GRAM POSITIVE INFECTIONS

Staphylcocci

Strepticocci

Enterococci

GRAM NEGATIVE INFECTIONS

E. Coli

Klebsiella

Enterococci

STAPHYLOCOCCUS AUREUS

Gram Positive

Anaerobic

(can be MRSA or VRE)

ANTIBIOTIC ANTAGONISM

two antibiotics cancel each other out

(can lead to resistence)

OPPORTUNISTIC ORGANISMS

Microbes in Normal Flora that become pathanogenic

(Herpies, E.Coli)

BROAD SPECTRUM ANITBIOTICS

Tx a wide variety of infections

more likely to cause a superinfection

INTRACELLULAR BACTERIA

Mycobacterium TB

Samonella

Toxoplasma

Listeria

(Most bacteria thrive extracellularly)

PENICILLINS

• has beta-lactam ring 
• Causes cellular lysis w/ bacterial cell wall (human cells have no walls)
• Effective Tx for Gram Positive Infections
• Tx~ Pneumonia, meningitis, skin/bone/joint infections, gangrene, tenitus, anthrax, + sickle cell anemia in peds.

Chemically Modified Penicillins

(Penicillin Resistant Penicillins)

Oxacillin

Cloxicillin (Cloxapen)

*anti-staphylococcus penicillins

BROAD SPECTRUM PENICILLINS

(Amino  penicillins)

Ampicillin (Principin)

Amoxicillin (Amoxil, Trimox)

EXTENDED SPECTRUM PENICILLINS

*even broader than broad spectrum

Carbinicillin (Geocillin) + Piperacillin

Tx~ psuedomonas

enterobacter

klebsiella

bacteroid fragiles

PENICILLINS+BETA-LACTAMASE INHIBITORS

Augmentin= Amoxicillin + Clavulate

Timentin= Ticarcillin + Clavulate

Unasyn= Ampicilin + Sulbactum

Zosyn= Piperacillin + Tazobactum

ADVERSE EFFECTS FOR

PENICILLIN

common= allergic reactions

uncommon= rash, pruritis, fever

rare= lowered RBC, WBC, PTT

CEPHALOSPORINS

• largest class
• similar mechanism to penicillin (beta-lactam ring)
• four generations (selection depends on sensitivity of pathogen)
• allergic to Penicillin~ 5-10% allergic to Cephalosporins            (reasonable alternative to most)
• side effects= stomach cramps or upset, nausea, vomiting, and diarrhea can cause overgrowth; sore tongue, sores inside the mouth, or vaginal yeast infections.

FIRST GENERATION CEPHALOSPORIN

• Effective against Gram positive infections
• Tx~ Staphylococcus, Streptococci; respiratory tract infections; skin and soft tissue infections; bone and joint infections; genito-urinary infections, including acute prostatitis and dental infections
• can cause nephrotoxicity
• keflex

SECOND GENERATION CEPHALOSPORINS

• increased potency
• increased resistance to beta-lactamase
• Tx~Gram Positive Cocci, EKP Gram Neg Bacteria, Gram Neg Coccobacilli
• has largely been replaced by third generations

THIRD GENERATION

CEPHALOSPORINS

• increased spetrum against Gram Negative infections
• Longer duration of action
• Resistant to beta-lactamase
• Tx~ Psuedomonas, Klebsiella, Neisseria, Salmonella, Proteus, H. Influenza

FOURTH GENERATION

CEPHALOSPORINS

• Effective against pathogens that have become resistant to predacessors
• Capable of entering CSF!!

TETRACYCLINES

• Effective against Gram Negative and Gram Positive pathogens
• Very Broad Spectrum
• BACTERIOSTATIC (inhibits bacterial protein synthesis)
• all have the same spectrum+ same side effects
• Tx~ drug resistant intra-abdominal infections + skin infections (esp. caused by MRSA)
• Calcium/Iron= decreased absoption

TETRACYCLINES'

SIDE EFFECTS

• GI distress (take w/ food)
• Catagory D= effects fetal bone growth
• yellowing of children's teeth
• Photosensitivity
• Hepatoxicity (esp. w/ pre-existing liver disease)
• Broad Spectrum= Risk for SuperInfection
• Expired Tetracycline= NEPHRATOXIC

TETRACYCLINE IS

EFFECTIVE AGAINST:

• Rocky Mtn. Spotted Fever
• Thyphus
• Cholera
• Lyme Disease
• Peptic Ulcers (caused by Heliobacter Pyloris)
• Chlamidia
• Acne

MACROLIDES

• Bacteriostatic @ low doses
• Bacteriocidal @ high doses
• Effective against Gram Positive and some Gram Negative
• Have Longer Half lives
• Cause less GI irratation
• Newer Microlides are synthesized from Erythromycin

MACROLIDES

EFFECTIVE AGAINST:

Whooping Cough

Legionnare's Disease

Streptococcus

H. Influenza

Mycoplasma Pnuemonia

Used against bacteria that infect intracellularly:

Listeria

Chlamidia

Neissaria

Legionnare's

MACROLIDE

MEDICATIONS

• Clarithromycin
• Azithromycin
• Vancomycin
• Erythromycin

AMINOGLYCOSIDES

• More toxic than any other class
• Effective against Gram Negative pathogens (mycobacteria, some protozoans)
• Given Pre-Op PO to sterilize bowel
• Bacteriocidal and Bacteriostatic

