Non beta lactam cell wall syntehsis inhibitors

Bactoprenol inhibitors bacitracin (BACIIM)

• bactoprenol phosphate → transmembrane transporter embedded within the bacterial cell membrane

• Bacitracin → blocks bactoprenol phosphate, bacteria cant make new peptidoglycan, inhibits cell wall synthesis

• Given topically (skin, eye)

Bacitracin

• narrow spectrum antibiotic

• Bacterostatic → bactericidal at high concentrations

Bacitracin effective agaisnt

Staphylococcus aureus, staphylococcus epidermis, streptococcus pyogenes

Bacitracin topical ointment side effects

Contact urticaria syndrome and anaphylaxis (rare)

Beta lactamase inhibitors

Clavulanic acid, tazobactum, and sulbactam

• given with beta lactam

• Amoxicillin/ clavulanic acid - augumentin

• Ampicillin/ sulbactam - unasyn

• Peperacillin/ tazobactam - zosyn

Beta lactase inhibitors

Inside the bacteria → bind permanently to beta lactamase enzymes disabling them → allows penicillin to work

• effective against gram negative bacteria

Carbapenems

• imipenem

• Meropenem

• Ertapenem

• Doripenem

Carbapenems

• bind to PBPs and inhibit cell wall synthesis

Carbapenems

• broad spectrum antibiotics

• Cover most gram positive and gram negative bacteria and anaerobes

• Bactericidal

Carbapenems effective agiasnt

• acinterobacter specie- cause nosocomial infections

  • Ventilator associated pneumonia

  • Pesudomonas aeruginosa

Carbapenems side effects

• severe CNS toxicity

• Imipenem is rapidly broken down by kidneys, metabolites are Nephrotoxicity → inhibits tubular dehydropeptidase

Monobactams aztreonam

Beta lactam ring is not fused to any other ring → sticking out on its own → resistant to beta lactamasesv

Monobactams aztreonam effective against

• gram positive bacteria and proteus species

• Ineffective agiasnt gram positive bacteria

• Very few side effects (if any, skin rash)

• Bactericidal

• Narrow spectrum antibiotic

Glycopeptides

Vancomycin- IV, PO

Telavancin- IV

Teicoplanin- IV, IM, PO

Glycopeptides mechanism of action

Latch onto the tetrapeptide chains → prevent them from being linked by PBP enzyme → inhibit cell wall synthesis → do not act on the PBP which allow them to bypass the PBP mutations to make MRSA so resistant to beta lactamas

Glycopeptides cant bind to vancomycin

• VISA - partial resistance

• VRSA - complete resistance

Glycopeptides

• narrow spectrum

• Bactericidal

Glycopeptides effective

• gram positive bacteria

• Typically given IV - poorly absorbed in GI tract

• Oral vancomycin - treat GI infections

Glycopeptides adverse drug reactions

• thrombophlebitis

• Ototoxicity

• Nephrotoxicity

• VFS vancomycin flushing syndrome - red man syndrome (diffuse flushing)

Vancomycin flushing syndrome- red man syndrome

Infusion reaction NOT allergic reaction

• flushing, erythema, itching

• Rarely: hypotension/ tachycardia

• Reactions occur after stop IV

• Give Benadryl ahead of dose and slow down infusion