MISCELLANEOUS ANTIBIOTICS

MECHANISM OF DOSE CLINICAL USE PHARMACOKINETICS,

ACTION AND ADVERSE EFFECTS,
EFFECTS INTERACTIONS
METRONIDAZOLE/TINIDAZOLE  Taken up non- 250 mg oral  Anaerobic or mixed  Well-absorbed after oral
enzymatically dose intra-abdominal administration
reduced by infections  Can also be given by IV
reacting with  Vaginitis – or by rectal suppository
reduced trichomonas  Widely distributed in
ferredoxinpro infection, bacterial tissues serum level of
ducts that are vaginosis 4-6 mcg/mL after 250
toxic to  Single 2 g dose mg oral dose
anaerobic cells   Vaginal gel –  Penetrates well into
selective topical CSF reach levels
accumulation in  Clostridium difficile similar to serum level
anaerobes colitis  Metabolized in the
 Partial reduction  Brain abscess liver may accumulate
of metronidazole  Typical dosage: 500 in hepatic insufficiency
occurs only in mg 3 times daily oral
anaerobic cells or IV (30mg/kg/d)
metabolite taken ADVERSE EFFECTS
into bacterial  Nausea, diarrhea,
DNA unstable stomatitis, peripheral
molecules neuropathy – prolonged
use
 Disulfiram-like effect
patient should avoid
alcohol

MUPIROCIN  Inhibits 100 mg/l  Topical treatment of  Rapidly inactivated after

 staphylococcal minor skin infections absorption 
isoleucyltRNAsy such as impetigo undetectable systemic
nthetase  Eliminates S. aureus levels
nasal carriage by  Ointment for topical
patients or health administration
care workers
 NOT recommended
for topical
application over
large infected areas
like decubitus ulcers
or open surgical
wounds

POLYMYXINS  Cationic 0.5 mg/g  Ointments: 0.5 mg/g  Toxicity in systemic

detergents  polymyxin B + administration 
attach to and bacitracin or largely restricted to
disrupt neomycin  infected topical use
bacterial cell superficial skin
membranes; lesions
bind and  Parenteral for
inactivate salvage therapy of
endotoxin infections caused by
strains of
Acinetobacterbauma
nii,
Pseudomnasaerugion
osa and
Enterobacteriaceae
that are resistant to
other agents

FIDAMOXICIN  Binds to sigma  200 mg  Treatment of C.  Oral administration 

 subunit of RNA twice difficile colitis negligible systemic
polymerase daily  Active against G(+) absorption, high fecal
Inhibits (oral) aerobes and concentration
bacterial anaerobes
protein  Lacks activity
synthesis against G(-) bacteria

URINARY ANTISEPTICS
NITROFURANTOIN  Antibacterial  100 mg  Lower urinary tract  Well-absorbed after
activity correlate oral infection only ingestion
with rapid taken 4  Suppression of  Metabolized and
intracellular times chronic UTI – oral excreted rapidly  no
conversion of daily form systemic antibacterial
nitrofurantoin to   Single daily dose action
highly reactive prevent recurrent  Excreted into the urine
intermediates by UTI in some women by glomerular filtration
bacterial and tubular secretion
reductases  Average daily dose 
intermediates 200 mcg/mL in urine
react  Renal failure –
nonspecifically insufficient for bacterial
with many action, high blood levels
ribosomal may cause toxicity
proteins  Contraindicated for
disrupt patient with significant
synthesis of renal insufficiency
proteins, RNS, (creatinine clearance
DNA and <60 mL/min)
metabolic
processes ADVERSE EFFECTS
 Anorexia, nausea,
vomiting – principal side
effects
  Neuropathies and
hemolytic anemia – in
patients with G6PD
deficiency
 Antagonize action of
nalidixic acid
 Rashes, pulmonary
infiltration and fibrosis
and other
hypersensitivity
reactions

METHENAMINE MANDELATE &  pH<5.5  1g  Used only to  Sulfonamides should not

METHENAMINE HIPPURATE methenamine twic SUPPRESS, not be given at the same
release e treat, UTI time  may cause
formaldehyde  daily  Mandelic acid or formation of insoluble
antibacterial by Hippuric acid are compounds with
mou excreted unchanged formaldehyde
th in the urine  Persons taking
bactericidal for methenaminemandelate
some G(-) bacteria may exhibit falsely
when pH <5.5 elevated tests for
catecholamine
metabolites