Antibiotic Review | Mnemonics And Proven Ways To Memorize For Your Exam!

All right, so antibiotic review. Um,

this is going to be like a triple

distilled antibiotic review. I basically

took and went through all the

antibiotics and I pretty much just kept

all of the bare necessities that you

need to know for your boards, for your

exams, and things like that. I'm not

going to cover every single detail. I'm

not going to cover every single

antibiotic, but I'm going to go over the

main ones, the ones that you really need

to know for your exams, and the things

that you need to really be familiar

with. Um, so let's go ahead and get

started with that. I wanted to thank

everybody for the support, the really

nice comments, everything. Um, as

always, thank you so much for that. I

appreciate that more than you know. Um,

so let's go ahead and get started with

antibiotics. Um, so we're going to first

start with the betalactam. So that's

penicellin, sephilisporins, carbopenams,

monobact. Um, makes sense to start with

the OG antibiotic and that's

penicillans. Um, there's a lot of

different subtypes of penicellin. Um, we

basically had to evolve as bacteria

became resistant. So I'll break down

each individual one and kind of progress

as we did um, in real time with the

penicellin. So let's start with plain

penicellin. the original. So we have

penicellin G, penicellin V or also known

as penicellin VK. Uh V is PO. So it's by

mouth and then penicellin G comes in

both an IV and an IM and intramuscular

form. So what is penicellin cover? Well,

it covers Graham positive really well.

It has really good grandpositive

coverage. But the problem is it's been

around for so long that it doesn't cover

a lot of things that much anymore. Um

there's just been a lot of time for it

to build resistance. a lot of the

organisms are resistant against it now,

but there's still a few things that it's

really good at. So, what is it still

good at? What are the high yield

indications that you need to know? Now,

again, with these indications, I'm not

going to list every single thing. That's

ridiculous. You'd never be able to

memorize them all. I'm going to focus on

the main things, the things that always

seem to come up on the board. So, for

penicellin G and penicellin V, that's

going to be syphilis. That one's huge.

If you don't remember any of the other

ones, I'd remember that. Uh, strep

fingitis, dental infections, roheatic

fever. Of course, rheumatic fever is

caused by strep, so it makes sense that

it would cover that. So, those are your

your first lines for your penicillins.

Um, so first line for strep, that's why

I said we also see it indicated for

rheumatic fever. Um, can be used for

dental infections. It does cover most of

your oral um anorobes, but the high

yield one, like I said, that's syphilis.

That's the one they always ask you about

on exams. Um, that's one we use

penicellin G, of course. So, that's the

injectable. Um, and just an FYI in

regards to strep feritis coverage. So in

real life when you're actually

practicing and you're prescribing while

penicellin V is a first line for strep

it works well you're really not going to

prescribe it very often because in

children specifically moxicylin is used

much more often it's more palatable it

tastes better they have the bubble gum

amoxicylin penicellin V does not taste

good and then the other thing is

amoxicylin has twice daily dosing where

penicellin VK sometimes can be up to

four times a day so in real life you're

probably going to prescribe amoxicylin

but know on the boards on the exams that

um you may have to pick penicellin V for

your for your strep treatment as your

first line but amoxicylin works just as

well um all right so let's progress on

here so penicellin was our first

antibiotic but eventually bacteria

started to evolve it and resisted

penicellin by producing something called

penicillinase so we had to go back to

the drawing board we had to come up with

a semi a semiynthetic penicellin and

that was called penicyinase resistant

also known as antistafloakal

penicillins so um What penicellinace is,

it's an enzyme that's produced by the

bacteria that basically destroys the

betalactam ring of penicellin which

makes it ineffective. So the meds in

this class are napsylan, oxicylin,

dicloroxicylin. Back in the day, this

list also included methasylin. It's how

we came up with the name MRSA.

Methasylan resistant stafforius. We

don't use meth methylin anymore. Just

has a really poor side effect profile

and these meds work better. So methasyl

is how we came up with MRSA. It's in

this class, but we just don't use it

anymore in practice. So what do your

penicellinase resistant um penicillans

work well at grandpositive it's going to

be your um MSSA your high yield

indication is going to be your methylin

sensitive uh staff ora so that's what

you're going to use it for so whether

it's bacteria osteomiitis cellulitis

endocarditis if it's from M MSSA um

these are generally going to be your

drug of choice these meds basically

exist to treat staff that's why we made

them that's what they're good at it's

the only indication I would know for

them napsylan oxicylin dicloroxicylin

staff MSSA does not cover MRSA it's not

good for MRSA but it's good for your

methasylan sensitive staff orius so when

you think of your napsylan oxycilin

dicloicin just think of staff coverage

that's all you should be focusing on for

these drugs that's why we made it and

that's what they're really good at all

right so we created penicellin we

covered strep and staff so most of our

gram positive organisms but the last two

generations we just talked about they

didn't really cover gram negatives they

had very poor gram negative coverage. So

we had to come up with something that

did. We had to create a penicellin that

also covered our gram negatives. So we

developed what's known as

amopenicillans. You'll definitely

recognize these. They were created for

that specific reason to fight gram

negative infection. So our amopenicans

are going to be all the am prefixes

amoxicilin ampillin. Um if you ever

forget which one is oral, which one is

parental, um parental of course means

non-oral root ivim. Um remember

amoxicillin the third letter is an O

which stands for oral and ampein the

third letter is P which stands for

parental. So because your parental is

your IVIM your moxicylin is your oral

just in case you forgot that you

probably already know that. Um now what

do these cover? Like I said before they

cover our gram positives but they also

cover our gram negative organisms. We

broadened our spectrum. So our amino

penicillins brought in our coverage with

penicellin. Now we have the ability to

fight gram negative as well as the gram

positives. So what are some of the high

yield indications for the

amopenicillans? They're going to be

acute otitis media, strep feritis and

lististeria. So those are the three big

ones I'd know for your amopenicans. Um

otitis media, strep lististeria. There's

some other less high yield indications.

