ANTIBIOTICS

Antibiotics:
• disrupts proteins or enzymes within a bacterium.
 bacteriostatic – prevents multiplication
 bactericidal – kills bacteria

• Goal : to reduce the number of bacteria  immune system can deal with infection.

Culture & Sensitivity test

• identify the causative bacteria & the antibiotic which it is most sensitive

 Gram- positive bacteria

 cell wall retains stain or resist decolorization by alcohol
 MC in respiratory & soft tissue infections

 Gram – negative bacteria

 cell wall loses stain or decolorized by alcohol
 MC in GI & GU tract infections

 Aerobic bacteria vs Anaerobic bacteria

 Broad – spectrum Antibiotic

• used for both gram – positive & gram negative bacteria

 Narrow – spectrum antibiotics

• used for either gram – positive or gram – negative bacteria

 Synergistic effect  combination of antibiotics produce greater effects

ex. amoxicillin + clavulanic acid ( Augmentin)
ampicillin + sulbactam (Unasyn)

 Prophylaxis  prevention of potential infection.

Antibiotic resistance:
• bacteria mutate that they become resistant to certain antibiotics.
• common in nosocomial infections
• cause: indiscriminate antibiotic use

Cross – resistance
• resistance that occurs bw antibacterials with similar actions.

General adverse reactions to antibacterials:

1. allergy / hypersensitivity reactions
 2. superinfections
3. organ toxicity

Classes of Antibiotics:

I. Aminoglycosides • azithromycin (Zithromax)

 gentamicin (Garamycin) • clarithromycin

• amikacin V. Lincosamides
 clindamycin
• neomycin • lincomycin
• tobramycin
• streptomycin VI. Monobactam Antibiotic
• kanamycin  aztreonam

II. Cephalosporins VII. Penicillins & Penicillinase Resistant

 cefaclor (Ceclor) Antibiotics
 Amoxicillin
a. 1st generation
• cephalexin (Keflex) a. Penicillins
• cefazolin (Zolicef) • penicillin G
• penicillin V
b. 2nd generation
• cefaclor b. extended- spectrum penicillin
• cefuroxime ( Zinacef) • amoxicillin
• cefoxitin • ampicillin

c. 3rd generation c. penicillin – resistant antibiotics

• ceftazidime • dicloxacillin
• ceftriaxone (Rocephin) • nafcillin
• ceftizoxime • oxacillin

d. 4th generation VIII. Sulfonamides

• cefepime  sulfasalazine
• ceftditoren • sulfadiazine
• cotrimoxazole
III. Fluoroquinolones
 ciprofloxacin (Cipro)
• levofloxacin IX. Tetracyclines
 tetracycline
• norfloxacin
• doxyclcine
• ofloxacin
• minocycline
• gatifloxacin
X. Antituberculosis drugs
IV. Macrolides
 erythromycin XI. Leprostatic drugs
I. Aminoglycosides
 gentamicin (Garamycin)
• amikacin
• neomycin
• tobramycin
• streptomycin
• Kanamycin

Indic: Tx of serious infections

• Gm (-) infections {Kleb, enterobacter, E. coli. Proteus, Pseudomonas,
Serratia- ( KEEPPS) }
• Methicillin-resistant staph aureus (MRSA)

Action: inhibits protein synthesis of gram (–) negative bacteria (bactericidal)

Monitor for:
 nausea & anorexia
 ototoxicity
 nephrotoxicity
 neurotoxicity
 BM depression & superinfections

II. Cephalosporins
 cefaclor (Ceclor)

Indications: Tx of respiratory, dermatological, urinary tract & middle ear infections

Actions: inhibits cell wall synthesis of wide-range of bacteria (bactericidal )

Monitor for:
 GI upsets & diarrhea
 Pseudomembranous colitis
 headache, dizziness
 nephrotoxicity
 superinfections & bone marrow suppression
 hypersensitivity reactions

b. 1st generation
• cephalexin (Keflex)
• cefazolin (Zolicef)

Indications: same as gram – positive bacteria affected by Pen G & gram – negative bacteria
( Proteus mirabilis, E. coli, & Klebsiella pneumoniae) PEcK
 c. 2nd generation
• cefaclor
• cefuroxime ( Zinacef)
• cefoxitin

