Antibiotic Antibiotic (classification)

(classification) Sul onamides

)inhibits metabolism/

Mechanism Mechanism
)tr!ct!ral analo%s of para&aminoben:oic acid (pABA) that inhibits dihydropteroate synthase (DHTS). *selectivity= bacteria synthesize folate but humans cant )tr!ct!ral analo% of pteridine portion of dihydrofolic acid. (ompetitive inhibitor of dihydrofolate reductase (DH!").

ANTIBIOTIC REVIEW SHEET Resistance Antibacterial Side E ects Antibacterial Spectrum Resistance Side E ects Spectrum
*. en:yme m!tations of D T) 7. Increase in pABA +. permeability to dr!% 0. !tili:ation of preformed folate Bacteriostatic. emolytic anemia ( G>'D) ypersensitivity 4xn. (incl. )teven ?ohnson )yndrome@) Kernicter!s in infants AdonBt !se in pre%nancy6 lactation (rystall!ria

Metabolism Metabolism
,xcreted via %lomer!lar filtration Cdr!%D in !rine. )pecial care in -idney dx5 renal fail!re dose

!istribution !istribution Adm" # CNS Adm" # CNS

Eell absorbed peritoneal6 ple!ral fl!ids F cross placenta. ()G

'lasmid mediated m!tations in D G4 (rare)

Trimethoprim
)inhibits metabolism/

!ue to dru& resistanc( combo therap% is recommende )i"e" isonia*id( ri ampin( and p%ra*inamide +ith ethambutole i resistance to isonia*id
*selectivity= affinity for bacterial dihydrofolate reductase (#$%%%). (bactericidal) Activated by mycobacterial KAT G (a catalase )tr!ct!ral analo% of D&ala D&ala "5 peroxidase). It rin%. binds to InhA (an enoyl intact lactam acyl carrierpeptido%lycan protein NAD crosslin-in% red!ctase). *.'revents InhA iscell involved in mycolic acid by d!rin% "all phase of synthesis sythesis and hence inhibits cell "all inhibitin% peptido&lycan transpeptidase. synthesis. 7. Activates murine hydrolase. *selectivity= cell 'all or (bactericidal) Inhibits initiation of transpeptidase tar&ets in humans transcription by bindin% to the s!b!nit of bacterial 4NA polymerase AdonBt !se in pre%nancy@ #!tation in InhA. $oss of KAT G activity *. lactamase inactivation. 7. Alterations in 'enicillin Bindin% 'roteins ('B') +. permeability to 'enicillin ('N(). #!tation of 4NA polymerase res!ltin% in affinity or permeability It penetrates macropha%es and is effective a%ainst intra and extre& Bacteriocidal. cell!lar or%anisms #ycobacteria Kansasii 'eripheral ne!ritis $iverdirect dama%e $o" toxicity (so Glossitisto bacteria). specific GIGI dist!rbance *. effects (diarrhea) Aller%ic rxn 7. Thrombophlebitis post I; (N) reversed by pyridoxine inHection +. (N) effects "5 very dose. .ran%e5red feces6 !rine6 0. )!perinfection saliva6 and s"eat colitis. pse!domembrano!s $iver dama%e imbalance. 1. ,lectrolyte GIH%persensiti4it% dist!rbance >. r2n" Aller%y (immediate6 accelerated6 delayed) H%persensiti4it% r2n" (cross .ptic ne!ritis reactive 'N( F ()) vis!al to ac!ity Aothers same as for 'N( red %reen vision aller%ic rxn &for very ill pt6 often !sed "5 exacerbate %o!t6 b!t less than amino%lycoside ris- of pyra:inamide nephrotoxicity. *. Thrombophlebitis6 chills6 $iver dama%e fever. GI dist!rbance 7. Ototo2ic" ,xacerbates %o!t more than Amonitor renal F a!ditory ethamb!tol f!nction d!rin% !se. (*&+ ho!rs) lon% or short is %enetically determined Aonly 71I of oral dose (ethnic) is Activity of absorbed inhepatic&N&acetyl small intestine transferase inactivaiton (remainder feces) ,xcreted via -idney 4apid excretion by -idney ('T secretion). J T K +2m8 ("5 renal dx F 'robenecid) (7&1 ho!rs8 deacylation) ,xcreted )pecial care in renal fail!re in bile and enterohepatic dose circ!lation $iver clearance Bs "5 renal dx

Bacteriostatic ("hen !sed alone) !ru&s' Golate deficiency. Anti$M%cobacterial Na!sea F vomitin%. 1 is bacteriocidal +hen used )-in er!ptions. (TB Treatment) +ith Sul ametho2a*ole )SM3/ (N) dist!rbances.

