Bacterial protein synthesis inhibitors

Aminoglycosides

Gentamicin, Tobramycin, Amikacin

• For Gram -ve infections ($\downarrow$ activity against most Gram +ve and anaerobes)
• Gentamicin used for eye infections, Otitis Externa along with other combination uses
• Poor GI absorption
• Tobramycin has $\uparrow$ activity against Pseudomonas
• Amikacin has least resistance
• Nephrotoxic and ototoxic

Macrolides

Azithromycin, clarithromycin, erythromycin

• Gram +ve cocci, syphilis, chlamydia
• Not enterococci or staphylococci
• Cytochrome P450 inhibitor (less with azithromycin)
  • $\uparrow$ warfarin
  • rhabdomyolysis with statins
  • $\uparrow$ calcineurin inhibitor levels

Tetracyclines and derivatives

Tetracycline, doxycycline

• Exacerbation of COPD, chlamydia, Lyme disease, mycoplasma, rickettsia, brucella, Anthrax, Syphilis, MRSA, malaria prophylaxis
• Contraindicated in pregnancy and children <8 y/o

Tigecycline

• Gram +ve & -ve including $\beta$-lactam-resistant strains
• Dose adjust in liver dysfunction

Other

Antibiotic	Indications	Considerations
Clindamycin	Gram +ve cocci (not enterococci), MRSA, anaerobes	$\uparrow$ risk C. diff
Linezolid	Gram +ve cocci, MRSA, VRE, anaerobes, mycobacteria	MAOI check interactions
Chloramphenicol	Gram +ve & -ve, anaerobes, mycoplasma, chlamydia, Conjunctivitis	Systemic use limited by myelosuppression
Fusidic acid	Staphylococci	$\uparrow$ LFTs