Ward Round Notes

The mechanisms and uses for several groups or antibiotics are described below but resistance and preferred antibiotic choices may vary between local regions and hospital. Please refer to these when considering antibiotic choice for different infections. Antibiotic group Mechanism Indications Examples Side effects and contra-indications Penicillins (Benzylpenicillin, phenoxy-methylpenicillin)   Binds to penicillin binding protiens and inhibits the last stage of cell wall synthesis causing cell lysis. Narrow spectrum – effective against streptococcus (e.g. group A strep, strep pneumonia, s.viridans) Occaisionally effective against non penicillinase producing staphylococcus. Aminoglycosides can be added synergistically against Group B strep, s viridans and enterococcus faecalis. Respiratory infections. Syphilis. Anaphylaxis/ hypersensitivity B lactamase resistant penicillins: flucloxa

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Group Examples Mechanism Contrindications and side effects Other notes Biguinides Metformin Reduce hepatic glucose production Increases insulin sensitivity GI side effects are common Risk of lactic acidosis in acute illness or reduced GFR. CI in those with impaired hepatic function and hx of ETOH excess due to increased lactic acidosis risk. Sulfonylureas Gliclazide Glimepiride (long acting sulfonylurea) Glimbenclamide glipizide Increases insulin secretion from pancreatic B cells through closing ATP-sensitive potassium channels. Risk of hypoglycaemia Weight gain Meglitinides Repaglinide Nateglinide Works the same way as sulfonylurea – but shorter acting. Hypoglycaemia Dipeptidyl peptidase IV inhibitors (DPP4) Linagliptin Sitagliptin Saxagliptin Alogliptin Inhibit DPP-4 which breaks down incretins (GLP-1 and GIP) there