抗生素概论 Review of Antibiotics Part 1ppt课件.pptVIP

* * * * * * * * * * * * * * * * Bacterocidal vs Staph Bacterostatic vs Enterococcus 2hr. Post antibiotic effect * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * Trimethoprim/Sulfamethoxazole Each component inhibits sequential steps of tetrahydrofolic acid synthesis thus act synergistically High oral bioavailablilty Trimethoprim/Sulfamethoxazole Toxicity 75% adverse reactions involve skin urticarial rash most common Stevens-Johnson Syndrome, exfoliative dermatitis, toxic epidermal necrolysis are rare allergic cholestatic hepatitis reversible drop in creatinine clearance in patients with normal renal function irreversable renal failure in patients with renal disease Uses of Trimethoprim/Sulfamethoxazole Useful alone or in combo with Rifampin in mild MRSA infections UTI, Bronchitis, cellulitis Switch to PO TMP/SMX after a course of IV vancomycin Use in combination with vancomycin and rifampin in serious MRSA infections Drug of choice for Stenotrophomonas maltophilia Drug of choice for Pneumocystis Rifampin Inhibits DNA-dependent RNA polymerase Concentration in lung exceeds serum levels PO = IV Synergy demonstrated with cefazolin vs MSSA and with Vancomycin vs MRSA Never use as monotherapy, resistance develops rapidly Rifampin - Toxicity Chemical hepatitis GI intolerance Increase serum creatinine Rifampin - Drug-Drug Interactions Increases hepatic metabolism of many drugs thus reducing their serum levels: coumadin theophyline fluconazole, itraconazole, ketoconazole digoxin cyclosporin propranolol sulfonylureas prednisone dilantin Synercid - quinupristin Synercid - dalfopristin Synercid Class : Streptogramin Quinupristin and dalfopristin act synergistically Mechanism of action: bind to 50s ribosome to inhibit protein synthesis Synercid - Antibacterial Spectrum MSSA - bacterocidal MRSA - bacterocidal Vancomycin-resistant E. faecium - bacterostatic unreliable vs E. faecalis Coag. neg. staph Corynebacterium jeikeium S. agalactiae S. pneumoniae (i