Antibiotics: Beta-Lactams Flashcards
(26 cards)
Abx With Highest C. Diff Risk
-broad-spectrum penicillins
-broad-spectrum cephalosporins
-quinolones
-carbapenems
-clindamycin** (BBW)
PQ CCC
Beta-lactam Antibiotics
-penicillins, cephalosporins, carbapenems
-characterized by beta-lactam ring
-inhibit bacterial cell wall synthesis (prevents peptidoglycan synthesis)
-carbapenems are only parenteral (pcn/ceph in multiple formulations)
Penicillins: BBW/CI/AE (entire class)
BBW:
-PCN G benzathine: NOT FOR IV USE (cardio-resp death)
CI:
-Type 1 hypersensitivity reaction to pcn/bl
-Augmentin/Unasyn: cholestatic jaundice or hepatic dysfunction with prior use
-Augmentin XR or 875 strength: do not use CrCl < 30
AE:
-Seizures*
-Rash, SJS, TEN
-Anaphylaxis, allergic rxn
-Hemolytic anemia (+ Coombs)
-GI
HUA RIC SASA, XR/875 30
Antistaphylococcal Penicillins
-Dicloxacillin, Nafcillin, Oxacillin
FOR
-MSSA soft tissue/bone/joint/endocarditis/bloodstream
NO renal dose adjustments
-Nafcillin is a vesicant (central line preferred)
*if extravasation occurs, use cold packs and hyaluronidase
Aminopenicillins
-Amoxicillin, Augmentin, Ampicillin, Unasyn
Ampicillin PO is rarely used due to poor bioavailability
-Amoxicillin is preferred if switching from IV ampicillin
Augmentin ES-600: preferred formulation for AOM (ear tx in children, lower risk of clavulanate = less diarrhea)
IV ampicillin and unsays is preferably diluted in NS
Augmentin XR or 875 strength: do not use CrCl < 30
Penicillins: DDIs
-Probenecid (increase levels of BLs)
-Methotrexate
-Nafcillin/Dicloxacillin can inhibit AC effect of warfarin (the other BLs enhance AC effect of warfarin)
Exceptions to PCN Allergy
Treatment of syphilis during pregnancy or in patients with poor compliance/follow-up
-desensitize and treat with penicillin G benzathine
First Line for Pharyngitis
Penicillin VK (strep throat)
First Line for AOM
Amoxicillin (peds dose 80-90 mg/kg/day)
Augmentin (peds dose 90 mg/kg/day)
DOC for Infective Endocarditis PPX Prior to Dental
Amoxicillin 2 g PO x 1, 30-60 min before procedure
First Line for Bacterial Sinusitis
Augmentin
DOC for Syphilis
PCN G Benzathine (Bicillin LA)
-2.4 mil units IM x1
NOT FOR IV USE
Only PCN Active Against Pseudomonas
Zosyn (PIPTAZO)
Extended infusions (4 hours) can be used to maximize T > MIC
Cephalosporins: Class Overview
-generally, the gram-negative spectrum increases with each generation
-not active against Enterococcus spp. or atypical organisms as a class
Cephalosporins: BBW/CI/AE
CI FOR CTX ONLY:
-Hyperbilirubinemic neonates (0-28 days old) (biliary sludging, kernicterus)
Warning:
-Cross-reactivity with PCN allergy (< 10%, higher risk with first gens)
-Don’t use in type 1 hypersensitivity to PCN
AE: SR ANAML
-Seizures*
-Rash, SJS, TEN
-Anaphylaxis, allergic rxn
-Acute interstitial nephritis
-Hemolytic anemia (+ Coombs)
-Myelosuppression with long usage
-Increased LFTs
TRI BILI CH SR ANAML
Ceftriaxone
CI: Hyperbilirubinemic neonates
NO RENAL DOSE ADJUSTMENTS NEEDED
CNS penetration at high doses (2g BID) when meninges inflamed
Cefiximie
Available in chewable tablet
Ceftazidime/avibactam
activity against some carbapenem-resistant Enterobacterales (CRE)
Cefiderocol
Increase to 2 grams Q6H if CrCl ≥ 120 mL/min
Cephalosporins: DDIs
-CTX: precipitates form when used in same line as Ca-containing fluids (administer at different times for adults, concurrent use CI in neonates)
-Cefuroxamine, Cefpodoxime, Cefdinir: should be separated by 2 hours form antacids
*AVOID H2RAs and PPIs
PUD HAP
Cephalosporin with Pseudomonas Activity
Ceftazidime
Cephalosporin with MRSA Activity
Ceftaroline (only one)
Carbapenems: CI/AE
CI:
-Anaphylactic rxn to BLs
Warning:
-Do not use in PCN allergy (cross-reactivity)
-CNS (seizures, confusion = higher risk with imipenem/cilastatin, large doses or impaired renal function)
AE:
-DRESS
-Bone marrow suppression with long usage
-Increased LFTs
-Diarrhea
ABCD carbs are L
All are IV
Ertapenem
Stable in NS only
No coverage of Pseudomonas, Acinetobacter or Enterococcus
APE ertAPEnem
