Written and peer-reviewed by physicians—but use at your own risk. Read our disclaimer.

banner image

amboss

Trusted medical answers—in seconds.

Get access to 1,000+ medical articles with instant search
and clinical tools.

Try free for 5 days

Overview of antibiotic therapy

Last updated: March 8, 2021

Summarytoggle arrow icon

Antibiotics are a class of drugs employed mainly against bacterial infections. Some antibiotics are also used against parasitic infections. Antibiotics can have bacteriostatic (i.e., stopping bacterial reproduction), bactericidal (i.e., killing bacteria), or both mechanisms of action. Antibiotics are effective against either a small group of bacteria (narrow-spectrum) or a wide range of pathogens (broad-spectrum). Most antibiotics work by inhibiting cell wall synthesis, protein synthesis, or certain enzymes (e.g., THF, RNA-polymerase) in bacteria. Common side effects of antibiotic treatment include hypersensitivity reactions, as well as nephrotoxic and hepatotoxic effects. Many antibiotics are contraindicated in certain patient groups (e.g., children, pregnant and/or breastfeeding women). In the case of severe infection, one or more antibiotics may be initiated without waiting for a microbiological confirmation (empirical antibiotic therapy) to target the most likely pathogens. Antibiotics are widely used because they are instrumental in the management of infectious diseases; however, use of antibiotics without valid indications and with inappropriate dosages and timing has led to the emergence of antibiotic-resistant pathogens (e.g., MRSA, Pseudomonas).

Definitions

As a general rule, agents that inhibit cell wall synthesis are bactericidal (except ethambutol), while those that inhibit protein synthesis are bacteriostatic (except tigecycline, rifamycins, and aminoglycosides).

Overview of antibiotics [1][2]

Antibacterial classes Examples Mechanism of action Bacteriostatic/bactericidal Mechanisms of resistance
Inhibition of cell wall synthesis

β-lactams

Penicillins
Cephalosporins
Carbapenems
Monobactams
  • Cleavage by β-lactamases (less suceptible than other ß-lactams)

Glycopeptides

Epoxides

  • Reduced penetration
  • Enzyme gene overexpression
  • Enzymatic inactivation
Disruption of cell membrane integrity
Lipopeptides
Polymyxins
Inhibition of protein synthesis - 30S ribosomal subunit
Aminoglycosides
  • Inhibit initiation complex → protein mistranslation
Tetracyclines
  • Reduced cell wall penetration
  • Removal by efflux pumps (plasmid-encoded)
  • Production of a protein that protects ribosome
Glycylcylines (tetracyclin derivative)
Inhibition of protein synthesis - 50S ribosomal subunit
Macrolides and ketolides
  • Bind to 23S rRNA inhibition of transpeptidation, translocation, and chain elongation → ↓ protein synthesis
Lincosamides
  • Reduced penetration
  • Mutation of bacterial ribosome binding site
Streptogramins
Oxazolidinones
Amphenicols
  • Reduced penetration
  • Enzymatic inactivation by acetyltransferase (plasmid-encoded)
DNA gyrase inhibition
Fluoroquinolones
Disruption of DNA integrity
Nitroimidazoles
  • Prodrug [6]
  • Free radical formation → single-strand breaks in DNA molecules
  • Reduced activation due to decreased enzymatic activity
Inhibition of folic acid synthesis and reduction
Sulfonamides and diaminopyrimidines
  • Overproduction of para-aminobenzoate (PABA)
  • Decreased uptake
  • Structural changes on target enzymes (e.g., dihydropteroate synthase)
  • Efflux pumps
Antimycobacterial drugs
Rifamycins
Hydrazides

Nicotinamides

  • Prodrug
  • Not completely understood
Ethylenediamine derivates
Sulfones
Others
Nitrofurans
  • Enzyme-mediated reduction
  • Efflux pumps

AcTions at 30, CELebrationS at 50: Aminoglycosides and Tetracyclines are 30S inhibitors; Chloramphenicol/Clindamycin, macrolides (e.g., Erythromycin), Linezolid, and Streptogramin are 50S inhibitors.

All protein synthesis inhibitors are bacteriostatic, except aminoglycosides (bactericidal) and linezolid (can be either bactericidal or bacteriostatic depending on concentration).

