What drug classes should be tried first before CPNs?
Penciillins, bactrim and erythromycin
Should 1st generation CPNs be used for meningitis, why or why not?
No, because they have poor spinal fluid penetration
Are 1st generation CPNs susceptible to B-lactamases produced by G+ staph aureus?
No
What are the major organisms that CPNs can treat?
Staphylococcus, Streptococcus, E. coli, Klebsiella and P. mirabilis
How does the G+ spectrum of 2nd generation CPNs compare to 1st generation CPNs?
Same organisms, just less activity in the 2nd gen
How does the G- coverage of 2nd generation CPNs compare to the 1st generation CPNs?
Covers same as 1st gen with increased activity and resistance to G- B-lactamases. Also covers: anaerobes, H. influenza, Moraxella catarrhalis and Niesseria species
How does the 3rd generation CPNs G+ coverage compare to the 2nd gens?
Same organisms, less activity
How does the G- coverage of 3rd generation CPNs compare to the 2nd gen?
increased G- activity, additional coverage of P. aeruginosa, Serratia enterobacter and B. fragilis
What does VRE stand for?
Vancomycin resistant enterococci
Which 3rd generation CPNs have good penetration into the CSF?
Ceftazidime and ceftriaxone
Which 3rd generation CPN has oral availability and high stability against B-lactamases?
Cefixime
Which 3rd generation CPNs cover B. fragilis?
Cefoxitin and cefotetan
What are the spectrum changes for 4th generation CPNs over 3rd generation CPNs?
Increased G+ coverage and addition of P. aeruginosa and some enterobacteria
Can 4th generation CPNs treat Enterococcus faecalis and Enterococcus faecium?