CELL WALL INHIBITORS
Beta- Lactams
Penicillin’s
Penicillin G & Penicillin V: very old, basic penicillin’s
Brand Names:
› Penicillin G: Pfizerpen
› Penicillin V: Pen VK
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Both are just called Penicillin now
Cell wall inhibitor
Bactericidal
Used for minor cases of infection due to Gram + bacteria
Narrow Spectrum antibiotic- specifically penicillinase susceptible/sensitive
Penicillinase sensitive- not effective against bacteria that produce penicillinase enzymes
Route and absorption: BOTH Penicillin G & V
• IV
• Oral- don’t take with food as it affects absorption
Pharmacodynamics: Time above MIC (Minimal Inhibitory Concentration)- If the drug level is
kept above the MIC of the organism for 50% of the dosing interval (or longer) better killing is
observed and a post antibiotic effect occurs- even after the drug is out of the system, there still is
bacterial killing.
Elimination: RENAL- need to dose adjust for renally impaired patients, smaller dose than given
normally as well as a longer dosing interval
Treatment:
• Mainly used for/ against: Acne and cellulitis
o Peptococcus- acne Gram + Anaerobe cocci
o Peptostreptococcus- acne Gram + Anaerobic cocci
o Propionibacterium- acne Gram + Anaerobic rod
o Streptococcus (some strains are resistant)- Mild cases of cellulitis Gram + aerobic
• But also used for/ against:
o Corynebacterium (usually a containment, some strains are very resistant) Gram +
aerobic
o Enterococcus faecalis only Gram + aerobic
o Gram + ANAEROBIC cocci and rods
 Finegoldia Gram + Anaerobic rod
 Clostridium perfergins Gram + Anaerobic rod
 Clostridium tetani Gram + Anaerobic rod
 Bacillus Gram + Anaerobic rod
o Neisseria meningitidis- not used against anymore Gram – aerobic cocci
o Neisseria gonorrhea- not used against anymore Gram – aerobic cocci
o Borrelia Burgdorferi Miscellaneous, Spirochete, Gram Adverse Drug Reactions:
• Allergies
1. ranging from rash to anaphylaxis
2. Steven Johnson Syndrome
3. Allergic/acute interstitial reaction
• Neutropenia- low neutrophil count
• N/V/D- with oral intake
• Super infections
1. C. diff
2. Yeast infections of the mouth and genital area
3. UTI
Cross Reactivity with other drugs: ALL ABOUT THE SIDE CHAINS
• Cephalosporins – LOW
a) 1st generation= 1-10%
b) 2nd generation-5th generation= <0.1%
• Carbapenems= 11%- LOW
• Aztreonam- NEGLIGIBLE
Contraindications due to history of:
• Allergic reactions- N/V/D is not a “true” allergy
• Acute interstitial nephritis
• Seizure disorders or renal impairment- especially if patient had a seizure with a
carbapenem antibiotic
• Adverse events- leukopenia
Counseling Points to tell patients:
• May cause N/V/D
• Report rash, breathing or swallowing difficulty
• Report persistent diarrhea such as c. diff- these antibiotics can kill off normal flora in the
stomach that can lead to C. diff
• Report changes in urinary pattern- ADR of acute interstitial nephritis
• Report signs of other infections
 Vaginal Itching- can lead to fungal infections
 Sores in the mouth- can lead to fungal infections
 Blood in the urine or stool- could be a c.diff
• Report any CNS changes- specifically seizures and carbapenems
Piperacillin: Ureidopenicillin
Brand Name: Generic is only form available
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Cell wall inhibitor
Bactericidal
Extended Spectrum antibiotic- specifically antipseudomonal
Treats more Gram – and less of Gram + organisms
DOES NOT TREAT STAPH AUREUS
Route and absorption: IV ONLY
Pharmacodynamics: Time above MIC (Minimal Inhibitory Concentration)- If the drug level is
kept above the MIC of the organism for 50% of the dosing interval (or longer) better killing is
observed and a post antibiotic effect occurs- even after the drug is out of the system, there still is
bacterial killing.
Elimination: RENAL- need to dose adjust for renally impaired patients, smaller dose than given
normally as well as a longer dosing interval
Treatment:
• Mainly used for/ against:
o Penicillin resistant Streptococcus Gram +, aerobic
o Enterococcus faecalis Gram +, aerobic
o Listeria Gram +, aerobic
o Pseudomonas aeruginosa Gram -, NON Enterobacteriaceae aerobic rod
o H. influenzae (some resistance) Gram -, Aerobic cocci
o Enterobacteriaceae (EXCEPT Enterobacter species, Proteus, Citrobacter, Serratia,
Providencia) Gram –, Enterobacteriaceae, aerobic rod
 E coli Gram –, Enterobacteriaceae, aerobic rod
 Klebsiella Gram –, Enterobacteriaceae, aerobic rod
Adverse Drug Reactions:
• Allergies
1. ranging from rash to anaphylaxis
2. Steven Johnson Syndrome
3. Allergic/acute interstitial reaction
• Neutropenia- low neutrophil count
• N/V/D- with oral intake
• Super infections
1. C. diff
2. Yeast infections of the mouth and genital area
3. UTI
Cross Reactivity with other drugs: ALL ABOUT THE SIDE CHAINS
• Cephalosporins – LOW
a) 1st generation= 1-10%
b) 2nd generation-5th generation= <0.1%
• Carbapenems= 11%- LOW
• Aztreonam- NEGLIGIBLE
Contraindications due to history of:
• Allergic reactions- N/V/D is not a “true” allergy
• Acute interstitial nephritis
• Seizure disorders or renal impairment- especially if patient had a seizure with a
carbapenem antibiotic
• Adverse events- leukopenia
Counseling Points to tell patients:
• May cause N/V/D
• Report rash, breathing or swallowing difficulty
• Report persistent diarrhea such as c. diff- these antibiotics can kill off normal flora in the
stomach that can lead to C. diff
• Report changes in urinary pattern- ADR of acute interstitial nephritis
• Report signs of other infections
 Vaginal Itching- can lead to fungal infections
 Sores in the mouth- can lead to fungal infections
 Blood in the urine or stool- could be a c.diff
• Report any CNS changes- specifically seizures and carbapenems
Ticarcillin: Carboxypenicillin
Brand Name: Ticar
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Cell wall inhibitor
Bactericidal
Extended Spectrum antibiotic- specifically antipseudomonal
Treats more Gram – and some Gram + organisms
REALLY good at treating PSEUDOMONAS infections
Route and absorption: IV ONLY
Pharmacodynamics: Time above MIC (Minimal Inhibitory Concentration)- If the drug level is
kept above the MIC of the organism for 50% of the dosing interval (or longer) better killing is
observed and a post antibiotic effect occurs- even after the drug is out of the system, there still is
bacterial killing.
Elimination: RENAL- need to dose adjust for renally impaired patients, smaller dose than given
normally as well as a longer dosing interval
Treatment:
• Mainly used for/ against:
o Pseudomonas aeruginosa Gram -, NON Enterobacteriaceae aerobic rod
o Penicillin resistant Streptococcus Gram +, aerobic
o Enterococcus faecalis Gram +, aerobic
o Listeria Gram +, aerobic
o Gram + anaerobic cocci
 Peptococcus Gram + Anaerobic cocci
 Peptostreptococcus Gram + Anaerobic cocci
 Finegoldia Gram + Anaerobic cocci
o H. influenzae (some resistance) Gram -, Aerobic cocci
o Enterobacteriaceae (EXCEPT Enterobacter species, Proteus, Citrobacter, Serratia,
Providencia) Gram –, Enterobacteriaceae, aerobic rod
 E coli Gram –, Enterobacteriaceae, aerobic rod
 Klebsiella Gram –, Enterobacteriaceae, aerobic rod
 Salmonella Gram –, Enterobacteriaceae, aerobic rod
 Shigella Gram –, Enterobacteriaceae, aerobic rod
 Morganella Gram –, Enterobacteriaceae, aerobic rod
Adverse Drug Reactions:
• Allergies
1. ranging from rash to anaphylaxis
2. Steven Johnson Syndrome
3. Allergic/acute interstitial reaction
• Neutropenia- low neutrophil count
• N/V/D- with oral intake
•
Super infections
1. C. diff
2. Yeast infections of the mouth and genital area
3. UTI
Cross Reactivity with other drugs: ALL ABOUT THE SIDE CHAINS
• Cephalosporins – LOW
a) 1st generation= 1-10%
b) 2nd generation-5th generation= <0.1%
• Carbapenems= 11%- LOW
• Aztreonam- NEGLIGIBLE
Contraindications due to history of:
• Allergic reactions- N/V/D is not a “true” allergy
• Acute interstitial nephritis
• Seizure disorders or renal impairment- especially if patient had a seizure with a
carbapenem antibiotic
• Adverse events- leukopenia
Counseling Points to tell patients:
• May cause N/V/D
• Report rash, breathing or swallowing difficulty
• Report persistent diarrhea such as c. diff- these antibiotics can kill off normal flora in the
stomach that can lead to C. diff
• Report changes in urinary pattern- ADR of acute interstitial nephritis
• Report signs of other infections
 Vaginal Itching- can lead to fungal infections
 Sores in the mouth- can lead to fungal infections
 Blood in the urine or stool- could be a c.diff
• Report any CNS changes- specifically seizures and carbapenems
Ampicillin & Amoxicillin: Aminopenicillins
Brand Names:
› Ampicillin: Principen
› Penicillin V: Amoxil
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Cell wall inhibitor
Bactericidal
BROAD SPECTRUM antibiotic- PENICILLINASE SENSITIVE/SUSCEPTIBLE
Penicillinase sensitive- not effective against bacteria that produce penicillinase enzymes
Mainly used for Gram + coverage and a little bit of Gram – coverage
Route and absorption:
• Ampicillin- IV & ORAL- don’t take with food as it affects the absorption
• Amoxicillin- ORAL ONLY- good to take with food
Pharmacodynamics: Time above MIC (Minimal Inhibitory Concentration)- If the drug level is
kept above the MIC of the organism for 50% of the dosing interval (or longer) better killing is
observed and a post antibiotic effect occurs- even after the drug is out of the system, there still is
bacterial killing.
