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a*ectar claves
ol1culas
?denti*icacin del
icror!anis o
Bacterias. 0i"os
2nterobacteriaceas
Concentracin bactericida
)ni a CDBDE/
F Caracter)sticas del
edica ento/
@)as de ad inistracin
IralG uso intestinal 2@G ?D 0"ica (itios es"eciales/ (JC5 o=o5 etc
0era"ia Racional
Basada en la *ar acocin1tica y *ar acodina ia Antibiticos bacteriost7ticos vs bactericidas
F 2*ecto sin1r!ico CcidaKcidaE F 2*ecto anta!nico CcidaKestaticoE
0era"ia racional
Antibiticos de"endientes de tie "o/
F 2*ecto L de"endiendo del tie "o que su ;< este "or enci a del D?C/ betalacta icos5 acrolidos5 clinda icina5 etc
2*ecto "ostantibiotico
0era"ia racional
Jaturale9a y severidad de la in*eccin 2l antibitico de es"ectro as restrin!ido a los "osibles a!entes causales Ce ")ricoE. Co binaciones de antibiticos (e debe antener el trata iento durante al enos -2 3oras lue!o de "aciente a*ebril 2n ciertos casos la duracin es ayor Costeo elitis5 endocarditisE
Cultivo y antibiotico!ra a
Resistencia
icrobiana
Cuando las dosis 78i a tolerada no odi*ica el creci iento bacteriano Decanis os/
F >en1ticos/ utaciones es"ontaneas5 trans*erencia de ADJ F Alteracin de ol1culas blanco F Dis inucin de la concentracin/ Lsalida Cbo bas de e*lu=oE5 :entrada Calteracin de "orinasE F ?nactivacin en9i 7tica
Aro*ila8is antibitica
(ola ente en aquellos casos que el bene*icio su"ere el ries!o
F Aacientes con v7lvulas cardiacas "rot1sicas y "rocedi ientos dentales F Fa iliares cercanos de "acientes con tuberculosis y enin!itis F Aacientes so etidos a ciru!)a de intestino5 !inecol!ica5 re "la9o de cadera5 etc
@isto de otra
anera////////
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?. ?JH?B2J (SJ02(?( D2 AAR2D C2$N$AR T
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Historia de la Aenicilina
192'5 Ale8ander Fle in! observa la in3ibicin de un cultivo de (. aureus donde crec)a el 3on!o Aenicilliu notatu
Historia de la Aenicilina
19#.5 se sinteti9a "or "ri era ve9 la "enicilina "ara uso sist1 ico en I8*ord5 "or Florey5 C3ain y Abra3a . 19#25 uso en el 2=ercito a ericano Aara 19+.5 se inicio la "roduccin a !ran escala Jueva era en la 3istoria de las en*er edades in*ecciosas
Aenicilliu
c3ryso!enu
Acido ,Ga ino"enicilanico sin "recursores de la cadena lateral Aenicilinas se iGsinteticas/ 2s"ectro (usce"tibilidad Cin1tica
Aenicilina se iGsint1ticas/
! 6&!
Dis inucin de la "er eabilidad/ "or las "orinas CAseudo onaE Bo bas de e8"ulsin o de 2*lu=o/ Aseudo ona5 2. coli5 !onococo
Decanis os de resistencia
Decanis os en9i 7ticos/ Betalacta asas
F Me"a*i$mo ma$ (re"ue*te #e re$i$te*"ia F Aoco selectivas "or sustrato. F Aroducidas "or >ra K y >ra G. F Codi*icadas en cro oso as o en "l7s idos5 constitutivas o inducibles
Bo ba de e*lu=o
Decanis os de resistencia
Cuatro clases de betalacta asas/
A/ "enicilinasas5 ce*alos"orinasas y al!unas carba"enenasas5 betalacta asas de es"ectro e8tendido C2(B$E B/ de"enden del 9inc5 in3ibe todos e8ce"to a9treona C/ todas las ce*alos"orinas D/ clo8acilina
0ienen escasa actividad anti icrobiana ?nactivan las betalacta asas5 evitando la destruccin del antibitico CsuicidasE
Aenicilinas/ Clasi*icacin
A2J?C?$?JA( JA0NRA$2(/
F Aenicilina >/ sodica5 "otasica5 "rocainica5 ben9atinica F Aenicilina @
A2J?C?$?JA( (2D?G(?J0V0?CA(.
