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Antibiotic Grouping By Mechanism Cell Wall Synthesis Penicillins Cephalosporins Vancomycin Beta-lactamase Inhibitors Carbapenems Aztreonam Polymycin Bacitracin Inhibit 30s Subunit Aminoglycosides (gentamicin) Tetracyclines Inhibit 50s Subunit Macrolides Chloramphenicol Clindamycin Linezolid Streptogramins
DNA Synthesis Inhibitors RNA synthesis Inhibitors Mycolic Acid synthesis inhibitors Folic Acid synthesis inhibitors
Sulfonamides Trimethoprim
Antibiotic Grouping By Mechanism Cell wall synthesis inhibitor inhibits the synthesis of the peptidoglycan layer of bacterial cell walls. Peptidoglycan is important for cell wall structural integrity, especially in Gram-positive organisms, being the outermost and primary component of the wall. Penicillins Cephalosporins Vancomycin Beta-lactamase Inhibitors Carbapenems Aztreonam Polymycin Bacitracin
Penicillins (bactericidal: blocks cross linking via competitive inhibition of the transpeptidase enzyme that cross-links the peptidoglycan chains to form rigid cell walls)
Class/Mechanism Penicillin Drugs Indications Penicillin G Strep. pyogenes (Grp.A) Aqueous penicillin G Step. agalactiae (Grp.B) Procaine penicillin G C. perfringens(Bacilli) Benzathine penicillin G Penicillin V Ampicillin Amoxicillin Above + Gram-negative: E. faecalis E. Coli Above + PCNase-producing Staph. aureus Toxicity Hypersensitivity reaction Hemolytic anemia
Aminopenicillins
Above
Penicillinase-resistantpenicillins
Antipseudomonal penicillins
Above
Cephalosporins (bactericidal: inhibits bacterial cell wall synthesis via competitive inhibition of the transpeptidase enzyme) 1st generation Cefazolin Staph. aureus Allergic reaction Cephalexin Staph. epidermidis Coombs-positive Some Gramanemia (3%) negatives: E. Coli Klebsiella 2nd generation Cefoxitin Cefaclor Cefuroxime Ceftriaxone Cefotaxime Ceftazidime Cefepime (4th generation) Above + Gram-negative Allergic Reaction ETOH Disulfiram reaction Allergic Reaction ETOH Disulfiram reaction
3rd generation
Other Cell Wall Inhibitors Vancomycin (bactericidal: disrupts peptioglycan cross-linkage) Beta-lactamase Inhibitors (bactericidal: blocking cross linking) Carbapenems Vancomycin MRSA S. aureus S. epidermidis Red man syndrome Nephrotoxicity Ototoxicity Hypersensitivity Reaction Hemolytic anemia
Aztreonam
Other Cell Wall Inhibitors Aztreonam Gram-negative rods Aerobes Hospital-acquired infections
Polymyxins
Bacitracin
Polymyxin B Polymyxin E
Bacitracin
Antibiotic Grouping By Mechanism Protein Synthesis Inhibitors 30s subunit inhibitor Binding to the bacterial 30S ribosomal subunit inhibiting the translocation of the peptidyl-tRNA from the A-site to the P-site causing misreading of mRNA, leaving the bacterium unable to synthesize proteins vital to its growth Inhibit 30s Subunit Aminoglycosides (gentamicin) Tetracyclines
Antibiotic Grouping By Mechanism Protein Synthesis Inhibitors 50s subunit inhibitor inhibition of bacterial protein biosynthesis by binding reversibly to the subunit 50S of the bacterial ribosome, thereby inhibiting translocation of peptidyl tRNA. Inhibit 50s Subunit Macrolides Chloramphenicol Clindamycin Linezolid Streptogramins
Anti-30S ribosomal subunit Aminoglycosides (bactericidal: irreversible binding to 30S) Tetracyclines (bacteriostatic: blocks tRNA) Gentamicin Neomycin Amikacin Tobramycin Streptomycin Tetracycline Doxycycline Minocycline Demeclocycline Aerobic Gramnegatives Enterobacteriaceae Pseudomonas Rickettsia Mycoplasma Spirochetes (Lyme's disease) Nephrotoxicity Ototoxicity
Hepatotoxicity Tooth discoloration Impaired growth Avoid in children < 12 years of age
Anti-50S ribosomal subunit Erythromycin Streptococcus Azithromycin H. influenzae Clarithromycin Mycoplamsa pneumonia Chloramphenicol H influenzae Bacterial Meningitis Brain absces Bacteroides fragilis S aureus Coagulase-negative Staph & Strep Excellent Bone Penetration Resistant Grampositives VRE GAS and S. aureus skin infections
Chloramphenicol (bacteriostatic) Lincosamide (bacteriostatic: inhibits peptidyl transferase by interfering with amino acyl-tRNA complex) Linezolid (variable) Streptogramins
Clindamycin
Antibiotic Grouping By Mechanism DNA synthesis inhibitor inhibit the bacterial DNA gyrase or the topoisomerase IV enzyme leads to DNA fragmentation via the nucleasic activity of the intact enzyme domains inhibiting DNA replication and transcription. Fluoroquinolones Metronidazole
1st generation
Nalidixic acid
2nd generation
3rd generation
As Above +Pseudomonas
As above + Grampositives
As above + Grampositives + anaerobes
as above
4th generation
Moxifloxacin Gemifloxacin
as above
Other DNA Inhibitors Metronidazole (bacteridical: metabolic biproducts disrupt DNA) Metronidazole (Flagyl) Anaerobics Seizures Crebelar dysfunction ETOH disulfram reaction
Antibiotic Grouping By Mechanism RNA synthesis inhibitor Binds to the subunit of RNA polymerase to inhibit transcription blocks RNA synthesis by physically preventing extension of RNA products beyond a length of 2-3 nucleotides ("steric-occlusion" mechanism) Rifampin
RNA Synthesis Inhibitors Rifampin (bactericidal: inhibits RNA transcription by inhibiting RNA polymerase) Rifampin Staphylococcus Mycobacterium (T B) Body fluid discoloration Hepatoxicity (with INH)
Antibiotic Grouping By Mechanism Mycolic acid synthesis inhibitor prodrug and must be activated by bacterial catalase. Specficially, activation is associated with reduction of the mycobacterial ferric KatG catalase-peroxidase by hydrazine and reaction with oxygen to form an oxyferrous enzyme complex. Isoniazid
Once activated, isoniazid inhibits the synthesis of mycoloic acids, an essential component of the bacterial cell wall.
Specifically isoniazid inhibits InhA, the enoyl reductase from Mycobacterium tuberculosis
Dihydropteroate Synthetase
Sulfonamides
Dihydropteroic Acid
Folic acid Synthesis Inhibitors Trimethoprim/Sulf onamides (bacteriostatic: inhibition with PABA) Trimethoprim/Sulfa methoxazole (SMX) Sulfisoxazole Sulfadiazine UTI organisms Proteus Enterobacter Thrombocytopenia Avoid in third trimester of pregnancy
Pyrimethamine
Pyrimethamine
Malaria T. gondii