Elimination: RENAL- need to dose adjust for renally impaired patients, smaller dose than given
normally as well as a longer dosing interval
Treatment:
• Mainly used for/ against:
o Penicillin resistant Streptococcus Gram +, aerobic
o Enterococcus faecalis Gram +, aerobic
o Listeria Gram +, aerobic
o Corynebacterium Gram + aerobic
o Gram + anaerobic cocci & rods
 Peptococcus Gram + Anaerobic cocci
 Peptostreptococcus Gram + Anaerobic cocci
 Finegoldia Gram + Anaerobic cocci
 Clostridium difficile Gram + Anaerobic rod
 Closttridium perfringens Gram + Anaerobic rod
 Propionibacterium acnes Gram + Anaerobic rod
 Bacillus Gram + Anaerobic rod
o Neisseria gonorrheae Gram – aerobic cocci
o H. influenzae (some resistance) Gram -, Aerobic cocci
o Enterobacteriaceae (EXCEPT Enterobacter species, Citrobacter, Serratia,
Morganella, Providencia) Gram –, Enterobacteriaceae, aerobic rod
 E coli Gram –, Enterobacteriaceae, aerobic rod
 Klebsiella Gram –, Enterobacteriaceae, aerobic rod
 Proteus Gram –, Enterobacteriaceae, aerobic rod
 Salmonella Gram –, Enterobacteriaceae, aerobic rod
 Shigella Gram –, Enterobacteriaceae, aerobic rod
o Campylobacterium Gram -, NON Enterobacteriaceae aerobic rod
o Borrelia Burgdorferi Miscellaneous, Spirochete, Gram Adverse Drug Reactions:
• Allergies
1. ranging from rash to anaphylaxis
2. Steven Johnson Syndrome
3. Allergic/acute interstitial reaction
• Neutropenia- low neutrophil count
• N/V/D- with oral intake
• Super infections
1. C. diff
2. Yeast infections of the mouth and genital area
3. UTI
Cross Reactivity with other drugs: ALL ABOUT THE SIDE CHAINS
• Cephalosporins – LOW
a) 1st generation= 1-10%
b) 2nd generation-5th generation= <0.1%
• Carbapenems= 11%- LOW
• Aztreonam- NEGLIGIBLE
Contraindications due to history of:
• Allergic reactions- N/V/D is not a “true” allergy
• Acute interstitial nephritis
• Seizure disorders or renal impairment- especially if patient had a seizure with a
carbapenem antibiotic
• Adverse events- leukopenia
Counseling Points to tell patients:
• May cause N/V/D
• Report rash, breathing or swallowing difficulty
• Report persistent diarrhea such as c. diff- these antibiotics can kill off normal flora in the
stomach that can lead to C. diff
• Report changes in urinary pattern- ADR of acute interstitial nephritis
• Report signs of other infections
 Vaginal Itching- can lead to fungal infections
 Sores in the mouth- can lead to fungal infections
 Blood in the urine or stool- could be a c.diff
• Report any CNS changes- specifically seizures and carbapenems
Nafcillin, Oxacillin, Dicloxacillin:
Brand Names:
› Nafcillin: Unipen
› Oxacillin: Bactocil
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Cell wall inhibitor
Bactericidal
VERY NARROW SPECTRUM antibiotic- PENICILLINASE RESISTANT
ANTISTAPHYLOCCAL infections
Penicillinase resistant- effective against bacteria that produce penicillinase enzymes
Gram + coverage only
Route and absorption:
• Nafcillin- IV ONLY due to erratic absorption
• Oxacillin- IV ONLY due to erratic absorption
• Dicloxacillin- ORAL ONLY
Pharmacodynamics: Time above MIC (Minimal Inhibitory Concentration)- If the drug level is
kept above the MIC of the organism for 50% of the dosing interval (or longer) better killing is
observed and a post antibiotic effect occurs- even after the drug is out of the system, there still is
bacterial killing.
Elimination: HEPATIC- need to dose adjust for hepatically impaired patients, smaller dose than
given normally as well as a longer dosing interval
Treatment:
• Mainly used for/ against:
o Staphylococcus aureus- Methicillin sensitive (MSSA) only Gram +, aerobic
o Staphylococcus epidermis- Methicillin sensitive (MSSE) only Gram +, aerobic
o Streptococci Gram +, aerobic
Adverse Drug Reactions:
• Allergies
1. ranging from rash to anaphylaxis
2. Steven Johnson Syndrome
3. Allergic/acute interstitial reaction
• Neutropenia- low neutrophil count
• N/V/D- with oral intake
• Super infections
1. C. diff
2. Yeast infections of the mouth and genital area
3. UTI
Cross Reactivity with other drugs: ALL ABOUT THE SIDE CHAINS
• Cephalosporins – LOW
a) 1st generation= 1-10%
b) 2nd generation-5th generation= <0.1%
• Carbapenems= 11%- LOW
• Aztreonam- NEGLIGIBLE
Contraindications due to history of:
• Allergic reactions- N/V/D is not a “true” allergy
• Acute interstitial nephritis
• Seizure disorders or renal impairment- especially if patient had a seizure with a
carbapenem antibiotic
• Adverse events- leukopenia
Counseling Points to tell patients:
• May cause N/V/D
• Report rash, breathing or swallowing difficulty
• Report persistent diarrhea such as c. diff- these antibiotics can kill off normal flora in the
stomach that can lead to C. diff
• Report changes in urinary pattern- ADR of acute interstitial nephritis
• Report signs of other infections
 Vaginal Itching- can lead to fungal infections
 Sores in the mouth- can lead to fungal infections
 Blood in the urine or stool- could be a c.diff
• Report any CNS changes- specifically seizures and carbapenems
Amoxicillin/Clavulanate & Ampicillin/Sulbactam:
Brand Names:
› Amoxicillin/Clavulanate: Augmentin
› Ampicillin/Sulbactam: Unasyn
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Cell wall inhibitor
Bactericidal
BROAD SPECTRUM antibiotic- BETA LACTAMASE INHIBITORS
Beta lactamase inhibitor- effective against bacteria that produce beta lactamase enzymes
Used for Gram +, Gram -, Anaerobes
Route and absorption:
• Augmentin (Amoxicillin/Clavulanate)- ORAL ONLY
• Unasyn (Ampicillin/Sulbactam)- IV ONLY
Pharmacodynamics: Time above MIC (Minimal Inhibitory Concentration)- If the drug level is
kept above the MIC of the organism for 50% of the dosing interval (or longer) better killing is
observed and a post antibiotic effect occurs- even after the drug is out of the system, there still is
bacterial killing.
Elimination: RENAL- need to dose adjust for renally impaired patients, smaller dose than given
normally as well as a longer dosing interval
Treatment:
• Mainly used for/ against:
o Enterococcus faecalis Gram +, aerobic
o MSSA (produces penicillinases) Gram +, aerobic
o Streptococcus Gram +, aerobic
o Listeria Gram +, aerobic
o Anaerobes- Gram + & Gram –
 Peptococcus Gram + Anaerobic cocci
 Peptostreptococcus Gram + Anaerobic cocci
 Finegoldia Gram + Anaerobic cocci
 Clostridium difficile Gram + Anaerobic rod
 Closttridium perfringens Gram + Anaerobic rod
 Propionibacterium acnes Gram + Anaerobic rod
 Bacillus Gram + Anaerobic rod
 Bacteroids GRAM – ANAEROBES
 Fusobacterium GRAM – ANAEROBES
 Prevotella GRAM – ANAEROBES
o Haemophilus Gram -, Aerobic cocci
o Moraxella (MCAT) Gram –, aerobic cocci
o Acinetobacter (CRAB- Carbapenem Resistant Acinetobacter Baumannii) Gram –,
NON Enterobacteriaceae, aerobic rod
o Enterobacteriaceae (EXCEPT Enterobacter species, Citrobacter, Serratia)
 E coli Gram –, Enterobacteriaceae, aerobic rod
 Klebsiella Gram –, Enterobacteriaceae, aerobic rod
 Proteus Gram –, Enterobacteriaceae, aerobic rod
 Salmonella Gram –, Enterobacteriaceae, aerobic rod
 Shigella Gram –, Enterobacteriaceae, aerobic rod
 Morganella Gram –, Enterobacteriaceae, aerobic rod
 Providencia Gram –, Enterobacteriaceae, aerobic rod
Adverse Drug Reactions:
• Allergies
1. ranging from rash to anaphylaxis
2. Steven Johnson Syndrome
3. Allergic/acute interstitial reaction
• Neutropenia- low neutrophil count
• N/V/D- with oral intake
• Super infections
1. C. diff
2. Yeast infections of the mouth and genital area
3. UTI
Cross Reactivity with other drugs: ALL ABOUT THE SIDE CHAINS
• Cephalosporins – LOW
a) 1st generation= 1-10%
b) 2nd generation-5th generation= <0.1%
• Carbapenems= 11%- LOW
• Aztreonam- NEGLIGIBLE
Contraindications due to history of:
• Allergic reactions- N/V/D is not a “true” allergy
• Acute interstitial nephritis
• Seizure disorders or renal impairment- especially if patient had a seizure with a
carbapenem antibiotic
• Adverse events- leukopenia
Counseling Points to tell patients:
• May cause N/V/D
• Report rash, breathing or swallowing difficulty
• Report persistent diarrhea such as c. diff- these antibiotics can kill off normal flora in the
stomach that can lead to C. diff
• Report changes in urinary pattern- ADR of acute interstitial nephritis
• Report signs of other infections
 Vaginal Itching- can lead to fungal infections
 Sores in the mouth- can lead to fungal infections
 Blood in the urine or stool- could be a c.diff
• Report any CNS changes- specifically seizures and carbapenems
Piperacillin/Tazobactam & Ticarcillin/Clavulanate:
Brand Names:
› Piperacillin/Tazobactam: Zosyn
› Ticarcillin/Clavulanate: Timentin
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Cell wall inhibitor
Bactericidal
BROAD SPECTRUM antibiotic- BETA LACTAMASE INHIBITOR
Beta lactamase inhibitor- effective against bacteria that produce beta lactamase enzymes
Used for Gram +, Gram -, Anaerobes
Route and absorption:
• Zosyn (Piperacillin/Tazobactam)- IV ONLY
• Unasyn (Ticarcillin/Clavulanate)- IV ONLY
Pharmacodynamics: Time above MIC (Minimal Inhibitory Concentration)- If the drug level is
kept above the MIC of the organism for 50% of the dosing interval (or longer) better killing is
observed and a post antibiotic effect occurs- even after the drug is out of the system, there still is
bacterial killing.
