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INTRODUCTION

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This chapter will be most useful after having a basic understanding of the material in Chapter 53, Penicillins, Cephalosporins, and Other β-Lactam Antibiotics in Goodman & Gilman’s The Pharmacological Basis of Therapeutics, 12th Edition. In addition to the material presented here, the 12th Edition contains:

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  • A detailed discussion of the mechanisms of action and resistance of the penicillins and cephalosporins

  • A detailed discussion of each of the penicillins and cephalosporins, including their pharmacokinetics and therapeutic uses in specific infections

  • Figure 53-3 which shows a comparison of the structure and composition of gram-positive and gram-negative bacterial cell walls

  • Table 53-1 which shows the chemical structures and major properties of the various penicillins

  • Table 53-2 which shows the chemical structures and dosage forms of selected cephalosporins and related compounds

  • Table 53-3 which shows the cephalosporin generations and the useful spectrum of each generation

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LEARNING OBJECTIVES

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  • Understand the mechanisms of action of the penicillins, cephalosporins, and other β-lactam antibiotics.

  • Understand the mechanisms of resistance of the penicillins, cephalosporins, and other β-lactam antibiotics.

  • Describe the therapeutic effects of the penicillins, cephalosporins, and other β-lactam antibiotics.

  • Describe the untoward effects and contraindications of the penicillins, cephalosporins, and other β-lactam antibiotics.

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DRUGS INCLUDED IN THIS CHAPTER

Penicillins

  • Penicillin G

  • Penicillin V

  • Methicillin

  • Oxacillin (BACTOCILL)

  • Nafcillin

  • Ampicillin

  • Amoxicillin

  • Carbenicillin

  • Ticarcillin

  • Mezlocillin

  • Piperacillin

Cephalosporins

  • Cephazolin (ANCEF, KEFZOL, others)

  • Cephalexin (KEFLEX, others)

  • Cefadroxil (DURACEF)

  • Cephradine (VELOCEF)

  • Cefuroxime (ZANACEF)

  • Cefuroxime axetil (CEFTIN)

  • Cefprozil (CEFZIL)

  • Cefmetazole (ZEFAZONE)

  • Loracarbef (LORABID)

  • Cefotaxime (CLAFORAN)

  • Ceftriaxone (ROCEPHIN)

  • Cefdinir (OMNICEF)

  • Cefditoren pivoxil (SPECTRACEF)

  • Ceftibuten (CEDAX)

  • Cefpodoxime proxetil (VANTIN)

  • Ceftizoxime (CEFIZOX)

  • Cefoperazone (CEFOBID)

  • Ceftazidime (FORTAZ, others)

  • Cefepime (MAXIPINE)

Other β-Lactam Antibiotics

  • Imipenem (PRIMAXIN)

  • Meropenem (MERREM)

  • Doripenem (DORIBAX)

  • Ertapenem (INVANZ)

  • Aztreonam (AZACTAM)

β-Lactamase Inhibitors

  • Clavulanic acid (AUGMENTUM, combination with amoxicillin; TIMENTIN, combination with ticarcillin)

  • Sulbactam (UNASYN, combination with ampicillin)

  • Tazobactam (ZOSYN, combination with piperacillin)

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MECHANISMS OF ACTION AND RESISTANCE OF PENICILLINS, CEPHALOSPORINS, AND β-LACTAMASE INHIBITORS
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Figure 39-1

Action of β-lactam antibiotics in Staphylococcus aureus. The bacterial cell wall consists of glycopeptide polymers (a NAM-NAG amino-hexose backbone) linked via bridges between amino acid side chains. In S. aureus, the bridge is (Gly)5-d-Ala between lysines. The cross-linking is catalyzed by a transpeptidase, the enzyme that penicillins and cephalosporins inhibit. NAM, N-acetyl-muramic acid; ...

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