F Resistentes a la Aenicilinasa Cantiesta*ilococicasE/
I8acilina5 diclo8acilina5 *luco8acilina
K
A$CIHI$ B2JWS$?CI UC?DI ,GAA
D20?C?$?JA
I4AC?$?JA
ADI4?C?$?JA
A?A2RAC?$?JA
A2J?C?$?JA >
.CIDO CLA/UL.NICO
SULBACTAM
A2J?C?$?JA >
2(A2C0RI AJ0?D?CRIB?AJI A2RRB?CI( 2(0R?C0I( T FACN$0A0?@I(. AJA2RIB?I( 2(0R?C0I(. AC0?JID?C20I(. 2(A?RIMN20A(.
C$A(?F?CAC?RJ D2 (0R2A0ICICI(
C XGHe ol)ticosE/
F F F >ru"o A C(tr. "yo!enesE >ru"o B C(tr. a!alactiaeE >ru"o C5 F y > Cse e=antes al (tr. "yo!enesE (tr. "neu oniae (tr. utans (tr. san!uis (tr. salivarius (tr. itior (tr. Dilleri
CGHe ol)ticosE/
F F F F F F
(tr. viridans
Str. Co*$te%%atu$ Str. I*terme#iu$ Str. a*-i*o$u$
C$A(?F?CAC?RJ D2 (0R2A0ICICI(
C GHe ol)ticosE C>ru"o DE
F 2nterococos/ 2. *aecalis 2. *aeciu 2. durans F Jo 2nterococos/ (tr. bovis (tr. equinus
A2J?C?$?JA >
2(A2C0RI AJ0?D?CRIB?AJI A2RRB?CI( 2(0R?C0I( T FACN$0A0?@I( >RAD K CICI(
(tr. ATI>2J2(Y1a (tr. AJ2NDIJ?A2 CAenG(E Y1a 2J02RICICIY1a (tr. BI@?(Y1a (tr. @?R?DAJ(Y1a (tr. A>A$AC0?A2Y1a
BAC?$I(
B. AJ0HRAC?(2da C. D?AH0H2R?A2Qra D?AH0H2RI?D2(2da $. DIJIC?0I>2J2(Qra 2R?(?A2$I0R?4Y1a
Reco endada
Aen >G( A2J?C?$?JA > CC?D: ..1Z!6 lE ADI4?C?$?JA Aen >GR? CC?D [ ..1GG : 1..E C2FI0A4?DA Aen >GR C2F0R?A4IJA CC?D [ 1.. Z!6 lE @AJCID?C?JA Aen >G(
A2J?C?$?JA > AenG> Caltas dosisE C04 o CF0 @AJCI C04 o CF0 K @AJCI K R?F,
C04 o CF0 02?CI5 ? i"ene 5 Da"to5 Dalba 0eico K R?F ? i"ene Da"to5 Dalba
#E&')8 acti9a in01n t2 con+iable22. &ntentar contra el +enoti7o *& E3)*&45 6$423. Van:%24.
A2J?C?$?JA >
A2J?C?$?JA >
2(A2C0RI AJ0?D?CRIB?AJI AJA2RIB?I( 2(0R?C0I( >RAD K
CICI( Y1a A2A0I2(0R2A0ICICI(Y1a BAC?$I( C$. A2RFR?J>2(Y1a C$. 020AJ?Y1a
AJA2RIB?I(
Reco endado CsE Alternativas Clinda icina DI4? DI4? 0a bi1n e*ectivo CsE
@AJCI5 DI4?5 2R?0RI 0?C o A?A5 Ce*o8itina CARB5 2R?0RI5 C$IR
(tre"t. Anaerobios A2J?C?$?JAG> Clostridiu "er*rin!es Clostridiu Cl. di**icile Bacteroides *ra!ilis
2i&enella corrodens A2J?C?$?JAG> K6G C$?JDAD?C?JA
tetani
A2J?C?$?JAG> D20RIJ?DAWI$
D20RIJ?DAWI$ C@IE @AJCI D20RIJ?DAWI$ A2J?C?$?JAG> ADA?C?$?JA5 AD6C$ A2J?C?$?JAG> C$?JDAD?C?JA CARBAA2J2D D20RIJ?DAWI$ CoralE Clinda icina
0DA6(D4 C2FI4?0?J5 CF05 $2@I5 >A0?5 ?DA6D2R62R0A DI4? DI4? Detronida9ol C2FG1> 0CGC$5CF45 Clinda icina
Ce*o8itina5 CARB
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I4AC?$?JA
Aenicilinas antiesta*ilococcicas
Resisten la 3idrolisis "or "enicilinasas del esta*ilococo Denos activas que Aen > contra otros icror!anis os (u utilidad 3a dis inuido "or la e er!encia de esta*ilococos resistentes a eticilina CDR(AE5 *rente a todas la "enicilinas y ce*alos"orinas CABA de alto ADE 2n este caso5 el antibitico de eleccin es @anco icina
I4AC?$?JA
2(A2C0RI AJ0?D?CRIB?AJI A2RRB?CI( 2(0R?C0I( T FACN$0A0?@I(. AJA2RIB?I( 2(0R?C0I(. AC0?JID?C20I(. 2(A?RIMN20A(.
