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KEY POINTS BETA LACTAMS

Name examples:
• Penicillins, cephalosporins, carbapenems, monobactams all have a 4 member beta lactam ring
KEY POINTS BETA LACTAMS

bactericidal or bacteriostatic?

therapeutic index: high or low?
• Bactericidal, high therapeutic index, safe
KEY POINTS BETA LACTAMS

Pregnancy?
• Widely used, including pregnancy
KEY POINTS BETA LACTAMS

Resistance by what 2 mechanisms?
• Resistance by beta lactamases or altered target binding site
KEY POINTS BETA LACTAMS

Allergic reactions?
• Allergic reactions – rash, anaphylaxis; hematologic toxicity
Drug Classes:

Cell Wall Synthesis Drugs:
Cycloserine
Bacitracin
Beta-Lactams
Glycopeptides
Drug Classes:

Folic Acid Metabolism:
Trimethoprim
Sulfonamides
Sulfones
Drug Classes:

DNA Replication Drugs:
Quinolones
Nitroimidazoles
Drug Classes:

Protein Synthesis Drugs:
Aminoglycosides
Macrolides
Lincosamides
Streptogramins
Amphenicols
Tetracyclins
Rhupirocin
Drug Classes:

DNA-Dependent RNA polymerase Drugs:
rifamycins
KEY POINTS PENICILLINS

Drug of choice for?
• Drug of choice for susceptible bacteria
KEY POINTS PENICILLINS

Which class of drugs are combined for a synergistic effect?
• Combined with aminoglycoside for synergy
KEY POINTS PENICILLINS

Standard penicillins are used for which bugs?
streptococci ( S pneumoniae resistance, susceptibility cutoff changed),

meningococci,

syphilis,

actinomycosis
KEY POINTS PENICILLINS

Antistaphylococcal (oxacillin) used for treatment of which bug?
• used for methicillin sensitive (but not resistant) S. aureus
KEY POINTS PENICILLINS

Aminopenicillin (ampicillin) used for which bugs?
• Aminopenicillin ( ampicillin) better for E coli, proteus, hemophilus – sinusitis, otitis, bronchitis
KEY POINTS PENICILLINS

Antipseudomonal (piperacillin) is active against?
active pseudomonas,
enterobacter,
bacteroides fragilis

also against resistant gram negatives and anaerobes
KEY POINTS BETA LACTAMASE INHIBITORS

Major function?
• These destroy beta lactamases produced by bacteria, extend the spectrum of penicillins
KEY POINTS BETA LACTAMASE INHIBITORS

Examples?
• Clavulanic acid, sulbactam, tazobactam
KEY POINTS BETA LACTAMASE INHIBITORS

Of the many anaerobes covered, which specifically is of interest to know?
• Cover anaerobes (bacteroides fragilis)
KEY POINTS BETA LACTAMASE INHIBITORS

Commonly used for infections affecting which body regions?

T/F
Beta lactamase inhibitors are used as empiric therapy for minor infections
• Used for head and neck, intraabdominal, pelvic infections

F
Used as empiric therapy for SERIOUS infection
KEY POINTS BETA LACTAMASE INHIBITORS

Name the penicillin+B-Lactam inhibitor combination drugs (give the combination name along with each constituent)
Amoxicillin-clavulanate (augmentin) - used for H.flu

Ampicillin-sulbactam (unasyn), used for S.aureus, H. flu, B. Fragilis

Ticarcillin – clavulanate (timentin) used for Gram -

Piperacillin-tazobactam ( zosyn) used for intra-abdominal sepsis
KEY POINTS CEPHALOSPORINS

Most are excreted via?

Require dosage adjustments when?
Kidneys

Renal failure
KEY POINTS CEPHALOSPORINS

In what circumstance do you adjust dosage?
• Dosage adjustment renal failure
KEY POINTS CEPHALOSPORINS

What generation of cephalosporins are better against gram negative?
• 3rd, 4th generations better gram negative coverage ( stable to beta lactamases)
KEY POINTS CEPHALOSPORINS

Which generation of cephalosporins penetrate CSF? (i.e. which can you give for meningitis?)
• CSF penetration limited to 3rd, 4th

Except cefuroxime, 1st and 2nd generations do not penetrate CSF 
KEY POINTS CEPHALOSPORINS

Which 2 cephalosporins cover pseudomonas aeruginosa?
• Pseudomonas aeruginosa covered by 4th (cefepime), and one 3rd ( ceftazidime)
KEY POINTS CEPHALOSPORINS

T/F
Cephalosporins do NOT cover enterococci, MRSA, and listeria
• Do not cover enterococci, MRSA, listeria
KEY POINTS CEPHALOSPRINS 2

_______(generation) has better gram positive coverage; used for skin and soft tissue infection, surgical prophylaxis

CSF entry?

