Sulfonamides are effective against streptococcal

Sulfonamides are effective against streptococcal infections with a wide range of gram-
positive and gram-negative organisms, P. jiroveci and Toxoplasma gondii and work by inhibiting
bacterial folic acid synthesis (Arcangelo et al., 2017). They are metabolized by the liver and
eliminated via glomerular filtration (Arcangelo et al., 2017). The sulfonamides (Sulfasalazine) is
used to manage ulcerative colitis and in combination therapy (Trimethoprim–sulfamethoxazole
(Bactrim)) will treat UTIs, P. jiroveci pneumonia (PCP), toxoplasmosis, and some resistant gram-
negative infections (Arcangelo et al., 2017). Silver sulfadiazine (Silvadene) is used topically for
burns (Arcangelo et al., 2017). The common side effects are rash (which can occur 1 to 2 weeks
after initiating therapy), fever, Stevens-Johnson and GI side effects (Arcangelo et al., 2017). The
drugs will increase the effect of Coumadin, Methotrexate, phenytoin and hypoglycemic drugs
(Arcangelo et al., 2017).
Glycopeptides
Glycopeptides are interfere with cross-linking of peptidoglycan in the bacterial cell wall
(Arcangelo et al., 2017). Vancomycin which is the first generation Glycopeptide along with more
recent additions of dalbavancin, oritavancin, and telavancin have a narrow spectrum of activity
directed toward gram-positive organisms, methicillin-sensitive and methicillin-resistant
staphylococci, streptococci, enterococci, and Clostridium species (Arcangelo et al., 2017).
Although poorly absorbed in the GI tract, oral Vancomycin is used to treat Clostridium difficile
colitis (Arcangelo et al., 2017). Glycopeptides have a good penetration in most body fluids and
tissues and are dosed based on kidney function (Arcangelo et al., 2017). Serum drug monitoring

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(10 and 20 μg/mL) is recommended for Vancomycin but not required for dalbavancin,
oritavancin, or telavancin since the have bactericidal activity and a post antibiotic effect (PAE) of
one to four hours (Arcangelo et al., 2017). Vancomycin is given in neutropenic fever,
endocarditis, and meningitis while the newer agents are used for the treatment of skin and skin
structure infections (Arcangelo et al., 2017). The most reported side effects related to
vancomycin administration are “fever and chills, phlebitis, and “red man” syndrome (pruritus;
flushing of the head, neck, and face; and hypotension) which resolves when the drug is
discontinued (Arcangelo et al., 2017). Vancomycin can be nephrotocix and ottoxics especially if
given with aminoglycosides, amphotericin B, acyclovir, and cyclosporine (Arcangelo et al.,
2017).
Oxazolidinones
The oxazolidinones (Linezolid (Zyvox) and tedizolid (Sivextro))are synthetic antibiotic
which disrupt bacterial protein synthesis and are efficient against gram-positive aerobic
organisms (staphylococci, streptococci, and enterococci) and resistant pathogens (MRSA,
penicillin-resistant streptococci and VRE) (Arcangelo et al., 2017). The oxazolidinones are well
absorbed from GI tract without regards to food and the possible side effects are diarrhea, nausea,
taste perversion, vomiting, anemia, leukopenia, and pancytopenia (Arcangelo et al., 2017). If
patients receive linezolid for over two weeks a complete blood count should be ordered.