1. Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc. Chapter 90 Miscellaneous Antibacterial Drugs: Fluoroquinolones, Metronidazole, Daptomycin, Rifampin, Bacitracin, and Polymyxins

2. Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc.2 Fluoroquinolones  Broad-spectrum agents with multiple applications  Disrupt DNA replication and cell division  All can be administered orally or IV  Side effects generally mild but can cause tendon rupture (low risk)  Usually affects Achilles tendon  Avoid in patients younger than 18 years of age

3. Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc.3 Fluoroquinolones: Ciprofloxacin (Cipro)  Ciprofloxacin (Cipro)  Broad-spectrum antibiotic (gram-negative and some gram-positive)  Inhibits bacterial DNA gyrase and topoisomerase II  Uses: multiple systems  Drug of choice for anthrax  Infections: respiratory, UTI, GI, bones, joints, skin, and soft tissue

4. Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc.4 Fluoroquinolones: Ciprofloxacin (Cipro)  Adverse effects  Mild GI – nausea/vomiting, diarrhea, abdominal pain GI – nausea/vomiting, diarrhea, abdominal pain CNS – dizziness, headache, restlessness, confusion, rarely seizures CNS – dizziness, headache, restlessness, confusion, rarely seizures Candida infections – pharynx and vagina Candida infections – pharynx and vagina  Elderly patients Confusion, somnolence, psychosis, visual disturbances Confusion, somnolence, psychosis, visual disturbances

5. Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc.5 Fluoroquinolones: Ciprofloxacin (Cipro)  Drug and food interactions  Cationic compounds  Absorption reduced by: Aluminum antacids Aluminum antacids Magnesium antacids Magnesium antacids Iron salts Iron salts Zinc salts Zinc salts Sucralfate Sucralfate Milk and dairy products Milk and dairy products  Elevation of drug levels

6. Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc.6 Other Fluoroquinolones  Ofloxacin  Lomefloxacin  Sparfloxacin  Moxifloxacin  Norfloxacin  Levofloxacin  Gemifloxacin

7. Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc.7 Metronidazole (Flagyl)  Bactericidal  Uses  Protozoal infections  Infections caused by obligate anaerobes  Helicobacter pylori  Adverse effects  Neurotoxicity  Allergy  Superinfections

8. Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc.8 Daptomycin (Cubicin)  Cyclic lipopeptide (new class)  Kills virtually all gram-positive bacteria, including MRSA  No significant drug interactions  Adverse effects – possible muscle injury  Given only once daily IV – no lab needed

9. Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc.9 Additional Antibacterial Drugs  Rifampin  Broad-spectrum antibacterial used primarily for TB  Also used for some meningitis – not monotherapy  Rifaximin  PO non-absorbable form of rifampin used for traveler’s diarrhea  Nausea, flatulence, and defecation urgency

10. Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc.10 Additional Antibacterial Drugs  Bacitracin  Almost always used topically for bacterial infections  Systemic can cause serious toxicity  Polymyxin B  Topical treatment for ears, eyes, and skin  Skin treatment usually in combination  Not used for systemic infections (because of toxicity risk)