)pecial care in -idney dx5 renal fail!re dose

Isonia*id 0enicillin
)inhibits cell +all Ri ampin s%nthesis/

$eprae Kansasii

Ethambutol Cephalosporins
)inhibits cell +all s%nthesis/

)tr!ct!ral analo% of D&ala D&ala. (bacteriostatic) Inhibits arabin o%alactan 'revents peptido%lycan crosslin-in% sythesis (cell "all). This "ea-ens the d!rin% cell "all phase of synthesis "all and enhances lipophillic dr!%sby li-e inhibitin% peptido&lycan transpeptidase. 4ifampin

*. lactamase inactivation. 9n-no"n Ab!t are not as readily inactivated as penicillin@ 7. Alterations in 'enicillin Bindin% 'roteins ('B') +. permeability to (ephalosporin (()). 'lasma modification of $oss of mediated pyra:in amidase action6 D&ala D&ala to D&ala D&lactate6 "hich activates pyra:inamide. "hich can be !sed to elon%ate cell "all b!t canBt be affected by vancomycin (;().

Bacteriocidal. T!berc!losis #A( Kansasii

,xcretion by t!b!lar secretion F (0 ho!rs) !nchan%ed %lomer!lar filtration. -idney J T K +2m&7 hrs. ("5 renal dx F 'robenecid) )pecial care in renal fail!re dose M2I excreted by %lomer!lar Kidney filtration. )pecial care in renal fail!re dose. A T J K >&*2 days in anephric pt.8 not removed by hemodialysis. (+ ho!rs) 9nchan%ed Kidney

(oncentrates in prostate. 9rine/Blood *22 Ahas hi%her ;D than is s!lfonamides , -./ T#'/)#= of 0/72 is optimal .ral *. 'N( G/ .ral L Dr!% interaction/ administer on empty Al!min!m antacid stomach. decreases 7. 'N( ;/absorption. I; Decreases '012 A'N( concentrates in phenytoin toxicity -idney. .ral Dr!% interaction/ '012 .ther dr!% activity ("arfarin6 prednisone6 contraception6 methadone) st * F 7nd %eneration oral () penetrate tiss!e "ell.

(N)

3es 'oor (N) penetration not !sed for (N) infections.

+rd %eneration () penetrate (N) "ell

0%ra*inamide Vancom%cin
)inhibits cell +all s%nthesis/

Glycopeptide6 not a lactam. (bactericidal) 9n-no"n 'revents elon%ation of cellform6 "all by ydroly:ed into its active bindin% to D&ala end of the cell pyra:inoic acid. D&ala Tho!%ht to tar%et fatty "all b!ildin% bloc inhibits acid synthase I6 "hich converts peptido&lycan synthetase cell %lycolipid to mycolic acid.d!rin% ence6 the membrane . cell "all is phase affected Inhibits ala "acemase (prevents $&ala Inhibits bacterial protein synthesis by D&ala) D(ala D(ala Synthetase bindin% to and ribosomes (D&ala D&ala formation) d!rin% cytoplasmic synthesis phase.

Bacteriocidal. 'enetrates the macropha%e lysosome beca!se it operates best at lo" p A used to t2 pseudomembranous T!berc!losis colitis )metronida*ole can also be used to do this/ Bacteriocidal. 'oor diff!sion across plasma membrane. ence6 it only affects extracell!lar t!berc!losis. 1contraindicated in pt5s +ith histor% o epileps% or mental instabilit%" Bacteriocidal. Atypical mycobacteri!m that affects I; < #A( Kansasii

I; .ral If %iven rapidly6 ca!ses fl!shin% (histamine release).

