bind penicillin-binding protein, block transpeptidase cross-linking of peptidoglycan in cell wall

used for gram+ organism(S.pneumoniae, S.pyogenes, Actinomyces), gram- cocci(N.meningitis) and spirochetes

resistance: β-lactamase, mutation in penicillin-binding protein

similar to penicillin, wider spectrum, with clavulanic acid to protect against β-lactamase

H.influenzae, H.pylori, E.coli, Listeria monocytogenes, Proteus mirabilis, Salmonella, Shigella

adverse: hypersensitivity, rash, pseudomembranous colitis

β-lactam, inhibit wall synthesis, less susceptible to penicillinase

Listeria, Atypical(chlamydia, mycoplasma), MRSA, Enterococci are not covered

1st-generation(cefazolin, cephalexin): gram+ cocci, Proteus mirabilis, E.coli, Klebsiella pneumoniae

2nd-generation(cefaclor, cefoxitin, cefuroxime, cefotetan): gram+ cocci, H.influenzae, E.aerogenes, Neisseria spp., Serratia, E.coli, Klebsiella

3rd-generation(ceftriaxone, ceftaxine, cefpodoxime, ceftazidime): gram- resistant to other β-lactam

5th generation(ceftaroline): broad, cover Listeria, MRSA, Enterococcus faecalis

resistance: inactivated by caphalosporinase, structual change

gram - only, for penicillin-allergic patient, those wtih renal insufficiency

inhibit cell wall synthesis by binding D-Ala-D-Ala portion of cell wall precursors, not susceptible to β-lactamase

adverse: nephrotoxicity, ototoxicity, thrombophlebitis(血栓静脈炎), redman syndrome(diffuse flushing), DRESS syndrome(eosinophilia, systemic symptom)

binding 30s of ribosome, require O₂ (ineffective against anaerobic)

adverse: nephrotoxicity, neuromuscler blockade, ototoxicity, teratogen

M.pneumoniae, Rickettsia, Chlamydia, MRSA(dexycycline), acne

discoloration of teeth and inhibitation of bone growth in children, contraindicated in pregnancy, doxycycline has no nephrotoxicity

adverse: bone marrow suppression, peripheral neuropathy, serotonin syndrome

adverse: gastrointestinal motility issues, arrhythmia, acute colestatic hepatitis, rash, eosinophilia

bind to phospholipid, disrupt cell membrane→leakage of cellular component→cell death

adverse: hypersensitivity reaction, nephrotoxicity, kernicterus in infant

ciprofloxacin, enoxacin, norfloxacin, pfloxacin; respiratory: gemifloxacin, levofloxacin, moxifloxacin

adverse: GI upset, superinfection, skin rash, headache, dizziness, contraindicated in pregnant women, nurshing(授乳中) mothers, and children (damage to cartilage), tendonitis, tendon rupture

adverse: myopathy, rhabdomyolysis(横紋筋融解症)

giardia, entamoeba, trichomonas, gardnerella vaginalis, anaerobe

can be used in place of amoxicillin in H.pylori in case of penicillin allergy

adverse: disulfiram-like reaction(アルデヒド蓄積により悪酔い)

M avium-intracellulare(非結核性抗酸菌): azithromycin, rifabutin (prophylaxis); azithromycin or clarithromycin + ethambutol (treatment)

M.tuberculosis: isoniazid (prophylaxis); rifampin, isoniazid, pyrazinamide, ethambutol (treatment)

rifabutin favored in HIV infection (less cytochrome P-450 stimulation)

hepatotoxicity, P-450 inhibition, SLE, acidosis, vitB6 deficiency

tinnitus, vertigo(回転性めまい), ataxia, nephrotoxicity

pregnant woman carrying group B strep: penicillin G or ampicillin

high risk for endocarditis, undergoing surgical or dental procedure: amoxicillin

meningococcal infection: ceftriaxone, ciprofloxacin, rifampin

strep pharyngitis(連鎖球菌咽頭炎) in child with prior rheumatic fever: benzathine penicillinG or oral penicillin V

CD4<100: TMP-SMX: pneumocystis pneumonia and toxoplasmosis

CD4<50: azithromycin, clarithromycin: mycobacterium avium complex

MRSA: vancomycin, daptomycin, linezolid, tigecycline, ceftaroline, doxycycline

VRE: linezolid, streptogramins(quinupristin, dalfopristin)

multidrug-resistant P aeruginosa, Acinetobacter baumannii: polymyxin B, E

adverse: fever, hypotension, nephrotoxicity, arrhythmias, anemia, IV plhebitis(静脈炎)

clotrimazole, fluconazole, isaconazole, ketoconazole, miconazole, vericonazole

inhibit fungal sterol synthesis by inhibiting cytochrom P-450

fluconazole to cryptococcal meningitis in AIDS and candidal infection; itraconazole to blastomyces, coccidioides, histoplasma; voriconazole for aspergillus and some candida; isavuconazole for serious aspergillus and mucor

adverse: testosterone synthesis inhibition, liver dysfunction

adverse: GI upset, headache, hepatotoxicity, taste disturbance

inhibit cell wall synthesis by inhibiting synthesis of β-glucan

treat P.falciparum with artemether/lumefantrine and atovaquone/proguanil, if life-threatening, use quinidine

inhibit influenza neuraminidase→↓release of progeny virus

guanosine analog, monophosphorylated by HSV/VZV thymidine kinase→few adverse effect, inhibit DNA polymerase

valacyclovir is a prodrug of acyclovir, have better oral bioavailability

guanosine analog, 5'-monophosphate formed by CMV viral kinase, inhibit viral DNA polymerase

viral DNA/RNA polymerase inhibitor and HIV reverse transcriptase inhibitor

for CMV retinitis (when ganciclovir fails), acyclovir-resistant HSV

adverse: nephrotoxicity, electrocyte abnormalities, seizure

adverse: bone marrow suppression, lactic acidosis, anemia, pancreatitis

abacavir, didanosine, emtricitabine, lamivudine, stavudine, tenofovir, zidovudine

atazanavir, darunavir, fosamprenavir, indinavir, lopinavir, ritonavir, saquinavir

HIV-1 protease (cleave polypeptide into functional part) inhibitor

hyperglycemia, GI intolerance, lipodystrophy(脂肪異栄養症), nephropathy, hematuria, thrombocytopenia

bind CCR5 on Tcell or monocyte, inhibiting interaction with gp120