Elimination: RENAL- need to dose adjust for renally impaired patients, smaller dose than given
normally as well as a longer dosing interval
Treatment:
• Mainly used for/ against:
o Enterococcus faecalis Gram +, aerobic
o MSSA (produces penicillinases) Gram +, aerobic
o Streptococcus Gram +, aerobic
o Listeria Gram +, aerobic
o Anaerobes- Gram + & Gram –
 Peptococcus Gram + Anaerobic cocci
 Peptostreptococcus Gram + Anaerobic cocci
 Finegoldia Gram + Anaerobic cocci
 Clostridium difficile Gram + Anaerobic rod
 Closttridium perfringens Gram + Anaerobic rod
 Propionibacterium acnes Gram + Anaerobic rod
 Bacillus Gram + Anaerobic rod
 Bacteroids GRAM – ANAEROBES rod
 Fusobacterium GRAM – ANAEROBES rod
 Prevotella GRAM – ANAEROBES rod
o Enterobacteriaceae (everyone) Gram –, Enterobacteriaceae, aerobic rod
 E coli Gram –, Enterobacteriaceae, aerobic rod
 Klebsiella Gram –, Enterobacteriaceae, aerobic rod
 Enterobacteriaceae species Gram –, Enterobacteriaceae, aerobic rod
 Citrobacter Gram –, Enterobacteriaceae, aerobic rod
 Proteus Gram –, Enterobacteriaceae, aerobic rod
 Salmonella Gram –, Enterobacteriaceae, aerobic rod
 Serratia Gram –, Enterobacteriaceae, aerobic rod
 Shigella Gram –, Enterobacteriaceae, aerobic rod
 Morganella Gram –, Enterobacteriaceae, aerobic rod
 Providencia Gram –, Enterobacteriaceae, aerobic rod
o Haemophilus Gram -, Aerobic cocci
o Moraxella Gram –, aerobic cocci
o Pseudomonas Gram –, NON Enterobacteriaceae, aerobic rod
Adverse Drug Reactions:
• Allergies
1. ranging from rash to anaphylaxis
2. Steven Johnson Syndrome
3. Allergic/acute interstitial reaction
• Neutropenia- low neutrophil count
• N/V/D- with oral intake
• Super infections
1. C. diff
2. Yeast infections of the mouth and genital area
3. UTI
Cross Reactivity with other drugs: ALL ABOUT THE SIDE CHAINS
• Cephalosporins – LOW
a) 1st generation= 1-10%
b) 2nd generation-5th generation= <0.1%
• Carbapenems= 11%- LOW
• Aztreonam- NEGLIGIBLE
Contraindications due to history of:
• Allergic reactions- N/V/D is not a “true” allergy
• Acute interstitial nephritis
• Seizure disorders or renal impairment- especially if patient had a seizure with a
carbapenem antibiotic
• Adverse events- leukopenia
Counseling Points to tell patients:
• May cause N/V/D
• Report rash, breathing or swallowing difficulty
• Report persistent diarrhea such as c. diff- these antibiotics can kill off normal flora in the
stomach that can lead to C. diff
• Report changes in urinary pattern- ADR of acute interstitial nephritis
• Report signs of other infections
 Vaginal Itching- can lead to fungal infections
 Sores in the mouth- can lead to fungal infections
 Blood in the urine or stool- could be a c.diff
• Report any CNS changes- specifically seizures and carbapenems
CELL WALL INHIBITORS
Beta Lactams
Cephalosporins & Cephamycins
1st generation: Cefazolin, Cefadroxil, Cephalexin
Brand Names:
› Cefazolin: Ancef
› Cefadroxil: Duricef
› Cephalexin: Keflex
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Cell wall inhibitor
Bactericidal
Used for Gram + and Gram –
GOOD for treating UTIs because it has high urine concentrations
NOT a heavy hitter drug for MRSA or pseudomonas
Route and absorption:
• Cefazolin- IV ONLY due to poor oral absorption, commonly used in patients in pre-op
surgery especially orthopedic surgery to cover Gram + bacteria that reside on the skin and
bones such as staphylococcus bacteria
• Cefadroxil- ORAL
• Cephalexin- ORAL
Pharmacodynamics: Time above MIC (Minimal Inhibitory Concentration)- If the drug level is
kept above the MIC of the organism for 50% of the dosing interval (or longer) better killing is
observed and a post antibiotic effect occurs- even after the drug is out of the system, there still is
bacterial killing.
Elimination: RENAL- need to dose adjust for renally impaired patients, smaller dose than given
normally as well as a longer dosing interval
Treatment:
• Mainly used for/ against:
o Staphylococcus aureus- Menthicillin sensitive (MSSA) Gram + Anaerobe cocci
o Streptococcus species Gram + aerobic
o Gram + ANAEROBIC cocci and rods
 Peptococcus Gram + Anaerobic cocci
 Peptostreptococcus Gram + Anaerobic cocci
 Finegoldia Gram + Anaerobic cocci
 Clostridium difficile Gram + Anaerobic rod
 Clostridium perfergins Gram + Anaerobic rod
 Propionibacterium acnes Gram + Anaerobic rod
 Bacillus Gram + Anaerobic rod
o E. coli- most common UTI bacteria Gram –, Enterobacteriaceae, aerobic rod
o Klebsiella Gram –, Enterobacteriaceae, aerobic rod
o Proteus- CEFAZOLIN ONLY! Gram –, Enterobacteriaceae, aerobic rod
Adverse Drug Reactions:
• Allergies
1. ranging from rash to anaphylaxis
2. Steven Johnson Syndrome
3. Allergic/acute interstitial reaction
• Neutropenia- low neutrophil count
• N/V/D- with oral intake
• Super infections
1. C. diff
2. Yeast infections of the mouth and genital area
3. UTI
Cross Reactivity with other drugs: ALL ABOUT THE SIDE CHAINS
• Penicillins– LOW
a) 1st generation= 1-10%
b) 2nd generation-5th generation= <0.1%
Contraindications due to history of:
• Allergic reactions- N/V/D is not a “true” allergy
• Acute interstitial nephritis
• Seizure disorders or renal impairment- especially if patient had a seizure with a
carbapenem antibiotic
• Adverse events- leukopenia
Counseling Points to tell patients:
• May cause N/V/D
• Report rash, breathing or swallowing difficulty
• Report persistent diarrhea such as c. diff- these antibiotics can kill off normal flora in the
stomach that can lead to C. diff
• Report changes in urinary pattern- ADR of acute interstitial nephritis
• Report signs of other infections
 Vaginal Itching- can lead to fungal infections
 Sores in the mouth- can lead to fungal infections
 Blood in the urine or stool- could be a c.diff
• Report any CNS changes- specifically seizures and carbapenems
2nd generation: Cefuroxime axetil, cefuroxime, cefoxitin, cefotetan
Brand Names:
› Cefuroxime axetil (oral only): Ceftin
› Cefuroxime (IV): Zinacef
› Cefoxitin: Mefoxin
› Cefotetan: Cefotan
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Cell wall inhibitors
Bactericidal
Used for Gram +, Gram –, and ANAEROBES
Cefoxitin and cefotetan are both CEPHAMYCINS, which treat anaerobes so they are good
for treating intrabdominal infections which are usually polymicrobial infections.
Route and absorption:
• Cefuroxime axetial- ORAL ONLY, the axetil compound stabilizes the antibiotic to be
able to be used in oral form
• Cefuroxime- IV ONLY
• Cefadroxil- IV ONLY
• Cephalexin- IV ONLY
Pharmacodynamics: Time above MIC (Minimal Inhibitory Concentration)- If the drug level is
kept above the MIC of the organism for 50% of the dosing interval (or longer) better killing is
observed and a post antibiotic effect occurs- even after the drug is out of the system, there still is
bacterial killing.
