Slide 1SulfonamidesTrimethoprim (Primsol)TMP/SMZ (Bactrim)FluoroquinolonesBlack box warningCiprofloxacin (Cipro)Levofloxacin (Levaquin)Metronidazole (Flagyl)Daptomycin (Cubicin)UTIsMedication to treat UTINitrofurantoin (Microdantin)TuberculosisTo treat or not to treatLatent TBActive TBIsoniazid (INH)Rifampin (RIF)Anti-fungalsAmphotericin-B or “amphoterrible”Fluconazole (Diflucan)Clotrimazole (Lotrimin)VirusesAcyclovir (Zovirax)GanciclovirInterferon alphaOseltamivir (Tamiflu)Human immunodeficiency virus(HIV)NRTIsEmtricitabine (FTC)Tenovir (TDF)Efavirenz (EFV)AtriplaAnti-microbial IIIOctober 28, 20131Inhibits DNA and RNA and protein production by blocking folate pathway. Reaching therapeutic levels is limited by precipitation in urine (crystals)Work around-Combine with other agents2SulfonamidesBroad spectrum antibiotic Initial treatment of uncomplicated UTISuppresses potassium excretion (watch for hyperkalemia with ACE, ARB, K sparing diuretic)AE: itching, rash, GI symptoms3Trimethoprim (Primsol)Fixed dose of trimethoprim and sulfamethoxazoleInhibits several steps in formation of DNA, RNAUses: UTI, PCP, otitis mediaAE: N/V, rash are most commonHIV patient are susceptible to toxicity55% experience rash, recurrent fevers, leukopenia4TMP/SMZ (Bactrim)Disrupts DNA synthesisCan cause tendinitis and tendon rupture (usually Achilles' tendon)Broad spectrum antibiotic Minimal side effectsHepatic metabolism with Renal excretion5FluoroquinolonesFluoroquinolones are associated with an increased risk of tendinitis and tendon rupture. This risk is further increased in those over age 60, those on concomitant steroid therapy, as well as in kidney, heart, and lung transplant recipients. The fluoroquinolone should be discontinued if the patient experiences pain or inflammation in a tendon (symptoms that may precede rupture of the tendon), or tendon rupture. Advise patients, at the first sign of tendon pain, swelling, or inflammation, to stop taking the fluoroquinolone, to avoid exercise and use of the affected area, and to promptly contact their healthcare provider about changing to a non-fluoroquinolone antimicrobial drug.Healthcare professionals should consider the potential benefit and risks to each individual patient before prescribing a fluoroquinolone antimicrobial. While most patients prescribed fluoroquinolones tolerate these medicines, rarely patients develop serious adverse reactions which may include convulsions, hallucinations, depression, QTc prolongation and torsade de pointes, or Clostridium difficile associated diarrhea. Rarely, damage to the liver, kidneys or bone marrow, or alterations in glucose homeostasis may occur.Fluoroquinolones should only be used for the treatment or prevention of infections that are proven or strongly suspected to be caused by bacteria. Fluoroquinolones, like other antibacterial drugs, do not treat viral infections such as the common cold or influenza. 6Black box warningBroad spectrum Gram – and Gram + coveragePO and IVRespiratory, UTI, GI, bone, joints, skin and soft tissue and prevention of AnthraxAE: GI, CNS (dizziness, headache, restlessness) tendon rupture7Ciprofloxacin (Cipro)Broad spectrum approved for:Community acquired pneumonia (CAP)UTISinusitisExacerbation of chronic bronchitisPO/IVPO don’t take with milk (decreases absorption)AE: peripheral neuropathy, rhabdomylosis, tendinitis, photosensitivity8Levofloxacin (Levaquin)Anaerobic organism and protozoal infections.C.diff, infections in CNS, Abd organs, bones, joints, skin and soft tissues and GU tract. Often used with other antibioticIV, PO, topicalAE: dizziness, headache, abd pain, nausea, SJS, Seizures Interaction with ETOH: flushing, vomiting, headache9Metronidazole (Flagyl)Approved in 2006 for Gram + organismsMRSAIVAE: Elevated CK, headache, nausea2010: Black box for Eosinophilia pneumoniaDapto resistance (DAP-R)reported in Korea, Europe, Taiwan, and USA10Daptomycin (Cubicin)Most common infection in the USUrethritisPyelonephritisCystitisProstitisComplicatedUncomplicated11UTIsDoses and length of treatment change for severity of infection◦TMP/SMZ◦Cipro◦LevaquinRecurrent frequent UTI◦Nitrofurantoin (Microdantin)12Medication to treat UTIInjures bacteria by damaging DNAUsed to treat infection and as prophylacticAE: N/V diarrhea, anorexia, can cause pulmonary fibrosis, pneumonitis, hepatotoxicityPO take with food or meals13Nitrofurantoin (Microdantin)Caused by mycobacterium tuberculosisSpreads through dropletsLatent TB infectionbacteria lives in body without making host sick. Not infectious!TB disease- Bacteria becomes active and host is sick14TuberculosisLatent TBIf you have latent TB infection but not TB disease, your health care provider may want you be treated to keep you from developing TB disease. Treatment of latent TB infection reduces the risk that TB infection will progress to TB disease. Treatment of latent TB infection is essential to controlling and eliminating TB in the United States. The decision about taking treatment for latent TB infection will be based on your chances of developing TB disease15To treat or not to treatIsoniazidRifampinRifapentine16Latent TBIsoniazid (INH)Rifampin (RIF)Ethambutol (EMB)Pyrazinamide (PZA)17Active TBDrugs Initial phase Continuation phaseINH, RIF, PZA, EMBDaily for 8 weeksINF, RIF Daily for 18 weeksDestroys a component needed for cell wallPO or IMMetabolized in liver, excreted in kidneysAE: hepatotoxicity, peripheral neuropathy (reverse with pyridoxine B6)18Isoniazid (INH)Blocks RNA synthesis IV,PO (decreased absorption with meal)AE: Discoloration of body fluids (Red-orange sweat, urine, saliva, tears), hepatoxicity, GI. Reduces effects of many other drugs19Rifampin (RIF)Medications for systemic infectionsMedications for superficial infectionsWe are focused on drugs for systemic infections20Anti-fungalsBroad spectrum antifungalIV daily or every other day for WEEKS/MONTHSReactions during infusion◦Fever, chills rigors, nausea, headacheAE: Nephrotoxic, occurs in all patients: pre-hydrate, avoid other nephrotoxic drugs, hypokalemia, bone marrow suppression21Amphotericin-B or “amphoterrible”Used to treat candida, histoplasmosis, vaginitis, esophagitisPO, IVUse caution with other medication can cause increase in blood level (P450)AE: nausea, headache, rash, vomiting, diarrhea22Fluconazole