Major antibiotics classes
Antimicrobial drugs
Ending | Category | Example |
‑asvir | NS5A inhibitor | Ledipasvir |
‑bendazole | Antiparasitic/antihelminthic | Mebendazole |
‑buvir | NS5B inhibitor | Sofosbuvir |
‑cillin | Transpeptidase inhibitor | Ampicillin |
‑conazole | Ergosterol synthesis inhibitor | Ketoconazole |
‑cycline | Protein synthesis inhibitor | Tetracycline |
‑floxacin | Fluoroquinolone | Ciprofloxacin |
‑mivir | Neuraminidase inhibitor | Oseltamivir |
‑navir | Protease inhibitor | Ritonavir |
‑ovir | Viral DNA polymerase inhibitor | Acyclovir |
‑previr | NS3/4A inhibitor | Grazoprevir |
‑tegravir | Integrase inhibitor | Dolutegravir |
‑thromycin | Macrolide | Azithromycin |
Antimicrobial therapy
- Gentamicin ototoxicity can generate free radicals within the inner ear, leading to permanent damage to sensory hair cells (HCs) and eventually hearing loss.
Antibiotics by class
Antibiotics | Example(s) | Mechanism | Coverage and resistance |
Beta‑lactam | ㅤ | ㅤ | ㅤ |
Penicillins | Amoxicillin, Flucloxacillin, Co‑amoxiclav, Piperacillin–tazobactam | Cell wall synthesis inhibitors | Penicillin V/G: gram positives. Amoxicillin: as penicillin plus gram‑negative rods. Flucloxacillin: as penicillin plus MSSA. Piperacillin: gram positives plus Pseudomonas, gram‑negative rods, and anaerobes. Beta‑lactamases confer resistance, overcome by combining with beta‑lactamase inhibitors (e.g. clavulanic acid, tazobactam). |
Carbapenems | Meropenem | Cell wall synthesis inhibitors | Broad‑spectrum gram positive, gram negative, and anaerobic; not active against MRSA. |
Cephalosporins | Cefuroxime (2nd gen), Ceftriaxone (3rd), Ceftazidime (3rd) | Cell wall synthesis inhibitors | With newer generations, gram‑positive cover decreases and gram‑negative cover increases. |
Monobactam | Aztreonam | Cell wall synthesis inhibitors | Gram‑negative aerobes only. |
Antiribosomal | ㅤ | ㅤ | ㅤ |
Aminoglycosides | Gentamicin | Protein synthesis inhibitors | Gram‑negative aerobic bacteria. |
Macrolides | Erythromycin, Clarithromycin | Protein synthesis inhibitors | Atypicals (Legionella, Mycoplasma, Chlamydia) and some gram‑positive cocci. |
Tetracyclines | Tetracycline | Protein synthesis inhibitors | Intracellular pathogens and specific gram negatives. |
Lincosamides | Clindamycin | Protein synthesis inhibitors | Anaerobes and some aerobic gram positives, including MRSA but not enterococci. |
Amphenicol | Chloramphenicol | Protein synthesis inhibitors | Broad‑spectrum (gram positive, gram negative, and anaerobes) but limited use because of high toxicity. |
Oxazolidinones | Linezolid | Protein synthesis inhibitors | Gram positives including MRSA and VRE; no activity against most gram negatives. |
Others | ㅤ | ㅤ | ㅤ |
Fluoroquinolones | Ciprofloxacin (2nd gen), Levofloxacin (3rd), Moxifloxacin (4th) | DNA gyrase inhibitor | Narrow gram‑negative coverage (1st gen) plus atypicals (2nd gen) plus Streptococcus (3rd gen) plus anaerobes (4th gen). |
Nitroimidazoles/furans | Metronidazole, Nitrofurantoin | Enzyme damage and DNA damage | Metronidazole: gram negatives and enteric anaerobes. |
Glycopeptides | Vancomycin | Cell wall synthesis inhibitor | Gram positives including MRSA; oral formulation used to treat gut Clostridioides difficile colitis. |
Lipopeptides | Daptomycin | Cell membrane dysfunction | Gram‑positive organisms including methicillin‑ and vancomycin‑resistant strains. |
