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Topicupdatedon02/17/1512:52pm

11

OverviewofByMechanism

FatEmbolismSyndrome
Thromboembolism(PE&DVT)
Anticoagulation
NeurologicDiseases
MultipleSclerosis
AmyotrophicLateralSclerosis
(ALS)
ComplexRegionalPain
Syndrome(CRPS)
SystemicDiseases
RheumatoidArthritis
SystemicLupusErythematosus
(SLE)
LymeDisease
AcuteRheumaticFever
MetabolicDisease

Hypercalcemia

PENICILLINS CEPHALOSPORINS FLUOROQUINOLONES AMINOGLYCOSIDES MONOBACTAMS CARBAPENEMS MACROLIDES

OTHER

Hypocalcemia
Hypoparathyroidism

Natrual

Firstgeneration

Hyperparathyroidism

Ciprofloxacin(Cipro)

Amikacin

Ertapenem

Azithromycin

Levofloxacin

Gentamicin

Aztreonam

Imienem

Clarithromycin Rifampin

Vancomycin

Meropenem

PenicillinG

Cephalothin

(Levaguin)

Kanamycin

Dirithromycin

Doxycycline

PenicillinVK

Cefazolin(Ancef,

Moxifloxacin(Avelox)

Neomycin

Erythromycin

Linezolid

Pseudohypoparathyroidism

Kefzol)

Norfloxacin

Tobramycin

Clindamycin Tetracycline

Scurvy

Cephapririn

Trimethoprim/

Cephalexin(Keflex)

sulfamethoxacole

Hypophosphatasia

other

Medications&Toxicity
Penicillinase

Medications
Bisphosphonates

SecondGeneration

Resistant
Methicillin

Cefacor

Nafcillin

Cefotetan(Cefotan)

AntibioticClassification&
Mechanism

Oxacillin

other

AntiinflammatoryMedications

Aminopenicillins

AnalgesicMedications

Ampicillin

ProphylaxisAntibiotics

other

(Rocephin)

Anesthesia
PlateletRichPlasma

other

Toxicology
LeadToxicity

ThirdGeneration
Ceftriaxone

FourthGeneration
Cefpirome

Cefepime

ClinicalScience
ClinicalStudies

AntibioticGroupingByMechanism
CellWallSynthesis

StatisticDefinitions
LevelofEvidence
ClinicalTrialDesign
OutcomeMeasureTools
HealthcareWorplace
OccupationalHealth

Penicillins
Cephalosporins
Vancomycin
BetalactamaseInhibitors
Carbapenems
Aztreonam
Polymycin
Bacitracin

ProteinSynthesisInhibitors

LegalandEthics
JobBank

http://www.orthobullets.com/basicscience/9059/antibioticclassificationandmechanism

Inhibit30sSubunit
Aminoglycosides(gentamicin)
Tetracyclines
Inhibit50sSubunit

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Inhibit50sSubunit
Macrolides
Chloramphenicol
Clindamycin
Linezolid
Streptogramins
DNASynthesisInhibitors

Fluoroquinolones
Metronidazole

RNAsynthesisInhibitors

Rifampin

MycolicAcidsynthesisinhibitors

Isoniazid

FolicAcidsynthesisinhibitors

Sulfonamides
Trimethoprim

AntibioticClassification&Indications

InhibitsCellWallSynthesis
Penicillins
(bactericidal:blockscrosslinkingviacompetitiveinhibitionofthetranspeptidaseenzyme)
Class/Mechanism

Drugs

Indications(**Drugof
Choice)

Toxicity

Penicillin

PenicillinG
AqueouspenicillinG
ProcainepenicillinG
BenzathinepenicillinG
PenicillinV

Aminopenicillins

Ampicillin
Amoxicillin

Penicillinaseresistant
penicillins

Methicillin
Nafcillin
Oxacillin
Cloxacillin
Dicloxacillin

Above+
PCNase
producingStaph.
aureus

Above+
Interstitialnephritis

Antipseudomonal
penicillins

Carbenicillin
Ticarcillin
Piperacillin

Above+
Pseudomonas
aeruginosa**

Above

Hypersensitivity
Strep.pyogenes
reaction
(Grp.A)**
Hemolyticanemia
Step.agalactiae
(Grp.B)**
C.perfringens(Bacilli)**

