Exploring Beta-Lactam Antibiotics

Beta-lactam ring

Inhibiting bacterial cell wall synthesis by binding to penicillin-binding proteins (PBPs)

Gram-positive cocci, including Streptococci and Enterococci, and Gram-positive anaerobes typically found in mouth flora

<p>Enhanced efficacy, showing added activity against MSSA, more resistant strains of Gram-negative bacteria (HNPEK), and Gram-negative anaerobes like B. fragilis</p> Signup and view all the answers

<p>Extended-spectrum penicillins, especially when combined with a beta-lactamase inhibitor such as piperacillin/tazobactam, exhibit a broad-spectrum activity. They are effective against the same organisms as aminopenicillin/beta-lactamase inhibitor combinations, as well as more resistant strains of HNPEK, Gram-negative anaerobes (B. fragilis), and other Gram-negative bacteria including Citrobacter, Acinetobacter, Providencia, Enterobacter, and Serratia, which are grouped as CAPES, in addition to Pseudomonas aeruginosa.</p> Signup and view all the answers

<p>Antistaphylococcal penicillins are primarily effective against Streptococci and methicillin-susceptible Staphylococcus aureus (MSSA). However, they do not have activity against Enterococcus, Gram-negative pathogens, and anaerobes.</p> Signup and view all the answers

<p>Natural Penicillins: Penicillin V Potassium (Pen VK): Oral dosing is 125-500 mg every 6-12 hours on an empty stomach. Penicillin G Aqueous (Pfizerpen-G): Administered intravenously at 2-4 million units every 4-6 hours.</p> Signup and view all the answers

<p>Administered intramuscularly at 2.4 million units as a single dose.</p> Signup and view all the answers

<p>The dosing frequency for the extended-release tablet varies, but it is taken once daily. It also comes in chewable tablet form.</p> Signup and view all the answers

<p>Administered intravenously at 1.5-3 grams every 6 hours.</p> Signup and view all the answers

<p>Dosed at 3.375 grams every 6 hours or 4.5 grams every 6-8 hours. Prolonged or extended infusions with doses infused over 4 hours.</p> Signup and view all the answers

<p>Contraindications for Augmentin and Unasyn are related to a history of cholestatic jaundice or hepatic dysfunction.</p> Signup and view all the answers

<p>Main side effects include seizures (with accumulation), gastrointestinal upset, diarrhea, rashes (including SJS/TEN). Other side effects include allergic reactions, hemolytic anemia, renal failure, and myelosuppression with prolonged use.</p> Signup and view all the answers

<p>KEY FEATURES OF PENICILLINS CLASS EFFECTS: All penicillins should be avoided in patients with a beta-lactam allergy (exception: pregnant patients with syphilis). All penicillins increase the risk of seizures if accumulation occurs (e.g., with renal failure).</p> Signup and view all the answers

<p>Penicillin VK is a first-line treatment for strep throat and mild nonpurulent skin infections (no abscess).</p> Signup and view all the answers

<p>Penicillin G Benzathine (Bicillin L-A) is the drug of choice for syphilis treatment (2.4 million units IM x1). Not for IV use; can cause death.</p> Signup and view all the answers

<p>Piperacillin/Tazobactam (Zosyn) is the only penicillin active against Pseudomonas.</p> Signup and view all the answers

<p>Natural penicillins are active against Gram-positive cocci, including Streptococci and Enterococci, as well as Gram-positive anaerobes found in mouth flora.</p> Signup and view all the answers

<p>Aminopenicillins have a broader range of activity that includes Streptococci, Enterococci, Gram-positive anaerobes, and certain Gram-negative bacteria such as Haemophilus, Neisseria, Proteus, E. coli, and Klebsiella (HNPEK). When combined with beta-lactamase inhibitors, their efficacy is enhanced, showing added activity against MSSA, more resistant strains of Gram-negative bacteria (HNPEK), and Gram-negative anaerobes like B. fragilis.</p> Signup and view all the answers

<p>Beta-lactam antibiotics inhibit bacterial cell wall synthesis by binding to penicillin-binding proteins (PBPs), preventing the final step of peptidoglycan synthesis in bacterial cell walls.</p> Signup and view all the answers

<p>Natural penicillins show little to no activity against MRSA, atypical organisms, Staphylococci, and Gram-negative bacteria. Aminopenicillins, when combined with beta-lactamase inhibitors, target MSSA, more resistant strains of Gram-negative bacteria (HNPEK), and Gram-negative anaerobes like B. fragilis.</p> Signup and view all the answers

