(Gob) Anti-Infectives

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Preliminaries & Quick Mnemonics

  • G+ → staph (90% of skin infections), strep, entero,
  • G- → all else
  • AT@30 → targets 30s ribo subunit
    • Aminoglycosides
    • Tetracyclines
  • CEL@50 targets 50s ribo subunit
    • Clyndo
    • Erythro
    • Linezolid
  • Resistance to β-Lactam antibiotics
    • G- have lipid bilayer for protection
    • G- / G+ can both secret β-lactamase
    • MRSA (methicillin-res staph aureus) is resistant to ALL penicillin
    • β-Lactamase Inhibitors (and corresponding ABs)
      • Clavulanic Acid (amox)
      • Sulbactam (ampi)
      • Tazobactam (piper)

Drug Classes

PENICILLINS

PEN G

  • G+, some G-, NO BL+, NO acid res, Very Low t1/2
  • NOSE:
    • Neisseria Meningitidis
    • Oral Anaerobes
    • Streptococcus pneumoniae (G-)
    • Enterococcus (G+)

ANTI-STAPH PEN

  • G+, BL+
  • Clox-acillin
  • Staphylococcus aureus
  • Common for infected skin wounds


AMINO-PEN

  • G+, ETK G-, NO BL+ but usually combined w/ clavulanic acid
  • Amoxi-cillin (better PO)
  • Ampi-cillin
  • Ampi-Gentomycin combination → broad G- coverage
  • ETK G- (targeted by amino pens): HPEELSS
    • H. influenza
    • Proteus Mirabilis
    • E coli
    • Enterococcus (1st choice)
    • Listeria
    • Shigella
    • Salmonella


ANTI-PSEUDOMONAL

(Not widely used clinically)

  • G+, ETK G-,anaerobe, NO BL+ but coupled w/ clavulanic acid
  • Ticar-cillin
  • Ticar-Gent → broad G- coverage
  • Pseudomonas aeruginosa
  • Bacteroides fragilis
  • Note: in terms of cost, coverage and side-effect profile, Piperacillin is superior and is more widely used. (see next)

UREIDO PEN

  • G+, ETK G-, DTK G-, anaerobes, NO BL+ but coupled w/ tazobactam
  • Piper-acillin
  • Pip-gent → broad G- coverage
  • Pseudomonas aeruginosa
  • Bacteroides fragilis

CEPHALOSPORINS

  • No MRSA & Enterococci

1st GEN

  • G+ (staph), strep, ETK G-
  • Ceph-alexin – po
  • Cef-azolin – iv
  • ETK G- (targeted by 1st gen Cephs ): PEKSS (Same as HPEELSS except for Kleb)
    • Proteus mirabilis
    • E. coli
    • Klebsiella pneumonia
    • Shigella
    • Salmonella

2nd GEN

  • Adds H. influenzae coverage (G+ coverage not as good, G- coverage better than 1st gen)
  • Cef-aclor – po, H. influenzae
  • Cef-uroxime – po/iv, H. influenzae
  • Cef-otetan – iv, B. fragilis

3rd GEN

  • Poor G+ but covers Strep', DTK G-
  • Cef-tizoxime – iv, B. fragilis
  • Cef-otaxime – iv
  • Cef-tazidime – iv
  • Cef-triaxone – im


FLUOROQUINOLONES (FQ)

OLD FQ

  • G+, DTK G- (incl. P. aeruginosa)
  • Cipro-floxacin

NEW FQ

  • G+, DTK G- (but NOT P. aeruginosa)
  • Levo-floxacin
  • Moxi-floxacin
  • Gati-floxacin

VANCOMYCIN

  • G+ (incl res-staph)

AMINOGLYCOSIDES

  • Bacteriocidal, G-, some G+, TB
    • targets 30s ribo subunit
  • Tobra-mycin
  • Amik-acin

TETRACYCLINES

  • Bacteriostatic, broad spectrum
  • targets 30s ribo subunit


CLINDAMYCIN

  • BS, G+ (res staph)
  • targets 50s ribo subunit


MACROLIDES

  • BS, G+ (res staph), ETK G-
  • targets 50s ribo subunit
  • Erythro-mycin
  • Azithro-mycin


LINEZOLID

  • targets 50s ribo subunit


RX APPROACH ( BUG → DRUG)

STREPTOCOCCUS PNEUMONIAE

  • G+, BL+
  • Any penicillin


STAPHYLOCOCCUS AUREUS

  • G+, BL +/-
  • MSSA
    1. Clox-acillin
    2. 1st gen Ceph
    3. 2nd gen Ceph
    4. Clox or higher (with &Beta-Lactamase inhibitor)
    5. Macrolides
    6. New FQ
  • MRSA
    1. Vanco-mycin


GRAM NEGATIVE INFECTIONS

  • ETK G-
    1. 1st gen Ceph → PEKSS
      • Proteus mirabilis
      • E. coli
      • Klebsiella pneumoniae
      • Shigella
      • Salmonella
    2. Amox-icillin, Ampi-cillin → HPEELSS
      • H. influenza
      • Proteus mirabilis
      • E. coli
      • 'Enterococcus G+'
        • Pen
        • Amox
        • Ampi
        • Vanco
      • Listeria
      • Shigella
      • Salmonella
    3. Macrolides
  • DTK G- : PACES P
    • Provindentia
    • Acinetobacter
    • Citrobacter
    • Enterobacter
    • 'Serratia'
      1. FQ
      2. 3rd gen Ceph
      3. Aminoglycosides
      4. Piper-acillin
      5. Carbapenem
    • 'Pseudomonas Aeruginosa'
      1. Cipro-floxacin
      2. Tobra-mycin
      3. Cef-tazidine
      4. Amik-acin
      5. Ticar-cillin / Piper-acillin +


ANAEROBES

  • B. fragilis
    1. Metro-idazole
    2. Clindo-mycin
    3. Cef-oxitin & Cef-otetan ONLY
  • C. Difficile
    1. Metro-idazole
    2. Vanco-mycin


ATYPICALS

  • Mycoplasma pneumoniae
  • Chlamydia pneumoniae
  • Legionella""
    1. Macrolides
    2. New FQs
    3. Tetracyclins