ANTIBIOTICS

Antibiotics are antimicrobial medications that kill or inhibit the growth of bacteria. Antibiotics are
used to treat infections caused by bacteria.

What conditions require treatment with antibiotics?

Infectious disease and conditions treated with antibiotics:

Sexually transmitted infections (STIs)

 Syphilis
 Chlamydia
 Gonorrhoea
 Vaginal infections
 Chancroid

Ear, nose, and throat infections:

 Otitis media (ear infection)

 Pharyngitis (strep throat), tonsillitis, tonsillopharyngitis
 Sinusitis (sinus infection)

Lower respiratory tract infections:

 Tracheobronchitis, bronchitis
 Pneumonia

Urinary tract infections:

 Pyelonephritis (kidney infection)

 Cystitis (bladder infection)
 Bacterial prostatitis

Skin and skin structure infections

 Cellulitis
 Carbuncles, abscesses
 Impetigo (large vessicles or honey-crusted sores)
 Infected ulcers and burns
 Surgical wounds
 Acne

Other infections:
  Meningitis and septicaemia
 Helicobacter pylori infection
 Malaria
 Infectious diarrhea
 Inhalational anthrax
 Lyme disease
 Rheumatic fever

Types of antibiotics

The different types of antibiotics are known as classes. Different antibiotics destroy bacteria in
different ways and treat different infections. Antibiotics within a class generally have similar
effectiveness, mechanism of action and resistance, spectrum of antimicrobal activity, and side
effects potential.

Major classes of antibiotic drugs includ:

 Penicillins (beta-lactam antibiotics)

 Cephalosporins (beta-lactam antibiotics)
 Macrolides
 Quinolones (fluoroquinolones)
 Tetracyclines
 Aminoglycosides
 Sulphonamides
 Glycopeptides

Some antibiotics are "bactericidal", meaning that they work by killing bacteria. Other antibiotics are
"bacteriostatic", meaning that they work by stopping the growth or multiplication of bacteria.

Penicillins

Penicillin was the the first antibiotic re-discovered by Alexander Fleming in 1929 as a natural
product produced by Penicillium notatum mold. Penicillin is still one of the most useful and
important antibiotics.

Penicillins are bacteriocidal, they kill bacteria by inhibiting the formation of the bacterial cell wall,
causing the walls to break down.

Penicillins are used to treat strep throat, tonsillitis, skin infections, urinary tract infections, dental
infections, ear infections, gonorrhea. Penicillins are sometimes combined with other ingredients
called beta-lactamase inhibitors, which protect the penicillin from bacterial enzymes that may
destroy it before it can do its work.

Penicillins are usually very safe. The greatest risk is an allergic reaction, which can be severe.
  Amoxicillin (Amoxil)
 Ampicillin (Omnipen)
 Bacampicillin (Spectrobid)
 Oxacillin (Bactocil)
 Penicillin, Penicillin VK
 Amoxicillin-clavulanic acid (Augmentin)

Cephalosporins (Cepha drugs)

Cephalosporins are one of the most widely used antibiotics. Cephalosporins produce bacteriocidal
effect by inhibiting bacteria cell wall formation. They treat a broader range of bacterial infections
than penicillins.

Cepha antibiotics are closely related to the penicillins and many people allergic to penicillins also
have allergic reactions to cephalosporins.

Cephalosporins are used to treat pneumonia, strep throat, staph infections, tonsillitis, bronchitis,
urinary tract infections, otitis media, various types of skin infections, gonorrhea. Cephalosporins are
preferred antibiotics for prevention of infection during surgery.

Cephalosporins are among the most diverse classes of antibiotics, and are divided into
generations. Each newer generation of cephalosporins has greater gram negative antimicrobial
activity than the preceding one.

