Antibacterials

Bacteriostatic

inhibits a bacteria’s reproductive ability

Bacteriocidal

destroys bacteria

Both Gram + & Gram - Bacteria contain what 2 structures?

peptidoglycan wall & plasma membrane

Is the Peptidoglycan wall thicker in Gram + or Gram - Bacteria?

Gram +

What is the unique structure that belongs to Gram - Bacteria?

Outer Membrane

What is the Outer Membrane of Gram - Bacteria composed of?

lipopolysaccharide & protein

What are the medication classes that are considered to be Bacteriostatic agents?

• Tetracyclines

• Macrolides 

• Lincosamides

• Sulfonamides

• Oxazolidinones

What are the medication classes that are considered to be Bacteriocidal agents?

• Aminoglycosides

• Beta-Lactams

• Fluoroquinolones

• Glycopeptides

• Lipopeptides

• Cyclic Lipopeptides

• Nitromidazoles

What are the medications that are considered to be Antitubercular Agents?

• Isoniazid

• Rifampin

What is the one medication that is an Antibacterial that does not belong to any classification?

Nitrofurantoin (Urinary Tract Antiseptic)

Classify: Doxycycline

Tetracyclines

Brand Name: Doxycycline

MoA: Doxycycline

• inhibits protein synthesis

  • RNA / DNA

• binds to the 30s ribosomal subunit of bacterial ribosomes

Indication for Use: Doxycycline

• respiratory tract infections

• STIs

• acne vulgaris

• tick-borne illnesses

• malaria 

Contraindications: Doxycycline

• pregnancy

• liver / renal impairment 

• myasthenia gravis

• concurrent use of oral retinoids

Side Effects: Doxycycline

• GI disturbances

• In Children:

  • photosensitivity

  • permanent discoloration of teeth

Adverse Effects: Doxycycline

medication-induced lupus erythematosus

Patient Education: Doxycycline

• take antacids at least 2 hours after a dose

• sun protection

• not recommended for children 8 y/o & under

• liberal fluid intake

Classify: Erythromycin

Macrolides

Brand Name: Erythromycin

MoA: Erythromycin

binds to bacteria & prevents decoding of mRNA

• blocks enzymes needed for transcription

Indications for Use: Erythromycin

• respiratory tract infections

  • first-line agents for CA-Pneumonia

• pharyngitis, tonsillitis, & sinusitis

  • for those allergic to Penicillin

Contraindications: Erythromycin

• taking of medications metabolized by the CYP3A4 enzyme system

• QT interval prolongation

Side Effects: Erythromycin

• GI effects

• transient liver enzyme elevations 

Adverse Effects: Erythromycin

• QT interval prolongation

• acute pancreatitis

• ototoxicity

Patient Education: Erythromycin

• N/V/D

• loss of appetite 

When taking Erythromycin, what are the S&S that must be made known to a provider?

• fast/irregular/pounding heartbeat

• fainting

• 2+ months of diarrhea

• yellowing of skin

• dark urine

• tinnitus

• loss of hearing 

Classify: Clindamycin

Lincosamides

Brand Name: Clindamycin

MoA: Clindamycin

• blocks protein synthesis 

• can be bacteriostatic / bactericidal 

Indications for Use: Clindamycin

• effective against anaerobic bacteria & many Gram + organisms

• skin & soft tissue infections

• bacterial vaginosis 

• bone & joint infections 

Contraindications: Clindamycin

• GI disease / severe liver disease 

• pregnancy / breastfeeding

Side Effects: Clindamycin

• diarrhea 

• metallic taste

Adverse Effects: Clindamycin

• increases the risk of developing a severe Clostridiodes difficile-associated diarrhea 

• agranulocytosis

• jaundice & severe hepatic dysfunction

Patient Education: Clindamycin

• N/V/D

• stomach pain

• unpleasant / metallic taste

When taking Clindamycin, what are the S&S that must be made known to a provider?

• watery / bloody stools

• stomach cramps

• fever

• unusual bleeding

• peeling 

• sores 

• widespread rash

• dark urine

• muscle weakness

Classify: Trimethoprim-Sulfamethoxazole (TMP-SMX)

Sulfonamides

Brand Name: TMP-SMX

MoA: SMX

inhibits production of dihydrofolic acid in folate synthesis pathway

MoA: TMP

inhibits conversion of dihydrofolic acid —> tetrahydrofolic acid

Indications for Use: TMP-SMX

• UTIs

• ear infections, bronchitis, shigellosis

• pneumonia

• traveler’s diarrhea

Contraindications: TMP-SMX

• severe hepatic impairment 

• severe renal insufficiency

• megaloblastic anemia due to folate deficiency

• pregnancy / lactation

• G6PD deficiency

Side Effects: TMP-SMX

• GI disturbances 

• photosensitivity

• loss of appetite

• headaches 

• skin rashes

Adverse Effects: TMP-SMX

• Stevens-Johnson Syndrome 

• Toxic Epidermal Necrolysis

• blood dyscrasias

• aseptic meningitis

• acute liver failure

• acute pancreatitis 

Patient Education: TMP-SMX

drink plenty of fluids