Uh remember is one of the meds that we

use to treat H pylori. Remember in

triple therapy you have chloriththramy

and oxycylin PPI. Um it's another option

in Lyme disease. Doxy is generally

preferred though unless the patient's

pregnant or a young child. Some caveats

I'll discuss when we get to the

tetracycans. But generally when you're

thinking of your amino penicillins be

thinking otitis media strep and

lististeria. Those are the ones you need

to know. All right. So this subclass of

penicellin worked well. We picked up

some gram negative coverage in addition

to our gram positives. But the problem

was this class was susceptible to

betalacttoase. So betalacttomase are

enzymes produced by bacteria that break

open the betalactim ring in inactivating

the betalactam antibiotic. So what we

had to do was we had to find a way to

take these antibiotics and help them

resist that betalacttoase. So what we

did was we came up with the

betalacttoase inhibitor penicellin. So

we take the same antibiotics we just

went over a moxicylin ail and we added a

betalacttoase inhibitor which prevents

the betalacttoase from eating the

betalactim ring and destroying the

antibiotic. You can think of it as a

shield for the antibiotic and that's

exactly what I used to think of. So I

used to think of you have amoxicylin

here same amoxicylin antibiotic but you

just gave him a shield you give him

clavilani which is his shield to protect

against those betalacttomy so it doesn't

break it down so whether it's amoxicylin

um or um ampeoin we just give them a

shield so betalacttoase so the shield

for amoxicylin is the clavulonate or

clavulonic acid and that combo is known

as augmentin and then with ain we gave

it soulback soulactam is it shield and

then we have unisonin which is known as

So moxicylin clavulonate that's

augmentin and then ampein sulactum

municin we're taking the same

antibiotics we just talked about in the

imopenic but we gave them a shield to

help them broaden their coverage and

help them protect against some other

things. So they cover gram positive gram

negative like we went over but the key

here is they picked up really good

anorobic coverage with these

betalacttoase inhibitors which allowed

them to fight some bugs we haven't

really talked about before. So what are

the high yield indications for these

betalacttoase inhibitors panicillans? So

we now have coverage for our acute

sinocitis. So moxylclav is going to be

your first line for sinocitis. Um animal

bites as well as human bites. Moxylclav

is first line. And then aspiration

pneumonia. So first line for aspiration

pneumonia because if you remember

aspiration pneumonia most commonly

caused by anorobes which I talked about

we picked up coverage for and that's why

this class is a good choice. Um also be

aware moxylclav can be used as a first

line for acutoitis media as an

alternative to amoxicylin in some

specific cases in adults few other

things um but I wouldn't worry about

that too much for this those are the

main ones that I remember hearing about

and those are the ones that I would

remember for this class all right so we

have all of these different types of

penicellin we've covered a bunch of

different things a wide variety of

organisms but what about sudamonus we

haven't talked about sudamonus none of

these have really covered sudamonus yet

so where do our anti anti-seudonal

penicillins come in. Well, that's what

they're antiudetamonopal penicillins.

So, these are broadspectctrum

antibiotics. You're not going to use

this on your average patient. The key

here is their coverage of sudamonus. And

what we have is we have pipaso,

pipperyl, tasobactim, and take our

silent clabulate. So, they cover most

organisms. They're going to cover your

gram negatives. They're going to cover

your gram positives. Um, they're going

to cover sudamonus anorobes. um which is

really pseudomonus is really the the key

the one the reason they're used most

commonly. Um it's really easy to focus

easier to focus on what they don't cover

because they cover almost everything

else. Um they're not going to cover MRSA

and they're not going to cover your

atypicals like mopplasma.

They're just really good at everything

else though. Um there's not really a

specific high yield indication I would

say to know for these. Just be aware

particularly when sudamonis is suspected

like in hospitalacquired pneumonia. This

class is going to be utilized

particularly with pipaso because that

has the best coverage of sudamonus. They

also can be used in really severe soft

tissue infections in tradinal

infections. Um so those are your

anti-seudonal penicillins. Remember um

pipasil because that's the one you'll

hear most commonly about which is also

known as zosin. You'll hear about that

when you're on your hospital rotations

and things like that. It's more for your

really sick patients. Again, it's not

going to be used in your everyday

run-of-the-mill infection. Um, all

right. So, let's go over some general

adverse drug reactions for the

penicellin class as a whole, there's a

few things I think you should know

about. So, first, hypersensitivity

reactions. Of all the drug classes we're

going to talk about, penicellin is the

class most associated with

hypersensitivity reactions. Um, another

one is your hematlogic reaction. So,

whether it's thrombocytoenia,

neutropenia, immune mediated hemolytic

anemia, it's all possible in the

betalactim class in general, but

particularly in the penicellin

antibiotics. And then finally, GI. So

this is really non-specific because all

of the antibiotic classes can cause GI

problems. But in the penicellin class,

there's a couple main culprits to look

out for. That's ampeinil and amoxicylin.

They're well known for causing diarrhea,

but particularly augmented, which

remember is the combo of amoxicilonate.

This penicellin has the highest

incidence of diarrhea of all the

penicillins. And I would advise you in

real life when you're prescribing if you

can give somebody emoxicylin rather than

augmentin the emoxy cloud combo please

do because augmentin just has a really

high incidence of diarrhea. So it's not

great for your patients if you don't

have to give it. So just keep that in

mind. Um again GI is really non-specific

for antibiotics but for penicillins

remember your moxicylin and pacillin

specifically augmenting that combo. All

right so that's penicillans. Those are

the main things I think you should know.

