Penicillins and Cephalosporins青霉素类和头孢菌素类.pptVIP

The Beta-Lactam Antibiotics Cell wall active agents Prevent the final step in the synthesis of the bacterial cell wall Range from very narrow spectrum to very broad spectrum β-Lactams How do they work? The β-lactam binds to Penicillin Binding Protein (PBP) PBP is unable to crosslink peptidoglycan chains The bacteria is unable to synthesize a stable cell wall The bacteria is lysed PK/PD The β-lactams are “time-dependent” killers The effect is directly proportional to the amount of TIME the concentration of the antibiotic at the site of infection is ABOVE the MIC of the organism. The β-lactams are BACTERIOCIDAL… (at therapeutically attainable levels) “Time Dependant” “Time Dependant” So many choices… which one to pick? What is the likely organism? What’s its major mode of resistance? Where’s the infection? What’s my local environment? the UNC Hospital antibiogram What does the micro lab say? in vitro sensitivity testing Classification Penicillins Natural penicillins PenG, PenVK, Benzathine Pen, Procaine Pen Aminopenicillins Ampicillin, Amoxicillin Anti-Staph penicillins Oxacillin, Dicloxacillin Anti-Pseudomonal [Carboxy] Ticarcillin [Ureido] Piperacillin Classification Cephalosporins 1st Generation Cephalexin, Cefazolin 2nd Generation Cefoxitin, Cefuroxime, Cefotetan 3rd Generation Cefotaxime, Ceftriaxone, Ceftazidime 4th Generation Cefepime Penicillin G Available PO, IM, IV (dosed in units) Drug of Choice (DoC) [2-4 MU IV q4h] T. pallidum, N. meningitidis, Group A Strep, and Actinomycosis Long-acting forms Procaine PenG (12 hrs) Benzathine Pen (5 days) [2.4 MU IM for syphilis] Adverse Reactions – other than skin rash Penicillin “serum sickness”/drug fever Jarisch-Herxheimer reaction (1° and 2° syphilis) Hemolytic anemia, pancytopenia, neutropenia Ampicillin/Amoxicillin Amp (IV, PO) Amox (PO) Spectrum: PenG + H. flu and some E. coli DoC: Listeria monocytogenes and Enterococcus [Amp 2g IV q4h] Dental Prophylaxis Amox 1 gram PO x 1 prior to appt. Integral