Beta-lactams

Beta-lactamase inhibitors

CATS: Clavulanate, Avibactam, Tazobactam, Sulbactam are β-lactamase inhibitors.

Natural penicillins (prototype beta-lactam antibiotics)

Penicillinase-resistant penicillins

Use NAF (nafcillin) for STAPH (S. aureus).

Aminopenicillins (penicillinase-sensitive penicillins)

AmOxicillin is administered Orally, while amPicillin is administered by a Prick!

Aminopenicillin therapy HHEELPSSS against H. influenzae, H. pylori, E. coli, Enterococci, Listeria monocytogenes, Proteus mirabilis, Salmonella, Shigella, Spirochetes.

Antipseudomonal penicillins

The PIPER in his CAR full of TICks ran over Pseudomonas: PIPERacillin, CARbenicillin, and TICarcillin are antipseudomonals.

  • Examples
    • IV imipenem (combined with cilastatin)
    • IV meropenem
    • IV ertapenem
    • IV doripenem
  • Special characteristics
    • Imipenem is always given with cilastatin, which inhibits human dehydropeptidase I (a renal tubular enzyme that breaks down imipenem).
    • Meropenem is stable to dehydropeptidase I.
  • Clinical use
  • Adverse effects
  • Mechanism of resistance: inactivation by carbapenemase

Get a kill that is lastin' with imipenem plus cilastatin.

don't DIe on ME: Doripenem, lmipenem, Meropenem, and Ertapenem are carbapenems and used in life-threatening infections.

Clinical use of cephalosporins
1st generation cephalosporins 2nd generation cephalosporins 3rd generation cephalosporins 4th generation cephalosporins 5th generation cephalosporins
Examples
  • Oral: cephalexin
  • IV, IM: cefazolin
  • Oral: cefixime, cefpodoxime
  • IV: ceftriaxone, cefotaxime, ceftazidime
  • IM: ceftriaxone
  • IV cefepime
  • IV ceftaroline
Microbial coverage
Activity against gram-positive bacteria
  • Highly active
  • Less active than 1st generation
  • Highly active
  • Highly active
Gram-negative bacteria coverage
  • Extended-spectrum
  • Extended-spectrum
  • Extended-spectrum
MRSA
  • No
  • No
  • No
  • No
  • Yes
Listeria
  • No
  • No
  • No
  • No
  • Yes
Pseudomonas
  • No
  • No
  • Yes
  • No
Enterococcus
  • No
  • No
  • No
  • No
Atypicals (Chlamydia, Mycoplasma, Legionella)
  • No
  • No
  • No
  • No
  • No
Special clinical considerations
  • N/A
  • Used for severe life-threatening infections (including nosocomial)
  • N/A

1 PEcK: 1st generation cephalosporins cover Proteus mirabilis, E. coli, Klebsiella pneumoniae.
2 HENS PEcK: 2nd generation cephalosporins cover H. influenzae, Enterobacter aerogenes (now Klebsiella aerogenes), Neisseria,
Serratia marcescens, Proteus mirabilis, E. coli, Klebsiella pneumoniae.

2nd graders wear fake fox fur to tea parties: 2nd generation cephalosporins include cefaclor, cefoxitin, cefuroxime, and cefotetan.

Cephalosporins are LAME: 1st–4th generation cephalosporins do not act against Listeria, Atypical organisms (e.g., Chlamydia, Mycoplasma), MRSA, and Enterococci (with the exception of ceftaroline, which does act against MRSA).

The vancomycin van carries a TON of red DRESSes: the side effects of vancomycin are Thrombophlebitis, Ototoxicity, Nephrotoxicity, red man syndrome, and DRESS syndrome.

The fine for VANdalism is one DALlAr in LACjac: VANcomycin resistance is caused by amino acid modification (D-Ala-D-Ala to D-Ala-D-Lac).

Dap-to-my-cin is good to my skin: daptomycin is used to treat skin infections.

Me and my NEw AMIgA are taking GENeral STEPs to AMeliorate our TOBacco intake but are still unsuccessful: NEomycin, AMIkAcin, GENtamicin, STrEPtomycin AMinoglycosides, and TOBramycin are unsuccessful in killing anaerobes.