I4AC?$?JA
2(A2C0RI AJ0?D?CRIB?AJI A2RRB?CI( 2(0R?C0I( T FACN$0A0?@I( >RAD K CICI(
(. ANR2N( CD20G(E1\ (tr. ATI>2J2( (tr. AJ2NDIJ?A2 CAenG(E 2J02RICICIY1a (tr. BI@?(Y1a (tr. @?R?DAJ(Y1a (tr. A>A$AC0?A2Y1a
BAC?$I(
B. AJ0HRAC?(1a C. D?AH0H2R?A2???a D?AH0H2RI?D2(Y1a $. DIJIC?0I>2J2(Y1a 2R?(?A2$I0R?41a
I4AC?$?JA
2(A2C0RI AJ0?D?CRIB?AJI AJA2RIB?I( 2(0R?C0I( >RAD K
CICI(
1a
A2A0I2(0R2A0ICICI(
GRAM 0 (. aureus CDetG(E (. aureus CDetGRE (tr. "yo!enes (tr. bovis (tr. viridans (tr. a!alactiae (tr. "neu oniae CAenG(E 2nterococo C@ancoG(E AJA2RIB?I(/ Ae"toestre"tococo
PEN G JI JI 0 0 00 00 0 0 00 0 0 00 0 0 00 0 0 000 00 0 0
(ta*ilococo aureus
>RNAI
1.G (ensible a Deticilina CD20G(E u CI4AG(E
Reco endada
I4AC?$?JA CAarenteralE
Alternativa
C2F 1G>Q @anco o 0eico Clinda icina. Clinda icina+.5 $JW'5 Dalba
0a bi1n e*ectivos
B$6?B$ o Carba"en1 icos Dacrlido#5 FM C>AE+ o 0DA6(D4-5 $JW5 M6D5 Da"to5 Dalba5 R?F,.
$JW'5 M6D5 Da"to5 Dalba D20GR CJosoco ialE Q.G Resistencia ?nter edia a @AJCI C@?(AE CC?D/ ^ 1, Z!6 lE #.G Alto nivel de Resistencia a @AJCI CHR(AE CC?D / [ ,# Z!6 lE @AJCID?C?JA 0eico5$JW'5 M6D5 Da"to5 Dalba. Do8i o Dino95 0i!e 0DAG(D4-5 R?F,5 Jovob, Do8iciclina o Dinociclina95 0i!eciclina 0DAG(D4Ri*a "icina,
I4A K @AJCI I8a K 0eico $?J2WI$?D' M6D Da"to5 Dalba5 FM C>AE+ $JW2WI$?D' M6D Da"to icina Dalbavancina
4 4
MECANISMO DE ACCI5N O1ACILINA0/ANCOMICINA
AD?JIA2J?C?$?JA(
ADI4?C?$?JA
A ino"enicilinas
2s"ectro a "lio y i8to >ra K y !ra G5 cocos y bacilos5 H. in*luen9ae5 enterobacteriaceas C2. coli5 Aroteus irabilis5 (al onella y (3i!ellaE. Anaerobios Cno B *ra!ilisE. Helicobacter "ylori A "icilina as activa que Aen > contra 2nterococos y $isteria
A ino"enicilinas
Nnidos con sulbactan o clavulanato a "l)an su es"ectro de actividad absorbe as que a "icilina
ADA F AD4
2(A2C0RI AJ0?D?CRIB?AJI A2RRB?CI( 2(0R?C0I( T FACN$0A0?@I(. AJA2RIB?I( 2(0R?C0I(. AC0?JID?C20I(.