Let's move on to a class that seems to

give a lot of people problems and it's

the sephilisporins. Uh it always seems

to come up and there's a few things that

you really need to know for it. So this

is where some of your pneummonics come

in that I that I created that I think

are going to help you. So before we

start with the sephilosporins, I wanted

to review an easy way to remember uh the

coverage for sephilosporins. So

particularly your gram negative versus

gram positive coverage. So as the

sephisporn generations go on from first

to second to third to fourth generation

they lose gram positive coverage and

they gr they gain gram negative

coverage. Now it's not 100% accurate in

every case. There's some exceptions but

a general rule with the sephilosporins

is as the generations go on from first

to fourth they lose gram positive and

they gain gram negative. So in general,

first generation's really good at gram

covering gram positive, not so good at

gram negative. And fourth generation uh

has really good gram negative but not so

good gram positive. Fifth generation

doesn't really follow these rules. Is

really good at both gram positive, gram

negative. Um particularly really great

gram positive. Um but generally first to

fourth you're going to see um decreasing

gram positive and increasing gram

negative. Um so as the sephisporins like

I wrote out here go on from first to

second to third to fourth they lose gram

positive and gain gram negative that

seems so simple and it seems like oh

I'll definitely remember that on the

exam but you have so many things to

remember and I remember even like having

an exam question and being like wait is

it is the first better at gram negative

or gram positive so I have a really

simple way to remember that so all you

think of is the podium you know with the

Olympics you have your first place

second place third place etc. This helps

you remember when you get in first place

on the podium, you are super positive.

You're super happy, super positive. And

that's your first generation. So that

helps you remember first place. First

generation Sephlesporins, super

positive. Covers positives really well.

As the generations go on, as the places

go on, when you're like in second place,

you're still pretty positive, but you're

a little bit more negative. And then

third place, you're pretty negative at

this point. You're not very positive at

all. So, that helped me remember. Um,

when you think about that, you're like,

"Wait, is first better at positive or

negative?" Just think about it. When

you're in first place, are you positive

or you're negative? You're super

positive. When you're all the way in

third place, you're pretty negative at

that point. That's cuz your third gen's

covered negative much better and you're

much less positive. So, hopefully that

helps you remember. It helped me. Um,

let's move on to our first generation

and get started. So, first generation

sephilisporns, we have sephyllexin, also

known as Kelex is the brand name. That's

going to be your PO version. And then we

have sephazolin that's ansef and that's

going to be your IV version of the

firstgens. So what do you need to know

for these? As I said before, these are

going to have really great gram positive

coverage. Um staff strep it's going to

cover really well. So your skin

infections really um it does have some

mild gram negative coverage but it's

mainly u gram negative like for ecoli

proteus kleella but the main use for

your firstgens. What they do best is

gram positive organisms. Remember you're

in first place on the podium. You're

super positive. you got first place.

Now, high yield indications, there's two

that you need to know. Um, skin

infections and surgical prophylaxis. So,

skin infections, MSSA, methasylan

sensitive staff orius. So, all of your

skin infe all your skin infections

involving staff feliculitis, parinchia,

etc. MSSA be thinking of your firstgens,

particularly sephilis, uh, sephylexin,

which is your pommed. And then surgical

prophylaxis, that's going to be

sephosolin, which is known as anseph. So

when you do your surgical rotate

rotations, you're going to hear this all

the time be before every surgery.

They're going to say two grams of ANSF

on board. It's basically the most

commonly used antibiotic for surgical

prophylaxis. And I feel like that's

really the only thing you should

memorize is these two things. Those are

the main things for your first gent. All

right, so let's move on to our second

generation. That is going to be the main

ones are going to be sephoxitin,

sephiroxim, sephylchlore, and sephot10.

So how the heck do you remember that? I

mean there's so many different

sephilosporins. So, the way that I used

to remember that is I thought of this. I

thought of your second generations. I

thought of um two furry fox drinking tea

on the floor. So, two, you have two of

these foxes. That helps you remember

your second generation sephilosporin.

Furry, they're furry. That helps you

remember your se furoxim fox.

Sephoxitin. Drinking tea. Sephotan

on the floor. Sephylchlore which f l o

r. So you say sephyl kind of sounds like

floor. So two furry fox drinking tea on

the floor. Two second generation furry

sephoroxim fox sephoxitin drinking tea.

Sephotan on the floor. They're drinking

tea on the floor. And that's sepho um

that's sephyliclore. So that helps me

remember the second generation

sephilosporins. All right. What are they

good at? So they have um gram positive

coverage but weaker compared to firstg

gen and they have gram negative coverage

but broader compared to the um first

generations and they they pick up some

coverage for entrobacttor niceria and

the gram negative but then they have

anorobic coverage. So this is really

important. So firstgens had better gram

positive coverage your third gen as I'll

go over next have better gram negative

coverage. So the second genens are kind

of like the forgotten middle child. But

the key for the second genens is their

anorobic coverage with sephoxitin and

sephotin. This is particularly good for

your pelvic infections, some of your

intraabdominal infections. And this is

what you're normally going to see them

tested on. That's really what I'd focus

on because like I said, they're not

great as as the first are firstgens as

gram positive. There's not as good as

the third gen for gram negatives. So

they're kind of in between, but what

they have unique about them is their

anorobic coverage, and that's what

you're going to see come up. Um so they

do have some indications for covering

UTI, respiratory infections, Lyme

disease, second uh line to dooxy, but

for the sake of the exam, what you need

to focus on is your intraabdominal and

your pelvic infections involving anobes

like bactaroides. That's what you're

going to see when you um see these

covered. You're going to see your

intraabdominal and your pelvic

infections. Sephotan and sephoxitin are

really good for P for pelvic

inflammatory disease. There is some

resistance being seen with uh sephot10

for uh bergillis. So for your

intraabdominal infections, infections

might not be the best choice anymore,

but overall they're really good for P.

And in general, this is what you're

going to see them tested on. Um, your

intraabdominal, your pelvic infection.

So that's what I would know for your

second generation. All right, let's move

on to our third generation

sephilosporins. That's going to be uh

seph trioxone, sephotaxine, and

septacidine. There's some others in this

class uh like sephodoxine, but really

these are the three that ever really

ever seem to come up. These are the ones

that I would focus on. So how do you

remember these? How do you remember

those three for the third generation? I

remember this sentence. You can try seph

trioxone and also try helps you remember

third generation. Taxing sepho taxim me

but you won't get a dime. Septazadime.