Above+
Gramnegative:
E.faecalis**
E.Coli**

Above

Cephalosporins
(bactericidal:inhibitsbacterialcellwallsynthesisviacompetitiveinhibitionofthetranspeptidaseenzyme)
1stgeneration

Cefazolin
Cephalexin

Staph.aureus**
Allergicreaction
Staph.epidermidis**
Coombspositive
SomeGramnegatives: anemia(3%)
E.Coli
Klebsiella

2ndgeneration

Cefoxitin
Cefaclor
Cefuroxime

Above+
Gramnegative

AllergicReaction
ETOHDisulfiram
reaction

3rdgeneration

Ceftriaxone
Cefotaxime
Ceftazidime
Cefepime(4thgeneration)

Above+
Gramnegative
Pseudomonas

AllergicReaction
ETOHDisulfiram
reaction

Vancomycin
(bactericidal:disrupts
peptioglycancrosslinkage)

Vancomycin

BetalactamaseInhibitors
(bactericidal:blockingcross
linking)

ClavulanicAcid
Sulbactam
Tazobactam

Carbapenems

Imipenem(+cilastatin)
Meropenem

OtherCellWallInhibitors

http://www.orthobullets.com/basicscience/9059/antibioticclassificationandmechanism

MRSA**
PCN/Cephallegies**
S.aureus
S.epidermidis

Saureus**
Sepidermis**
E.Coli**
Klebsiella**
Broadestactivityof
anyantibiotic

Redmansyndrome
Nephrotoxicity
Ototoxicity

Hypersensitivity
Reaction
Hemolyticanemia

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Meropenem
Doripenem
Ertapenem

anyantibiotic
(exceptMRSA,
Mycoplasma)

Aztreonam

Aztreonam

Gramnegativerods
Aerobes
Hospitalacquired
infections

Polymyxins

PolymyxinB
PolymyxinE

TopicalGramnegative
infections

Bacitracin

Bacitracin

TopicalGrampositive
infections

ProteinSynthesisInhibition
Anti30Sribosomalsubunit
Aminoglycosides
(bactericidal:irreversible
bindingto30S)

Gentamicin
Neomycin
Amikacin
Tobramycin
Streptomycin

Tetracyclines
Tetracycline
(bacteriostatic:blockstRNA) Doxycycline
Minocycline
Demeclocycline

AerobicGram
negatives
Enterobacteriaceae
Pseudomonas

Rickettsia
Mycoplasma
Spirochetes(Lyme's
disease)

Nephrotoxicity
Ototoxicity

Hepatotoxicity
Toothdiscoloration
Impairedgrowth
Avoidinchildren<
12yearsofage

Anti50Sribosomalsubunit
Macrolides
(bacteriostatic:reversibly
binds50S)

Erythromycin
Azithromycin
Clarithromycin

Streptococcus
H.influenzae
Mycoplamsa
pneumonia

Coumadin
Interaction
(cytochromeP450)

Chloramphenicol
(bacteriostatic)

Chloramphenicol

Hinfluenzae
BacterialMeningitis
Brainabsces

AplasticAnemia
GrayBaby
Syndrome

Lincosamide
(bacteriostatic:inhibits
peptidyltransferaseby
interferingwithaminoacyl
tRNAcomplex)

Clindamycin

Bacteroidesfragilis
Saureus
Coagulasenegative
Staph&Strep
ExcellentBone
Penetration

Pseudomembranous
colitis
Hypersensitivity
Reaction

Linezolid
(variable)

Linezolid

ResistantGram
positives

Streptogramins

Quinupristin
Dalfopristin

VRE
GASandS.aureus
skininfections

DNASynthesisInhibitors
Fluoroquinolones
(bactericidal:inhibitDNAgyraseenzyme,inhibitingDNAsynthesis)
1stgeneration

