ANTIBIOTICS SUMMARY Pg 1

General key: GRAM +VE; GRAM VE; DO NOT GRAM STAIN

Antibiotics Mechanism Spectrum Important resistance S/Es or interactions

mechanism
Benzylpenicillin (G -lactam ring binds pencillin- Narrow, useless for G(-) Any -lactam can cause group I
or V). binding proteins (PBPs) and aerobes e.g. in gut Beta-lactamases HS (IgE-mediated) = usually
break the strain ring microbiome. immediate. Can be severe
G: IV covalent bond with PBPs anaphylaxis.
V: PO catalytic serine covalently Use for Streptococci,
inhibits X-linking of PG. Neisseria, Spirochaetes. Others: Stevens Johnsons
Syndrome; toxic epidermal
PBP have a reactive serine that is necrolysis. AIHA (direct
used to X-link D-Ala-D-Ala of one Coombs mechanism)
NAM to a L-lysine in another
NAM, via a pentaglycine chain
(varies). Some risk of X-allergy (if very
severe allergy or SJS/TEN
No action on bacteria contraindicate any -lactam
without PG cell wall e.g. Abx); if not use another
chlamydia, mycoplasma, penicillin / lactam Abx type
atypicals. Extended spectrum Can be used in combination
Amoxicillin > aminopenicillin. Useful in Beta-lactamases with clavulanic acid =
Ampicillin (in terms of Recall: G(-) have outer cell RTI/UTI Gram (-)s e.g. co-amoxiclav.
bioavailability) membrane and thin PG cell Hib, E. coli; covers
wall. May have porins. Listeria
Amox: PO or IV
Antistaphylococcal - Intrinsically useless
Flucoxacillin and lactamase-resistant for G(-). MRSA mecA
methicillin penicillin (bulky R grp). gene PBP2a
Best used for MSSA. altered binding site.
IV Some use in Streptococci Use vancomycin
(skin infections). instead.
Piperacillin Antipseudomonals Often in combination with
IV tazobactam (tazocin).
 ANTIBIOTICS SUMMARY Pg 2
General key: GRAM +VE; GRAM VE; DO NOT GRAM STAIN

-lactam inhibitor Blocks beta-lactamases that

e.g. clavulanic acid, break down beta-lactam Abx,
tazobactam hence preserving spectrum of
activity.
ESBL G(-) bacteria
Cefalexin In general, cephalosporins Inactive against Hib e.g. Kleb and E. coli S/Es include hypersensitivity
Gen I have wider spectrum vs can hydrolyse reactions; AIHA (both similar
penicillins. Outpatient Rx for Resp, cephalosporins. ESBL to penicillin); X-reactivity with
PO UTI, soft tissue infections contains a plasmid penicillins.
Most are active against SA encoding the enzyme
and Strept because stable to and therefore can
Cefuroxime -lactamases. Wide range of G (+) / (-) spread widely, Increases nephrotoxicity of
Gen II but NOT pseudomonas affecting 1st to 3rd aminoglycosides (also cleared
Variable spectrum vs generation renally).
G (-) cephalosporins.
Severe sepsis, including
Any cephalosporin does NOT urinary, respiratory and Hence, switch to
cover Listeria (actually soft tissue infections. carbapenems.
crosses CSF well but
intrinsically ineffective to
this bug) nor Enterococci
cover with ampicillin or
amoxicillin.

Inactive against anaerobes

cover with metronidazole
 ANTIBIOTICS SUMMARY Pg 3
General key: GRAM +VE; GRAM VE; DO NOT GRAM STAIN

Wide range of G (+) / (-)

Ceftriaxone Ceftriaxone is given IV. but NOT pseudomonas Long t1/2 so once daily.
Gen III
High doses allow it to
IV attain high levels in CSF,
Gen III use for SERIOUS therefore used in severe
infections. infections including acute
bacterial meningitis

Good biliary penetration

(more lipid soluble).
Ceftazidine Similar activity to
Gen III ceftriaxone / cefotaxime.

IV But also an anti-

pseudomonal

Resistant to MOST -
Meropenem A carbapenem BROADEST spectrum - lactamases including Meropenem is stable to renal
lactam active against ESBL producing G(-)! dehydropeptidase I unlike other
IV MOST G(+) or (-) but not carbapenems (not inactivated).
MRSA! Carbapenemase Unlike other carbapenems, very
producing Klebsiella low risk of seizures.
and Carbapenemase
Producing HS reaction, rash, GI distress.
Enterococci (CPE)
oxa-48, NDM (New
Delhi metallo) now
developing.
 ANTIBIOTICS SUMMARY Pg 4
General key: GRAM +VE; GRAM VE; DO NOT GRAM STAIN

Glycopepetide that binds to Intrinsically Nephrotoxic monitor levels.

