24 Questions
What is a specific indication for the use of Amidinopenicillins?
Urinary Tract Infections (UTI)
Which bacterium is not affected by Cephalosporins?
Enterococci
Which adverse reaction to antibiotics can cause fever, myalgias, and flushing?
Herxheimer reaction
Which Cephalosporin is effective against Pseudomonas?
Ceftazidime
What is a common adverse reaction to Amoxicillin-Clavulanic acid?
Cholestatic jaundice
Which generation of Cephalosporins includes Ceftriaxone?
3rd generation
What is Cefazolin IV commonly used for?
Surgical prophylaxis
Which of the following is a side effect of prolonged treatment with Ceftriaxone?
Biliary sludge
What percentage of patients that developed an allergic reaction to a Penicillin are also allergic to Cephalosporins?
10%
What is Cefuroxime IV/PO commonly used for?
Meningitis and respiratory infections
What is Cephalexin commonly used for?
Urinary infections in penicillin-allergic patients
Which of the following is a contraindication for Cephalosporins?
Penicillin allergy
What is Ceftriaxone commonly used for?
Severe intraabdominal and urinary infections
Which generation of Cephalosporins includes Cefepime?
4th generation
What is a common indication for the use of Carbapenems?
Severe ESBL-producing GNB infections
Which of the following is NOT a mechanism of action of Carbapenems?
Binds to PBP3
What is a common adverse reaction of Carbapenems?
Nausea, vomiting, diarrhea
Which of the following is a Cephalosporin + Beta-lactamase inhibitor combination?
Ceftazidime + Avibactam
What is the mechanism of action of Monobactams?
Binds to PBP3
Which of the following is a Glycopeptide?
Teicoplanin
What is the mechanism of action of Glycopeptides?
Binds to cell wall peptides
Which of the following is an indication for the use of Aztreonam?
Inhalations in patients with bronchiectases colonized by Pseudomonas aeruginosa
What is the spectrum of activity of Carbapenems?
Ultralarge spectrum, active against most Gram-positive and Gram-negative bacteria
What is a common adverse reaction of Imipenem and Ertapenem?
Seizures
Study Notes
Cephalosporins
- Cephalosporins are classified into five generations: 1st, 2nd, 3rd, 4th, and 5th.
- Each generation has its specific spectrum and indications.
- Examples of cephalosporins include Cefazolin, Cephalexin, Cefadroxil, Cefuroxime, Ceftriaxone, and Ceftobiprole.
Indications
- Cephalosporins are used for surgical prophylaxis, intraabdominal infections, urinary infections, respiratory infections, and meningitis.
- 1st generation cephalosporins are used for surgical prophylaxis and ENT infections.
- 2nd generation cephalosporins are used for intraabdominal infections and urinary infections.
- 3rd generation cephalosporins are used for meningitis, respiratory infections, and urinary infections.
- 4th generation cephalosporins are used for severe intraabdominal infections, CNS infections, and urinary infections.
- 5th generation cephalosporins are used for community-acquired pneumonia and severe MRSA infections.
Adverse Reactions
- Cephalosporins have similar adverse reactions to penicillins.
- High risk of C. difficile infection.
- Biliary sludge can occur with prolonged treatment with ceftriaxone.
- Only 10% of patients with a penicillin allergy are also allergic to cephalosporins.
Penicillins
- Adverse reactions include hypersensitivity, seizures, tubulointerstitial nephritis, cholestatic jaundice, and Herxheimer reaction.
- Herxheimer reaction occurs within the first 2 hours of antibiotic therapy and resolves after 24-36 hours.
Cephalosporins - Black Sheep
- Enterococci, Listeria, Clostridioides difficile, and atypical bacteria are not covered by cephalosporins.
- MRSA is not covered by cephalosporins except for the 5th generation.
Carbapenems
- Representatives include Imipenem, Meropenem, Ertapenem, and Doripenem.
- Ultralarge spectrum, but do not cover MRSA, Ampicillin-Resistant Enterococci, Cl. difficile, and Stenotrophomonas maltophilia.
- Indications include severe ESBL-producing GNB infections, hospital-acquired infections, and empirical treatment of febrile neutropenia and immunocompromised patients.
- Adverse reactions include seizures, nausea, vomiting, diarrhea, hepatic cytolysis, and C. difficile infection.
Beta-Lactam + Beta-Lactamase Inhibitor
- Representatives include Amoxicillin + Clavulanic acid, Ceftolozane + Tazobactam, and Ceftazidime + Avibactam.
- Indications include ABP, UTI, ENT and respiratory infections, and intraabdominal infections with KPC/OXA-48-producing bacteria.
Monobactams
- Representative: Aztreonam.
- Mechanism of action: binds to PBP3.
- Spectrum: MDR GNB (even MBL-producing bacteria).
- Indications: severe infections with MDR GNB sensitive to Aztreonam and inhalations in patients with bronchiectases colonized by Pseudomonas aeruginosa.
Glycopeptides
- Representatives: Vancomycin and Teicoplanin.
- Mechanism of action: binds to cell wall peptides D-ala termination preventing their cross-linking into the peptidoglycan form.
- FDA pregnancy category: B for Vancomycin PO and C for Vancomycin IV.
This quiz covers the different generations of cephalosporins, their indications, and administration routes. Learn about the various types of cephalosporins and their uses.
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