Ah, MI(y) NEPHew's OTter keeps TERrorizing our block: the side effects of AMInoglycosides include NEPHrotoxicity, OTotoxicity, TERatogenicity, and neuromuscular blockade.

Teethracyclines: teeth discoloration is a side effect of tetracyclines.

  • Examples: tigecycline
  • Mechanism of action [35]
  • CNS penetration: poor
  • Route of elimination: mostly biliary
  • Clinical use
  • Special considerations
  • Adverse effects [4]
  • Contraindications [38]
    • Children < 8 years of age
    • Pregnant women
    • Breastfeeding women
    • Cautious use in patients with hepatic dysfunction

Macroslides: macrolides inhibit translocation during protein synthesis, in which ribosomes slide along mRNA.

The adverse effects of MACROlides include gastrointestinal Motility issues, Arrhythmia (due to prolonged QT interval), acute Cholestatic hepatitis, Rash, and eOsinophilia.

Fluoroquinolones hurt the attachments to your bones.

Take the Metro To lonG BEaCH: Metronidazole treats Trichomonas, Giardia/Gardnerella, Bacteroides, Entamoeba, Clostridium, and H. pylori.

TMP Treats Marrow Poorly.

ROCk, PAper, SCiSSors: the most important sulfa drugs are fuROsemide, (hydro)Chlorthalidone, Probenecid, Acetazolamide, Sulfamethoxazole/Sulfadiazine, Celecoxib, Sulfasalazine, and Sulfonylureas).

See “Treatment” in “Tuberculosis.”

The 6Rs of Rifampin: Red or orange urine, RNA polymerase Repression, Ramping up of cytochrome P450 activity, and Rapid Resistance development if used alone.

Rifampin really amplifies (induces) cytochrome P450, but rifabutin does not.

INH Is Not Healthy In Neurons and Hepatocytes.

Neurotoxicity may be prevented by supplementing with pyridoxine (vitamin B6).

  • Mechanism of action
    • Not completely understood
      • Prodrug: converted into active form pyrazinoic acid
      • Most effective at acidic pH (e.g., in acidic phagolysosomes)
    • Bactericidal effect
  • CNS penetration: only when meninges are inflamed
  • Route of elimination: renal elimination after hepatic metabolism
  • Clinical use: M. tuberculosis
  • Adverse effects
  • Contraindications
    • Consider use in pregnant and breastfeeding women only if benefits outweigh the risks [76]
    • Hepatic failure [77]
    • Acute gout
  • Mechanisms of resistance: mutations in RpsA gene coding for ribosomal protein S1 [78]

EYEthambutol: Ethambutol causes optic neuropathy.

Absolute contraindication Relative contraindication Safe to use
Children
Pregnant women
Breastfeeding women
Individuals with renal failure
Individuals with hepatic failure

For SAFe Children, these Tablets are Contraindicated: Sulfonamides, Aminoglycosides, Fluoroquinolones, Clarithromycin, Tetracyclines, and Chloramphenicol are contraindicated in children.

Cut the Tablets for your Child's SAFety: Chloramphenicol, Tetracyclines, Clarithromycin, Sulfonamides, Aminoglycosides, and Fluoroquinolones are contraindicated in pregnancy.

We list the most important contraindications. The selection is not exhaustive.

Empiric antibiotic therapy

Empiric antibiotic therapy covers the most probable causative organism(s) before the pattern of resistance and/or causative organism are known.

Indications

Choosing empiric antibiotic therapy

Target the most probable causative organism(s) but consider factors which might affect the success of usage of the chosen agent:

Other guiding principles

Blood cultures should be taken before initiating empiric antibiotic therapy.

