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Chapter 90

Chapter 90. Miscellaneous Antibacterial Drugs: Fluoroquinolones, Metronidazole, Daptomycin, Rifampin, Bacitracin, and Polymyxins. Fluoroquinolones. Broad-spectrum agents with multiple applications Disrupt DNA replication and cell division All can be administered orally or IV

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Chapter 90

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  1. Chapter 90 Miscellaneous Antibacterial Drugs: Fluoroquinolones, Metronidazole, Daptomycin, Rifampin, Bacitracin, and Polymyxins

  2. Fluoroquinolones • Broad-spectrum agents with multiple applications • Disrupt DNA replication and cell division • All can be administered orally or IV • Side effects generally mild but can cause tendon rupture (low risk) • Usually affects Achilles tendon • Avoid in patients younger than 18 years of age

  3. Fluoroquinolones: Ciprofloxacin (Cipro) • Ciprofloxacin (Cipro) • Broad-spectrum antibiotic (gram-negative and some gram-positive) • Inhibits bacterial DNA gyrase and topoisomerase II • Uses: multiple systems • Drug of choice for anthrax • Infections: respiratory, UTI, GI, bones, joints, skin, and soft tissue

  4. Fluoroquinolones: Ciprofloxacin (Cipro) • Adverse effects • Mild • GI – nausea/vomiting, diarrhea, abdominal pain • CNS – dizziness, headache, restlessness, confusion, rarely seizures • Candida infections – pharynx and vagina • Elderly patients • Confusion, somnolence, psychosis, visual disturbances

  5. Fluoroquinolones: Ciprofloxacin (Cipro) • Drug and food interactions • Cationic compounds • Absorption reduced by: • Aluminum antacids • Magnesium antacids • Iron salts • Zinc salts • Sucralfate • Milk and dairy products • Elevation of drug levels

  6. Other Fluoroquinolones • Ofloxacin • Lomefloxacin • Sparfloxacin • Moxifloxacin • Norfloxacin • Levofloxacin • Gemifloxacin

  7. Metronidazole (Flagyl) • Bactericidal • Uses • Protozoal infections • Infections caused by obligate anaerobes • Helicobacter pylori • Adverse effects • Neurotoxicity • Allergy • Superinfections

  8. Daptomycin (Cubicin) • Cyclic lipopeptide (new class) • Kills virtually all gram-positive bacteria, including MRSA • No significant drug interactions • Adverse effects – possible muscle injury • Given only once daily IV – no lab needed

  9. Additional Antibacterial Drugs • Rifampin • Broad-spectrum antibacterial used primarily for TB • Also used for some meningitis – not monotherapy • Rifaximin • PO non-absorbable form of rifampin used for traveler’s diarrhea • Nausea, flatulence, and defecation urgency

  10. Additional Antibacterial Drugs • Bacitracin • Almost always used topically for bacterial infections • Systemic can cause serious toxicity • Polymyxin B • Topical treatment for ears, eyes, and skin • Skin treatment usually in combination • Not used for systemic infections (because of toxicity risk)

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