DAVIS_Respiratory_Infections_1_Pharm_2024.1.pdf

Respiratory System 2024 02/19/24 1:00 pm Pharmacology: Respiratory Infections Part 1 Randall L. Davis, PhD NH 433 1 2 Learning objectives 1. List the pharmacologic agents used to treat the following respiratory infections: Mycoplasma pneumonia (Atypical) Chlamydia pneumonia (Atypical) Streptococcus...

Respiratory System 2024 02/19/24 1:00 pm Pharmacology: Respiratory Infections Part 1 Randall L. Davis, PhD NH 433 1 2 Learning objectives 1. List the pharmacologic agents used to treat the following respiratory infections: Mycoplasma pneumonia (Atypical) Chlamydia pneumonia (Atypical) Streptococcus pneumoniae Streptococcus pyogenes Bacillus anthracis Corynebacterium diphtheria Bordetella pertussis Haemophilus influenzae Moraxella catarrhalis Pseudomonas aeruginosa Klebsiella pneumoniae Legionella pneumophila (Atypical) Yersinia pestis 2. Describe the mechanism of action and adverse effects of the pharmacologic agents used to treat the infections listed in #1. 3 Empiric antibiotics for community acquired pneumonia (CAP) in adults Q (Likely Mycoplasma pneumoniae or Streptococcus pneumoniae) 30% viral most likely bacteria Outpatient No antimicrobials in past 3 mo Co-morbidity present or antimicrobials used in previous 3 mo Inpatient, non-severe Inpatient, severe 4 Outpatient: CAP No antimicrobials in past 3 mo Amoxicillin wear inhibits cell wall synthesis OR Doxycycline heavy effects adverse inhibit bacterial protein synthesis (at 30S ribosomal subunit) OR Macrolide over prescribed (azithromycin, clarithromycin, erythromycin) inhibit bacterial protein synthesis (at 50S ribosomal subunit) 5 Outpatient: CAP Co-morbidity present or antimicrobials used in previous 3 mo Fluoroquinolone (levofloxacin, moxifloxacin, gemifloxacin) inhibit DNA gyrase and type IV topoisomerase β-lactam (amoxicillin or ceftriaxone) PLUS macrolide 6 Inpatient, non-severe: CAP ceftriaxone (or ampicillin-sulbactam) + macrolide OR Fluoroquinolone ceftriaxone = Ceph 3; inhibits cell wall synthesis AMP-sulbactam = extended spectrum penicillin + β-lactamase inhibitor macrolide = protein synthesis inhibitor 7 Inpatient, severe: CAP ceftriaxone (or ampicillin-sulbactam) + macrolide OR ceftriaxone (or AMP-sulbactam) + fluoroquinolone) 8 Antibiotics for select respiratory infections 9 Streptococcus pneumonia Gram + diplococcus Levofloxacin fluoroquinolone inhibits DNA gyrase and type IV topoisomerase 10 Mycoplasma pneumoniae Azithromycin Macrolide inhibits bacterial protein synthesis (at 50S ribosomal subunit) 11 Mycoplasma pneumoniae Doxycycline tetracycline inhibits bacterial protein synthesis (at 30S ribosomal subunit) 12 Mycoplasma pneumoniae Levofloxacin (Moxifloxacin, Gemifloxacin) fluoroquinolone inhibits DNA gyrase and type IV topoisomerase 13 Haemophilus influenzae Augmentin is a good alternate Gram - rod Cefotaxime or Ceftriaxone 3rd generation cephalosporins inhibits cell wall synthesis Figure 38-1 14 Moraxella catarrhalis Gram - diplococcus Amoxicillin + Clavulanate (Augmentin) AMOX: Extended spectrum penicillin; inhibits cell wall synthesis CL: β-Lactamase inhibitor 15 Klebsiella pneumoniae Gram - rod Imipenem A carbapenem, which is a penicillin-like antibiotic Broad spectrum and resistant to many β-Lactamases. Cilastatin is included in preparation to prevent inactivation of IMP by renal dehydropeptidase 16 Yersinia pestis Gram - bacilli Gentamicin aminoglycoside inhibits protein synthesis Gentamicin binds 30S subunit and interferes with initiation of protein synthesis and causes “misreading”; 17 thus, insertion of wrong amino acid. Bacillus anthracis Gram + rod Ciprofloxacin fluoroquinolone inhibits DNA gyrase and type IV topoisomerase 18 Bordetella pertussis TMP-SMX is a good alternate Azithromycin Gram - rod Macrolide inhibits bacterial protein synthesis (at 50S ribosomal subunit) 19 Corynebacterium diphtheriae Gram + bacillus Erythromycin Macrolide Inhibits protein synthesis Penicillin also effective 20 Streptococcus pyogenes Group A Streptococcus (GAS) Pen V β-Lactam antibiotic narrow-spectrum penicillin Inhibits cell wall synthesis Gram + confirm GAS before antibiotics Pharyngitis w/ tonsillar exudate Amoxicillin (children; tastes better) Macrolide (azithromycin, erythromycin) if Pen allergy 21 Pseudomonas aeruginosa Gram - rod Piperacillin + Tazobactam PIP: Extended spectrum, antipseudomonal penicillin inhibits cell wall synthesis TZ: β-Lactamase inhibitor 22 Pseudomonas aeruginosa Cefepime 4th generation cephalosporin inhibits cell wall synthesis Gram - rod 23 Pseudomonas aeruginosa Gram - rod Imipenem A carbapenem, which is a penicillin-like antibiotic Broad spectrum and resistant to many β-Lactamases. inhibits cell wall synthesis Cilastatin is included in preparation to prevent inactivation of IMP by renal dehydropeptidase 24 Legionella pneumophila Gram - rod Levofloxacin fluoroquinolone inhibits DNA gyrase and type IV topoisomerase OR a Macrolide 25 Adverse effects Penicillin G/V: GI distress, hypersensitivity Amoxicillin: GI distress, hypersensitivity Piperacillin + Tazobactam: Cefotaxime/Ceftriaxone: GI distress, yeast infection hypersensitivity; yeast infection cross-sensitivity with penicillins 26 Adverse effects Levofloxacin/Ciprofloxacin: Doxycycline: GI distress, tendonitis, phototoxicity, prolongled QT interval Phototoxicity, discoloration of teeth Azithromycin/Erythromycin: GI distress Erythromycin binds receptors for the gastric hormone, motilin, inducing uncoordinated peristalsis Gentamicin/Tobramycin: Imipenem: nephrotoxic, ototoxic hypersensitivity; cross-sensitivity with penicillins 27