ADA G AD4
2(A2C0RI AJ0?D?CRIB?AJI A2RRB?CI( 2(0R?C0I( T FACN$0A0?@I( >RAD K CICI(
(tr. ATI>2J2( (tr. AJ2NDIJ?A2 CAenG(E Y1a 2J02RICICIY1a (tr. BI@?(Y1a (tr. @?R?DAJ(Y1a (tr. A>A$AC0?A2Y1a
BAC?$I(
B. AJ0HRAC?( C. D?AH0H2R?A2???a D?AH0H2RI?D2(2da $. DIJIC?0I>2J2(Y1a 2R?(?A2$I0R?4Y1a
ADA G AD4
A2RRB?CI( 2(0R?C0I( T FACN$0A0?@I( CICI( >RADG BAC?$I(
2. CI$? 1\ (A$DIJ2$$A
H. ?JF$N2JWA2 CADAG(E 1\
ADA G AD4
2(A2C0RI AJ0?D?CRIB?AJI AJA2RIB?I( 2(0R?C0I( >RAD K
CICI( A2A0I2(0R2A0ICICI( BAC?$I( C$. A2RFR?J>2( C$. 020AJ?
GRAM 0
PEN G
AMP6AMO1
(. aureus CDetG(E (. aureus CDetGRE (tr. "yo!enes (tr. bovis (tr. viridans (tr. a!alactiae (tr. "neu oniae CAenG(E 2nterococo CAenG(E
#E&')8 acti9a in01n t2 con+iable22. &ntentar contra el +enoti7o *& E3)*&45 6$423. Van:%24.
ANAEROBIOS
PEN G
AMP6AMO1
Ae"tococos Ae"toestre"tococo Cl. "er*rin!es Cl. tetani Cl. di**icile 2. corrodens F. nucleatu A. elanino!enicus B. *ra!ilis A. israelii
GRAM 7
ENTEROBACTERIACEAS
PEN G JI JI JI
2. coli CADAG(E A. irabilis (al onella Itros >ra CGE/ A. ultocida (. onili*or e H. in*luen9ae CADAG(E
0000 0000 JI
A2J?C?$?JA( AJ0?A(2NDIDIJA(
TICARCILINA
A?A2RAC?$?JA
0?CARC?$?JA
>RAD K CICI(
(tr. ATI>2J2( (tr. AJ2NDIJ?A2 CAenG(E 2J02RICICI (tr. BI@?( (tr. @?R?DAJ( (tr. A>A$AC0?A2
