I NHIBIT& C ELL& W ALL& S YNTHESIS& &

a.
Inhibit"Peptidoglycan"Synthesis""
i. Vancomycin"[Resistance:!modify!D"ala%D"ala!to!D8ala!D8lac]!!
1.
Inhibits"transglycosylation"by"binding"d7ala7dala"on"cell"wall"
precursors."Bacteriocidal."
2.
Serious"Gram"+"infections:"MRSA,"enterococci,"C."diff."
3.
Nephrotoxic,"Ototoxic,"Thrombophebitis,"diffuse"flushing7"Red"
Man"Syndrome"(prevent"with"antihistamines"and"slow"infusion"
rate)"
ii. Bacitracin""
b.
Inhibit"Peptidoglycan"Cross7Linking""
i. Penicillins"
1.
Pennicillinase7Sensitive"[Resistance:!Penicillinase]""
a.
Pen&G"(IV"&"IM)"and"Pen&V"(oral)"
i. Bind"PBP"&"block"transpeptidase"cross7linking"
ii. Gram"+"cocci,"Gram7"rods:"N."meningitides,"
Spirochetes:"T.%pallidum%(Syphilis)"
iii. HSV,"hemolytic"
b.
Ampicillin,&Amoxicillin"(better"oral"bioavailability)"
i. Same"as"above"but"wider"spectrum"
ii. H."Influenza,"E."coli,"Listeria,"Proteus"mirabilis,"
Salmonella,"Shigella,"enterococci."Ampicillin7"
pregnant&women&with&strep."
iii. HSV,"rash,"pseudomembranous"colitis"
2.
Penicillinase7Resistant"
a.
Oxacillin,&Nafcillin,&Dicoxacillin&
i. Same"as"above,"narrow"spectrum,"penicillinase"
resistant"
ii. Staph%aureus"(except"MRSA)"
iii. HSV,"Interstitial"nephritis""
3.
Antipseudomonals"
a.
Ticarcillin,&Piperacllin&
i. Same"as"above,"broad"spectrum,"susceptible"to"
penicillinase"(use"clavalonic"acid)""
ii. Pseudomonas%spp,"Gram7"rods"
iii. HSV"
4.
Cephalosporins"
a.
Cephazolin7"prevent"post7surg"S."aureus"infection"
b.
Cefoxitin"
c.
Ceftriaxone"
i. Serious"Gram7"infections"resistant"to"other"beta7
lactams,"Gonorrhea"prophylaxis""
d.
Cefipime"
i. Pseudomonas"and"gram"+"
e.
Ceftaroline""
i. Broad"spectrum,"including"MRSA,"nor"Pseudomonas.""
f.
HSV,"Vit"K"deficiency,"low"cross7reactivity"with"penicillins,"
!nephrotoxicity"when"combined"with"aminoglycosides.""
Cefotetan,"cefoperazone7"disulfiram7like"rxn."
ii. Carbapenems""(7penems)"
1.
Imipenem"
a.
Broad"spectrum,"b7lactamase7resistant."Administered"
with"cilastatin"which"inhibits"renal&dihydropeptidase&I"
which"decreases"the"inactivation"of"the"drug"at"the"renal"
tubules"(Meropenem"is"resistant"to"DHPI"and"also"has"
decreased"risk"of"seizures).""
b.
Gram"+"cocci,"Gram""rods,"anaerobes."Side"effects"limit"
use"to"life7threatening"infections"after"other"drugs"fail.""
c.
GI"distress,"rash,"seizures.""
iii. Monobactams"
1.
Aztrenam"
a.
Resistant"to"b7lactamase.""Synergistic"with"
aminoglycosides,"no"penicillin"allergy"cross7reactivity.""
b.
Gram""rods"ONLY."
c.
For"patients"allergic"to"penicillin"or"those"with"renal"
insufficiency"and"cant"take"aminoglycosides"
d.
Occasional"GI"upset.""
I NHIBIT& B ACTERIAL& P ROTEIN& S YNTHESIS& &
a.
30S"
i. Inhibit&initiation&complex&formation"(can"cause"misreading,"also"
block"translocation,"require"O2"for"uptake)"[Resistance:!transferase!
enzymes!inactivate!drug!by!acetylation,!phosphorylation,!or!adenylation]!
1.
Aminoglycosides"[Genta,"Neo,"Tobra,"Strepto"mycin,"Amikacin]"
Bacteriocidal""
a.
Severe!Gram!!Rod!infection.""Synergistic"with"b7lactams"
b.
Neomycin"for"bowel&surgery"
c.
Nephrotoxic"(especially"with"cephalosporins),"Ototoxic"
(especially"with"loop"diuretics),"Teratogenic.""
!

ii.

