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Antibiotics Simplified
SECOND EDITION

Jason C. Gallagher, PharmD, BCPS

Clinical Associate Professor
Temple University School of Pharmacy
Adjunct Assistant Professor of
Pharmacology and Physiology
Drexel University School of Medicine

Conan MacDougall, PharmD, MAS, BCPS

Associate Professor of Clinical Pharmacy
University of California–San Francisco
School of Pharmacy
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Antibiotics Simplified
SECOND EDITION

Jason C. Gallagher, PharmD, BCPS

Clinical Associate Professor
Temple University School of Pharmacy
Adjunct Assistant Professor of
Pharmacology and Physiology
Drexel University School of Medicine

Conan MacDougall, PharmD, MAS, BCPS

Associate Professor of Clinical Pharmacy
University of California–San Francisco
School of Pharmacy
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Library of Congress Cataloging-in-Publication Data
Gallagher, Jason C.
Antibiotics simplified / Jason C. Gallagher, Conan MacDougall. — 2nd ed.
p. ; cm.
Includes bibliographical references and index.
ISBN-13: 978-1-4496-1459-1
ISBN-10: 1-4496-1459-0
1. Antibiotics. I. MacDougall, Conan. II. Title.
[DNLM: 1. Anti-Bacterial Agents—Handbooks. QV 39]
RM267.G27 2012
615⬘.7922—dc22
2010046112
6048
Printed in the United States of America
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Contents

Introduction vii
New to the Second Edition xi
Acknowledgments xiii

PART 1: Considerations with Antibiotic Therapy 1

Chapter 1: The Wonderful World of Microbiology 3

Chapter 2: General Approach to Infectious Diseases 15
Chapter 3: Antibiotic Pharmacodynamics 23
Chapter 4: Adverse Consequences of Antibiotic Use 29

PART 2: Antibacterial Drugs 35

Chapter 5: Beta-Lactams 37
Penicillins 39
Natural Penicillins 41
Antistaphylococcal Penicillins 43
Aminopenicillins 45
Antipseudomonal Penicillins 47
Beta-Lactam/Beta-Lactamase Inhibitor Combinations 49
Cephalosporins 53
First-Generation Cephalosporins 55
Second-Generation Cephalosporins 57
Third-Generation Cephalosporins 61
Fourth-Generation Cephalosporins 65

iii
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iv CONTENTS

Fifth-Generation Cephalosporins 67
Carbapenems 69
Monobactams 73
Chapter 6: Glycopeptides 75
Chapter 7: Fluoroquinolones 79
Chapter 8: Aminoglycosides 83
Chapter 9: Tetracyclines and Glycylcyclines 87
Chapter 10: Macrolides and Ketolides 91
Chapter 11: Oxazolidinones 95
Chapter 12: Nitroimidazoles 97
Chapter 13: Nitrofurans 101
Chapter 14: Streptogramins 105
Chapter 15: Cyclic Lipopeptides 109
Chapter 16: Folate Antagonists 113
Chapter 17: Lincosamides 117
Chapter 18: Polymyxins 121

PART 3: Antimycobacterial Drugs 125

Chapter 19: Antimycobacterial Drugs 127

Chapter 20: Rifamycins 131
Chapter 21: Isoniazid 135
Chapter 22: Pyrazinamide 139
Chapter 23: Ethambutol 141

PART 4: Antifungal Drugs 143

Chapter 24: Antifungal Drugs 145

Chapter 25: Polyenes 149
Chapter 26: Antimetabolites 153
Chapter 27: Azoles 157
Fluconazole 159
Itraconazole 163
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CONTENTS v

Voriconazole 167
Posaconazole 171
Chapter 28: Echinocandins 175

PART 5: Antiviral Drugs 179

Chapter 29: Antiviral Drugs 181

Chapter 30: Anti-Herpes Simplex Virus and
Varicella-Zoster Virus Agents 185
Chapter 31: Anti-Cytomegalovirus Agents 187
Chapter 32: Neuramidase Inhibitors 191
Chapter 33: Antiretroviral Drugs 195
Nucleoside and Nucleotide Reverse
Transcriptase Inhibitors 197
Non-nucleoside Reverse Transcriptase Inhibitors (NNRTIs) 201
Protease Inhibitors 205
Entry and Integrase Inhibitors 209

