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A.

Notes

Class SE

Individual agents
Erythromycin: (+sulfisoxazole-->
Pediazole)

N,V,Burning
For Mycoplasma,
stomach+abdominal cramp, Clarithromycin (biaxin)
Legionella,
Cholestatic hepatitis
Chlamydia,
Azithromycin (zithromax)
Diphtheria,
(estolate form)
Pertusis)
DI: HME inh.
Clindamycin (cleocin or dalacinC)

Macrolides
Inh. Protein synth
by binding to 50s
ribosomal subunit

S.E

Comments

N,V,D, Epi gastric distress, inc HLE,


Cholestatic jaundice, venous irritation,
thrombophelbetis

inc blood glucose level of


Digiotalis, theophylline, warfarin

N, V, D bitter after taste taken e juice or food.

Better tolerated than


erythromycin

OD, short 5 day course,


less diarrhea, least HME

Diarrhea,blood dysc.

Pot. Effect of neuromuscular


blocker

Troleadomycin
Natural Penicillin (Penicllinase sensetive) +VE

Extensive cross
reactivity between
Penicillins and
Imipenem
No igE crossreactivity between
penicillins and
aztreonam.
Most patients will
have ampicillin
rash with no crossreactivity with any
other penicillins.
Most common in
patients with
mononucleosis OR
receiving
allopurinol

Penicillin

Inh. cell wall syn.

Benzyl Penicilin(G)-Parentral - DOC

Mild to severe Hypersensitivity + ( K load)

Pain of IM inj, (+)coomb`s.


Need to monitor K, Na

Phenoxy Me Penicillin (V)--Oral

Mild to severe Hypersensitivity

shld be given full 10 D for


group A & R.fever

Penicillinase resistant Penicillin(Not hydrolysed by staphylococcal pencillinase) +VE


methicillin

Nephritis & Interstitial nephr.

nafacillin (unipen)

Neutropenia
(Cloxa -Eosinophilia). ( OxaHEPATITIS,Billiary phelbitis)

Oxa,Cloxa,Dicloxa,Flucloxacillin
N,V, Hypersensitivity Rn,
Bone marrow supp,
Pseudomembraneous
colitis, Super infection, If
high level seizures

DI: Probencid inh.


Pencillins excretion

Aminopenicillins (broad spectrum,penicllinase senstive)

Ampicillin (Omnipen)
Amoxicillin
(Amox+clav)=AUGMENTIN
(amp.+sulbact)=UNASYN

Hypersensitivity-seizures with xxs Rapidly


I.V. Diarrhea

High incidence of rash with


concurrent use of
ALLOPURINOL

MILD diarrhea.

Excellent safety profilebetter oral absorption than


ampicillin

to be penicllinase resistant

Bacampicillin
Cyclacillin
Extended spectrum penicllins (All inhibit platlet aggregation)
Carbenicillin

( geocillin )

Ticarcillin
Azlocillin

(ticar)

Piperacillin

CIDAL

Excreted by liver

Mezlocillin

May cause hypokalemia,High sodium load


danger to HT,CHF

Ticarcillin + clavulinic a->Timentin

pipercillin + tozbactam->zosyn

CIDA

Aminoglycosides

inhibit protein synth


by binding to 30s

Cephalospo
rins

Ototoxicity IRR.-Nephrotoxicity
REV.(after 5-7 d of therapy) - Streptomycin
Neuromuscular blockade(with
large doses via interperitoneal
Gentamycin (garamycin)
OR mythenia gravis pt )

The least nephrotoxic. (Plague,


Tularemia, T.B, Brucellosis)

Nephrotoxicity ( inc. with nephrotoxic ds) Ototoxicity ( inc. with loop diuretics)

S.E can be inactivated if mixed


with some penicillins.

The most nephrotoxic.

Orally :in hepatic


encephalopathy

Amikacin (amikin)

C.I PREGNANCY

Each generation
shifted to G - ve
activity but less +
ve and resistance
to B lactamase

Vestibular/cochlear
toxicity.Ataxia.Nystagmus.proteinurea

DI: Loop diuretic: Toxicity,

Netilmicin - Kanamycin

Cephalothin, Cisplatin,
Amphotericin B, Methoxy
flurane: Nephrotoxicity

Neomycin (mycifradin)

N,V,D.

Hypersensitivity
reactions,
Pseudomembraneous
colitis, super infection,
nephrotoxicity

Tobramycin (nebcin)
1st Gen.:Cefadroxil-cefazolincephalexin-cephalothin-cephradine.
2nd Gen:Cefaclor-cefotetancefuroxime-cefpodoxime-cefprozilloracarbef-

CEFACLOR:Serum-Sickness Rn in 1%
of children.CEFUROXIME:diarrhea /
bitter after taste taken e juice or food

cefamandole
3rd :Cefoperazone (Diarrhea)

Bleeding diathesis-Disulfiuram like Rn

Hypothrombinemia &
Dislfuram Rn Most
common e'
(cefamandole,cefotetan,c
efoperazole,cefmetazole).