BAC?$I(
B. AJ0HRAC?( C. D?AH0H2R?A2 D?AH0H2RI?D2( $. DIJIC?0I>2J2( 2R?(?A2$I0R?4
0?CARC?$?JA
CICI(
J. >IJIRRHI2A2 CAasaGEJ2 J. D2J?J>?0?D?(
>RADG
BAC?$I(
(A$DIJ2$$A (H?>2$$A
A. DN$0IC?DA (. DIJ?$?FIRD2
2. CI$? A. D?RAB?$?( 1\ A. @N$>AR?( C. D?@2R(N( A. (0NAR0?? D. DIR>A>J?
A?A2RAC?$?JA
>RAD K CICI(
(tr. ATI>2J2( (tr. AJ2NDIJ?A2 CAenG(E 2J02RICICIY1a (tr. BI@?(Y1a (tr. @?R?DAJ(Y1a (tr. A>A$AC0?A2Y1a
BAC?$I(
B. AJ0HRAC?( C. D?AH0H2R?A2???A D?AH0H2RI?D2(Y1a $. DIJIC?0I>2J2(Y1a 2R?(?A2$I0R?4
A?A2RAC?$?JA
CICI( >RADG BAC?$I(
J. >IJIRRHI2A2 CAasaGEJ2 J. D2J?J>?0?D?( A. DN$0IC?DA (. DIJ?$?FIRD2
2. CI$? (A$DIJ2$$A (H?>2$$A A. D?RAB?$?( 1\ A. @N$>AR?( C. D?@2R(N( A. (0NAR0?? D. DIR>A>J? ]. AJ2NDIJ?A2 2. A2RI>2J2( (. DARC2(C2J( A(. A2RN>?JI(A 1\ CK 0IBRA o C?AE H. ?JF$N2JWA2 CADAG(E
CIDAARAC?RJ D2 2(A2C0RI(
A2J > G ADA6AD4 F 0?C G A?A
A2J?C?$?JA >
>RADG
BAC?$I(
A. DN$0IC?DA 1\ (. DIJ?$?FIRD2 1\
ADA G AD4
A2RRB?CI( 2(0R?C0I( T FACN$0A0?@I( CICI( >RADG BAC?$I(
2. CI$? A. D?RAB?$?( 1\ (A$DIJ2$$A
H. ?JF$N2JWA2 CADAG(E 1\
0?CARC?$?JA
A2RRB?CI( 2(0R?C0I( T FACN$0A0?@I( CICI( >RADG BAC?$I(
J. >IJIRRHI2A2 CAasaGEJ2 J. D2J?J>?0?D?( A. DN$0IC?DA (. DIJ?$?FIRD2
2. CI$? A. D?RAB?$?( 1\ A. @N$>AR?( C. D?@2R(N( A. (0NAR0?? D. DIR>A>J? (A$DIJ2$$A (H?>2$$A
A?A2RAC?$?JA
A2RRB?CI( 2(0R?C0I( T FACN$0A0?@I( CICI( >RADG BAC?$I(
J. >IJIRRHI2A2 CAasaGEJ2 J. D2J?J>?0?D?( A. DN$0IC?DA (. DIJ?$?FIRD2
2. CI$? (A$DIJ2$$A (H?>2$$A A. D?RAB?$?( 1\ A. @N$>AR?( C. D?@2R(N( A. (0NAR0?? D. DIR>A>J? ]. AJ2NDIJ?A2 2. A2RI>2J2( (. DARC2(C2J( A(. A2RN>?JI(A 1\ CK 0IBRA o C?AE H. ?JF$N2JWA2 CADAG(E
CIM89 2:-.6m%.4
AMP
E. (ae"a%i$ L. mo*o"it,-e*e$ E*tero+a"teria"ea$ 2. coli CADAG(E A. irabilis ]lebsiella 2. cloacae (. arcescens A. vul!aris C. diversus A. stuartii D. or!a!ni (al onella (3i!ella As. aeru!inosa Q Q 2.. L+.. L+.. L+.. L1.. L+.. 2.. 1.+ 1.+ >;99 1.; 9.;
TIC
;9 < , Q #.. +. 1.. 1' 1' 1' '; ) ) 1'
PIP
1.; 9.; 1. ..' = ) '; 1' = = = ) = )
in. Nso en in*usion continua o bolos c6QG#3 ArocainicaGben9atinica/ *or as de de"osito5 uso ?D.
PENICILINA G
A2J?C?$?JA > A2J?C?$?JA @ I4AC?$?JA C$I4AC?$?JA D?C$I4AC?$. F$NC$I4AC?$ ADA?C?$?JA ADI4?C?$?JA 0?CAR6A?A2R
Distribucin y e8crecin
A "lia distribucin/ 3)!ado5 bilis5 rin5 se en5 liquido sinovial5 lin*a5 intestino ,.H unida a "rote)nas "las 7ticas C+HE 28crecin renal 3asta 9.H de la dosis5 "or *iltracin C1.HE y secrecin tubular C9.HE. Dis inuida en RJ y ancianos 0162 se "rolon!a en ?R y 3e"7tica.
2*ecto adverso as *recuente Causa as co Pn de aler!ia edica entosa ?ncidencia !lobal/ de 1 a 1.H Auede a"arecer a cualquier dosis y sin antecedente de e8"osicin "revia ?nducidas "or co "uesto ori!inal y sus "roductos de de!radacin C3a"tenosE Das *recuentes en individuos at"icos
H?A2R(2J(?B?$?DAD
2n orden de *recuencia
F F F F F F F F F 28ante a aculo"a"ular Nrticaria Fiebre Broncoes"as o @asculitis 2n* del suero Der atitis e8*oliativa (indro e de (tevensGJo3nson Ana*ila8ia
Reacciones adversas
+H de los "acientes desarrollar7 una reaccin de 3i"ersensibilidad C7cido
Ras3 G reaccin
7s co Pn.
