[PHARMA] Beta-Lactam Antibiotics.pdf

BASIC PHARMACOLOGY 09/10/2024. MOD 5: BETA-LACTAM ANTIBIOTICS Mar Rusta...

BASIC PHARMACOLOGY 09/10/2024. MOD 5: BETA-LACTAM ANTIBIOTICS Mar Rustan Enriquez, MD Trans Group/s: 7A I. INTRODUCTION A. FOUR MAIN CLASSES OF BETA-LACTAMS The Beta-lactam class of antibiotics inhibits the transpeptidase enzyme responsible for cell wall FOUR MAIN CLASSES OF BETA-LACTAMS synthesis. 1 Penicillins 2 Cephalosporins 3 Monobactams 4 Carbapenems Every beta-lactam contains the core, beta-lactam ring. The blue structures show the unique side chain of each class of beta-lactam, contributing to pharmacokinetic characteristics: ○ Alter bacterial membrane for penetration susceptibility to beta-lactamase enzymes ○ Binding to specific penicillin-binding proteins (PBPs) Primary Sites Of Activity For The Four Major Classes Of Antibacterial Agents. II. BETA-LACTAMS Basic chemical structure of the four main subclasses of Beta-Lactams. Penicillins and cephalosporins are the most complex subclasses of beta-lactams. ○ Divided into groups – (e.g. penicillins) ○ Divided into generations – (e.g. cephalosporins) Basic chemical structure of the Beta-Lactam Amoxicillin. A diverse group of antibiotics. Named after their common central core, the square-shaped Beta-Lactam ring, as seen in the basic chemical structure of the beta-lactam amoxicillin. The differences in the properties between the Beta-Lactam subclasses, such as spectrum of activity Classification of Beta-Lactam Antibiotics. and tolerability, are largely due to unique specific side chains that are synthetically attached to this core. Bactericidal: inhibits the bacterial cell wall synthesis, 1. PEPTIDOGLYCAN LAYER leading to loss of cell wall integrity and eventually cell lysis. ALL beta-lactams inhibit the synthesis of the peptidoglycan layer found on the bacterial cell wall. Pharmacology - Mod # Topic Title 1 of 9 The use of trans, practice questions, and evals ratio must be used discreetly and social media/public exposure of the aforementioned shall be strictly prohibited.  A heteropolymer component of bacterial cell wall that ○ These PBPs are located in the periplasmic space provides rigid mechanical stability between the peptidoglycan layer and plasma Functions: membrane. ○ Maintains bacterial cell shape and integrity Inhibitory action of the transpeptidase enzyme has a ○ Prevents bacterial cell lysis from high osmotic bactericidal effect pressure ○ Results to impaired peptidoglycan synthesis → loss Composed of glycan chains which are linear strands of of bacterial shape and integrity → cell lysis and two alternating amino sugars (N-acetylglucosamine death (NAG) & N-acetylmuramic acid (NAM)) that are cross-linked by peptide chains If peptidoglycan is weakened or synthesis is inhibited, cell lysis occurs or the cell would not be able to replicate. Cross-linking of peptidoglycan chains. Peptidoglycan layer. 3. MAJOR MECHANISM OF BETA-LACTAM RESISTANCE Both gram-positive and gram-negative bacteria contain Depicts the formation mechanisms of bacterial peptidoglycan in their cell walls. resistance of the beta-lactam class, namely: GRAM-POSITIVE Very thick outer peptidoglycan Decreased entry of the beta-lactam into the cell via 1 porin mutations Thin peptidoglycan layer between the Altered target; specifically refers to GRAM-NEGATIVE outer membrane and plasma 2 penicillin-binding proteins (PBPs) mutations not membrane allowing beta-lactam to bind to their target Degradation of the antibiotic once inside the cell, this 3 is represented by the action of beta-lactamases Removal of an antibiotic once inside the cell via 4 efflux pumps (e.g., P. aeruginosa) Bacterial Cell Wall Difference. 