Cell Wall Drugs
Therapeutic Use
  • hospital acquired MRSA
  • spectrum includes GP organisms (aerobic and anaerobic)
B-Lactams
Resistance
  • change D-Ala to D-lactace and prevents binding of drug
B-Lactamase Inhibitors
Others
Penicillins
Structure
Consist of an unusual four-member ring common to all
MOA
  • bactericidal
  • active against organisms synthesizing peptidoglycan cell wall
1) inactivate PBPs
2) block transpeptidase reaction preventing crosslinking which is needed for structural rigidity
3) bacterial autolysins constantly remodel cell wall-unopposed destruction of cell wall by bacteria
Cephalosporins
Carbapenems
Monobactams
Inhibit B-lactamase enzyme
  • Clavulanic Acid
  • Sulbactam
  • Tazobactam
Astreonam
  • unique B-lactam ring not fused to another ring
  • resistant to most B-lactamases
  • aerobic GNR
  • not active against GP or anerobes
Vancomycin
Bacitracin
Imipenem
  • Cilastatin- peptidase inhibitor that protects imipenem from degredation
  • Broadest B-lactam
  • resistant to most B lactamases
  • Empirit therapy
  • Klebsiella pneumonia producing extended spectrum B-lactamases
MOA
  • bactericidal
  • glycopeptide that binds to the D-Ala-DAla terminal
Very Broad Spectrum
  • Kills more GN
  • pseudomonas
  • enteric GNR
Broad Spectrum
  • can get through porin and kill some GN
  • enterococci
  • ampicillin for listeria
  • ampicillin reaches therapeutic levels in CSF
Narrow Spectrum
  • streptococci and treponema (benzathine pen G)
  • GPR, N. menigitidis
Very Narrow Spectrum
  • MSSA, streptococci, and s. epidermidis
Resistance
  • natural=organism lacks cell wall
  • acquired= 1)plasmid transfer B-lactamase gene, 2) decreased penetration through outer membrane (modify porins), 3) modified PBPs that do not bind drug
Very Broad Spectrum
  • same as 3rd generation
Very Broad Spectrum
  • same as 2nd plus more GNR
  • great for GNR
  • adequate levels in CSF
  • ceftriaxone is metabolized by liver
Natural Penicillins
Penicillin G and Penicillin V
Antistaphylococcal
  • Nafcillin, dicloxacillin, oxacillin, and methicillin
  • coNDOM for your staph
Amino
  • Amoxicillin and Ampicillin
Antipsuedomonal
  • Piperacillin and ticarcillin
Broad Spectrum
  • same as 1st plus anaerobes, GNC and GNR
  • great for empiric therapy
  • cefuroxime reaches adequate levels in CSF
2nd Generation
  • cefaclor, cefoxitin, cefuroxime, cefamandole
3rd Generation
  • ceftriaxone
  • cefdinir, cefixime, cefotaxime, ceftazidime, ceftibuten, ceftizoxime
4th Generation
  • cefepime
1st Generation
  • cefazolin and cephalexin
Narrow spectrum
  • GPC and PEcK (Proteus E. coli, and klebsiella
Therapeutic Use
  • topically for GP
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