Antibiotics Affecting the Bacterial Cell Wall Medications for infection

Overview Bactericidal Penicillin Cephalosporin Carbapenems Monobactams

Penicillins Penicillin G potassium Other Narrow spectrum PCN G benzathine PCN v Broad Spectrum amoxicillin-clavulanate antistaphylococcal nafcillin antipseudomonas ticarcillin-clavulanate piperacillin tazobactam

Purpose Expected Action Therapeutic Use Destroy bacteria by weakening the bacterial cell wall Therapeutic Use Gram positive cocci Gram negative cocci Syphilis Extended spectrum pcn prophylaxis

Complications Allergies/anaphylaxis Renal impairment Hyperkalemia/dysrhythmias Hypernatremia Contraindications/Precautions Contraindicated - severe history of allergies to pcn, cephalosporin &/or imipenem Caution – at risk for kidney dysfunction If allergic to one pcn should be considered cross allergic to other pcn & at risk for allergy to cephalosporin

Interactions Aminoglycosides Probenecid

Cephalosporins Cephalexin Other 1st generation – cefazolin 2nd generation – cefaclor 3rd generation – ceftriaxone 4th generation - cefepime

Purpose Expected Action Therapeutic Use Beta lactam antibiotics Destroy bacterial cell walls Four generations Therapeutic Use Urinary tract infections Postoperative infections Pelvic infections meningitis

Complications Allergic/hypersensitivity/anaphylaxis Possible cross sensitivity Bleeding tendencies Thrombophlebitis Pain Antibiotic associated pseudomembranous colitis Contraindications/Precautions Contraindications – history of severe allergic reactions to pcn Caution – renal impairment or bleeding tendencies

Interactions Disulfiram reaction Probenecid

Carbapenems Imipenem-cilastatin Other Meropenem

Purpose Expected Action Therapeutic Use Beta lactam antibiotic Destroy bacterial cell wall Therapeutic Use Serious infections Pneumonia Peritonitis UTI Combine with antipseudomonal medications to avoid resistance when treating pseudomonas aeruginosa

Complications Allergy/hypersensitivity Possible cross sensitivity GI Supra-infection Contraindications/Precautions Pregnancy risk C Caution – renal impairment

Other inhibitors Vancomycin Aztreonam fosfomycin

Purpose Expected Action Therapeutic Use Destroys bacterial cell walls MRSA E.coli Staphylococcus epidermidis

Complications Ototoxicity Infusion reactions Thrombophlebitis Renal toxicity Contraindications/Precautions Contraindicated – allergy to corn/corn products or previous allergy to vancomycin Caution – renal impairment, hearing impairment, geriatrics

Interactions Increased risk for ototoxicity When vancomycin used with other ototoxic medications