Penicillin beta-lactams

Class(es)

Penicillins/Beta-Lactams.
Clinical use(s)

FDA approved: Syphilis, anthrax, listeria infections, meningococcal infections, pasteurella, serious gram-positive infections.
Off-label/clinical use: CAP (children), group B strep, osteomyelitis, SSTI.
Mechanism(s) of action

Bactericidal.
Inhibits bacterial cell wall synthesis during active multiplication.
Key adverse effects

Nausea, vomiting, diarrhea, seizure (rare).
Key drug/food interactions

Tetracyclines (may ↓ effectiveness)
Food (may ↓ peak penicillin concentrations)
Special considerations

Renally adjusted: CrCl < 10 ml/min.

Class(es)

Penicillins/Beta-lactam antibiotic
Clinical use(s)

FDA approved: Ear, nose and throat bacterial infection, skin and soft tissue infection
Off-label/clinical use: Uncomplicated acute otitis media
Mechanism(s) of action

Binds penicillin binding protein, which prevents cell wall synthesis
Key adverse effects

Allergy (~10%), N/V/D (>1%)
Key drug/food interactions

Concurrent use of PENICILLINS and TETRACYCLINES may decrease effectiveness.
Special considerations

Available in oral form only. Contraindicated in serious hypersensitivity reactions to Beta Lactam antibiotics. Cross-sensitivity with cephalosporin antibiotics has been reported to be between .2% and 10%.

Class(es)

Penicillins/Beta-Lactams
Clinical use(s)

FDA approved: Bacterial meningitis, gonorrhea, endocarditis, respiratory tract infection, sepsis, genitourinary/digestive tract infections.
Off-label/clinical use: Bacterial endocarditis (prophylaxis), bacteremia associated with IV line.
Mechanism(s) of action

Bactericidal.
Inhibits cell wall synthesis by binding to one or more penicillin-binding proteins (PBPs).
Key adverse effects

Diarrhea, anaphylaxis.
Key drug/food interactions

Tetracyclines, bupropion/donepezil (lowers seizure threshold).
Special considerations

Rapid infusion may cause seizures.
Renally adjusted: CrCl < 50 ml/min.

Class(es)

Penicillins/Beta-Lactams
Clinical use(s)

FDA approved: Infection due to staph aureus (MSSA).
Off-label/clinical use: Impetigo, SSTI.
Mechanism(s) of action

Bactericidal.
Inhibits cell wall synthesis by binding to one or more penicillin-binding proteins (PBPs).
Key adverse effects

Neurotoxicity (high doses), hypokalemia, bone marrow suppression, diarrhea
Key drug/food interactions

Tetracylines, bupropion/donepezil (lowers seizure threshold), Food (may ↓ dicloxacillin concentrations)
Special considerations

CYP3A4 inducer

Class(es)

Pencillins/Beta-Lactams
Clinical use(s)

FDA approved: Confirmed MSSA—meningitis, endocarditis.
Off-label/clinical use: Skin/soft tissue necrotizing infection, streptococcal skin infection, surgical site infection, catheter-related bacteremia.
Mechanism(s) of action

Bactericidal.
Inhibits cell wall synthesis by binding to one or more penicillin-binding proteins (PBPs).
Key adverse effects

Neurotoxicity (high doses), hypokalemia, bone marrow suppression, diarrhea.
Key drug/food interactions

Fentanyl, cyclosporine, tetracylines, Food (may ↓ nafcillin concentrations).
Special considerations

CYP3A4 inducer.
Dose adjust for severe renal and hepatic impairment.

Class(es)

Aminopenicillins beta lactamase inhibitors
Clinical use(s)

FDA approved: Acute otitis media, CAP, impetigo, SSTI, LRTI, sinusitis, UTI
Off-label/clinical use: Febrile neutropenia, streptococcal pharyngitis.
Mechanism(s) of action

Amoxicillin: Inhibits bacterial cell wall synthesis by binding to one or more of the penicillin-binding proteins (PBPs).
Clavulanic acid: Inactivates beta-lactamase enzymes.
Key adverse effects

Diarrhea, nausea, vomiting
Key drug/food interactions

Tetracyclines
Special considerations

Renally adjusted: CrCl < 30 ml/min.
Do not use ER and 875 mg tablet in HD patients and CrCl < 30 ml/min.
Take with food.

Class(es)

Extended Spectrum Pencillins/Beta-Lactams.
Clinical use(s)

FDA approved: Appendicitis, CAP/HAP, SSTI, pelvic inflammatory disease, peritonitis, puerperal endometritis.
Off-label/clinical use: Bacteremia associated with IV line, febrile neutropenia, infectious disease of abdomen.
Mechanism(s) of action

Piperacillin: Inhibits bacterial cell wall synthesis by binding to one or more of the penicillin-binding proteins (PBPs). Tazobactam: Inhibits many beta-lactamases.
Key adverse effects

Diarrhea, nausea, headache, neutropenia.
Key drug/food interactions

Tetracycline, vancomycin (↑ risk AKI).
Special considerations

Renally adjusted: CrCl < 40 ml/min.

Class(es)

Carbapenem.
Clinical use(s)

FDA approved: Bacterial meningitis, SSTI, infection of the abdomen.
Off-label/clinical use: Bacteremia associated w/ IV line, cystic fibrosis, febrile neutropenia, HAP.
Mechanism(s) of action

Exerts bactericidal activity by inhibiting cell wall synthesis by penetrating the cell wall of most gram-positive and gram-negative bacteria to reach penicillin-binding–protein (PBP) targets.
Key adverse effects

Diarrhea, N/V, rash, anemia, headache.
Key drug/food interactions

Valproic acid, cholera vaccine, live typhoid vaccine, probenecid.
Special considerations

Injection only.
Renal impairment: CrCl <50 ml/min—dose adjust.

Class(es)

Monobactam.
Clinical use(s)

FDA approved: Cystic fibrosis, disease w/ Gram negative bacteria, endometritis, female genital infection, SSTI, LRTI, peritonitis, sepsis, UTI.
Off-label/clinical use: Meningitis, musculoskeletal infection, febrile neutropenia, gonorrhea, post-op prophylaxis, traveler’s diarrhea.
Mechanism(s) of action

Bactericidal against gram-negative aerobic bacteria by binding to penicillin-binding protein-3(PBP-3), which results in inhibition of bacterial cell wall synthesis.
Key adverse effects

Chest discomfort, ALT/AST elevation, SCr elevation, cough, congestion.
Key drug/food interactions

Cholera vaccine.
Special considerations

Injection and inhalation routes.
Renal impairment: CrCl <30 ml/min—dose adjust.