Beta Lactams

Class: Penicillins
MOA: inhibits transpeptidation of the peptidoglycan, penicillins are look alike of Dala D ala and thus compettively inhibit using up the transpeptidase enzyme. This is CIDAL--thus should not be used w/ static abx.
resistance: penicillin G and penicillin V are penicillinase susceptible, are narrow spectrum

MOA: resembles D ala D ala and inhibits transpeptidation of peptidoglycan
Resistance: very narrow spectrum, penicillinase resistant thus can work on staphylococcus (does NOT work on MRSA)
MOR: mutn in PBPs

Extended spectrum
Resistance: penicillinase susceptible

Class: Cephalosproins
Gen: 1st
MOA: D ala D ala analogs which bind to PBPs and inhibit transpeptidase rxn. Activate autolysins

- CLEAN surgery (i.e. breast, bone, NOT colon) prophylaxis
- UTIs
- Gram - activity-- proteus, E coli, Klebsiella- PEcK

Gen: 2nd gen cephalosporin
Use: surg proph, UTIs, community acquired adult pneumo
- gram - activity against HENPEcK-- H flu, Enterobacter, Neisseria, Proteus, E coli, Klebsiella)

Gen: Second Gen Cephalosporin
Use: bacteroides mixed intabd/pelvic infections

Gen: 2nd gen cephalosporins
Add Use: CNS, staph, strep, serious pediatric pneumonia

Gen: 3rd generation cephalosporins
Use: PS HENPEcK- Pseudomonas, serratia, H flu, Enterobacter, Neisseria, Proteus, E coli, Klebsiella

- DOC for gonorrrhea, community acuired pneumonia if coverage against strep pneumo is needed, and has good CNS penetration for
meningitis
- v. long half life

Gen: 4th generation cephalosporin
Use: gram + effects of 1st gen w/ gram- effects of 3rd gen. good for everything except Listeria, enterococcus, and MRSA

1. decrease in gram + coverage
2. increase in gram - coverage
3. increase in resistance to beta lactamases
4. increase in CNS penetration
5. cephalosporins should not be used if pt has had life threatening rxn to penicillins

Superfinfection, pseudomembranous colitis

Class: Monobactams
MOA: bind to PBP3
Use: active against AEROBIC GNRs (the drugs are resistant to beta-lactamase produced by these rods)
- no activity against: gram(+) bacteria and anaerobes

Class: Carbapenems
Resistance: resistant to most beta lactamases, but susceptible to metallo beta lactamase
Spectrum- have the broadest spectrum of all the abx
- exceptions-- MRSA and listeria monocytogenes
Imipenem- sz in elderly

- clavulanic acid, sulbactam, tazobactam
MOA: resemble beta lactams so will inhibit beta lactamases by competitive inhibition

1. Clavulanic acid
2. Ampicillin
3. Tazobactam
4. Ticarcillin & Clavulanic acid

Class: cell wall synthesis inhibitor
MOA: inhibits transglycosylase rxn by binding the d ala d ala terminus, and damages teh cytoplasmic membrane

Use: gram(+) bacteria and NOT gram negative, but reserved for treating serious infections of MRSA & PRSP, C diff colitis from abx use
Receptor/Res: does NOT bind to PBPs and lacks a beta lactam ring (so is not susceptible to beta lactamases)
- however-- modification of D ala d ala binding site may allow Vanc resistant enterococci and vanc resistant staphylococcus aureus-- VRE and VRSA

Class: cell wall synthesis inhibitor
Use: active against VRE and VRSA, resistant gram + infections

Class: cell wall synthesis inhibitor
MOA: prevents NAM formation in peptidoglycan,
Resistance: if decreased intracellular accumulation

- delayed onset anaphylaxis, mediated by IgE, rash (IgG)

- c diff colitis, NM irritability, interstitial nephritis

nerou rxn and abnormal behavior

Meth- interstitial nephritis
Naf- neutropenia, phlebitis
Oxacillin- neutropenia, LFTs
- dose change for LIVER failure except methacillin

Dose change in renal failure except for pipracillin

2nd gen ceph
- antabuse rxn to alcohol

super long
- 3rd gen ceph

Synergy w/ aminoglycosides for PSEUDOMONAS
- doc-- TEST Q!!

- 3rd gen ceph

nephro and ototoxicity, red neck syndrome (if given too quickly)

myalgias in skeletal muscle, synergistic tox w/ statins

- strep, staph (non penicillinase), ANAEROBES (except bacteroides), N. men, TREPONEMESS

- Amp/amox-- community acquired ENT and lung infections
- Tic/pip- serious gram - infections, w/ aminoglycosides-- can do bacteroides, proteus, pseudomonas,