+.H no tiene ras3 recurrente. A "icilina F "rovoca ras3 en +.G1..H de los "acientes con ononucleosis.
A2J?C?$?JA >
A2J?C?$I?$GAI$?G$?(?JA CAA$E
D7s con la ad inistracin "arenteral que con la oral5 ortalidad 1/+.....G1/1...... de los trata ientos. Al!unas reacciones ocurren entre 1G-2 3 ediadas "or ?!2.
He lisis5 0ro bocito"enia 2n*er edad del suero5 dao tisular Der atitis de contacto
JI JI
?!2 no est7 involucrado Co "le=os in unes se alo=an en el te=ido_ *iebre "or *7r acos
H?A2R(2J(?B?$?DAD
?JD2D?A0A(/ : 2. D?J. C: ..+HE C?!2E
F AJAF?$A4?( C....#HG...#HE DIR0A$?DAD ....1H CD2 $I( CA(I( D2 AJAF?$A4?(E
H?AI02J(?RJ (2@2RA T DN2R02 RUA?DA BRIJCICIJ(0R?CC?RJ CIJ A(DA (2@2RA AJ>?I2D2DA D2 @SA( A2R2A( (NA2R?IR2( ARR?0D?A( T (HIC] CARD?I>VJ?CI DI$IR ABDID?JA$5 JAN(2A( T @RD?0I(
H?A2R(2J(?B?$?DAD
AC2$2RADA( T 0ARDSA(/ L 2. D?J. HA(0A -G1+ DSA( CHA(0A 'HE
F 2JF2RD2DAD D2$ (N2RI DIRB?$?FIRD2E F D2RDA0?0?( 24FI$?A0?@A. F (?JDRID2 D2 AR0RA$>?A R2CNRR2J02
@?A IRA$/
F RA(H/ CADA6AD4E5 CDIJIJNC$2I(?( ?JF2CC?I(A5 A$IANR?JI$E F (NA2R?JF2CC?RJ/ CADAE
?J02RACC?IJ2(
INTERACCIONES IN /ITRO
Pe*i"i%i*a G / F 2(0AB?$?DAD. Jo es estable en solucin !lucosada a "H alcalino. A "H +.+ a ,.+ es estable slo durante 12 3oras. F ?JCIDAA0?B?$?DAD. ?nco "atible en solucin con/ Anti icrobianos/ Ce*alos"orinas5 @anco icina5 Aoli i8ina5 An*otericina B5 A ino!licosidos5 0etraciclinas5 Clinda icina5 (ul*ona idas. Jo Anti icrobianos/ Ucido Ascrbico5 A ino*ilina5 BarbitPricos5 Bicarbonato5 Clor*enira ina5 Co "le=o B5 Fenitoina5 He"arina.
INTERACCIONES IN /ITRO
Ampi"i%i*a/ F 2(0AB?$?DAD. Jo es estable en solucin !lucosada a "H alcalino. 2s estable en / Y De8trosa al +H5 solo # 3oras5 3asta 2 !6 l. Y 2n a!ua destilada5 solo 1 3ora. F ?JCIDAA0?B?$?DAD. ?nco "atible en solucin con/ Anti icrobianos/ A ino!licsidos50etraciclinas5 Cloran*enicol5 Aoli i8inas5Clinda icina. Jo Anti icrobianos/ Adrenalina5 Joradrenalina5 BarbitPricos5 Cloro"ro acina5 (uccinilcolina5 Hidroli9ados de Aroteinas.
C$A(?F?CAC?RJ D2 AJ0?D?CRIB?AJI(
?. ?JH?B2J (SJ02(?( D2 AAR2D C2$N$AR T
AC0?@AJ AN0I$?(?JA(. A. B20A$AC0UD?CI(/ 1E Aenicilinas 2E ?n3ibidores de Glacta asas QE Ce*alos"orinas #E Carba"en1 icos +E Donobacta icos B. >$?CIAVA0?DI/ @anco icina. C. $?AI>$?CIAVA0?DI(/ 0eico"laninaGDalbavancin.
