Antibiotics
Bactericidal: kill bacteria Bacteriostatic: limit bacterial growth and replication Tetracyclines : Cat D: doxycycline, minocycline, tetracycline Bacteriostatic
Cause permanent discoloration of teeth and skeletal defects if taken in last ½ of pregnancy, in infancy, or by kids younger than 9
Can treat acne starting at age 13-14 because all permanent teeth have erupted Photosensitivity (wear sunblock), esophageal ulceration (swallow w/ full glass of water), vertigo (minocycline- goes away after 1-2 after d/c) Give tetracycline for moderate inflammatory acne that doesn’t respond to prescription topicals after 2-3 months Take on empty stomach- 1 hr before or 2 hrs after a meal. Antacids and bile sequestrants and sucralfate can decrease absorption Can decrease effectiveness of birth control! Throw away expired meds- it degenerates For mild acne: start with OTC topicals (salicylic acid) and benzoyl peroxide If it doesn’t respond: prescription topicals (benzoyl peroxide, erythromycin/benzamycin), tretinoin (Retin-A), azelaic acid cream Macrolides : Cat B: erythromycin, azithromycin, clarithromycin (Cat C) Bacteriostatic
Gram + cocci- Staph aureus, Strep pyogenes, and atypical bacteria Erythromycin & clarithromycin= CYP34A inhibitors- potent
Azithromycin- fewer drug interactions Adverse effects: GI distress (nausea, vomiting, diarrhea), ototoxicity, cholestatic jaundice, QT prolongation Contraindication: Myasthenia gravis (respiratory failure)
Interactions: anticoagulants (can prolong INR), antacids (decrease effectiveness), calcium channel blockers, benzos, asthma meds (Salmeterol, Theophylline), Tegretol, phenytoin, ergotamine, statins, Digoxin Consider macrolide resistant S. pneumoniae if pt was on macrolide in the previous 3 months Cephalosporins : Cat B (beta-lactam family)
Bactericidal 1st generation: gram + cocci (group A step, Staph aureus): Keflex
NOT EFFECTIVE against MRSA Increased risk of cross sensitivity if allergy to PCN- especially if they have a true allergy (anaphylaxis, angioedema= IgE mediated reactions)
Indications: Pregnancy UTI, skin- cellulitis not caused by MRSA, impetigo Would give this for pregnant woman with UTI in her 3rd trimester- remember this because in the third trimester you Kick the baby out 2nd generation: “broad spectrum”: Cefuroxime, Cefprozil, Cefaclor (avoid- doesn’t cover common pathogens)
Gram + cocci (strep pneumoniae) and gram – (Haem. Influenzae, moraxella catarrhalis) ex. Rhinosinusitis or AOM Indications: rhinosinusitis, ARM, CAP, exacerbation of chronic bronchitis
3rd generation: less effective against gram + compared to 1 st generation: Ceftriaxone, Cefixime, Cefdinir Better protection against enterobacteria and gram – bacteria Rocephin: 1st line for gonorrhea Indications: PID, pyelonephritis, AOM in kids, rhinosinusitis, AOM, CAP MRSA skin infections (boils, abscesses): 1 st line= Bactrim DS, doxy, or minocycline and clindamycin. Treat for at least 5-10 days
Bactericidal: kill bacteria Bacteriostatic: limit bacterial growth and replication Tetracyclines : Cat D: doxycycline, minocycline, tetracycline Bacteriostatic
Cause permanent discoloration of teeth and skeletal defects if taken in last ½ of pregnancy, in infancy, or by kids younger than 9
Can treat acne starting at age 13-14 because all permanent teeth have erupted Photosensitivity (wear sunblock), esophageal ulceration (swallow w/ full glass of water), vertigo (minocycline- goes away after 1-2 after d/c) Give tetracycline for moderate inflammatory acne that doesn’t respond to prescription topicals after 2-3 months Take on empty stomach- 1 hr before or 2 hrs after a meal. Antacids and bile sequestrants and sucralfate can decrease absorption Can decrease effectiveness of birth control! Throw away expired meds- it degenerates For mild acne: start with OTC topicals (salicylic acid) and benzoyl peroxide If it doesn’t respond: prescription topicals (benzoyl peroxide, erythromycin/benzamycin), tretinoin (Retin-A), azelaic acid cream Macrolides : Cat B: erythromycin, azithromycin, clarithromycin (Cat C) Bacteriostatic
Gram + cocci- Staph aureus, Strep pyogenes, and atypical bacteria Erythromycin & clarithromycin= CYP34A inhibitors- potent
Azithromycin- fewer drug interactions Adverse effects: GI distress (nausea, vomiting, diarrhea), ototoxicity, cholestatic jaundice, QT prolongation Contraindication: Myasthenia gravis (respiratory failure)
Interactions: anticoagulants (can prolong INR), antacids (decrease effectiveness), calcium channel blockers, benzos, asthma meds (Salmeterol, Theophylline), Tegretol, phenytoin, ergotamine, statins, Digoxin Consider macrolide resistant S. pneumoniae if pt was on macrolide in the previous 3 months Cephalosporins : Cat B (beta-lactam family)
Bactericidal 1st generation: gram + cocci (group A step, Staph aureus): Keflex
NOT EFFECTIVE against MRSA Increased risk of cross sensitivity if allergy to PCN- especially if they have a true allergy (anaphylaxis, angioedema= IgE mediated reactions)
Indications: Pregnancy UTI, skin- cellulitis not caused by MRSA, impetigo Would give this for pregnant woman with UTI in her 3rd trimester- remember this because in the third trimester you Kick the baby out 2nd generation: “broad spectrum”: Cefuroxime, Cefprozil, Cefaclor (avoid- doesn’t cover common pathogens)
Gram + cocci (strep pneumoniae) and gram – (Haem. Influenzae, moraxella catarrhalis) ex. Rhinosinusitis or AOM Indications: rhinosinusitis, ARM, CAP, exacerbation of chronic bronchitis
3rd generation: less effective against gram + compared to 1 st generation: Ceftriaxone, Cefixime, Cefdinir Better protection against enterobacteria and gram – bacteria Rocephin: 1st line for gonorrhea Indications: PID, pyelonephritis, AOM in kids, rhinosinusitis, AOM, CAP MRSA skin infections (boils, abscesses): 1 st line= Bactrim DS, doxy, or minocycline and clindamycin. Treat for at least 5-10 days