<p>2-4 million units every 4-6 hours</p> Signup and view all the answers

<p>History of cholestatic jaundice or hepatic dysfunction</p> Signup and view all the answers

<p>Streptococci and methicillin-susceptible Staphylococcus aureus (MSSA)</p> Signup and view all the answers

<p>1-2 grams every 4-6 hours</p> Signup and view all the answers

<p>It is not for intravenous use due to risks of cardiorespiratory arrest and death</p> Signup and view all the answers

<p>Seizures (with accumulation), gastrointestinal upset, diarrhea, rashes (including SJS/TEN), allergic reactions, hemolytic anemia, renal failure, myelosuppression</p> Signup and view all the answers

<p>125-500 mg every 6-12 hours on an empty stomach</p> Signup and view all the answers

<p>HNPEK, Gram-negative anaerobes (B. fragilis), CAPES bacteria (Citrobacter, Acinetobacter, Providencia, Enterobacter, Serratia), Pseudomonas aeruginosa</p> Signup and view all the answers

<p>Specific dosing instructions</p> Signup and view all the answers

<p>MSSA soft tissue, bone and joint, endocarditis, and bloodstream infections</p> Signup and view all the answers

<p>It is a vesicant, and administration through a central line is preferred</p> Signup and view all the answers

<p>1.5-3 grams every 6 hours</p> Signup and view all the answers

<p>Beta-lactam antibiotics inhibit bacterial cell wall synthesis by binding to penicillin-binding proteins (PBPs), preventing the final step of peptidoglycan synthesis in bacterial cell walls.</p> Signup and view all the answers

<p>The main targets of antistaphylococcal penicillins are Staphylococci, including MSSA (Methicillin-Sensitive Staphylococcus aureus) and more resistant strains of Staphylococci.</p> Signup and view all the answers

<p>Natural penicillins show little to no activity against MRSA, atypical organisms, Staphylococci, and Gram-negative bacteria. Aminopenicillins, when combined with beta-lactamase inhibitors, target additional bacterial strains such as Haemophilus, Neisseria, Proteus, E. coli, and Klebsiella.</p> Signup and view all the answers

<p>When aminopenicillins are combined with beta-lactamase inhibitors like clavulanate, sulbactam, and tazobactam, their efficacy is enhanced, showing added activity against MSSA and more resistant strains of Gram-negative bacteria, as well as Gram-negative anaerobes like B. fragilis.</p> Signup and view all the answers

<p>Dicloxacillin</p> Signup and view all the answers

<p>2-4 million units every 4-6 hours</p> Signup and view all the answers

<p>125-500 mg every 6-12 hours on an empty stomach</p> Signup and view all the answers

<p>3.375 grams every 6 hours or 4.5 grams every 6-8 hours</p> Signup and view all the answers

<p>1.5-3 grams every 6 hours</p> Signup and view all the answers

<p>Not for intravenous use due to risks of cardiorespiratory arrest and death</p> Signup and view all the answers

<p>Seizures (with accumulation), gastrointestinal upset, diarrhea, rashes (including SJS/TEN), allergic reactions, hemolytic anemia, renal failure, and myelosuppression</p> Signup and view all the answers

<p>First-line treatment for strep throat and mild nonpurulent skin infections (no abscess)</p> Signup and view all the answers

<p>Piperacillin/Tazobactam (Zosyn)</p> Signup and view all the answers

<p>Penicillin G Benzathine (Bicillin L-A)</p> Signup and view all the answers

<p>A history of cholestatic jaundice or hepatic dysfunction</p> Signup and view all the answers

<p>Streptococci and methicillin-susceptible Staphylococcus aureus (MSSA)</p> Signup and view all the answers

<p>First generation</p> Signup and view all the answers

<p>Coverage for Staphylococci, more resistant strains of S. pneumoniae, Haemophilus, Neisseria, Proteus, E. coli, Klebsiella, and added coverage against Gram-negative anaerobes like B. fragilis</p> Signup and view all the answers

<p>Group 1: effective against more resistant Streptococci, Staphylococci, Gram-positive anaerobes, and more resistant strains of HNPEK. Group 2: coverage for Pseudomonas but lacks Gram-positive activity</p> Signup and view all the answers

<p>Enterococcus spp. or atypical organisms</p> Signup and view all the answers

<p>ceftazidime/avibactam and ceftolozane/tazobactam</p> Signup and view all the answers

<p>fourth generation</p> Signup and view all the answers

<p>ceftaroline</p> Signup and view all the answers

<p>It is the only beta-lactam antibiotic that is effective against MRSA</p> Signup and view all the answers