Targeted antibiotic therapy

  • Targeted antibiotic therapy is chosen based on the results of culture and antibacterial sensitivity testing.
  • Aims to decrease the risk of treatment toxicity, prevent the development of antimicrobial resistance, and reduce the cost of the treatment
  • Usually employs narrow-spectrum agents to maximize efficacy and reduce the risk of side effects

Antibiotic prophylaxis

  1. Katzung BG, Masters S, Trevor A. Basic and Clinical Pharmacology 12/E. McGraw Hill Professional ; 2012
  2. Quinupristin. https://www.drugbank.ca/drugs/DB01369. Updated: July 2, 2019. Accessed: July 9, 2019.
  3. Cheryle Gurk-Turner. Quinupristin/dalfopristin: the first available macrolide-lincosamide-streptogramin antibiotic. Proceedings (Baylor University. Medical Center)".. 2000 .
  4. Ellie Hershberger, Susan Donabedian, Konstantinos Konstantinou, Marcus J. Zervos, George M. Eliopoulos. Quinupristin-Dalfopristin Resistance in Gram-Positive Bacteria: Mechanism of Resistance and Epidemiology. Clinical Infectious Diseases. 2004 .
  5. Dalfopristin. https://www.drugbank.ca/drugs/DB01764. Updated: July 13, 2019. Accessed: July 24, 2019.
  6. dalfopristin/quinupristin - Drug Summary. https://www.pdr.net/drug-summary/Synercid-dalfopristin-quinupristin-1492. Updated: January 1, 2019. Accessed: July 25, 2019.
  7. Krcméry V Jr, Matejicka F, Pichnová E, Jurga L, Sulcova M, Kunová A, West D.. Documented fungal infections after prophylaxis or therapy with wide spectrum antibiotics: relationship between certain fungal pathogens and particular antimicrobials?. Journal of Chemotherapy. 1999 .
  8. Peter M Hawkey, David M Livermore. Carbapenem antibiotics for serious infections. The BMJ. 2012 .
  9. Tomasz A. Penicillin-Binding Proteins and the Antibacterial Effectiveness of β-Lactam Antibiotics. Clinical Infectious Diseases. 1986; 8 (Supplement_3): p.S260-S278. doi: 10.1093/clinids/8.supplement_3.s260 . | Open in Read by QxMD
  10. George Garratty. Drug-induced immune hemolytic anemia. American Society of Hematology. 2009 .
  11. Li-Ju Chen, Fei-Yuan Hsiao, Li-Jiuan Shen, Fe-Lin Lin Wu, Woei Tsay, Chien-Ching Hung, and Shu-Wen Lin. Use of Hypoprothrombinemia-Inducing Cephalosporins and the Risk of Hemorrhagic Events: A Nationwide Nested Case-Control Study. PLOS One. 2016 .
  12. Shirakawa H, Komai M, Kimura S.. Antibiotic-induced vitamin K deficiency and the role of the presence of intestinal flora.. International Journal for Vitamin and Nutrition. 1990 .
  13. Grill MF, Maganti R.. Cephalosporin-induced neurotoxicity: clinical manifestations, potential pathogenic mechanisms, and the role of electroencephalographic monitoring.. Annals of Pharmacotherapy. 2008 .
  14. Peter F Weller, MD, MACP. Vancomycin hypersensitivity. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/vancomycin-hypersensitivity.Last updated: February 9, 2019. Accessed: July 12, 2019.
  15. Blumenthal KG, Patil SU, Long AA.. The importance of vancomycin in drug rash with eosinophilia and systemic symptoms (DRESS) syndrome.. Allergy & Asthma Proceedings. 2012 .
  16. Black E, Lau TT, Ensom MH.. Vancomycin-induced neutropenia: is it dose- or duration-related?. Annals of Pharmacotherapy. 2011 .
  17. Vancomycin Pregnancy and Breastfeeding Warnings. https://www.drugs.com/pregnancy/vancomycin.html. Updated: March 27, 2019. Accessed: July 29, 2019.
