Cell wall inhibitors- Penicillins

Question 1

Benzyl penicillin Forms

Answer 1

• penicillin G IV/IM

- penicillin V PO

Question 2

Benzyl penicillin Coverage

Answer 2

GP except Staphylococcus
Enterococcus
N. meningitidis
Oral anaerobes
Syphilis

Question 3

Benzyl penicillin MOA

Answer 3

Bactericidal: β-lactam inhibits cell wall synthesis by binding penicillin binding protein (PBP) preventing cross-linking of peptidoglycan

Question 4

Benzyl penicillin Adverse Effects

Answer 4

Immediate allergy (IgE): anaphylaxis, urticaria
Late-onset allergy (IgG): urticaria, rash, serum sickness Interstitial nephritis
Dose related toxicity: seizures
Diarrhea

Question 5

Benzyl penicillin Indications

Answer 5

Mild to moderately severe infections caused by susceptible organisms including:
actinomycosis
streptococcal pharyngitis
streptococcal skin and soft tissue infections
pneumococcal pneumonia
syphilis

Question 6

Benzyl penicillin Contraindicaions

Answer 6

Hypersensitivity to penicillin cov?

Question 7

Aminopenicillin Forms

Answer 7

• ampicillin IV
• amoxicillin PO (Amoxil®)

NOTE: Same adverse effects and MOA as benzyl penicillin

Question 8

Aminopenicillin Coverage

Answer 8

Same as penicillin AND
Enterococcus
Listeria
Some strains of:
H. influenzae
E. coli
K. pneumoniae

Question 9

Aminopenicillin Indications

Answer 9

Bacterial meningitis and endocarditis (IV ampicillin)
acute otitis media (AOM)
streptococcal pharyngitis
sinusitis
acute exacerbations of COPD
part of multidrug therapy for H. pylori treatment
Lyme disease
pneumococcal pneumonia
UTI (amoxicillin and ampicillin)
for most enterococci and susceptible Gram negative pathogens

Question 10

Aminopenicillin Contraindicatons

Answer 10

Hypersensitivity to penicillin or β-lactam antibiotics

Question 11

Isoxazyolyl penicillin Forms

Answer 11

• cloxacillin
• methicillin
• nafcillin
• oxacillin

NOTE: Same adverse effects and MOA

Question 12

Isoxazyolyl penicillin Coverage

Answer 12

Methicillin-sensitive Staphylococcus aureus;

streptococci

Question 13

Isoxazyolyl penicillin Indications

Answer 13

Bacterial infections caused by staphylococci and streptococci including skin and soft-tissue infections

Question 14

Isoxazyolyl penicillin Contraindications

Answer 14

Hypersensitivity to cloxacillin or any penicillin

Question 15

β-lactam/β-lactamase inhibitor combinations

Answer 15

• amoxicillin-clavulanate (Clavulin®, Augmentin®)
• piperacillin/tazobactam (Tazocin®)

NOTE: Same adverse effects

Question 16

β-lactam/β-lactamase inhibitor combinations Coverage

Answer 16

Same as penicillin AND
Staphylococcus
H. influenzae
Enterococcus
Anaerobes (oral and gut)

Question 17

β-lactam/β-lactamase inhibitor combinations MOA

Answer 17

β-lactamase produced by certain bacteria inactivate β-lactams. Lactamase inhibitors prevent this process, preserving antibacterial effect of β-lactams

Question 18

β-lactam/β-lactamase inhibitor combinations Indications

Answer 18

Various β-lactamase producing bacteria
Clavulin® sensitive bacteria including
   RTI
   sinusitis
   AOM
   skin and soft tissue infections
   UTI
   severe intra- abdominal and pelvic infections

Question 19

β-lactam/β-lactamase inhibitor combinations Contraindications

Answer 19

Hypersensitivity

to penicillin or cephalosporin History of Clavulin®- associated jaundice or hepatic dysfunction