Anti-Biotics pt.2

SULF, CYCLINE, and FLOXACIN

Sulfonamides MoA

competitive inhibitors of dihydropteroate synthase, the bacterial enzyme responsible for the incorporation of PABA into hydropteroic acid, the immediate precursor to folic acid. folic acid inhibitor

Sulfamethoxazole

• trimethoprom/sulfamethoxazole (bactrim, cotrim) - iv/po

• sulfadiazine - po

• sulfacetamide - topical cream, lotion, etc.

TMP-SMX indications

• skin/soft tissue infections

• UTIs

• meningitis

• pneumocystis pneumonia

• toxoplasma encephalitis

-CYCLINE (Tetracycline) MoA

inhibits bacterial protein synthesis by binding to the 30S bacterial ribosome and preventing acces of the aminoacyl tRNA to the acceptor (A) site on the mRNA-ribosome complex

Tetracycline BBW

Tigecycline - can increase all-cause mortality vs comparators in phase 3 and 4 clinical trials

Treatment for hospital acquired pneuomonia and ventilator assoc. pneumonia

Tetracycline ADRs

• GI

  • epigastric burning, nv, abdominal discomfort, diarrhea

  • esophagitis/esophageal ulcers

• photosensitivity

• tooth/enamel hypoplasia: not to be used long-term in children under 8 yo

  • short course okay for lime disease

-Floxacin (Fluoroquinolones) MoA

inhibits topoisomerase II (DNA gyrase) and IV which inhibits relaxation of supercoiled DNA and promotes DNA breakage

FLOXACIN spectrum

treats everything:

• plague

• gram pos

• gram neg

FLOXACIN BBWs

Serious ADRs:

• achillies tendon rupture

• CNS effects: (seizures, tremors, dizziness)

• peripheral neuropathy