So you can try seph trioxone try third

gen. Taxing me sephoaxim but you won't

get a dime. Septazadime. That helped me

remember the ones the main ones you need

to know for this class. They have

excellent gram negative covers. That's

the main thing including sudamonus with

septacazidem

um grand positive coverage overall is

decreased. Some antibiotics in this

class like sept septazidem have

virtually no grandpositive coverage at

all. Um your third gen is mainly about

your gram negatives and sudamonus um but

only with septazidm. That's important.

Remember septacidm has pseudomonus

coverage and I have another pneummonic

for that. So the way that I used to

remember that is if you sue me you won't

get a dime. So, septazadime only third

gen to cover sue doonus. I know that's

not how it's spelled, but that's how

it's pronounced. That helps you

remember. If you sue me, you won't get a

dime. Septazadime only third gen to

cover sueonus. All right. So, what are

your high yield indications for your

thirdgens? So, there's a few things that

always seem to come up. Gyneakal

infections, sept trioxone, um menitis.

So third generation sephilisporins like

sephotaxim seph trioxone are the

betalactims of choice in the empiric

treatment of menitis generally they're

going to be combined with other

antibiotics but those will definitely be

used and then community acquired

pneumonia hospitalized um are you're

going to use some of your third

generations for that so those are the

main things that I think you need to

know for your third gen sephilisporins

let's move into the last two which are a

lot easier there's not as much to know

um so fourth generation there's only one

you have to know sephop nice and easy

that's the only fourth generation

sephilisbborne. Now what does your

sephopime cover? What does your fourth

generation cover? It's basically gram

negative. Main thing here to know is

pseudamonus. Very limited gram positive

coverage. It does have some coverage of

MSSA. Um but sudamonus that's the key to

remember. Like I said you get some gram

negative some gram positive mainly for

staff but specifically remember

sudamonus. That's the main thing you

need to know if you're fourth gen. Um,

so there's not a lot to know about

sephop basically that it's a fourth

generation sephilisbborne and then it

has good coverage against pseudomonus.

That's all I'd remember. But how do you

remember that? So the way that you

remember that is sephop instead of

remembering sephopime remember

sephforime.

So sephorpe helps you remember it's a

fourth generation sephilospor and then

sephorpime helps you remember sudomonus

which has four syllables. So that's all

I remember for sephop. So instead of

sephop remember sephorpime fourth

generation sephilisbborne covers

pseudomonus four syllables and that's it

that's your fourth generation

sephilasbborne. Um let's move on to

fifth generation which is also very

simple because you basically just have

septarene. It's another easy one. That's

really the only one that you need to

know. Um because that's the only fifth

generation we have in the US. Outside of

the US there's another fifth gen

sephosporin called sephtober. Don't

worry about that one. Seerlene is really

all you need to know about. The only

thing you really need to know about it

is that it covers MRSA. It's the only

sephilisporin that does. That's the

primary use for this drug. MRSA that's

really it. So, how do you remember that?

Okay. So, septaralene instead of

remembering septarlene add an s here.

You see sepharolene just add an s in

there. You have searene.

So, what do you need to know about

sepharene? So, seph starline is all

about the stars. So, remember this. So

septarene sepharene a star has five

sides. One 2 3 four five. That helps you

remember this is your fifth generation

sephilosporin. What else do you need to

know about the stars? Well, when you

look out into the stars, what's the

closest planet nearby that you can see

out in the stars? It's Mars. Well, what

is Mars rearranged? MRSA. When you spell

MRSA, M RSA, that's just Mars

rearranged. You put this A right here,

you have Mars. So remember sepharlene

just think of seph starline the stars

and you think a star has five sides

fifth generation sephless born you think

when you look out into the stars you see

Mars what is Mars MRSA rearranged this

has this is the only sephilis born that

has merca coverage so that's it that's

all you need to know for your fifth

generation sephless borins all right

let's keep moving along so monoactam

monobactam is an easy one there's only

one medication in this med uh this class

and that's triionamm what does this

triionam do it covers gram negatives

including sudamonus. That's basically

all it does. It covers your gram

negative aerobes. Has no gram positive

coverage. So obviously doesn't cover

MRSA, doesn't cover your anorobes. It's

just gram negatives. Pseudamonus is the

main thing you need to know here. The

problem is with estrion is that um

there's a lot of resistance in most

institutions against pseudomonus

coverage. So normally you need to

utilize empiric double coverage with

your estrion with your monoactam.

There's really only one thing you need

to know about as trionam and that is

that it has no cross reactivity with

other betalactum antibiotics you can

give if they have a penicellin or

sephilosporin allergy that's the main

thing this is really the only thing that

this drug as far as exams exists for if

you see as tranam they're just asking

you a question that says a patient has a

pen penicellin allergy and which one of

these are you going to give and they're

going to list a bunch of penicillins and

sephilosporins and estrinam's going to

be on there. That's why that question is

there. It literally exists for exam

purposes just for that. So the only FYI

I'll give you with that which you

probably don't need to remember for the

exam because I don't think they're going

to be that evil. But so it's safe in

penicellin allergy, it's safe in

sephilosporin allergy, but there is an

exception septacidine because they share

a similar side chain. Um like I said, I

don't think they're going to be cruel

and do this to you in a question. But

it's just important to know that real

life estrriam you can give with a

sephilisporn or penicellin allergy

except septacazidem because it is um it

does have a similar side chain. Um and

as we know septazidm is a third

generation sephilisporin. How do you

know that? Because remember if you try

taxing me you won't get a dime. So try

third generation dime septazadime. All

right. Okay. The other thing to know

about it, I would say not as important

as that as the cross reactivity, but it

can be used in patients with renal

insufficiency. It doesn't cause any

renal toxicity. So that's another side

thing to know about it. All right, so

that's your monobactim. Let's move on to

our carbopenms and then wrap up our um

betalactims. So carbopen, what's

included in this class? Immipenum,

salastine, muropenum, and ertopenim. So

just an FYI, immipen, you see it's the

only one that has an additional

medication. Um that's because it can

never be administered alone. It always

gets combined with salastin. The reason

is because if you give it by itself, it

actually gets inactivated by the

proximal renal tubules and it leads to

necrosis of the proximal tubule. So

you'll always see this carropenum

combined with uh salastin. So that's

just a little thing to know about it. So

what do car cover carropen cover? Almost

everything. They're extremely

broadspectctrum antibiotics. So they're

going to cover your gram positive.

