Pharmacology Cheat Sheet
Antimicrobial Choice and Stewardship
Antimicrobial pharmacology for NEET-PG: cephalosporin LAME gaps, IV artesunate for malaria, isoniazid pyridoxine, BPaLM for MDR-TB, and antifungal choices.
MedNext Academy | 3 min read
Antimicrobial Choice and Stewardship
Antimicrobial pharmacology for NEET-PG: cephalosporin LAME gaps, IV artesunate for malaria, isoniazid pyridoxine, BPaLM for MDR-TB, and antifungal choices.
Antimicrobials and chemotherapy covering antibacterials, antitubercular drugs, antimalarials, antifungals, antivirals, and antiretroviral therapy.
High-yield lines
- Bactericidal drugs are mandatory in endocarditis and meningitis because phagocytes cannot access avascular vegetations or the CSF effectively.
- No cephalosporin except the fifth generation covers the LAME organisms: Listeria, atypicals, MRSA, and enterococci.
- Co-trimoxazole combines trimethoprim, which inhibits dihydrofolate reductase, with sulfamethoxazole, which inhibits dihydropteroate synthase, for synergistic folate blockade.
- Aminoglycoside toxicity is ototoxicity, nephrotoxicity, and neuromuscular block, and extended-interval dosing reduces nephrotoxicity.
- Tetracyclines chelate calcium and are contraindicated in pregnancy and children under 8 due to tooth discolouration.
- Rifampicin is the most potent sterilising anti-TB drug, and rifampicin resistance on GeneXpert is a surrogate marker for MDR-TB.
- Pyridoxine must be given with isoniazid to prevent peripheral neuropathy, especially in malnourished, alcoholic, diabetic, pregnant, or HIV patients.
- The modern all-oral 6-month BPaLM regimen of bedaquiline, pretomanid, linezolid, and moxifloxacin is recommended for MDR or rifampicin-resistant TB.
- Intravenous artesunate is the drug of choice for severe falciparum malaria, having replaced IV quinine due to lower mortality.
- Amoebic liver abscess is treated with metronidazole followed by a luminal amoebicide such as diloxanide furoate to eradicate cysts.
- Voriconazole is the drug of choice for invasive aspergillosis, while echinocandins are first-line for candidaemia but do not treat CNS infection.
- G6PD status must be checked before dapsone or primaquine because of the haemolysis and methaemoglobinaemia risk.
- NNRTIs have a low genetic barrier to resistance, so a single K103N mutation confers high-level resistance to efavirenz and nevirapine.
- Immune reconstitution inflammatory syndrome causes paradoxical worsening of an opportunistic infection within 4 to 8 weeks of starting antiretroviral therapy.
Mapped competency codes
- PH1.42
- PH1.43
- PH1.44
- PH1.45
- PH1.46
- PH1.47
- PH1.48
Continue into the full chapter
This summary maps to PH11-antimicrobials-and-chemotherapy.
Frequently Asked Questions
Which organisms are not covered by most cephalosporins?
The LAME organisms: Listeria, atypicals, MRSA, and enterococci; only fifth-generation cephalosporins cover MRSA.
What is the drug of choice for severe falciparum malaria?
Intravenous artesunate, which replaced IV quinine because it lowers mortality.
Why is pyridoxine given with isoniazid?
To prevent isoniazid-induced peripheral neuropathy, and it also treats INH-overdose seizures refractory to benzodiazepines.
What is the current WHO regimen for MDR-TB?
The all-oral 6-month BPaLM regimen: bedaquiline, pretomanid, linezolid, and moxifloxacin.
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