Streptom%cin C%loserine
)inhibits cell +all s%nthesis/

'oint m!tation in ribosome

*. (N) effects (conf!sion6 ;estib!lar f!nction coma) earin% loss 7. 'eripheral ne!ritis. Aller%ic rxn +. $iver dama%e. 4ash 0. Golate deficiency. 4enal dama%e 1. #alabsorption syndrome.

.ral I#

(N)

Ri abutin Bacitracin
)inhibits cell +all s%nthesis/

Inhibits re%eneration of the lipid carrier6 (bactericidal) Inhibits initiation of "hich is responsible for transportin% transcription by bindin% to the the s!b!nit peptido%lycan prec!rsors across cell of bacterial 4NA polymerase membrane..

#!tation of 4NA polymerase res!ltin% in affinity or permeability

GI dist!rbance 4ash Discolor body fl!ids

(0&1 ho!rs) #etaboli:ed by liver ,xcreted in feces and !rine

9sed topically b5c .ral oral !se is toxic. D!r% interaction/ '012 Thereby6 other dr!%t concentrations li-e A=T $imited F slo" oral absorption. #!st be %iven parenteral (I;) in C)#D. Acc. in ple!ral6 pericardial6 synovial fl!ids F fet!s.

Streptom%cin
)inhibits protein s%nthesis/

Binds at5near domain of )*7 protein on bacterial +2). *. Allo"s N2) initiation complex to form b!t inhibits it from movin% alon% m4NA. 7. prevents peptide elon%ation (prevents bindin% of aminoacyl t4NA) +. disr!pts bacterial cell membrane *selectivity= )%s only in bacteria

*. #!tation in )*7 protein in +2) s!b!nit 7. 'lasmid mediated acetylation6 adenylation6 F phosphorylation inactivates the dr!%.

Bacteriocidal. 1 has lo+ TI must monitor6 to2icit% +# prolon&ed use )78$9 da%s/6 to2icit% +# CN VIII" 11used rarel% b#c lots o resistance to it no+"

*. Vestibular toxicity (di::iness6 verti%o) O ototo2icit% (deafness). 7. Nephroto2icit%" +. M%oneural bloc:ade Arare 0. 4ash5fever post parenteral administration.

No metabolism. ,xcretion by %lomer!lar filtration. T J K 7 hrs. ("5 renal dx F a%e) adH!st dose. )elective acc!m!lation in 'T of -idney6 endo F perilymph of hair cells.

$ittle ()G penetration.

!apsone

'ABA a%onist. ence6 folic acid biosynthesis is bloc-ed. 'rod!ction of methionine6 serine6 p!rines6 and N forml met 4NA are inhibited

C'ABAD ,n:yme m!tation

$eprae

4ash emolytic anemia GI dist!rbance $iver dama%e 'eripheral ne!ropathy

,limiated in free form and %l!c!ronide Kidney

.ral

Clo a*imine

Binds to DNA and inhibits template f!nction and prod!ction of cytotoxic oxy%en radicals.

Ne".

ence6 fe" cases -no"n

$eprae

4ed discolori:ation o s-in6 !rine6 sp!t!m6 and s"eat GI dist!rbance

.ral

Thalidomide

9n-no"n Gl!tamin acid derivative It has anti&inflammatory and imm!no& mod!latin% effects

Ne"

,rethema Nodos!m lepros!m $eprae

Terato%en 'eripheral ne!ropathy )edation (onstipation

9n-no"n

.ral

Anti$;un&al A&ents' Antibiotic

(classification) Amphotericin B (polyene) N%statin (polyene)

Mechanism
Binds to er%osterol of the cell membrane and ma-es a pore that allo"s ionic fl!x and cell lysis

Resistance
4are

Antibacterial Spectrum
9sef!l a%ainst all f!n%i6 b!t !se limited to systemic 'ro%ressive infections $ife threatenin% infection Asper%ill!s

