PENICILINE ANTISTAFILOCOCICE

PENICILINE PENICILINE ANTISTAFILOCOCICEANTISTAFILOCOCICE

Meticilina, Nafcilina, Oxacilina, Meticilina, Nafcilina, Oxacilina, Dicloxacilina, FlucloxacilinaDicloxacilina, Flucloxacilina

Sunt active pe stafilococi secretori Sunt active pe stafilococi secretori de betalactamaza-exceptie Staf. de betalactamaza-exceptie Staf. MRSAMRSA

Reactii adverse : tulburari digestive, Reactii adverse : tulburari digestive, hepatice,leucopenie, nefrite toxice, hepatice,leucopenie, nefrite toxice, reactii alergicereactii alergice

OxacilinaOxacilina

AdministrareAdministrare Per os, i.m., i.v.Per os, i.m., i.v.

T1/2T1/2 30-60 min30-60 min

Biodisponibilitate 33%Biodisponibilitate 33%

Legare de prot. Legare de prot. plasmaticeplasmatice

90%90%

Distributie in Distributie in tes.tes.

In majoritatea tes. Nu trece In majoritatea tes. Nu trece in LCRin LCR

Traverseaza placenta, Traverseaza placenta, partial in laptele maternpartial in laptele matern

EliminareaEliminarea Renala 45% forma activa, Renala 45% forma activa, restul sub forma de restul sub forma de metabolitimetaboliti

OXACILINAOXACILINA

POSOLOGIA:POSOLOGIA:Adulti: 2-3g/zi la 6oreAdulti: 2-3g/zi la 6ore Nou-nascuti 20-30mg/kg/zi - 4 prizeNou-nascuti 20-30mg/kg/zi - 4 prizeSugar, copil mic :Sugar, copil mic : - 50-80mg/kg/zi - 4 prize- 50-80mg/kg/zi - 4 prizeInfectii grave: Adulti 2-12g/zi i.m. sau i.v.Infectii grave: Adulti 2-12g/zi i.m. sau i.v. Copii 100-200mg/kg/zi i.m. Copii 100-200mg/kg/zi i.m.

sau i.v.sau i.v.

NafcilinaNafcilina

AdministrareAdministrare i.m., i.v.i.m., i.v.

T1/2T1/2 60 min60 min


90%90%


In majoritatea tes. Nu trece In majoritatea tes. Nu trece in LCRin LCR


EliminareaEliminarea Renala 33% forma activa, Renala 33% forma activa, restul prin metabolizare restul prin metabolizare hepaticahepaticaAdulti 500mg la 6 ore, copii 25mg/kg/ziAdulti 500mg la 6 ore, copii 25mg/kg/zi

PENICILINE CU SPECTRU PENICILINE CU SPECTRU LARGLARG

AMOXICILINA, AMPICILINAAMOXICILINA, AMPICILINA PIVAMPICILINA, BACAMPICILINA, PIVAMPICILINA, BACAMPICILINA,

TALAMPICILINATALAMPICILINA

Gram-pozitivi Gram-pozitivi Gram-negativiGram-negativi

pen-susc pen-susc S. aureusS. aureus Proteus mirabilis Proteus mirabilisGroup streptococciGroup streptococci SSalmonella, Shigellaalmonella, Shigella E. coliE. coliEnterococcus sp.Enterococcus sp. L- L- H. influenzaeH. influenzae Listeria monocytogenesListeria monocytogenes

AMPICILINAAMPICILINA


T1/2T1/2 90 min90 min



18%18%


In majoritatea tes. trece in In majoritatea tes. trece in LCR LCR


EliminareaEliminarea Renala 82% forma activa, Renala 82% forma activa, restul prin bila si scaunrestul prin bila si scaun


POSOLOGIA:POSOLOGIA: Adulti: 2-4g/zi la 6oreAdulti: 2-4g/zi la 6ore Nou-nascuti 50-100mg/kg/zi - 4 prizeNou-nascuti 50-100mg/kg/zi - 4 prize Sugar, copil mic :Sugar, copil mic : - 100-200mg/kg/zi - 4 prize- 100-200mg/kg/zi - 4 prize Infectii grave: Adulti 4-12g/zi i.m. sau i.v.Infectii grave: Adulti 4-12g/zi i.m. sau i.v. Copii 200-400mg/kg/zi i.m. Copii 200-400mg/kg/zi i.m.

sau i.v.sau i.v.


