WEEK 1
-Things to know about each of the major antibiotic drug classes
• Contraindications and high-risk patients
• Know examples of each of the
... [Show More] major antibiotic drug classes
• Monitoring needs
• Which ones require renal dosing adjustments and how much (i.e., 25%, 50%, etc.)
• Patient education
• Lifespan considerations including pregnancy
• Indications for use
Penicillins
• caution with patients allergic reactions to penicillins, cephalosporins, or carbapenems
• Treats infection cause by sensitive bacteria check culture to identify infecting organism
• Can order skin test to assess allergy status
• adjusted doses for patients with impaired renal fnx
NARROW SPECTRUM PENICILLINS: PENICILLIN SENSITIVE(PEN G &PEN
V)
-Mechanism of Action: “Bactericidal”- Weakens the cell wall, causing bacteria to take up excessive amounts of water and rupture.
Occurs by two actions simultaneously: inhibiting transpeptidases and activating autolysins which disrupts synthesis of the cell wall and promotes the active destruction resulting in cell lysis and death.
-Examples: Penicillin G (Prototype Drug), Penicillin V, Nafcillin, Oxacillin, Dicloxacillin, Ampicillin, Amoxicillin, Piperacillin
Penicillin G-
-First Penicillin Available and often referred to plainly as Penicillin
-Bactericidal for gram negative and gram positive bacteria
-Should be taken with medications whereas Penicillin V is stable in stomach acids.
-Side Effects: Allergic reactions, pain at IM injection sites, prolonged (but reversible) sensory and motor dysfunction if injected into peripheral nerves, and neurotoxicity (seizures, confusion, hallucinations- if levels too high)
.
-Life Span Considerations:
*Infants- Used safely in infants with bacterial infections including syphilis, meningitis, & group A streptococcus
*Children/Adolescents- Common drug used to treat bacterial infections in children.
*Pregnant- No well controlled studies but evidence suggests no 2nd or 3rd trimester fetal risk.
*Breastfeeding- Amoxicillin is safe. Data is lacking about transmission of other PCNs from mother to infant through breast milk.
*Older Adults- Doses should be adjusted in older adults with renal dysfunction.
Penicillin Allergy:
-Most common drug allergy to date with severity ranging from minor rash to anaphylaxis
-Can possibly display cross sensitivity to cephalosporins and should not be used if possible
-observed 30 minutes minimum post drug injection for adverse reactions
-For history of PCN allergy, a skin allergy test can be done to assess current risk by injecting a tiny amount of allergen ID (only to be done where epinephrine and respiratory support is available if needed)
Penicillin V-
• Stable in stomach acid (Pen G is not)
• Used for oral therapy, can be taken with meals
NARROW SPECTRUM PENICILLIN: PENICILLIN RESISTANT: (Nafcillin, Oxacillin,
Dicloxacillin)
-Treats S. aureus and S. epidermidis
Broad-Spectrum Penicillins (Ampicillin & Amoxicillin):
-Most common side effects are rash and diarrhea (rash usually 3-10 days post TX start).
-Therapy can be PO or IV and requires dosage adjustment for renal impairment
-Treats Haemophilus influenzae, E. Coli, proteus mirabilis, enterococci, and Neisseria gonorrhoeae
EXTENDED SPECTRUM PENICILLIN: (Piperacillin)
-Treats same diseases as broad spectrum PLUS: *pseudomonas aeruginosa*, enterobacter spp, proteus, bacteroides fragilis, klebsiella spp
-Can cause bleeding secondary to disrupting platelet function
-Usually administered IV
-Reduce dose in renal pt’s
Cephalosporins (Cephalexin)
-Bactericidal drug (similar to PCNs)
-Increases activity against gram-negative agents
-Increases ability to reach cerebral spinal fluid (CSF)-3rd,4th,5th generations
-no routine lab monitoring
-Administered IM or IV
-Take cultures to determine sensitivity and infecting organism
-Contraindicated in pt’s with severe allergic reaction to cephalosporins or penicillins
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