2. MECHANISM OF ACTION All beta-lactams inhibit the synthesis of the peptidoglycan layer by binding to and inhibiting the Formation mechanism of bacterial resistance of action of transpeptidase enzyme involved in the beta-lactams. cross-linking of the peptidoglycan chains Transpeptidase represents one of the multiple types of 3.1 Beta-Lactamases penicillin-binding proteins (PBPs) ○ They are named as such because penicillins and all Major mechanism in gram-negative bacteria other beta-lactams bind to this enzyme to inhibit its ○ Enzymes produced by bacteria that hydrolyze the action. beta-lactam ring of certain penicillins and cephalosporins Pharmacology - Mod 5 🏠 Beta-Lactam Antibiotics 2 of 9 The use of trans, practice questions, and evals ratio must be used discreetly and social media/public exposure of the aforementioned shall be strictly prohibited.  Resistance of beta-lactams in gram-negative bacilli are ○ The structural integrity of the 6-aminopenicillanic usually due to beta-lactamase production acid nucleus is essential for the biologic activity of Currently there are over 1,000 named beta-lactamases these compounds. ○ There are multiple functional or sequence-based categorizations used by both microbiologists and clinicians May be plasmid or chromosomally-mediated ○ Beta-lactamases encoded either in plasmid which can pass from bacterium to bacterium via horizontal transfer ○ Encoded by the bacterial chromosome itself THREE MAIN TYPES OF BETA-LACTAMASES TYPE ACTION Basic Structure of Penicillins. Penicillinases Inactivates penicillins A. PENICILLIN CLASSIFICATION In general, penicillins are classified according to their Extended Inactivate most spectrum of activity. Spectrum beta-lactams except ○ From narrower-spectrum groups (mostly Beta-Lactamases carbapenems gram-positive) to broader-spectrum groups (both (ESBLs) Most commonly produced by: gram-positive, gram-negative, and even anaerobic ○ E. coli bacteria). ○ Klebsiella species Carbapenemases Inhibit carbapenems CLASSIFICATION CHARACTERISTICS Treatment of last resort for multidrug-resistant Oldest penicillin available, gram-negative infections developed in the 1940s. They have the greatest activity against: 3.2 Altered Penicillin Binding Proteins (PBPs) ○ Gram-positive (+) Major mechanism in gram-positive bacteria organisms Not as complex as the beta-lactamase group of ○ Gram-negative (-) cocci enzymes ○ Non-ß-lactamase NATURAL producing anaerobes A diverse group of enzymes involved in peptidoglycan PENICILLINS synthesis and Include different enzymes such as: Have NO activity against (PENICILLINASE- ○ Transpeptidases – main target of beta-lactams SENSITIVE) bacteria that produce ○ Carboxypeptidases penicillinase enzymes — a ○ Endopeptidases type of ß-lactamase enzyme With regard to beta-lactam class resistance which is one of the mechanisms mechanisms, altered PBPs are more commonly of antimicrobial resistance observed among gram-positive pathogens. against this group of antibiotics. Altered PBPs may be unique to a particular pathogen. Susceptible to hydrolysis by ○ Example: PBP2a is the name of the main altered penicillinases. PBP in methicillin-resistant S. aureus (MRSA) EXAMPLES: infection 1. Penicillin G PBP confers resistance to all beta-lactam antibiotics 2. Penicillin V ○ Exception: Ceftaroline (a newer cephalosporin) Resistant against ß-lactamases. ONLY active against Staphylococci and ANTI- Streptococci, but not against STAPHYLOCOCCAL other types of bacteria. PENICILLINS (PENICILLINASE- EXAMPLES: (CON-DoMs) RESISTANT) 1. Cloxacillin 2. Oxacillin 3. Nafcillin 4. Methicillin 5. Dicloxacillin EXTENDED- These