*For what conditions is bactericidal antibiotic therapy required? (4 dz’s)
- Meningitis - Endocarditis - Osteomyelitis - Febrile neutropenia
Bactericidal or bacteriostatic? Cell wall formation/synthesis inhibitors are in general _____________. Nucleic acid synthesis inhibitors are ___________. Protein synthesis inhibitors tend to be ____________. Metabolic inhibitors are usually ______________.
Cell wall formation/synthesis inhibitors are in general bacteriocidal. Nucleic acid synthesis inhibitors are bacteriocidal. (exception: aminoglycosides) Protein synthesis inhibitors tend to be bacteriostatic. Metabolic inhibitors are usually bacteriocidal.
What are the 3 key concepts to consider regarding infection when considering antibiotic tx?
- Severity - Site - Organism
What are the 6 key concepts to consider regarding the host when considering antibiotic tx?
- Allergies - Age - Pregnancy - Renal/hepatic function - Drug interactions (w/theirs) - Underlying disease
What are the 7 key concepts to consider regarding the drug when considering antibiotic tx?
- Predicted activity/measured susceptibility - Clinical efficacy - “Drug of choice” - PK and tissue penetration - PD (need cidal?) - Side Effects - Cost
What are the 2 groups of natural PCNs?
PCN G and PCN VK (oral)
What are the 4 types of penicillinase-resistant penicillins?
Nafcillin, oxacillin, methacillin, dicloxacillin
What are the 2 aminopenecillins?
Ampicillin and amoxicillin
What is the name of the carboxypenicillin?
Ticarcillin (not avail.)
What is the name of the ureidopenicillin?
Name 4 beta-lactamase inhibitor-combo treatments. (just the overall drug names)
- Unasyn - Timentin - Zosyn - Augmentin
Are PCNs time- or conc-dependent killing?
What group does PCNs have synergy w/?
Aminoglycosides (against Enterococcus spp., Staphylococcus spp., viridans strep, and gram-negative bacteria)
PCNs distribute throughout body tissues/fluids except for these 3 sites:
Eye, prostate, and uninflammed CSF.
*What 5 things are natural PCNs commonly used for treating, besides the organisms previously mentioned? (extra stuff that's on slides but not blue)
- Actinomyces - Bacillus anthracis (anthrax) - Endocarditis prophylaxis - Prevention of rheumatic fever
What type of infections (not organisms) are amino-PCNs used to treat?
- Respiratory tract infections - Pharyngitis - Sinusitis - Otitis media - Bronchitis - UTIs
Although not clinically available, what types of conditions do ticarcillin and pipercillin typically treat?
The beta-Lactamase Inhibitor Combination treatment Augmentin is typically used to treat what sx?
Sinusitis, otitis media, upper and lower respiratory tract infections, human or animal bite wounds (similar to amino-PCNs)
The beta-Lactamase Inhibitor Combination treatments Unasyn, Zosyn, Timentin are typically used to treat what major types of infections?
- Polymicrobial infections - Empiric therapy for febrile neutropenia or hospital-acquired infections (Zosyn)
MoA of all beta-lactams? - Cidal or static?
Inhibit cell wall synthesis by binding and thus inhibiting PBPs. Inhibits final transpeptidation step of peptidoglycan synthesis. - Bactericidal
*Most beta-lactams are eliminated by the ___________. *What are the exceptions? (don't forget cephalosporins)
Kidneys - Nafcillin, oxacillin, dicloxacillin (PRPs) - Ceftriaxone (cephalosporin) - Cefoperazone (cephalosporin)
What are the beta-lactam mechs of resistance? (Which is most important?)
Beta-lactamase enzymes (most important; cephalosporins are less susceptable), PBP alteration, decreased membrane penetration
2 eg's of organisms that inhibit beta-lactams via beta-lactamase are:
- PRSP - MRSA
What 2 drugs are contained in Unasyn?
What 2 drugs are contained in Timentin?
What 2 drugs are contained in Zosyn?
What 2 drugs are contained in Augmentin?
What is the route of administration of PCN G, aqueous form? Benzathine salt form? Procaine form?
- Aqueous: IV - Benzathine: IM - Procaine: IM
What is the route of administration for PCN VK?
PO (acid stable)
Which of the 4 penicillinase-resistant penicillins can be given orally?