Antimetabolites | Trimethoprim, Sulfamethoxazole | Folate synthesis inhibitor | Gram positives and gram negatives; also used for parasites including Toxoplasma and Pneumocystis jirovecii. |
- Aminoglycosides: Nephrotoxicity, neuromuscular blockade (higher risk with (succinylcholine, curare-like drugs), ototoxicity (cochlear and vestibular)
- Fluoroquinolones: GI upset, headache, dizziness, mood changes, impaired glucose tolerance, retinopathy, bone and cartilage anomalies like Achilles tendon rupture, prolongation of QTc, pseudomembranous colitis, photosensitivity, exacerbates myasthenia gravis
- Chloramphenicol: Aplastic anemia, “gray baby” syndrome, optic and peripheral neuritis
- Macrolides: Increased GIT motility, diarrhea, hypersensitivity reactions, erythromycin shows QTc prolongation, cholestatic jaundice, tinnitus and deafness; clarithromycin and erythromycin are potent inhibitors of cyt P450
- Telithromycin: Exacerbates myasthenia gravis hence contraindicated, liver failure, hepatitis, prolongation of QTc, inhibits CYP3A4
- Colistin and Polymyxin B: Nephrotoxicity (ATN, hematuria, casts), neurotoxicity, paresthesias, vertigo, ataxia, visual defects, neuromuscular blockade, hypersensitivity, chest tightness, bronchoconstriction
- Tetracyclines: Yellowing of teeth, vestibular problems like dizziness, vertigo, pseudomembranous colitis, photosensitivity, fatty liver, risk of esophageal ulcerations; increase the effect of oral anticoagulants
- Tigecycline: GI upset, diarrhea, hepatotoxicity, photosensitivity
- Sulfonamides: Stevens-Johnson syndrome, crystalluria, kernicterus
- Trimethoprim plus sulfamethoxazole: All adverse effects of sulfonamides plus folate deficiency, hyperkalemia, renal insufficiency, increases levels of warfarin, phenytoin, rifampin and methotrexate causes hypoglycemia when combined with sulfonylureas
- Rifampin: Orange-red discoloration of skin and body fluids, jaundice, monitor LFTs
- Metronidazole: Neuropathy, GI upset, headache, seizures, disulfiram-like effect with alcohol, dark urine, reduce dose in liver disease, increases anticoagulant effect of warfarin
- Linezolid: Increased serum lactic acid, myelosuppression, neuropathy, serotonin syndrome, optic neuritis
- Lincosamides: Neuromuscular blockade, C.difficile colitis
- Isoniazid: Hepatitis, jaundice
- Clindamycin: Pseudomembranous colitis, esophagitis and esophageal ulceration, hypersensitivity
- Daptomycin: Myopathy, increased creatine kinase, eosinophilic pneumonia
- Carbapenems: GI upset, seizures (imipenem), adjust dose of ertapenem and meropenem in renal insufficiency
- Cephalosporins: Pseudomembranous colitis, hypersensitivity reactions, leukopenia, thrombocytopenia, Coombs positive hemolytic anemia; cefotetan shows disulfiram-like effect with ethanol and elevates PT, INR and PTT
- Penicillins: Hypersensitivity reactions, rashes, anaphylaxis, urticaria, angioedema, serum sickness, exfoliative dermatitis, seizures, nephritis, pseudomembranous colitis, Coombs positive hemolytic anemia, leukopenia, thrombocytopenia, GI upset, ticarcillin causes bleeding tendency in patients with renal failure
- Monobactam (aztreonam): Phlebitis, rash, elevated LFTs, adjust dose in renal failure
- Quinupristin/Dalfopristin: Phlebitis, arthralgia, myalgia, hyperbilirubinemia, decrease dose in liver disease
- Vancomycin: Hypersensitivity reactions like rash, fever, neutropenia, phlebitis, “red man” syndrome due to histamine release, monitor renal function
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