drugs retain the SPECTRUM antibacterial spectrum of natural Altered Penicillin Binding Protein (PBP) PENICILLINS penicillins and have improved (AMINOPENICILLINS activity against gram-negative & III. PENICILLINS ANTI- (-) rods. All penicillins have the same basic structure, which is a PSEUDOMONAL Susceptible to hydrolysis by 6-aminopenicillanic acid nucleus. PENICILLINS) ß-lactamases, which is similar ○ It is a thiazolidine ring. to the natural penicillins. ○ Attached to the beta-lactam ring that has a secondary amino group. Pharmacology - Mod 5 🏠 Beta-Lactam Antibiotics 3 of 9 The use of trans, practice questions, and evals ratio must be used discreetly and social media/public exposure of the aforementioned shall be strictly prohibited.  They are most commonly formulated and administered in 1. PENICILLINASE-SENSITIVE PCNs (Natural PCNs) combinations with ß-lactamase Active vs. Gram (+), Gram (-) cocci, and anaerobes inhibitors (BLIs). Drug of choice (DOC) for infections caused by EXAMPLES: streptococci, meningococci, penicillin-susceptible 1. Aminopenicillins: pneumococci, non-β-lactamase-producing a. Ampicillin staphylococci, Treponema pallidum, Actinomyces b. Amoxicillin Clostridium sp. 2. Antipseudomonal Example: Penicillins: ○ Treatment of “strep throat” (Streptococcus a. Carbencillin pyogenes) b. Ticarcillin ○ Treatment of syphilis (Treponema pallidum) c. Piperacillin ○ Treatment of pneumonia (Streptococcus pneumoniae) B. PENICILLIN PHARMACOKINETICS ○ Treatment of Meningococcemia (Neisseria meningococci) Pharmacokinetic Parameter 2. PENICILLINASE-RESISTANT PCNs (Anti-staphylococcal PCNs) Differs greatly depending on their acid stability and protein-binding. Active vs. β-lactamase-producing staphylococci and Can be given orally (e.g. Penicillin V, streptococci Amoxicillin, Dicloxacillin) or parenterally These are the drugs of choice for infections due to (e.g. Penicillin G, Nafcillin, proven Methicillin-susceptible Staphylococcus aureus Antipseudomonal PCNs) Should NOT be used if the clinician suspects ○ Gastrointestinal absorption of Methicillin-resistant S.aureus (MRSA) infection Penicillin G, Nafcillin, and ○ None of the β-lactams work against MRSA, with Antipseudomonal PCNs is erratic. one exception, Ceftaroline. Therefore, it is not suitable for oral ○ Ceftaroline is an example of fifth generation Absorption cephalosporin. administration. ○ Dicloxacillin, Amoxicillin, and Methicillin is no longer used clinically due to high rates Penicillin V are acid-stable and of adverse effects. relatively well absorbed orally. Oxacillin and Nafcillin are considered drugs of choice Absorption of oral penicillins (except for serious staphylococcal infections such as Amoxicillin) is impaired by food and endocarditis. should be administered at least 1-2 hours before or after meals. 3. EXTENDED-SPECTRUM PCNs (Aminopenicillins, ○ Amoxicillin can be given before or Antipseudomonal PCNs) after meals. Greater activity against gram-negative bacteria Widely distributed in body fluids and compared to the other classes of β-lactams due to their Distributio enhanced ability to penetrate the gram-negative tissues except for the eye, prostate, and n outer membrane. non-inflamed meninges. Ampicillin & Amoxicillin have very similar spectrums of Rapidly excreted by the kidneys via activity. tubular secretion (90%) and glomerular ○ Both are active against pneumococci. Metabolism filtration (10%). ○ Ampicillin and Amoxicillin are the most active of and Small amounts are excreted by other the oral β-lactam antibiotics against pneumococci. Excretion routes such as sputum and breast milk. ○ They are preferred β-lactam antibiotics for