Antibiotics

Aminoglycosides

• Aminoglycosides are used for infections caused by gram negative aerobic bacilli, but are also effective against certain other infections such as Staphylococci and Mycobacterium tuberculosis.

Examples

• Gentamicin (generic version - IV only)

• Amikacin (IV only)

• Tobramycin

• Gentak and Genoptic (eye drops)

• Kanamycin

• Streptomycin*

• Neo-Fradin

• Neomycin (generic version - IV only)

*ONLY for special cases, because of its effect on the 8th cranial nerve and kidney

Pharmacokinetics

• Route: IM (intramuscular), IV (intravenous)

• Onset: rapid

• Peak: 30-90 mins

• Duration: N/A

• Half-life: 2-3 hours

• Metabolism: liver

• Excretion: kidneys/urine

Contraindicators

• known allergies

• renal and/or hepatic disease

• preexisting hearing loss

• active herpes or mycobacterial infection → might be worsened by effects on defense mechanisms

• myasthenia gravis or Parkinson’s disease → might be worsened by effects on the nervous system

• lactation → any excretion into the breast milk can have serious complications for infants

Adverse effects

Central Nervous System

• ototoxicity (= toxicity to the ears)

• irreversible deafness

• vestibular paralysis

• confusion and disorientation

• depression

• numbness, tingling, and weakness

Urinary System

• renal failure

Immune/Hematological System

• bone marrow depression → immunosuppression and resultant infections

GI System

• nausea

• vomiting

• diarrhea

• weight loss

• stomatitis (= inflammation of the mouth)

• hepatotoxicity (= toxicity to the liver)

Cardiovascular System

• palpitations

• excessively high/low BP (hyper-/hypotension)

Hypersensitivity

• purpura (= purplish spots caused by bleeding from blood vessels in the skin)

• rash

• urticaria (= hives)

• exfoliative dermatitis

Carbapenems

• Carbapenems are effective against gram positive and negative bacteria, and are used for infections caused by serious strains that are resistant to other antibiotics such as:

  • S. pneumoniae

  • H. influenzae

  • E. coli

  • K. pneumoniae

  • B. fragilis

  • P. mirabilis

  • P. aeruginosa

  • P. bivia

Examples

*associated with development of pseudomembranous colitis, should be used with caution in patients with inflammatory bowel disease

**not recommended for patients under the age of 18

Pharmacokinetics

• Route: IM (intramuscular), IV (intravenous)

• Onset: rapid

• Peak: 30-120 min

• Duration: n/a

• Half-life: 4 hours

• Metabolism: n/a

• Excretion: kidney/urine; unchanged

Contraindicators

• known allergies to carbapenems or beta-lactams

• seizure disorders

• meningitis

• lactation → drug might be excreted in breast milk

Adverse Effects

• superinfections (= secondary infections that are resistant to the existing treatment)

GI System

• pseudomembranous colitis (= inflammation of the colon caused by overgrowth of C. difficile bacteria, associated with antibiotic use)

• diarrhea

• nausea

• vomiting

• dehydration

• electrolyte imbalance

Central Nervous System

• headache

• dizziness

• altered mental state

Cephalosporins

• Cephalosporins are not typically used as a first choice antibiotic and are reserved for when others cannot be used (especially due to rising numbers of cephalosporin-resistant bacteria). They are typically used in place of penicillin due to similar structure and function but are also used in place of other antibiotics. They tend to be used to treat the following infections:

  • bone infections

  • ear infections (otitis media)

  • skin infections

  • upper respiratory tract infections

  • urinary tract infections (UTIs)

Examples

Pharmacokinetics

• Route: oral, IM (intramuscular), IV (intravenous)

• Onset: n/a

• Peak: 30-60 minutes

• Duration: 8-10 hours

• Half-life: 30-60 minutes

• Metabolism: n/a

• Excretion: kidney/urine; unchanged

Contraindicators

• known allergy to cephalosporins and beta-lactamase

• hepatic and/or renal impairment → could interfere with the metabolism and excretion

• pregnancy and lactation → effects on the fetus and infant are not known

• preexisting renal insufficiency → increased risk of nephrotoxicity

Adverse Effects

• superinfections

• phlebitis (= inflammation of a vein) or local abscess (= concentration of pus in a confined tissue space) near the site of administration if IM/IV

GI System

• nausea

• vomiting

• diarrhea

• anorexia

• abdominal pain

• flatulence

• pseudomembranous colitis

Central Nervous System

• headache

• dizziness

• lethargy

• paresthesia (= sensation of tingling, burning, or pricking felt on or just underneath the skin)

Fluoroquinolones

• Fluoroquinolones are broad-spectrum antibiotics that are used for a wide variety of infections such as:

