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Penicillins
Derived from Penicillium fungi
All penicillins are -lactam antibiotics
Oldest known antibiotic
Subtypes
Natural Penicillins
Penicillinase-resistant Penicillins
Methicillin, Oxacillin
Aminopenicillin extended spectrum, wider
coverage
Ampicillin, Amoxicillin
Disrupt the
synthesis of
the
peptidoglycan
layer of
bacterial cell
walls
Narrow-spectrum
-lactamase sensitive
-Benzathine penicillin
-Benzylpenicillin
(penicillin G)
-Phenoxymethylpenicillin
(penicillin V)
-Procaine penicillin
Penicillinase-resistant
penicillins
-Methicillin
-Oxacillin
-Nafcillin
-Cloxacillin
-Dicloxacillin
-Flucloxacillin
-lactamase-resistant
penicillins
-Temocillin
Moderate-spectrum
-Amoxicillin
-Ampicillin
Broad-spectrum
Co-amoxiclav
(amoxicillin+clavulanic
acid)
Extended-spectrum
-Azlocillin
-Carbenicillin
-Ticarcillin
-Mezlocillin
-Piperacillin
Wide range of
infections;
penicillin used for
streptococcal
infections, syphilis,
and Lyme disease
Side effects
Gastrointestinal
upset and diarrhea
Allergy with serious
anaphylactic
reactions
Brain and kidney
damage (rare)
Pregnancy Category
B
Cephalosphorins
Beta-lactam ring structure (similar to Penicillins)
Derived from cephalosporin C which is produced from
Cephalosporium acremonium
Widely used for surgical prophylaxis
Grouped into generations
First Generation
Most gram positive, few gram negative
Cefazolin, Cephalexin,, Cephapirin
Second Generation
Gram positive, expanded gram negative
spectrum
Cefaclor, Cefuroxime, Cefonicid
Third Generation
Expanded gram negative spectrum, less
gram positive
Cefixime, Ceftriaxone, Cefotaxime
Fourth Generation
Extended coverage on both spectrums,
can cross BBB
Greater resistance to beta lactamases
than 3
rd
generations
Cefepime,Cefpirome, Cefclidine
Disrupt the
synthesis of
the
peptidoglycan
layer of
bacterial cell
walls
Good coverage against
Gram positive infections
Less gram positive cover,
improved gram negative
cover
Improved coverage of
Gram negative
organisms, except
Pseudomonas. Reduced
Gram positive cover
Covers pseudomonal
infections, extended
coverage on both
spectrums, can cross
BBB, greater resistance
to beat lactamases than
3
rd
generation
Treatment of
bacterial infections
caused by
susceptible
organisms
Surgical prophylaxis
(1
st
Generation)
Skin & Soft Tissue
Infections (SSTI)
Upper Respiratory
Tract Infections
(2
nd
Generation)
Community Acquired
Pneumonia
Bronchitis, Sinusitis,
Otitis
Skin & Soft Tissue
Infections (SSTI)
MSSA
Abdominal Surgical
Prophylaxis
(3
rd
Generation)
Community acquired
pneumonia
Bacterial meningitis
(except Listeria)
Lyme disease
Viridans strep
endocarditis
Intra-Abdominal &
Pelvic Infections
Hospital Acquired
Pneumonia
Anogenital
gonorrhea
510% of patients with
hypersensitivity to
penicillins will have cross-
reactivity with
cephalosporins
Side effects
Gastrointestinal
upset and diarrhea
Nausea (if alcohol
taken concurrently)
Allergic reactions
Pregnancy Category
B
Flouroquinolones
Contains the root floxacin
Ciprofloxacin, Ofloxacin, Levofloxacin,
Norfloxacin
Inhibit the
bacterial DNA
gyrase or the
topoisomerase
IV enzyme,
thereby
inhibiting DNA
replication
and
transcription
Broad Spectrum
Urinary tract
infections,
bacterial
prostatitis,
community-
acquired
pneumonia,
bacterial diarrhea,
mycoplasmal
infections,
gonorrhea
Side effects
Nausea (rare),
irreversible
damage to central
nervous system
(uncommon),
tendinosis (rare)
Pregnancy
Category C
Tetracyclines
Four rings in chemical structure
Derived from a species of Streptomyces bacteria
Malaria prophylaxis
Tetracycline, Doxycycline, Minocycline
Inhibiting the
binding of
aminoacyl-
tRNA to the
mRNA-
ribosome
complex. They
do so mainly
by binding to
the 30S
ribosomal
subunit in the
mRNA
translation
complex
Broad Spectrum Acne treatment,
Syphilis, chlamydial
infections, Lyme
disease,
mycoplasmal
infections, acne
rickettsial
infections
Side effects
Gastrointestinal
upset
Sensitivity to
sunlight
Potential toxicity to
mother and fetus
during pregnancy
Enamel hypoplasia
(staining of teeth;
potentially
permanent)
transient
depression of bone
growth
Pregnancy Category
D
Macrolides
Derived from Streptomyces bacteria
Have a macrocyclic lactone chemical structure
Erythromycin prototype of this class
Clarithromycin, Azithromycin, Roxithromycin
Inhibition of
bacterial
protein
biosynthesis
by binding
reversibly to
the subunit
50S of the
bacterial
ribosome,
thereby
inhibiting
translocation
of peptidyl
tRNA
Broad Spectrum
Active against gram-
positive cocci (mainly
staphylococci and
streptococci) and
bacilli, and to lesser-
extent gram-negative
cocci
Streptococcal
infections, syphilis,
upper respiratory
tract infections,
lower respiratory
tract infections,
mycoplasmal
infections, Lyme
disease
Nausea, vomiting,
and diarrhea
(especially at higher
doses)
Prolonged QT
interval (especially
erythromycin)
Jaundice (used with
caution in patients
with liver
dysfunction
Pregnancy Category
C
Aminoglycosides
Derived from various species of Streptomyces
used along with penicillins or cephalosporins
Amikacin, Gentamicin, Kanamycin, Neomycin,
Streptomycin, Tobramycin
Binding to the
bacterial 30S
ribosomal
subunit (some
work by binding
to the 50S
subunit),
inhibiting the
translocation of
the peptidyl-
tRNA from the
A-site to the P-
site and also
causing
misreading of
mRNA, leaving
the bacterium
unable to
synthesize
proteins vital to
its growth
Broad Spectrum
Infections caused
by Gram-negative
bacteria, such as
Escherichia coli and
Klebsiella
particularly
Pseudomonas
aeruginosa.
Effective against
Aerobic bacteria
(not
obligate/facultative
anaerobes) and
tularemia
The major side
effect is ototoxicity.
Streptomycin and
Gentamicin are
vestibulotoxic,
Amikacin,
Neomycin,
Dihydrostreptomyci
n, and Kanamicin
are cochleotoxic
Pregnancy Category
D