Elimination: RENAL- need to dose adjust for renally impaired patients, smaller dose than given
normally as well as a longer dosing interval
Treatment:
• Mainly used for/ against:
o Streptococcus Gram +, aerobic
o Staphylococcus aureus- Methicillin Sensitive Gram +, aerobic
o Clostridium perfingens* (anaerobe) Clostridium perfergins Gram + Anaerobic rod
o Peptostreptococcus Peptostreptococcus Gram + Anaerobic cocci
o H. influenzae (including β-lactamase producers) Gram -, Aerobic cocci
o Moraxella catarrhalis Gram –, aerobic cocci
o Enterobacteriaceae (except Enterobacter) Gram – aerobic rods
 E coli Gram –, Enterobacteriaceae, aerobic rod
 Klebsiella Gram –, Enterobacteriaceae, aerobic rod
 Citrobacter Gram –, Enterobacteriaceae, aerobic rod
 Proteus Gram –, Enterobacteriaceae, aerobic rod
 Salmonella Gram –, Enterobacteriaceae, aerobic rod
 Serratia Gram –, Enterobacteriaceae, aerobic rod
 Shigella Gram –, Enterobacteriaceae, aerobic rod
 Morganella Gram –, Enterobacteriaceae, aerobic rod
 Providencia Gram –, Enterobacteriaceae, aerobic rod
o
o
o
o
Bacteroides fragilis* (anaerobe) Gram – Anaerobic rods
Prevotella* (anaerobe) Gram – Anaerobic rods
Fusobacterium* (anaerobe) Gram – Anaerobic rods
Borellia burgdorfii (cefuroxime) Miscellaneous, Spirochete, Gram
Adverse Drug Reactions:
• Allergies
1. ranging from rash to anaphylaxis
2. Steven Johnson Syndrome
3. Allergic/acute interstitial reaction
• Neutropenia- low neutrophil count
• N/V/D- with oral intake
• Super infections
1. C. diff
2. Yeast infections of the mouth and genital area
3. UTI
Cross Reactivity with other drugs: ALL ABOUT THE SIDE CHAINS
• Penicillins– LOW
a) 1st generation= 1-10%
b) 2nd generation-5th generation= <0.1%
Contraindications due to history of:
• Allergic reactions- N/V/D is not a “true” allergy
• Acute interstitial nephritis
• Seizure disorders or renal impairment- especially if patient had a seizure with a
carbapenem antibiotic
• Adverse events- leukopenia
Counseling Points to tell patients:
• May cause N/V/D
• Report rash, breathing or swallowing difficulty
• Report persistent diarrhea such as c. diff- these antibiotics can kill off normal flora in the
stomach that can lead to C. diff
• Report changes in urinary pattern- ADR of acute interstitial nephritis
• Report signs of other infections
 Vaginal Itching- can lead to fungal infections
 Sores in the mouth- can lead to fungal infections
 Blood in the urine or stool- could be a c.diff
• Report any CNS changes- specifically seizures and carbapenems
3rd generation: Cefdinir
Brand Name: Omnicef
•
•
•
Cell wall inhibitors
Bactericidal
Used mostly for Gram –, but there is some Gram + coverage
Route and absorption: ORAL ONLY
Pharmacodynamics: Time above MIC (Minimal Inhibitory Concentration)- If the drug level is
kept above the MIC of the organism for 50% of the dosing interval (or longer) better killing is
observed and a post antibiotic effect occurs- even after the drug is out of the system, there still is
bacterial killing.
Elimination: RENAL- need to dose adjust for renally impaired patients, smaller dose than given
normally as well as a longer dosing interval
Treatment:
• Mainly used for/ against:
o Methicillin Sensitive Staphylococcus aureus Gram +, aerobic
o Methicillin Sensitive Staphylococcus epidermidis Gram +, aerobic
o Streptococcus Gram +, aerobic
o Enterobacteriaceae (EXCEPT Enterobacter species & Providencia) Gram–
aerobic rods
 E coli Gram –, Enterobacteriaceae, aerobic rod
 Klebsiella Gram –, Enterobacteriaceae, aerobic rod
 Citrobacter Gram –, Enterobacteriaceae, aerobic rod
 Proteus Gram –, Enterobacteriaceae, aerobic rod
 Salmonella Gram –, Enterobacteriaceae, aerobic rod
 Shigella Gram –, Enterobacteriaceae, aerobic rod
 Morganella Gram –, Enterobacteriaceae, aerobic rod
o Campylobacter Gram -, NON Enterobacteriaceae, aerobic rod
o Moraxella Gram –, aerobic cocci
o Neisseria Gram -, aerobic cocci
o Haemophilus influenzae Gram -, aerobic cocci
Adverse Drug Reactions:
• Allergies
1. ranging from rash to anaphylaxis
2. Steven Johnson Syndrome
3. Allergic/acute interstitial reaction
• Neutropenia- low neutrophil count
• N/V/D- with oral intake
• Super infections
1. C. diff
2. Yeast infections of the mouth and genital area
3. UTI
Cross Reactivity with other drugs: ALL ABOUT THE SIDE CHAINS
• Penicillins– LOW
a) 1st generation= 1-10%
b) 2nd generation-5th generation= <0.1%
Contraindications due to history of:
• Allergic reactions- N/V/D is not a “true” allergy
• Acute interstitial nephritis
• Seizure disorders or renal impairment- especially if patient had a seizure with a
carbapenem antibiotic
• Adverse events- leukopenia
Counseling Points to tell patients:
• May cause N/V/D
• Report rash, breathing or swallowing difficulty
• Report persistent diarrhea such as c. diff- these antibiotics can kill off normal flora in the
stomach that can lead to C. diff
• Report changes in urinary pattern- ADR of acute interstitial nephritis
• Report signs of other infections
 Vaginal Itching- can lead to fungal infections
 Sores in the mouth- can lead to fungal infections
 Blood in the urine or stool- could be a c.diff
• Report any CNS changes- specifically seizures and carbapenems
3rd generation: Ceftriaxone
Brand Name: Rocephin
•
•
•
•
•
Cell wall inhibitors
Bactericidal
Used for Gram +, and Gram –
One of the MOST COMMON CEPHALOSPORINS you will see on the INPATIENT
UNITS
Used a lot to treat PNEUMONIA and UTI’s
Route and absorption: IV ONLY
Pharmacodynamics: Time above MIC (Minimal Inhibitory Concentration)- If the drug level is
kept above the MIC of the organism for 50% of the dosing interval (or longer) better killing is
observed and a post antibiotic effect occurs- even after the drug is out of the system, there still is
bacterial killing.
Elimination: RENAL- need to dose adjust for renally impaired patients, smaller dose than given
normally as well as a longer dosing interval
Treatment:
• Mainly used for/ against:
o Streptococcus Gram +, aerobic
o Staphylococcus aureus- Methicillin Sensitive (MSSA) Gram +, aerobic
o Staphylococcus epidermidis- Methicillin Sensitive (MSSE) Gram +, aerobic
o Peptostreptococcus Gram + Anaerobic cocci
o Propionibacterium Gram + Anaerobic rod
o Clostridium perfergins Gram + Anaerobic rod
o Enterobacteriaceae (EXCEPT Enterobacter species) Gram – aerobic rods
 E coli Gram –, Enterobacteriaceae, aerobic rod
 Klebsiella Gram –, Enterobacteriaceae, aerobic rod
 Citrobacter Gram –, Enterobacteriaceae, aerobic rod
 Proteus Gram –, Enterobacteriaceae, aerobic rod
 Salmonella Gram –, Enterobacteriaceae, aerobic rod
 Serratia Gram –, Enterobacteriaceae, aerobic rod
 Shigella Gram –, Enterobacteriaceae, aerobic rod
 Morganella Gram –, Enterobacteriaceae, aerobic rod
 Providencia Gram –, Enterobacteriaceae, aerobic rod
o Campylobacter Gram -, NON Enterobacteriaceae, aerobic rod
o Acinetobacter- Gram –, NON Enterobacteriaceae, aerobic rod
o Neisseria Gram -, aerobic cocci
o H. influenzae Gram -, Aerobic cocci
o Moraxella Gram –, aerobic cocci
o Borellia burgdorfii Miscellaneous, Spirochete, Gram -
Adverse Drug Reactions:
• Allergies
1. ranging from rash to anaphylaxis
2. Steven Johnson Syndrome
3. Allergic/acute interstitial reaction
• Neutropenia- low neutrophil count
• N/V/D- with oral intake
• Super infections
1. C. diff
2. Yeast infections of the mouth and genital area
3. UTI
Cross Reactivity with other drugs: ALL ABOUT THE SIDE CHAINS
• Penicillins– LOW
a) 1st generation= 1-10%
b) 2nd generation-5th generation= <0.1%
Contraindications due to history of:
• Allergic reactions- N/V/D is not a “true” allergy
• Acute interstitial nephritis
• Seizure disorders or renal impairment- especially if patient had a seizure with a
carbapenem antibiotic
• Adverse events- leukopenia
Counseling Points to tell patients:
• May cause N/V/D
• Report rash, breathing or swallowing difficulty
• Report persistent diarrhea such as c. diff- these antibiotics can kill off normal flora in the
stomach that can lead to C. diff
• Report changes in urinary pattern- ADR of acute interstitial nephritis
• Report signs of other infections
 Vaginal Itching- can lead to fungal infections
 Sores in the mouth- can lead to fungal infections
 Blood in the urine or stool- could be a c.diff
• Report any CNS changes- specifically seizures and carbapenems
3rd generation: Ceftazidime
Brand Name: Fortaz
•
•
•
•
•
•
Cell wall inhibitors
Bactericidal
Used for Gram – mostly and some Gram + and Gram + ANAEROBES
This is the DRUG OF CHOICE in NEONATES
VERY GOOD coverage for PSEUDOMONAS
ONLY CEPHALOSPORIN THAT DOES NOT TREAT STAPH AUREUS INFECTIONS
Route and absorption: IV ONLY
Pharmacodynamics: Time above MIC (Minimal Inhibitory Concentration)- If the drug level is
kept above the MIC of the organism for 50% of the dosing interval (or longer) better killing is
observed and a post antibiotic effect occurs- even after the drug is out of the system, there still is
bacterial killing.
