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Golden Points

Unit-7 Antibiotics

  1. All antibiotics acting by inhibiting protein synthesis other than tetracyclins act by inhibiting 50-S ribosomal inhibition
  2. Tetracyclins cause deformities of bones & teeth (maximum damage between, 3-6 years)-CI, pregnancy, lactation & children below 8 years
  3. Tigecycline is a newer tetracycline and is eliminated by bile. It is effective against MRSA, VRSA.
  4. Doxycycline & demeclocycline cause photosensitivity
  5. Chloramphenicol causes gray baby syndrome which occurs due to defective glucoronidation
  6. Erythromycin is MC used macrolides that causes diarrhea and hepatitis (more in pregnant women-specially estolate salt); acts on motilin receptors, increase intestinal motility
  7. Fluroqunolones such as ciprofloxacin (has anti-pseudomonal activity) are used in typhoid fever but damage growing cartilages; therefore are avoided in children <17Y age
  8. Gatifloxacin & sparfloxacin prolong QT interval & trofloxacin cause hepatitis
  9. Levofloxacin & pefloxacin cause photosensitivity
  10. Sulphonamides are contraindicated in newborns because they cause jaundice due to albumin displacement
  11. Vancomycin is DOC for MRSA, causes ototoxicty, nephrotoxicty, MC side effect is RED MAN SYNDROME
  12. Cotrimoxazole act by sequential blockade, & is the DOC for pneumocystic carnii, Whipple’s disease and nocardiosis
  13. Spiramycin is DOC for toxoplasmosis in pregnancy
  14. Sulfadiazine +pyrimethamine is DOC in non-pregnant women
  15. Fluoroquinolones inhibit DNA gyrase (topisomerase-2), and damage cartilages (CI children <17y)
  16. Levofloxacin and Pefloxacin cause photosensitivity
  17. Methicillin causes interstitial nephritis, acid labile
  18. Methoxypenicllin (Penicllin V) is acid stable, given orally
  19. Penicillins are excreted unchanged by tubular filtration
  20. Probenacid can be given to prolong their duration
  21. Ampicillin causes rashes in patients with infectious mononeuclosis and with allopurinol
  22. MC side effect of ampicillin is diarrhea
  23. Ampicillin is DOC for listeria meningitis
  24. Imipenem is DOC for eneterobacter & s broadest spectrum antibiotic of penicillin class
  25. Ceftriaxone is the longest acting cephalosporine and is DOC for H. Infleunza, meningitis (except listeria), gonorrhea & typhoid fever. It is partly eliminated by bile. Another antibiotic of generation-III eliminated partly by bile is cefpiramide. Note that cefoperazone is eliminated totally by bile.   
  26. Aminoglycosides are ototoxic & nephrotoxic- Gentamicin is most nephrotoxic, while streptomycin is most vestibultoxic antibiotic.
  27. Aminoglycosides cause misreading of t-RNA-amino acid complex & premature termination of chain elongation
  28. Amphotericin-B is DOC for invasive or systemic fungal infections; causes hypokalemia, nephrotoxticy and hypersensitivity (test dose is needed)
  29. Amp B causes both hypo & hyperkalemia and can also cause significant nephrotoxicity. An important feature of drug is hypomagnesemia. Note that furesemide too can cause significant hypomagnesemia. 
  30. Itracnazole is DOC for blastomycosis, and Fluconazole for cryptococcal meningitis (can cause hypokalemia). It is a weak enzyme inhibitor; however, saquinavir, a protease inhibitor is weaker than itraconazole. 
  31. Griseofulvin (inhibits microtubules) is DOC for systemic dermatophytoses, due to low efficacy, its been replaced by terbinafine in onychomycosis
  32. Nevaripine+Zidovudine combination is used to reduce maternal to fetal transmission
  33. Zidovudine+lamividuine is used following accidental needle injury while drawing blood from HIV positive patient
  34. Lamividuine (DOC for HBV) does NOT cause neuropathy while Stavudine (MC drug), zalcitabine, diadanosine cause peripheran neuropathy. Indinavir causes renal stones and is MC drug causing lipodystrophy.
  35. HIV Protease inhibitors (Nelfinavir, squinavir, amprenavir, lopinavir, ritonavir & indinavir etc) should not be used with rifampin
  36. Rifabutin can safely be used with HIV protease inhibitors
  37. MC side effect of zidovudine is anemia (avoid with paracetamol as it can interfere with its metabolism
  38. Amantadine is antiviral with anti-Parkinson activity; ankle edema is MC side effect and is CI in epilepsy & renal failure
  39. Chloroquine is DOC for prophylaxis, malaria in pregnancy and vivax malaria
  40. Quinine is DOC for severe falciparum malaria. MC side effect is hypoglycemia
  41. Mefloquine prolongs QT interval and is contraindicated in heart block, psychiatric and epileptic patients
  42. Artemisinin derivatives (artether, artemether) are fastest acting anti-malarial drugs used in severe & resistant malaria
  43. Metronidazole is DOC for giardiasis, ameobisis (hepatic &intestinal), trichomonas vaginalis & gardnerella vaginalis (MC -s\e nausea, metallic taste, disulfiram like reaction)
  44. Diloxanide furate is DOC for asymptotic cyst passers
  45. Emetine\Dehydroemetine are used in serious cases with hepatic Amoebiasis but are cardiotoxic
  46. INH is most rapidly acting ATT, acts on both intra and extracellular bacterial penetration into caseous material is best; peripheral neuropathy (prevented by B6) is MC side effect, also hepatitis
  47. Mutation in INHA gene/KatG gene can give rise to resistance in case of INH
  48. Rifampin is slowly acting ATT, acts on intermittent growers & spurters-can sterlize cavities, cause organish red coloration, inhibits DNA dependent RNA polymerasecause hepatitis
  49. If given once a month or fortnightly, rifampin produces more s\e such as cutaneous syndrome, abdominal syndrome, flu like syndrome
  50. Ethambutol is not metabolized, excreted unchanged, causes interference of red-green vision (optic neuritis-MC serious s\e), and is CI in children below 6 years. Note that the drug is NOT hepatotoxic. 
  51. Pyrizinamide causes hepatitis, hyperuricemia (aspirin can be used), and is slowly acting bactericidal ATT-has cavity sterilizing activity
  52. Streptomycin is bacteriostatic ATT with oto & nephrotoxicity
  53. Dapsone is DOC for leprosy, anemia (mostly hemolytic) is MC side effect; also methemoglobinemia, megaloblastic anemia (as it is antifolate drug)
  54. Melarsoprol is DOC for CNS stage of African trypanosomiasis
  55. Suramin is DOC for hemolymphatic stage of African trypanosomiasis
  56. Nifurtimox is DOC for American trypanosomiasis
  57. Sodium stibogluconate is DOC for leishmanisis (both visceral & cutaneous)
  58. Pentamidine is used in resistant cases with visceral leishmanisis; but causes hypotension, and pancreatitis (diabetes may be permanent)
  59. Miltefostine is most effective drug against leishmanisis; also is the safest drug for leishmania discovered so far.
  60. Albendazole is DOC for all nematodes helminthic infections except strongyloides (ivermectin is DOC), W. Bancrofti (DEC is DOC) & Oncocerchiasis (ivermectin is DOC)
  61. Albendazole is the DOC for neurocysticercosis. Though, praziquantel can also be used but is NOT the DOC

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