pharm unit 1 antibiotics

Which antibiotics are Bactericidal?

Penicillins

Cephalosporins

Aminoglycosides

Vancomycin

Fluoroquinolones

Metronidazole

Which antibiotics are Bacteriostatic?

Erythromycin

Tetracyclines

Sulfonamides

Trimethoprim

Clindamycin

What is the drug of choice for syphilis, gas gangrene, and meningococcus?

Penicillin G (Pfizerpen®)

Penicillin G (Pfizerpen®):

Anaerobe ?

Gram - ?

Gram + ?

Staph coverage ?

Time or concentration dependent ?

Anaerobic activity (except Bacteroides)

Gram +

No staph coverage

Time

Penicillin Dosage Forms: Penicillin V Potassium (Pen VK)

Oral

Penicillin Dosage Forms: Penicillin G (benzylpenicillin)

IV

Penicillin Dosage Forms: Penicillin G Benzathine (Bicillin)

IM

Amoxicillin (Amoxil®):

Anaerobe ?

Gram - ?

Gram + ?

Staph coverage ?

Anaerobic activity (except Bacteroides)

Gram +

No staph coverage

What is Amoxicillin (Amoxil®) the drug of choice for?

Enterococcus, Listeria, endocarditis prophylaxis, URTI (sinusitis, otitis, bronchitis), CAP

What are the two aminopenicillins?

Ampicillin (Omnipen®, Principen®)

Amoxicillin (Amoxil®)

What are the interactions of aminopenicillin?

prolongation of prothrombin time (bleeding)

Decreases effectiveness of oral contraceptives

What are the side effects of aminopenicillins?

hepatic, C. diff, stevens-johnson, TEN, nephritis, anemia

What are the adverse effects of penicillins?

Hypersensitivity Reaction

Rash

Diarrhea

What are examples of b-lactamase inhibitors?

Sulbactam With ampicillin (Unasyn®)

Tazobactam With pipercillin (Zosyn®)

Clavulanate/Clavulanic acid With amoxicillin (Augmentin®)

Aminopenicillin's With Beta-lactamase Inhibitors:

Anaerobe ?

Gram - ?

Gram + ?

Staph coverage ?

anaerobe: yes (Bacteroides)

Gram - : intermediate

gram + : yes

Covers MSSA

What medication is indicated for skin/soft tissue, diabetic foot, animal/human bites?

Aminopenicillin's With Beta-lactamase Inhibitors

Which medication was designed solely to cover S. aureus (MSSA)?

Nafcillin, oxacillin (Bactocill), dicloxacillin

Penicillinase-Resistant Penicillins(Anti-staphylococcal Penicillins)

Nafcillin, oxacillin (Bactocill), dicloxacillin

Penicillinase-Resistant Penicillins

Anaerobe ?

Gram - ?

Gram + ?

Staph coverage ?

gram +

staph coverage

Which drugs are Antipseudomonal Penicillins?

Piperacillin (Pipracil®)

Piperacillin/tazobactam (Zosyn®)

Antipseudomonal Penicillins

Piperacillin (Pipracil®)

Piperacillin/tazobactam (Zosyn®)

Anaerobe ?

Gram - ?

Gram + ?

yes for all

but Maintains Gram + coverage (MSSA only)

What is the drug of choice for Polymicrobial infections

Nosocomial infections (esp. pneumonia)

Intra-abdominal infections

Pseudomonal infections?

why ?

Antipseudomonal Penicillins

Piperacillin (Pipracil®)

Piperacillin/tazobactam (Zosyn®)

-Broad Spectrum Antibiotic

1st generation cephalosporins

Anaerobe ?

Gram - ?

Gram + ?

Cefazolin (Ancef®)

Cephalexin (Keflex®)

Great gram + activity (No Enterococcus coverage)

Some gram - coverage (E. Coli, Proteus, Klebsiella)

Which drugs cover MSSA?

Augmentin (Amoxicillin/Clavulanate)

Unasyn (Ampicillin/Sulbactam)

Nafcillin

oxacillin (Bactocill)

dicloxacillin

Cefazolin (Ancef®)

Macrolides- gram + aerobes

Tigecycline (Tygacil®)

2nd Generation Cephalosporin

anaerobes

gram -

gram +

Cefotetan (Cefotan) IV

Cefoxitin (Mefoxin®)IV

Cefuroxime (Zinacef®)PO/IV

Cefprozil (Cefzil®)PO

more gram - activity than 1st generation

also gram +

Why indications are used for 2nd Generation Cephalosporin?

UTIs, URIs, Surgical prophylaxis

What drug is used for surgical prophylaxis/MSSA/UTI?

Cefazolin (Ancef®)

What drug is used for tissue infections (Cellulitis) & UTIs?

Cephalexin (Keflex®)

What Gram-negatives are covered by 1st generation cephalosporins?

- by 2nd generation?

1: E. Coli, Proteus, Klebsiella

2: H. influenzae, Enterobacter (rapid resistance occurs), Neisseria, Proteus, E. coli, Klebsiella

covers more in 2nd generation and even better in the 3rd generation

What are the 3rd generation cephalosporins?

Ceftriaxone (Rocephin®)

Ceftazidime (Fortaz®)

Cefotaxime (Claforan) IV

Cefdinir (Omnicef®)PO, cefixime (Suprax®)PO

3rd generation cephalosporins

Anaerobe ?

Gram - ?

Gram + ?

What extra coverage?

just gram + and -

good strep coverage-rocephin

Extra coverage against Serratia and Moraxella catarrhalis

What medication can you not do in the first 30 days of life b/c it competes for the same binding sites as bilirubin?

Ceftriaxone (Rocephin®)

4th generation cephalosporins

Cefepime (Maxipime®): (Broad Spectrum Antibiotic)

gram - coverage

gram + coverage no MRSA or enterococcus

What is indicated for 4th generation cephalosporins?

Neutropenic fever

Nosocomial infections (HAP, VAP)

Pseudomonal infections

What will treat MRSA and Pseudomonas?

Ceftaroline (Teflaro®)

5th Generation Cephalosporins

Ceftolozane/tazobactam (Zerbaxa®) coverage

Gram - coverage

Gram + coverage, no MRSA or Enterococcus

Anti-pseudomonal activity

Some anaerobic activity (including bacteroides)

what medication would you give

Complicated Intra-abdominal infections (plus metronidazole)

Complicated urinary tract infections

Ceftolozane/tazobactam (Zerbaxa®)

5th Generation Cephalosporins

Monobactam (Aztreonam) coverage

Only Gram - coverage

Activity against P. aeruginosa

Enterobacteriaceae activity

Which medication can you use if a pt has a true penicillin allergy? why?

Monobactam

NO cross-reactivity with beta-lactams

Carbapenems coverage

broad all

not MRSA

pseudomonas coverage

Which drug is more resistant to hydrolysis from b-lactamases and you have to get approval from infectious disease?

Carbapenems

Carbapen examples

Imipenem (Primaxin®) (seizures)

Meropenem (Merrem®)

Doripenem (Doribax®)

Ertapenem (Invanz®)