Examples? (2)
• First generation ( cefazolin) better gram positive coverage; used for skin and soft tissue infection, surgical prophylaxis

- Do NOT enter CSF

- Examples include:
Cephalexin (oral)
Cefazolin (IV)
KEY POINTS CEPHALOSPRINS 2

________ (generation) slightly better gram negative coverage including hemophilus, used for sinusitis, otitis ;

Bonus:
_______ covers anaerobes and is used to cover what kind of infection?
• Second generation slightly better gram negative coverage, used for sinusitis, otitis ;

cefoxitin covers anaerobes and is used for intrabdominal and pelvic infections
KEY POINTS CEPHALOSPRINS 2

______ (generation) better gram negative coverage, used for meningitis, nosocomial pneumonia, sepsis

Bonus:
______ once daily, used for meninigitis, community acquired pneumonia (CAP), Gynococcus? (GC);

only _________ for pseudomonas; poor Gram+ coverage
• Third generation better gram negative coverage, used for meningitis, nosocomial pneumonia, sepsis

ceftriaxone once daily, used meninigitis, CAP, GC;

only ceftazidime for pseudomonas; though, ceftazidime has poor Gram+ coverage
KEY POINTS CEPHALOSPRINS 2

_____ (generation) very broad spectrum, including pseudomonas , resistant gram negatives; widely used in hospitals;

name?
• Fourth generation very broad spectrum, including pseudomonas , resistant gram negatives; widely used in hospitals

cefepime
What do 4th generation cephalosporins NOT cover?
anaerobes
KEY POINTS CARBAPENEMS

T/F:
Carbapenems are stable to most beta lactamases
True

• Carbapenems are stable to most beta lactamases
KEY POINTS CARBAPENEMS

carbapenems cover _______, ________, AND ________
• Cover gram positives, gram negatives AND anaerobes
KEY POINTS CARBAPENEMS

carbapenems do NOT cover ________, and some _________
• Do not cover MRSA, some enterococci
KEY POINTS CARBAPENEMS

T/F
Carbapenems are first line treatment for many hospital infections
F
• RESERVE for serious infection with resistant bacteria
KEY POINTS CARBAPENEMS

Imipenem side effects?
Meropenem more or less of side effects?

Which does not cover pseudomonas?
Imipenem causes seizures in patients with renal insufficiency

Meropenem causes less seizures

Ertapenem does not cover pseudomonas
KEY POINTS MONOBACTAMS

Monobactams (aztrenoam) ONLY cover ________ and not _________ or __________;

they are used in patients allergic to _______
• Monobactams ( aztreonam) only cover gram negatives, not gram positives or anaerobes;

used in penicillin allergic patients
KEY POINTS VANCOMYCIN

Mechanism of action?
• Cell wall synthesis inhibitor
KEY POINTS VANCOMYCIN

Covers ________ only
• Covers gram positive bacteria ONLY
KEY POINTS VANCOMYCIN

What happens if it is infused rapidly?

What are 2 side effects?
• Rapid infusion leads to histamine release (red man syndrome);

Side Effects: hematologic, ototoxicity
KEY POINTS VANCOMYCIN

How is it excreted?

Under what circumstance does it build up?

What specifically needs to be monitored when it is administered?
Exceted via kidneys,

Builds up in renal failure

Monitor trough levels
KEY POINTS VANCOMYCIN

What types of infections Indicate use?
• MRSA, coagulase neg staph, JK corynebacteria, beta lactam resistant pneumococci, c difficile (oral)
KEY POINTS VANCOMYCIN

Alternative therapy for __________ treatment/prophylaxis caused by staph/strep/enterococci
• Alternative therapy for endocarditis

also for penicillin allergic patients
KEY POINTS AMINOGLYCOSIDES

Binds to ____ ribosome and is _______________ (cidal or static?)
 Bind to 30s ribosome,

bactericidal
KEY POINTS AMINOGLYCOSIDES

_____ (wide/narrow?) therapeutic index

Excreted via _________
Narrow therapeutic index

Excreted via kidney; monitor serum levels (peak, trough)
KEY POINTS AMINOGLYCOSIDES

Side effects?
• Nephrotoxicity, ototoxicity
KEY POINTS AMINOGLYCOSIDES

Indicated for what organisms?

Has no effect on what organisms?
Active gram negative bacilli, staphylococci, mycobacteria;

No anaerobic activity
KEY POINTS AMINOGLYCOSIDES

Synergistic with what other antibiotics? synergism useful specifically for what condition?
Synergistic with penicillin, vancomycin;
used in endocarditis (gentamicin)
KEY POINTS AMINOGLYCOSIDES

1) Streptomycin used for?

2) Amikacin used for?
1) used in TB, plague, tularemia

2) least susceptible to inactivating enzymes; reserved for resistant gram negatives