INDICATII TERAPEUTICE:INDICATII TERAPEUTICE:

- meningite bacteriene- meningite bacteriene

- sinuzite, otite medii, bronsite - sinuzite, otite medii, bronsite cronice acutizatecronice acutizate

- infectii urinare- infectii urinare

- infectii biliare, inf. Intestinale- infectii biliare, inf. Intestinale

Reactii adverse: reactii alergice si Reactii adverse: reactii alergice si tulburari gastrointestinaletulburari gastrointestinale

AMOXICILINAAMOXICILINA


T1/2T1/2 110 min110 min




In majoritatea tes. trece in In majoritatea tes. trece in LCR LCR



AMOXICILINAAMOXICILINA POSOLOGIA:POSOLOGIA: Adulti: inf. Medii-grave 2-4g/zi la 8oreAdulti: inf. Medii-grave 2-4g/zi la 8ore inf usoare- 250mg la 8 oreinf usoare- 250mg la 8 ore copil >2ani 62,5 mg la 8 orecopil >2ani 62,5 mg la 8 ore copil >2ani 125 mg la 8 orecopil >2ani 125 mg la 8 ore Infectii grave: Adulti 500mg/8ore i.m. sau i.v.Infectii grave: Adulti 500mg/8ore i.m. sau i.v. Copii 50-100mg/kg/zi i.m. sau i.v. Copii 50-100mg/kg/zi i.m. sau i.v.

3prize3prize

COMBINATIICOMBINATII

AMPICILINA + SULFBACTAM 2:1AMPICILINA + SULFBACTAM 2:1 AMOXICILINA + ACID AMOXICILINA + ACID

CLAVULANIC 4:1CLAVULANIC 4:1

PENICILINE ACTIVE PE PENICILINE ACTIVE PE PSEUDOMONAS PSEUDOMONAS AERUGINOSAAERUGINOSA

CARBOXIPENICILINE: CARBOXIPENICILINE: carbenicilina, carbenicilina, ticarcilinaticarcilina

Gram-negativiGram-negativi

Proteus mirabilisProteus mirabilis

SSalmonella, Shigellaalmonella, Shigella E. coliE. coliH. influenzaeH. influenzaeEnterobacter sp.Enterobacter sp.Pseudomonas aeruginosaPseudomonas aeruginosa

PENICILINE ACTIVE PE PENICILINE ACTIVE PE PSEUDOMONAS PSEUDOMONAS AERUGINOSAAERUGINOSA

UREIDOPENICILINE : piperacilina, UREIDOPENICILINE : piperacilina, azlocilinaazlocilinaGram-pozitivi Gram-pozitivi Gram-negativi Gram-negativi viridans strepviridans strep Proteus mirabilisProteus mirabilis SSalmonella, Shigellaalmonella, Shigella EnterococcusEnterococcus E. coliE. coli

L- L- H. influenzaeH. influenzae AnaerobiAnaerobi Enterobacter sp.Enterobacter sp. Pseudomonas Pseudomonas aeruginosaaeruginosa

Serratia marcescensSerratia marcescens

CARBENICILINACARBENICILINA

AdministrareAdministrare Per i.m., i.v.Per i.m., i.v.

T1/2T1/2 60 min60 min


50%50%


In majoritatea tes. Trece in In majoritatea tes. Trece in LCR 30-50%, nu LCR 30-50%, nu traverseaza meningele traverseaza meningele inflamatinflamat



INDICATII TERAPEUTICE:INDICATII TERAPEUTICE:

- Infectii cu PSEUDOMONAS- Infectii cu PSEUDOMONAS

- inf respiratorii pneumonii, - inf respiratorii pneumonii,

- arsuri infectate,infectii cutanate- arsuri infectate,infectii cutanate

- infectii urinare- infectii urinare

- Se asociaza cu aminoglicozide- Se asociaza cu aminoglicozide

Reactii adverse: accidente hemoragice, Reactii adverse: accidente hemoragice, hipokaliemie hepatice,leucopenie, nefrite hipokaliemie hepatice,leucopenie, nefrite toxice, reactii alergicetoxice, reactii alergice


POSOLOGIA: POSOLOGIA: In inf urinare: 50-100mg/kg/ziIn inf urinare: 50-100mg/kg/zi In inf sistemice cu Enterobacte, Proteus In inf sistemice cu Enterobacte, Proteus 200 mg/kg/zi200 mg/kg/zi

Infectii grave: Adulti 20-40g/zi i.m. sau Infectii grave: Adulti 20-40g/zi i.m. sau i.v la 8ore.i.v la 8ore.

Copii 100-600mg/kg/zi i.m. Copii 100-600mg/kg/zi i.m. sau i.v.sau i.v.