Vancomycin; D-Ala-D-Ala portion of PG Most G(+) including ineffective against Ototoxic.
teichoplanin precursors, preventing enterococci and MRSA G (-) because large Thrombophlebitis
addition of new blocks to cell molecule cannot Diffused flushing red man
IV (oral only if wall. Bactericidal. penetrate outer syndrome (counter by anti-
dealing w C. diff) membrane. histamines).
Large molecules so must be
given IV (poor oral f) VRE: modification of 2-component system: vanH
deHydrogenase reduces pyruvate to
D-Ala-D-Ala to D-Ala-
D-Lac; vanA ligase D-Ala-D-Lac.
D-Lac. VanX cleaves D-Ala-D-Ala.
Translation inhibitor Staphylococci, most G(-) Requires O2 for uptake Streptococci susceptible IF this
Aminoglycosides irreversible inhibition of including pseudomonas (active transport) drug is used with penicillin that
e.g. gentamicin initiation complex by binding hence ineffective disrupts cell wall (synergism).
30S (bactericidal because Drug resistant TB. against anaerobes!
IV (poor oral f) cause misreading of mRNA) Nephrotoxic (aminoglycoside
but also blocks translocation. Streptococci also lack sugar so water soluble and
the transporter, so not eliminated renally) and
susceptible. ototoxic (especially if given
with loops).
Transferase enzymes
inactivates drug by NM blockade sometimes.
Ac, Phos or
Adenylation. Teratogen.
Most G(+), G(-). Do not take tetracyclines w
Tetracyclines e.g. Translation inhibitor binds Weird bugs Borrelia Efflux or reduced cations (milk, antacids, iron
doxycycline 30S to prevent attachment of burgdorferi, Mycoplasma, uptake (plasmid- supplements): chelates &
aminoacyl-tRNA. Rickettsia, Chlamydia and encoded pumps). inhibit drug absorption via gut.
PO Bacteriostatic. malarial prophylaxis. Resistance is
Ability to accumulate increasing. GI distress, teeth
intracellular is key. discolouration, bone growth
inhibition in children,
photosensitivity.
 ANTIBIOTICS SUMMARY Pg 5
General key: GRAM +VE; GRAM VE; DO NOT GRAM STAIN

Macrolides e.g. Inhibit translocation by Atypical or severe Resistant in staph and All except azithromycin are
erythromycin, blocking translocation (23S pneumonias and strept mainly via P450 inhibitors (statins conc
clarithromycin, rRNA of 50S) causing intracellular bacteria such methylation of 23S increase). Also that of
azithromycin dissociation of growing as Mycoplasma, rRNA binding site. warfarin (vitamin K
peptide chain. Legionella, Chlamydia, producing bacteria loss).
PO or IV Mycobacterium avium
intracellulae. MACRO-lides:
Motility (GI); Arrhythmia
Also works for G (+) / (-) (torsades); Cholestasis; Rash;
Hib, Neisseria, eOsinophilia / Ototoxicity
Moraxella (reversible).

Azithromycin is used for

enterococci and
Chlamydia.

Clindamycin (a Translation inhibitor 50S Good soft tissue and Treat anaerobes above Pseudomembranous colitis (C.
lincosamide) blockade of peptide BONES / JOINTS diaphragm (lung difficile overgrowth)
translocation. infections (staph, strep, abscess, aspiration
PO anaerobes e.g. invasive pneumonia, oral
GAS infection). infections) vs
metronidazole below
Some protozoa PCP, Pf diaphragm.

Linezolid (an Translation inhibitor via Gram + including MRSA rRNA point mutation. BMS.
oxazolidinone) preventing formation of and VRE
initiation complex.
Bacteriostatic.
 ANTIBIOTICS SUMMARY Pg 6
General key: GRAM +VE; GRAM VE; DO NOT GRAM STAIN

Fluoroquinolones Nucleic acid synthesis Mutate DNA gyrase Antacids decrease gut
e.g. ciprofloxacin, inhibitor. MoDA = DNA Ciprofloxacin (PO): (chromosome); efflux absorption. Many S/Es.
moxifloxacin gyrase and DNA G (+) and G (-) including pumps (plasmid)
topoisomerase IV inhibitor. pseudomonas. Contraindicated in pregnant
PO Cannot transcribe or replicate women, nursing mums,
and causes DNA damage. Use in GIT and UT. children < 18 distribute in
Bactericidal. bones and block cell cycle.
Moxifloxacin: better for
staph, strep but NOT Torsades. Also lowers seizure
pseudomonas threshold.

Use for RESP infections in >60 yo tendonitis/ rupture

severe penicillin allergy. (or also in patients taking
Also use in MDR-TB. prednisone).

Folate antagonist NA synthesis inhibitor. Multiple resistance SMX: HS (sulfa drug),

e.g. sulphonamides mechanisms e.g. nephrotoxic, kernicterus in
and trimethoprim SMX: dihydropteroate altered enzyme, infants, displace other drugs
(TMP-SMX = co- synthase inhibitor decrease uptake, from albumin (e.g. warfarin),
trimoxazole) increase PABA G6PD = hemolysis.
PABA + pteridine -/-> DHP synthesis.
PO TMP: MEGALOBLASTIC
TMP: bacterial DHFRi anaemia folinic acid
supplement alleviate.
DHP DHF -/-> THF
purines, thymidine, met
Nitroimidazoles e.g. NA synthesis inhibitor, Protozoa (Entamoeba and Only works in Disulfiram-like reaction
metronidazole, damages DNA via toxic Giardia) and anerobes anaerobic severe flushing, tachy,
nitrofurantoin metabolites (free radicals); environment. R is hypotension, headache (do not
given orally (excellent f) Nitrofurantoin: UTI common. drink). Metallic taste.
PO