The most commonly prescribed cephalosporins:

 First generation
o Cephazolin (Ancef, Kefzol)
o Cefadroxil (Duricef)
o Cephalexin (Keflex)
 Second generation
o Cefaclor (Ceclor)
o Cefuroxime (Ceftin)
o Cefprozil (Cefzil)
o Loracarbef (Lorabid)
 Third generation
o Cefotaxime (Claforan)
o Cefixime (Suprax)
o Cefpodoxime (Vantin)
o Ceftazidime (Ceptaz)
o Cefdinir (Omnicef)
 Fourth generation
o Cefepime (Maxipime)
o Cefpirome (Cefrom)
Macrolides

Erythromycin, the first macrolide antibiotic, was discovered in 1952. Macrolides belong to the
polyketide class of natural antibiotics and are derived from Streptomyces bacteria.

Macrolides bind with ribosomes from susceptible bacteria to prevent protein production. This action
is mainly bacteriostatic, but can also be bactericidal at higher doses.

Macrolide antibiotics are valuable alternatives to pencillins and cephalosporins for the treatment of
a number of infections. Newer members of the group, azithromycin and clarithyromycin, are
particularly useful for respiratory tract infections because of their high level of lung penetration.
Clarithromycin has been widely used to treat Helicobacter pylori infections, the cause of stomach
ulcers. Macrolides are very effective against mycoplasma, mycobacteria, and chlamydia.

Macrolides cause very little allergy problems compared to the penicillins and cephalosporins.

Commonly prescribed macrolide antibiotics:

 Erythromycin
 Clarithromycin (Biaxin)
 Azithromycin (Zithromax)
 Roxithromycin (not available in US)
 Dirithromycin (Dynabac)
 Troleandomycin (Tao)

Fluoroquinolones

Fluoroquinolones (fluoridated quinolones) are broad-spectrum synthetic antibacterial medications.

Nalidixic acid was the first quinolone, introduced in 1962.

Fluoroquinolones are bactericidal agents. These drugs inhibit bacteria by interfering with their
ability to make DNA. This activity makes it difficult for bacteria to multiply.

Fluoroquinolones are prescribed for a variety of infections, including respiratory tract infections,
sexually transmitted diseases, urinary tract infections, and skin infections. Fluoroquinolones have
excellent activity against most bacterial causes of infectious diarrhea.

Fluoroquinolones can cause tendinitis and tendon ruptures1. Fluoroquinolones should not be given
during pregnancy.

Fluoroquinolone antibiotics include:

 Ciprofloxacin (Cipro)
 Gatifloxacin (Tequin)
 Levofloxacin (Levaquin)
  Lomefloxacin (Maxaquin)
 Moxifloxacin (Avelox)
 Norfloxacin (Noroxin)
 Ofloxacin (Floxin)
 Trovafloxacin (Trovan)

Tetracyclines

Tetracyclines were discovered in the late 1940s and were extremely popular because their
antimicrobial spectrum was broader than of most other antibiotics. Because of the development of
bacterial resistance to the tetracyclines, these antibiotics have lost some of their usefulness.

Tetracyclines are bacteriostatic antibiotics that work by inhibiting bacterial protein synthesis.

Tetracyclines are effective against a wide variety of bacteria and are used to treat acne, Rocky
Mountain spotted fever, Lyme disease, chlamydia infections, respiratory tract infections, urinary
tract infections, variety of sexually transmitted diseases (STD). Doxycycline is used for prophylaxis
of malaria. Minocycline is an alternative to rifampin for elimination the meningococcal carrier
state2.

Tetracyclines should not be given to pregnant women and children under 8 years.

Commonly prescribed tetracyclines are:

 Tetracycline (Sumycin)
 Doxycycline (Vibramycin)
 Minocycline (Minocin)
 Oxytetracycline

Related information: Sore Throat - causes, signs and symptoms, comfort measures and
treatment.

References

 1. van der Linden PD, Sturkenboom MC, Herings RM, Leufkens HG, Stricker BH.
Fluoroquinolones and risk of Achilles tendon disorders: case-control study. BMJ. 2002 Jun
1;324(7349):1306-7.
 2. Devine LF, Johnson DP, Hagerman CR, Pierce WE, Rhode SL 3rd, Peckinpaugh RO. The
effect of minocycline on meningococcal nasopharyngeal carrier state in naval personnel.
American Journal of Epidemiology. 1971 May;93(5):337-45.

Last updated: June, 2010