They're going to cover your gram

negatives, including your ESBL

organisms, which is your extended um

spectrum betalacttomases. They're going

to cover sudamonus. They're going to

cover your anorobes. Um they're really

going to cover almost everything. It's

easier just to remember what they don't

cover. And that's really just MRSA and

your atypicals. Otherwise, you can

pretty much use these for anything else.

And that's why in practice, you won't

because really broadspectctrum drugs

like these should rarely be used because

they breed resistance. They're basically

just reserved for severe infections

where you don't know what the bug is

yet. The person's on their way out and

you just kind of have to throw

everything at them. Now, I put sudamonus

up there and I put a little asterisk.

That's because there is one exception to

that. Eradipenum is the only drug in

this class that does not cover

sudamonus. So, the way that you remember

that if they give you a question and

they say patient has blah blah blah

infection with sudamonus, which one of

these are you going to use? And they

give you a bunch of carbopenums. um or

they say which is the only one that you

wouldn't want to use. If you see

erdipenum that's the only one that does

not cover sudamonus the way that I used

to remember that it's the only drug in

the class that has an E. So I just

remember that E stood for exception to

the rule that rule being all carbopenoms

cover sudamonus because it does not. So

that is what you need to remember. Now,

the um what I'm going to say as far as

like the the ADRs, the adverse drug

reactions is there's really only one

thing that I would remember and that's

that these drugs can lower the seizure

threshold. This is particularly

important with your immipenum. Um and

they can cause CNS toxicities. Outside

of that, I wouldn't really remember too

much else about them. Just remember

they're super broadsp spectrum antibi

antibiotics and remember that exception

to that rule with erdependent. All

right, so that's the end of the

betalactams that covered penicellin,

syphilisporins, carbopenms, monobactams.

So those are some of your big heavy

hitters for your exams. You'll get a lot

of questions based off of those, but

let's keep on moving for some other

important ones. Let's move on to our

amoglycosides. So that's going to

include genttoycin, tobery, amicasin,

neomy, and streptoyc. So what do these

cover? Basically just gram negatives

including pseudomonus. They have little

to no gram positive coverage, no

anorobic coverage. They're basically

just gram negative. Now, there's not

really any high yield indications I'd

memorize for your amoglycosides. There's

very few instances where you'd use

monotherapies for with systemic

aminoglycosides. There's really just two

and it's tarmia and plague. So, those

aren't exactly high yield diseases. Um,

you also can use it for its synergistic

effect with other drugs in endocarditis.

But overall, the highest yield thing

about amoglycosides isn't their

indications, it's their ADRs. I remember

getting asked about clinical rotations

about this on exam questions. It's the

most important thing I would remember

about your amoglycosides. And there's

two things that you need to know. They

can be autototoxic. So amoglycoside

induced autotoxicity can result in

either vestibular or coclear damage. And

they can be nephrotoxic. So 10 to 20% of

patients can experience some degree of

nephrotoxicity.

In most cases though, amoglycide

nephrotoxicity is reversible, which is

good. All right. So with your

amoglycosides, there's really two things

that you need to know. You need to know

that they basically just cover gram

negatives including sudamonus. And you

need to know those ADRs. They're really

important. So how do you remember that?

Well, all medications with amoglycide

end in cin. Tobbery, amasin, neomy, they

all end in cin. I know there's other

drugs in other classes that also end in

cin, but you're just going to kind of

have to remember this for the

pneummonic. So they all end in cin. What

does cin stand for? So CIN and

amoglycosides you need to remember is

that coverage includes negatives because

remember they only include negatives um

gram negatives and then CIN stands for

crushes incis and nephrons. So incis of

course one of your auditory oicles that

helps you remember it gets crushed

leading to autotoxicity and nephrons of

course your functional unit of the

kidney helps you remember

nephrotoxicity. So amoglycosides just

remember they all end in CIN. CIN stands

for coverage includes negatives because

they only really cover gram negatives

and then that also stands for crushes

incis and nephrons. That helps you

remember the autotoxicity and the

nephrotoxicity because that's really all

you need to know about your amoglycides.

All right, moving right along to our

tetracyc. So tetracycans is going to

include doxycyc tetracyc minyc. So

there's a few different meds in the

tetracyc class, but it doesn't matter

because this is the doxycyc show. Most

things that you're going to need to know

about tetracycans is going to be about

doxy. So make that your focus.

