Carbapenems, Monobactams & Glycopeptides
These are potent antibiotics used for serious or resistant infections, especially in hospital settings. They work by inhibiting bacterial cell wall synthesis, but they differ in spectrum and clinical application.
Pharmacodynamics
All are bactericidal
Side Effects
Common:
- GI upset (nausea, vomiting, diarrhea)
- Rash, hypersensitivity
- C. difficile-associated diarrhea
Serious (rare):
- Nephrotoxicity (esp. vancomycin)
- Neurotoxicity (seizures with imipenem)
- Hepatotoxicity
- Red man syndrome (with rapid vancomycin infusion)
- Blood dyscrasias (leukopenia, thrombocytopenia)
Therapeutic Uses
Used for severe infections, especially multi-drug resistant (MDR) organisms:
- Carbapenems: Hospital-acquired pneumonia, intra-abdominal infections, septicemia, complicated UTI, skin/soft tissue infections, endocarditis
- Monobactams (Aztreonam): Gram-negative infections in patients with penicillin allergies, including Pseudomonas
- Glycopeptides: MRSA infections, Clostridium difficile colitis (oral vancomycin), enterococcal infections, endocarditis, osteomyelitis
Recap Questions
- Which antibiotic is safe for use in penicillin-allergic patients and targets Gram-negative bacteria only?
- What unique site of action do glycopeptides like vancomycin bind to in the bacterial cell wall?
- Which carbapenem is co-administered with cilastatin and why?
- Which class is effective against MRSA but has no activity against Gram-negative bacteria?
- What is the side effect called that occurs with rapid vancomycin infusion?