Nafcillin is primarily cleared by biliary treating infections suspected to be caused by these excretion. strains. ○ Amoxicillin is given orally to treat bacterial sinusitis, otitis & LRTIs C. PENICILLIN: CLINICAL USES ○ Ampicillin has added activity against Shigella, Listeria monocytogenes, E.coli, Salmonella, Haemophilus influenzae. INFECTION DOC Antipseudomonal PCNs are used for the treatment of Gram (-) bacilli infections caused by Pseudomonas Syphilis aeruginosa and Klebsiella pneumoniae. Penicillin G Ampicillin, but not amoxicillin, is effective for Meningococcemia shigellosis. ○ It is also useful for treating serious infections Cloxacillin, Oxacillin, caused by susceptible organisms including MSSA infection Nafcillin, Dicloxacillin anaerobes, Listeria monocytogenes, and non beta-lactamase producing strains of E. coli, MRSA infection Ceftaroline, Vancomycin Salmonella, and Haemophilus influenzae ○ Due to production of beta-lactamases, ampicillin Piperacillin, 4th Gen can no longer be used for empirical therapy of Cephalosporins, urinary tract infections and typhoid fever. Pseudomonas infection Antipseudomonal penicillins such as carbenicillin, Carbapenems, Monobactams ticarcillin, and piperacillin were developed to broaden the spectrum of penicillins against gram-negative Pharmacology - Mod 5 🏠 Beta-Lactam Antibiotics 4 of 9 The use of trans, practice questions, and evals ratio must be used discreetly and social media/public exposure of the aforementioned shall be strictly prohibited.  pathogens, specifically Pseudomonas aeruginosa 2. CROSS ALLERGY/CROSSOVER ALLERGY (most common cause of hospital acquired pneumonia). Due to this cross-allergenicity, patients with a history of These extended spectrum penicillins are usually given in severe allergy or anaphylaxis to penicillins, the use combinations with beta-lactamase inhibitors (BLIs) of ALL beta-lactam antibiotics are also contraindicated. However, for patients with mild penicillin allergy, like D. PENICILLIN: ADVERSE EFFECTS minor rashes or itchiness, other beta-lactam antibiotics Penicillins are generally well-tolerated which may can be used with caution, especially for treating encourage inappropriate use infections wherein the use of beta-lactam antibiotics are Allergic/Hypersensitivity reaction — MOST warranted. COMMON ○ Penicillins and their breakdown products act as 3. CONSIDERED SAFE hapten after covalent reaction with proteins → All non-beta-lactam antibiotics are considered safe to Penicilloic acid use in patients with allergy to Penicillins. Most of the serious adverse effects are due to hypersensitivity. E. ADVERSE REACTION TO PENICILLINS ○ The antigenic determinants are degradation products of penicillins, particularly penicilloic acid and products of alkaline hydrolysis bound to host ADVERSE EFFECTS OF PENICILLINS protein ○ Most serious hypersensitivity reaction is Large doses of penicillins anaphylactic shock given orally may lead to Because of the potential for anaphylaxis, penicillin GASTROINTESTINAL gastrointestinal should be administered with caution or a substitute drug DISTURBANCE disturbances, particularly given if the person has a history of serious penicillin nausea, vomiting, and allergy. diarrhea. Penicillin skin testing may also be used to evaluate type 1 hypersensitivity Ampicillin has been ○ Negative skin testing = most patients can safely PSEUDOMEMBRANOUS associated with receive penicillin COLITIS Pseudomembranous Allergic reactions include colitis ○ Anaphylactic shock (very rare) ○ Serum-sickness type reactions characterized by In patients with renal failure, urticaria, fever, joint swelling, angioneurotic MYOCLONIC JERKS