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51 Cards in this Set
- Front
- Back
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cell wall synth inh
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beta-lactam, glycopeptide, bacitracin, fosfomycin, fosmidomycin
has to be small/polar to pass through porin on outer lipid bilayer, hydrophilicity helps bac growth req expansion, can't stretch cell wall so use autolysin to break down and rebuild (inh this step = bacteriocidal) |
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beta-lactams
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pcn (natural, antistaph, aminopcn, antispeudomonal, pcn + b-lactamase inh combo), cephalosporin (5 gen), carbapenem, monobactam
moa bind transpeptidase, inh pg polymer xlink 4 member ring, good tissue penetration (even cns except 1/2nd gen ceph), time-dependent, most renal elim (good for pyelo), no prostate ae t1hs (ige/idiopathic, can use desensitization to deplete ige over 4 hrs, temp immunity), n/v/d, seizure w/ high dose |
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natural pcn (g/v)
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pcn g (benzylpcn, iv only), pcn v (phenoxymethyl pcn, po only), depot formulation (oil immersion, im only for syphillis), renal elim, hl 30 min, most bac res (e.g., staph b-lactamase)
use group a strep, enterococci, treponema pallidum (syphillis, neurosyph) |
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antistaph pcn
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penicillinase-res pcn, bulky r group
use mssa (cellulitis, endocarditis), strep, NOT enterococci nafcillin/oxacillin (iv), dicloxacillin/cloacillin (po), methicillin nafcillin, oxacillin, dicloxacillin, cloacillin, methicillin |
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dicloxacillin
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po antistaph pcn
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cloacillin
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po antistaph pcn
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nafcillin
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iv antistaph pcn, hepatic elim, high incidence phlebitis (use central line)
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oxacillin
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iv antistaph pcn, hepatic elim
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methicillin
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antistaph pcn, not used since ae ain
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aminopcn
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better v gram neg (more hydrophilic), not staph (susceptible to b-lactamase), good v strep/enterococci, some gnr w/o b-lactamase (listeria, h. pylori, 60-70% e. coli)
use uri, uti, pud, enterococci ampicillin (iv, po), amoxicillin (po), bacampicillin |
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ampicillin
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iv aminopcn, po causes lots of diarrhea
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amoxicillin
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po aminopcn
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bacampicillin
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aminopcn
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antipseudomonal pcn
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all iv, additional ae thrombocytopenia, good v gnr, pseudomonas, strep/enterococci, susceptible to b-lactamase (still not good v staph), use nosocomial (hap)
ureidopcn: piperacillin, mezocillin, azlocillin carboxypcn: ticarcillin, carbenicillin (po) piperacillin>>>ticarcillin |
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piperacillin
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ureidopcn (antipseudomonal)
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ticarcillin
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carboxypcn (antipseudomonal)
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b-lactam + b-lactamase inh
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inh similar structure but not active, distracts b-lactamase, broad spectrum, empiric coverage for gi, abscess, hap, nosocomial, dm wound inf
good v strep, mssa, enterococci, gnr, anaerobes, doesn't help v pseudomonas piperacillin + tazobactam ampicillin + sulbactam amoxicillin + clavulanate, iv/po ticarcillin + clavulanate (still worse than piperacillin) |
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tazobactam
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b-lactamase inh, use w/ piperacillin
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sulbactam
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b-lactamase inh, use w/ ampicillin
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clavulanate
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b-lactamase inh, use w/ amoxicillin or ticarcillin
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ceaphlosporins
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6 member ring (v 5 pcn) same moa, less b-lactamase susceptible (but new cephalosporinase evolve)
1st gen: cefazolin (iv), cephalexin (po) 2nd gen: cefuroxime (iv/po) 3rd gen: ceftriaxone, cefotaxime, ceftazidime*, all iv 4th gen: cefepime 5th gen: ceftaroline, ceftobiprole |
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1st gen cephalosporin
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renal elim, no cns penetration, good v mssa, strep, some gnr
use surg prophylaxis (gram pos from skin), cellulitis, uti (not ideal since e. coli res) cefazolin iv, cephalexin po |
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cefazolin
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iv 1st gen cephalosporin
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cephalexin
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po 1st gen cephalosporin
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2nd gen cephalosporin
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no cns penetration, worse gram pos strep than 1st gen, little worse staph, better gram neg (neisseria)
use uti, gonorrhea cefotetan/cefoxitin have anaerobic act (use surg prophylaxis) |
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cefuroxime
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2nd gen cephalosporin