Nalidixicacid

Steptococcus
Mycoplasma
AerobicGram+

Phototoxicity
Achillestendon
rupture
Impairedfracture
healing

2ndgeneration

Ciprofloxacin
Norfloxacin
Enoxacin
Ofloxacin
Levofloxacin

AsAbove
+Pseudomonas

asabove

3rdgeneration

Gatifloxacin

Asabove+Gram
positives

asabove

4thgeneration

Moxifloxacin
Gemifloxacin

Asabove+Gram
asabove
positives+anaerobes

Metronidazole
(bacteridical:metabolic
biproductsdisruptDNA)

Metronidazole(Flagyl)

OtherDNAInhibitors
Anaerobics

Seizures
Crebelardysfunction
ETOHdisulfram
reaction

RNASynthesisInhibitors

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RNASynthesisInhibitors

Rifampin
Rifampin
(bactericidal:inhibitsRNA
transcriptionbyinhibitingRNA
polymerase)

Staphylococcus
Mycobacterium(TB)

Bodyfluid
discoloration
Hepatoxicity(with
INH)

MycolicAcidsSynthesisInhibitors
Isoniazid

Isoniazidz

TB
LatentTB

FolicacidSynthesisInhibitors
Trimethoprim/Sulfonamides Trimethoprim/Sulfamethoxazole UTIorganisms
(bacteriostatic:inhibitionwith (SMX)
Proteus
PABA)
Sulfisoxazole
Enterobacter
Sulfadiazine

Pyrimethamine

Pyrimethamine

Malaria
T.gondii

Thrombocytopenia
Avoidinthird
trimesterof
pregnancy

BacteriaOverview

GramPostiveCocci
Staphylococcus

Staph.aureus
MSSA
MRSA
Staph.epidermis
Staphsaprophyticus

Streptococcus

Streppneumoniae
Streppyogenes(GroupA)
Strepagalacticae(GroupB)
Strepviridans
StrepBovis(GroupD)

Enterococci

E.faecalis(GroupDstrep)
GramPositiveBacilli

SporeForming
Bacillusanthracis
Bacilluscereus
Clostridiumtetani
Clostridiumbotulinum
Clostridiumperfringens
Clostridiumdifficile
NonSporeForming

Corynebacteriumdiphtheriae
Listeriamonocytogenes

Neisseria

Neisseriameningitidis
Neisseriagonorrhoeae

GramNegativeCocci

GramNegativeBacilli
Enterics

Escherichiacoli
Salmonellatyphi
Salmonellaenteridis
Shigelladysenteriae
Klebsiellapneumoniae
Serratia
Proteus
Campylobacterjejuni
Vibriocholerae
Vibrioparahaemolyticus/vulnificus
Helicobacterpylori
Pseudomonasaeruginosa
Bacteroidesfragilis

Respiratorybacilli

Haemophilusinfluenzae
Haemophiliusducreyi
Bordatellapertussis

Zoonoticbacilli

Yersiniaenterocolitica
Yersiniapestis
Brucella
Francisellatularensis
Pasteurellamultocida
Bartonellahenselae

