Protozoans Entamoeba histolytica Giardia lambia Toxoplasmosis gondii Trichomonas vaginalis Plasmodium species

Pathogenic Fungi Candida albicans Histoplasma capsulatum Coccidioides immitis Blastomyces dermatitidis Cryptococcus neoformans Pneumocystis jirovecii

Acid-Fast bacilli Mycobacterium tuberculosis Mycobacterium bovis Mycobacterium leprae

Spirochetes Treponema pallidum

Gram Positive Cocci Staphylococcus aureus Streptococcus pyogenes, Streptococcus pneumoniae Enterococcus faecalis

Gram Positive Bacilli Bacillus anthracis Corynebacterium diphtheria Clostridium botulinum Clostridium perfringens Clostridium tetani Clostridium difficile

Gram Negative Cocci Neisseria gonorrhoeae Neisseria meningitidis

Gram Negative Bacilli Escherichia coli Enterobacter aerogenes Proteus mirabilis Salmonella enterica Klebsiella species

Drugs Sulfonamides o Trimethoprim (Trimpex, Proloprim) o Co-trimoxazole (Septra, Bactrim) o Silver sulfadiazine (Silvadene Cream) o Mafenide (Sulfamylon) o Sulfacetamide (Blephamide) o Sulfasalazine (Azulfidine)

Inhibitors of Folate Metabolism Useful For Urinary tract infections (UTI) o Co-trimoxazole Alternative for some pneumonias Inflammatory Bowel Disease Agents o Sulfasalazine (Azulfidine)

Side Effects Sulfa class allergic reactions (5%) Hemolytic anemia in G-6-PD deficiency Can cause aplastic anemia (rare)

Inhibitors of Cell Wall Synthesis Useful For Beta-Lactam Antibiotics Gram positive organisms o Penicillins Gram negative cocci Naturals o Neisseria gonorrhoeae Penicillin G o Neisseria meningitidis Pen G benzathine or procaine (Bicillin) Treponema pallidum (syphilis) Penicillin V (Veetids) Extended spectrums Anti-Staph o Otitis o UTI Methicillin (Staphcillin) o Dental Prophylaxis Cloxacillin Nafcillin Weaknesses Oxacillin o Staphylococcus aureus Extended Spectrum o Gram negative rods/bacilli Ampicillin o Polycillin o Amcil o Omnipen Amoxicillin o Larotid o Polymox o Amoxil Anti-Psuedomonal Carbenicillin (Geocillin) Mezocillin (Mezlin) Piperacillin (Pipracil) Ticarcillin (Ticar) Drugs

Side Effects Hypersensitivity (5% incidence) o Rash o Angioedema o Anaphylaxis Diarrhea Nephritis (esp. methicillin)

Drugs Beta-Lactam Antibiotics o Cephalosporins 1st Generation Cephalosporins Cephalothin (Keflin) Cefazolin (Ancef, Kefzol) Cephalexin (Keflex) Cefadroxil (Duracef) 2nd Generation Cephalosporins Cefamandole (Mandol) Cefoxitin (Mefoxin) Cefaclor (Ceclor) Cefotetan (Cephotan) Cefmetazole (Zefazone) Loracarbef (Lorabid) 3rd Generation Cephalosporins Cefoxatine (Claforan) Ceftizoxime (Cefizox) Ceftriaxone (Rocephin) Cefoperazone (Cefobid) Cefexime (Suprax) 4th Generation Cephalosporins Cefepime (Maxipine) o Carbapenems o Monobactams

Inhibitors of Cell Wall Synthesis Useful For 1st Generation o Gram + active agents 2nd Generation o Better gram negative coverage 3rd Generation o Better gram neg o Better for CNS sepsis 4th Generation o Better beta-lactamase resistance

Side Effects 1-2% allergic reaction Allergic cross-reactivity with Pens: 5-15% Disulfiram-like effect o Cefamandole o Cefaperazone Bleeding due to anti-vitamin K action

Not in slides

Not in slides

Drugs Non-Beta Lactams o Vancomycin (Vancocin) Teicoplanin (Targocid) o Bacitracin (ointment, Neosporin, Polysporin) o Fosfomycin (Monurol) o Cycloserine (Seromycin)

Inhibitors of Cell Wall Synthesis Useful For Vancomycin o Synergistic with aminoglycosides o Enterococcus o Resistant staph and strep o Clostridium dificle Fosfomycin (Monurol) o UTI treatment Cycloserine (Seromycin) o Active against TB & gram negatives

Side Effects

Drugs Broad Spectrum Bacteriostatic Agents o Tetracyclines Tetracycline (TCN) Doxycycline (Vibramycin) Minocycline (Minocin) Demeclocycline (Declomycin) Oxytetracycline (Terramycin) Methacycline (Rondomycin) Others o o o o

