Narrow spectrum penicillins Pencillinase sensitive Narrow spectrum penicillins

Narrow spectrum penicillins pencillinase sensitive

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Narrow-spectrum penicillins Pencillinase-sensitive Narrow-spectrum penicillins Pencillinase-resistant Broad-spectrum penicillins Extended-spectrum penicillins
PENICILLIN G (BENZYLPENICILLIN)Bactericidal to numerous gram-positive and some gram-negative organismsAdverse effectsLeast toxic of all antibioticsPenicillins are the most common cause of drug allergy
PENICILLIN ALLERGY Development of penicillin allergy Skin tests for penicillin allergy Management of patients with a history of penicillin allergy Assess for penicillin allergy in each patient who will be receiving penicillin If history of mild reaction, consider cephalosporin If history of anaphylaxis, avoid administration of penicillin or cephalosporins
PENICILLIN ALLERGY Types Immediate (reaction in 2–30 minutes) Accelerated (reaction in 1–72 hours) Late (reaction takes days or weeks to develop) Anaphylaxis Laryngeal edema Bronchoconstriction Severe hypotension
PENICILLIN ALLERGY Treatment Epinephrine Respiratory support Prevention: skin testing
BROAD-SPECTRUM PENICILLINS Broad-spectrum penicillins (aminopenicillins) Ampicillin (Principen) Amoxicillin (Amoxil, DisperMox, Moxatag, Trimox) Adverse effects Rash Diarrhea
EXTENDED-SPECTRUM PENICILLINS Extended-spectrum penicillins (antipseudomonal penicillins) Piperacillin Broad-spectrum, but penicillinase-sensitive
PENICILLIN COMBINATIONS Beta-lactamase inhibitors Clavulanic acid, tazobactam, sulbactam Extends antimicrobial spectrum when combined with penicillinase- sensitive antibiotics Ampicillin/sulbactam (Unasyn) Amoxicillin/clavulanic acid (Augmentin) Ticarcillin/clavulanic acid (Timentin) Piperacillin/tazobactam (Zosyn)
CEPHALOSPORINS Most widely used group of antibiotics Beta-lactam antibiotics Similar to penicillin structure Bactericidal Usually given parenterally Toxicity is low
CEPHALOSPORINS Mechanism of action Interferes with cell wall synthesis Bactericidal Allergy If allergy to penicillin, cross-allergy to cephalosporin ADR Rash, malaise, palpitations, nausea, constipation, muscle cramps Education Take with food (↓ GI effects)
CLASSIFICATION OF CEPHALOSPORINS First-generation Cefazolin (Ancef) Second-generation Cefaclor (Ceclor) Third-generation Cefoperazone (Cefobid) Fourth-generation Cefepime (Maxipime)
CEPHALOSPORIN
Copyright © 2015 Wolters Kluwer • All Rights Reserved CHAPTER 38 Figure 38.10
CEPHALOSPORINS Therapeutic uses 19 cephalosporins currently used in United States First- and second-generation agents rarely used for active infection Third-generation Preferred therapy for several infections Highly active against gram-negative organisms Able to penetrate to cerebrospinal fluid (CSF) Fourth-generation Broad spectrum Penetration to CSF is good
VANCOMYCIN (VANCOCIN, VANCOLED) Action Inhibits cell wall synthesis Uses Severe infections only Methicillin-resistant Staphylococcus aureus or Staphylococcus epidermidis Oral dose used for Clostridium difficile if metronidazole was tried and found ineffective

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