General Facts and Figures Classification Presentation History Physical Exam Labs Radiology Diagnosis Criteria for diagnosis Differential Microbiology General Specific organisms Pharmacology Drug Classes Mechanism of action Resistance Treatment General Site of care Medication Duration Assessment of response Prevention References Literature cited Complete bibliography Links More...		Pharmacology Drug Classes beta-lactams - cell wall synthesis inhibitors; ineffective against M. pneumoniae, C. pneumoniae, and L. pneumophila penicillins - mostly Gram-positives natural penicillins penicillinase-resistant semisynthetic penicillins (PRSPs) (nafcillin, oxacillin, cloxacillin) - many Gram-negatives aminopenicillins (extended spectrum) (amoxicillin, ampicillin) carboxypenicillins (extended spectrum) (ticarcillin) ureidopenicillins (extended spectrum) (piperacillin) amidinopenicillins combination with beta-lactamase inhibitors cephalosporins - Gram-positives to Gram-negatives carbapenems (imipenem, meropenem) - broad spectrum of aerobic and anaerobic Gram-positives and Gram-negatives monobactams (aztreonam) beta-lactamase inhibitors - combined with beta-lactams are active against H. influenzae, anaerobes, M. catarrhalis, methicillin-susceptible S. aureus (MSSA) clavulanic acid - + amoxicillin (Augmentin), + ticarcillin (Timentin) sulbactam - + ampicillin (Unasyn) tazobactam - + piperacillin (Zosyn) aminoglycosides (gentamicin, tobramycin, netilmicin, amikacin) - translation inhibitors; in vitro activity against aerobic and facultative Gram-negative bacilli, including P. aeruginosa; also covers MSSA macrolides (erythromycin, clarithromycin, azithromycin) - translation inhibitors; generally useful for M. pneumoniae, C. pneumoniae, and L. pneumophila; many S. pneumoniae isolates are resistant quinolones (ciprofloxacin, ofloxacin, levofloxacin, sparfloxacin, grepafloxacin, trovafloxacin) - DNA synthesis inhibitors; cover most clinically significant Gram-positive cocci, Gram-negative bacilli, H. influenzae, M. catarrhalis, M. pneumoniae, C. pneumoniae, and L. pneumophila; except for cipro, all are effective against S. pneumoniae; variable efficacy against S. aureus tetracyclines (tetracycline, doxycycline) - translation inhibitors; M. pneumoniae, C. pneumoniae, and L. pneumophila; usually good for S. pneumoniae and H. influenzae but resistance is increasing miscellaneous trimethoprim/sulfamethoxazole - DNA synthesis inhibitor; broad spectrum Gram-positive and Gram-negatives, resistance is increasing (especially S. pneumoniae and H. influenzae) metronidazole - DNA synthesis inhibitor clindamycin - translation inhibitor; Gram-positive cocci (including most S. pneumoniae isolates - PRSP, macrolide-RSP), MSSA, anaerobes; no coverage of H. influenzae or M. pneumoniae, C. pneumoniae, L. pneumophila vancomycin - cell wall synthesis inhibitor; all S. pneumoniae isolates, other Gram-positives including MRSA (see CDC statement regarding prevention of vancomycin resistance) rifampin - transcription inhibitor chloramphenicol - translation

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