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An Antibiotics and Antifungals Review > Beta Lactams > Flashcards

Beta Lactams Flashcards

1
Q

What 4 families of antibiotics are classified as Beta Lactams and what is their mechanism of action?

A

Penicillin, Cephalosporin, Carbapenem, Monobactam

MOA: bind PBPs (penicillin-binding proteins) and prevent crosslinking of bacterial cell wall

Bactericidal

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2
Q

What are 4 common side-effects of Beta Lactams use?

A
  • hypersensitivities (anaphylaxis)
  • myelosuppression
  • rashes
  • GI symptoms (nausea, vomiting, C. diff)
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3
Q

Why are beta lactams poor candidates for deep-seated or serious infections?

Which antibiotic in this group has the most bioavailability?

A

poor bioavailability and low serum concentrations

Amoxicillin has best bioavailability

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4
Q

What 4 organisms do beta lactams not have coverage against?

A
  • MRSA (except Ceftaroline)
  • atypical intracellular organisms: Legionella, Mycoplasma, Chlamydia
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5
Q

What kind of killing do beta lactams have?

A

TIME-dependent killing

  • efficacy depends on amount of time concentration is above the MIC
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6
Q

What is the only beta lactam antibiotic that has coverage against MRSA?

A

Ceftaroline

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7
Q

Among patients with penicillin allergy, what percentage of them can tolerate treatment with penicillins?

A

85-90%

  • either never truly allergic or resolution of remote prior allergy
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8
Q

What are the oral and IV forms of penicillin?

A

Oral = Penicillin V
IV = Penicillin G

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9
Q

What 5 organisms does Penicillin typically have coverage against?

A
  • Streptococcus (MAJORITY; Group A universally sensitive)
  • Staphylococcus (minority - most resistant)
  • Enterococcus (some)
  • Oral anaerobes (most)
  • Syphilis (universally sensitive)
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10
Q

What are the oral and IV forms of aminopenicillin?

A

Oral = Amoxicillin
IV = Ampicillin

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11
Q

What organisms do aminopenicillins typically cover?

What 3 Gram - organisms do aminopenicillins NOT cover?

A

some Gram + (strep, enterococcus, listeria) but NOT MSSA

  • limited Gram - coverage (no Klebsiella, Moraxella, SPICE-A)
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12
Q

What antibiotics are preferred for enterococcal infections if susceptible?

A

AMINOPENICILLINS

  • add aminoglycosides for synergy with enterococcal endocarditis
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13
Q

What are the 4 common anti-staphylococcal penicillins? Which one is PO?

What are these antibiotics the first-line treatment for?

A

IV = Methicillin, Nafcillin, Oxacillin
Oral = Dicloxacillin

  • first-line treatment for MSSA
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14
Q

When is Dicloxacillin a better choice then its IV counterparts?

A

for non-severe MSSA cellulitis

  • all other MSSA infections (bacteremia, osteomyelitis, sepsis) should be treated with IV antibiotics
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15
Q

Which IV penicillin is better tolerated: Nafcillin or Oxacillin?

A

Nafcillin

  • less rash and hepatitis occurance
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16
Q

What are the two main anti-pseudomonas penicillins?

A

Piperacillin and Ticarcillin

  • typically given with beta-lactamase inhibitors for broader coverage
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17
Q

What 4 organisms do beta lactamase inhibitors help provide additional coverage against?

A
  • MSSA
  • H. influenza
  • Moraxella
  • virtually all anaerobes
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18
Q

What are the 4 most common configurations of Penicillin/Beta-Lactamase inhibitors?

How are they administered: IV or Oral?

A
  1. Amoxicillin/Clavulanate - PO
  2. Ampicillin/Sulbactam - IV
  3. Piperacillin/Tazobactam - IV
  4. Ticarcillin/Clavulanate - IV
19
Q

What are the brand names for the 4 common Penicillin/Beta-Lactamase inhibitors?

A
  1. Augmentin - Amox/Clav
  2. Unasyn - Amp/Sulbactam
  3. Zosyn - Pip/Tazo
  4. Timentin - Ticar/Clav
20
Q

What two organisms does Augmentin NOT have coverage over?

A

Pseudomonas and SPICE-A organisms

21
Q

What additional organism does Unasyn cover for that Augmentin does not?

A

Acinetobacter

  • no activity against other SPICE organisms or pseudomonas
22
Q

What coverage does Zosyn have that Augmentin and Unasyn do not?

A

Covers pseudomonas AND SPICE-A organisms

23
Q

What 5 groups of organisms does Zosyn NOT cover?

