Download Chapter 16 Cholinesterase Inhibitors

Miscellaneous Antibacterial Drugs:
Fluoroquinolones, Metronidazole,
Daptomycin, Rifampin, Rifaximin,
Bacitracin, and Polymyxins
Fluoroquinolones
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Broad-spectrum agents with multiple
applications
Disrupt DNA replication and cell division
All can be administered orally or IV
Fluoroquinolones
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Side effects generally mild but can cause
tendon rupture (low risk)
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Usually affects Achilles tendon
Avoid in patients younger than 18 years
Risk to all patients, especially those older than 60
years, those taking glucocorticoids, and those who
have undergone kidney, heart, or lung
transplantation
Fluoroquinolones: Ciprofloxacin
(Cipro)
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Ciprofloxacin (Cipro)
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Broad-spectrum antibiotic (gram-negative and
some gram-positive)
Inhibits bacterial DNA gyrase and
topoisomerase II
Uses: multiple systems
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Drug of choice for anthrax
Infections: respiratory, urinary tract (UTI), GI,
bones, joints, skin, and soft tissue
Fluoroquinolones: Ciprofloxacin
(Cipro)
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Adverse effects

Mild
• GI: nausea/vomiting, diarrhea, abdominal pain
• Central nervous system (CNS): dizziness, headache,
restlessness, confusion, rarely seizures
• Candida infections: pharynx and vagina
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Older adult patients
• Confusion, somnolence, psychosis, visual disturbances
Fluoroquinolones: Ciprofloxacin
(Cipro)
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Drug and food interactions
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Cationic compounds
Absorption reduced by:
• Aluminum antacids
• Magnesium antacids
• Iron salts
• Zinc salts
• Sucralfate
• Milk and dairy products
Elevation of drug levels
Other Fluoroquinolones
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Ofloxacin
Moxifloxacin
Norfloxacin
Levofloxacin
Gemifloxacin
Metronidazole (Flagyl)
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Bactericidal
Uses
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Protozoal infections
Infections caused by obligate anaerobes
Helicobacter pylori
Adverse effects
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Neurotoxicity
Allergy
Superinfections
Daptomycin (Cubicin)
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Cyclic lipopeptide (new class)
Kills virtually all gram-positive bacteria,
including methicillin-resistant Staphylococcus
aureus (MRSA)
No significant drug interactions
Adverse effects: possible muscle injury
Given only once daily IV: no laboratory work
needed
Additional Antibacterial Drugs
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Rifampin
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Broad-spectrum antibacterial used primarily for
tuberculosis (TB)
Also used for some meningitis: not monotherapy
Rifaximin
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Nonabsorbable PO form of rifampin used for
traveler’s diarrhea
Nausea, flatulence, and defecation urgency
Newer indication: prevention of encephalopathy in
patients with chronic liver disease
Additional Antibacterial Drugs
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Bacitracin
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Almost always used topically for bacterial infection
Systemic; can cause serious toxicity
Polymyxin B
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Topical treatment for ears, eyes, and skin
Skin treatment usually in combination
Not used for systemic infection (because of toxicity
risk)