AND SEIZURES Penicillin G in high doses edema, intense pruritus & respiratory can cause seizures. compromise occurring 7-12 days after exposure ○ Variety of skin rashes Methicillin commonly For penicillin allergy causes interstitial ○ Always assume COMPLETE INTERSTITIAL nephritis, and is no longer cross-allergenicity/hypersensitivity within the NEPHRITIS used for this reason. different groups of penicillins and only PARTIAL Nafcillin is also used for cross-allergenicity between penicillins and other interstitial nephritis. classifications of beta-lactam antibiotics (e.g. Cephalosporins, Monobactams) Nafcillin is associated with NEUTROPENIA neutropenia and interstitial nephritis. Oxacillin can cause HEPATITIS hepatitis JARISCH-HERXHEIMER REACTION 1. JARISCH-HERXHEIMER REACTION In patients undergoing penicillin treatment for syphilis, a Jarisch-Herxheimer reaction may occur. Occurs several hours after the first injection of penicillin Symptoms: chills, fever, headache, myalgias, arthralgias More prominent syphilitic cutaneous lesions Cross-allergenicity with other beta-lactam antibiotics. ○ Edematous and brilliant in color ○ It does not recur with the second or subsequent 1. CONTRAINDICATED injections of penicillin. For patients with a history of allergy, all ○ This reaction is thought to be due to the release of groups/classifications of penicillins are contraindicated spirochetal antigens. including all natural penicillins, antistaphylococcal Release of spirochetal antigens with subsequent host penicillins, aminopenicillins, and antipseudomonal reactions to the products penicillin. Treatment: ○ Aspirin — for symptomatic treatment Pharmacology - Mod 5 🏠 Beta-Lactam Antibiotics 5 of 9 The use of trans, practice questions, and evals ratio must be used discreetly and social media/public exposure of the aforementioned shall be strictly prohibited.  ○ Penicillin therapy SHOULD NOT BE discontinued cephalosporin) penetrate well into the CSF IV. CEPHALOSPORINS All cephalosporins have the same basic structure: Metabolism Rapidly excreted by the kidneys via ○ The 7-aminocephalosporanic acid nucleus, & Excretion tubular secretion and glomerular filtration which is a dihydrothiazine ring attached to a beta-lactam ring. B. ADVERSE EFFECTS OF CEPHALOSPORINS 1 Allergy or hypersensitivity reactions 2 Gastrointestinal disturbance 3 Hypoprothrombinemia and bleeding disorders 4 DISULFIRAM-LIKE REACTIONS (Cefoperazone, Cefamandole, Cefotetan, Cefoxitin) 1. ALLERGY OR HYPERSENSITIVITY REACTIONS Reactions: ○ Anaphylaxis ○ Fever ○ Skin rashes Structure of Cephalosporins. ○ Nephritis ○ Granulocytopenia The intrinsic antimicrobial activity of natural ○ Hemolytic anemia cephalosporins is low, but the attachment of R1 and Patients with documented penicillin anaphylaxis have R2 groups has yielded hundreds of potent compounds an increased risk of reacting to cephalosporins with low toxicity. compared to patients without history of penicillin allergy A. CLASSIFICATION OF CEPHALOSPORINS 2. DISULFIRAM-LIKE REACTIONS Subdivided into generations depending mainly on their spectrum of antimicrobial activity. Reactions: Similar to penicillins, they are ordered from the narrower ○ Flushing spectrum (mostly active against gram-positive bacteria) ○ Tachycardia to broader spectrum (mostly active against ○ Hypotension or Low blood pressure gram-negative bacteria) activity. ○ Nausea Newer cephalosporins such as the 5th generation, do ○ Dizziness not fit the traditional classification groups and have Occurs upon intake of alcohol or alcohol-containing activity against MRSA. medications Other newer cephalosporins are only available in Disulfiram-like