Antupseudomonals -Penicillins

Question 1

What are common indications?

Answer 1

1.lower RTI
2. UTI
3.intraabdopminal infection
4. Skin and soft tissue

Question 2

What group of people are anti pseudomonas reserved for ?

Answer 2

For severe infections
Where there is broad spec
If antibiotic resistance is likely (HAP) or severe immune suppression

Question 3

What is the mechanism of action?

Answer 3

Penicillins inhibit enzymes responsible for cross-linking peptidoglycans.

This weakens bacterial cell walls,

This reduces their ability to maintain osmositis leading to cell swelling, lysis, and death

Question 4

What part of penicillin structure gives it badteriacidal activity?

Answer 4

The beta-lactam ring

Question 5

How do anti pseudomorals differ structurally from other penicillins?

Answer 5

The beta - lactic ring has a longer side chainI, improving affinity to penicillin-binding proteins, increasing spectrum of activity

Formulated with beta lactmase inhibitor which is Tazobactam

Question 6

What is the spectrum of activity?

Answer 6

Broad spectrum
Gram positive aNd negative
Anaerobes

Question 7

What are important side effects?

Answer 7

Gl upset
Colitis
C. Diff
( can be complicated by colonic perforation and/death )

Question 8

Who should be prescribed with caution?

Answer 8

Patients with C diff infections
Older people
Those in Hospital
Dose reduced in moderate/severe renal impairment

Question 9

Why should those with penicillin allergy not be prescribe cephalosporins?

Answer 9

It is a similar structure to pencillin (beta lactam abx)

Question 10

Wear are important interactions?

Answer 10

Penicillins reduce renal excretion of ▲ methotrexate increasing risk of toxicity

Enhances the anticoagulant effects of warfarin by killing GI flora that synthesise vitamin K

Question 11

Give examples

Answer 11

Piperacillin with tazobactam

Tazocin

Question 12

How is piperacillin and tazobactam administered ?

Answer 12

IV 4.5g
4g of piperacillin
500mg of tazobactam every 6-8 hours

Question 13

What is the length of course for piperacillin and tazobactam?

Answer 13

5-14 days
Only available via IV so can only be switched from IV to oral if alternative is available.

Question 14

Why should caution be taken when given to patients with HF or oedema?

Answer 14

It contains 11mmol Na+ and is infused in 50-150ml fluid and can affect patients with HF and oedema