Elimination: RENAL- need to dose adjust for renally impaired patients, smaller dose than given
normally as well as a longer dosing interval
Treatment:
• Mainly used for/ against:
o Streptococcus- some species has RESISTANCE Gram +, aerobic
o Peptostreptococcus Gram + Anaerobic cocci
o Propionibacterium Gram + Anaerobic rod
o PSEUDOMONAS*** Gram -, NON Enterobacteriaceae, aerobic rod
o Enterobacteriaceae (ALL species) Gram – aerobic rods
 E coli Gram –, Enterobacteriaceae, aerobic rod
 Klebsiella Gram –, Enterobacteriaceae, aerobic rod
 Enterobacteriaceae species Gram –, Enterobacteriaceae, aerobic rod
 Citrobacter Gram –, Enterobacteriaceae, aerobic rod
 Proteus Gram –, Enterobacteriaceae, aerobic rod
 Salmonella Gram –, Enterobacteriaceae, aerobic rod
 Serratia Gram –, Enterobacteriaceae, aerobic rod
 Shigella Gram –, Enterobacteriaceae, aerobic rod
 Morganella Gram –, Enterobacteriaceae, aerobic rod
 Providencia Gram –, Enterobacteriaceae, aerobic rod
o Acinetobacter- Gram –, NON Enterobacteriaceae, aerobic rod
o Campylobacter Gram -, NON Enterobacteriaceae, aerobic rod
o Neisseria Gram -, aerobic cocci
o H. influenzae Gram -, Aerobic cocci
o Moraxella Gram –, aerobic cocci
Adverse Drug Reactions:
• Allergies
1. ranging from rash to anaphylaxis
2. Steven Johnson Syndrome
3. Allergic/acute interstitial reaction
• Neutropenia- low neutrophil count
• N/V/D- with oral intake
• Super infections
1. C. diff
2. Yeast infections of the mouth and genital area
3. UTI
Cross Reactivity with other drugs: ALL ABOUT THE SIDE CHAINS
• Penicillins– LOW
a) 1st generation= 1-10%
b) 2nd generation-5th generation= <0.1%
• Aztreonam- CEFTAZIDIME ONLY
Contraindications due to history of:
• Allergic reactions- N/V/D is not a “true” allergy
• Acute interstitial nephritis
• Seizure disorders or renal impairment- especially if patient had a seizure with a
carbapenem antibiotic
• Adverse events- leukopenia
Counseling Points to tell patients:
• May cause N/V/D
• Report rash, breathing or swallowing difficulty
• Report persistent diarrhea such as c. diff- these antibiotics can kill off normal flora in the
stomach that can lead to C. diff
• Report changes in urinary pattern- ADR of acute interstitial nephritis
• Report signs of other infections
 Vaginal Itching- can lead to fungal infections
 Sores in the mouth- can lead to fungal infections
 Blood in the urine or stool- could be a c.diff
• Report any CNS changes- specifically seizures and carbapenems
4th generation: Cefepime
Brand Name: Maxipime
•
•
•
•
•
Cell wall inhibitors
Bactericidal
Used for Gram – mostly and some Gram + and Gram + ANAEROBES
This is the DRUG OF CHOICE in NEONATES
VERY GOOD coverage for PSEUDOMONAS
Route and absorption: IV ONLY
Pharmacodynamics: Time above MIC (Minimal Inhibitory Concentration)- If the drug level is
kept above the MIC of the organism for 50% of the dosing interval (or longer) better killing is
observed and a post antibiotic effect occurs- even after the drug is out of the system, there still is
bacterial killing.
Elimination: RENAL- need to dose adjust for renally impaired patients, smaller dose than given
normally as well as a longer dosing interval
Treatment:
• Mainly used for/ against:
o Methicillin Sensitive Staphylococcus aureus (MSSA) Gram +, aerobic
o Methicillin Sensitive Staphylococcus epidermidis (MSSE) Gram +, aerobic
o Streptococcus species Gram +, aerobic
o Peptostreptococcus Gram + Anaerobic cocci
o PSEUDOMONAS*** Gram -, NON Enterobacteriaceae, aerobic rod
o Enterobacteriaceae (ALL species) Gram – aerobic rods
 E coli Gram –, Enterobacteriaceae, aerobic rod
 Klebsiella Gram –, Enterobacteriaceae, aerobic rod
 Enterobacteriaceae species Gram –, Enterobacteriaceae, aerobic rod
 Citrobacter Gram –, Enterobacteriaceae, aerobic rod
 Proteus Gram –, Enterobacteriaceae, aerobic rod
 Salmonella Gram –, Enterobacteriaceae, aerobic rod
 Serratia Gram –, Enterobacteriaceae, aerobic rod
 Shigella Gram –, Enterobacteriaceae, aerobic rod
 Morganella Gram –, Enterobacteriaceae, aerobic rod
 Providencia Gram –, Enterobacteriaceae, aerobic rod
o Neisseria Gram -, aerobic cocci
o H. influenzae Gram -, Aerobic cocci
o Moraxella Gram –, aerobic cocci
Adverse Drug Reactions:
• Allergies
1. ranging from rash to anaphylaxis
2. Steven Johnson Syndrome
3. Allergic/acute interstitial reaction
• Neutropenia- low neutrophil count
• N/V/D- with oral intake
• Super infections
1. C. diff
2. Yeast infections of the mouth and genital area
3. UTI
Cross Reactivity with other drugs: ALL ABOUT THE SIDE CHAINS
• Penicillins – LOW
a) 1st generation= 1-10%
b) 2nd generation-5th generation= <0.1%
Contraindications due to history of:
• Allergic reactions- N/V/D is not a “true” allergy
• Acute interstitial nephritis
• Seizure disorders or renal impairment- especially if patient had a seizure with a
carbapenem antibiotic
• Adverse events- leukopenia
Counseling Points to tell patients:
• May cause N/V/D
• Report rash, breathing or swallowing difficulty
• Report persistent diarrhea such as c. diff- these antibiotics can kill off normal flora in the
stomach that can lead to C. diff
• Report changes in urinary pattern- ADR of acute interstitial nephritis
• Report signs of other infections
 Vaginal Itching- can lead to fungal infections
 Sores in the mouth- can lead to fungal infections
 Blood in the urine or stool- could be a c.diff
• Report any CNS changes- specifically seizures and carbapenems
5th generation: Ceftaroline
Brand Name: Teflaro
•
•
•
•
Cell wall inhibitor
Bactericidal
Used for Gram – mostly and some Gram + and Gram + ANAEROBES
GOOD for treating MRSA
Route and absorption: IV ONLY
Pharmacodynamics: Time above MIC (Minimal Inhibitory Concentration)- If the drug level is
kept above the MIC of the organism for 50% of the dosing interval (or longer) better killing is
observed and a post antibiotic effect occurs- even after the drug is out of the system, there still is
bacterial killing.
Elimination: RENAL- need to dose adjust for renally impaired patients, smaller dose than given
normally as well as a longer dosing interval
Treatment:
• Mainly used for/ against:
o Methicillin Resistant Staphylococcus aureus (MRSA)- Used as salvage therapy
for pneumonia Gram +, aerobic
o Methicillin Sensitive Staphylococcus aureus (MSSA) Gram +, aerobic
o Streptococcus species Gram +, aerobic
o Peptostreptococcus Gram + Anaerobic cocci
o Propionibacterium Gram + Anaerobic rod
o Enterobacteriaceae (EXCEPT Citrobacter, Serratia, Salmonella, Shigella,
Providencia) Gram – aerobic rods
 E coli Gram –, Enterobacteriaceae, aerobic rod
 Klebsiella Gram –, Enterobacteriaceae, aerobic rod
 Enterobacteriaceae species Gram –, Enterobacteriaceae, aerobic rod
 Proteus Gram –, Enterobacteriaceae, aerobic rod
 Morganella Gram –, Enterobacteriaceae, aerobic rod
o H. influenzae Gram -, Aerobic cocci
o Moraxella Gram –, aerobic cocci
Adverse Drug Reactions:
• Allergies
1. ranging from rash to anaphylaxis
2. Steven Johnson Syndrome
3. Allergic/acute interstitial reaction
• Neutropenia- low neutrophil count
• N/V/D- with oral intake
• Super infections
1. C. diff
2. Yeast infections of the mouth and genital area
3. UTI
Cross Reactivity with other drugs: ALL ABOUT THE SIDE CHAINS
• Pencillins – LOW
a) 1st generation= 1-10%
b) 2nd generation-5th generation= <0.1%
Contraindications due to history of:
• Allergic reactions- N/V/D is not a “true” allergy
• Acute interstitial nephritis
• Seizure disorders or renal impairment- especially if patient had a seizure with a
carbapenem antibiotic
• Adverse events- leukopenia
Counseling Points to tell patients:
• May cause N/V/D
• Report rash, breathing or swallowing difficulty
• Report persistent diarrhea such as c. diff- these antibiotics can kill off normal flora in the
stomach that can lead to C. diff
• Report changes in urinary pattern- ADR of acute interstitial nephritis
• Report signs of other infections
 Vaginal Itching- can lead to fungal infections
 Sores in the mouth- can lead to fungal infections
 Blood in the urine or stool- could be a c.diff
 Report any CNS changes- specifically seizures and carbapenems
Cephalosporin/Beta Lactamase Inhibitors Combinations:
Ceftazidime-Avibactam
Brand Name: Avycaz
•
•
•
•
•
•
Cell wall inhibitor and BETA LACTAMASE INHIBITOR
BETALACTAMASE INHIBITION DUE TO AVIBACTAM
New drug for resistant organisms
Bactericidal
May be active vs. ESBL’s and CARBAPENAMASE PRODUCING ORGANISMS
Used for Gram – mostly and some Gram + and Gram + ANAEROBES
Route and absorption: IV ONLY
Pharmacodynamics: Time above MIC (Minimal Inhibitory Concentration)- If the drug level is
kept above the MIC of the organism for 50% of the dosing interval (or longer) better killing is
observed and a post antibiotic effect occurs- even after the drug is out of the system, there still is
bacterial killing.
