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Penicillins
beta lactam antibiotic
Penicillin resistance
both gram pos and neg bacteria produce beta lactamases or penicillinases that bind to beta lactam ring and make it useless
Penicillin class
narrow spectrum, gram positive
Penicillinase resistance penicillin class
developed to overcome penicillinase enzyme of S. aureus
eg methicillin
Aminopenicillins
increased activity against gram neg
eg amoxicillin
Carboxypenicillins
further resistance against gram neg like pesudomonas than aminopenicillins
eg ticarcillin
Beta lactamase inhibitor combos
gain or enhance activity against beta lactamase producing microbes
Zosyn
Side effects of penicillins
has lease SE of all antibiotic classes :)
allergic rxn common
Penicillin nursing considerations
monitor for allergic rxns
monitor patients receiving ticarillin for bleeding
dont mix in same bag with aminoglycosides
reduce broad spectrum doses in kidney disease
Cephalosporins
beta lactam antibiotics
similar in structure and function to penicillins
cross allerginicity in class and 1% with penicillins
first gen cephalosporins
best activity against gram pos
limited activity against gram negs
eg cefazolin
second gen cephalosporins
less active against gram pos than first gen
more active against gram negs than first gen
eg cefaclor
third gen cephalosporins
less active than second gen against gram pos
more active against gram neg than second gen
can reach CSF
eg Rocephin
fourth gen cephalosporins
very broad spectrum
resistance to beta lactamases
can reach CSF
eg cefepime (Maxipime)
side effects of cephalosporins
allergic rxn
bleeding disorders (deficient vit K)
ethanol intolerance
pseudomembranous colitis
cephalosporin nursing considerations
monitor for allergic rxn, bleeding, diarrhea
use caution in patient on blood thinners
dont get Spectracef if milk allergic
give IM injections deep into large muscle
alter doses in renal impairment
Imipenem (Primaxin)
beta lactam antibiotic
very broad spectrum
SE hypersensitivity, suprainfection with fungi, and seizures
Ertapenem (Ivanz)
beta lactam antibiotic
very broad spectrum
SE diarrhea, nausea, rashes, seizures
Aztreonam (Azactam)
beta lactam antibiotic
active against gram negs
structure is half a ring, so ok to give if allergic to other beta lactams
Macrolide resistance
acrive efflux- bacteria pumps macrolide out of cell
altered target sites- alteration of macrolide binding site on bacterial ribosome=HIGH RESISTANCE
some notes about good macrolides, called Azythromycin and Clairithromycin
broad spectrum
improved pharmocokinetic properties: bioavailibility, tissue penetration, long half life, tolerability
half life of azythromycin is approx 68 hrs!
side effects of macrolides
nausea, vomiting, hepatitis, thrombophlebitis
prolonged QT interval
pyloric stenosis in infants
toxicity of macrolidies
ototoxic in high doses
hepatotoxic
nursing considerations of macrolides
food decreases absorption, but irritates GI, so take with food when allowed
don't give with antacids
educate about long half life
CYP450 and macrolides
erythromycin and clarithromycin increase drug levels of other drugs, look for WARFARIN AND DIGOXIN