  18. Levofloxacin. https://www.drugbank.ca/drugs/DB01137. Updated: July 13, 2019. Accessed: July 15, 2019.
  19. Nau R, Sörgel F, Eiffert H. Penetration of drugs through the blood-cerebrospinal fluid/blood-brain barrier for treatment of central nervous system infections. Clin Microbiol Rev. 2010; 23 (4): p.858-883. doi: 10.1128/CMR.00007-10 . | Open in Read by QxMD
  20. Quinolones. http://www.antimicrobe.org/new/d17.asp. Updated: February 21, 2017. Accessed: February 21, 2017.
  21. Gordon JJ, Kauffman CA.. Superinfection with Streptococcus pneumoniae during therapy with ciprofloxacin.. The American Journal of Medicine. 1990 .
  22. Jones SC, Sorbello A, Boucher RM.. Fluoroquinolone-associated myasthenia gravis exacerbation: evaluation of postmarketing reports from the US FDA adverse event reporting system and a literature review.. Drug Safety. 2011 .
  23. Marchbanks CR. Drug-drug interactions with fluoroquinolones.. Pharmacotherapy. 1993 .
  24. Sulfisoxazole. https://www.drugbank.ca/drugs/DB00263. Updated: July 24, 2019. Accessed: July 24, 2019.
  25. Anthony Montanaro, MD, FAAAAIS. Sulfonamide allergy in HIV-uninfected patients. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/sulfonamide-allergy-in-hiv-uninfected-patients.Last updated: October 10, 2018. Accessed: July 12, 2019.
  26. Sultan Ayed Al Qahtani. Drug-induced megaloblastic, aplastic, and hemolytic anemias: current concepts of pathophysiology and treatment. International Journal of Clinical and Experimental Medicine. 2018 .
  27. Perazella MA. Trimethoprim-induced hyperkalaemia: clinical data, mechanism, prevention and management. Drug Saf. 2000; 22 (3): p.227-236.
  28. Kastrup J, Petersen P, Bartram R, Hansen JM. The effect of trimethoprim on serum creatinine. Br J Urol. 1985; 57 (3): p.265-268.
  29. Daptomycin. https://www.drugbank.ca/drugs/DB00080. Updated: July 11, 2019. Accessed: July 12, 2019.
  30. Yoshitsugu Higashi, Shigeki Nakamura, Yasuhiro Tsuji, Chika Ogami, Kaoru Matsumoto, Koyomi Kawago, Kotaro Tokui, Ryuji Hayashi, Ippei Sakamaki, and Yoshihiro Yamamoto. Daptomycin-induced Eosinophilic Pneumonia and a Review of the Published Literature. Internal Medicine Journal. 2018 .
  31. Tran TT, Munita JM, Arias CA. Mechanisms of drug resistance: daptomycin resistance. Ann N Y Acad Sci. 2015; 1354 (1): p.32-53. doi: 10.1111/nyas.12948 . | Open in Read by QxMD
  32. Chloramphenicol. https://www.drugbank.ca/drugs/DB00446. Updated: July 16, 2019. Accessed: July 17, 2019.
  33. Johnson BA, Nunley JR. Use of Systemic Agents in the Treatment of Acne Vulgaris. Am Fam Physician. 2000; 62 (8): p.1823-1830.
  34. Paula E Beattie. Drug induced photosensitivity. Medicines Update. 2014 .
  35. Mark H. J. Litzinger, Mersedyes D. Boatman, Eugene Talatala, Monica Litzinger. Fanconi Syndrome. NEPHROLOGY. 2011 .
  36. Holst AV, Danielsen PL, Romner B. A severe case of tetracycline-induced intracranial hypertension. Dermatology Reports. 2011; 3 (1): p.1. doi: 10.4081/dr.2011.e1 . | Open in Read by QxMD
  37. Todd SR, Dahlgren FS, Traeger MS, et al. No Visible Dental Staining in Children Treated with Doxycycline for Suspected Rocky Mountain Spotted Fever. J Pediatr. 2015; 166 (5): p.1246-1251. doi: 10.1016/j.jpeds.2015.02.015 . | Open in Read by QxMD
  38. Katzung B,Trevor A. Basic and Clinical Pharmacology. McGraw-Hill Education ; 2014
  39. Tigecycline. https://www.drugbank.ca/drugs/DB00560. Updated: July 16, 2019. Accessed: July 17, 2019.