Protein Synthesis Inhibitors Useful For Broad spectrum bacteriostatic agents o More effective against gram pos than gram neg o Chlamydia species o Mycoplasma pneumoniae o Acne vulgaris (anti inflammatory) o Some protozoal infections

Chloramphenicol (Chloromycetin) Lincomycins Spectrogramins Oxazolidinones

Side Effects Tetracyclines o Oral absorption reduced by food, dairy products, antacids o All contraindicated: Pregnancy & children (age < 814) Dental enamel dysplasia & discoloration Dental caries and cavities Growth inhibition, bone deformity o Beware of photosensitivity!! Especially TCN, Doxy, demeclocycline Avoid sun or double up on sunscreen Can burn easier Reduces latency to burn by to 2/3

Drugs Bacteriocidal Agent o Aminoglycosides Streptomycin (Strep) Amikacin (Amikin) Gentamicin (Garamycin) Tobramycin (Nebcin) Neomycin (Neosporin et al)

Protein Synthesis Inhibitors Useful For Widely used in gram negative infections Rarely used as single agents o Usually combined with gram + effective agent

Side Effects Parenterals: poorly absorbed from GI tract All are potentially ototoxic All are potentially nephrotoxic Toxicity increased by loop diuretics o Most potent to shed sodium o Reduce fluid volume

Drugs Macrolides o Erythromycin (EES, Erythrocin) o Azithromycin (Zithromax) o Clarithromycin (Biaxin) o Telithromycin (Proteck)

Protein Synthesis Inhibitors Useful For Good gram + coverage, some gram neg Chlamydia, legionella, mycoplasma Treponema, helicobacter, diptheria Safe in pregnancy & pediatrics

Side Effects GI upset (motilin like effects) o Cramps/nausea common side effects Liver toxicity CYP 450 3A inhibitor toxic effects

Drugs Fluoroquinolones Gram negative efficacy only o Norfloxicin (Noroxin) Gram + activity added o Ciprofloxin (Cipro) o Enoxacin (Penetrex) o Lomefloxacin (Maxaquin) o Levofloxacin (Levaquin) o Ofloxacin (Floxin) Augmented anti-staphylococcal activity o Gatifloxacin (Tequin) o Moxifloxacin (Avelox) o Sparfloxacin (Zagam) o Trovafloxacin (Trovan)

Inhibitors of Nucleic Acid Useful for Norfloxicin (Noroxin) o People with frequent UTI Gonorrhea Mycoplasma, ureaplasma, chlamydia Legionella Some mycobacteria (TB, avium) Anaerobes

Side Effects GI symptoms (nausea, diarrhea) CNS symptoms (dizziness, headache) Liver toxicity: trovafloxacin Photosensitivity: lomefloxacin Fluoroquinolones damage growing cartilage Dont use <18 years of age o Exceptions: serious resistant infections Avoid (if possible) use during pregnancy Tendon rupture

Drugs Mycobacterium leprae o Dapsone, o Colfazamine o Rifampin Mycobacterium tuberculosis o Isoniazid (INH) o Rifampin (Rifadin, Rimactane) o Ethambutol (Myambutol) o Streptomycin o Pyrazinamide o Aminosalicyclic sodium (Paser) o Ethionamide (Trecator-SC) o Cycloserine (Seromycin)

Anti-Mycobacterium Agents Useful For Battling Leprosy (Hansens Disease) o Works best w/ triple drug treatment Tuberculosis Treatment o Two or more drugs based on sensitivity studies o Duration of treatment varies from 4-7 months Longer in selected cases

Side Effects

Isoniazid (INH) o Toxicity: Peripheral Neuritis (paresthesia) Pyridoxine (B6) insufficiency Hepatitis/Hepatotoxicity Age linked o The older you are the greater the risk Means no ethanol while under RX Drug Interactions

Drugs Anti-HSV & VZV Agents o Acyclovir (Zovirax): oral & IV o Famciclovir (Famvir): oral o Valacyclovir (Valtrex): oral o Foscarnet (Foscavir): IV o Penciclovir (Denavir): topical o Trifluridine (Viroptic): topical

Anti-CMV Agents o Ganciclovir (Cytovene) o Cidofovir (Vistide) o Foscarnet (Foscavir) o Fomivirsen (Vitravene) o Valfanciclovir (Valcyte)

Anti-Hepatitis Agents o Lamivudine (Epivir) o Adefovir (Hepsera) o Interferon alfa-2a (Roferon) 2b (Intron) N3 (Alferon) o Ribavirin (Rebetol/Virazole)

