Flashcards in B lactams and monobactam Deck (46):
What is the hallmark sign of infection?
fever, above 38C
What are noninfectious causes of fever?
malignancy, drug fever, blood transfusions
What is the level of leukocytosis?
What does a low WBC in the setting of confirmed infection indicate?
What are bacterial infections associated with?
elevated neutrophils and bands
What is associated with lymphocytosis?
viral infections, TB or fungal infection
What is empiric therapy?
directed against suspected organism before identification of the pathogen, outcomes will always be better if initial therapy was later found to provide adequate coverage
What is important in determining the right antimicrobial?
the PK, causative organism for site of infxn, host factors, drug factors, resistance
What is concentration dependent abx?
efficacy and extent of killing is directly related to the [drug] compared to the MIC, give higher doses less frequently
What is time dependent abx?
efficacy and extent of killing is directly to time the [drug] is greater than MIC, give lower doses more frequently
When using combo abx, what are the effects?
synergy, additive, antagonist
What does date support for treatment of pseudomonas?
double empiric coverage- always use different classes, 1 time dependent 1 concentration dependent
Natural PCNs options
penicillin G, penicillin benzathine, penicillin VK
ampicillin, amoxicillin (amoxil)
penicillinase resistant PCNs (anti-staphylococcal)
nafcillin, dicloxacillin, oxacillin
B lactamase inhibtors
taxobactam, sulbactam, clavulanate
B lactam/B lactamase inhibitor combos
piperacillin/tazobactam (Zosyn), ampicillin/sulbactam (Unasyn), amoxicillin/clavulanate (augmentin)
What is MOA of penicillins
inhibition of bacterial cell wall synthesis by binding to and inactivating binding proteins
What account for penicillin antimicrobial activity
the B lactam ring
What are the pk of penicillin
time dependent, rapid bactericidal, short T1/2, onlly penetrates CNS in inflamed meninges, renally eliminated
Spectrum of natural penicillins
viridans strep, Group A strep, S. pneu, neisseria meningitidis, oral anaerobes, trepnema pallidum, clostridium
What do natural penicillins not cover?
staphlococcus since most staph produce A beta lactamase
Clinical uses of natural penicillins?
s. pneu, syphilius, prophylactic dental procedures, oral anaerobes, labor and delivery, strep pharyngitis
Anti-staphlococcal penicillin spectrum of activity
penicillinase resistant, MSSA
What do anti-staphlococcal penicillins not cover?
MRSA, not as good for strep, no gram -
Clinical use of anti-staphlococcal penicillins
any infection with confirmed MSSA, skin, bacteremia, pneu, osteoarthritis, septic arthritis
Spectrum of aminopenicillins
gram +, DOC for enterococci and listeria, adds gram - coverage not seen with naturals, H. influenzae, E. coli, proteus mirabilis, salmonella, shigella
Clinical use aminopenicillins
upper RTI, dental prophylaxis, enteroccal UTI, endocarditis, Meningitis
What do aminopenicillins not cover?
alone, they do not cover S. Aureus
decreases effectiveness of birth control pills, amoxicillin better absorbed than ampicillin so higher doses of ampicillin required, ampicillin penetrates inflamed meninges
Beta lactamase inhibitors antimicrobial activity
alone do not have antimicrobial activity, gives stability to other penicillins, provides additional activity against anaerobes
What SE is high in beta lactamase inhibtors
abx associated diarrhea
Aminopenicillins+ B lactamase inhibitor spectrum
improves activity against H influ, e coli, proteus mirabilis, s aureus (MSSA), moraxella catarrhalis, anaerobes
Clinical use of aminopenicillins + B lactamase inhibitor
abd infxn (anaerobes, gram -, enterococcus)
Clinical use of augmentin
otitis media, sinusitis, chronic bronchitis, skin and soft tissue, lower resp tract infxn, human or animal bite
Clinical use of Ampicillin/sulbactam (Unasyn)
otitis media sinusitis, chronic bronchitis, skin and soft tissue, lower RTI, human or animal bite, better for enterococci
Spectrum of carboxypenicillins
pseudomonas, drug resistant proteus, morganella, enterobacter, MSSA, anaerobes, enterobacteriasceae
Clinical use of carboxypenicillins
multi-drug resistant gram -, many conditions, IV only
Dose of Zosyn
IV 3.375 gm Q 6hrs
Spectrum of ureidopenicillins
even more broad spectrum than carboxypenicillins, better reliability against klebsiella, serratia, enterobacter, enterobacteriaeceae, enterococcus faecalis, pseudomonas, MSSA
What is the DOC against pseudomonas
Clinical use of ureidopenicillins
Multi-drug resistant gram -, many conditions
What is the drug of choice for empiric therapy for any severe infection?