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Fighting Bacterial Infections

Major Classes of Antibiotic Drugs: Penicillins

Examples of agents

• Amoxicillin (Amoxil, Moxatag)
• Ampicillin
• Penicillin G
• Penicillin V (Pen VK)
• Dicloxacillin
• Nafcillin
• Oxacillin
• Piperacillin
• Ticarcillin
• Amoxicillin-clavulanate (Augmentin)
• Ampicillin-sulbactam (Unasyn)
• Piperacillin-tazobactam (Zosyn)
• Ticarcillin-clavulanate (Timentin)

Safety Alert

• Up to 10% of patients in the US report penicillin allergies. Although true penicillin allergies are serious and can be life-threatening, many self-reported allergies are in fact adverse drug reactions and not an allergic reaction. If you are taking a patient history, specifically ask what his or her reaction is to the offending agent.

Major Classes of Antibiotic Drugs: Cephalosporins

• How they work: Kill bacteria by inhibiting the formation of their cell wall
• Therapeutic uses: Depending on generation of cephalosporin: dental work, oral infections, surgical prophylaxis, upper respiratory tract and sinus infections, UTIs, meningitis, intra-abdominal infections
• Side effects: nausea, vomiting, diarrhea, headache, dizziness, mental disturbances, seizures, heart palpitations, bleeding abnormalities
• Dispensing issues: allergies, high sugar content of cefdinir suspension, refrigerate suspensions except cefdinir and cefixime

Examples of agents:

• Cefazolin (Ancef)
• Cephalexin (Keflex)
• Cefaclor (Ceclor)
• Cefotetan (Cefotan)
• Cefoxitin (Mefoxin)
• Cefuroxime (Zinacef)
• Cefdinir (Omnicef)
• Cefditoren (Spectracef)
• Cefixime (Suprax)
• Cefotaxime (Suprax)
• Cefotaxime (Claforan)
• Cefpodoxime (Claforan)
• Ceftazidime (Fortaz, Tazicef)
• Ceftibutin (Cedax)
• Ceftriaxone (Rocephin)
• Cefepime (Maxipime)
• Ceftaroline (Teflaro)

Safety Alert

• Alert the pharmacist and prescriber if a patient who is allergic to penicillin is prescribed a cephalosporin. Even if the prescriber wants the drug dispensed, it is important to document this communication in case the person does have a cross-reaction.

Major Classes of Antibiotic Drugs: Carbapenems and Monobactams

• How they work: Kill bacteria by inhibiting the formation of their cell wall
• Therapeutic uses: Intra-abdominal infections, complicated skin/skin structure infections, complicated UTIs
• Side effects of carbepenems: skin rash, headache, anemia, pain
• Aztreonam inhalation: sore throat, cough, nasal congestion, wheezing, fever, chest discomfort
• Aztreonam IV: neutropenia, increased liver enzymes, skin rash
• Dispensing issues: special compounding and stability information on doripenem

Examples of agents:

Carbapenems:

• Doripenem (Doribex)
• Ertapenem (Invanz)
• Imipenem-cilastatin (Primaxin)
• Meropenem (Merrem I.V.)

Monobactam:

• Aztreonam (Azactam)

Major Classes of Antibiotic Drugs: Vancomycin

• How it works: Not fully understood, most likely inhibits cell wall formation
• Therapeutic uses: MRSA infections, endocarditis, Clostridium difficile infections
• Side effects: nephrotoxicity, ototoxicity
• Dispensing issues: drug:diluent ratio is 1 gm:200 mL, mix in larger amount of fluid to prevent red man syndrome
• Examples of agents: Vancomycin

Major Classes of Antibiotic Drugs: Lincosamides and Macrolides

• How they work: Block bacterial ability to produce needed proteins for survival

Therapeutic uses:

• Lincosamides: acne, dental work, anaerobic pneumonia, bone infections, bowel infections, female genital infections, intra-abdominal infections
• Macrolides: chlamydia, group A beta-hemolytic streptococcus, influenza, Legionnaire’s disease, mycoplasma pneumonia, streptococcus pneumonia
• Side effects: stomach upset, nausea, vomiting, heartburn, abdominal pain, diarrhea
• Dispensing issues: take with food, seek medical attention for severe abdominal pain or diarrhea, clindamycin used topically for acne

Examples of agents:

Lincosamide:

• Clindamycin (Cleocin)

Macrolides:

• Azithromycin (Zitromax, Z-Pak, Z-Max, Zitromax, Tri-Pak)
• Clarithromycin (Biaxin)
• Erythromycin (EES, Eryc, EryPed, Ery-Tab, Erythrocin, Pediazole)

Work Wise

• The azithromycin Z-Pak is an example of a drug that is supplied in a dose pack but can be dispensed from a bottle. The 250 mg and 500 mg tablets can be dispensed in a bottle or as a package. Just put same instructions on the label and use the same strength of the drug that is in the package.

Major Classes of Antibiotic Drugs: Aminoglycosides

• How they work: Kill bacteria by blocking their ability to make essential proteins for survival
• Therapeutic uses: Life-threatening infections due to Gram negative aerobes, sepsis, peritonitis
• Side effects: nephrotoxicity, ototoxicity
• Dispensing issues: variable doses, dosing is individualized and based on patient weight or therapeutic levels

Examples of agents:

• Amikacin
• Gentamicin (Garamycin, Gentak)
• Tobramycin (TOBI, Tobrex)

Major Classes of Antibiotic Drugs: Tetracyclines

• How they work: Inhibit protein synthesis within bacterial cells
• Therapeutic uses: Acne, anthrax, chronic bronchitis, Lyme disease, Mycoplasma pneumoniae infection, Rickettsia infection, chlamydia
• Side effects: upset stomach, nausea, vomiting, photosensitivity, permanent tooth discoloration
• Dispensing issues: may be taken with food, apply sunscreen, expired product may degrade and cause kidney failure

Examples of agents:

• Doxycycline (Vibramycin, Oracea, Adoxa)
• Minocycline (Minocin, Solodyn)
• Tetracycline (Sumycin)

Major Classes of Antibiotic Drugs: Fluoroquinolones

• How they work: Inhibit the enzyme that helps DNA to coil
• Therapeutic uses: Bone and joint infections, eye infections, serious RTIs, serious UTIs, anthrax
• Side effects: nausea, vomiting, dizziness, diarrhea, bitter taste in the mouth, liver toxicity, alterations in glucose metabolism. QT prolongation
• Dispensing issues: taking with food may not reduce GI effects, dose conversions when switching from oral to IV doses, must be dispensed with a Medication Guide

Examples of agents:

• Ciprofloxacin (Cipro)
• Levofloxacin (Levaquin)
• Moxifloxacin (Avelox)