Antibiotic classes, mechanism, spectrum of coverage, and one signature side effect per class.
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- What is the mechanism of action of penicillins?
- Inhibit bacterial cell wall synthesis by binding penicillin-binding proteins and cross-linking peptidoglycan
- Penicillin G gram-positive and gram-negative coverage
- Gram-positive cocci and rods; narrow gram-negative coverage (mainly Neisseria)
- Most common allergic reaction to penicillins
- IgE-mediated hypersensitivity (anaphylaxis, rash, urticaria)
- Ampicillin gram-negative spectrum compared to penicillin G
- Better gram-negative coverage (includes E. coli, Proteus, Haemophilus), but still susceptible to beta-lactamase
- What does clavulanic acid do when combined with amoxicillin?
- Irreversibly inhibits beta-lactamase, protecting amoxicillin from degradation
- Cephalosporin mechanism of action
- Inhibit bacterial cell wall synthesis like penicillins; beta-lactam ring binds penicillin-binding proteins
- First-generation cephalosporin spectrum (e.g., cephalexin)
- Good gram-positive (including Staphylococcus aureus), limited gram-negative, no anaerobes
- Third-generation cephalosporin spectrum (e.g., ceftriaxone)
- Improved gram-negative (including Enterobacteriaceae, Neisseria, Haemophilus), reduced gram-positive vs first-gen
- Cephalosporin cross-reactivity with penicillin allergy
- Low cross-reactivity (~1-2%) with modern cephalosporins; safe in most penicillin-allergic patients
- Carbapenem spectrum (e.g., meropenem, ertapenem)
- Broad spectrum: gram-positive, gram-negative, anaerobes; resistant to most beta-lactamases
- Aminoglycoside mechanism of action
- Inhibit bacterial protein synthesis by binding to 30S ribosomal subunit and causing misreading of mRNA
- Aminoglycoside spectrum coverage
- Gram-negative aerobes (e.g., Pseudomonas, E. coli, Klebsiella); poor activity against anaerobes and against gram-positive organisms when used alone (though useful in synergistic combination with cell wall-active agents against some gram-positive organisms like Enterococcus or Staphylococcus).
- Dose-dependent nephrotoxicity caused by which antibiotic?
- Aminoglycosides; risk increases with prolonged use, baseline renal impairment, and concurrent nephrotoxic drugs
- Aminoglycoside-induced ototoxicity affects which cranial nerve?
- Cranial nerve VIII (vestibulocochlear); causes irreversible hearing loss and vestibular dysfunction
- Tetracycline mechanism of action
- Inhibit bacterial protein synthesis by binding to 30S ribosomal subunit and blocking aminoacyl-tRNA entry