Cell Wall antibiotics

Question 0

Penicillins - narrow spectrum

Penase-resistant

Answer 0

Nafcillin, oxacillin, dicloxacillin

• Use: Making it penase-resistant made uses too narrow. Staph Aureus.
• PK: Rapid renal elim. Short 1/2 life. *some biliary clearance
• Tox: hypersens., GI distress

Question 1

Penicillins - narrow spectrum

Penase-sensitive

Answer 1

Pencillin G, Pencillin V.

• Use: Gram (+)s mostly. Streptococcal, meningococcal, syphillis
• PK: rapid renal elim. short 1/2 life (need freq. dosing).
• Tox: hypersensitivity rxn. GI distress.

Question 2

Penicillin - wider spectrum

Penase-Sensitive

Answer 2

Ampicillin, Amoxicillin (the work horses of penicillins).

• Changed solubility of PCN so we could get through gram(-) porins. So these target gram (-)s as well.
• PK: give w/clavulanic acid to protect against beta-lactamases.
• Tox: Same as PCN; ampicillin can give maculopapular rash.

Question 3

Penicillin - wide spectrum

Penase - sensitive

Answer 3

Piperacillin, ticarcillin

-Use: Pseudomonas and gram (-) rods.

Question 4

Cephalosporins - 1st gen

Answer 4

Cephalexin, cefazolin

-Use: gram (+) cocci. Cefazolin used prior to surgery to prevent S. aureus wound infection.

Question 5

Cephalosporins - 2nd gen

Answer 5

Cefoxitin, cefaclor, cefuroxime (this one = first to cross BBB).

• Use: targets more gram (-) than first gen. S. pneumoniae, H. influenzae, B. fragilis.
• PK: short 1/2 lives

Question 6

Cephalosporins - 3rd gen

Answer 6

Ceftriaxone, cefotaxime, ceftazidime

• Use: VERY broad spectrum - used in sepsis and meningitis. Used for serious gram (-) infections. Meningitis, gonorrhea, pseudomonas (ceftazidime).
• cross BBB

Question 7

Cephalosporins: 4th gen

Answer 7

Cefipime

Use: inc. activity against gram (+) and pseudomonas

Question 8

Cephalosporins: 5th gen

Answer 8

Ceftaroline
Use: broad gram (+) and (-). including MRSA!
*does NOT cover pseudomonas.

Question 9

Carbapenems

Answer 9

Imipenem (w/cisplatin), doripenem, meropenem, ertapenem.

• Use: broad spectrum, b-lactamase resistant. Used for severe nosocomial infections. Most potent lactams!
• PK: IV
• Tox: partial cross-reactivity w/PNC. Seizures and confusion.

Question 10

Aztreonam: a monobactam

Answer 10

• Use: gram (-) rods ONLY. klebsiella, pseudomonas, serratia, etc.
• PK: parenteral, renal elim.
• Tox: NO cross-reactivity w/beta-lactams!

Question 11

Glycopeptides

Answer 11

Vancomycin: NOT a lactam

• Use: gram (+) including MRSA and PRSP, oral dose for C.Dif
• Tox: red man syndrome (type 1 hyper). Ototoxicity. Nephrotox. Thromboplebitis.