1) BENZYL PENICILLIN - prophylaxis (Benzathine)/meningitis
Procaine; I.M. w/ Comb P.G; I.V. & I.M.., Benzathine; I.M. , Penicillin V; oral + Phenethicillin
2) Resistant Penicillin - one indication - Anti-Staph
Methicillin, Cloxacillin, Dicloxacillin, Flucloxacillin, Nafcillin - Methoxanaf
3) Amino-Penicillins - Broad -SPECTRUM PENICILLINS
Amoxicillin & Ampicillin; Pros Piva, Tala, Paca
4) Anti-Pseudomonal Penicillins pseudmonas & ampicillin resistant proteus
Carbencillin, Ticarcillin, Azlocillin, Mezlocillin, and Piperacillin
cillins exception Methoxanaf
5) Amidino-Penicillens
Mecillinam, Pivmecillinam. Nam
| (Penicillen_ G) | Penicillenase resistant (Anti-staph). | - Amino penicillins (Broad Spectrum) | - Anti-Pseudomonal | |
|---|---|---|---|---|
| Spectrum | - Gram +ve: Streptococci Pneumococci Staphylcocci Gram –ve: Gonorrhea Treponema | - Staphylcocci Only | - Pen G like **G-**ve: Salmonella Shigella Proteus H.Influenza | - + - pseudomonas and - anerobes. |
| Beta Lactamase susceptibility | - Yes | - No | - Yes | - Yes |
| Can Be combined with Clavulanic Acid to make it resistant (Hepatotoxic) |
PENICILLIN/BETA-LACTAMASE INHIBITOR
COMBINATIONS Agents: synergism effect to oppose bacterial resistance
- Ampicillin / sulbactam
- Amoxicillin /clavulanate [Augmentin]
- piperacillin / tazobactam
-The beta-lactamase inhibitors (sulbactam, clavulanate, avibactam and tazobactam) counter beta-lactamases; these drugs mimic the structure of beta-lactams but have little antimicrobial activity on their own. They bind to beta-lactamases irreversibly, preventing the beta-lactamase from destroying any beta-lactams that are coadministered and enabling the therapeutic beta-lactam to be effective.
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Clavulinic acid (hepatotoxic) has little antibacterial activity but inhibit the activity of B-lactamase enzyme by competitive inhibition. This combined with amoxycillin (Augmentin) , this extends the spectrum of amoxycillin to include B-lactamase producing organisms. Other B-lactamase inhibitors include sulbactam, which can combine with ampicillin to extend its spectrum (Unasyn).**
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N.B: New beta-lactamases with the ability to destroy many types of beta lactams are continually being discovered and are becoming more prevalent.
When considering the activity of a beta-lactamase inhibitor combination, remember that the beta-lactamase inhibitor only frees up the beta-lactam to kill the organism—it doesn’t enhance the activity. Therefore, the combination products are active only against the bacteria that the beta-lactam in the combination has intrinsic activity against in the absence of beta-lactamase production. For example, ampicillin/sulbactam is active against beta-lactamase producing E coli because ampicillin alone is active against non-beta-lactamase producing E coli. However, it has no useful activity against P aeruginosa, because ampicillin lacks activity against this organism.
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In contrast, piperacillin/tazobactam is active against P aeruginosa because piperacillin itself is active. Though these drugs have very broad spectra of activity, there are differences among the agents. Keep in mind the rule that beta-lactamase inhibitors restore activity, not add to it, to set them straight.
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Empiric therapy with piperacillin/tazobactam. Because they have activity against aerobes and anaerobes, they are a good empiric choice for mixed infections, such as intra-abdominal infections, diabetic ulcers, and aspiration pneumonia.
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Amoxicillin/clavulanate is used for upper and lower respiratory tract infections when beta-lactamase–producing organisms are found or suspected. It can also be useful for UTIs when resistance to other drugs is seen.