What are the three classes of Beta Lactums?
1) Penicillins (-cillin)
2) Cephalosporins (cef- or ceph-)
3) Carbapenems (-penem)
Bacterial cell walls are unique in what way?
they are very stiff and rigid with cross-links
This creates a very high oncotic pressure within the cell, if the wall fails, the cell will fill with fluid from outside and burst
This is how many antibiotics work
How do Beta Lactums (-cillin, -cef, -ceph, & -penem) work?
They block the cross-links within the rigid cell walls of bacteria from forming. This weakens the cell wall, allowing pressure to build up until the cell bursts and dies
What are the common penicillin (-cillin) types?
- Penicillin G
- Penicillin V or VK
- Amoxicillin
- Amoxicillin/clavulanate
What defense do bacteria have against Beta Lactams?
Beta-Lactamase
An enzyme that breaks down Beta-Lactam ring and destroys it (counterattack)
Which bacteria is well known to have the enzyme beta Lactamase?
Staphylococcus (80%)
Which Beta-Lactam antibiotic has the ability to block Beta-Lactamase and prevent it from working?
Amoxicillin/clavulanate
The clavulanate was added to block the enzyme from destroying Beta-Lactam ring
Which class of Beta-Lactams has a stronger group attached to the Beta-Lactam ring, thus making it more difficult for Beta-Lactamase to work?
Cephalosporin
remember it’s got a basement as well
How many generations of Cephalosporin are there?
Five
Newer it is, the more broad-spectrum it is
With each successive generation of Cephalosporin, what happened?
- Increased gram - coverage
- increased anaerobe coverage
- increased Beta-Lactamase resistance
- increased CSF distribution (BBB crossing)
Which generation of Cephalosporin has a lot of Gram+ coverage but little Gram- coverage?
First Gen
Which generation of Cephalosporin has the most gram- coverage?
Fourth Gen
Which generation of Cephalosporin is used prophylactically before surgery?
First Gen
Which gernation of Cephalosporin is used to treat C. diff?
Third Gen
3 looks like a butt
Which generation of Cephalosporin is the least used?
Second Gen
Which generation of Cephalosporin is best for Meningitis?
3, 4, 5
Gen 1 & 2 cannot cross BBB so they are not useful to treat meningitis
Which generation of Cephalosporin is used for Nosocomial Infections?
Fourth Gen (cefepime)
Which generating of Cephalosporin is used to treat MRSA?
Fifth Gen (ceftaroline)
Adverse effects of Beta-Lactams?
- Nausea
- Diarrhea
- Superinfection (thrush, C. diff)
- Allergic Reactions (primarily w/-cillin)
What if you have an anaphylactic reaction to penicillin?
Stop and give Epinephrine
What are three common superinfection caused by Beta-Lactams?
- Thrush
- Yeast
- C. diff
What are the three interventions for a client diagnosed w/ C. diff?
Stop, Swap, & Zole (or Vanco-)
STOP the third gen drug
SWAP the hand-foam and use soap instead (hand-foam not strong enough)
Give metranidaZOLE (or Vancomycin)
What is the first question you would ask a client who says they had a penicillin allergy?
What was the reaction like?
so that we can determine which type of beta-lactam we can give them
If the allergic response to penicillin was anaphylaxis, should we give a Ceph-?
NO
If the allergic response to penicillin was Hives, should we give a Ceph-?
NO
If the allergic response to penicillin was a Morbilliform Rash, should we give a Ceph-?
Yes, it’s ok to give a ceph-
moribilliform rash doesn’t itch, Hives do
Which two responses to penicillin prohibit us from prescribing a ceph-?
Anaphylaxis
Hives (itching)
Teaching plan for a client taking an antibiotic?
Call if you don’t feel better in a few days
Complete the entire course
