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OTHER B LACTAMS Cheat Sheet by

CEPHAL­OSP­ORINS

Indications
Respir­atory, UTI, skin/bone infect­ions, septic­emia, gonorrhea, bacterial meningitis
AE
Hypers­ens­iti­vity, NVD, pain at IM injection site

1st GENERATION CEPHAL­OSP­ORINS

CEPHALEXIN
CEFAZOLIN
Only 1st gen parenteral still used
Long T½
Surgical prophy­laxis, UTI, SSTI
Act as penicillin G substi­tutes and have activity against Proteus mirabilis, E. coli, and Klebsiella pneumoniae (PEcK)

2ND GENENR­ATION CEPHAL­OSP­ORINS

CEFUROXIME
CEFOXITIN
CEFOTETAN
AE: hypopr­oth­rom­inemia, disulf­ira­m-like rxns with ethanol
CEFONICID
CEFAMANDOLE
AE: hypopr­oth­rom­inemia, disulf­ira­m-like rxns with ethanol
Indi­cat­ion: commun­ity­-ac­quired infections of the respir­atory tract (H. influe­nzae, Moraxella catarr­halis, S. pneumo­niae) and UTI (Esche­richia coli)

3RD GENERATION CEPHAL­OSP­ORINI

CEFIXIME
Useful activity against B. fragilis
CEFDINIR
Useful activity against B. fragilis
CEFTAZ­IDIME
CEFOXATIME
CEFTRIAXONE
Penetrate CNS and used to treat meningitis caused by gram-n­egative rods except L. monocy­togenes

Indication: Useful activity genital, anal, and pharyngeal penici­lli­n-r­esi­stant N. gonorr­hoeae
CEFOTAXIME
Penetrate CNS and used to treat meningitis caused by gram-n­egative rods except L. monocy­togenes
CEFOPERAZONE
AE: hypopr­oth­rom­inemia, disulf­ira­m-like rxns with ethanol
Indi­cat­ions: Hospit­al-­acq­uired gram-n­egative bacteremia
 

4TH GENERATION CEPHAL­OSPORIN

CEFIPIME
Only one in the US, penetrates CNS

5TH GENERATION CEPHAL­OSPORIN

CEFTAR­OLINE
CEFTOB­IPROLE
metabo­lized in plasma, majority excreted in urine

CARBAP­ENEMS

DORIPENEM
IMIPINEM-CILASTIN
Inacti­vated by dehydr­ope­pti­dases in renal tubes
MEROPENEM
Greater activity against gram negative aerobes and less activity against gram positives compared to imipenem
ERTAPENEM
Indi­cations : infections resistant to other drugs, enterb­acter infect­ions, extended spectrum B lactam producing gram negatives

PK: penetrates CNS, cleared by kidney

MONOBA­CTAMS

AZTREONAM
Indi­cat­ions: pts allergic to penici­llins and/or cephal­osp­orins to treat pneumonia, mening­itis, and sepsis, penetrates CNS
No activity against gram-p­ositive organisms

BACITRACIN (topical)

MOA
Inhibits cell wall formation by interf­erence with the dephos­pho­ryl­ation of the C55-is­oprenyl pyroph­osp­hate, a molecule that carries the buildi­ng-­blocks of the peptid­oglycan bacterial cell wall
Indica­tions
Highly nephro­toxic when admini­stered system­ically and is thus used topically for gram positive cocci and bacilli skin infections

CYCLOS­ERINE

MOA
Structural analog of D-alanine and inhibits the incorp­oration of D-alanine into peptid­oglycan pentap­eptide chain
Indications
Treats tuberc­ulosis
Toxicity
Serious dose-r­elated CNS toxicity

GLYCOP­EPTIDES

VANCOMYCIN
Resistance in entero­cocci develops due to modifi­cation in binding site (D-ala­-D-ala D-lactate) and increased numbers of D-ala-­D-ala residues (S. aureus)

Effective against gram positive producing lactamases and those resistant to nafcillin and methac­illin (MRSA, MRSE) or allergic to penicillin or cephal­osporin

Indi­cat­ions: infections caused by MRSA (sepsis, endoca­rdi­tis), penici­lli­n-r­esi­stant entero­cocci, indivi­duals with prosthetic heart valve, oral admini­str­ation of antibiotic induced colitis due to C. diff

SE: fever, chills, phlebitis
VANCO + GENT
Use: entero­coccal endoca­rditis (penic­illin allergy)
VANCO + CEFTRIAXONE
VANCO + CEFOTAXIME
VANCO + RIFAMPIN
Use: meningitis (penic­ill­in-­res­istant strain of pneuom­ococcus
TELAVANCIN
Two mechanisms of action; first is the same as vancomycin and the second is it disrupts the bacterial cell membrane potential and increases membrane permea­bility

t1/2 is 8 hours allowing for daily dosing

Terato­genic
DAPTOMYCIN
Long half life of 6-11 days allows for weekly dosing
Methic­ill­in-­sus­cep­tible and methic­ill­in-­res­istant Strept­ococcus pneumo­niae, Strept­ococcus pyogenes, Coryne­bac­terium jeikeium, E. faecalis and E. faecium (including VRE)

Indi­cat­ions: skin infections and bacteremia caused by S. aureus

AE: consti­pation, nausea, HA, insomnia
FOSFOMYCIN
MOA: inhibits UDP-N acetyl­glu­cos­amine 3-Enol­pyruvte transf­erase

Indica­tions: UTI

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