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Cell Wall Antibiotics
Terms in this set (59)
what are the 3 classes of cell wall agents?
what are the 4 sub-classes of beta lactams?
what are the 4 sub-divisions of penicillins?
Extended-spectrum penicillins (antipseudomonal)
Gram + cell wall?
thicker peptidoglycan layer above the cell membrane
Gram - cell wall?
Thinner peptidoglycan layer located in the periplasmic space between the inner and outer plasma membranes
Beta Lactam MOA?
Beta-lactams bind to penicillin binding proteins (transpeptidase) preventing this enzyme from cross-linking the peptidoglycan cell wall
causes a weak cell wall and osmotic lysis of bacteria
what are the 2 natural penicillins?
Penicillin G (IV/IM)
Penicillin VK (oral)
Penicillin G use?
given IV or IM
used for Strep, Syphilis and mouth anaerobes
Penicillin VK use?
primarily used for strep pharyngitis and dental infections (oral anaerobes)
what are 4 different mechanisms or resistance to beta lactams?
drug inactivation (lactamases)
altered target site
antibiotic efflux pump
what is beta lactamase?
bacterial enzyme that "opens" the beta lactam ring inactivating the drugs
there are many types of beta lactamases that confer resistance to different types of beta lactams
how does altering the target site confer antibiotic resistance?
changes the conformational shape of the transpeptidase enzyme so beta lactams can no longer bind it
what are the 3 major anti-staphylococcal penicillins?
structural modification of the beta lactam ring made anti-staphylococcal penicillins what?
resistant to beta lactamase (produced by some bacteria)
strep and methacillin sensitive Staph
(bacteremia, cellulitis/osteomyelitis, and endocarditis)
strep and methacillin sensitive staph
(cellulitis and dental infections)
what are the aminopenicillin drugs?
ampicillin (mainly IV also PO)
structural changes to aminopenicillins allowed what?
extended spectrum coverage
covers "lesser gram -" (H influenza, N minigitidis, M catarrhalis, proteus, E coli, klebsiella, serratia, salmonella)
what resistance to aminopenicillins were developed?
high dose for otitis media
drug of choice for Listeria meningitis
amoxicillin and ampicillin where combined with what to counteract bacterial resistance thru beta lactamase?
beta lactamase inhibitors (suicide inhibitors)
- Clauvulanic acid
Beta lactamase inhibitors MOA?
bind to beta-lactamase enzyme forming an inactive complex so the antibiotic can work
what are the beta lactamase inhibitor drugs?
ampicillin +sulbactam (Unasyn IV)
amoxicillin + clauvulanic acid (Augmentin PO)
clinical use of amoxicillin and ampicillin + beta lactamase inhibitors?
extended spectrum penicillin drugs (anti-pseudomonals)?
(often paired with beta lactamase inhibitors)
extended spectrum combo penicillin drugs?
Piperacillin + Tazobactam (Zosyn IV)
Ticaracillin + Clavulanic acid (Timentin IV)
extended spectrum combo penicillin coverage?
strep, staph (methicillin sensitive), enterococcus
broad gram -
extended spectrum combo penicillin clinical use?
cellulitis/osteomyelitis/diabetic foot infection
febrile neutropenia/complicated UTI
what patients should you change beta lactam dose for?
renal compromised patients
broad spectrum (no MRSA coverage)
none are orally active
Carbapenem therapeutic uses (except Ertapenem)?
should be reserved for resistant infections
Ertapenem clinical uses?
often utilized in outpatient home based
complicated skin soft tissue infection
community acquired pneumonia
Penicillin major adverse effects?
anaphylactic shock (more rare)
pancytopemia (esp neutropenia & thrombocytopenia)
seizures (when given to renal patients w/o adjustment)
Carbapenem major adverse effects?
seizures (and other CNS effects)
infusion related reactions (thrombophlebitis, pain)
hepatotoxicity, thrombocytopenia (meropenem)
Monobactam clinical use?
can be used in patients with beta lactam allergies
works against most beta lactamase producing bacteria
Monobactam adverse effects?
(cross-reactivity with beta-lactam allergy is rare but possible)
similar to penicillin - bind to transpeptidase and inhibit the cross-linking of the peptidoglycan cell wall
how does the spectrum of coverage generally change from 1st gen cephalosporin to 4th gen?
gram - activity increases from 1st gen -> 4th gen
gram + activity decreases slightly from 1st -> 4th gen (still pretty strong gram + coverage at 4th)
what is the major exception of gram + coverage for cephalosporins?
Strep pneumoniae 3rd/4th generation > 1st/2nd (when it normally decreases slightly)
what bacteria is resistant to ALL cephalosporins?
1st generation cephalosporin drugs?
1st gen cephalosporin clinical use?
2nd generation cephalosporin drugs?
1st gen cephalosporin coverage?
limited gram -
2nd gen cephalosporin coverage?
slightly weaker gram + coverage than 1st
expanded gram - coverage
2nd gen cephalosporin gram - bugs covered?
when are 2nd generation cephalosporins primarily used?
when both gram- and anaerobic coverage is needed
(intra-abdominal infection, PID, Surg prophylaxis)
3rd generation cephalosporins?
3rd gen cephalosporin coverage?
Strong S. pneumoniae coverage
extended gram -
ceftazidime has pseudomonas coverage
4th gen cephalosporin drugs?
4th gen cephalosporin coverage?
expanded gram -
reserved for resistant infections
4th gen cephalosporin indications?
5th gen cephalosporin drugs?
5th gen cephalosporin coverage?
same gram - as 4th gen + MRSA coverage
**the ONLY beta lactam that covers MRSA
major adverse reactions to cephalosporins?
allergic reactions (similar to penicillins)
hematologic effects (thrombocytopenia, neutropenia, hemolysis)
sludging of gall bladder (ceftriaxone)
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