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Antimicrobial Drugs Session Objectives 2010

Antibiotics I - Overview (Dery)

By the end of the session you should be able to:

1. Discuss the process of choosing the correct antibiotic.
2. Discuss the process of identifying the infecting organism.
3. Describe the time dependent and concentration dependent pharmacokinetic/pharmacy of antibiotics.
4. Describe how to determine the antimicrobial susceptibility of infecting organisms.
5. Describe the host factors necessary to understand so that the correct antibiotic is chosen.
6. Describe the indications for antimicrobial combinations, including antimicrobial synergism and antagonism.
7. Discuss therapeutic drug monitoring.
   

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Antibiotics II - Beta Lactams (Schieffelin)

1. Explain the mechanism of action of β-lactam antibiotics.
2. Describe the metabolism and pharmacokinetic properties of penicillins and other beta-lactams.
3. Discuss primary therapeutic indications for penicillin G and the repository penicillins.
4. Describe the indications for broad-spectrum penicillins, including penicillinase-resistant penicillins, aminopenicillins and anti-pseudomonal penicillins.
5. List the combinations of inhibitors of β-lactamase with penicillins, their clinical usage & explain the reason why they are combined.
6. Describe the antimicrobial spectrum and pharmacokinetic properties of the four generations of cephalosporins.
7. Explain the major side effects of penicillins and other beta-lactams including superinfection and hypersensitivity.
8. Describe the antimicrobial activity of monobactams and carbapenems.
9. List the major side effects of carbapenems and monobactams.
   

Drug List:   

• Penicillins: penicillin G, penicillin V, methicillin, oxacillin, nafcillin, dicloxacillin, ampicillin, amoxicillin, ticarcillin, piperacillin
• Cephalosporins: cephalexin, cefazolin, cefuroxime, cefoxitin, cefotetan, cefaclor, cefotaxime, ceftriaxone, ceftazidime, cefixime, cefepime
• Monobactams: aztreonam
• Carbapenems: doripenem, ertapenem, meropenem, imipenem (& imipenem + cilastatin)
• Beta-Lactamase Inhibitors: clavulanic acid, sulbactam, tazobactam

Antibiotics III  - Macrolides, Tetracyclines & Fluoroquinolones (Oberhelmen)

1. Describe the mechanism of action of each class
2. Explain the pharmacokinetic properties and compare erythromycin with clarithromycin, and azithromycin
3. Describe the primary therapeutic indications for each class of antibiotics
4. Describe the major drug interactions of macrolides due to inhibition of cytochrome P450 enzymes
5. Discuss the major toxicities and side effects of each class of  antibiotics
6. Explain the drug interaction of tetracyclines & antacids, and tetracyclines and penicillins
7. List the advantages of newer fluoroquinolones over older fluoroquinolones
8. Describe the adverse effects of fluoroquinolones, including contraindications in children & pregnant women.

Drug List:

• Macrolides: erythromycin, clarithromycin, azithromycin;
• Tetracyclines: tetracycline, doxycycline, minocycline
• Fluoroquinolones: ciprofloxacin, levofloxacin, moxifloxacin
  

Antibiotics IV - Aminoglycosides, Nitrofurantoin & Polymyxins (Van Dyke)

Aminoglycosides:

1. Discuss the mechanism of action of the aminoglycosides
2. Explain the mechanism of acquired microbial drug resistance to aminoglycosides
3. Describe the range of organisms which the aminoglycosides are active against
4. Describe the pharmacokinetic properties of the aminoglycosides; explain the importance of peak and trough levels.
5. Discuss the dose adjustment for aminoglycosides in patients with compromised renal function
6. Explain the rational basis for combination therapy with an aminoglycoside and a cell wall synthesis inhibitor
7. Discuss the main toxicities of aminoglycosides
   

Nitrofurantoin:

1. Discuss the mechanism of action of nitrofurantoin
2. Describe the range of organisms which nitrofurantoin is active against
3. Describe why its use is limited to urinary tract infections
4. Discuss the main toxicities from nitrofurantoin

Polymyxins:

1. Discuss the mechanism of action of polymyxins.
2. Describe the range of organisms which polymyxins are active against.
3. Describe the toxicities from polymyxins and how this influences their use

Drug List: 

• Aminoglycosides: amikacin, gentamicin, kanamycin, neomycin, netilmicin, streptomycin, tobramycin
• Urinary Antiseptic: nitrofurantoin
• Polymyxins: colistin, colistimethate, polymyxin B

Antibiotics V - Clindamycin, Metronidazole, Rifamycins & Sulfonamides (Mushatt)

1. Discuss the mechanisms of action of clindamycin, metronidazole and the rifamycins
2. Discuss the mechanism of action of sulfonamides and explain the synergistic inhibition due to sequential blockade with trimethoprim
3. Describe their pharmacokinetic/pharmacodynamic properties
4. Describe the range of organisms which these agents are active against
5. Discuss their therapeutic indications
6. Describe the major toxicities of these antibiotics
7. Understand the mechanism of drug interactions with rifampin
8. Explain the rational basis for combination therapy between rifampin and other antibiotics.

Drug List:

• Clindamycin
• Metronidazole
• Rifamycins: rifampin, rifabutin
• Sulfonamides: trimethoprim-sulfamethoxazole, sulfadiazine

Antibiotics VI - Vancomycin, Daptomycin, Linezolid & Quinupristin/Dalfopristin (Barbeau)

1. Discuss the differences in the mechanisms of action for each class of agents: glycopeptides (e.g. vancomycin, telavancin, teicoplanin), daptomycin, linezolid, and streptogramins (e.g., quinupristin/dalfopristin).
2. Describe the pharmacokinetic properties of each class of agents: glycopeptides (e.g., vancomycin, telavancin, teicoplanin), daptomycin, linezolid, and streptogramins (e.g., quinupristin/dalfopristin).
3. Describe the antimicrobial spectrum of each class of agents: glycopeptides (e.g., vancomycin, telavancin, teicoplanin), daptomycin, linezolid, and streptogramins (e.g., quinupristin/dalfopristin).
4. Describe the main therapeutic indications and toxicities/side effects of each class of agents: glycopeptides (e.g., vancomycin, telavancin, teicoplanin), daptomycin, linezolid, and streptogramins (e.g., quinupristin/dalfopristin).

Drug List:

• Glycopeptides: vancomycin, telavancin, teicoplanin
• Membrane Active Agents: daptomycin
• Oxazolidinones: linezolid
• Streptogramins: quinupristin/dalfopristin (combination)
  

Antifungal Drugs (Mondal)

1. List the antifungal drugs useful in treatment of fungal infections.
2. Explain the mechanism of action of each of these drugs.
3. Compare the pharmacokinetic properties of various antifungals.
4. Describe the major therapeutic indications of each of these drugs.
5. List the adverse effects associated with the antifungal drugs.
6. Know the liposomal preparations of Amphotericin B.
7. Be aware of the antifungal drug interactions, e.g. with warfarin.
   

Drug List:  
Amphotericin-B, Nystatin, Ketoconazole, Fluconazole, Itraconazole, Terbinafine, Griseofulvin, Flucytosine, Caspofungin

PBL on Antimicrobial Drugs (Faculty)

1. Generate hypotheses in relation to patient’s illness.
2. Predict the infecting organisms and list the antibiotics that can be used to treat an infection.
3. Be able to select alternative antibiotics for patients with a history of antibiotic allergy
   

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