Beta-lactam ABx: PCN, Cephalosporins, Carbapenemps, Aztreonam

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  1. Beta-lactams include:
    PCN's, Cephalosporins, Carbapenems, Aztreonams
  2. PCN coverage
    viridans strep, S. Pyogenes, oral anaerobes, syphillis, Leptospira
  3. Ampicillin & Amoxicillin coverage:
    • (same as PCN) plus:
    • -E.Coli
    • -Lyme Dz
    • -few GNB
  4. Bacteria Covered by Amoxicillin
    • H. influenza
    • E. Coli
    • Listeria
    • Proteus
    • Salmonella
  5. 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
  6. PRP's (penicillinase resistant PCN)
    Oxacillin, Cloxacillin, Dicloxacillin, Nafcillin
    Tx of?
    • -Skin infxn: Cellulitis, impetigo, erysipelas
    • -Endocarditis, meningitis

    NOT for MRSA
  7. Piperacillin, Ticarcillin, Azlocillin, Mezlocillin
    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)
  8. Cephalosporins
    *Listeria, MRSA, and Enterococcus are resistant to all forms of Ceph's*

    <3% cross-rxn with PCN
  9. Cephalosporin Coverage (all classes)
    • Group A, B, C strep
    • Viridans group Strep
    • E. coli
    • Klebsiella
    • Proteus mirabilis
  10. If rash to PCN, use?
  11. If anaphylaxis, use what instead?
    Non- beta-lactam Abx
  12. 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
  13. 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
  14. 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!!
  15. 4th gen Ceph: Cefepime
    Staphylococcus coverage: better than 3rd gen

    • Tx of:
    • Neutropenia / fever
    • Vent-assoc pneumonia
  16. 5th gen Ceph: Ceftaroline
    First Ceph to cover MRSA!!
  17. Adverse Effects of Cephalosporins
    • Cefoxitin and cefotetan deplete prothrombin, and therefore incr risk of bleeding
    • Ceftriaxone: inadequate biliary metabolism
  18. Carbapenems
    (Imipenem, Meropenem, Ertapenem, Doripenem)
    • Cover: GNB (incl resistant, anaerobes, strep, staph), Pseudomonas*
    • Tx: neutropenia and fever
  19. Ertapenem differs from other carbapenems in that...
    no Pseudomonas coverage
  20. Aztreonam
    (only drug of Monobactam class)
    • Exclusively for GNB, including Pseudomonas
    • no cross-rxn w PCN
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Beta-lactam ABx: PCN, Cephalosporins, Carbapenemps, Aztreonam
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