  40. Jonathan Cohen, William G Powderly, Steven M. Opal. Infectious Diseases. Elsevier ; 2016
  41. Nickie D. Greer. Tigecycline (Tygacil): the first in the glycylcycline class of antibiotics. Proceedings (Baylor University Medical Center). 2006 .
  42. Briggs GG, Freeman RK, Yaffe SJ. Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk. Lippincott Williams & Wilkins ; 2011
  43. Eberly MD, Eide MB, Thompson JL, Nylund CM. Azithromycin in Early Infancy and Pyloric Stenosis. Pediatrics. 2015; 135 (3): p.483-488. doi: 10.1542/peds.2014-2026 . | Open in Read by QxMD
  44. Nahata M. Drug interactions with azithromycin and the macrolides: an overview.. Journal of Antimicrobial Chemotherapy. 1996 .
  45. ZITHROMAX. https://www.rxlist.com/zithromax-drug.htm. Updated: March 30, 2020. Accessed: August 21, 2020.
  46. ERYTHROMYCIN. https://www.rxlist.com/erythromycin-drug.htm. Updated: May 20, 2020. Accessed: August 21, 2020.
  47. BIAXIN. https://www.rxlist.com/biaxin-drug.htm. Updated: May 13, 2020. Accessed: August 21, 2020.
  48. Le T, Bayer AS. Combination antibiotic therapy for infective endocarditis. Clin Infect Dis. 2003; 36 (5): p.615-621. doi: 10.1086/367661 . | Open in Read by QxMD
  49. Linezolid. https://www.drugbank.ca/drugs/DB00601. Updated: July 16, 2019. Accessed: July 18, 2019.
  50. Katherine S. Long and Birte Vester. Resistance to Linezolid Caused by Modifications at Its Binding Site on the Ribosome. Antimicrobial Agents and Chemotherapy. 2012 .
  51. Can Fosfomycin Treat Multidrug-Resistant UTIs?. https://www.medscape.com/viewarticle/778281. Updated: January 30, 2013. Accessed: July 11, 2019.
  52. Fosfomycin. https://www.drugbank.ca/drugs/DB00828. Updated: July 8, 2019. Accessed: July 9, 2019.
  53. Castañeda-García A, Blázquez J, Rodríguez-Rojas A. Molecular Mechanisms and Clinical Impact of Acquired and Intrinsic Fosfomycin Resistance. Antibiotics. 2013; 2 (2): p.217-236. doi: 10.3390/antibiotics2020217 . | Open in Read by QxMD
  54. Edouard G. Vannier, PhD, Maria A. Diuk-Wasser, PhD, Choukri Ben Mamoun, PhD, and Peter J. Krause, MD. Babesiosis. Infectious Disease Clinics of North America. 2016 .
  55. Clindamycin Pregnancy and Breastfeeding Warnings. https://www.drugs.com/pregnancy/clindamycin.html. Updated: December 14, 2018. Accessed: July 17, 2019.
  56. Johns Hopkins Antibiotic (ABX) Guide: Bacteroides fragilis. https://www.hopkinsguides.com/hopkins/view/Johns_Hopkins_ABX_Guide/540052/all/Bacteroides_fragilis. Updated: January 30, 2016. Accessed: February 21, 2017.
  57. Metronidazole - Drugs.com. https://www.drugs.com/metronidazole.html. Updated: December 26, 2018. Accessed: July 15, 2019.
  58. Karamanakos PN, Pappas P, Boumba VA, Thomas C, Malamas M, Vougiouklakis T, Marselos M.. Pharmaceutical agents known to produce disulfiram-like reaction: effects on hepatic ethanol metabolism and brain monoamines.. International Journal of Toxicology. 2007 .
  59. METRONIDAZOLE. https://www.rxlist.com/metronidazole-drug.htm. Updated: March 8, 2019. Accessed: August 21, 2020.
  60. Maddalena Diana Iadevaia, Anna Del Prete, Claudia Cesaro, Laura Gaeta, Claudio Zulli, and Carmelina Loguercio. Rifaximin in the treatment of hepatic encephalopathy. Hepatic Medicine. 2011 .
  61. Muthukumar T, Jayakumar M, Fernando EM, Muthusethupathi MA.. Acute renal failure due to rifampicin: a study of 25 patients.. American Journal of Kidney Diseases. 2002 .
