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RavLect19: MiscABx

Miscellaneous Antibiotics

QuestionAnswer
Bactrim, Septra (Trimethoprim+Sulfamethoxazole) SMX – structural analogue of PABA; blocks production of folic acid TMP – DHFR inhibitor that blocks the conversion of DHF to THF. Together this combination produces a synergistic effect
Bactrim, Septra (T+S) PK Distributes to most tissue/fluid including the CSF & prostate Needs renal adjustment b/c cleared by kidney
Bactrim dosing 5:1 ration of SMX to TMP. Dosing based on TMP 80TMP:400SMX is reg. strength tab 160TMP:800SMX is dbl strength tab 16TMP:80SMX/ml IV. Every 10ml IV is like a dbl-strength tab. KNOW HOW TO CONVERT FR ml IV to mg PO! Oral dose is BID. IV is Q6h
Bactrim (Septra) SoA G+: S. pneumo, not for DRSP; MSSA, Listeria, CA-MRSA on SKIN ONLY (NOT IV HA-MRSA pneumo) G-: E. Coli, UTIs, COPD (H. influ, M. catarrhalis, Kleb) Septra is #1 for: S. maltophila, B. cepacia, Toxoplasmosis, Prostatitis, Shigellosis, CA-MRSA, Nocardi
Bactrim dosing (cont'd) Usual dose: 1 DS BID PCP prophylaxis is 1 DS TIW
Bactrim ADRs NV Insoluble, crystallization sun sensitivity -> rash/allergy hypo/hyperglycemia hyperK with IV Pancreatits, Hepatitis Blood dyscrasias teratogenic
Bactrim DDIs Warfarin: check INR (increases) - more bleeds MTX (methotrexate) is displaced Increases hypoglycemic effect of sulfonylureas
Clindamycin (Cleocin) PK & MoA Static, 50s ribosomal protein synthesis inhibitor Penetrates most tissue well except CSF Accumulates in Segs/Macs and in abscessed tissue Above diaphragm anaerobic agent Main antibiotic implicated in C. dif colitis
Clindamycin SoA Oral anaerobes, abscess Abdominal C. diff, C. perfringens, and B. Fragilis Used topically for acne If PCN allergy, good for Staph, MSSA, Strep G. vaginalis (G- rod, facultative anaerobe, vaginitis) dental prophy NOT for enterococcus
Clindamycin ADRs AAD (C. diff) Metabolizes to benzyl alcohol. If used in kids, monitor conc to avoid seizures. Bitter taste Prolongs NMJB (neuromuscular junction blockers) - reverse w/ pancuronium Dizziness & HA
Metronidazole (Flagyl) PK & MoA Mainly used for anaerobes BELOW diaphragm (but active above as well. Cidal mostly No activity against aerobes (req anoxic pore to enter organism) Penetrates all tissues and fluids
Metronidazole (Flagyl) SoA Best for anaerobic C. diff, B. frag IA infections Trichomonas, Giardia, Entamoeba, Gardnerella, H. pylori
Metronidazole (Flagyl) Contraindicated in pregnancy and nursing moms nasty metallic taste (take with snack) Dizziness, HA, rarely -seizures, neuropathy, tingling, numbness Pancreatitis dark urine
Metronidazole (Flagyl) interactions Warfarin (increased conc. more bleeding risk) Alcohol (disulfiram rxn like Antabus) *Avoid in alcholics! Light - degrades Flagyl and makes it browner
Nitrofurantoin (MacroBID, Macrodantin) uses & SoA UTI Tx or prophylaxis E. coli, S. sap, E. faecalis, Group B Strep (prenatal)
Nitrofurantoin (MacroBID, Macrodantin) MoA & PK Binds to ribosomal protein, damages DNA May antagonize quinolone activity when Tx G- absorbed in small intestine Excretion decreases in proportion w/ ClCr decreases Macrocrystal helps w/ absorption. Causes dark brown feces Not given to kids
Nitrofurantoin (MacroBID, Macrodantin) ADRs Pulmonary rxns (asthma-like, SOB, fibrosis) Diarrhea Elevated LFTs G6PD deficiency -> anemia peripheral neuropathy discolors urine orange/brown
Colistin (Colistimethate sodium, Coly-Mycin) MoA & PK Cidal Cationic polypeptide polymixin - detergent-like mechanism which interferes with cytoplasmic membrane of G- organisms Removed by GFR almost completely unchanged Concentration dependent
Colistin SoA G-: mostly used for MDR (multidrug resistant) Pseudomonas, Kleb, Acinetobacter, Enterbacteria, E. Coli Proteus, Providencia, Serratia, Burkholderia, Stenotropheomonas Only drug that works for NMD1 beta-lactamases!! NOT for anaerobes
Colistin ADRs nephrotoxicity neurotoxicity respiratory arrest, apnea (breathing cessation) w/ IM due to NMJ blockade SEs worse w/ renal dysfxn
Metronidazole dose for Trichomoniasis 2g x single dose
Created by: cheeoh
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