Tetracycans basically just remember

doxycyc. What do they cover a lot? So

they cover your gram negatives, they

cover your gram positives including

MRSA. Um they cover your atypicals and

then they cover your weird stuff. So

weird stuff, what's that? Well, anytime

you have some odd organism, some unusual

pathogen, you should be thinking about

using a tetracycline. Uh so vibrio,

brucillaa, q fever, anthrax, lyme

disease, they're all covered by tetra

tetracycans, usually doxy, of course. Um

what are some of your high yield

indications? So again this is just going

to be focused on doxycycline. Um there's

not a lot of high yield indications for

minocyc and tetracyc. Minocyc is really

just used for acne. So high yield

indications are all going to be about

doxy. So what does doxy cover? Covers

three things really well. These are your

first line indications. So chlamydia,

rocky mountain spotted fever and Lyme

disease. So chlamyia doxy is now your

first line for chlamydia. It used to be

a zithroyc but due to superior efficacy

with doxy compared to a zithro the

guidelines have changed and now it's

going to be doxy 100 milligrams b 7 days

for firstline treatment. You may still

give a zithroycin to some patients

especially your non-compliant patients

because the nice thing about a

zithramycin is it's a onetime dose. You

give them one gram of a zithro and

they're done. But the problem is it

doesn't cover it as well as doxy. But

really first line, the right uh answer

choice on a question is going to be

doxy. Also covers Rocky Mountain spotted

fever. First line pretty much all

patients are going to get doxy for Rocky

Mountain spotted fever. Even in young

children, um just a heads up about Rocky

Mountain spotted fever treatment in

pregnancy. Chlorenol used to be first

line for your pregnant patients, but now

even that's being replaced by doxy if

you look at the updated guidelines. So

Rocky Mountain spotted fever pretty much

doxy all the way. Lyme disease. So first

line for your non-pregant adults, your

older children with Lyme disease,

they're always going to get doxy. Kids

under eight, the guidelines are kind of

muddy. Uh you're going to be taught that

less than eight, you normally give them

a moxicillin over eight doxy. I'd

probably learn it that way for the

boards, but the guidelines again, it's

it's changing. It really depends on the

stage of the infection the child has. If

it's just cutaneous disease, normally

you'll give them a moxicillin, but if

there's any signs of neurologic

involvement, then you're going to use

doxy because it covers it better. Um,

and actually the American Academy of

Pediatrics supports the use of doxy for

children under eight as long as it's

administered less than 21 days, which it

is for Lyme disease. Anyways, I know

that made kind of confusing. Overall,

when you see tetracycans, think

particularly doxy, you're going to be

covering chlamydia, rocky mountain

spotted fever, and Lyme disease first

line. So, how do you remember that? This

is the way that you remember that. So, I

used to remember when you're sitting on

a dock by the sea, dock sea cycling,

eating clams and Rocky Mountain spotted

oy Rocky Mountain um oysters with a

squeeze of lime. So, you're sitting on a

dock by the sea. Dock sea cycling.

Eating clams helps you remember

chlamydia and Rocky Mountain oysters.

Rocky Mountain oysters are not oysters

if you want to look that up, but it

helps the pneummonic work. Um that helps

you remember Rocky Mountain spotted

fever with a squeeze of lime. So that's

Lyme disease. So that helps you

remember. Doc C, sitting by a ducks by

the sea. It's your first line treatment

for chlamydia. You're eating clams,

Rocky Mountain spotted fever, you're

eating Rocky Mountain oysters, and Lyme

disease. And that's your lime squeezed

over the top. So that helps you remember

all of the high yield indications for

your doxycyc. All right, what are the

adverse drug reactions that you need to

know? There's a few that are pretty high

yield here. First one is teeth

discoloration and the fact that it can

also inhibit bone growth in children. So

tetraycling antibiotics have been

associated with permanent tooth

discoloration in children under 8 years

old if used repetitively or for

prolonged courses. This does not happen

in adults. Um tetracycans also may

deposit in the bone and affect growth.

And this is why we're cautious about

using this class in young children. Um

they also have impaired absorption when

taken with certain minerals and acids uh

like aluminum, calcium, iron, magnesium.

So certain vitamins or dairy products

when taken at the same time as a

tetracycline can chilate with the

antibiotic and impair its absorption. So

just be careful. Make sure you tell your

patients about when they're taking this

medication to avoid certain supplements

and acids etc. And then finally

photosensitivity. So there's other

classes that can cause photosensitivity

reactions but it seems to come up most

commonly in questions about tetracycans.

So the effect can range from a red rash

to blistering on exposed areas of the

sun. Um, so you just want to warn your

patients about this as well. All right,

so that's our tetracycans. Let's move on

to our fluoricquinolones. So the first

thing to know about this class is you're

generally going to avoid using it in

your run-of-the-mill infection. So if

you have like a rhinocyusitis,

uncomplicated UTI, the risks outweigh

the benefits. So keep that in mind when

you're practicing. You're not going to

give cypro for a simple UTI when you can

just as easily give nitrofurantoin.

So save this for your more complicated

infections. So the CL the medications in

this class are going to be cyproloxicin,

levofluxisonin, and moxy fluxicin. Those

are the three that you need to know.

Let's start with moxy. So moxyfluxin is

what's known as your quote unquote

respiratory fluoroquinolone. It's not an

official term, but that's the term

that's most commonly used. Um, a lot of

people know this one as far as well as

levofluxisonin as your respiratory

fluorocquinolone. So moxy in addition to

levofluxisonin they're considered

respiratory fluorocquin quinolones um

and the reason is because they're both

both active against your most common

respiratory pathogens including strep

numo um h influenza moracella

threw a little accidental there um and

that's why we call them unofficially our

respiratory fluoricquinolones now moxy

in particular has our best gram positive

coverage also our best anorob coverage

also has really good coverage of our

atypicals. Um it's really the only of

all the fluoroquinolones that has decent

anorobic coverage and because of this it

can be used for some intra abdominal

infections although it's somewhat

limited due to some resistance among the

bactaroides species. So it's not the

best option. Um it can also be used as

an alternative to amplanin soactim and

aspiration pneumonia. So be aware that

moxy unlike the other fluoricquinolones

actually has some anorobic coverage. So

you may see that come up in a question.

Um, I'd say of the three

fluoroquinolones, this is probably going

to be the one you're asked about least.

Um, most questions from my experience

come uh about cypro and levofluxisonin.