Elimination: RENAL- need to dose adjust for renally impaired patients, smaller dose than given
normally as well as a longer dosing interval
Treatment:
• Mainly used for/ against:
o May be active vs. ESBL’s and CARBAPENAMASE PRODUCING
ORGANISMS
o PSEUDOMONAS
o Streptococcus species Gram +, aerobic
o Peptostreptococcus Gram + Anaerobic cocci
o Enterobacteriaceae Gram – aerobic rods
 E coli Gram –, Enterobacteriaceae, aerobic rod
 Klebsiella Gram –, Enterobacteriaceae, aerobic rod
 Enterobacteriaceae species Gram –, Enterobacteriaceae, aerobic rod
 Proteus Gram –, Enterobacteriaceae, aerobic rod
 Citrobacter Gram –, Enterobacteriaceae, aerobic rod
 Salmonella Gram –, Enterobacteriaceae, aerobic rod
 Serratia Gram –, Enterobacteriaceae, aerobic rod
 Shigella Gram –, Enterobacteriaceae, aerobic rod
 Morganella Gram –, Enterobacteriaceae, aerobic rod
 Providencia Gram –, Enterobacteriaceae, aerobic rod
o H. influenzae Gram -, Aerobic cocci
o Moraxella Gram –, aerobic cocci
Adverse Drug Reactions:
• Allergies
1. ranging from rash to anaphylaxis
2. Steven Johnson Syndrome
3. Allergic/acute interstitial reaction
• Neutropenia- low neutrophil count
• N/V/D- with oral intake
• Super infections
1. C. diff
2. Yeast infections of the mouth and genital area
3. UTI
Cross Reactivity with other drugs: ALL ABOUT THE SIDE CHAINS
• Penicillins – LOW
a) 1st generation= 1-10%
b) 2nd generation-5th generation= <0.1%
• Aztreonam- ONLY CEFTAZIDIME
Contraindications due to history of:
• Allergic reactions- N/V/D is not a “true” allergy
• Acute interstitial nephritis
• Seizure disorders or renal impairment- especially if patient had a seizure with a
carbapenem antibiotic
• Adverse events- leukopenia
Counseling Points to tell patients:
• May cause N/V/D
• Report rash, breathing or swallowing difficulty
• Report persistent diarrhea such as c. diff- these antibiotics can kill off normal flora in the
stomach that can lead to C. diff
• Report changes in urinary pattern- ADR of acute interstitial nephritis
• Report signs of other infections
 Vaginal Itching- can lead to fungal infections
 Sores in the mouth- can lead to fungal infections
 Blood in the urine or stool- could be a c.diff
 Report any CNS changes- specifically seizures and carbapenems
Cephalosporin/Beta Lactamase Inhibitors Combinations:
Ceftolozane-Tazobactam
Brand Name: Zerbaxa
•
•
•
•
•
•
Cell wall inhibitor and BETA LACTAMASE INHIBITOR
BETALACTAMASE INHIBITION DUE TO TAZOBACTAM
New drug for resistant organisms
Bactericidal
May be active vs. ESBL’s and CARBAPENAMASE PRODUCING ORGANISMS
Used for Gram – mostly and some Gram + and Gram + ANAEROBES
Route and absorption: IV ONLY
Pharmacodynamics: Time above MIC (Minimal Inhibitory Concentration)- If the drug level is
kept above the MIC of the organism for 50% of the dosing interval (or longer) better killing is
observed and a post antibiotic effect occurs- even after the drug is out of the system, there still is
bacterial killing.
Elimination: RENAL- need to dose adjust for renally impaired patients, smaller dose than given
normally as well as a longer dosing interval
Treatment:
• Mainly used for/ against:
o May be active vs. ESBL’s and CARBAPENAMASE PRODUCING
ORGANISMS
o PSEUDOMONAS
o Streptococcus species Gram +, aerobic
o Peptostreptococcus Gram + Anaerobic cocci
o Enterobacteriaceae Gram – aerobic rods
 E coli Gram –, Enterobacteriaceae, aerobic rod
 Klebsiella Gram –, Enterobacteriaceae, aerobic rod
 Enterobacteriaceae species Gram –, Enterobacteriaceae, aerobic rod
 Proteus Gram –, Enterobacteriaceae, aerobic rod
 Citrobacter Gram –, Enterobacteriaceae, aerobic rod
 Salmonella Gram –, Enterobacteriaceae, aerobic rod
 Serratia Gram –, Enterobacteriaceae, aerobic rod
 Shigella Gram –, Enterobacteriaceae, aerobic rod
 Morganella Gram –, Enterobacteriaceae, aerobic rod
 Providencia Gram –, Enterobacteriaceae, aerobic rod
o H. influenzae Gram -, Aerobic cocci
o Moraxella Gram –, aerobic cocci
Adverse Drug Reactions:
• Allergies
1. ranging from rash to anaphylaxis
2. Steven Johnson Syndrome
3. Allergic/acute interstitial reaction
• Neutropenia- low neutrophil count
• N/V/D- with oral intake
• Super infections
1. C. diff
2. Yeast infections of the mouth and genital area
3. UTI
Cross Reactivity with other drugs: ALL ABOUT THE SIDE CHAINS
• Penicillins – LOW
a) 1st generation= 1-10%
b) 2nd generation-5th generation= <0.1%
Contraindications due to history of:
• Allergic reactions- N/V/D is not a “true” allergy
• Acute interstitial nephritis
• Seizure disorders or renal impairment- especially if patient had a seizure with a
carbapenem antibiotic
• Adverse events- leukopenia
Counseling Points to tell patients:
• May cause N/V/D
• Report rash, breathing or swallowing difficulty
• Report persistent diarrhea such as c. diff- these antibiotics can kill off normal flora in the
stomach that can lead to C. diff
• Report changes in urinary pattern- ADR of acute interstitial nephritis
• Report signs of other infections
 Vaginal Itching- can lead to fungal infections
 Sores in the mouth- can lead to fungal infections
 Blood in the urine or stool- could be a c.diff
 Report any CNS changes- specifically seizures and carbapenems
CELL WALL INHIBITORS
Beta Lactams
Carbapenems
Carbapenems: Doripenem, Ertapenem, Meropenem,
Meropenem/Vaborbactam, Imipenem/ Cilistatin, Imipenem/Cilistatin
with Relebactam
Brand Names:
› Doripenem: Doribax
› Ertapenem: Invanz
› Meropenem: Merrem
› Meropenem/Vaborbactam: Vabomere
› Imipenem/Cilistatin: Primaxin
› Imipenem/Cilistatin with Relebactam: Recarbrio
•
•
•
•
•
Cell wall inhibitor
Bactericidal
Treats infections due to Gram +, Gram + ANAEROBES, Gram -, and Gram – ANAEROBES
ALL CARBAPENEMS treat PSEUDOMONAS EXCEPT ERTAPENEM!
Extended Spectrum Beta Lactamase (ESBL) producers ARE covered
Route and absorption: IV ONLY
Pharmacodynamics: Time above MIC (Minimal Inhibitory Concentration)- If the drug level is
kept above the MIC of the organism for 50% of the dosing interval (or longer) better killing is
observed and a post antibiotic effect occurs- even after the drug is out of the system, there still is
bacterial killing.
Elimination: RENAL- need to dose adjust for renally impaired patients, smaller dose than given
normally as well as a longer dosing interval
Treatment:
• Mainly used for/ against:
o PSEUDOMONAS & ACINETOBACTER Gram -, NON Enterobacteriaceae
Aerobic Rods
o Methicillin Sensitive Staphylococcus Aureus (MSSA) Gram +, aerobic
o Streptococcus Gram +, aerobic
o Enterococcus faecalis Gram +, aerobic
o Most gram negative rods including Pseudomonas (except ertapenem) and
Acinetobacter

NOT Carbapenemase producers!!!! (Carbapenem Resistant
Enterobacteriaceae (CRE)/Klebsiella Pneumoniae Carbapenemase (KPC)
(except/ unless you have Relebactam)
 Extended Spectrum Beta Lactamase (ESBL) producers ARE covered
o GRAM + ANAEROBES & GRAM – ANAEROBES
 Peptococcus Gram + Anaerobic cocci
 Peptostreptococcus Gram + Anaerobic cocci
 Finegoldia Gram + Anaerobic cocci
 Clostridium difficile Gram + Anaerobic rod
 Closttridium perfringens Gram + Anaerobic rod
 Propionibacterium acnes Gram + Anaerobic rod
 Bacillus Gram + Anaerobic rod
 Bacteroids GRAM – ANAEROBES
 Fusobacterium GRAM – ANAEROBES
 Prevotella GRAM – ANAEROBES
Adverse Drug Reactions:
• Allergies
1. ranging from rash to anaphylaxis
2. Steven Johnson Syndrome
3. Allergic/acute interstitial reaction
• Neutropenia- low neutrophil count
• N/V/D- with oral intake
• Super infections
1. C. diff
2. Yeast infections of the mouth and genital area
3. UTI
Cross Reactivity with other drugs: ALL ABOUT THE SIDE CHAINS
• Penicillins= 11%- LOW
Contraindications due to history of:
• Allergic reactions- N/V/D is not a “true” allergy
• Acute interstitial nephritis
• Seizure disorders or renal impairment- especially if patient had a seizure with a
carbapenem antibiotic
• Adverse events- leukopenia
Counseling Points to tell patients:
• May cause N/V/D
• Report rash, breathing or swallowing difficulty
• Report persistent diarrhea such as c. diff- these antibiotics can kill off normal flora in the
stomach that can lead to C. diff
• Report changes in urinary pattern- ADR of acute interstitial nephritis
• Report signs of other infections
 Vaginal Itching- can lead to fungal infections
 Sores in the mouth- can lead to fungal infections
 Blood in the urine or stool- could be a c.diff
• Report any CNS changes- specifically seizures and carbapenems
CELL WALL INHIBITORS
Beta Lactams
Monobactams
Only Class: Aztreonam
Brand Name: Azactam
•
•
•
Cell wall inhibitor
Bactericidal
GRAM – ONLY, DOES NOT COVER GRAM + OR ANAEROBES AT ALL!