reactions caused by cephalosporins is combination with Beta-lactamase inhibitors. due to the inhibition of the enzyme, acetaldehyde dehydrogenase, which is responsible for the 1. CEPHALOSPORINS WITH BETA-LACTAMASE breakdown of acetaldehyde into its metabolites INHIBITOR Elevated acetaldehyde concentration in the body causes the symptoms of this reaction Combined activity of Cephalosporins with Beta-lactamase Inhibitor have been developed to combat resistant Gram-negative infections FDA-approved examples (for the treatment of intraabdominal infections and UTIs): 1. Ceftolozane + Tazobactam 2. Ceftazidime + Avibactam Both agents have potent activity against gram-negative (-) organisms including Pseudomonas and extended spectrum Beta-lactamase producing Enterobacter. Used for treatment of: ○ Complicated intra-abdominal infections ○ UTI A. PHARMACOKINETICS OF CEPHALOSPORINS PHARMACOKINETICS: CEPHALOSPORINS Absorption Can be given orally or parenterally Disulfiram-like reactions. Distribution Widely distributed in body fluids and V. CARBAPENEMS tissues Cefuroxime (3rd and 4th generation Pharmacology - Mod 5 🏠 Beta-Lactam Antibiotics 6 of 9 The use of trans, practice questions, and evals ratio must be used discreetly and social media/public exposure of the aforementioned shall be strictly prohibited.  VII. BETA-LACTAMASE INHIBITORS 1 Imipenem 2 Ertapenem 3 Doripenem 4 Meropenem Beta-Lactamase Inhibitors. Among the BROADEST spectrum of all beta-lactam antibiotics Beta-lactamase inhibitors are structurally similar to ○ Excellent activity against Gram (+) and (-), aerobic beta-lactam antibiotics. and anaerobic Potent inhibitors of many but not all bacterial ○ Good activity against Pseudomonas aeruginosa beta-lactamases and can protect hydrolyzable penicillins and Bacteroides fragilis (except Ertapenem) from inactivation by these enzymes. NO ANTIMICROBIAL ACTIVITY A. CILASTATIN Suicide inhibitors of beta-lactamase enzyme Added to Imipenem Spectrum of activity: Competitive enzyme inhibitor of renal tubular ○ Most active against plasmid encoded dehydropeptidase beta-lactamases ○ Imipenem is inactivated by dehydropeptidase in ○ Inactive against chromosomal beta-lactamases renal tubules resulting in low urinary concentrations → inhibition of cleavage of Imipenem BETA-LACTAMASE INHIBITORS Prolongs half-life of Imipenem Consequently administered together, Imipenem + 1 Clavulanic Acid Cilastatin (renal inhibitor of dehydropeptidase) for clinical use. 2 Sulbactam 1. PHARMACOKINETICS OF CARBAPENEMS 3 Tazobactam All are available only in parenteral form Penetrate body tissues and fluids well, including the 4 Avibactam CSF for all except Ertapenem All undergo RENAL elimination Beta-lactamase inhibitors are available only in fixed combinations with specific penicillins and 2. ADVERSE EFFECTS cephalosporins. Most common adverse effects of Carbapenems, which tend to be more common with Imipenem: 1 Piperacillin + Tazobactam (PipTazo) ○ Gastrointestinal distress (nausea, vomiting, diarrhea) 2 Ampicillin + Sulbactam (AmpiSul) ○ Skin rashes at the infusion sites Other adverse effects: 3 Amoxicillin + Clavulanic acid (Co-Amoxiclav) ○ Seizures: occur with excessive levels of Imipenem in patients with renal failure ○ Allergy NOTABLE FEATURE: Beta-lactams extend the spectrum of its companion beta-lactam provided that the VI. MONOBACTAMS inactivity against a particular organism is due to Aztreonam destruction by a beta-lactamase that is produced. Drugs with a monocyclic beta-lactam ring Extremely resistant to beta-lactamases COMMON BETA LACTAM-BLI COMBINATIONS Spectrum of activity: ○ Limited to aerobic GRAM-NEGATIVE organisms Ampicillin-Sulbactam (including Pseudomonas aeruginosa) ○ Unlike other beta-lactam antibiotics, they have no activity against Gram (+) bacteria or anaerobes Amoxicillin-Clavulanic Acid (Co-Amoxiclav) NOTABLE FEATURE: Little (if none) cross-reactivity with other beta-lactam antibiotics hence, it can be used Piperacillin-Tazobactam as an alternative drug to patients with gram-negative infections who are allergic to penicillins. Ceftolozane-Tazobactam 1. PHARMACOKINETICS OF MONOBACTAMS Ceftazidime-Avibactam NOT absorbed orally, hence, only available as Imipenem-Cilastatin-Relebactam parenteral preparation Penetrates well into all body fluids, tissues, and CSF 70% is excreted unchanged in the kidneys, small fraction excreted in the bile Pharmacology - Mod 5 🏠 Beta-Lactam Antibiotics 7 of 9 The use of trans, practice questions, and evals ratio must be used discreetly and social media/public exposure of the aforementioned shall be strictly prohibited.  ANNEX A: Summary of Cephalosporin Antibiotics CEPHALOSPORINS FIRST GENERATION 2ND GENERATION 3RD GENERATION 4TH GENERATION 5TH GENERATION SUSCEPTIBLE Gram positive Very active against Expanded Gram negative Spectrum similar to 3rd Spectrum similar to 3rd MICROORGANISM ○ Streptococcus organisms inhibited by 1st coverage and some are generation cephalosporins generation cephalosporins ○ Staphylococcus gen cephalosporins able to cross the but with better activity with added activity Very limited activity Expanded/Additional blood-brain barrier against Pseudomonas against MRSA and it is against gram negative activity against gram aeruginosa and NOT active against bacteria negative bacteria Enterobacteriaceae against Pseudomonas ○ Proteus mirabilis ○ Haemophilus family aeruginosa ○ Escherichia coli influenzae ○ Klebsiella pneumonia ○ Enterobacter ○ Neisseria Mnemonics: ○ P. mirabilis, E. coli, K. “PEcK FIRST” pneumoniae ○ Serratia marcescens Mnemonics: “HEN PEcKS” CLINICAL USES Urinary tract infections (UTI), Sinusitis, Otitis, LRTIs, Serious infections requiring IV Pseudomonas aeruginosa MRSA infections Staphylococcal and Community-acquired therapy (e.g. meningitis, and Enterobacter infections streptococcal infections pneumonia (CAP) neutropenic fever), Wide including cellulitis, soft tissue (Because of their activity variety of serious infections abscess; Drugs of choice for against H. influenza and many caused by organisms that are surgical prophylaxis pneumococci) resistant to other drugs EXAMPLES CeFADRoxil CeFAMandole CeFEtamet CefePIme CeftaROLine CefaZOLin CeFOXitin CefPOdoxin CefPIrome CeftobipROLe Cephalexin CeFURoxime CefoPERAzone Cephalothin CefoTEtan CeFIXime Cephapirin CefTRIaxone Cephradine MNEMONIC: In a FAMily CefTazidime gathering, you see your FOXy CefoTaxime cousin wearing a FUR coat CefTizoxime MNEMONIC: FADer, help me and drinking TEa. CefTibuten FAZ my PHarmacology exam! CeFAClor MNEMONIC: FEnge PO ng Alternative mnemonics: LORAcarbef PERA to FIX my 3 (TRI) “DR ZOL is a 1st class doctor CefPROzil TTTTV! in the PH” CefmetAZOLE CeFONicid Or anything related to “money” Dr: CefaDRoxil CefoPERAzone, CeftaziDIME, ZOL: CefaZOLine MNEMONIC: FAC! LORA the CefoTAXime, CeftibuTEN 1st class: 1st gen PROfessional AZhoLE is still PH: “cePH-” on the FONe Pharmacology - Mod 5 🏠 Beta-Lactam Antibiotics 8 of 9 The use of trans, practice questions, and evals ratio must be used discreetly and social media/public exposure of the aforementioned shall be strictly prohibited.  Pharmacology - Mod 5 🏠 Beta-Lactam Antibiotics 9 of 9 The use of trans, practice questions, and evals ratio must be used discreetly and social media/public exposure of the aforementioned shall be strictly prohibited.