Side E ects
Ac!te febrile rxn !pon inf!sion 4enal dama%e A:otemia ypo-alemia Thrombophlebitis Anorexia Aller%ic rxn GI dist!rbance

Metabolism
M2I protein bo!nd )lo" I;

!istribution Adm" # CNS

No

Binds to er%osterol of the cell membrane and ma-es a pore that allo"s ionic fl!x and cell lysis

4are

)!perficial mycosis #ostly candida

Topical

No

;luc%tosine (pyrimidine)

<etocona*ole (imida:ole)

Deaminated by cytosine deaminase to 1 fl!oro!racil and anaboli:ed into a n!cleotide6 1&Gd9#' or 1&G9T'. The n!cleotide binds to thymidilate synthetase and deprives the cell of thymidilic acid6 an essential DNA component. 1&G9T' incorporates into 4NA and disr!pts n!cleic acid and protein synthesis. (G!n%icidal) 4ed!ction of er%osterol synthesis by inhibition of f!n%al '012. The sterol affected is *0 demethylase. The res!lt is a disr!ption of the membrane permeability and f!nction.

$oss of cytosine permease 9#' phophorlyase or cytosine deaminase

(rytococc!s Neoformans )ome candida (hromobastomycosis (dermitacio!s mold)

Intestinal conversion to fl!oro!racil ca!ses bone marro" toxicity6 le!-openia6 thrombocytopenia GI dist!rbance

9nchan%ed Kidney

.ral

3es

)!perficial #!coc!taneo!s candidiasis Non&menin%ial coccidiodomycosis

)ele tive than ne" a:oles '012 Adrenal and %onadal steroids (man&boobs) Na!sea6 vomit6 pr!iritic6 GI6 verti%o6 headache6 fever6 chill epatotoxicity

,xtensive liver metabolism ,xcreted into bile 4ifamyc hepatic metabolism

%astric p reP!ired for .ral absorption

No

Clotrima*ole (imida:ole)

(G!n%icidal) 4ed!ction of er%osterol synthesis by inhibition of f!n%al '012. The sterol affected is *0 demethylase. The res!lt is a disr!ption of the membrane permeability and f!nction.

)!perficial mycosis

,rythema 'r!ritis B!rnin% GI irritation

Topical .ral

Antibiotic
(classification) Micona*ole (imida:ole) ;lucona*ole (tria:ole) Itracona*ole (tria:ole) Terbina ine (allylamine) =riseo ul4in (%risan)

Mechanism
(G!n%icidal) 4ed!ction of er%osterol synthesis by inhibition of f!n%al '012. The sterol affected is *0 demethylase. The res!lt is a disr!ption of the membrane permeability and f!nction

Resistance

Antibacterial Spectrum
)!perficial mycosis

Side E ects
B!rnin% Irritation

Metabolism
Topical

!istribution Adm" # CNS

(G!n%icidal) 4ed!ction of er%osterol synthesis by inhibition of f!n%al '012. The sterol affected is *0 demethylase. The res!lt is a disr!ption of the membrane permeability and f!nction.

.ral and esopha%eal candidiasis )!perficial mycosis ("idest of a:oles) (ryptococcal menin%itis Dimorphic f!n%i

Q side effects than imida:ole No interaction "ith liver en:yme GI ypo-alemia ,dema ypertension Interat "ith some hepatic en:ymes GI ypo-alemia ,dema ypertension Irritation

9nchan%ed Kidney

.ral I;

3es

(G!n%icidal) 4ed!ction of er%osterol synthesis by inhibition of f!n%al '012. The sterol affected is *0 demethylase. The res!lt is a disr!ption of the membrane permeability and f!nction.