Route and absorption: IV ONLY
• Can penetrate the CSF at high doses- so if patient has meningitis that is hospital acquired
vs community acquired or at higher risk for more morbid pathogens, than this antibiotic
is a good agent overall for patients to get it at a high dose
• Normal dose: I gram
• High dose: 2 grams IV every 8 hours to increase penetration in the CSF
Pharmacodynamics: Time above MIC (Minimal Inhibitory Concentration)- If the drug level is
kept above the MIC of the organism for 50% of the dosing interval (or longer) better killing is
observed and a post antibiotic effect occurs- even after the drug is out of the system, there still is
bacterial killing.
Elimination: RENAL- need to dose adjust for renally impaired patients, smaller dose than given
normally as well as a longer dosing interval
Treatment:
• Mainly used for/ against:
o PSEUDOMONAS Gram –, NON Enterobacteriaceae, aerobic rod
o Enterobacteriaceae Gram – aerobic rods
 E coli Gram –, Enterobacteriaceae, aerobic rod
 Klebsiella Gram –, Enterobacteriaceae, aerobic rod
 Enterobacteriaceae species Gram –, Enterobacteriaceae, aerobic rod
 Proteus Gram –, Enterobacteriaceae, aerobic rod
 Citrobacter Gram –, Enterobacteriaceae, aerobic rod
 Salmonella Gram –, Enterobacteriaceae, aerobic rod
 Serratia Gram –, Enterobacteriaceae, aerobic rod
 Shigella Gram –, Enterobacteriaceae, aerobic rod
 Morganella Gram –, Enterobacteriaceae, aerobic rod
 Providencia Gram –, Enterobacteriaceae, aerobic rod
o H. influenzae Gram -, Aerobic cocci
o Moraxella Gram –, aerobic cocci
o Neisseria Gram -, aerobic cocci
Adverse Drug Reactions:
• Allergies
1. ranging from rash to anaphylaxis
2. Steven Johnson Syndrome
3. Allergic/acute interstitial reaction
• Neutropenia- low neutrophil count
• N/V/D- with oral intake
• Super infections
1. C. diff
2. Yeast infections of the mouth and genital area
3. UTI
Cross Reactivity with other drugs: ALL ABOUT THE SIDE CHAINS
• Ceftazidime- has similar side chain structure so if patient has allergy to Ceftazidime, they
could have an allergy to Aztreonam
• Penicillins- Negligible
Contraindications due to history of:
• Allergic reactions- N/V/D is not a “true” allergy
• Acute interstitial nephritis
• Seizure disorders or renal impairment- especially if patient had a seizure with a
carbapenem antibiotic
• Adverse events- leukopenia
Counseling Points to tell patients:
• May cause N/V/D
• Report rash, breathing or swallowing difficulty
• Report persistent diarrhea such as c. diff- these antibiotics can kill off normal flora in the
stomach that can lead to C. diff
• Report changes in urinary pattern- ADR of acute interstitial nephritis
• Report signs of other infections
 Vaginal Itching- can lead to fungal infections
 Sores in the mouth- can lead to fungal infections
 Blood in the urine or stool- could be a c.diff
• Report any CNS changes- specifically seizures and carbapenems
CELL WALL INHIBITORS
Glycopeptides/Lipoglycopeptides
Glycopeptide: Vancomycin
Brand Name: Vancocin
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Cell wall inhibitor- Glycopeptide
Bactericidal
Used for treating GRAM + and GRAM + ANAEROBES ONLY!
Can treat MRSA
ONLY ORAL form is DRUG OF CHOICE for C. DIFF
Route and absorption:
• IV- DOES NOT penetrate the GUT, can only PENETRATE the CSF in high
concentration/doses
• ORAL- has poor absorption but is the drug of choice for C. difficile because oral reaches
the lumen of the gut, oral form also does absorb systemically
Distribution: Distributes widely except into the lumen of the gut in IV form and into the CSF
unless it high, concentrated doses
Pharmacodynamics:
• AUC/ MIC ratio
• Trough levels (checked right before last dose is given) must be checked on patients to see
if the antibiotic is in therapeutic range and if the drug is near or over toxicity level
• Target levels for Vancomycin:
 MODERATE Infections: 10-15 mcg/ml
o Skin infections
o UTI
 SEVERE Infections: 15-20 mcg/ml
o Endocarditis
o Pneumonia
o Sepsis
o Bacteremia
 AREA OF POOR PENETRATION: 20 mcg/ml or higher
o Brain
o CSF
Elimination: RENAL- need to dose adjust for renally impaired patients, smaller dose than given
normally as well as a longer dosing interval
Treatment:
• Mainly used for/ against:
o Methicillin Resistant Staphylococcus aureus (MRSA)- Gram + aerobic- IV
ONLY
o Methicillin Sensitive Staphylococcus aureus (MSSA)- Gram + aerobic
o Clostridium Difficile (C.diff) Gram + aerobic- ORAL ONLY
o Enterococcus species (EXCEPT VANCOMYCIN RESISTANT
ENTEROCOCCUS) Gram + aerobic- IV ONLY
o Streptococcus- Gram + aerobic- IV ONLY
o Corynebacterium Gram + aerobic
o Gram + ANAEROBES
 Peptococcus Gram + ANAEROBIC cocci
 Streptopeptococcus Gram + ANAEROBIC cocci
 Finegoldia Gram + ANAEROBIC cocci
 Clostridium difficile Gram + ANAEROBIC rod
 Clostridium Perfringens Gram + ANAEROBIC rod
 Propionobacterium acnes Gram + ANAEROBIC rod
 Bacillus Gram + ANAEROBIC rod
Adverse Drug Reactions:
• Allergies- RARE
1. Rash
2. Hives
3. Anaphylaxis
• N/V
• HYPOTENSION with FLUSHING- seen with rapid IV, vanc has to have a certain rate at
which it achieves to slow down to prevent hypotension & prevent dermatological
response of Red Man’s Syndrome. Rule of thumb: for every 500 mg given, you have to
infuse over 30 minutes… For example: a patient who gets 1500 mg of vancomycin, 30
minutes times 3 would give you 90 minutes of infusing it
• Red Man/Red Neck- flushing of skin, redness all over the body- STOP INFUSION &
GIVE BENADRYL. Infusion & rate related!
• Phlebitis: inflammation of the vein- Vanco has a very low PH of about 4-5 and if infused
over a long period, it might irritate the veins. Long term get a PICC line.
• ***Renal Failure***- look at serum creatinine levels on daily basis or over 2 days- if you
start seeing a trend, if the trend is going up for the serum creatinine level & patient is on
vancomycin, it is good to check a level of vancomycin- CAN CAUSE ACUTE KIDNEY
INJURY, especially with higher trough levels above theuropeutiic levels, longer time
on the drug or when combined with piperacillin/tazobactam (zosyn) or an
aminoglycoside
Contraindications due to history of:
• Hypersensitivity reactions
Counseling Points to tell patients:
• If infused report any chills, pain, swelling, redness at infusion site, red mans syndrome,
or hypotension
• Report any respiratory difficulty
• May cause N/V, diarrhea
• Report signs of other infections
o Vaginal Itching- can lead to fungal infections
o Sores in the mouth- can lead to fungal infections
o Blood in the urine or stool
• Report any change in urine output or serum creatinine- can be nephrotoxic & cause acute
kidney injury, so check the level of the trough to see where levels are at or patient’s renal
level. If nephrotoxic- the vancomycin level will be extremely high & the creatinine level
will be elevated all due to the kidneys not processing the medication.
Lipoglycopeptide: Telavancin
Brand Name: Vibativ
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Cell wall inhibitor- Lipoglycopeptide
RARELY USED DUE TO MAJOR TOXIC EFFECTS
Bactericidal
Used for treating GRAM + and GRAM + ANAEROBES ONLY!
Can treat MRSA
Route and absorption: IV ONLY
Distribution: Into most tissues INCLUDING THE LUNGS but the BRAIN is questionable so if
patient has meningitis, you should not prescribe this
Elimination: RENAL- need to dose adjust for renally impaired patients, smaller dose than given
normally as well as a longer dosing interval
Treatment:
• Mainly used for/ against:
o Methicillin Resistant Staphylococcus aureus (MRSA)- Gram + aerobic- IV
ONLY
o Methicillin Sensitive Staphylococcus aureus (MSSA)- Gram + aerobic
o Enterococcus species (EXCEPT VANCOMYCIN RESISTANT
ENTEROCOCCUS) Gram + aerobic- IV ONLY
o Streptococcus- Gram + aerobic- IV ONLY
o Corynebacterium Gram + aerobic
o Gram + ANAEROBES
 Peptococcus Gram + ANAEROBIC cocci
 Streptopeptococcus Gram + ANAEROBIC cocci
 Finegoldia Gram + ANAEROBIC cocci
 Clostridium difficile Gram + ANAEROBIC rod
 Clostridium Perfringens Gram + ANAEROBIC rod
 Propionobacterium acnes Gram + ANAEROBIC rod
 Bacillus Gram + ANAEROBIC rod
Adverse Drug Reactions:
• Black Box Warnings
o Increased mortality in Pneumonia patients with impaired renal function
(CrCl ≤ 50 ml/min)
 Only use when benefit > risk
o Nephrotoxicity
o Teratogenicity: ability to cause defects in developing fetus
 Check for pregnancy prior to use
Contraindications due to history of:
• Hypersensitivity reactions
Lipoglycopeptide: Oritavancin
Brand Name: Vibativ
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Cell wall inhibitor- Lipoglycopeptide
RARELY USED DUE TO MAJOR TOXIC EFFECTS
Bactericidal
Used for treating GRAM + and GRAM + ANAEROBES ONLY!
