Mechanism: covalently bind PBPs

Toxicities: Rash to anaphylaxis, nephrotoxicity, bleeding

Resistance: Beta lactam ring

Kinetics: Short half life, renal elimination of organic acids, hepatic lysis of lactam ring

Methicillin

Narrow spectrum penicillin

G+ aerobes (reserved for S. aureas)

Nephrotoxic: interstitial nephritis

• Broad spectrum penicillin, penase sensitive
• G+/- aerobes (H influenzae, E coli, P mirabilis, N gonorrhoeae, N. meningitis, enterococci

Ticarcillin, Piperacillin

• Extended spectrum, antipseudomonal carboxypenicillins
• G- aeroves, E, coli, Pseudomonas sp, Proteus sp, Enterobacter sp, NOT staph
• Toxicity: bleeding disorders

• Monobactam (Beta lactam)
• aerobic Gram neg, some pseudomonas and H. influenzae (not anaerobes or G+)
• Penase resistant

Imipenem

• Carbapenem (B lactam)
• broadest activity against G+/- aerobic or anaerobic infections(esp. nosocomial, but not enterococcus)
• Combine with cilastin to prevent renal degrad.
• Penase resistant

• Covalent inhibitor of penicillinase
• Is added to penicillins ( i.e with Amoxicillin=Augmenten)

• Organic acid that competes for renal secretion or penicillins and cephalosporins

• Good for G+, steptococci, s. auereas (except MRSA),
•  not good for G- (except some E. coli, K pneumonia, P. mirabilis)
• poor for anaerobes, enterococci, and listeria
• Cross reactive with penicillins
• Cephalexin, Cefazolin, Cephalothin, Cephradine

• Cefuroxamine, cefactor, cefoxitin, cefiximine, cefotetan
• active against G- and pen'ase, E coli, Klebsiella, Proteus, H. influenzae, M Caterrhalis
• Not as good against G+ as 1st gen

Third Generation Cephalosporins

• Ceftazidime, Cefoperazone, Cefataxime, Ceftriaxone, Ceftizoxime
• good for aerobic G-, poor G+
• Best tx for Klebsiella, enterobacter, proteus, providencia, serratia, Haemophilus sp.
• Good CNS penetration

• Cefepime
• More active against G-, less G+
• good for Pseudomonas, resistance to Beta lactamases

• binds to end of D-Ala bacterial cell wall building block, prevents cross linking by transpeptidase, inhibits bacterial RNA syn
• Parenteral (unless tx for GI), broad distrib. except CSF, renal elim
• G+, S. auereas, S epidermis, strep, enterococci, Corynebacterium, Clostridium, MRSA
• Penase resistant, Pen sensitive
• Ototoxic, rare nephrotoxicity, His release(redman)