PART 6: Antiparasitic Drugs 213

Chapter 34: Antiparasitic Drugs 215

Chapter 35: Quinolines 219
Chapter 36: Atovaquone 223
Chapter 37: Benzimidazoles 227
Chapter 38: Pentamidine 229
Chapter 39: Ivermectin 233
Appendix 1: Selected Normal Human Flora 236
Appendix 2: Clinically Useful Spectra of Activity 238
Appendix 3: Empiric Regimens for
Common Infections 240
Index 245
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Introduction

Antibiotics—the word sends terror coursing through

the veins of students and makes many healthcare
professionals uncomfortable. The category of antibi-
otics actually contains many different classes of
drugs that differ in spectrum of activity, adverse ef-
fect profiles, pharmacokinetics and pharmacody-
namics, and clinical utility. These classes can seem
bewildering and beyond comprehension. We believe
that taking a logical, stepwise approach to learning
the pharmacotherapy of infectious diseases can help
burn away the mental fog preventing optimal use of
these drugs.
Learning the characteristics of antibiotics sim-
plifies learning infectious disease pharmacother-
apy. Students and clinicians who attempt to learn
the antibiotics of choice for different types of infec-
tions before knowing the characteristics of those
drugs never truly understand the context of what
they are attempting to learn. Once the characteris-
tics of the antibiotics are known, making a logical
choice to treat an infection is much easier. This ap-
proach takes some time up front, but it will be well
worth the effort when the clinician realizes that the
pharmacotherapy of all infections is fundamentally
similar and logical.

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viii INTRODUCTION

■ How to Use This Book

We wrote this book in an effort to condense the many
facts that are taught about antibiotics in pharmacol-
ogy and pharmacotherapy courses into one quick
reference guide. It is meant to supplement material
learned in pharmacology, not to supplant it. Use this
book as a reference when you encounter a class of an-
tibiotics that you know you have heard about; it will
remind you of key points you may have forgotten.
This book contains six parts. Part 1 reviews
basic microbiology and how to approach the phar-
macotherapy of a patient with a presumed infec-
tion. The chapters in Parts 2–6 provide concise
reviews of various classes of antibacterial, antimy-
cobacterial, antifungal, antiviral, and antiparasitic
drugs. Again, this book is intended to supplement
your other pharmacology textbooks. These chapters
give key points about each class of antibiotics—they
are not thorough reviews. The appendices contain
references that may help in daily use.

■ Format of the Drug Class Reviews

Each drug class chapter follows the same basic for-
mat. The agents belonging to each class are listed
first. The drugs used most commonly in practice
are bolded.

Spectrum
The spectra listed are not exhaustive. This section
summarizes key organisms against which each
class has or does not have activity.

Adverse Effects
This section lists key adverse effects. This list is not
exhaustive, but it gives the most common and/or
concerning adverse effects of each class.
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INTRODUCTION ix

Dosing Issues
This section discusses common problems or poten-
tial errors in drug dosing for select drug classes.

Important Facts
This section provides a summary of significant
facts for each drug class.

What They’re Good For

This section lists some of the most common and/or
useful indications for the agents in the class. Often
the agents discussed have not been approved for
these indications by the Food and Drug Adminis-
tration (FDA), but they are commonly used for
them anyway. Conversely, many FDA indications
that the antibiotics do have are not listed here, be-
cause they are often out-of-date.

Don’t Forget!
In this section, we list points that are often over-
looked or especially important when dealing with
the drug class.
As you read this book, try to think of situations
in which the antibiotics would be useful to your pa-
tients. Think of why an antibiotic is useful for an
indication; don’t just learn that it is. It is our sin-
cere hope that you too have that magic moment
where the world of antibiotics and the study of in-
fectious diseases click together. Let us know when
it happens.
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New to the Second Edition

The Second Edition of Antibiotics Simplified ex-

pands on the drug classes covered in the first while
retaining the “key point” focus of the text that has
made it successful. In addition to antibacterial and
antifungal agents, the Second Edition includes an-
tiviral agents (including antiretrovirals for HIV),
antimycobacterial agents, and antiparasitic agents.
A new appendix includes empiric regimens for com-
mon infections for quick reference.

xi
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Acknowledgments

Our thanks go to those who helped to edit this text,

and to our wives, who put up with us while we
wrote it.
We dedicate this text to the pharmacy students
of Temple University and University of California–
San Francisco. We hope you find it useful.

xiii
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