mcp-abx
TRANSCRIPT
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Most Commonly PrescribedAntibiotics
Kristina NelsonPharmD Candidate Class of 2012
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Definitions
Antimicrobial
Bacteriostatic
Substance that kills or inhibits the growth ofmicroorganisms like bacteria, fungi and protozoa
Substance that kills or inhibits the growth of bacteria
Antibacterial
Inhibits the growth or reproduction of bacteria
Bactericidal
Acts by killing bacteria
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Definitions
ABSAOM CAP
HAPPharyngitis
UTICellulitis
MAC
Bacterial vaginosis
CDAD
Pseudomembranous colitis
URI LRI
PCP
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General Antibiotic Counseling Tips
Most important: Take all antibiotics until they are gone!!Why...?
General side e!
ects: N/V/D and yeast infections"women
#
What can you recommend to your patients?
Take with food "drug permitting#
OTC anti diarrhea meds "except when?#
Probiotics?
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General Antibiotic Counseling Tips
When will they feel better?
So what about oral contraceptives?
Exception: azithromycin
Very controversial...
Usual length of therapy is 5 to 14 daysSome are less, some are more
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Allergies
General Antibiotic Counseling Tips
Your first question for the patient when they saythey have an allergy...
Penicillin allergies are very commonand come in 3 varieties:
Immediate "30$60 minutes#
Accelerated "1$72 hours#Delayed ">72 hours#
What should the patient look for and do??
????
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General Storage and Administration
Shake suspensions well before each use
Watch out for those that need to be refrigerated
Check the stability of the drug after reconstitution vs.the length of therapy
Tablets$cool, dry place
What if they miss a dose?
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Beta$lactams
Penicillins and Cephalosporins
Mechanism and Site of Action
Penicillin binding
proteins in thebacterial cell walland inhibits cellwall synthesis
Bactericidal
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Beta$lactamsPenicillins
Penici!in VK, amoxicillin,amoxici!in/clavulanat"
Tablets, chewable tablets, capsules, suspension
Indications :Pharyngitis, AOM,ABS, CAP, UTIs, cellulitis
Special administration:
PCN$without foodAmox$with or withoutAmox/clav$with food
Dosing is usually BID$QID
Brand names: Veetids, Amoxil,Augmenti#
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Beta$lactamsCephalosporins
Cephalexin, cefuroxime, cefdinir
Tablets, capsules, suspensions
Indications: Cellulitis, gonorrhea, AOM, ABS
Special administration:
Most are ok with or without food,some suspensions vary
Cefdinir $Not with antacids or ironcontaining supplements
Dosing usuallyBID $QID
Brand names: Keflex, Ceftin, Omnicef
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Beta$lactams
Side e!
ects: N/V/D, yeast infections
Allergic reactions
What does a penicillin allergy mean for cephalosporins?
What does a cephalosporin allergy mean forpenicillins?
N/V/D is especially common with clavulanateSo why do we use it?
Rash vs. Anaphylaxis
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Sulfonamides
Mechanism and Site of Action
Competes with enzyme required forfolate synthesis in bacterial cell and
slows cell cycle
Bacteriostatic
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Sulfonamides
Sulfamethoxazole/Trimethoprim
Tablets, suspension SS and DS
Indications:uncomplicated UTIs, AOM, PCPSpecial administration:
Best taken with food
Full glass of water
Suspension should not be refrigerated
Dosing usually BID
Brand name: Bactrim, Septra, Sulfatrim
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Side e!ects:
Sulfonamides
Sun sensitivity, dizziness, rash
N/V/D
Allergies: urticaria, Stevens$Johnson Syndrome
Should not be used in pregnant women >38 weeks, lactatingwomen or infants
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Macrolides
Mechanism and Site of Action
Binds ribosome and inhibitsprotein biosynthesis
Bacteriostatic
50S ribosome subunit
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Macrolides
Azithromycin, erythromycin, clarithromycin
Indications: CAP, URI/LRI, chlamydia, MAC, "conjunctivitis#
Special administration:
Tablets, suspensions, "ophthalmic#
Best without food, but
okay
Azithromycin$antacids
Clarithromycin and erythromycin$grapefruit
Dosing: Azithromycin$QD
Clarithromycin$BIDErythromycin$BID$QID
Brand name: Zpak, Ery$Tab, Biaxin
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MacrolidesSide e!ects:
Clarithromycin: metallic taste, sun sensitivityAzithromycin: normal side e!ects, especially
in high single$dose regimens
N/V/D, yeast infections
Potential for QTc prolongation with all
Drug interactions: all are P450 inhibitors and substrates
Some key drugs to watch for: warfarin, digoxin,
amiodarone, statinsClarithromycin worst o!ender for DDIs
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Fluoroquinolones
Mechanism and Site of Action
Inhibits DNA replication &
transcription by binding enzymes inthe bacterial cell
Bactericidal
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Fluoroquinolones
Ciprofloxaci", levofloxacin, moxifloxacin
Tablets, suspension
Indications:Pyelonephritis , UTIs, CAP, ABSCipro$anthrax post exposure prophylaxis
Special administration:
With or without food $separateantacids, iron, MVTs and dairy
Dosing is QD$BID
Brand names: Cipro, Levaquin, Avelox
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FluoroquinolonesSide e!ects:
Sun sensitivity, headache, dizziness, dyspepsia
RARE$tendon toxicity
Drug interactions:
Cipro and ca!eineWarfarin
Increased blood sugar in DM
N/V/D, yeast infections
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Tetracyclines
Mechanism and Site of Action
Binds ribosome and inhibitsprotein biosynthesis
30S ribosome subunit
Bacteriostatic
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TetracyclinesTetracycline, doxycycline, minocycline Tablets, capsules
Indications: acne, skin infections, STDs, "respiratory infections#
Special administration:
Doxycycline and minocycline$with or without food
Tetracycline$withoutfood
All with a full glass of waterand sit up for 30 minutes
Avoid antacids, iron, MVT and
dairy
Patients should never useexpired medication
Dosing is usually BID$QID
Brand names: Sumycin, Vibramycin, Minocin
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Tetracyclines
Side e!ects: N/V/D, yeast infections
Sun sensitivity, headache, indigestion, teeth discoloration
Should not be used in children
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Lincosamides
Mechanism and Site of Action50S ribosome subunit
Binds ribosome and inhibitsprotein biosynthesis
Bacteriostatic
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LincosamidesClindamycin
Capsules, suspension, topical
Indications : anaerobic upper GI infections, bacterialvaginosis, topical for acne
Special administration:
Full glass of water
With or without food
Dosing usually TID
Brand name: Cleocin
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Lincosamides
Side e!ects: N/V/D, yeast infections
Diarrhea$higher risk for C. di%cile associateddiarrhea and Pseudomembranous colitis "Black
Box#
Drug interactions: very few!!
Use of probiotics
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Nitroimidazoles
Mechanism and Site of Action
Absorbed into anaerobic andprotozoal cells where converted intotoxic compound that causes loss ofhelical DNA structure and strand
breakage
Bactericidal
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Nitroimidazoles
Metronidazole
Tablets, topical "vaginal#
Indications: anaerobic lower GI infections, C. di!
cileassociated diarrhea, bacterial vaginosis
Special administration:
Take with food or milk"except ER#
Disulfiram$like reactionwith alcohol
Dosing usually TID"BID$QID#
Brand name: Flagyl
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Nitroimidazoles
Side e!ects:Metallic taste, discolored/dark urine, dysuria, dry mouth
Should not be used in pregnant women in the first trimester
Drug interactions: lithium
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Nitrofurantoin
Mechanism and Site of Action
Inhibition of acetyl CoA
interfering with themetabolism of carbohydrates
in susceptible bacteria
Bacteriostatic
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NitrofurantoinCapsules
Indications: uncomplicated UTIs, and UTI prophylaxis
Special administration:
Take with food Dosing is usually BID
Brand names: Macrobid and Macrodantin
Nitrofurantoin
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Nitrofurantoin
Side e!ects:
Drug interactions:
N/V/D, flatulence, headache, discoloration of urine
Shouldn't be used in renal impairment, low/nosystemic absorption
Magnesium salts decrease e!ectiveness
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Questions?
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Feedback!
Please take out a 1/2 sheet of paper and respond to thesequestions:
1#What was the most useful information you learned today?
2#What questions remain about my lecture material?
3#What constructive feedback do you have for me? I can take it!