Dimorphic/ blastomycosis6 histoplasma6 sporothrix #ost potent of tria:ole6 b!t bioavailability Q "th rifampin Asper%ill!s Dermatophytosis .nchomycosis )!perficial mycosis R* dermatophyte .nchomycosis

$iver ,xcreted in bile and !rine

.ral

Inhibits the en:yme sP!aline epoxidase "hich inhibits er%osterol prod!ction and cell "all inte%rity

Topical

#ytotic inhibitor Binds to microt!b!les to bloc- assembly and f!nction

)!perficial mycosis

GI dist!rbance Aller%ic rxn 'hotosensitivity Ind!ce '012. o"ever6 it tar%ets -eratin cells and effects are minimal eadache

$iver ,xcreted in feces and !rine

.ral

'ne!mocystic carinni pne!monia Blastomycosis

0entamidine
'ne!mocystic carinni pne!monia Blastomycosis

Ato4a>uone

Anti$;un&al A&ents' )continued/

+

Cell Wall Inhibitors' !istribution Adm" # CNS

0arentall% !s!ally I; or I#6 not orally b5c stomach p inactivates N1I 0oor CNS penetration6 !nless the menin%es are inflamed L as "ith infection

Antibiotic
(classification)

Mechanism

Resistance

Antibacterial Spectrum
Narro" )pectr!m & 'rimarily active a%ainst =pos aerobes and anaerobes

Side E ects
Ao+ direct to2icit% b5c tar%et is spec to bact & GI6 Thrombophelbitis after I;6 (N) "5 very hi%h doses6 )!perinf (). enterocolitis)6 pse!domembrano!s colitis6 Ne!tropenia6 ,lectrolyte imbalance (K<5 Na< "5 I; doses)6 (;5ne!ro toxicity "5 renal impairment H%persensiti4it% r2ns 1111 Immediate (2&+2 min) L rare ac!te anaphylactic rxn & I%, mediated Also/ !rticaria6 an%ioedema6 rhinitis6 asthma6 laryn%eal edema Accelerated (*&N7 hrs) & similar (b!t6 severe anaphylaxis6 hypotension6 death are rare) Delayed 4eactions (+&+2 days) L self&limitin% L mostly rashes Also/ ser!m sic-ness6 hemolytic anemia6 thrombocytopenia6 nephropathies6 )tevens&?ohnson syn6 exfoliatave dermatitis Cross$h%persensiti4it% occ!rs "ith all the penicillins L ie yo! are sensiti:ed to other ',NBs and cephalosporins

Metabolism
& 71I of oral dose absorbed L th!s !s!ally %iven parentally & "ide distrib!tions in body L conc in -idney & excreted by :idne% mainly 0T $ t?#@ B 8C min6 probenecid slo"s excretion & liver inactivation minor !nless renal dysf!nction

0enicillin =

& (idal ?/ Inhibits peptido&l%can transpeptidase (a 'B' that forms crosslin-s b5t NA#5NAG in the cell "all) & mimics the D&ala&D&ala end of NA# (!s!al s!bstrate) bindin% covalently to the en: and inhibitin% it @/ activates endo%eno!s a!tolytic en:yme murein h%drolase "hich de%rades the cell "all f!rther

Beta$lactamase & hydroly:es the beta&lactam bond & most common esp in Gpos & Gpos secrete o!tside cell "all & Gne% -eep in periplasmic space !ecreases perm to 0EN & Gne% can chan%e the porin so it dosent let ',N in Alterations in 0B0 s!ch as alterin% the transpeptidases L ex is #4)A

& a ',Nase resistant ',N

& #4)A

Na cillin
& an aminopenicillin L extended spectr!m & inactivated by beta&lactamase

& (an -ill ',Nase prod!cin% Gpos (',Nase prod!cin% strains of ). a!re!s) & Ineffective a%ainst Gne% & Gpos & effective a%ainst some Gne% AA

& very rare ca!se of hepatitis

& mainly biliary excretion

0arentall% d!e to variable GI absorption

Ampicillin
& an aminopenicillin L extended spectr!m & inactivated by beta&lactamase

& GI distress6 diarrhea & delayed reactions & s-in rashes (mac!lopap!lar5!rticaria) & mac!lopap!lar L StoxicT rxn "5o imm!ne basis & !rticaria & tr!e ',N hypersensitivity rxn & better tolerated than Ampicillin