PIPERACILINAPIPERACILINA


T1/2T1/2 90 min90 min


50%50%


In majoritatea tes. Trece in In majoritatea tes. Trece in LCRLCR


PIPERACILINAPIPERACILINA

Indicatii terapeutice: inf. Indicatii terapeutice: inf. Abdominale, pulmonare, urinare, Abdominale, pulmonare, urinare, ginecologice si ale pielii oaselor si ginecologice si ale pielii oaselor si articulatiilor cu germeni sensibiliarticulatiilor cu germeni sensibili

125-300mg/kg/zi la 6 ore <2g/doza125-300mg/kg/zi la 6 ore <2g/doza Piperacilina+Tazobactam- 4,5 g Piperacilina+Tazobactam- 4,5 g

(8:1) la 8 ore(8:1) la 8 ore R. adverse:R. adverse:

CEFALOSPORINECEFALOSPORINE

Cephalosporium acremonium Inel dihidrotiazinic + inel

betalactamic 4 generatii

Cefalosporinele de Cefalosporinele de generatia Igeneratia I

CEFAZOLINA,CEFALOTINA,CEFAPIRINCEFAZOLINA,CEFALOTINA,CEFAPIRINA,CEFATRIZINA,CEFATRIZIN, CEFALEXINA, , CEFALEXINA, CEFADROXIL, CEFRADINACEFADROXIL, CEFRADINA

Actiune foarte buna impotriva germenilor Actiune foarte buna impotriva germenilor aerobi gram pozitivi si actiune limitata aerobi gram pozitivi si actiune limitata impotriva catorva germeni aerobi gram-impotriva catorva germeni aerobi gram-negativi.negativi.

Gram-pozitivi Gram-pozitivi Gram-negativiGram-negativimeth-susc meth-susc S. aureusS. aureus E. coliE. colipen-susc pen-susc S. pneumoniaeS. pneumoniae K. pneumoniaeK. pneumoniae streptococcistreptococci P. mirabilisP. mirabilisviridans streptococci viridans streptococci

Cefalosporinele de Cefalosporinele de generatia IIgeneratia II

CEFAMANDOL,CEFUROXIM, CEFAMANDOL,CEFUROXIM, CEFOXITINA, CEFOTETAN, CEFONICID, CEFOXITINA, CEFOTETAN, CEFONICID, CEFORANIDCEFORANID, CEFACLOR, CEFACLOR

Gram-pozitiviGram-pozitivi Gram-Gram-negativinegativi

meth-susc meth-susc S. aureusS. aureus E. coliE. colipen-susc pen-susc S. pneumoniaeS. pneumoniae K. pneumoniaeK. pneumoniaeGroup streptococciGroup streptococci P. mirabilisP. mirabilisviridans streptococciviridans streptococci H. influenzaeH. influenzae

M. catarrhalisM. catarrhalisNeisseria sp.Neisseria sp.

Cefalosporinele de Cefalosporinele de generatia IIIgeneratia III

CEFTRIAXON, CEFOTAXIM, CEFOPERAZONA, CEFTRIAXON, CEFOTAXIM, CEFOPERAZONA, CEFTAZIDIM, CEFPIRON, MOXALACTAMCEFTAZIDIM, CEFPIRON, MOXALACTAM

Gram-negativi aerobiGram-negativi aerobiE. coliE. coli, , K. pneumoniaeK. pneumoniae, , P. mirabilisP. mirabilisH. influenzaeH. influenzae, , M. catarrhalisM. catarrhalis, , N. gonorrhoeaeN. gonorrhoeae ; ; N. N. meningitidismeningitidis

CitrobacterCitrobacter sp., sp., EnterobacterEnterobacter sp., sp., AcinetobacterAcinetobacter sp. sp.Morganella morganiiMorganella morganii, , Serratia marcescensSerratia marcescens, , ProvidenciaProvidenciaPseudomonas aeruginosaPseudomonas aeruginosa (ceftazidim si (ceftazidim si cefoperazona)cefoperazona)

Gram-pozitivi aerobiGram-pozitivi aerobiS. Pneumonie pen. rez. S. Pneumonie pen. rez. (ceftriaxon si cefotaxim)(ceftriaxon si cefotaxim)

Cefalosporinele de Cefalosporinele de generatia IVgeneratia IV

Extinderea spectrului de activitateExtinderea spectrului de activitate gram-positivi: similar cu ceftriaxongram-positivi: similar cu ceftriaxon gram-negatives: similar cu ceftazidim, gram-negatives: similar cu ceftazidim,

incluzand incluzand Pseudomonas aeruginosaPseudomonas aeruginosa; ; EnterobacterEnterobacter sp producator de betalactamaza. sp producator de betalactamaza.

Sunt stabile la Sunt stabile la -lactamases; spectrul -lactamases; spectrul acopera toti germenii producatori de acopera toti germenii producatori de betalactamaza betalactamaza

• CEFEPIMACEFEPIMA

REACTII ADVERSEREACTII ADVERSE

Reactii de hipersensibilizare : urticarie, Reactii de hipersensibilizare : urticarie, bronhospasm, soc anafilacticbronhospasm, soc anafilactic

Reactii hematologice: tulburari de Reactii hematologice: tulburari de coagulare, neutropenie, trombocitopenie.coagulare, neutropenie, trombocitopenie.

