1st Generation
Bacteroides fragilis
 Cefazolin (P)
 Cephalexin (O)
 Act as Penicillin G substitute
 (-) Anaerobic
 Skin Infections
Gram (+)
 Staphylococcus Aureus
 Staphylococcus Epidermidis
 Streptococcus Pneumoniae
 Streptococcus Pyogenes
 Anaerobic Streptococcus
Gram (-)
 Escherichia Coli
 Proteus Mirabilis
 Klebsiella Pneumoniae
2nd Generation
Pseudomonas aeruginosa
 Cefotetan (P)
 Cefoxitin (P)
H influenzae or M catarrhalis
 Cefamandole (P)
 Cefuroxime (O/P)
 Cefaclor (O)
 Better activity 3 additional
gram (-) organisms
 Activity against gram (+) is
weaker
 (+) Anaerobic
 Intraabdominal Infections
Gram (+)
 Staphylococcus Aureus
 Streptococcus Pneumoniae
 Streptococcus Pyogenes
 Anaerobic Streptococcus
Gram (-)
 Escherichia Coli
 Proteus Mirabilis
 Klebsiella Pneumoniae
 Haemophilus Influenzae
 Enterobacter Aerogenes
 Neisseria Species
3rd Generation
Pseudomonas Aeruginosa
 Ceftazidime (P)
 Cefoperazone
 Cefotaxime (P)
Bacteroides fragilis
 Ceftizoxime (P)
Meningitis
 Ceftriaxone (P)
 Cefotaxime (P)
N. Gonorrhea
 Ceftriaxone (P)
 Cefixime (O)
Acute Otitis Media
 Ceftriaxone (P)
 Ceftibuten (O)
 Cefdinir (O)
 Less potent than 1st generation
against MSSA
 Used caution as drugs is
associated with significant
“collateral damage”
e.g. Fluoroquinolones
 (-) Anaerobic
 Lung Infections
Gram (+)
 Streptococcus Pneumoniae
 Streptococcus Pyogenes
 Anaerobic Streptococcus
 ↓Staph
Gram (-)
 Escherichia Coli
 Proteus Mirabilis
 Klebsiella Pneumoniae
 Haemophilus Influenzae
 Enterobacter Aerogenes
 Neisseria Species
 Neisseria Gonorrhea
 Serratia Marcescens
 Pseudomonas aeruginosa
4th Generation
Methillin RSA
 Cefepime (P)
 Not Methicillin susceptible
 (-) Anaerobic
 Serious Infections
 Fever of unknown origin
Gram (+)
 Staphylococcus Aureus
 Staphylococcus Epidermidis
 Streptococcus Pneumoniae
 Streptococcus Pyogenes
 Anaerobic Streptococcus
Gram (-)
 Escherichia Coli
 Proteus Mirabilis
 Klebsiella Pneumoniae
 H. Influenzae
 Enterobacter Aerogenes
 Neisseria Species
 Neisseria Gonorrhea
 Serratia Marcescens
 Pseudomonas Aeruginosa
Advanced Generation
 Ceftaroline (P)
Pseudomonas Aeruginosa
 Ceftolozane (P)
 Administered IV as prodrug,
Ceftaroline Fosamil
 Commercially available against
MRSA
 (+) Anaerobic
 Complicated skin structures
 CA Pneumonia
Gram (+)
 Staph (MRSA)
 Streptococcus Pneumoniae
Gram (-)
 Escherichia Coli
 Proteus Mirabilis
 Klebsiella Pneumoniae
 H. Influenzae
 Enterobacter Aerogenes
 Neisseria Species
 N. Gonorrhea
 Serratia Marcescens
 Pseudomonas aeruginosa
 ESBL-- Enterobacteriaceae
 Acinetobacter Baumannii
 Other Beta- Lactam Drugs

Monobactam Carbapenems Beta- Lactamase Inhibitors

 Disrupts bacterial wall synthesis.  Synthetic B-lactam antibiotic that differ in structure from  Do not have significant antibacterial activity.
 B-lactam ring is not fused to another ring. penicillins in the sulfur atom of thiazolidine ring has been  They bind to inactivate beta-lactamases, thereby
 Low immunologic potential. externalized and replaced by a carbon atom. protecting antibiotics that are normally substrates
 Little cross-reactivity with antibodies induced by other for these enzymes.
beta-lactams
 Alternative for Tx for patients allergic to other penicillin,
cephalosporin and carbapenem.