& acid stabile and "ell absorbed via =I

& same as Ampicillin

Amo2icillin
& an Antipse!domonal ',N L (also has an extended spectr!m) & !sef!l in tx of septicemia d!e to s!sceptible or%anisms in patients "ith impared imm!ne defenses (%iven "ith an amino%lycoside) & (lav!lanic acid inhibits beta&lactamase b!t has no intrinsic anti&microbial activity A & "hen %iven "ith a ',N the spectr!m of ',N is extended & inactivated by beta&lactamase & Gpos & enhanced activity a%ainst select Gne% (esp 'se!domonas)

& better =I absorption than Ampicillin (almost completely absorbed) & food does not impair absorption & 0arentall% (inactivated by %astric p )

0iperacillin
Cla4ulonic acid 7 beta$lactam a&ent

& note/ not all beta&lactamases are bloc-ed by (lav!lonic acid & resistance can occ!r by a mech other than beta&lactamase prod!ction

& Gpos & Beta&lactamse prod!cin% strains of ). a!re!s & Gne% bacilli

Vancom%cin

& Inhibits peptido&l%can s%nthetase (en: that extends the cell "all) by bindin% to the D&ala&D&ala termin!s of disaccharide b!ildin% bloc-s and bloc-in% their addition to the %ro"in% peptido%lycan strands & note/ this is not a Beta&lactam antibiotic

& 'lasmid&mediated modification of D&ala&D&ala to D&ala&D&lactate "hich can be incorporated into the peptido%lycan stands L this doesnBt affect str!ct!ral inte%rity of the cell "all & Gro"in% n!mber of ;( resistant strains of ,nterococci and #4)A

& Gpos Incl!din%/ & #4)A & )trep pne!moniae strains resistant to beta&lactams

& GreP!ent/ Thrombophlebitis8 chills and feber & .totoxic L esp in lar%e5contin!o!s doses6 in the presence of renal dama%e or in the elderly L esp if co&administered "ith another ototoxic dr!% & ne!tropenia6 renal dama%e & #onitor renal and a!ditory f!nction !se.

& ,xcreted via -idney

& =i4en IV( not absorbed orall%. & %iven orally to tx (. dificile

Antibiotic
(classification) Cipro lo2acin (fl!oroP!inolone)

Mechanism
Inhibit DNA Gyrase and Topoisomerase

Resistance
#!tation in Gyrase ,ffl!x

Antibacterial Spectrum
Gram Ne% Gram 'os not some anaerobes #ycobacteria

Side E ects
Inhibit GABA (N) effects

Metabolism
4,NA$ .ral

!istribution Adm" # CNS

(N) ,GG,(T)

Inhibit DNA Gyrase and Topoisomerase

Nor lo2acin (fl!oroP!inolone) Nitro urantoin (!nrinary antiseptic) Methenamine (!rinary antiseptic)
9n-no"n DNAU .xy%en free radicalU

#!tation in Gyrase ,ffl!x

Gram Ne% 'oor tiss!e penetration 9TI only

Inhibit GABA (N) effects

4,NA$

.ral

(N) ,GG,(T)

)lo" resistance 4are

Gram 'ost Ge" Gram Ne% Not 'se!domonas or 'rote!s

Bro"n 9rine Na!sea and ;omitin% '!lmonary Gibrosis

4,NA$

.ral

Decomoses at p V1.1 to G.4#A$D, 3D,

4are

#ost Bacteria ,xcept !rease splittin% bacteria ie. 'rote!s

Toxic to GI Bladder irritation

4,NA$

.ral

>

Miscellaneous Anti$Bacterial !ru&s' Antibiotic

(classification)

Mechanism
binds 12 ) and inhibits peptidyl transferase no protein elon%ation Binds $*1 protein of 12) and bloc-s translocation from the A site to the ' site

Resistance
'lasmid ma-es (AT (cholrampenicol acetyl transferase) acetylation inactivation 'lasmid/ methylation6 decrease permeability6 hydrolysis by esterases (hromosomal/ alternation of 12s protein at ,#& bindin% site 'lasmid/ methylation6 decrease permeability6 hydrolysis by esterases (hromosomal/ alternation of 12s protein at ,#& bindin% site 'lasmid/ methylation6 decrease permeability6 hydrolysis by esterases (hromosomal/ alternation of 12s protein at ,#& bindin% site