Nefrotoxicitate la asocierea cu Nefrotoxicitate la asocierea cu aminoglicozideaminoglicozide

HepatotoxicitateHepatotoxicitate Tulburari gastrointestinaleTulburari gastrointestinale Flebita, durere la locul administrariiFlebita, durere la locul administrarii

CEFALOTINACEFALOTINA


DozeDoze Adult: 05-1g la 6 oreAdult: 05-1g la 6 ore

Copil: 100mg/kg/zi la 6 oreCopil: 100mg/kg/zi la 6 ore

T1/2T1/2


90 min90 min

50%50%

Distributie in tes.Distributie in tes. In majoritatea tes. Nu trece In majoritatea tes. Nu trece in LCR.in LCR.

EliminareaEliminarea Renala 50% forma activa,Renala 50% forma activa,

CefazolinaCefazolina


DozeDoze Adult: 0.5-2g la 12 oreAdult: 0.5-2g la 12 ore


T1/2T1/2


180 min180 min

80%80%

Distributie in tes.Distributie in tes. In majoritatea tes. Nu trece In majoritatea tes. Nu trece in LCR.in LCR.

EliminareaEliminarea Renala 100% forma Renala 100% forma activa,filtrare glomerularaactiva,filtrare glomerulara

CEFALEXINACEFALEXINA

AdministrareAdministrare Per osPer os


Copil: 50-100mg/kg/zi la 8 Copil: 50-100mg/kg/zi la 8 oreore

T1/2T1/2


120 min120 min

80%80%

Distributie in tes.Distributie in tes. In majoritatea tes. In majoritatea tes.


EliminareaEliminarea Renala 80% forma Renala 80% forma activa,secretie activaactiva,secretie activa

CEFUROXIMCEFUROXIMAdministrareAdministrare i.m., i.v.i.m., i.v.

DozeDoze Adult: 750-1500mg la 12 Adult: 750-1500mg la 12 oreore

Copil: 100mg/kg/zi la 12oreCopil: 100mg/kg/zi la 12ore

500mg la 12 ore in inf. 500mg la 12 ore in inf. Pulm.Pulm.

250 mg la 12 ore in inf. 250 mg la 12 ore in inf. urinareurinare

T1/2T1/2


Distributie in tes.Distributie in tes. In majoritatea tes. Trece in In majoritatea tes. Trece in LCR.-concentratii activeLCR.-concentratii active


CEFACLORCEFACLOR

AdministrareAdministrare Per osPer os

DozeDoze Adult: 750mg la 8 oreAdult: 750mg la 8 ore


T1/2T1/2


120 min120 min

80%80%

Distributie in tes.Distributie in tes. In majoritatea tes. Nu trece In majoritatea tes. Nu trece in LCRin LCR


EliminareaEliminarea Renala 60% forma Renala 60% forma activa,secretie activa, 40% activa,secretie activa, 40% biliarabiliara

CEFOTAXIMCEFOTAXIM



Copil: 50-100mg/kg/zi la Copil: 50-100mg/kg/zi la 12ore12ore

T1/2T1/2


180 min180 min

80-90%80-90%


EliminareaEliminarea Renala 40% forma activa, Renala 40% forma activa, 15% metaboliti activi, 45% 15% metaboliti activi, 45% metaboliti inactivimetaboliti inactivi

CEFTRIAXONCEFTRIAXON




T1/2T1/2


180 min180 min

90-95%90-95%


EliminareaEliminarea Renala 60% forma activa, Renala 60% forma activa, 40% prin bila40% prin bila

CEFOPERAZONACEFOPERAZONA




T1/2T1/2


180 min180 min

90%90%


EliminareaEliminarea Renala 30% forma activa, Renala 30% forma activa, 70% prin bila70% prin bila

CEFTAZIDIMCEFTAZIDIM




T1/2T1/2


180 min180 min



CEFEPIMACEFEPIMA




T1/2T1/2


120 min120 min

85%85%

Distributie in tes.Distributie in tes. Vol de distrib: 14-20 l.In Vol de distrib: 14-20 l.In majoritatea tes. Trece in majoritatea tes. Trece in LCR.-concentratii activeLCR.-concentratii active


CEFEPIMACEFEPIMA

Rezistenta germenilor la cefepima se Rezistenta germenilor la cefepima se realizeaza mai greurealizeaza mai greu

Are molecula cu sarcina pozitiva si Are molecula cu sarcina pozitiva si patrunde mai usor prin porii patrunde mai usor prin porii membranei bacterienemembranei bacteriene

Are afinitate mai mare pentru Are afinitate mai mare pentru proteinele receptoare PBP proteinele receptoare PBP

Este stabila la actiunea Este stabila la actiunea betalactamazelorbetalactamazelor

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PENICILINE ANTISTAFILOCOCICE