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cefotetan
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2nd gen cephalosporin w/ anaerobic act
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cefoxitin
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2nd gen cephalosporin w/ anaerobic act
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3rd gen cephalosporin
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renal elim (ceftrixaxone dual elim, can cause biliary sludging or pseudogallstones in neonate), can penetrate cns, worse at staph, better at strep, ceftazidime no gram pos but good v pseudomonas
good v klebsiella, e. coli, better gram neg use meningitis, pneumonia, lyme (1st), sssi, uti, febrile neutropenia ceftriaxone (community), cefotaxime, ceftazidime (nosocomial, pseudomonas, not gram pos), all iv |
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ceftriaxone
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3rd gen cephalosporin, use community, dual elimination
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cefotaxime
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3rd gen cephalosporin
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ceftazidime
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3rd gen cephalosporin, use nosocomial, good v pseudomonas but not gram pos
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ceftaroline
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5th gen cephalosporin, anti mrsa, use cap, ssti
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cefepime
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4th gen cephalosporin, iv only
renal elim, cross cna, good v mssa, strep, gnr incl pseudomonas use hap, nosocomial, febrile neutropenia |
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ceftobiprole
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5th gen cephalosporin, anti mrsa, pseudomonas, not yet approved
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aztreonam
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monobactam, iv only, similar to ceftazidime but not x-reactive to other b-lactam (except ceftazidime itself), renal elim, only use gnr incl pseudomonas, use if allergic to other b-lactam
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carbapenems
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broadest spectrum anti gnr (not first line), renal elim, stable to most b-lactamase, good v mssa, strep, anaerobe, some enterococci, many gnr incl pseudomonas (exception ertapenem bad v enterococci/pseudomonas/actinetobacter)
use esbl gnr (exteneded spectrum b-lactamase), nosocomial, mix (an)aerobic, febrile neutropenia ae seizure (esp imipenem), nausea (proportional to rate of infusion) imipenem (admin w/ cilastatin, inh renal dihydropeptidase), meropene, doripene, ertapenem (1ce/day v others 3-4/day) |
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imipenem
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carbapenem, admin w/ cilastatin, ae psychosis
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cilastatin
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admin w/ carbapenem, inh renal dihydropeptidase
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meropenem
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carbapenem
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doripenem
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carbapenem
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ertapenem
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carbapenem, inactive v enterococci, pseudomonas, actinetobacter
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vancomycin
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glycopeptide, moa bind term d-ala-d-ala of pg chain (prevent elongation, x-link pg), not as quick as b-lactam, time-dependent, poor ba (po only for c. dificil)
good v gram pos (an)aerobe incl mrsa (1st line), new vre, monitor renal dysfxn or alt vol of dist use mrsa, gram pos w/ b-lactam allergy ae red man syndrome if infused quickly (not allergy but histamine assoc), nephro/ototox w/ old mississippi mud formulation teicoplanin (euro/jap)>vancomycin |
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televancin
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lipoglycopeptide, 2 moa (bind term d-ala-d-ala AND disrupt cell mem fxn), better v vanco-res, use csssi, hap
ae taste disturb, ha, dizziness, foamy urine, inj site rxn, teratogen? |
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bacitracin
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peptide abx, moa disrupt pg translocation (inh dephosphorylation of bactoprenol pyrophosphate), highly nephrotoxic if systemic
use topical for minor skin inf (gpc/gpr) |
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fosfomycin
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inh pg monomer synth, use simple uti
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cycloserine
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inh enz that links d-ala, use tb, ae psychosis
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cell mem inh
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cyclic lipopeptides (daptomycin), polymixin (colistin)
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daptomycin
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cyclic lipopeptide, rapidly bactericidal, insert into cell mem gram pos --> cation leak --> depol --> death, efficacy conc-dep, tox time-dep, poorly abs, inactive in lungs (surfactant), doesn't cross into cns, renal excretion
good v gram pos aerobe (anaerobe?), incl mrsa, vre use bacteremia, ssti, endocarditis ae skeletal m tox --> inc ck, rhabdo? |
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polymixin
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colistin (polymyxin e), polymixin b
bind cell mem of gram neg, disrupt perm (detergent-like effect), rapidly bacteriocidal, conc-dep, poor ba, renal excrete good v gram neg incl mdr, not serratia/providentia use inhalation (pneumonia prophylaxis in colonized cf), iv tx mdr gnr inf, also topical ae commonly nephrotoxic, uncommonly neurotoxic |
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ceftaroline
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5th gen cephalosporin
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