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a.Penicillins combined with a Beta-Lactamase Inhibitori.By combining these two it will extend the anti-microbial spectrum of the penicillin.1.Sulbactum, tazobacum, clavulanic acid (clavulanate)ii.These drugs are not available alone, they are only available in fixed combonations with penicillin1.Ampicillin/sulbactam (Unasyn)2.Amoxicillin/Clavulanate (Augumentin, Clavulin)3.Ticarcillin/Clavulanate (Timentin)4.Pipercillin/Tazobactam (Zoysn, TazocinF.Identify a prototype or representative example for each of the five generations of cephalosporins and differentiate the groups in terms of mechanism of action, spectrum
of action, susceptibility to destruction/inactivation by beta-lactamases, and access to thecerebrospinal fluid. i.As we progress from 1stto 5thgeneration agents there is increasing activityagainst gram-negative bacteria and anaerobes, increasing resistance to destruction by beta-lactamases and increasing ability to reach the cerebrospinal fluid1.First generation: Cefadroxil (PO, renal), Cefazolin (IM, IV, Renal),Cephalexin (PO, Renal), these drugs are highly active against gram-positive bacteria, staphylococci and nonenterococcal streptococci, however if the staphylococci is resistance to methicillin they will be resistant to First generation Cephalosporinstoo. Activity against ram-negative is low, resistance to beta-lactamases is low, distribution to CSF is poor2.Second Generation: Cefaclor (PO, Renal) Cefotetan (IM, IV, Renal) Cefoxitin (IM, IV, Renal) Cefprozil (PO, Renal), Cefuroxime (PO, IM, IN, Renal), have enhanced activity against gram-negative bacteria, the increase is due to a combo of factors like increased (Higher)affinity for PBPs of gram-negative bacteria, increased ability to penetrate the gram-negative cell envelope, and increased (higher) resistance to beta-lactamases produced by gram-negative organisms. None of these are active against Pseudomonas aeruginosa, and they don’t reach effective (Poor) concentration in the CSF.3.Third Generation: Cefdinir (PO), Cefitoren (PO), Cefixine (PO), Cefotaxime (IM, IV) Cefpodoxime (PO), Ceftazidime (PO), Ceftibuten (PO), Ceftriaxone (IM, IV, Hepatic), broad-spectrum of anti-microbial activity, active against gram-negative aerobes, activity against gram-negative bacteria is high, resistance to Beta-Lactamases is high, distribution to CSF is good4.Fourth Generation: Cefepime (IM, IV) highest resistant to beta-lactamases and has a very broad anti-bacterial spectrum, acitivity against P. aeruginosa, penetration to CSF is good, highest resistance to Beta-Lactamases5.Fifth generation: Ceftaoline (IV), only cephalosporin with activity against MRSA, activity against gram-negative bacteria is high, resistance to Beta-Lactamases is the highest, and distribution to CSF is goodG.