CLASSES OF ABX: PENICILLINS Flashcards
Narrow spectrum penicillins
(Beta-lactamase sensitive)
- Benzylpenicillin (Penicillin G),
- Phenoxymethylpenicillin (Penicillin V)
Benzylpenicillin (Penicillin G)
o Not gastric stable
o Parenteral use only
Phenoxymethylpenicillin (Penicillin V)
o Gastric acid stable
o Suitable for oral administration
Broad-spectrum penicillins
(but inactivated by beta-lactamases)
- Amoxicillin, Ampicillin
o Co-amoxiclav – beta-lactamase resistance
Penicillinase-resistant penicillins
Flucloxacillin
Flucloxacillin counselling points
To be taken on an empty stomach. An hour before food or 2hrs after food.
Flucloxacillin: cholestatic jaundice and hepatitis
may occur very rarely
o Up to 2 months after treatment with flucloxacillin has been stopped
o Administration for more than 2 weeks nad increasing age are risk factors
Antipseudomonal penicillin
HOSPITAL
* Piperacillin only available in combination with beta-lactamase inhibitor tazobactam
* Ticarcillin only available in combination with beta-lactamase clavulanic acid
MOA
- Penicillins are bactericidal beta-lactam antibiotics that inhibit bacterial cell wall synthesis by inhibiting peptidoglycan cross-linking.
- They diffuse well into body tissues and fluids, but penetration into the cerebrospinal fluid is poor except when the meninges are inflamed.
Activity against
Gram +
some Gram - cocci
Indications
- Oral infections
- Otitis media
- Cellulitis
- Respiratory tract infections
- Pneumonia.
Side effects
- Hypersensitivity (1-10% of exposed individuals)
- Anaphylaxis (<0.05%)
- Penicillin allergy
- Diarrhoea (with broad spectrum)
- CNS toxicity
- Hepatic disorders may occur rarely with flucloxacillin.
- Maculopapular rashes commonly occur in patients with glandular fever
Penicillin allergy (true allergy)
o True allergy = immediate rash –> anaphylaxis
May not be an allergy
minor rash, small, not itchy and non-confluent
or rash after 72 hours
Patients allergic to one penicillin may be allergic to all
o hypersensitivity can be related to the basic penicillin structure
o caution should be used in severe allergy with cephalosporins and other beta-lactam antibiotics.