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Beta-lactams include:
PCN's, Cephalosporins, Carbapenems, Aztreonams
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PCN coverage
viridans strep, S. Pyogenes, oral anaerobes, syphillis, Leptospira
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Ampicillin & Amoxicillin coverage:
- (same as PCN) plus:
- -E.Coli
- -Lyme Dz
- -few GNB
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Bacteria Covered by Amoxicillin
(HELPS)
- H. influenza
- E. Coli
- Listeria
- Proteus
- Salmonella
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Ampicillin and Amox are the Best Initial Tx of ?
- - OM
- - Dental infx / endocard prophylax
- - Lyme (@ rash, joint, CN7 involvement)
- - UTI in Prego
- - Listeria monocytogenes
- - Enterococcal
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PRP's (penicillinase resistant PCN)
Oxacillin, Cloxacillin, Dicloxacillin, Nafcillin
Tx of?
- -Skin infxn: Cellulitis, impetigo, erysipelas
- -Endocarditis, meningitis
NOT for MRSA
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Piperacillin, Ticarcillin, Azlocillin, Mezlocillin
Cover?
Best Intial Tx of?
Cover: GNB (E.coli, Proteus), Enterobacteriaciae group & Pseudomonads
- Best Initial Tx:
- - Cholecystitis and Ascnd Cholangitis
- - Pyeloneph
- - Bacteremia
- - Hosp-Acq /Vent-assoc Pneumonia
- - Neutropenia & Fever
Usually used in combo w Beta-Lac inhib (Tazobactam or Clavulanic Acid)
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Cephalosporins
*Listeria, MRSA, and Enterococcus are resistant to all forms of Ceph's*
<3% cross-rxn with PCN
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Cephalosporin Coverage (all classes)
- Group A, B, C strep
- Viridans group Strep
- E. coli
- Klebsiella
- Proteus mirabilis
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If rash to PCN, use?
Cephalosporins
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If anaphylaxis, use what instead?
Non- beta-lactam Abx
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1st gen Ceph: Cefazolin, Cephalexin, Cephradrine, Cefadoxyl
used to treat?
- staphylococci: methicillin sens = oxacillin sens= cephalosporin sens
- Streptococci (except Enterococcus)
- some GNB (e.g. E. coli), but NOT Pseudomonas
- Osteomyelitis, septic arthritis, endocarditis, cellulitis
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2nd Gen Cephalosporins
(Cefotetan, Cefoxitin, Cefaclor, Cefprozil, Cefuroxime, Loracarbef)
- Cover same as the 1st gen, & add anaerobes, and more GNB
- (Cefotetan or Cefoxitin) --> best initial PID (combo w Doxycycline)
- :( Cefotetan, Cefoxitin incr risk bleeding & EtOH-Disulfram Rxn
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3rd Gen Ceph
(Ceftriaxone, Cefotaxime, Ceftazidime)
- Ceftriaxone: 1st line pneumococcus, incl partially insens orgs (Meningitis, CAP in combo w macrolide, Gonorrhea, Lyme involving heart or brain)
- Avoid Ceftriaxone in neonates: impaired biliary metabolism
- Cefoxatime: Superior to ceftriaxone in neonates; spontaneous bacterial peritonitis
- Ceftazidime has Pseudomonal coverage!!
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4th gen Ceph: Cefepime
Staphylococcus coverage: better than 3rd gen
- Tx of:
- Neutropenia / fever
- Vent-assoc pneumonia
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5th gen Ceph: Ceftaroline
First Ceph to cover MRSA!!
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Adverse Effects of Cephalosporins
- Cefoxitin and cefotetan deplete prothrombin, and therefore incr risk of bleeding
- Ceftriaxone: inadequate biliary metabolism
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Carbapenems
(Imipenem, Meropenem, Ertapenem, Doripenem)
Cover?
Tx?
- Cover: GNB (incl resistant, anaerobes, strep, staph), Pseudomonas*
- Tx: neutropenia and fever
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Ertapenem differs from other carbapenems in that...
no Pseudomonas coverage
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Aztreonam
(only drug of Monobactam class)
- Exclusively for GNB, including Pseudomonas
- no cross-rxn w PCN
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