  62. Xun-Chao Cai, Huan Xi, Li Liang, Jia-Dong Liu, Chang-Hong Liu, Ya-Rong Xue and Xiang-Yang Yu. Rifampicin-Resistance Mutations in the rpoB Gene in Bacillus velezensis CC09 have Pleiotropic Effects. Frontiers in Microbiology. 2017 .
  63. Henrik Cordes, Christoph Thiel, Hélène E. Aschmann, Vanessa Baier, Lars M. Blank, Lars Kuepfer. A Physiologically Based Pharmacokinetic Model of Isoniazid and Its Application in Individualizing Tuberculosis Chemotherapy. Antimicrobial Agents and Chemotherapy. 2016 .
  64. Isoniazid. https://www.drugbank.ca/drugs/DB00951. Updated: July 21, 2019. Accessed: July 23, 2019.
  65. UpToDate. Isoniazid: Drug Information. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/isoniazid-drug-information.Last updated: January 1, 2018. Accessed: November 12, 2018.
  66. TB Treatment & Pregnancy. https://www.cdc.gov/tb/topic/treatment/pregnancy.htm. Updated: April 5, 2016. Accessed: July 23, 2019.
  67. PYRAZINAMIDE. https://www.rxlist.com/pyrazinamide-drug.htm. Updated: May 13, 2019. Accessed: August 21, 2020.
  68. Zhang Y, Shi W, Zhang W, Mitchison D. Mechanisms of Pyrazinamide Action and Resistance. Microbiology Spectrum. 2014; 2 (4). doi: 10.1128/microbiolspec.mgm2-0023-2013 . | Open in Read by QxMD
  69. MYAMBUTOL. https://www.rxlist.com/myambutol-drug.htm. Updated: December 21, 2017. Accessed: August 21, 2020.
  70. Nazir T, Rasool MH, Hameed A, Ahmad B, Qureshi JA. Ethambutol resistance of indigenous Mycobacterium tuberculosis isolated from human patients.. Brazilian journal of microbiology : [publication of the Brazilian Society for Microbiology]. 2010; 41 (4): p.1065-9. doi: 10.1590/S1517-838220100004000026 . | Open in Read by QxMD
  71. Brunton L. Goodman and Gilman's The Pharmacological Basis of Therapeutics, 13th Edition. McGraw-Hill Education / Medical ; 2017
  72. Hauser AR. Antibiotic Basics for Clinicians. Lippincott Williams & Wilkins ; 2012
  73. Metronidazole - Drugbank. https://www.drugbank.ca/drugs/DB00916. Updated: July 8, 2019. Accessed: July 9, 2019.
  74. Nitrofurantoin. https://www.drugbank.ca/drugs/DB00698. Updated: July 8, 2019. Accessed: July 9, 2019.
  75. Francis J. Squadrito, Daniel del Portal.. Nitrofurantoin. StatPearls. 2019 .
  76. Colistin. https://www.drugbank.ca/drugs/DB00803. Updated: July 18, 2019. Accessed: July 19, 2019.
  77. David Landman, Claudiu Georgescu, Don Antonio Martin, and John Quale. Polymyxins Revisited. Clinical Microbiology Reviews. 2008 .
  78. MACROBID. https://www.rxlist.com/macrobid-drug.htm. Updated: August 11, 2020. Accessed: August 21, 2020.
  79. A Parthasarathy. Textbook of Pediatric Infectious Diseases. Jaypee Brothers Medical Publishers ; 2019
  80. Dapsone - Drugbank. https://www.drugbank.ca/drugs/DB00250. Updated: August 21, 2020. Accessed: August 21, 2020.
  81. Gillis TP, Williams DL. Dapsone resistance in Mycobacterium leprae. Lepr Rev. 2000; 71 . doi: 10.5935/0305-7518.20000076 . | Open in Read by QxMD
  82. Cho H, Uehara T, Bernhardt TG. Beta-Lactam Antibiotics Induce a Lethal Malfunctioning of the Bacterial Cell Wall Synthesis Machinery. Cell. 2014; 159 (6): p.1300-1311. doi: 10.1016/j.cell.2014.11.017 . | Open in Read by QxMD
  83. Sutter R, Rüegg S, Tschudin-Sutter S. Seizures as adverse events of antibiotic drugs: A systematic review.. Neurology. 2015 .
  84. Bennett JE, Dolin R, Blaser MJ. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. Elsevier Saunders ; 2015