neuropathy may develop (Arcangelo et al., 2017). Macrolides and Ketolides Erythromycin is a macrolide that has treated many different infections, but GI side effects make it intolerant for most patients, so clarithromycin and azithromycin are prescribed more since they have improved GI tolerance and longer half-lives (Arcangelo et al., 2017). The only ketolide is telithromycin. Each works by binding to the 50S ribosomal unit; however, ketolides have a higher binding affinity to the ribosomal unit (Arcangelo et al., 2017; Laureate Education, Inc., 2012). They are broad-spectrum agents and are advantageous in treating respiratory tract, skin and soft tissue infections, STDs, HIV-related infections, and chlamydia, rickettsiae, and legionella (Arcangelo et al., 2017). Telithromycin is hepatotoxic and can cause acute liver failure and severe liver injury. GI side effects are common in both macrolides and ketolides causing abdominal pain, nausea, and vomiting. Ketolides side effects such as diarrhea, dizziness, and blurred vision have also been noted (Arcangelo et al., 2017). Aminoglycosides Bacterial protein synthesis is inhibited when aminoglycosides bind to the smaller 30S ribosomal subunit (Arcangelo et al., 2018). They are effective against gram-negative bacilli, for
6 example, E. coli , Klebsiella , Proteus mirabilis , Enterobacter species, and others (Arcangelo et al., 2017; Laureate Education, Inc., 2012). Staphylococcus , Enterococcus , and Streptococcus gram-positive species are also susceptible to aminoglycosides; however, a combination treatment must be used such as ampicillin (Arcangelo et al., 2017). Aminoglycosides are nephrotoxic and ototoxic, so caution must be used when administering this medication (Arcangelo et al., 2017; Laureate Education, Inc., 2012). GI and CNS adverse events are known to occur with aminoglycosides. Tetracyclines Tetracyclines are divided into short-, intermediate-, and long-acting agents and they work by binding to the 30S ribosomal subunit, thereby, inhibiting bacterial protein synthesis (Arcangelo et al., 2017; Laureate Education, Inc., 2012). Atypical organisms such as rickettsia, chlamydia, and spirochetes are treated with tetracyclines, along with gram-negative infections, acne vulgaris, and pelvic inflammatory disease (Arcangelo et al., 2017; Laureate Education, Inc., 2012). Doxycycline is a tetracycline that is used to treat early Lyme disease (Arcangelo et al., 2017). This category of antimicrobials should not be administered to children younger than eight years of age since it may cause a gray-brown stain on teeth. Other side effects that occur are anorexia, nausea, vomiting, and epigastric distress (Arcangelo et al., 2017). Antacids, iron, cholestyramine, and sucralfate need to be administered at least one hour before or after taking tetracyclines and food and dairy products limits absorption (Arcangelo et al. 2017). Glycylcyclines Glycylcyclines are structurally similar to tetracyclines with an addition of a glycyl rink to minocycline to enhance the antimicrobial spectrum (Arcangelo et al., 2017; Laureate Education, Inc., 2012). The mechanism of action is the same as tetracycline, and it works against gram-
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