Indications: same as above plus Haemophilus influenzae, Enterobacter aerogenes &

Neisseria (HENPEcK)

Less effective against gram – positive bacteria

d. 3rd generation
• ceftazidime
• ceftriaxone (Rocephin)
• ceftizoxime

Indications: more potent against gram- negative bacilli as well as Serratia marcescens
(HENPEcKS)

e. 4th generation
• cefepime
• ceftditoren

Indications: for gram – negative & gram – positive organisms including P. aeroginosa

III. Fluoroquinolones
 ciprofloxacin (Cipro)
• levofloxacin
• norfloxacin
• ofloxacin
• gatifloxacin

Indications: Tx of respiratory, skin, urinary tract, eye, ear, bone & joint infections.
Tx after anthrax exposure, typhoid fever

Action: inhibit synthesis of bacterial RNA & DNA in wide spectrum of gram – negative bacteria

Monitor for:
 headache, dizziness
 GI upsets
 BM depression  CI in children < 18 yo
 risk of photosensitivity

IV. Macrolides
 erythromycin
• azithromycin (Zithromax)
• clarithromycin
 Indications: Tx of respiratory, skin, urinary tract & GI infections
Good alternative if allergic to penicillins

Action: inhibit protein synthesis (bacteriostatic or bactericidal)

Monitor for:
 nausea & vomiting, diarrhea, risk for pseudomonas colitis
 hepatotoxicity
 ototoxicty

V. Lincosamides
 clindamycin
• lincomycin

Indications: similar to macrolides but more toxic. Tx of serious infections.

Action: inhibit protein synthesis

Monitor for:
 severe pseudomembranous colitis
 BM depression
 pain

VI. Monobactam Antibiotic

 aztreonam

Indications: Tx of lower respiratory, skin, urinary tract, intra-abdomina & gynecological

infections caused by gram- negative bacteria including septicemia

Alternative to pxs allergic to penicillins or cephalosporins.

Action: inhibit cell wall synthesis of gram- negative enterobacteria

Monitor for:
 mild GI problems
 liver toxicity
 pain

VII. Penicillins & Penicillinase Resistant Antibiotics

 Amoxicillin
a. Natural Penicillins
• penicillin G
• penicillin V

b. extended- spectrum penicillin

• amoxicillin
• ampicillin
 c. penicillinase – resistant antibiotics
• cloxacillin
• nafcillin
• oxacillin

Indications: Tx broad spectrum respiratory & urinary tract infections

Action: inhibit cell wall synthesis (bactericidal)

Monitor for:
 GI effects
 superinfections
 hypersensitivity reactions
VIII. Sulfonamides
 sulfasalazine
• sulfadiazine
• cotrimoxazole

Indications: Tx of rheumatoid arthritis, ulcerative colitis

Action: blocks cellular metabolism of PABA for folic acid synthesis of susceptible gram-
positive & gram-negative baceria (bacteriostatic)

Monitor for:
 hepatotoxicity
 nephrotoxicity
 Stevens- Johnson syndrome
 CNS effects & BM depression

IX. Tetracyclines
 tetracycline
• doxyclcine
• minocycline

Indications: Tx of various infections, acne

Action: inhibit protein synthesis

Monitor for:
 damage teeth & bones
 GI effects
 BM suppression, photosensitivity & superinfections
 make oral contraceptives ineffective

X. Antituberculosis drugs
a. 1st line drugs
 isoniazid (INH)
 • rifampin
• ethionamide
• rifapentine

b. 2nd line drugs

• ethambutol
• pyrazinamide

c. 3rd line drugs

• capreomycin
• cycloserine

Indication: Tx & prophylaxis of tuberculosis

Monitor for:
 discoloration of body fluids
 hepatotoxicity
 peripheral neuritis

XI. Leprostatic drugs

• dapsone
• clofazimine
• thalidomide

To Prevent Drug- resistant strains of bacteria:

• use antibiotics cautiously

• complete full course of therapy
• avoid saving antibiotics for self-medication