And again, if you're asked anything

about moxy, it's probably going to be

related to its coverage of anorobes. All

right, so levofluxisonin,

this is another respiratory

fluoricquinolone as we just went over

with moxy. The same reasons. The big

difference between moxy and

levofluxisonin though is that

levofluxisonin also has some activity in

the urinary tract. It can be used as an

alternative to cyproloxisin in some

cases for pyo nephritis your complicated

UTI where Moxy cannot. Moxy has

virtually no urine activity. Um it has

good gram positive coverage. It has good

coverage of atypicals. So levofluxisin

as far as coverage it's kind of in the

middle here. Moxy has the best gram

negative. Cypro's got the the best gram

uh I'm sorry. Moxy has the best gram

positive. Cypro has the best gram

negative. Levloxin is kind of hanging

somewhere out in the middle, but it does

have really good strep numo coverage,

better than moxy actually, which is why

it can be used as monotherapy in

community acquired pneumonia, although

we try not to use it for pneumonia to

prevent fluorocquinolone resistance

among the respiratory pathogens. Um, and

like I went over before, levofluxisonin

also does have similar coverage as seen

in cyproloxisin for your UTI,

complicated UTI, etc. So, they can be

used interchangeably. So, that's

levofluxisonin. Let's move on to cypro.

So the main thing to know about cypro is

that it is not a respiratory

fluoroquinolone. It is a urinary

fluoricquinolone. So it's first line for

pyonfritis your complicated UTI.

Cyprolaxisin is the only fluoroquinolone

in it that has a P in it. So as soon as

I see cypro with a P in it that the

other ones don't have um it always makes

me think of your PEP stuff. So

pyonritis, UTI, prostatitis, and your

older males. Um, a lot of people think

the reason we don't use cypro for some

of the respiratory tract infections like

pneumonia is because it doesn't

penetrate the lungs, but that's actually

not the case. So, cypro has lesser

activity against your grandpositive

organisms in particular strep numo and

that's the reason why we don't use it

for most respiratory infections. Reserve

that for moxy and levofluxin which have

great grandpositive coverage. So it's

not that cypro doesn't penetrate the

lungs, it's just that it doesn't cover

our um our respiratory organisms. Um so

overall the main thing to know about

cypro is is has your best gram negative

coverage of the fluoroquinolones

including um sudamonus the best

sudamonus coverage. So remember for your

fluorocquinolones moxy is going to have

your best gram positive and it's also

the only one with really good anorobic

coverage. Cypro has your best gram

negative coverage including sudamonus

and then levoflaxisin is kind of in the

middle but it has really good strep numo

coverage. So what are your high yield

indications for your fluorocquinolones?

That's going to be pyonfritis with cypro

and levofluxisonin. complicated UTI

cypro and levofluxisonin uncomplicated

of course you're sticking to bactrum or

nitrofarorin which is macroid um

prostatitis um cyproloxis and

levofluxisonin can be used as empiric

therapy in your older patients younger

patients of course you're covering more

for um chlamydia and gorrhea but

prostatitis and your older patients you

can use cypron levofluxisonin and then

community acquired pneumonia so

levofluxisonin moxifyin these can be

used as monotherapy but generally

they're going to be reserved for your

patients with co-orbidities, older

patients, etc. All right, ADRs, there

are some high yield one with the

fluoroquinolones. So, um, they have a

bunch of adverse drug reactions that are

possible. GI, of course, being the most

common as in most antibiotics, but I'm

going to focus on the ones that always

seem to come up in the exam questions,

the more unique ones, and really there's

three. So, the first really big one is

your QT prolongation. So,

fluoroquinolones can prolong the QT

interval potentially leading to uh to

torsads. So we avoid this class in

patients taking QT prolonging drugs or

patients with long QT syndromes or any

other risk factors for arhythmia. So

that's the first big one for

fluorocquinolones, QT prolongation.

Second one is tendinopathy or tendon

rupture. So fluoroquinolones can cause

tendinopathy and tendon rupture. Um the

most common site is going to be the

Achilles tendon. So always be careful to

tell your patients avoid vigorous

exercise while on the medication and

have them alert you of any signs of

tendinopathy, pain, swelling, etc. And

then finally, an interesting one, but

one that I actually had on an exam

question is that they can precipitate

mythenic crises. So, um,

fluorocquinolones actually have a

blackbox warning for use in patients

with myastinia graphis because they can,

uh, cause neuromuscular blocking

activity which can precipitate a

myiathenic crisis. So remember that for

real life and your exam questions. It's

an important thing to know. All right.

So that's your fluoricquinolones. Let's

move on to our macrolytes. So that's

going to be uh a zithroyc,

chloriththramy, or ariththramycin. So

these are really good well-rounded

drugs. They cover a lot of different

things. They cover your gram negatives,

your gram positives, your atypicals. Um

class has pretty broad spectrum of

activity. Um particularly with your

atypicals, the zithroyc is going to have

your best atypical coverage. That's

going to be your drug of course uh drug

of choice for your atypicals. Now let's

go over some of your high yield

indications. Um, first one is going to

be chlamydia with an asterisk because I

talked about this before. This used to

be your first line for treatment of

chlamydia. But new evidence, like I

said, is showing that microbial efficacy

of doxy superior. So most guidelines are

going to say doxy is going to be your

first line, but a zithroycin is still a

good second line option and you still

need to be aware of it. Another high

yield indication is going to be your

MAC. So your microacterium avium

complex, a zithroyc chloriththroyc. So

macrolyze are your cornerstone of

antimicrobial back uh therapy for MAC

treatment and prophylaxis and your HIV

patients with MAC. Um it's usually going

to be combined with rafampen or aambutl.

But remember macrolytes are always going

to be used in patients with MAC. So just

remember when you're treating MAC, use a

macrolyide.