Inhibit&ANsite&tRNA&binding""[Resistance:!decreased!uptake!or!increased!
efflux!out!of!bacterial!cells!by!plasmid8encoded!transport!pumps]!
1.
Tetracyclines"[Tetracyclin,"Doxycyclin,"Minocyclin]"
Bacteriostatic"
a.
Lyme"Disease"(borrellia"burgdorferi),"Mycoplasma"
Pneumonia,"Rickettsia,"Chlamydia,"Acne.""
b.
GI"distress,"Tooth"Discoloration,"Inhibition"of"bone"growth"
in"children,"photosensitivity,"CI"pregnancy.""
c.
Doxycycline"is"fecally"eliminated"and"can"be"used"in"patients"
with"renal"failure."Absorption"is"impaired"by"dairy"foods"and"
antacids"(take"on"empty"stomach,"no"dairy).""
b.
50S"
i. Inhibit&Transferase&
1.
Chloramphenicol"[Resistance:!plasmid8encoded!acetyltransferae!
inactivates!drug]!!
a.
Meningitis"(H."influenza,"N."meningitis,"S."Pneumoniae,"
Rocky"Mountain"Spotted"Fever/Rikettsia"rickettsii)."Limited"
use"due"to"toxicities,"but"cheap"drug"often"used"in"
developing"countries.""
b.
Aplasic&Anemia,"Gray&Baby&Syndrome"(due"to"low"UDP7
glucouronyl"transferase)"
ii. Inhibit&Translocation&&
1.
Clindamycin""
a.
Anaerobic%infections"(bacteriodes"spp."Clostridium"
perferinges)"in"aspiration"pneumonia,"lung"abscess,"oral"
infections.""Also"effective"against"invasive"GAS,"
Campylobacter."[anaerobes&above&the&diaphragm;"
metronidazole"for"anaerobes"below"the"diaphragm]""
b.
Pseudomembranous"colitis,"fever,"diarrhea"
2.
Macrolides"[Azithromycin,"Clarithromycin,"Erythromycin]"
[Resistance:!Methylation!of!23S!rRNA8binding!site!prevents!drug!
binding]""
a.
Binds&23s&rRNA&of&50S&subunit&and&blocks&translocation"
b.
Atypical&pneumonias&(mycoplasma,"Chlamydia,"
Legionella),"STDs"(Chlamydia),"gram+"cocci&(strep&
infections&in&patients&allergic&to&penicillin)&"
c.
GI"Motility&issues&(less&likely&with&clarithro),"Arrythmia"
caused"by"prolonged"QT,"acute"cholestatic"hepatitis,"Rash,"
eosinophilia.""Increases"serum"Theophyllines"and"oral"
anticoagulants."(inhibits"CYPs)"
iii. Linezolid,"Stretotogranins"[Quinupristin,"Dalfopristin]""
1. Vancomycin"resistant%Staph%
I NHIBIT& N UCLEIC& A CID& S YNTHESIS& &
a.
Inhibit"DNA"Gyrase"(Top"II"&"Top"4)"
i. Fluoroquinolones"[Ciprofloxacin,"Levofloxacin]"[Resistance:!
chromosome8encoded!mutation!in!DNA!gyrase,!plasmid!mediated!
resistance,!efflux!pumps]!
1.
Typhoid,!Shigella,!Anthrax!!
2.
AE:"Cartilage"defects"(inhibits"resealing""tendon"rupture,"
tendonitis,"leg"cramps,"myalgias).""CI"in"pregnant"women"and"
people"under"18.""May"prolog"QT"interval.""May"cause"tendon"
rupture"in">60"year"olds.""
b.
Inhibit"DNA7Dependent"RNA"Polymerase""
i. Rifampin"
1.
Mycobacterium"TB:"delays"resistance"to"dapsone"when"used"
to"leprosy.""Prophylaxis&in&contacts&of&children&with&H.&
Influenza&Type&B&meningitis&(resistance&emerges&rapidly).""
2.
Minor"hepatotoxicity.""Increases"CYPs,"orange"body"fluids.""
Rifabutin"is"favored"over"Rifampin"in"HIV"patients"due"to"less"
cytochrome"p450"stimulation.""
I NHIBIT& F OLIC& A CID& S YNTHESIS& &
a.
Inhibit"Dihydropteroate&Synthase""
i. Sulfonamides"[Sulfamethoxazole,"Sulfisoxazole,"Sulfadiazine]"
[Resistance:"altered"bacterial"Dihydropteroate"Synthase,"decreased"
uptake,"increased"PABA"formation]""
1.
Gram+/7."Nocardia,"Chlamydia,"Triple"sulfas"or"SMT"7simple"UTI"
2.
HSV"reactions,"hemolysis"in"G6PD"deficiency,"nephrotoxic"
(tubulointerstial"nephritis),"photosensitivity,"kernicterus"in"
infants,"displaces"drugs"from"albumin"(warfarin).""
b.
Inhibit"Dihydrofolate&Reductase""
i. Trimethoprin"
1.
Used"in"combination"with"Sulfas"for"UTI."Shigella,"Salmonella,"
Pneumocystic"jirovecii"pneumonia"prophylaxis,"toxoplasmosis"
prophylaxis"
2.
Megaloblastic"anemia,"leukopenia,"granulocytopenia"(may"
alleviate"with"supplemental"folinic"acid)"
ii. Pyrimethamine""
"
!

!!!!!C.!Czawlytko!!1"""""""""!

C. Czawlytko
Cynthia Czawlytko