Antibiotics in Pharyngitis and Rheumatic Fever Treatment

Study Notes

Administered orally, achieving lower levels than parenteral benzylpenicillin
Used primarily against Streptococcus pyogenes in the treatment of pharyngitis and the prevention of rheumatic fever
Often replaced by amoxycillin, which has more reliable oral absorption and is less dependent on an empty stomach

Isoxazolyl penicillins:
- Cloxacillin, Dicloxacillin, Flucloxacillin, and Oxacillin
- Used for infections caused by beta-lactamase-producing staphylococci, streptococci, and pneumococci
Others:
- Methicillin and Nafcillin
Isoxazolyl penicillins are suitable for mild to moderate localized staphylococcal infections
Flucloxacillin is equivalent to cloxacillin but has better oral absorption

Carboxypenicillins:
- Carbenicillin and Ticarcillin
Ureidopenicillins:
- Azlocillin, Mezlocillin, and Piperacillin
Piperacillin is effective against Pseudomonas and most Enterobacteriaceae
Carboxypenicillins and ureidopenicillins possess additional effects against Gram-negative organisms

B-Lactam antibiotics similar to penicillins
Broad-spectrum antibiotics acting by inhibition of cell wall synthesis
Bactericidal, but inactive against enterococci, MRSA, Legionella, Mycoplasma, and Chlamydia spp.
Widely used in surgical procedures to reduce the risk of post-operative infections

First Generation:
- Cephalexin, Cefazolin, Cephalothin, and Cephradine
- Active against Gram-positive cocci, but not enterococci and MRSA
- Indicated for streptococcal pharyngitis and used as prophylaxis in surgical procedures
Second Generation:
- Cefoxitin, Cefuroxime, Cefaclor, and Cefprozil
- Mainly effective against Gram-negative bacteria
- Cefoxitin active against bowel anaerobes, Cefuroxime active against H. influenzae, M. catarrhalis, and S. pneumoniae
Third Generation:
- Ceftriaxone, Cefotaxime, Ceftazidime, and Cefoperazone
- Enhanced Gram-negative activity, effective against H. influenzae, N. meningitidis, N. gonorrhoeae, and P. aeruginosae
- Ceftriaxone has a long half-life and is not advised in neonates
Fourth Generation:
- Cefipime
- Active against Gram-positive bacteria, with enhanced activity against Pseudomonas

Hypersensitivity reactions (anaphylaxis, bronchospasm, urticaria)
Nephrotoxicity (especially with Cephradine)
Thrombophlebitis (with i.v. administration)
Superinfections
Diarrhea (with oral cephalosporins, Cefoperazone, and Ceftriaxone)
Cefamandole, Moxalactam, and Cefoperazone may cause bleeding disorders and interactions with alcohol intake