Beta Lactam Antibiotics pt 1 (penicillins) Flashcards
MOA of Beta Lactam antibiotics
interferes with bacterial cell wall synthesis during active multiplication causing death and resultant bactericidal activity against susceptible bacteria
what type of killing do beta lactam antibiotics exhibit?
time dependent killing
natural penicillins
Penicillin G
penicillin VK
penicillin benzathine/procaine
route of administration of
penicillin G
penicillin VK
penicillin bezathine/procaine
Pen G - IV
VK - oral
benzathine/procaine - IM
spectrum of activity for natural penicillins
most streptococci infections
mouth anaerobes (peprostreptococcus, prevotella, fusobacterium)
syphillis
avoid using natural penicillins when
strep pneumo
enterococcus
pharmacokinetics of natural penicillins
renally eliminated, wide distribution
ADR’s of natural penicillins
rash
anaphylaxis
fever
sometimes seizures due to renal insufficiency and
GI UPSET
what are some aminopenicillin names and RoA’s
ampicillin (IV/PO)
amoxicillin (PO only)
main uses of aminopenicillins (ampicillin and amoxicillin)
gram positive activity (step, mouth anaerobes)
ENTEROCOCCUS
STREP PNEUMO
gram negative: H. influenza, E. coli, proteus, salmonella, shigella
avoid using ampicillin and amoxicillin in which type of infections?
staph infections
do ampicillin and amoxicillin need to be dose adjusted?
yes, renally eliminated
where do aminopenicillins have good penetration?
sinusitis, lung, ear
useful for UTI’s
ampicillin and amoxicillin are drug of choice for which infections
listeria infections
enterococcus infections (only if susceptible)
ADRs of aminopenicillins (amoxicillin and ampicillin)
rash/allergic reactions
fever
seizures (secondary to renal insufficiency)
what are some aminopenicillin- beta lactamase inhibitor combinations? what are the ROA’s of them?
ampicillin + sulbactam (IV)
amoxicillin + clavulanate (PO)
main uses for the aminopenicillin-BLI combo
gram positive ADDS MSSA
gram negative (sulbactam adds acinetobacter)
gut anaerobes: adds bacreroides fragilis (because of BLI)
ADR of PCN-BLI combos
rash/allergic reactions
fever
seizures (due to renal insufficiency)
augmenten (amoxclav) increases GI side effects (diarrhea)
how to lessen GI side effects of some PCN’s
take with food
clinical pearls of amox-clav and amp-sul
treat infections caused by animal bites
more stable agains gram -
what are the antipseudomonal penicillins and there RoA?
piperacillin
spectrum of activity of piperacillin
gram positive
gram negative aeroSPACE
serratia
pseudomonas
acinetobacter
citrovacter
enterobacter/klebsiella aerogenes
avoid using piperacillin/antipseudomonal PCN in what?
staphylococcal infections
ADR of piperacillin
rash
SJS
C. difficile associated diarrhea
fluid adjustment (lots of sodium)
interstitial nephritis (check renal function)
clinical pearls of piperacillin/antipseudomonal penicillins
only available as BLI combos
antipseudomonal-BLI combinations and RoA
piperacillin + tazobactam
main uses of piperacillin-tazobactam
gram positive - streptococcus and enterococcus
gram negative - aeroSPACE (serratia, pseudomonas, acinetobacter citrobacter, enterobacter)
gut anaerobe - bacteroides fragilis
ADR piperacillin-tazobactam
rash
SJS
CDAD (c. dif associated diarrhea)
fever
interstitial nephritis (check renal function periodically)
piperacillin - tazobactam is used for which hospital/healthcare associated infections?
MDR gram negative organisms
- febrile neutropenia
- SIRS/sepsis
- pneumonia (VAP/HAP/healthcare associated)
- UTI
- kidney infections
- intra-abdominal infections
anti-staph PCN’s and their RoA’s
nafcillin (IV)
oxacillin (IV)
dicloxacillin (oral)
main uses of anti-staphylococcal PCN’s
MSSA
group A strep
which PCN is okay with renal problems?
oxacillin - adjust at CrCl <10
nafcillin - hepatically eliminated
ADR of anti-staph PCN’s
rash
allergic reactions
fever
interstitial nephritis
which PCN is generally limited to skin infections?
dicloxacillin
which anti-staph PCN’s are preferred for systemic infections?
nafcillin and oxacillin
which PCN’s treat systemic infections of bacteremia, endocarditis, osteomyelitis?
nafcillin and oxacillin
