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Most Commonly PrescribedAntibiotics

Kristina NelsonPharmD Candidate Class of 2012

[email protected]

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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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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


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


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


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


Binds ribosome and inhibitsprotein biosynthesis

Bacteriostatic

50S ribosome subunit

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Macrolides

Azithromycin, erythromycin, clarithromycin

Indications: CAP, URI/LRI, chlamydia, MAC, "conjunctivitis#


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


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


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



30S ribosome subunit

Bacteriostatic

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TetracyclinesTetracycline, doxycycline, minocycline Tablets, capsules

Indications: acne, skin infections, STDs, "respiratory infections#


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


Bacteriostatic

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LincosamidesClindamycin

Capsules, suspension, topical

Indications : anaerobic upper GI infections, bacterialvaginosis, topical for acne


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


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


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


Inhibition of acetyl CoA

interfering with themetabolism of carbohydrates

in susceptible bacteria

Bacteriostatic

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NitrofurantoinCapsules

Indications: uncomplicated UTIs, and UTI prophylaxis


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!

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