A
  1. MRSA
  2. VRE (vancomycin-resistant enterococcus)
  3. coag-negative Staphylococcus
  4. Atypicals (Legionella, Mycoplasma, Chlamydia)
  5. ESBLs (extended-spectrum beta lactamase)
24
Q

What is the only cephalosporin that covers enterococcus?

A

Ceftaroline (5th Generation)

  • no other cephalosporins cover enterococcus
25
Q

What are the only 2 cephalosporins that cover Pseudomonas infections?

A

Ceftazidime (3rd Generation)
Cefepime (4th Generation)

26
Q

What are the only 2 cephalosporins with good anaerobe coverage?

A

Cefoxitin (2nd Generation)
Cefotetan (2nd Generation)

27
Q

What are the two most commonly used 1st Generation cephalosporin?

Which is oral and IV?

A

Oral = Cephalexin
IV = Cefazolin

28
Q

What are the brand names for Cefazolin and Cephalexin?

A

Cefazolin = ANCEF, Kefzol
Cephalexin = KEFLEX

29
Q

What 5 organisms do 1st Generation cephalosporins (Cefazolin/Cephalexin) cover?

A
  1. MSSA
  2. Streptococcus
  3. Proteus
  4. Klebsiella
  5. E. coli

Gram + more than Gram -

  • typically used for non-purulent cellulitis
30
Q

Which 1st Generation cephalosporin is used for surgery prophylaxis and which is used for PCN-allergic patients?

A

Cefazolin for both

31
Q

What is the most common 2nd Generation cephalosporin and how is it typically administered?

A

Cefuroxime (both oral and IV)

32
Q

What coverage does Cefuroxime have and what additional organisms is it good against vs 1st Generation?

A

Gram + > Gram - (better Gram - coverage than 1st Generation)

  • covers: H. influenza, Enterobacter, Neisseria
33
Q

What are 4 common uses for Cefuroxime?

A
  1. respiratory infections (upper and lower)
  2. gonorrhea
  3. UTIs
  4. Lyme Dz (doxycycline alternate)
34
Q

What are the two “Cefomycins” of the 2nd Generation cephalosporins?

A

Cefoxitin
Cefotetan

  • covers anaerobes and Gram - organisms, but no Pseudomonas or Gram +
35
Q

What are the 3 most common 3rd Generation cephalosporins?

Which are IV vs oral administation?

A

Ceftriaxone (Rocephin) - IV
Cefotaxime - IV
Cefpodoxime - PO

36
Q

What coverage do 3rd Generation cephalosporins have?

What 2 organisms does this class NOT cover?

A

Good Gram +, excellent Gram - (E.coli, Proteus, Klebsiella, H.flu, Neisseria, SPACE-A)

  • does NOT cover Pseudomonas or anaerobes
37
Q

What two hepatic conditions can Ceftriaxone cause?

A

Biliary sludging and cholecystitis

38
Q

What makes Ceftazidime different from other 3rd Generation cephalosporins?

A

ONLY Gram - coverage, including Pseudomonas

  • virtually no Gram + or anaerobe coverage
39
Q

What is the common 4th Generation cephalosporin and what coverage does it have?

A

Cefepime - IV

  • broad Gram + (MSSA, strep) and Gram - (pseudomonas) but WEAK anaerobe coverage
  • empiric neutropenic fever (better than Ceftazidime)
40
Q

What is the common 5th Generation cephalosporin and what coverage does it have?

What are its only two FDA indications?

A

Ceftaroline - IV

  • covers MRSA, VISA, VRSA, Strep; similar Gram - coverage as Ceftriaxone (no pseudomonas, ESBL)

FDA: complicated SSTI and community-acquired PNA

41
Q

What are 4 common Carbapenems and what is their coverage?

A

Imipenem, Ertapenem, Meropenem, Doripenem - IV

  • BROADEST SPECTRUM Abx (Gram +, Gram -, pseudomonas, ESBL, anaerobes)
42
Q

What 3 organisms does Ertapenem not cover that other carbapenems do cover?

A

does not cover Pseudomonas, Acinetobacter, and Enterococci

43
Q

What coverage does the monobactam Aztreonam have?

A

Aerobic Gram - organisms

44
Q

What is the difference in coverage between these 3 broad-spectrum antibiotics:

Carbapenems, Zosyn, Cefepime

A

Carbapenem (broadest coverage) > Zosyn (no ESBL) > Cefepime (weak anaerobe/no enterococcus)

An Antibiotics and Antifungals Review (16 decks)

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