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

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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

Content Reviewers

Antonella Melani, MD,Lisa Miklush, PhD, RNC, CNS,Ashley Mauldin MSN, APRN, FNP-BC,Gabrielle Proper, RN, BScN, MN

Contributors

Kaylee Neff,Aileen Lin, MScBMC

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

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