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Which gram stain is strep spp?
positive
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Which gram stain is staph spp?
positive
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Which gram stain is enterococcus?
positive
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Which gram stain is klebsiella?
negative
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Which gram stain is serratia?
negative
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Which gram stain is proteus?
negative
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Which gram stain is salmonella?
negative
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Which gram stain is H flu?
negative
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Which gram stain is Legionella?
negative
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Which gram stain is neisseria spp?
negative
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Which gram stain is pseudomonas?
negative
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What is the MOA of PCNs?
They inhibit the cell wall by binding to PCN binding proteins and inhibiting enzymes that create the cross-linkages
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What are ADRs to PCNS?
- Hypersensitivity reactions (anaphylaxis, hemolytic anemia, serum sickness)
- Interstitial nephritis
- CNS seizures
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Describe the absorption of PCNs
When do they reach peak concentrations?
- Most are destroyed by gastric acid
- They are absorbed in the duodenum and reach peak concentrations in 1-2 hours
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Describe how PCNs are eliminated
- 70% are excreted by the kidneys
- T1/2 approx 1 hour
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How does PCN resistance come about?
- inactivation by various beta-lactamases
- development of new PCN binding proteins that have decreased affinity for PCNs
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List the GM+ organisms covered by PCNs
- Strep spp
- Corynebacterium diptheriae
- Listeria monocytogenes
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Lis the GM- organisms covered by PCNs
- Neisseria meningitidis
- Pasteurella multocida
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List the anaerobic organisms that PCNS cover
- Actinomyces
- Propionibacterium
- Lactobacillus
- Peptostreptococcus
- Peptococcus
- Clostridium spp
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PCNs are the drugs of choice for which conditions?
All stages of syphilis and strep infectinos
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Name the PCNase resistant PCNs
Oxacillin, nafcillin, dicloxacillin
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What organisms do PCNase resistant PCNs cover?
What isn't covered?
- Strep, staph, peptostreptococcus (better staph coverage than nl PCNS)
- No GM-!!
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When do you dose adjust for the PCNase PCNs?
severe hepatic impairment
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Name the two aminoPCNs
Ampicillin, amoxacillin
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What are the drugs of choice against enterococcal infections?
aminoPCNs (ampicillin, amoxacillin)
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Describe the aminoPCN stability around beta lacatamase
not very beta-lactamase stable
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What drug class does ticarcillin belong to?
carboxy PCNs
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What organisms does ticarcillin cover?
- Gram-, esp. pseudomonas
- Strep
- Usual anaerobes
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What drug class does piperacillin belong to?
UreidoPCNs
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What organisms does piperacillin cover?
- Strep and enterococcus
- GM-
- Usual anaerobes PLUS BACTEROIDES
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Describe piperacillin's activity with staph
NO ACTIVITY with staph
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Name the beta-lactamase inhibitors
- Unasyn
- Augmentin
- Timentin
- Zosyn
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Unasyn is a combo of:
ampicillin/sulbactam
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Augmentin is a combo of:
amoxicillin clavulanate
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Timentin is a combo of:
Ticarcillin clavulanate
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Zosyn is a combo of:
piperacillin tazobactam
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How are the beta-lactamase inhibitors better than piperacillin?
Improves GM- against H flu, M. cat, N. gonorrhea, as well as bacteroides
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Describe cephalosporin coverage of enterococcus
none
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