Antibacterial Spectrum
Ne4er irst choice6 b!t !sed for salmonella6 h. fl! (menin%ial inf.) and GN aerobes that ca!se brain abscesses *. corny infections 7. chlamydial infections +. (A pne!monia Gram positives (pneumococci* strep* staph and corny)8 pne!monia from myco and le&ionella (ombo therapy for AID)6 #A( (myco avium)6 strep and myco and le&ionella pne!monia

Side E ects
4apid and complete absorption6 especially to (N)6 inhibits p0126 ca!ses hepatic ins!fficeintcy Abdominal crampin%6 increase stomach motility6 cholestatic hepatitis6 ototoxicity

Metabolism
,xcreted M2I as non&toxic %l!c!ronide by t!b!lar secretion6 *2I as parent dr!% Activity enhanced at al-aline p 8 absorption inhibited by food8 concentrated in liver and excreted in bile More stable to acid than EM( lon&er hal li e than ,# t"ice daily dosin%8 metaboli:ed in liver6 excreted by -idney .nce daily dosin%( no dru&$ dru& interactions

!istribution Adm" # CNS

.phthalmic sol!tion and ointment 3es L !sed for treatment of menin%ial infections and brain abcesses No

Chloramphenicol

Er%throm%cin )EM/

.rally or parentally (I; as ,# %l!ceptate or ,# lactobionate ) .rally

Clarithrom%cin

Binds $*1 protein of 12) and bloc-s translocation from the A site to the ' site

GI probs6 inhibits p0126 terato%enic

No

A*ithrom%cin

Binds $*1 protein of 12) and bloc-s translocation from the A site to the ' site

(ombo therapy for AID)6 #A(* strep6 myco and le&ionella pne!monia6 chlamydia

GI6 reversible hearin% loss "hen !sed to treat #A( No inhibition o p-9C

orally

No

Clindam%cin )CAM/

Binds $*1 protein of 12) and bloc-s translocation from the A site to the ' site

Metronida*ole )MTN/

In anaerobes6 bacterial nitrored!ctase forms red!ced #TN "hich disr!pt bacterial DNA Binds 7+) of 12) and prevents formation of f!nctional N2)

'lasmid/ methylation6 decrease permeability6 hydrolysis by esterases (hromosomal/ alternation of 12s protein at ,#& bindin% site $o" nictrored!ctase lo" red!ced #TN red!ced bacterial disr!ption

Anaerobic infections (b. fra&ilis)* staph and strep 'rophylaxis of endocarditis "5 valv!lar heart disease8 penetratin% "o!nds $. +iardiasis* ,mebiasis* Trichomoniasis7. Anaerobic infections (b. fra&iles) + pse!domembrano!s colitis from c. difficile Aast resort treatment for vancomycin&resistant enterococcus* staph and strep (%ram <Bs)

pse!domembrano!s colitis (c. difficile)

Absorbed in liver

.rally and parentally

No

Metallic taste6 na!sea6 headache6 dar: reddish$bro+n urine( inhibits p012

#etaboli:ed by liver

oral

3es

4are/ m!tation of bindin% site

Aine*olid

S%nercid )8C.Euinupristin # FC.!al opristin/

W!in!pristin binds the 12)6 Dalfopristin binds nearby and enhances bindin% protein synthesis inhibition

#odification of P!ni!pristin bindin% site (#$)&B type)

vancomycin&resistant enterococcus faecium (not faecalis)* staph and strep (%ram <Bs)

Diarrhea6 na!sea( not or pts +ith 0<D( doesn5t inhibit p-9C( fatal if ta-en "ith tyramine (inhibits monoamine oxidase)6 administer pse!dophedrome and ))4IBs "ith ca!tion 'ain6 inflammation6 arthral%ias6 myal%ias6 increased conH!%ated bilir!bin6 pse!domembrano!s colitis

#etaboli:ed by liver

.rally (s!spension "ith phenylalani ne) and parentally

#etaboli:ed by liver

I;