Antimicrobials: Part 9: Clinical uses of drugs that work within the cell wall + membrane

Question 1

What are the clinical uses of natural penicillins?

Answer 1

• These treat gram + and some gram -

- Notably, they treat s. pyogenes, s. pneumo, actinomyces, treponema pallidum, and sometimes n. meningitidis.

Question 2

What are the clinical uses of aminopenicillins?

Answer 2

• These can do the same as the natural penicillins as well as some more gram - organisms due to how they penetrate porin channels
• Special extended spectrum for: H. influenza, H. pylori, E. coli, listeria, proteus, salmonella, shigella, and enterococci

Question 3

What are the clinical uses of penicillinase-resistant penicillins?

Answer 3

• Cover staph aureus (not the MRSA though) and most strep.
• Cover the same as penicillins
• Very commonly used in cellulitis and impetigo as well as endocarditis (if bacteria deemed sensitive to the agent)

Question 4

What are the clinical uses of antipseudomonals?

Answer 4

Obviously, these are used for pseudomonas!
This is due to how good they are at porin penetration.

Often given with beta-lactamases.

When given together with them, they cover most gram + except MRSA, most gram -, and most anaerobic bacteria.

Good for hospitalized patients with sepsis and pneumonia

Question 5

What are the clinical uses of 1st generation cephalosporins?

Answer 5

• Covers gram + including staph aureus but no listeria or enterococcus
• Gram - include proteus, klebsiella, and E. coli
• Cefazolin used in pre-op for surgical wound infections

Question 6

What are the clinical uses of 2nd generation cephalosporins?

Answer 6

• Gram + cocci
• Increased gram negative: H. Influenzae, enterobacter, proteus, E. Coli, klebsiella, serratia, and N. gonorrhea
• Increased anaerobic cover

Question 7

What are the clinical uses of 3rd generation cephalosporins?

Answer 7

• Good for serious gram - that are resistant to other beta-lactams
• Ceftazidime covers pseudomonas
• Most drugs in this class have good CNS penetration → good for meningitis
• Ceftriaxone is used for gonorrhea and meningitis commonly

Question 8

What are the clinical uses of 4th and 5th generation cephalosporins?

Answer 8

4th generation: cefepime
Many gram +, many gram -, and pseudomonas coverage increased

5th generation: ceftaroline is active against MRSA, VRSA, and E. faecalis!!! Woah.

Question 9

What are the clinical uses of carbapenems?

Answer 9

• Very strong antibiotics

- Can be used against g+, g- (including pseudomonas and enterobacter), and anaerobes (including bacteroides)

Question 10

What are the clinical uses of aztreonam?

Answer 10

• Only active against gram negatives!!!

- Active against pseudomonas

Question 11

What are the clinical uses vancomycin?

Answer 11

• Only effective in gram +
• For serious bugs only
• Typically only given in MRSA and oral therapy for C. diff
• Also for S. epidermidis, and enterococcus species

Question 12

What are the clinical uses of polymyxins?

Answer 12

• For multidrug resistant gram - bacteria

- Also part of neosporin

Question 13

What are the clinical uses of daptomycin?

Answer 13

• S. aureus skin infections (yes, MRSA too)
• NOT used for pneumonia as it avidly binds and is -inactivated by surfactant
• Bacteremia, endocarditis, and VRE