  • bronchitis

  • pneumonia

  • sinusitis

  • UTIs, PID, and other urethral/gynecological infections

  • septicemia (= blood poisoning) and intraabdominal infections

  • joint, bone, and skin infections

  • typhoid fever

  • anthrax

  • bacterial gastroenteritis

Examples

Pharmacokinetics

• Half-life: 3.5-4 hours

• Metabolism: liver

• Excretion: liver/bile, kidney/urine

Contraindicators

• known allergy to fluoroquinolones

• pregnancy and lactation → effects on the fetus and infant are unknown

• seizures → can be exacerbated by effects on cell membrane channels

• risk of tendinitis and tendon rupture in the following populations:

  • people over the age of 60

  • people on concurrent steroids

  • people with renal, heart, and/or lung transplants

Adverse Effects

• photosensitivity and severe skin reactions → advise patients to avoid intense sun/UV exposure and protect themselves with clothing/sunscreen when exposed

GI System

• nausea

• vomiting

• diarrhea

• dry mouth

Central Nervous System

• headache

• dizziness

• insomnia

• depression

Immune System

• bone marrow depression

Penicillin & Penicillinase-Resistant Antibiotics

• Penicillin and penicillinase-resistant antibiotics are often used for the following medical conditions:

  • dental abscesses

  • ear infections

  • gonorrhea

  • pneumonia

  • UTIs

  • streptococcal infections including:

    • pharyngitis

    • tonsillitis

    • endocarditis

  • meningococcal meningitis

Forms of Penicillin

Contraindications

• known allergy to penicillin and/or cephalosporins

• renal disease → impairs drug excretion

• pregnancy and lactation → no known effects on fetus, but diarrhea and superinfections can occur in infants

Adverse Effects

• superinfections (including yeast infections)

• pain/inflammation at the site of injection

GI System

• nausea

• vomiting

• diarrhea

• abdominal pain

• glossitis (= inflammation of the tongue)

• stomatitis

• gastritis

• sore mouth

• furry tongue (= improper shedding of papillae → keratin buildup)

Hypersensitivity Effects

• rash

• fever

• wheezing

• anaphylaxis (with repeated exposures)

Sulfonamides

• Sulfonamides are used to inhibit folic acid synthesis, and are used for infections caused by the following strains*:

  • C. trachomatis

  • Nocardia

  • some strains of the following:

    • H. influenzae

    • E. coli

    • P. mirabilis

  • sexually transmitted diseases (STDs)

*Non-antibiotic sulfonamides can be used for diabetes and pain relief, and some non-antimicrobial sulfonamides can be used for autoimmune disorders such as ulcerative colitis and rheumatoid arthritis.

Examples

Pharmacokinetics

• Route: oral

• Onset: rapid

• Peak: 1-4 hours

• Duration: n/a

• Half-life: 8-10 hours

• Metabolism: n/a

• Excretion: kidney/urine

Contraindicators

• known allergy to sulfonamides, sulfonylureas, and/or thiazide diuretics → risk of cross-sensitivity

• renal disease → increases toxic effects

• pregnancy → can cause birth defects

• lactation → increased risk for kernicterus (= brain condition in infants caused by excessive bilirubin in the blood), diarrhea, and rash in infants

Adverse Effects

• photosensitivity

• rash

• hypersensitivity reactions

GI System

• nausea

• vomiting

• diarrhea

• abdominal pain

• anorexia

• stomatitis

• hepatic injury

Urinary System

• crystalluria (= formation of crystals in the urine due to mineral imbalance)

• hematuria

• proteinuria

• toxic nephrosis

Central Nervous System

• headache

• dizziness

• vertigo

• ataxia (= poor muscle control resulting from damage to the cerebellum)

• convulsions

• depression

Immune System

• bone marrow depression

Tetracyclines

• Tetracyclines are broad-spectrum antibiotics that are either isolated or produced synthetically from Streptomyces bacteria. They are used to treat bacterial infections all over the body, but are often used for the following:

  • Lyme disease

  • malaria

  • severe acne

  • STDs (syphilis, gonorrhea, chlamydia)

Examples

Pharmacokinetics

• Half-life: 6-12 hours

• Metabolism: n/a

• Excretion: kidney/urine

Contraindicators

• known allergies to tetracyclines and/or tartrazine

• pregnancy and lactation → can damage developing bones and teeth

• ocular infections (fungal, mycobacterial, viral) → ophthalmic preparations can kill normal flora as well

• risk of damaging bones and teeth in children under the age of 8

• hepatic and/or renal dysfunction

Adverse Effects

• superinfections

• photosensitivity

• rash

• pain/stinging with topical and ocular preparations

GI System

• nausea

• vomiting

• diarrhea

• abdominal pain

• glossitis

• dysphagia

• fatal hepatotoxicity

Skeletal System

• weakening bone structure → staining and/or pitting in bones and teeth

Immune/Hematologic System

• bone marrow depression

• hemolytic anemia (= RBCs break down and/or die faster than they can be replaced by the body)