Download 401_07_bigbugs_bigdr..

1
Big Bugs
Review #1 – Beta Lactam Antimicrobials
Bug
Strep pyogenes
Characteristics
Gram (+) cocci
in chains
Strep pneumo
Gram (+) cocci
in chains or as
diplococci
Staph aureus (coag +)
Staph epi (coag –)
Gram (+) cocci
in clusters
E. faecalis
E. faecium
Gram (+) cocci
Enterobacteriaceae:
E. coli
Enterobacter
Klebsiella
Serratia
Proteus
Morganella
Providencia
Citrobacter
Salmonella
Shigella
Common Infections
Strep throat
Cellulitis
Erysiphelis
Scarlet fever
Necrotizing faciitis
CAP
Otitis media
Meningitis
Sinusitis
Bronchitis
Skin
Pneumonia
Bone
Sepsis etc.
UTI
Sepsis
Catheter infections
Endocarditis
Nosocomial infections
Gram (–) rods
UTI, traveler's diarrhea, etc.
misc. nosocomial
nosocomial pneumonia, etc.
misc. nosocomial
UTI
UTI
UTI
UTI
gut
gut
Common Treatment with -lactam
Pen G (IV)
Procaine Pen G (IM)
Benzathaine Pen G (IM)
Pen V (PO)
Resistance and Treatment
Not yet
Pen G (IV)
Pen V (PO)
Amoxicillin
PRSP - use vancomycin
(IV) or other appropriate
non beta lactam
Nafcillin (IV)
Dicloxacillin (PO)
If MRSA - use vancomycin
(IV) or other non beta
lactam
Ampicillin (IV)
Pen G (IV)
Vancomycin is 1st choice if
resistant to penicillins.
If vancomycin resistant,
then Zyvox or Synercid.
Not other beta lactams
E. faecium mostly resistant
Amoxicillin (PO)
Amox/Clav (PO)
Amp/Sulbactam (IV)
2 - 4th generation cephalosporins
Carbapenem
Aztreonam
If resistant, do sensitivity
tests to find an appropriate
drug.
2
Pseudomonas
Gram (–) rods
N. gonorrhoeae
Gram (–) cocci
Burns
Skin
Bronchitis
Sepsis
UTI
Gonorrhoea
N. meningitidis
Gram (–) cocci
Meningitis
Bacteriodes fragilis
Gram (–) rods
Anaerobe
Gram (–) cocci
Sepsis
Abscess
Otitis media
Sinusitis
Bronchitis
Otitis media
Sinusitis
Bronchitis
Moraxella cat.
H. influenza
Pleomorphic
Gram (–)
Piperacillin (w/wo tazobactam)
Ceftazidime (3rd gen cef)
Cefepime (4th gen cef)
a carbapenem
3rd gen cef:
Vantin (PO) stat dose
ceftriaxone (IM/IV) stat dose
Pen G
Cefuroxime or some 3rd gen cef
in Pen allergies
Amp/sulbactam (IV)
Cefotetan (IV)
Augmentin or 2nd/3rd gen cephs
Augmentin or 2nd/3rd gen cephs
May combine with
aminoglycosides.
Resistance is common due
to beta lactamases and
restricted porin.
Produce -lactamases
Not common
Produce -lactamase
All produce -lactamases
Many produce -lactamases
3
Big Drugs
Drugs class
Penicillins
Simple penicillins
Penicillinase-resistant Pens
Amino-penicillins
Extended-spectrum
(Anti-pseudomonal)
Penicillins with -lactamase
inhibitors
Cephalosporins (PO)
1st generation
3rd generation
Cephalosporins (IV)
1st generation
2nd generation
3rd generation
4th generation
Antibiotics
Effective against
Special notes
Pen G (IV/IM)
Pen V (PO) (for mild infections)
Nafcillin (IV)
Dicloxacillin (PO)
Ampicillin (IV)
Amoxicillin (PO)
Some gram (+) (not Staph)
Strep pyogenes, neisseria
Staph
Potent for Streptococcus
If PRSP, use vancomycin
If MRSA, use vancomycin
Will be hydrolyzed by
penicillinases and -lactamases
Piperacillin (IV)
Gram (+) (not Staph)
Weak Gram (–) (not -lactamases
producing ones)
Many pseudomonas
Amox/clav (PO)
Amp/sulbactam
Ticarcillin/clav
Pip/tazobactam
Gram (–)
Broad spectrum
Good Gram (–)
Pseudomonas in mixed infection
Augmentin: good for bugs
resistant to Amox
Amp/sulbactam: same and also
anaerobes
Cephalexin
Cefdinir (suspension)
Cefpodoxime
Gram (+) and some Gram (–)
Better resistance to -lactamases
Cefazolin
Cefuroxime
Cefotetan
Cefotaxime
Cetriaxone
Gram (+) and some Gram (–)
Better resistance to -lactamases
Good anaerobic activity
Ceftazidime
Cefepime
Carbapenems
Meropenem, Ertapenem
Monobactams
Imipenem
Aztreonam
N. gonorrhoea
Excellent Gram (+)
Gram (–) including Pseud.
Gram (+)
Gram (–) including Pseud.
Gram (+)
Gram (–) including Pseud.
Gram (–) only
PO for kids
Stat for gonorrhaea
Crosses into CNS
"Cefamycin" drug
Once daily drug
Crosses into CNS
Crosses into CNS
Crosses into CNS
Meropenem can be used in
meningitis
No meningitis indication
Can use in penicillin allergy
(anaphylactic)
4
Special Note:
- Pregnancies - All -lactams are okay
- In penicillin allergy (rash), give cephs
- Anaphylactic reaction:
PO: no suitable -lactams
IV: aztreonam (if infection is Gram (–))
4/4/07