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

Definitions & Key takeaways

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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Introduction0:00–1:51

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.Once administered, beta-lactam antibiotics act by inhibiting bacterial cell wall synthesis, which kills the bacteria.

Mechanism of action1:51–2:38

However, in resistant bacteria, the beta-lactamase enzyme binds to the beta-lactam ring within the antibiotic and breaks it down, thus inactivating the antibiotic.
This is where the beta-lactamase inhibitors come into play, by binding to the beta-lactamase enzymes in the bacteria. As a result, beta-lactamase inhibitors prevent the beta-lactamase enzyme from inactivating the beta-lactam antibiotic.
As a result, the antibiotics are left free to go about their job of killing the bacteria.The beta-lactam/beta-lactamase inhibitor combinations are generally well tolerated, and the few side effects they produce are usually the results of the antibiotic, or beta-lactam, counterpart.

Side effects2:38–3:49

Allergy to beta-lactams is quite common, and clients typically present with urticaria, pruritus, and some can even progress to anaphylaxis.
Other common side effects include headaches and gastrointestinal disturbances, such as nausea, vomiting, and diarrhea. Beta-lactams can also affect the healthy bacterial flora, making clients more susceptible to superinfections by more resistant pathogens, including vaginitis, candidiasis, and more rarely, Clostridioides difficile infection or CDI for short.
In particular, clavulanate increases the gastrointestinal side effects of amoxicillin, causing antibiotic-associated diarrhea, which can range from frequent loose stools to more severe colitis.
Additionally, clients on amoxicillin-clavulanate can also develop cholestatic hepatitis.Now, beta-lactam/beta-lactamase inhibitor combinations are contraindicated in clients allergic to any beta-lactam antibiotics due to the risk of cross-reactivity between the different classes.

Contraindications3:49–4:36

They should also be used with caution in clients with hepatic or renal disease, as well as during pregnancy and breastfeeding.
With respect to drug interactions, the beta-lactam/beta-lactamase inhibitor combinations should not be given along with aminoglycoside antibiotics, since this combination can result in reduced antibacterial effects of both medications.
Finally, penicillins increase the effects of methotrexate and warfarin and decrease the effects of oral contraceptives.Okay, when caring for a pediatric client with otitis media who has been prescribed a beta-lactam/beta-lactamase inhibitor combination like amoxicillin-clavulanate, first perform a baseline assessment by asking the parents or caregivers about current signs of infection, such as unusual fussiness, decreased appetite, as well as rubbing or tugging on the ear.

Nursing Considerations & Client Education4:36–7:10

Then, assess weight, vital signs, especially temperature; and the ear canal, making note of the presence of any drainage.
Lastly, review recent laboratory test results including renal and liver function tests, as well as CBC. Moving on to client education, teach the parents or caregivers about otitis media, and explain that the medication will help treat the ear infection and resolve the child’s symptoms.
Then, instruct them to give the medication with food at evenly spaced intervals, as directed. Instruct them to shake the oral solution well before use, and be sure they know how to use the provided oral dispenser to measure the correct dose.
Also let them know that they can mix the medication with a small amount of juice, milk, or formula if needed. Lastly, emphasize the importance of completing the full course of the medication, even if the child’s symptoms ameliorate.Then, review common side effects, such as nausea, vomiting, and diarrhea; and encourage increased fluid intake, as well as frequent diaper changes.
On the other hand, explain that they should call emergency services immediately if the child develops an allergic reaction, such as an itchy rash, swelling of the face or throat, or difficulty breathing.
Additionally, they should notify their healthcare provider if the child experiences any symptoms of a superinfection like white patches on the inner cheeks, tongue or roof of the mouth; and severe or bloody diarrhea; as well as symptoms of liver impairment, such as fatigue, anorexia, nausea, dark urine, or yellowing of their eyes or skin.
Finally, while caring for a pediatric client receiving amoxicillin-clavulanate, monitor for the development of side effects, and evaluate for the therapeutic effect of infection resolution and an absence of symptoms.
Alright, as a quick recap …. Beta-lactams are a group of antibiotics that contain a beta-lactam ring that is essential for their antibiotic activity.

Review7:10–8:20

Some bacteria have acquired resistance to these antibiotics 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.
Common side effects include headaches and gastrointestinal disturbances, such as nausea, vomiting, and diarrhea, as well as hypersensitivity reactions.
When caring for a client receiving a beta-lactam/beta-lactamase inhibitor combination, nursing considerations include performing a baseline assessment, monitoring for side effects, and evaluating for the therapeutic response.
Client education is focused on safe self-administration, learning to recognize side effects, as well as when to notify the healthcare provider.
education is focused on safe. Selfie Administration, learn to recognize side effects, as well as when to notify the