Antibiotic Work Sheet

Sulfamethoxazole + Trimethoprim Cellular Target Ciprofloxacin Amoxicillin + Clavulanic Nitrofurantoin

Dihdropteroate synthetase DHFR

DNA gyrase Topoisomerase IV

altered target efflux entry

PBP transpeptidase
beta-lactamase

Damages DNA

Primary mech. of resistance

efflux entry altered or target PABA

Nothing significant

Primary Elimination Primary mech. of drug-drug interactions Acute Hemolysis (G6PD def) Static or Cidal

Renal

Renal

Renal

Renal

Displacement from albumin

+
C

+
C

CSF entry

+ -

+
(with inflamed meninges)

Effective Against Pseudomonas Effective against MRSA Effective against enterococci

Fill in the blanks for each of the drugs and characteristics. To make the info most general, try to avoid using excessive descriptions as much as possible. For example, use + and as much as possible. Or single letters to indicate response (e.g., to indicate a static agentuse an S.) To indicate mechanisms of drug interactionsuse short handsuch as P450 to indicate induction of P450 enzymes.

Aminoglycosides (gentamicin) Cellular Target Primary mechanism of resistance Primary elimination Primary mechanism of drug-drug interaction Static or cidal 30S

Tetracyclines (doxycycline) 30S efflux Ribosome protection Renal (to some extent) Dox & mino bile milk antacids

Macrolides (erythromycin) 50S Altered binding site efflux Metabolism (CYP3A4) Inhibits CYP450 (azithro does not)

modifying enzymes Renal (GF)

CSF entry

(mino exception)

Effective against MRSA Effective against Pseudomonas

Vancomycin Cellular target Binds ala-ala

Amoxicillin PBP

Cephalexin PBP

Imipenem PBP

Aztreonam PBP (G only)

-

Sensitive to -lactamase

Not a betalactam drug

+
Renal

+/more resistant overall but can be sensitive to ESBLs Renal

Renal

ESBL Renal

Primary Elimination

Renal

CSF entry

+
(with inflamed meninges)

+
(with inflamed meninges)

+ -

+ +

+
(with inflamed meninges)

Cross-sensitive with pens Effective against MRSA Effective against Pseudomonas

+ -

+ -

Streptogramin (Q/D) Cellular target 50S Q: altered binding site, enzyme inactivation D: efflux, enzyme inactivation metabolism

Linezolid 50S

Daptomycin Plasma membrane

Primary mech. of Resistance Primary elimination Primary mech. of drug-drug interaction Static/cidal Effective against MRSA Effective against VRE: faecium faecalis

Altered binding site

metabolism

renal

Inhibits CYP3A4

MAO inhibitor

+ + -

+ + +

+ + +

MATCH THE DRUG OF CHOICE (DOC) WITH THE ORGANISM MRSA Rickettsia ricketsii Bordetelle pertussis Bacillis anthracis E. Coli Clostridia difficile Pseudomonas a Francisella tularensis Streptococcus pyrogenes (Pen allergic) Streptococcus pneumoniae (pen resistant) (abscess) (RMSF) (whooping cough) (inhalation) (UTI) ________ Vancomycin ___________ ________ Doxycycline ___________ ________ Erythromycin __________ ________ Ciprofloxacin or Doxycycline ________ TMP/SMX or Ciprofloxacin

(Pseudomem. Colitis) ________ Metronidazole _________ (sepsis) (tularemia) (pharyngitis) ________ Gentamicin + piperacillin ________ Gentamicin ___________ ________ Erythromycin _________

(pneumonia)

________ Vancomycin or linezolid

Ciprofloxacin Doxycycline Gentamicin Gentamicin + piperacillin Linezolid Metronidazole Trimethoprim/sulfamethoxazole (TMP/SMX) Vancomycin Erythromycin

Match the listed effect with the antimicrobial most likely associated with the effect Red man syndrome Kernicterus Pseudomembranous colitis Ruptured tendon Optic neuritis Nephrotoxicity Megaloblastic anemia Gray baby syndrome Monoamine oxidation Inhibition _____Vancomycin ________________________________ ______Sulfamethoxazole ___________________________ ______ Clindamycin _______________________________ ______ Ciprofloxacin ______________________________ ______ Ethambutol ________________________________ ______ Gentamicin ___ (Vanco) ______________________ _______ Trimethaprim ______________________________ _______ Chloramphenicol ___________________________ _______ Linezolid _________________________________

Cephalexin Chloramphenicol Ciprofloxacin Clindamycin Daptomycin Ethambutol Gentamicin Linezolid Sulfamethoxazole Trimethoprim Vancomycin