SULFONAMIDESMOA | Mammalian cells lack dihydropteroate synthase and require exogenous sources of folate. Inhibiting synthesis of folic acid (folate), a compound required by all cells to make DNA, RNA, and proteins | PK | Absorbed from the stomach and small intestines, widely distributed to tissues and body fluids (CNS, CSF, placenta, fetus) Excreted unchanged into the urine. Eliminated by glomerular filtration and breast milk. | AE | Crystalluria, hypersensitivity, hematopoietic disturbances (hemolytic anemia), kernicterus | CONTRA | Pregnant women, children <2 mo old |
SULFONAMIDESORAL, NONABSORB | | SULFASALAZINE | ORAL, ABSORBABLE | SHORT | SULFACYTINE | | SULFISOXAZOLE | Indications: UTI | | FULFAMETHIZOLE | INTERM | SULFADIAZINE | Indications: 1st line for acute toxoplasmosis | | SULFAMETHOXAZOLE | Indications: UTI | | SULFAPYRIDINE | LONG | SULFADOXINE | Indication: 2nd line for malaria
| TOPICAL | | SODIUM SULFACETAMIDE | | MAFENIDE ACETATE | | SILVER SULFADIAZINE |
Sulfadiazine and sulfadoxone are used in combo with pyrimethamine
DHFR INHIBITORSTMP/SMX | Drug of choice for infections such as Pneumocystis jiroveci pneumonia, toxoplasmosis, nocardiosis, and occasionally other bacterial infections | TRIMETHOPRIM | UTI | PYRIMETHAMINE | Parasitic |
AE: megaloblastic anemia, leukopenia, granulocytopenia
| | FLUOROQUINOLONESMOA | Inhibit one or both of the 2 prokaryotic type II topoisomerases | PK | Well absorbed, widely distributed in body fluids and tissues Excreted really | INDICATIONS | Resistant respiratory infections, anthrax, gonorrhea, UTI and bacterial diarrhea caused by shigella, salmonella, toxigenic E coli, and campylobacter | AE | NVD, HA, dizziness, phototoxic, connective tissue problems | BBW | Tendinitis, tendon rupture | CONTRA | Avoid in pregos, nursing mothers, and children <18 | DDI | THEOPHYLLINE, WARFARIN, CYCLOSPORINE |
Concentration-dependent killing
FLUOROQUINOLONESNALIDIXIC ACID | NORFLOXACIN | OFLOXACIN | CIPROFLOXACIN | No longer recommended for gonococcal in the US Indications: chlamydial urethritis, cervicitis | LEVOFLOXACIN | No longer recommended for gonococcal in the US Indications: chlamydial urethritis, cervicitis QD, long t1/2 | MOXIFLOXACIN | Only one not effective in UTI's QD, long t1/2 Contra: puts predisposed to arrhythmias or pts that are taking anti arrhythmic meds due to QT prolongation |
METHENAMINEMOA | Metabolized to formaldehyde and ammonia in acidic pH. The formaldehyde is lethal to bacteria. | INDICATION | Urinary tract antiseptics/antimicrobials | SIDE EFFECTS | GI distress, may cause albuminuria, hematuria, and rashes at higher doses | CONTRA | Pts with renal insufficiency |
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