Antivirals Useful For Battling Herpes Simplex o Type I: Oral Type II: Genital o Primary Infections often terrible Teratogenic in early pregnancy Potentially fatal to newborns o Latency, recurrences common o Severe infection possible in immunocompromised patients Battling Varicella-Zoster Virus (VZV) o Chickenpox o Zoster (herpes zoster) o Dangerous in immunocompromised hosts For HSV & VZV: o Reduce symptoms of primary infection For HSV: o Reduce frequency, duration, severity of recurrent outbreaks Battling CMV o Very common (60-80%) o Can infect embryo, fetus o Long latency o Serious problem in immunocompromised patients: Retinits Enchephalitis Hepatitis Viruses o Types A, B, C, others o Chronic infection (B,C) o Liver failure, hepatoma (B,C) Interferon o Immune cell produced cytokines which o Are anti-viral and anti-neoplastic because o They activate key immune system components: Macrophages Natural killer cells Antigen presentation to T cells

Side Effects Well tolerated o Many >10 years acyclovir suppression Famciclovir o Oncogenic o Testictular toxicity

Ganciclovir o Myelosupression o Additive with anti-HIV drugs Cidofovir o Renal toxicity (dose dependent)

Interferon o Neuropsychiatric Contraindicated in psychosis, depression o Flu-like syndromes o Marrow suppression o Hepatic toxicity Ribavirin o Hemolytic anemia (10-20%)

Drugs Anti-Influenza Agents o Prophylactic agents against influenza A Amantadine (Symmetrel): Rimantadine (Flumadine) o Neuraminidase inhibitors Zanamivir (Relenza) Oseltamivir (Tamiflu)

Antivirals Useful for Battling Influenza Amantadine/Rimantadine o Allergies and asthma o Some help with symptoms in first 24-48 hours o Best at prevention Patients allergic to vaccine (eggs) 70-90% effective o Mode of action uncertain May block viral attachment Neuraminidase Inhibitor o Preventive and shorten the duration o Prevention (prophylaxis) 70-80% effectiveness o Reduce symptoms/severity Reduce illness duration by 1-4 days The earlier its started, the better it works

Side Effects

Drugs Anit HIV o Nucleoside Reverse Transcriptase Inhibitors Zidovudine (Retrovir, AZT) Zalcitabine (Hivid, ddC) Stavudine (Zerit, d4T) Lamuvudine (Epivir, 3TC) Didanosine (Videx, ddi) Abacavir (Ziagen) Tenofovir (Viread) o Nonnucleoside RT Inhibitors Nevirapine (Viramune) Delavirdine (Rescriptor) Efavirenz (Sustiva) o Protease Inhibitors Saquinavir (Invirase) Ritonavir (Norvir) Ritonavir/lopinavir (Kaletra) Indinavir (Crixivan) Nelfinavir (Viracept) Amprenavir (Agenerase) o Nucleotide Inhibitors o Fusion inhibitor, Integrase inhibitor

Antivirals Useful For HIV Treatment o Multi-drug combinations o Usually 3 drugs o More effective o Less risk of drug resistance o Highly Active AntiRetroviral Therapy (HAART)

Side Effects NRTI Toxicity o Pancreatitis o Renal Impairment o Peripheral neuropathy o Bone marrow toxicity (esp. AZT) o Drug Interactions (esp. AZT) Cimetidine, indomethacin, lorazepam, acetoaminophen NNRTI Toxicity o Rash, Fever, Headache o Elevated Liver Enzymes o Epidermal Reactions Toxic Epidermal Necrolysis Stevens-Johnson Syndrome Protease Toxicity o Diarrhea, Nausea, fatigue, headache o Drug Interactions Elevated liver enzymes o Lipodystrophy Redistribution of fat (to back, abdomen) o Hyperglycemia & hyperlipidemia

Drugs Superficial Agents o Clotrimazole (Lotrimin) o Miconazole (Monistat) o Econazole (Spectazole) o Nystatin (Mycostatin) o Grieseofulvin (Grifulvin) Systemic/Subcutaneous o Amphotericin B (Amphotec) o Fluconazole (Diflucan) o Flucytosine (Ancobon) o Itraconazole (Sporanox o Ketoconazole (Nizoral) o Terbinafine (Lamasil)

Antifungals Useful For Amphotericin B o Potent against Candida, Histoplasma, Cryptococcus, Coccidioides, Blastomyces Fluconazole (Diflucan) o 1st choice for cryptococcal meningitis o GYN use: single dose for vaginitis Nystatin (Mycostatin) o Swish & swallow for oral candida o Alternative is clotrimazole troches

Side Effects Amphotericin B o Toxic: low therapeutic index o Fever, chills (preventable) o Hypotensive crisis o Anemia o Thrombophlebitis

Antiprotozoals Drugs Antiprotozoal Drugs o Metronidazole (Flagyl) o Chloroquine (Aralen) o Artemisinin

Useful For Metronidazole (Flagyl) o All but Plasmodium o Protozoal infections o Anaerobic infections o Abscesses o Pseudomembraneous colitis o Bacterial vaginosis Chloroquine (Aralen) o Plasmodium o Amebic liver abscess Artemisinin o Plasmodium

Side Effect Metronidazole (Flagyl) o Generally safe o Nausea, metalic taste, dizziness o Disulfiram (Antabuse)-like reaction possible Avoid ethanol