<p>Concurrent use with calcium-containing IV products in neonates &lt; 28 days old</p> Signup and view all the answers

<p>↑ the risk of bleeding and cause a disulfiram-like reaction with alcohol ingestion</p> Signup and view all the answers

<p>Cefotetan</p> Signup and view all the answers

<p>surgical prophylaxis and skin infections (MSSA), strep throat, respectively</p> Signup and view all the answers

<p>Ceftazidime/Avibactam and Ceftolozane/Tazobactam</p> Signup and view all the answers

<p>CAP, meningitis, spontaneous bacterial peritonitis, pyelonephritis</p> Signup and view all the answers

<p>Concurrent use with calcium-containing IV products in neonates &lt; 28 days old</p> Signup and view all the answers

<p>It is the only beta-lactam active against MRSA</p> Signup and view all the answers

<p>Second generation</p> Signup and view all the answers

<p>More resistant Streptococci (including S. pneumoniae and viridans group Streptococci), Staphylococci (MSSA), Gram-positive anaerobes (mouth flora), and more resistant strains of HNPEK</p> Signup and view all the answers

<p>Coverage for Pseudomonas but lacks Gram-positive activity</p> Signup and view all the answers

<p>Streptococci, Staphylococci, Proteus, E. coli, and Klebsiella (PEK)</p> Signup and view all the answers

<p>ceftazidime/avibactam and ceftolozane/tazobactam</p> Signup and view all the answers

<p>cefepime</p> Signup and view all the answers

<p>ceftaroline</p> Signup and view all the answers

<p>ceftaroline</p> Signup and view all the answers

<p>causes biliary sludging and kernicterus</p> Signup and view all the answers

<p>It contains a side chain which can increase the risk of bleeding and cause a disulfiram-like reaction with alcohol ingestion</p> Signup and view all the answers

<p>Seizures</p> Signup and view all the answers

<p>patients who have a swelling, angioedema, or anaphylaxis reaction</p> Signup and view all the answers

<p>Q6-8H</p> Signup and view all the answers

<p>Varies depending on the condition, typically 250-500 mg Q12H for uncomplicated infections</p> Signup and view all the answers

<p>surgical prophylaxis</p> Signup and view all the answers

<p>Cefotetan and Cefoxitin</p> Signup and view all the answers

<p>First generation cephalosporins have excellent coverage of Gram-positive cocci, such as Streptococci and Staphylococci, making them the preferred choice for MSSA infections.</p> Signup and view all the answers

<p>The second generation cephalosporins target Staphylococci and more resistant strains of S. pneumoniae, along with Haemophilus, Neisseria, Proteus, E. coli, and Klebsiella (HNPEK). Cefotetan and cefoxitin offer added coverage against Gram-negative anaerobes like B. fragilis.</p> Signup and view all the answers

<p>The third generation can be split into two groups: Group 1 targets more resistant Streptococci (including S. pneumoniae and viridans group Streptococci), Staphylococci (MSSA), Gram-positive anaerobes, and more resistant strains of HNPEK. Group 2 has coverage for Pseudomonas but lacks Gram-positive activity.</p> Signup and view all the answers

<p>Group 1 of the third generation cephalosporins targets more resistant Streptococci (including S. pneumoniae and viridans group Streptococci), Staphylococci (MSSA), Gram-positive anaerobes (mouth flora), and more resistant strains of HNPEK.</p> Signup and view all the answers

<p>ceftazidime/avibactam and ceftolozane/tazobactam</p> Signup and view all the answers

<p>4th Generation</p> Signup and view all the answers

<p>5th Generation</p> Signup and view all the answers

<p>hyperbilirubinemic neonates (causes biliary sludging, kernicterus); concurrent use with calcium-containing IV products in neonates &lt; 28 days old</p> Signup and view all the answers

<p>Cefotetan</p> Signup and view all the answers

<p>Ceftazidime/avibactam</p> Signup and view all the answers

<p>Ceftolozane/Tazobactam</p> Signup and view all the answers

<p>Ceftaroline</p> Signup and view all the answers

<p>skin infections (MSSA), strep throat</p> Signup and view all the answers

<p>acute otitis media, community-acquired pneumonia (CAP), sinus infection (if an antibiotic is indicated)</p> Signup and view all the answers

<p>CAP, sinus infection (if an antibiotic is indicated)</p> Signup and view all the answers