moxalactam
cefixime

Diarrehea

cefotaxime

Phelbitis. (+) coomb`s

ceftazidime

Phelbitis / inc AST, (+) coomb`s


Diarrhea /Billiary sludging & stones/
AST,superinfection

The only oral agent in


3rd genertion
SAFE IN
HEPATOBILIARY
disease

Inhibit cell wall synth

DI: Probencid:inhibit
excretion

ceftriaxone

4th Gen : CEFEPIME

N,V,D,dizziness-Rash,
Liver enzymes-Tendonitis
Ciprofloxacin (cipro)
common in elderly
.Crystalluria at alkaline PH
Oflaxacin (floxin)
.Prolong QT

Fluoroquino
lone
Inhibit DNA gyrase

C.I in
PREGNANCY - C.I
children <18y
arthropathy

Long t1/2 once daily

Photosensitivity,P.colitis,epatitis,Cartilge
toxicity. / INR if e warfarin

NOT a 1st line for CAP./


NOT recommended in
paediatric patient

against chlamydia

Norfloxacin (noroxin )
Lomefloxacin (maxaquin)
Enoxacin ( penetrex )

DI: e' LME inh.-antacids-

Pefloxacin

sucralfate (dec abs),


NSAID`s (seizures)

Levofloxacin ( levoquin )
Metronidazole ( flagyl)

Least effect on LMEAgainst G+VE

Block folic a synth.

Tetracycline

Broad Spectrum
static

Sulfonamide

Inhibit protein synth


by binding to 30s
ribosomal subunit

ttt for : MycoplasmaN,D, hypersensitivity Rn, phototoxic


chlamydia,ricketssia,spi
Rn, Teeth & bone deposition and
rochetes.
discoloration (avoid in PED),
C.I: PREGNANCY &
Hepatotoxicity (esp. in PREG &
infant & children: tooth
ELDERLY), Renal failure (azotemia)
discoloratn & retard
coz of anti-anabolic eff.
bone growth

Doxycycline-Tetracycline
Methacycline
Minocycline

N,V,D Not active agnst Group(A) / Skin rash more


common than amox. / May cause leukemia if taken
several weaks / HYPOGLYCEMIA with
sulfonylurea./Inc. nephro. e Cyclosporin.

Combine with Erythromycin in ttt of OM

antagonize ADH
Pseudo tumor cerebri,Candidiasis.
D.I : Ca,Al,Mg,Fe dec. ABSORPTION

vestibular toxicity

Chloramphen
icol

DI: Dairy product,


antacid, iron prepn (dec
abs), Methoxyflurane
(nephrotoxicity),
Barbiturate & Phenytoin
(dec eff)
Doxy: Absorption not
affected by dairy pr

Primaxin ( impenem + cilastatin)


Less likley sezieurs,not
combined e` cilastatin

Meropenem
Vancomycin (vancocin)

Ototoxicity -hypotension&flushing with rapid


infusion (RED MAN or RED NECK synd)

N,V,Rash,Inc liver enz

Not absorbed orally.


MRSA

-Against

G -ve bacteria including


Pseudomonas

MYALGIA & inc bilirubin


MAO inh.,Tongue discoloration,thrombocytopenia,neutopenia
GRAY SYND.in neonates(as premature liver cannot conj. Chloramphenicol), Idiosyncratic, irrev aplastic Anemia,bone
marrow suppresion
N,V,dizziness,insomnia

Used against penicillinresistant gonorrhea,single


dose.

NV,hemolytic
anemia,CNS,Mononuclosis
like synd.

Probenicid inc. dapsone level.


-Comb e` pyrimethamine in
Malaria prophylaxis

Blood
dysc.,rash,pruritis,exfoliative
dermatitis

M.leprae

Pectinomycin

inh
dihydrofolate
synth.

HME inh. (e' acetominophen,


inc hepatotox).

Static

Linzolide

Hypotension / NVD / high


level : seizures

Long shelf life at room


temp.Suitable for travellers /
FALSE INC. IN serum
creatinine.

broad

Dalfopristin/Qu
inupristin

Cidal

cell wall inh.

Aztreonam

protein synth inh.

Glycopeptides

Trimethoprim

Demeclocycline

Combine with
Pyrimethamine in ttt of

Chlortetracycline

Penems

Dapsone

N,D,cholestatic hepatitis
Sulfadiazine
(high incidence in AIDS).
C.I PREGNANCY - Blood dyscriasis (heam
C.I in neonates:
Sulfamethoxazole + Trimethoprim-Anemia in G6PD, bone
kernictures
marrow) Hypersensitivity Rn >Cotrimoxazole (cidal)
(caused by inc.
(Exfoliative dermatitis,
unbound drug as
Stevens-johnson synd)Sulfisoxazole
premature liver
Crystalluria & Haematuria
Sulfacytine
cannot conj.
DI: Displacement
Bilirubin )
Phenytoin,oral anti-coagulant- Sulfamethizole
sulfonylureas

(Rifadin)

Discoloratn of urine & tears (contact lens can be stained) + all S.E
xpt diziness

Isoniazid

Hepatitis, gynecomastia, galactorrhea, drowisness, lupus, seizures

Rifampin
(isotamine)

Pyrazinamide

Ethambutol
Cycloserine

HME IND.( e.g with O.C use additional


method of birth control)

Hepatotoxicity, inc uric a'


Ocular toxicity - red green color blindness -diziness
Headache,irritability,behaviour abnorm.,phsycosis ,neuropathy,anemia

Dec. level of I.N.H


Dec level of Cyclosporin

Should never be used as single


agent for CAP.