C.10. Carbapenems. Monobactams.beta-lactamase inhibitors. pharmacotherapy of respiratory infections. Flashcards
are carbapenems and monobactams bacteriostatic or bacteriocidal?
bacteriocidal
what is Aztreonam?
a monobactam
what is the mechanism of monobactams?
binds PBP-3 found only in gram - bacteria
can not bind to gram + PBP
what is the spectrum and clinical use of Aztreonam?
narrow
gram - aerobes (klebsiella, pseudomonas, serratia)
gram - in patients with penicillin allergy
what is Aztreonam and carbapenems resistant to?
most beta-lactamases
carbapenems–> including ESBL
how is Aztreonam given?
parenteral
Aztreonam has a synergistic effect with…
aminoglycosides
*Usually used in patients that cant tolerate aminoglycosides due to renal insufficiency
can Aztreonam and carbapenems enter the CNS?
YES
Aztreonam mechanism or resistance
alteration of PBP
adverse effects of Aztreonam
- hypersensitivity reaction
- GI symptoms, maybe superinfection
- headache, vertigo
- hepatotoxicity (rare)
what is Ertapenem?
1st generation Carbapenem
what is Imipenem and Meropenem?
2nd generation Carbapenem
how are carbapenems given?
parenteral
which carbapenem has a cross allergy with penicillin?
meropenem
strains resistant to carbapenems
MRSA strains
Carbapenemase (MBL- metallo beta lactamase) in klebsiella. acinetobacter, pseudomonas., enterobacter
side effects of carbapenems
hypersensitivity reaction
GI symptoms
skin rash
Imipenem-CNS presentation at high plasma levels (seizures)
with what is Imipenem given?
Cilastatin
a renal dehydropeptidase inhibitor in the renal tubules. DHP inhibits imipenem’s metabolism, hence cilastatin prevents nephrotoxicity.
what is Vaborbactam and with what drug is it given?
β-lactamase inhibitor
given with Meropenem
Meropenem + Vaborbactam is used for the treatment of…
complicated UTI
pyelonephritis
abdominal infections caused by CRE
what is the treatment for acute sinusitis and otitis media?
Amoxicillin+ Clavulanate PO
what is the 1st line treatment of Strep throat (Group A streptococcal)?
Penicillin V PO or
Amoxicillin PO or
Cephalexin PO
what is the alternative treatment of Strep throat (Group A streptococcal)? in case of penicillin allergy..
Clindamycin PO or
Azithromycin PO
what is the 1st line treatment of community-acquired pneumonia (previously healthy, out-patient)?
Clarithromycin PO or
Azithromycin PO
what is the alternative treatment of community-acquired pneumonia (previously healthy, outpatient)?
Doxycycline PO
what is the 1st line treatment of community-acquired pneumonia (comorbidities, outpatient)?
Amoxicillin+ Clavulanate PO
what is the alternative treatment of community-acquired pneumonia (comorbidities, outpatient)?
Moxifloxacin PO or
Levofloxacin PO
what is the 1st line in-patient treatment of pneumonia?
β-lactam (Ceftriaxone IV, ampicillin IV)
and
Macrolide (clarithromycin PO)
what is the alternate in-patient treatment of pneumonia?
Moxifloxacin PO/IV or
Levofloxacin PO/IV
what is the 1st line ICU treatment of Pneumonia?
β-lactam (Ceftriaxone IV, ampicillin IV)
and
Fluoroquinolone (Moxifloxacin IV, Levofloxacin IV)
what is the 1st line treatment of aspiration Pneumonia?
Ceftriaxone IV and metronidazole PO/IV
what is the 2nd line treatment of aspiration Pneumonia?
Levofloxacin PO/IV and Metronidazole PO/IV