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Other

Gardnerellavaginalis

Mycobacteria

Mycobacteriumtuberculosis
Mycobacteriumleprae
MOTTS

Spirochetes

Borreliaburgdorferi
Leptospirainterrogans
Treponemapallidum

Chlamydiaceae

Chlamydiatrachomatis
Chlamydophila
Rickettsia
Ehrlichia

Mycoplasmataceae

Mycoplasmapneumoniae
Ureaplasmaurealyticum

FunguslikeBacteria

Actinomycesisraelii
Nocardia

OtherBacteria

AntibioticResistanceMechanisms
Bacteriadevelopabilitytohydrolyzethesedrugsusinglactamase
confersresistancetopenicillin
e.g.E.coli,Staphepidermidis,Pseudomonasaeruginosa,Klebsiellapneumoniae
addlactamaseinhibitore.g.clavulanicacidinamoxicillinclavulanate(Augmentin)
GeneticmutationofmecA
abacterialgeneencodingapenicillinbindingprotein.NewPBPhasreducedaffinityfor
antibiotics
confersresistancetomethicillin,oxacillin,nafcillin
e.g.MRSA
Alteredcellwallpermeability
confersresistancetotetracyclines,quinolones,trimethoprimandlactamantibiotics
Creationofbiofilmbarrier
providesanenvironmentwhereoffendingbacteriacanmultiplysafefromthehosteimmune
system
Salmonella
Staphepidermidis
Activeeffluxpumps
confersresistancetoerythromycinandtetracycline
e.g.msrAgeneinStaph
Alteredpeptidoglycansubunit(alteredDalanylDalanineofNAM/NAGpeptide)
confersresistancetovancomycin
e.g.vancomycinresistantenterococcus(VRE)
Ribosomealteration
ermgeneconferinducibleresistancetoMLS(macrolidelincosamidestreptogranin)agents
viamethylationof23srRNA
demonstrateusingDzonetest
forinducibleclindamycinresistanceinStaphandbetahemolyticStrep
Penicillins
Mechanism
interferwithbacterialcellwallsynthesis
Subclassificationandtestedexamples
natural
penicillinG
penicillinaseresistant
methicillin(Staphcillin)
aminopenicillins
ampicillin(Omnipen,Polycillin)

Cephalosporins
Overview
bactericidal
Mechanism
disruptsthesynthesisofthepeptidoglycanlayerofbacterialcellwalls
doessothroughcompetitiveinhibitiononPCB(penicllinbindingproteins)
peptidoglycanlayerisimportantforcellwallstructuralintegrity.
samemechanicsmofactionasbetalactamantibiotics(suchaspenicillins)
Subclassificationandtestedexamples
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Subclassificationandtestedexamples
firstgeneration
cefazolin(Ancef,Kefzol)
secondgeneration
cefaclor(Ceclor)
thirdgeneration
cefriazone(Rocephin)
fourthgeneration
cefepime(Maxipime)
Fluoroquinolones

Mechanism
blocksDNAreplicationviainhibitionofDNAgyrase
Sideeffects
inhibitearlyfracturehealingthroughtoxiceffectsonchondrocytes
increasedratesoftendinitis,withspecialpredilectionfortheAchillestendon.
tenocytesintheAchillestendonhaveexhibiteddegenerativechangeswhenviewed
microscopicallyafterfluoroquinoloneadministration.
recentclinicalstudieshaveshownanincreasedrelativeriskofAchillestendonrupture
of3.7.
Subclassificationandtestedexamples
ciprofloxacin(Cipro)
levofloxacin(Levaquin)
Aminoglycosides
Mechanism
bactericidal
inhibitionofbacterialproteinsynthesis
workbybindingtothe30sribosomesubunit,leadingtothemisreadingofmRNA.This
misreadingresultsinthesynthesisofabnormalpeptidesthataccumulateintracellularly
andeventuallyleadtocelldeath.Theseantibioticsarebactericidal.
Subclassificationandtestedexamples
gentamicin(Garamycin)
Vancomycin
Coverage
grampositivebacteria
Mechanism
bactericidal
aninhibitorofcellwallsynthesis
Resistance
increasingemergenceofvancomycinresistantenterococcihasresultedinthedevelopment
ofguidelinesforusebythe(CDC)
indicationsforvancomycin
seriousallergiestopenicillinsorbetalactamantimicrobials
seriousinfectionscausedbysusceptibleorganismsresistanttopenicillins(MRSA,
MRSE)
surgicalprophylaxisformajorproceduresinvolvingimplantationofprosthesesin
institutionswithahighrateofMRSAorMRSE
Rifampin
MosteffectiveagainstintracellularphagocytizedStaphylococcusaureusinmacrophages
Linezolid
Linezolidbindstothe23Sportionofthe50Ssubunitandactsbypreventingtheformationof
theinitiationcomplexbetweenthethe30Sand50Ssubunitsoftheribosome.
Splenectomy
Splenectomypatientsorpatientswithfunctionalhyposplenismrequirethefollowingvaccines
and/orantibiotics
Pneumococcalimmunization
HaemophilusinfluenzatypeBvaccine
MeningococcalgroupCconjugatevaccine
Influenzaimmunization
Lifelongprophylacticantibiotics(oralphenoxymethylpenicillinorerythromycin)

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Creationofactiveeffluxpumps
Methylationof23srRNA
Biofilmproduction
Alterationofcellwallpermeability
Betalactamaseproduction

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