. G]. Azithromycin: respiratory inf. and urethritis by Chlamydia trachomatis Bacteriostatic. Bind 50s subunit, block Cholestatic jaundice, Ototoxicity, Gastric Macrolides Erythromycin Clarithromycin Azithromycin Telithromycin (ketolide) Clarithromycin: [higher than E] intracellular pathogens: Chlamydia, legionella, Moraxella, H. pylori translocation and transpeptidation distress and motility: used therapeutically Mycobactrium avium (Clarithromycin/Azithromycin) reaction for gastroparesis or post-operative ileus Oxazolidinone Linezolid ✓ Tedizolid ✓ Gram+. Bacterial pneumonia, VRE, skin and skin structure inf. Primary place: alternate to vancomycin Bacteriostatic. Inhibit formation of 70s complex 50s Streptogramins Quinapristin/Dalfopristin Bactericidal VRE, VRSA both bind separate site on 50s subunit → ternary complex, synergistically interrupt protein synthesis Inhibit CYP3A4, linezolid is always better Lincosamide Clindamycin ✓ Bacteroides fragilis (anaerobes) Bacteriostatic - Broad spectrum, restricted to life-threatening inf. w no alternative. Bacteriostatic, but Inhibits peptide chain by Blurred vision, digital paresthesia, encephalography, Chloramphenicol Chloramphenicol bactericidal depend: dose+organism. Chlamydiae, rickettsiae, spirochetes, anaerobe Bacteroide sp. interrupting transpeptidation Anemia, Gray baby syndrome, cardiomyopathy 1st generation Nalidixic acid (Quinolone) Gram- X Pseudomonas sp. UTI by P. aeruginosa. Bactericidal. Inhibit bacterial: GI: N/V/D, antibiotic associated Fluoroquinolones Gram- (including pseudomonas sp.) Bacterial diarrhea by 1. topoisomerase IV – interferes with separation of replicated chromosomal colitis. CNS: confusion, insomnia, 2 nd generation Norfloxacin Ciprofloxacin Enoxacin Ofloxacin Gram+ (s. aureus), Atypicals Shigella, Salmonella, DNA into respective daughter cells dizziness, anxiety, seizures (GABA 3rd generation Levofloxacin Sparfloxacin nd [2 gen.] Extended Gram+ and atypical coverage toxigenic E. coli, 2. DNA gyrase – prevents relaxation of positively supercoiled DNA required displacement). CVS: Prolong QT Nucleic Acid synthesis 4th generation Trovafloxacin Delafloxacin ✓ Moxifloxacin Gemifloxacin rd [3 gen.] broad anaerobic coverage Camphylobacter for normal transcription + replication interval. Cipro: tendon rupture Sulfonamides Sulfasalazine Sulfacetamide Sulfadiazine Silver sulfadiazine Sulfamethoxazole Bacterial inf.: pneumonia, bronchitis, UTI, ear, intestine DHFR inhibitor Trimethoprim Pyrimethamine Bactericidal. Gram+ Staphylococcus sp. - Traveler’s diarrhea Megaloblastic anemia, leukopenia, N/V/D, Anti folates Gram- enteric bacteria: K. pneumoniae, (co-trimoxazole) drug fever, granulocytopenia, vasculitis, Sulfamethoxazole E.coli, Salmonella, shigella, Enterobacter - 1st line in Acute toxoplasmosis renal damage. In AIDS & pneumocystis Sulfadiazine Sulfadoxine + sp., Nocardia sp. Chlamydia trachomatis (sulfadiazine + pyrimethamine) pneumonia: rash, leukopenia, hyperkalemia, Combinations + + trimethoprim and some protozoa. - 2nd line in Malaria hyponatremia, ↑hepatic aminotransferases. pyrimethamine pyrimethamine (co-trimoxazole) ✓ (sulfadoxine + pyrimethamine) Nitroimidazoles Metronidazole Tinidazole Dimetridazole Bactericidal. 1st line in Clostridium difficile diarrhea Mixed amebicide. Cause loss of helical DNA structure and strand breakage. Inhibit DNA replication Nausea, GI disturbance, metallic taste Acid fast Mycobacterium tuberculosis Nocardia Other: Treponema pallidum Spirochetes Atypical: Rickettsiae, Legionella, Chlamydia, Mycoplasma Gram+ Streptococci sp., (pneumoniae, epidermis) Staphylococcus sp., (aureus) MSSA, MRSA, VRSA Clostridium. Listeria monocytogenes. Bacillus anthracis Corynebacterium Gram- Acinetobacter sp. Brucella sp. Chlamydiae E. coli Haemophilus influenzae H. pylori Klebsiella pneumoniae Legionella pneumophila Moraxella catarrhalis Neisseria gonorrhoeae Pseudomonas aeruginosa Proteus mirabilis Salmonella typhi Serratia marcescens Shigella sp. Ureaplasma sp.Vibrio cholerae. Yersinia pestis Anaerobes: Bacteroides fragilis Clostridium (difficile, perfringe, tetani) Enterococcus sp. (faecalis, faecium) VRE Enterobacter sp. Peptostreptococcus sp Providancia sp Toxoplasma gondii