So macrolytes treating MAC. It helps you

remember that. Okay. [laughter]

Um community acquired pneumonia. So

zithramycin chloriththramycin both your

typical organisms like strep numo as

well as your atypicals like myopplasma

pneumonia macrolytes are going to be

your first line options particularly a

zithro for your atypicals like your

plasma gastroparesis is another one this

is really just with um particularly with

ariththramycin so ariththramycin

increases gastric motility and it can be

used as another option in addition to uh

metylopramide which is normally your

first line agent but be aware of uh

riiththramy as well. And then another

one that you may see come up is your

COPD uh COPD bacterial exacerbations. Um

so in chronic bronchitis uh with your

bacterial exacerbations, macrolyze will

commonly be used as your first line to

treat. Um and in selected patients with

severe COPD with frequent exacerbations,

macrolytes can actually be used

prophylactically to prevent

exacerbations. Now your ADRs, there's a

few ones that you need to know. Again,

this is going to be another one that can

cause QT prolongation. So, all

macrolytes have been associated with QT

interval prolongation. So, before giving

one of these meds, make sure that the

patient's not at risk for torsads,

taking any other meds that can prolong

the QT interval. They do have some

pretty prominent GI side effects. And I

know I've said this is non-specific, but

with your macrolytes, um, of course they

can have their run of run-of-the-mill

diarrhea, abdominal pain, but they also

have the possibility of hpatotoxicity

with a zithro and even acute

choleistatic hepatitis with

ariththroycin. So be aware of those as

well. And then your cytochrome P450

inhibition. So you have to look out for

drug interactions with other drugs they

may be taking like statins, warfare and

dioxin. This can um change the

absorption of these medications. All

right. So we are going to move on to our

last class that I feel is important for

you to know and that's venkco. So

venkcomy venkcomy covers your

grandpositive MRSA. That's what you

really need to know about venkcomy. MRSA

um it's really not used for a lot as far

as your high yield indications. Uh

there's really just two things that you

need to know. Um MRSA of course like I

said that's a big one. Veno and MRSA are

synonymous. As soon as you hear Venko

right away you should be thinking MRSA.

The other high yield indication is for

um for CIFF. So venkco is almost always

given introvenously. We don't usually

give venkco p because it has very poor

GI absorption. But the exception is when

we're treating ciff. We don't need venko

to get absorbed systemically to treat

ciff. We need it to just stay in the GI

tract and actually not get absorbed. And

that's why p vanco because of its poor

GI absorption is actually an asset when

treating ciff. So with venkco it's the

really the only time you're going to

give venkco p it's to treat ciff

otherwise merca you're going to give it

IV. So those are really the two main

high yield indications. I really

wouldn't worry about anything else. See

m be thinking either ma or ciff. This

does have some high yield ADRs though

some high yield adverse drug reactions.

First one is going to be red man

syndrome. So it's not really called red

man syndrome anymore. It's called

venkcomy infused infusion reaction

associated with rash. So, let's just

keep calling it red man syndrome. So,

this is something unique with venkco.

Um, and like most unique things, it's

often tested on. Basically, if you

infuse venko too quickly, you get this

confluent or blotchy rash that covers

the trunk, the extremities, the head,

the neck. Um, and you avoid this just by

infusing it slowly. So, that's red man

syndrome. Can be caused venko infused

too quickly. The other one is

autotoxicity.

So, this is more common in your older

patients. generally considered to be

reversible in most most cases and then

nephrotoxicity is also possible. So

venko can be nephrotoxic leading to

acute kidney injury. Um it's more common

when it's co-administered with other

nephrotoxic agents like loop diuretics,

IV contrast die, empoteras B, etc. So

Veno has a few high yield ADRs and it

has a a couple high yield indications.

So how do you remember them on the exam

in addition to the other 10,000 things

you need to know about antibiotics?

Well, the way that you remember that is

as soon as you think vancomy, I want you

to think of a pimped out van with chrome

rims. So chrome spelled C R O M. So

pimped out van with chrome rims. As soon

as you see vancomy, so you think of this

van here, vancomy with these pimped out

rims, these chrome rims. So pimped out

van vancomy with chrome CRM rims. And

chrome stands for CIFF. That is one of

your first indications for this

medication. Of course, that's going to

be PO. Um, the R is going to stand for

red man syndrome and renal toxicity,

your nephrotoxicity. The O in chrome

stands for autotoxicity. And then the M

stands for MRSA. So, if you remember, as

soon as you see venkcomy, think of a van

with chrome pimped out rims. And that

helps you remember CIFF, red man

syndrome, renal toxicity, autotoxicity,

and MRSA. And you can remember the main

things that you need to know about

venkcomy.

All right, let's wrap this up with five

quick high yield questions. See what you

remember. So first one, a patient with a

penicellin allergy can safely be given

which class or medication of betalactam

antibiotics with no risk of cross

reactivity. So that's going to be as

trienam your monobactam class. Um so

betalactam that has no cross reactivity

with penicellin or sephilosporins. The

exception of course remember that

septazidm that we discussed earlier.

Question two. Patient being treated for

MRSA with IV antibiotics begins to

develop a red rash across his head,

neck, thorax, and extremities as the IV

antibiotic is being administered. Which

antibiotic is this patient likely

receiving? Hopefully remember that

because we just went over that. It's

going to be venkcomy. So, we're treating

MRSA. There's really only a number of

meds uh to begin with for treatment of

MRSA. Then we see he's developing a rash

as the IV antibiotic is administered,

which we know can be caused by venkcomy.

Um if the medication is administered too

quickly they may develop that red man

syndrome that confluent or blotchy rash

spread throughout the body. Question

three which is the only medication in

the carbopenum class that does not cover

pseudomonus. So that is going to be

erdipenum. Remember it's the only

carbopenum that starts with an e? That's

because it's your exception to the rule

that all carbopen cover sudamonus

because erupenum does not. Question

four, which medication is the first line

for chlamydia, Rocky Mountain spotted

fever, and Lyme disease? That is going

to be doxycyc. So don't forget sitting

on a dock by the sea, doxycycan. Eating

clams, chlamydia, rocky mountain

oysters, Rocky Mountain spotted fever

with a squeeze of lime, lyme disease.

All right, question five, last one.

Which fifth generation sephilisporin has

coverage against MRSA? So that is going

to be septarolene. Remember your seph

starline star has five sides fifth

generation. What's up in the stars Mars

which is just the letters in MRSA

rearranged. All right, so that is

antibiotics. I hope that was helpful and

please let me know if it is or if

there's any suggestions or anything you

want me to cover coming up in the next

few weeks. I'm probably going to be

starting uh neurology pretty soon. Um

thank you as always for your support. I

really do appreciate it and good luck on

your pants, your panoro ears and good

luck in PA