Anti-infectives

Beta-lactams

Antibiotic class:

• Pencillin v potassium

• Penicillin G

• Amoxicillin

• Dicloxacillin

Cephalosporins (beta-lactams)

Antibiotic class:

• Cephalexin (1st gen)

• Cefazolin (1st gen)

• Cefuroxime (2nd gen)

• Ceftriaxone (3rd gen)

• Cefdinir (3rd gen)

• Cefepime (4th gen)

• Ceftaroline (5th gen)

fluoroquinolones

Antibiotic class:

• Moxifloxacin

• Ciprofloxacin

• Levofloxacin

Lincosamides

Antibiotic class:

• Clindamycin

Macrolides

Antibiotic class:

• Erythromycin

• Azithromycin

• Clarithromycin

Oxazolidinones

Antibiotic class:

• Linezolid

Sulfonamides

Antibiotic class:

• Trimethoprim-sulfamethoxazole

• Sulfadiazine

• Silver sulfadiazine

• Sulfacetamide

Trimethoprim

Antibiotic in the diaminopyrimidine class of drugs

• Functions as a folate antagonist that specifically inhibits the enzyme dihydrofolate reductase, preventing bacteria from synthesizing the folic acid they need to grow and multiply.

Nitrofuran

Antibiotic class:

• Nitrofurantoin

• It is reduced by bacterial enzymes into reactive intermediates that directly damage bacterial DNA, proteins, and cell walls.

• Bactericidal in urine at therapeutic doses, meaning it actively kills the bacteria causing the infection

Tetracyclines

Antibiotic class:

• Tetracycline

• Minocycline

• Doxycycline

Glycipeptides

Antibiotic class:

• Vancomycin

Bacteriocidal antibiotics

Bacteriocidal or bacteriostatic antibiotics?

• Beta lactams

• Oxazolidinones

• Fluroquinolones

• Glycopeptides

• Sort of lincosamides

bacteriostatic antibiotics

Bacteriocidal or bacteriostatic antibiotics?

• Sulfonamides

• Macrolides

• Tetracyclines

• Sort of lincosamides

Penicillins coverage

Gram -

• Streptococcus

• Some enterococcus strains

• Non-penicillinase-producing staphylococcus

• Urinary and GI pathogens (e. coli, proteus mirabilis, salmonella, some shigella, entercoccus faecalis)

• Respiratory pathogens (moraxella catarrhalis and haemophilus influenzae type B)

Cephalosporins coverage

Antibiotic Class Coverage:

Gram - and gram + depending on gen:

• Skin and soft tissue, gram + - 1st gen

• Skin and soft tissue, gram +, klebsiella, proteus, e. coli - 2nd gen

• Gram - - 3rd gen

• Gram +, those resistant to beta-lactamase - 4th gen

• Gram - and MRSA - 5th gen

fluoroquinolones coverage

Antibiotic Class Coverage:

• extensive gram - activity

• resistant tuberculosis

lincosamides coverage

Antibiotic Class Coverage:

• Gram +

• Corynebacterium acnes, Gardnerella vaginalis, some MRSA

macrolides coverage

Antibiotic Class Coverage:

• Aytpical and intracellular organisms commonly resistant to beta-lactam abx

oxazolidinones coverage

Antibiotic Class Coverage:

• aerobic gram +

(sulfonamides, trimethoprim, and nitrofurantoin) coverage

Antibiotic Class Coverage:

• gram + and -

• E. coli, S. pyogenes, S. pneumoniae, H. influenze, and some protozoa

tetracyclines coverage

Antibiotic Class Coverage:

• C. trachomatis

• P. acnes

• H. pylori (sometimes)

glycopeptides coverage

Antibiotic Class Coverage:

• Severe gram +

• MRSA

penicillins ADRs

Antibiotic class ADRs:

• Serious immediate allergic reactions

• Rash

• DIarrhea, N/V,

• Fungal overgrowth

• C. Diff

cephalosporins ADRs

Antibiotic class ADRs:

• Allergies

• Skin rashes

• Arthralgia

• Anemia, neutropenia, leukopenia, thrombocytosis, coag abnormalities

• Fever

• Seizures

• Renal/hepatic failure

Fluroquinolones ADRs

Antibiotic class ADRs:

• Boxed warning - tendonitits/tendon rupture

• Pseudomembranous colitis

• Sleep disorders, dizziness, acidosis

• Renal/hepatic failure

• Angina, A flutter, QTc prolongation

Lincosamides ADRs

Antibiotic class ADRs:

• Boxed warning - severe colitis

• Rash, burning, itching, erythema

• Transient eosinophilia, neutropenia, thrombocytopenia

Macrolides ADRs

Antibiotic class ADRs:

• Dose-related

• N/v, ABD pain, cramping, diarrhea

• Urticaria, bullous eruptions, eczema, Stevens-Johnson syndrome

Oxazolidinones ADRs

Antibiotic class ADRs:

• Boxed warning - Serotonin syndrome

• Diarrhea, nausea

• HA

• Myelosuppression

(sulfonamides, trimethoprim, and nitrofurantoin) ADRs

Antibiotic class ADRs:

• Anorexia, N/V, diarrhea, stomatitis

• Rashes, increased hypersensitivity, photosensitivity

• HA, dizziness, drug interactions

Glycopeptides ADRs

Antibiotic class ADRs:

• Ototoxicity

• Nephrotoxicity

• Red man syndrome if infused too fast

nucleoside analogues

Class of antivirals including:

• Acyclovir

• Valacyclovir

• Famciclovir

• Ganciclovir

Nucleoside analogues ADRs

Antiviral class ADRs:

• acyclovir - few when given PO

• famiciclovir - HA

• valacyclovir - thrombocytopenia purpura, hemolytic uremic syndrome in immunocompromised pts

hepatitis C

Antivirals for…

• Based on genotype of virus and stage of disease

• Most interferon-free regimen

• Most often a fixed dose combination of two antivirals (Ledipasvir and Sofosbuvir)

• Boxed warning for HBV reactivation

influenza

Antivirals for…

• Oseltamivir (Tamiflu)

• Peramivir (Rapivab)

• Zanamivir (Relenza)

covid-19

Antivirals for…

• Remdesivir

Antifungals

• Ketoconazole

• Fluconazole

• Itraconazole

• Nystatin

• Naftifine

• Terbinafine

• Griseofulvin

Ketoconazole

Antifungal with boxed warning - check AST, ALT, ALP, and bilirubin before and every 3-4 months

Anthelmintics

Clinical use

• Pinworms:  mebendazole, pyrantel pamoate, or albendazole

• Whipworms: pyrantel pamoate, albendazole, mebendazole

• Roundworms: mebendazole

• Hookworms: pyrantel pamoate, albendazole, mebendazole

• Threadworm: ivermectin or thiabendazole

• Scabies: off-label ivermectin in immunocompromised patients

Antiprotzoals

• Metronidazole

• Nitazoxanide

• Tinidazole

Antimycobacterials

Medications against slow growing and relatively resistant bacteria

• They have a lipid-rich cell wall

• Usually intracellular

• Can go into a dormant state

Med examples:

• Isoniazid

• Rifampin

• Ethambutol

• Pyrazinamide

• Rifabutin