Antibiotics - Beta lactam and beta lactamase inhibitor combinations: Nursing pharmacology

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Notes

Notes

ANTIBIOTICS: BETA LACTAM/BETA LACTAMASE INHIBITOR COMBINATIONS
DRUG NAME
Penicillins: ampicillin/sulbactam (Unasyn), amoxicillin/clavulanate (Augmentin),  piperacillin/tazobactam (Zosyn)

Cephalosporins: ceftolozane/tazobactam (Zerbaxa), ceftazidime/avibactam (Avycaz)
CLASS
Beta-lactam/beta-lactamase inhibitor combinations
MECHANISM of ACTION
Beta-lactamase inhibitors bind to beta-lactamase enzymes in the bacteria and prevent the breakdown of the beta-lactam ring in the antibiotic molecule
INDICATIONS
  • Infections caused by penicillin-resistant bacteria like Haemophilus influenzae, methicillin-sensitive Staphylococcus aureus, Bacteroides fragilis, Proteus spp., Escherichia coli, Klebsiella spp., and Acinetobacter spp.
  • Cephalosporin/beta-lactamase inhibitor combination: Pseudomonas aeruginosa
ROUTE(S) of ADMIN
  • Amoxicillin-clavulanate, ceftolozane-tazobactam: PO
  • Ampicillin-sulbactam: IV, IM 
  • Piperacillin-tazobactam, ceftazidime-avibactam: IV
SIDE EFFECTS
  • Allergic reactions (e.g., urticaria, pruritus, anaphylaxis)
  • Superinfections (e.g., vaginitis, candidiasis, Clostridioides difficile infection)
  • Nausea, gastrointestinal upset, diarrhea, taste disturbance
  • Clavulanate: increased gastrointestinal side effects; cholestatic hepatitis
CONTRAINDICATIONS & CAUTIONS
  • Hypersensitivity to other beta-lactam antibiotics
  • Hepatic or renal disease
  • Pregnancy and breastfeeding

Drug interactions:
  • Aminoglycoside antibiotics
  • Oral contraceptive medications
NURSING CONSIDERATIONS for
ANTIBIOTICS: BETA LACTAM/BETA LACTAMASE INHIBITOR COMBINATIONS
ASSESSMENT & MONITORING
Assessment
  • Current signs of infection: unusual fussiness, decreased appetite, rubbing or tugging on the ear 
  • Weight 
  • Vital signs
  • Presence of drainage in ear canal 
  • Laboratory test results: renal and liver function, CBC

Monitoring
  • Side effects
  • Evaluate the therapeutic effect: resolution of the ear infection and absence of symptoms 
CLIENT EDUCATION
  • About otitis media 
  • Purpose of medication: to treat the ear infection and solve the child’s symptoms 
  • Administration
    • Take with food at evenly spaced intervals
    • Shake oral solution well
    • Use oral solution dispenser
    • May take with juice, milk, formula 
    • Complete entire course of antibiotic
  • Side effects
    • Nausea, vomiting, diarrhea
      • Increase fluid intake, frequent diaper changes 
    • Notify emergency services 
      • Allergic reaction: itchy rash, swelling of the face or throat, difficulty breathing
    • Notify healthcare provider 
      • Superinfection: white patches on the inner cheeks, tongue, roof of the mouth, severe or bloody diarrhea
      • Liver impairment 
        • Fatigue, anorexia, dark urine, yellowing of the skin or eyes 

Transcript

Beta-lactams are a group of antibiotics that contain a beta-lactam ring in their structure that is essential for the antibacterial activity of antibiotics like penicillins and cephalosporins. However, over time, due to their widespread use, some bacteria have acquired resistance by developing enzymes called beta-lactamases. For this reason, some beta-lactam antibiotics are often combined with a class of medications known as beta-lactamase inhibitors in order to treat infections caused by beta-lactam-resistant bacteria like Haemophilus influenzae, methicillin-sensitive Staphylococcus aureus, Bacteroides fragilis, Proteus spp., Escherichia coli, Klebsiella spp., and Acinetobacter spp. Additionally, cephalosporin-containing combinations are effective against Pseudomonas aeruginosa.

Now, beta-lactam/beta-lactamase inhibitor combinations typically contain either a penicillin or a cephalosporin combined with a beta-lactamase inhibitor. Commonly used penicillin beta-lactamase inhibitor combinations include amoxicillin-clavulanate, which is given orally; ampicillin-sulbactam, which is given intramuscularly and intravenously; and piperacillin-tazobactam, which is given intravenously. Commonly used cephalosporin beta-lactamase inhibitor combinations include ceftazidime-avibactam, which is given intravenously; and ceftolozane-tazobactam, which is given orally.

Summary

Beta-lactam antibiotics, named after their beta-lactam ring in their chemical structure, are a type of antibiotic that kills bacteria. Beta-lactamase is an enzyme that these bacteria produce to disable beta-lactam antibiotics. Beta-lactamase inhibitors are another type of antibiotic that are co-administered with beta-lactam antibiotics, to prevent bacteria from disabling these antibiotics using their enzymes.

The combination of a beta-lactam and a beta-lactamase inhibitor is called a "beta-lactam/beta-lactamase inhibitor" (BL/BLI) combination. BL/BLI combinations are used to treat many types of infections, including lung infections, skin infections, urinary tract infections, and stomach infections.

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