<p>surgical prophylaxis</p> Signup and view all the answers

<p>Carbapenems are very broad-spectrum antibiotics generally reserved for MDR Gram-negative infections, active against most Gram-positive, Gram-negative, and anaerobic pathogens but provide no coverage of atypical pathogens, MRSA, VRE, C. difficile, and Stenotrophomonas.</p> Signup and view all the answers

<p>The main safety concerns and side effects associated with carbapenems include CNS adverse effects (such as confusion and seizures), potential for anaphylactic reactions in patients with beta-lactam antibiotic allergy, and a seizure risk with higher doses, renal failure, or use of imipenem/cilastatin.</p> Signup and view all the answers

<p>The key features of carbapenems include covering ESBL-producing organisms, except ertapenem, covering Pseudomonas, not recommended for use in patients with penicillin allergy, and the reminder of what they do not cover, such as atypicals, VRE, MRSA, C. difficile, and Stenotrophomonas. Ertapenem specifically does not cover Pseudomonas, Acinetobacter, or Enterococcus.</p> Signup and view all the answers

<p>The common uses of carbapenems include treating polymicrobial infections, such as MDR Gram-negative infections, and are generally reserved for cases where other antibiotics may not be effective.</p> Signup and view all the answers

<p>Carbapenems are generally reserved for MDR Gram-negative infections and are active against most Gram-positive, Gram-negative (including ESBL-producing bacteria) and anaerobic pathogens.</p> Signup and view all the answers

<p>Contraindications include anaphylactic reactions to beta-lactam antibiotics, and warnings include CNS adverse effects such as confusion and seizures. Carbapenems should not be used in patients with PCN allergy.</p> Signup and view all the answers

<p>Key features of carbapenems include coverage of ESBL-producing organisms, except ertapenem which does not cover Pseudomonas, Acinetobacter or Enterococcus. They should not be used with penicillin allergy, and there is a seizure risk with higher doses, renal failure, or use of imipenem/cilastatin.</p> Signup and view all the answers

<p>Common uses of carbapenems include treatment of polymicrobial infections.</p> Signup and view all the answers

<p>Anaphylactic reactions to beta-lactam antibiotics</p> Signup and view all the answers

<p>All cover ESBL-producing organisms; All except ertapenem cover Pseudomonas; Do not use with penicillin allergy; Seizure risk (with higher doses, renal failure, or use of imipenem/cilastatin); Remember what they do not cover: Atypicals, VRE, MRSA, C. difficile, Stenotrophomonas; Ertapenem does not cover Pseudomonas, Acinetobacter or Enterococcus</p> Signup and view all the answers

<p>Polymicrobial infections</p> Signup and view all the answers

<p>CNS adverse effects, including states of confusion and seizures</p> Signup and view all the answers

<p>Meropenem (Merrem) and Ertapenem (Ivanz)</p> Signup and view all the answers

<p>Anaphylactic reactions to beta-lactam antibiotics</p> Signup and view all the answers

<p>It has no activity against Pseudomonas, Acinetobacter or Enterococcus</p> Signup and view all the answers

<p>Polymicrobial infections</p> Signup and view all the answers

<p>The monobactam structure of Aztreonam makes cross-reactivity with a beta-lactam allergy unlikely, allowing it to be primarily used when a beta-lactam allergy is present.</p> Signup and view all the answers

<p>Aztreonam covers many Gram-negative organisms, including Pseudomonas.</p> Signup and view all the answers

<p>The side effects of Aztreonam are similar to penicillins, including rash, nausea/vomiting/diarrhea, and increased liver function tests.</p> Signup and view all the answers

<p>Aztreonam covers many Gram-negative organisms, including Pseudomonas. It has no Gram-positive or anaerobic activity.</p> Signup and view all the answers

<p>Similar to penicillins, Aztreonam side effects include rash, N/V/D, and increased LFTs.</p> Signup and view all the answers

<p>Aztreonam can be used when a beta-lactam allergy is present. Its monobactam structure makes cross-reactivity with a beta-lactam allergy unlikely.</p> Signup and view all the answers

<p>The monobactam structure makes cross-reactivity with a beta-lactam allergy unlikely, and Aztreonam is primarily used when a beta-lactam allergy is present.</p> Signup and view all the answers

<p>Aztreonam covers many Gram-negative organisms, including Pseudomonas, but it has no Gram-positive or anaerobic activity.</p> Signup and view all the answers

<p>Aztreonam has side effects similar to penicillins, including rash, nausea, vomiting, diarrhea, and elevated liver function tests. It can be used with a penicillin allergy.</p> Signup and view all the answers