The classification and difference of super whole super new antibacterial drugs (third edition)!

Author: Gcplive

Source: Center for Drug Evaluation

Antibacterial The application of drugs involves various clinical departments, and mastering the classification of antibiotics is the basis for the rational application of antibiotics. Today’s classification of antimicrobials and their differences are summarized below. I. Penicillins1. Penicillin has strong antibacterial activity against Streptococcus hemolyticus (G+ bacteria). 2. The pathogenic bacteria of acute bacterial pharyngitis and tonsillitis are mainly group A hemolytic streptococcus, so penicillin is the first choice, and the course of treatment takes 10 days. 3. Ampicillin is the drug of choice for Enterococcus and Listeria infections. 4. The common pathogens of bacterial meningitis (children aged <1 month) are G+ bacteria (group B hemolytic streptococcus, Listeria) and G- bacteria (Escherichia coli , Klebsiella pneumoniae), so ampicillin + ceftriaxone is preferred. 5. Penicillin potassium should not be injected intravenously (65mg potassium per 1 million IU); 6. The combination of amoxicillin and allopurinol will increase the risk of rash.

II. Cephalosporins

1. All cephalosporins It has poor activity against Enterococcus and methicillin-resistant Staphylococcus. 2. It is mainly excreted by the kidneys. Patients with moderate or higher renal insufficiency should adjust the dose appropriately according to renal function. 3. The dose of cefoperazone and ceftriaxone may need to be adjusted when the liver function is moderate or more severe. 4. Most of the cephalosporins have been reported to cause disulfiram-like reactions. During the treatment and at least 72 hours after the end of the treatment, you should stop drinking or avoid consuming alcoholic beverages. 5. Cefoperazone can cause hypoprothrombinemia or bleeding, and vitamin K can prevent bleeding.

Three, Cephamycins and Oxycephems

1 .Stable to β-lactamase. 2. It has stronger antibacterial effect on anaerobic bacteria such as Bacteroides fragilis than cephalosporins. 3. Cefmetazole and cefminox can cause disulfiram-like reactions. V. Carbapenems and Penems1.Current Penems There is only one (faropenem, orally). 2. Carbapenems can cause serious adverse reactions in the central nervous system. Patients with central nervous system infection should not use imipenem/cilastatin. 3. Meropenem is less likely to induce epilepsy and is approved for meningitis. 4. Imipenem/cilastatin is approved for bone and joint infections. 5. Carbapenems can reduce the plasma concentration of valproic acid or divalproex acid and increase the risk of seizures, so combined use is not recommended. 6. Aminoglycosides1. Mainly used for aerobic G-bacillus infection. 2. The drug concentration in renal cortex and inner ear lymph fluid is high, and all varieties have nephrotoxicity and ototoxicity (cochlea, vestibule). 3. It is a concentration-dependent rapid bactericide, and it adopts a once-daily dosing regimen. 4. It has neuromuscular blocking effect. VII. Lincosamides1. Mainly used for G+ bacteria and various anaerobic bacteria Infect. 2. Clindamycin can be excreted through bile and feces, and the antibacterial activity in feces can last for 5 days after drug withdrawal, which may easily cause superinfection and pseudomembranous colitis. 3. Lincosamides have the same mechanism of action as macrolides, and have cross-resistance and antagonism. 4. Both lincosamides and aminoglycosides have neuromuscular blocking effects, so avoid combined use. 5. Clindamycin inhibits the production of bacterial toxins and can be used in the treatment of necrotic skin and soft tissue infections. Octacyclines and glycylcyclines1. glycylcyclines It is a tetracycline derivative with broad-spectrum antibacterial effect. 2. Tetracyclines and glycylcyclines can cause permanent tooth staining and enamel dysplasia in patients with developing teeth (embryo stage to 8 years old). 3. Minocycline and doxycycline can cause benign intracranial hypertension, adverse vestibular reactions and skin pigmentation. 4. Minocycline and doxycycline should be taken with food and taken with a large glass of water. After taking the medicine, stand upright for more than 1 hour to reduce damage to the esophagus. 5. Avoid light. Nine, macrolides1. Non-antibacterial effects of macrolides, Including anti-inflammatory, immunosuppressive, and gastric motility. 2. Macrolides are hepatotoxic and can also cause tinnitus and hearing impairment. 3. Macrolides can prolong the QT interval and even cause fatal torsades de pointes. 4. Erythromycin has the risk of causing pyloric stenosis and is not recommended for neonates within 28 days. 5. Erythromycin and clarithromycin: strong inhibitors of CYP3A4, can significantly increase the blood concentration of “dipine” antihypertensive drugs such as nifedipine. X. Quinolones1. Anti-Pseudomonas aeruginosa effects of ciprofloxacin and levofloxacin strong. 2. When levofloxacin is used for abdominal cavity, biliary tract infection and pelvic infection, it should be used in combination with antianaerobic drugs such as metronidazole. 3. Moxifloxacin has strong anti-anaerobic activity, and can be used as a single drug to treat mild complicated abdominal infection. 4. The adverse reactions of quinolones, including tendonitis and tendon rupture, worsening of myasthenia gravis, photosensitivity reaction, central nervous system toxicity, peripheral neuropathy, prolongation of QT interval, blood sugar disturbance, etc. 5. Quinolones can cause crystalluria. Sufficient water should be added during medication. Undeca, nitroimidazoles1. Metronidazole and tinidazole inhibit the Aldehyde dehydrogenase, causing a disulfiram-like reaction, refrain from drinking alcohol during and for at least 3 days after discontinuation. 2. Instructions for Ornidazole Injection: Ornidazole has no inhibitory effect on acetaldehyde dehydrogenase (disulfiram-like reaction caused by ornidazole has been reported in China). 3. Metronidazole is the first choice for amebic enteropathy. 4. Oral metronidazole is the first choice for antibiotic-associated diarrhea or pseudomembranous colitis (Clostridium difficile infection). Oral vancomycin is the first choice when metronidazole is ineffective or severe. Twelve, other1. The main antibacterial spectrum of vancomycin and linezolid It is G+ bacteria.2. Linezolid can be used for vancomycin-resistant enterococcus (VRE) and penicillin-resistant Streptococcus pneumoniae (PRSP) infections.3. More The antibacterial spectrum of colistin E is G-bacteria, including multidrug-resistant Pseudomonas aeruginosa and Acinetobacter baumannii.4. Tigecycline is a tetracycline derivative with a wide range of Spectral antimicrobial activity (resistant G+ and G- bacteria), but resistant to Pseudomonas aeruginosa.strong