Can treat MRSA
Route and absorption: IV ONLY- ***Given as a single dose over 3 hours***
Distribution: EXTENSIVELY DISTRIBUTED into MOST TISSUES- so good for
CELLULITIS & SOFT SKIN TISSUE INFECTIONS, and can potentially can be used to treat
infections of the brain
Metabolism/Elimination:
• NOT METABOLIZED
• 1-5% EXCRETED in FECES & URINE after 2 WEEKS ADMINISTRATION
• VERY BENEFICIAL FOR NON-COMPLIANT PATIENTS or RENAL/HEPATIC Patients
because no adjustments needed for renal disorders or moderate to severe hepatic disorders
Treatment:
• Mainly used for/ against:
o Methicillin Resistant Staphylococcus aureus (MRSA)- Gram + aerobic- IV
ONLY
o Methicillin Sensitive Staphylococcus aureus (MSSA)- Gram + aerobic
o Enterococcus species (EXCEPT VANCOMYCIN RESISTANT
ENTEROCOCCUS) Gram + aerobic- IV ONLY
o Streptococcus- Gram + aerobic- IV ONLY
o Corynebacterium Gram + aerobic
o Gram + ANAEROBES
 Peptococcus Gram + ANAEROBIC cocci
 Streptopeptococcus Gram + ANAEROBIC cocci
 Finegoldia Gram + ANAEROBIC cocci
 Clostridium difficile Gram + ANAEROBIC rod
 Clostridium Perfringens Gram + ANAEROBIC rod
 Propionobacterium acnes Gram + ANAEROBIC rod
 Bacillus Gram + ANAEROBIC rod
Adverse Drug Reactions:
• Increased warfarin levels- look @ INR level & if INR is elevated long than it can be
problematic. Pretty much all antibiotics can increase warfarin levels. We get about 30%
of vit K from gut bacteria. If we kill bacteria, vitamin K goes down and INR go up even
after stopping warfarin due to half-life. You have four clotting factors, 7, 9, 10 and 2 and
some of them have half-life of up to 60 hours
o Increased risk of bleeding
• Prolonged aPTT (activated Partial Thromboplastin Time)
o Artificial elevation
• This is a 1-time dose medication so you can't stop the medication once it is given, so if
patient is on warfarin, then this medication should not be prescribed because it can cause
an increased risk of bleeds
Contraindications due to history of:
• Hypersensitivity reactions
Lipoglycopeptide: Dalbavancin
Brand Name: Dalvance
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Cell wall inhibitor- Lipoglycopeptide
RARELY USED DUE TO MAJOR TOXIC EFFECTS
Bactericidal
Used for treating GRAM + and GRAM + ANAEROBES ONLY!
Can treat MRSA
Route and absorption: IV ONLY
Distribution: achieves ADEQUATE SKIN & SOFT TISSUE infections, however, the lung and
brain are questionable
Elimination: RENAL Elimination 33%- Dose adjust for renal impairment in patients with a
creatine clearance < 30ml/min (moderate kidney disease: 30-59 ml/min)
Treatment:
• Mainly used for/ against:
o Methicillin Resistant Staphylococcus aureus (MRSA)- Gram + aerobic- IV
ONLY
o Methicillin Sensitive Staphylococcus aureus (MSSA)- Gram + aerobic
o Enterococcus species (EXCEPT VANCOMYCIN RESISTANT
ENTEROCOCCUS) Gram + aerobic- IV ONLY
o Streptococcus- Gram + aerobic- IV ONLY
o Corynebacterium Gram + aerobic
o Gram + ANAEROBES
 Peptococcus Gram + ANAEROBIC cocci
 Streptopeptococcus Gram + ANAEROBIC cocci
 Finegoldia Gram + ANAEROBIC cocci
 Clostridium difficile Gram + ANAEROBIC rod
 Clostridium Perfringens Gram + ANAEROBIC rod
 Propionobacterium acnes Gram + ANAEROBIC rod
 Bacillus Gram + ANAEROBIC rod
Adverse Drug Reactions:
• Infusion related reactions- slow infusion rate
• ALT elevations- hepatic enzyme elevations
Contraindications due to history of:
Hypersensitivity reactions
CELL WALL INHIBITORS
Lipopeptides
Lipopeptide: Daptomycin
Brand Name: Cubicin
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Cell wall inhibitor- Lipopeptide
Bactericidal
Used for treating GRAM +
Can treat MRSA/MRSE
INACTIVATED BY LUNG SURFACTANT- NOT GOOD TO USE FOR PNEUMONIA
Route and absorption: IV ONLY
Distribution: Highly protein bound, distributes to most sites- Good for bacteremia MRSA or
soft skin tissue infection.
• Inactivated by surfactant in the lungs- DO NOT use for respiratory infections like
pneumonia, COPD. So can penetrate the lungs but the lungs surfactant inactivates it
Elimination: RENAL 60%- need to dose adjust for renally impaired patients, smaller dose than
given normally as well as a longer dosing interval
Treatment:
• Mainly used for/ against:
o Methicillin Resistant Staphylococcus aureus (MRSA)- Gram + aerobic- IV
ONLY
o Methicillin Sensitive Staphylococcus aureus (MSSA)- Gram + aerobic
o Clostridium Difficile (C.diff) Gram + aerobic- ORAL ONLY
o Enterococcus species (EXCEPT VANCOMYCIN RESISTANT
ENTEROCOCCUS) Gram + aerobic- IV ONLY
o Streptococcus- Gram + aerobic- IV ONLY
o Corynebacterium Gram + aerobic
o Gram + ANAEROBES
 Peptococcus Gram + ANAEROBIC cocci
 Streptopeptococcus Gram + ANAEROBIC cocci
 Finegoldia Gram + ANAEROBIC cocci
 Clostridium difficile Gram + ANAEROBIC rod
 Clostridium Perfringens Gram + ANAEROBIC rod
 Propionobacterium acnes Gram + ANAEROBIC rod
 Bacillus Gram + ANAEROBIC rod
Adverse Drug Reactions:
• N/ V/ D
• Constipation
• Chest Pain
• Rash
• Myalgia: muscle pain
• Can include severe reactions CPK levels recommended- CPK and CK due
muscle breakdown or rhabdomyolysis. Muscle breakdown is bad for kidneys. The
myoglobin gums up the kidney
Contraindications due to history of:
• Hypersensitivity reactions
• NOT FOR USE IN PATIENTS WITH PNEUMONIA- antibiotic will be broken down
and inactivated by surfactant in the lung
Counseling Points to tell patients:
• Report any burning, pain or redness at infusion site
• Report any throat tightness or difficulty breathing
• Report persistent GI upset
• Report any skin rash, hives etc.
• Report any new or unusual muscle pain or tingling in the extremities
• Darkened urine (because of myoglobin) because drug can cause myalgia
PROTEIN SYNTHESIS
INHIBITORS
Macrolides
Macrolides: Azithromycin, Erythromycin, Clasrithromycin
Brand Names: Azactam
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Cell wall inhibitor
Bactericidal
GRAM – ONLY, DOES NOT COVER GRAM + OR ANAEROBES AT ALL!
Route and absorption: IV ONLY
Pharmacodynamics: Time above MIC (Minimal Inhibitory Concentration)- If the drug level is
kept above the MIC of the organism for 50% of the dosing interval (or longer) better killing is
observed and a post antibiotic effect occurs- even after the drug is out of the system, there still is
bacterial killing.
Elimination: RENAL- need to dose adjust for renally impaired patients, smaller dose than given
normally as well as a longer dosing interval
Treatment:
• Mainly used for/ against:
o PSEUDOMONAS
o Enterobacteriaceae Gram – aerobic rods
 E coli Gram –, Enterobacteriaceae, aerobic rod
 Klebsiella Gram –, Enterobacteriaceae, aerobic rod
 Enterobacteriaceae species Gram –, Enterobacteriaceae, aerobic rod
 Proteus Gram –, Enterobacteriaceae, aerobic rod
 Citrobacter Gram –, Enterobacteriaceae, aerobic rod
 Salmonella Gram –, Enterobacteriaceae, aerobic rod
 Serratia Gram –, Enterobacteriaceae, aerobic rod
 Shigella Gram –, Enterobacteriaceae, aerobic rod
 Morganella Gram –, Enterobacteriaceae, aerobic rod
 Providencia Gram –, Enterobacteriaceae, aerobic rod
o H. influenzae Gram -, Aerobic cocci
o Moraxella Gram –, aerobic cocci
o Neisseria Gram -, aerobic cocci
Adverse Drug Reactions:
• Allergies
4. ranging from rash to anaphylaxis
5. Steven Johnson Syndrome
6. Allergic/acute interstitial reaction
• Neutropenia- low neutrophil count
• N/V/D- with oral intake
• Super infections
1. C. diff
2. Yeast infections of the mouth and genital area
3. UTI
Cross Reactivity with other drugs:
• Cephalosporins – LOW
a) 1st generation= 1-10%
b) 2nd generation-5th generation= <0.1%
• Carbapenems= 11%- LOW
• Aztreonam- NEGLIGIBLE
Contraindications due to history of:
• Allergic reactions- N/V/D is not a “true” allergy
• Acute interstitial nephritis
• Seizure disorders or renal impairment- especially if patient had a seizure with a
carbapenem antibiotic
• Adverse events- leukopenia
Counseling Points to tell patients:
• May cause N/V/D
• Report rash, breathing or swallowing difficulty
• Report persistent diarrhea such as c. diff- these antibiotics can kill off normal flora in the
stomach that can lead to C. diff
• Report changes in urinary pattern- ADR of acute interstitial nephritis
• Report signs of other infections
 Vaginal Itching- can lead to fungal infections
 Sores in the mouth- can lead to fungal infections
 Blood in the urine or stool- could be a c.diff
• Report any CNS changes- specifically seizures and carbapenems