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Anti-microbial (Folate synthesis inhibitors (Cotrimoxazole (ORALLY,…

- - - - Causes Cloudy urine Crystalluria :warning: conjugated in liver but when travel to kidney, change in pH will cause crystallisation
      - G6PF --> thrombocytonenia
      - Kernicterus: Displace bilirubin out from albumin
  - - - works on those that can produce their own folic acid, those that use preformed folate acid are not affected
- - - - High concentrations in urine
        
        Not good for those with renal impairment :warning:
        
        Turns urine BROWN :warning:
- - - - Penicillinase-resistant penicillin
        
        Nafcillin
        
        For very severe cases
        
        Renal and hepatic (primarily)
        
        Cloxacillin
        
        Renal and hepatic
      - Aminopenicillin
        
        Ampicillin
        
        Oral absorption is poorer than amox
        
        Renal adjustment
        
        Amoxicillin
        
        Renal adjustment
      - Natural penicillin
        
        Penicillin G
        
        IM/IV
        
        Better for meningitis
        
        Renal adjustment
        
        Penicillin V
        
        Oral (absorption is better than G)
        
        For Strep pharyngitis
        
        Renal adjustment
      - Anti-pseudomonal penicillin
        
        Piperacillin
        
        Renal adjustment
        
        IV
      - Aderse effect:
        
        Rash/hypersensitivity
        
        SJS/TEN
        
        CDAD
        
        Neurotoxicity
        
        Hepatotoxicity (Nafcillin)
        In patients with renal failure, high dose of penicillin can cause seizures
    - - Third generation
        
        Penetration to CSF
        
        Targets pseudomonas
      - Fourth generation
        
        Greater coverage for beta lactamase and pseudomonas
      - Second generation
        
        Covers gram negs, mostly things that cause LRTI E. coli, H. infleunzae, Kleibsella, Moraxella COMMUNITY ACQUIRED PNEUMONIA :warning:
      - Fifth generation
        
        Only ones that treat MRSA
      - First generation
        
        Covers gram positive
      - Adverse effect:
        
        Hypersensitivity with penicillin
        
        GIT
        
        Thrombophlebitis
    - - Poor oral
      - First line for ESBL
        
        Useful against GN and anaerobes
        
        Imipenem with cilastatian
        
        Cilastatin increases half life of imipenem by binding to di-peptidase
        
        Towards anaerobes
        
        Meropenem
        
        Wider range because used against imipenem resistant pseud
        
        Imipenem
        
        Step, staph, pseud
      - Adverse effect:
        
        Hypersensitivity with penicillin
        
        Rashes
        
        Neurotoxicity
        
        GIT
    - - Sulbactam ampicillin
        
        Good against anaerobes, abdominal or gynaecological infection :warning:
        
        Renal adjustment
      - Pip-tazo
        
        wide spectrum drug :warning:
        
        Renal adjustment
      - Co-amoxiclav
        
        Used for UTI (e.coli and enterococci) :warning:
        
        Renal adjustment
    - - Aztreonam
        
        Only against Gram Negs
        
        IM/IV
        
        Little cross sensitivity with penicillin :warning:
- - - - Tetracycline
        
        Same effect as CIPROFLOXACIN milk, divalent, antacids :warning:
        
        Renal adjustment
        
        Crosses placenta barrier
        
        Against intracellular microbes, vibrio,
        
        Oral
      - Doxycycline
        
        Used for CAP
        
        Hepatic
        
        Oral
      - Minocycline
        
        Used for N. Meningitidis
        
        Hepatic
        
        Oral
      - ALL CANNOT USE FOR PREGNANCY :warning:
      - Tigecycline
        
        Overcome
        
        Resistance mediated by efflux pump
        
        Resistance from ribosomal protection
        
        IV
        
        For MRSA, VRE
      - ADVERSE EFFECT: :warning:
        
        Effect on bones
        
        Phototoxicity
        
        CDAD
        
        Gastric discomfort (drink a lot of water) similar to sulfoamides
      - Enhance warfarin, digoxin, oral contraceptive, sulfonyurea
    - - Requires aerobic and gram negative
        
        Cannot cross BBB
        
        IV
        
        Cross Placenta
      - Renal adjustment
      - Always used as empirical drug :pen:
      - Gentamicin :fire: combine with penicillin for enterococcal endocarditis
      - Strepto and ami is used for TB
      - Neomycin :fire: used for skin infection or bowel prep for surgery
      - Adverse effect:
        
        Ototoxicity and nephrotoxicity
        SO NEED DRUG MONITERING
  - - - Azithromycin has less side effects than erythromycin
      - Oral or IV
      - Food interferes
      - Useful for anything without cell wall, mycoplasma, chlamydia, legionella
      - Erythromycin :fire:
        
        Campylobacter
      - Clarithromycin :fire:
        
        Triple therapy for H pylori
      - Azithromycin :fire:
        
        CAP
      - Adverse effect:
        
        Hepatotoxicity
        
        Ototoxicity
        
        Qr interval
        
        Gastric distress
      - HEPATIC :warning:
    - - For anaerobic, gram positive
      - MRSA :warning:
      - Jerovicii :warning:
      - Causes CDAD :warning:
      - Hepatic
      - Poor entry to CSF
      - Category B drugs
    - - Gram positive
      - Good against VRSA, MRSA, VRE
      - Oral and IV
      - CSF penetration
      - No does adjustment needed
      - Adverse effect:
        
        Bone marrow
        
        GI problem
        
        Neuropathy, blindness
- - - - levofloxacin
        
        Gram positive
        
        Respiratory quinolones
      - Moxifloxacin
      - Ciprofloxacin
        
        Gram negas
        
        Traveller's diarrhoea, food poisoning
        
        Sometimes used for UTI
        
        Should be avoided with MRSA