1. Broad spectrum AMAs 2. Macrolides 3. Misc.

AMAs Class III

Dr.U.P.Rathnakar
MD.DIH.PGDHM
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 AMA which is not a macrolide isA. Vancomycin B. Azithromycin C. Roxithromycin D. Clarithromycin

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 Macrolide adminestered once a day is A. Erythromycin B. Azithromycin C. Roxithromycin D. Clarithromycin

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 Macrolide used against H.Pylori infection is-

A. Vancomycin B. Azithromycin C. Roxithromycin D. Clarithromycin

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 Advantages of azithromycin over erythromycin does not include A. It can be safely administered in pregnancy B. It is not an enzyme inhibitor C. It is administered once a day D. It is acid stable
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 Cholestatic jaundice is more common with A. Erythromycin base B. Erythromycin estolate C. Erythromycin ethylsuccinate D. Erythromycin stearate

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Protein synthesis inhibitors

1. Broad spectrum AMAs Tetracyclines Chloramphenicol
2. Macrolides 3. Misc. AMAs Clindamycin, Streptogramins, Linezolid Aminogycosides

Vancomycin{Cell wall[-]}

Topical agents [Varied MOA] Mupirocin Fusidic acid Polymyxin B, Colistin, Bacitracin, Tyrothricin

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Protein synthesis in microorganisms

Ch

Exit

Peptidyl

Acceptor

AG

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Miscellaneous
1. LINCOSAMIDES: Clindamycin, lincomycin

2. STREPTOGRAMINS: Quinpristin+Dalfopristin
3. OXAZOLIDINONES: Linezolid, Radezolid, Torezolid 4. GLYCOPEPTIDESVancomycin, Teicoplanin, Ramoplanin

Topical
1. 2. 3. Mupirocin Fusidic acid Polymyxin B, Colistin, Bacitracin, Tyrothricin

Dr.U.P.Rathnakar
MD.DIH.PGDHM

19

STREPTOGRAMINS [Quinupristin(A)-dalfopristin(B)] 30/70 Ratio MOA

Uses
Bind to 50s Prevent the extrusion of new peptide chain i.v. administration. Resistant HAIs -MRSA, VRE

ADEs/DIs

Enzyme inhibitor Eg. Inhibits the metabolism of cyclosporine

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OXAZOLIDINONES [Linezolid, Radezolid, Torezolid]

MOA Uses/oral-i.v. ADEs/DIs Inhibits protein synthesis-50s Prevents initiation complex G+ve only Resistant infections Hematological. Thrombocytopenia, anemia, neutropinia. Inhibits MAO- cheese reaction with tyramine foods Serotonin syndrome- with SSRIs

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Lincosamide antibiotics Clindamycin

MOA: Same as erythromycin Spectrum: Toxoplasma and pneumocystis carinii ADEs: Super infection-C. difficile- [pseudomembranous enterocolitis] Uses 1. Clindamycin plus primaquine -Pneumocystis jiroveci pneumonia. 2. Toxoplasmosis in AIDS patients Lincomycin-Not used
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GLYCOPEPTIDE ANTIBIOTICS Vancomycin

MOA: Inhibiting bacterial cell wall synthesis crosslinking Spectrum: MRSA, Strep.viridans, Enterococci, CL. Difficile

ADEs: Nerve deafness, nephrotoxic, red man syndrome [rapid i.v.- chills, fever, urticaria and intense flushing [Effect on mast cells-release histamine]

Uses-i.v Second choice drug to metronidazole for antibiotic associated pseudomembranous enterocolitis caused by C. difficile MRSA infections, enterococcal endocarditis with AG
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GLYCOPEPTIDE ANTIBIOTICS Teicoplanin and Ramoplanin

Teicoplanin-Newer glycopeptide-less toxic. MOA-similar to vancomycin No red man syndrome Effective against some VRE.

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Misc AMAs
Topically

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Topically used Misc. AMAs

Mupirocin- inhibitor of bacterial protein synthesis Fusidic acid- inhibitor of bacterial protein synthesis POLYPEPTIDE ANTIBIOTICS 1. Polymyxin B [Neosporin]- disrupt the integrity of the
bacterial cell membrane G-ve only including pseudomonas

2. Colistin- G-ve only including pseudomonas 3. Bacitracin- bacterial cell wall synthesis 4. Tyrothricin- disrupt the integrity of the bacterial cell membrane
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Antibiotic Use in Dermatologic Practice

Treatment of localized superficial bacterial

infections (eg, impetigo) Prevention of wound infection following minor surgical procedures Prevention of wound infection in minor wounds/injuries/abrasions to the skin Treatment of secondarily infected eczematous dermatitis Care of the umbilical stump of newborns
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Advantages Topical AMAs

Inexpensive Easy to administer No systemic effects Contraindicated for systemic use can be used