1.Sulfamethoxazole (SMX), Sulfisoxazole, Sulfadiazine

2. MOA- PABA antimetabolites inhibit dihydropteroate synthetase- Bacteriostatic

3. Use- Gram-positive, gram-negative, nocardia, chlamydia; triple sulfas or SMX for simple UTI

4. Toxicity: Hypersensitive, hemolysis if G6PD deficient, nephrotoxicity (tubulointerstitial nephritis), photosensitivity, kernicterus

5. displace warfarin from albumin

6. Resistance by altered enzyme, decreased uptake or increased PABA synthesis

1. MOA- inhibits bacterial dihydrofolate reductase- bacteriostatic

2. Clinical use- Used in combination with sulfonamides causing sequential block of folate synthesis; combination used for recurrent UTIs, Shigella, Salmonella, PJP

3. Toxicity- megaloblastic anemia, leukopenia, granulocytopenia (may alleviate with supplemental folinic acid)

TMP "Treats Marrow Poorly"

1. Ciprofloxacin, norfloxacin, ofloxacin, sparfloxacin, moxifloxacin, gatifloxacin, enoxacin, Nalidixic acid (quinolone)

2. MOA- Inhibition of DNA gyrase (topoisomerase II)- bactericidal

3. must not be taken with antacids

4. Clinical use: gram-negative rods of urinary and GI tracts (including pseudomonas), Neisseria, some gram-positive organisms

5. Toxicity- GI upset, superinfections, skin rashes, HA, dizziness, damage to cartilage, tendonitis and tendon rupture in adults; leg cramps and myalgias in children

6. Resistance by altered gyrase or reduced uptake

FluoroquinoLONES hurt attachments to you BONES

1. Only quinolone with Anaerobe coverage

2. SEVERE liver damage

1. Inhibits bacterial enzymes

2. Pts with CrCl <40 ml/min should not use

3. N/V/D, hypersensitivity, neurological

4. Category B in pregnancy

5. Prophylaxis and tx of UTI (E. coli, VRE)

1. Sparfloxacin (also photosensitivity)

2. grepafloxacin

3. moxifloxacin

1. MOA- forms toxic metabolites in the bacterial cell that damage DNA- bactericidal, antiprotozoal

2. clinical use- treats Giardia, Entamoeba, Trichomonas, Gardnerella vaginalis, Anaerobes; used with bismuth and amoxicillin for triple therapy against H. pylori

3. Toxicity- Disulfiram-like reaction with alcohol, HA, metallic taste

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Anaerobic infection below the diaphragm