AMINOGLYCOSIDES

Effective against:

• Serious Gram Negative pathogens
• E. Coli, Proteus, Klebsiella, Psuedomonas
• Given IV- porly absorbed by GI
• Many resistant strains
• Mainly used to Tx TB

AMINOGLYCOSIDE

MEDICATIONS

• Amphotericin B (For fungal infections)
• Neomycin (used topically for eyes, skin, ears)
• Paromomycin (PO for parasites)
• Gentomycin (Gram-negative bacteria including Psuedomonas, Proteus, Serratia, and Gram Positive Staphylococcus)

AMINOGLYCOSIDES

ADVERSE EFFECTS

• Ototoxicity
• Nephratoxicity (elevated BUN + Creatnine) 26% of pts!!!
• Dizziness
• Ringing in ears
• Persistant Headache
• D/C @ 1st sign S/S!!!

FLUOROQUINALONES

• newer fluoroquinalones are broad spectrum
• effective against Gram Negative (and some Gram Positve)
• Usually 1st line drugs (sometimes antibiotic replacement)
• Ciproflaxiin (Cipro)- most common; post-exposure prophilaxis for Anthrax, Resp. infections, GI infections, Gentourinary Tracts, Skin/soft tissue infections
• Well absorbed orally Once a Day or BID

FLUOROQUINALONE

ADVERSE EFFECTS

• N/V, diarrhea
• Gatoflaxin/Moxiflaxin= possible dysrhythmias + heptatoxicity
• CNS= dizziness, sleep disturbnces
• Tendonitus/Tendon Rupture (Achilles Tendon, Risk increased if over 60)
• May affect cartilidge development in peds

SULFONAMIDES

• Broad Spectrum Gram Positive and Gram Negative
• Tx suseptible UTIs
• Bacteriostatic= inhibits folic acid synthesis (B complex essential for rapidgrowth)
• Many resistant strains
• Clasiffied by route; systemic or topical

SULFONAMIDES

MEDICATIONS

• Sulfasalazine (Azulfidine)= PO Anti-inflammatory properties, Tx~ulcerative cholitis, rheumatoid arthritis
• Sulfamethoxazole (Gantrinsin), TMP-SMZ= PO excreted rapidly from kidneys, Tx= UTIs
• Bactrim(sulfamethoxazole and trimethoprim)= antibiotic to treat ear infections, urinary tract and other infections.
• Sulfadiazine (Microsulfon)= Topical
• Sulfadoxine Pyrimethamine (Fansidar)= PO, long half life, persribed for malaria

SULFONAMIDE

ADVERSE EFFECTS

• Relatively safe~ some adverse effects can be serious
• Formation of crystals in urine
• N/V
• Aplastic Anemia (decreased RBC from bone marrow)
• Acute hemalytic anemia
• Agranulocytosis

CLINDAMYCIN

• Tx Gram Positive and Gram Negative when others fail
• effective against: Fusobacterium and Clostridium Perfingens
• Contraindicated for pt.s: allergic to Clindamycin/Lincomycin, w/ Chrone's Disease, Ulcerative Colitis
• Risk for Superinfections= AAPMC (Antibiotic Associated Psuedomonas)
• can cause: diarrhea, dyspnea, rashes, dysphagia

METRONIDAZOLE

FLAGYL

• Effective against anaerobes (Abcsesses, Gangrene, Diabetic Ulcers, Deep wound infections, Clostridium Difficile)
• Effective against bacteria and parasites
• Adverse effects: Nausea, dry mouth, headache

QUINUPRISTIN/DALFOPRISTIN

(SYNERCID)

• effective against Vancomycin resistant infections
• use cautiously for pt.s w/ hepatic or renal failure

LINEZOLID

(ZYVOX)

• Oxazolidinone prototype
• as efective against MRSA as Vancomycin
• IV or PO
• contraindications= Pregnant, Hx of HTN
• Can cause Thrombocytopenia (decreased PTT)
• Report; dizzines, bleeding, N/V, headache, fever

VANCOMYCIN

• Reserved for gram-positive oganisms (S. Aureus, Streptococcus)
• commonly used for resistant pathogens esp. MRSA
• Adverse effects= Ototoxicity, Nephratoxicity, Superinfection, chills, fever, rash, hives, Red Man Syndrome (large amounts of histamine due to too fast of an infusion)
• Peak and Trough levels drawn after 3 doses, 30min post= peak, 30min pre= trough (5-10 for trough and 25-40 for peak)

DEPOMYCIN

(CUBICIN)

• Tx= serious skin infectins, major abcsesses, post surgical wound infections, infected ulcers
• Adverse effects= GI distress, fesver, headache, dizziness, insomnia, rash

CARBAPENEMS

• EXTRA-BROAD SPECTRUM ANTIBIOTICS
• Imipenum (Primaxin)= Broadest spectrum (always given w/ cilastatin= increases serum levels)
• Meropenum= Tx periontitis and bacterial meningitis
• Ertapenum= narrower spectrum~Longer half life (abdominal/pelvic infections + sin infections)
• Minimal Adverse Reactions include; N/V, Diarrhea, Rash, Thrombophlebitis