 Aztreonam (IM/IV)  Imipenem (IV)  Clavulanic Acid

 Doripenem  Sulbactam
 Meropenem (IV)  Tazobactam
 Ertapenem (IM/IV)

*Imipenem compounded with cilastatin to protect it from *Used in combination with certain hydrolysable penicillin.
metabolism by renal dehydropeptidases.

*Doripenem + Meropenem = Imipenem (antibacterial activity)

 (-) Anaerobic  (+) Anaerobic

 Resistant to most B-lactamases, with exception of the ESBL
 Narrow antimicrobial spectrum precludes its use alone in
empiric therapy.
 Tx: UTI
 Imipenem/Cilastatin and meropenem– broadest spectrum
 Imipenem plays a role in empiric therapy.
 Meropenem – reach therapeutic levels in bacterial
meningitis w/o inflammation.
 Ertapenem lacks coverage to P. Aeruginosa, Enterococcus
specie, and Acinetobacter species.
 Excreted: GF
Gram (+)

Gram (-) Gram (-)

 Enterobacteriaceae  Pseudomonas aeruginosa
 Pseudomonas aeruginosa

Nontoxic Imipenem/Cilastatin:
1. N/V
Causes: 2. Diarrhea
1. Phlebitis 3. Neutropenia & Eosinophilia (less common)
2. Skin rash
3. AbN liver function test High levels of Imipenem:
 Seizures
 Other Cell Wall or Membrane-Active Agents

 Vancomycin  Bacitracin  Daptomycin  Telavancin

 Inhibits synthesis of bacterial cell phospholipids as well as  Peptide antibiotic that  Bactericidal  Bactericidal
peptidoglycan polymerization. interferes with a last stage  Concentration-dependent cyclic  Concentration-dependent
 Time-dependent antibiotic in cell wall synthesis in lipopeptide antibiotic semisynthetic lipoglycopeptide
 Restrict use of Tx: Patients who have serious allergy with beta Gram (+) organism  Spectrum similar to vancomycin but active antibiotic
lactams. against vancomycin resistant strains of  Synthetic derivative of vancomycin
enterococci and staphylococci.

Oral: is limited for Tx for potentially life-threatening antibiotic-

associated colitis due to C. Difficile or Staphylococci.
Not absorbed after oral administration

IV: patients with prosthetic heart valves and with patients

undergoing implantation with prosthetic devices.

Gram (+) – effective primarily Gram (+)

 MRSA (DOC)  S. Aureus
 MRS Epidermis infections
 Enterococcal infections

Tx: Enterococcal Endocarditis Tx: Complicated skin and skin structure Tx: Complicated skin and skin structure
infections and bacteremia caused by S. Aureus, infections caused by resistant gram (+)
 Excretion: GF (90-100%) including Right- Sided Infective Endocarditis organism (MRSA)
 Half-Life: 6-10hrs
w/ end stage renal dse: 200hrs  Inactivated by pulmonary surfactants
 Never used in the Tx of Pneumonia
SE:
1. Fever Nephrotoxic – drug is limited to AE: AE:
2. Chills topical use 1. Rhabdomyolysis 1. QTc prolongation
3. Phlebitis at infusion site 2. Myalgias 2. Taste Disturbances
4. Flushing (Red man syndrome) 3. ↑hepatic transaminases and creatine 3. Foamy urine
5. Shock (from histamine release assoc. with rapid 4. Interference with coagulation
phosphokinases
infusion) laboratories (PT/INR, APTT, ACT)
*administer for 2hrs 5. Not recommended for pregnancy
*reactions can be treated with Antihistamine and Steroids

AE:
1. Dose-related hearing loss (Px with renal failure)
2. Ototoxicity and Nephrotoxicity