• Penicillen
• Cephalosporin
• Imipenem, meropenem
• aztreonam

Increased lipid solubility, allergy potential (sulfur)

1. Inhibit peptidoglycan cross-linking

2. Block peptidoglycan synthesis

Vancomycin

Bacitracin

1. Bind penicillin binding protein (PBP
2. Blocks transpeptidation
3. Blocks crosslinking on cell wall

1. Penicillinases (cleaves square ring)
2. Structural changes of PBPs
3. Change in porin structure

Penicillin G (IV form)

Penicillin V (oral)

(Prototype)

G+ organism (because of its peptidoglycan wall)

• Narrow spectrum--> β lactamase sensitive
• Very narrow spectrum--> β lactamase resistant
• Broad spectrum--> β lactamase sensitive
• Extended spectrum

Syphillis

G+ organisms (S. pneumo, S. pyogenes, Actinomyces)

Bactericidal for G+ cocci, G+ rods, G- cocci, spirochetes

• Hypersensitivity rxn
• Hemolytic anemia

• Methicillin
• Naficillin
• Oxacillins

S. aureus (NOT MRSA)

*Use naf(naficillin) for staph

• Hypersensitivity
• Methicillin-interstitial nephritis

• Amoxicillin (greater oral availability)
• Ampicillin (work horse of penicillins)
• (aminopenicillins)

• G+: Listeria monocytogenes
• G-: E.coli, H. influenzae, P. mirabilis, Salmonella, enterococci

 Ampicillin/Amoxicillin HELPS kill Enterococci

• Hypersensitivity rxn
• Ampicillin rash
• GI distress (esp with ampicillin)
• Pseudomembranous colitis

• Ticarcillin
• Carbenicillin
• Piperacillin

Pseudomonas and G- rods

Use w/ Clavulanic acid to increase spectrum

TCP: Takes Care of Pseudomonas

• Clavulanic acid
• Sulbactam
• Tazobactam

CAST

Added to penicillin antibiotics to protect antibiotic from penicillinase (β-lactamase)

• Cefazolin
• Cephalexin (if it has -ph, it's 1st generation)

PEcK and (G+ cocci)

• Proteus mirabilis
• E. coli
• Klebsiella pneumoniae

Used for surgical prophylaxis

What are the 2nd generation cephalosporins?

• Cefoxitin
• Cefotetan
• Cefaclor
• Cefuroxime

• Ceftriaxone
• Cefotaxime
• Ceftazidime

Broad spectrum, serious G- infections resistant to other B lactams.

DOES NOT work on: LAME

• Listeria (give Amox)
• Atypicals (give macrolides)
• MRSA (give vancomycin)
• Enterococci

Sepsis/meningitis (except cefoperazone

Ceftriazxone: meningitis/gonorrhea

Ceftazidine: Pseudomonas

• Hypersensitivities (use macrolides or aztreonam (for G-) in case of allergies
• Vitamin K deficiency
• inc nephrotoxicity of aminoglycosides
• disulfram like rxn w/ ethanol
• cefoperazone/ceftriaxone eliminated in bile (lipid soluble)

Imipenem/cilastatin

Meropenem

Like penicillin, but penicillinase resistant

Imipenem: use w/ cilastatin (inhibitor of renal dihydropeptidase I) to dec inactivation of drug in renal tubules

"the kill is LASTIN' w/ ciLASTIN"

• Broad spectrum
• G+ cocci
• G- rods
• anaerobes

• GI distress
• skin rash
• CNS toxicity (seizures) @ high plasma level in 50% of pts
• SE decreases use of drugs.  Meropenem has dec risk of seizures

Similar to penicillin but resistant to penicillinase

Binds to PBP3

G- rods only

Use for penicillin-allergic pts and those w/ renal insuficciency who can't take aminoglycosides

Usually nontoxic; occasional GI upset.  

No cross-sensitivity w/ penicillins or cephalosporins

• Inhibit mucopeptide formation by binding D-ala D-ala portion of cell wall precursors
• Hinders transglycosylation rxns

G+ only: MRSA, C.dif (not 1st choice), enterococci

Serious, multi-drug resistant bacteria

• Nephrotoxicity
• Ototoxicity
• Thrombophlebitis
• "Red man syndrome"
• well tolerated, NOT have many problems

• VRSA, VRE can change the amino acid of D-ala D-ala to D-ala D-lac
• Give linezolid to VRSA, VRE
  

• Binds to cell membrane of bacteria, disrupt osmotic properties
• Cationic, basic proteins that act like detergents

Polymyxin B

Colistimethate (polymyxin E)