?JH?B?DIR2( D2 B20A$AC0ADA(A
C$A(?F?CAC?RJ D2 XG$AC0ADA(A(Y
>ru"o 0i"o de en9i a 1 2a 2b 2be 2c 2d 2e 2* Q # Ce*alos"orinasa Aenicilinasa A "lioGes"ectro 2s"ectroGe8tendido Carbenicilinasa Clo8a8ilinasa Ce*alos"orinasa Carba"ene asa Detaloen9i as Aenicilinasa Clase olecular C A A A A DoA A A B G 2=e "lo Jo de en9i as +Q 2. 1, Q' 1+ 1' 19 Q 1+ 2. cloacae (. aureus5 Citrobacter 02DG15 02DG25 (H@G1 02DGQ5 02DG+5 (H@G2 A(2G15 CARBGQ5 BRIG1 I4AG16-5 A(2G2 A. vul!aris5 B. *ra!ilis 2. Cloacae (. Dalto"3ilia B. ce"acia5 As. aeru!inosa
C$A(?F?CAC?RJ D2 XG$AC0ADA(A(Y
Clase olecular A 0i"o de en9i a Aenicilinasas Ce*alos"orinasas Carba"ene asas B$22 Hidrolisan a todos los XG$act7 icos Ce8ce"to A9treona E Ce*alos"orinasas CA99E Clo8acilinasas ?nactivada "or/ C$@ L 0WB L(B
C D
YBus3 ]. 2..1
.CIDO CLA/UL.NICO
SULBACTAM
AA0R>2JI
ADA6AD4 2+, 2+, 2+, ,# 1, 12' L2+, 12' L2+, L2+, Q2 L12'
(. aureus CD20G(E (. aureus CD20GRE (. e"ider idis CD20G(E H. in*luen9ae CADAGRE D. catarr3alis J. !onorr3oeae 2. coli CADAGRE ]lebsiella "neu . A. irabilis A. vul!aris B. *ra!ilis 2nterobacter5 Citrobacter5 (erratia5 y As. aeru!inosa
AD6(B AD6C$ 1.. 1,.. 2.. ..+ ..2+ 1,.. '.. #.. #.. 2.. ..Q L12'
ADAGAD4 (. aureus CD20G(E 2. *aecalis D. catarralis 2. coli A. irabilis ]. "neu oniae A. vul!aris A. rett!eri D. or!a!ni (. ti"3y (. disenteriae 2. cloacae C. diversus (. arcescens As. aeru!inosa H. in*luen9ae B. (ra-i%i$ R S6R R (6R (6R R R R R (6R (6R R R R R (6R R
0?CARC?$?JA (. aureus CD20G(E 2. *aecalis $. onocito!enes D. catarralis 2. coli A. irabilis A. vul!aris A. rett!eri D. or!a!ni C. diversus (. ti"3y (. disenteriae 2. cloacae ]. "neu oniae (. arcescens As. aeru!inosa H. in*luen9ae B. (ra-i%i$ R R R R (6R (6R ( ( ( ( (6R (6R R R R ( (6R R
0?D2J0?J S R R S ( ( ( ( ( ( S S ( S S ( ( (
A?A2RAC?$?JA (. aureus CD20G(E 2. *aecalis D. catarralis 2. coli A. irabilis A. vul!aris A. rett!eri C. diversus (. ti"3y (. disenteriae 2. cloacae ]. "neu oniae (. arcescens As. aeru!inosa H. in*luen9ae B. (ra-i%i$ R S6R R (6R (6R ( ( ( (6R (6R ( ( ( ( ( R
0AWIAR?$ S S S ( ( ( ( ( S S ( S S ( ( (
C$A(?F?CAC?RJ D2 AJ0?D?CRIB?AJI(
?. ?JH?B2J (SJ02(?( D2 AAR2D C2$N$AR T
AC0?@AJ AN0I$?(?JA(. A. B20A$AC0UD?CI(/ 1E Aenicilinas 2E ?n3ibidores de Glacta asas QE Ce*alos"orinas #E Carba"en1 icos +E Donobacta icos B. >$?CIAVA0?DI/ @anco icina. C. $?AI>$?CIAVA0?DI(/ 0eico"laninaGDalbavancin.
Ce"3alos"oriu
acre oniu
CEFALOSPORINAS
C$A(?F?CAC?RJ D2 C2FA$I(AIR?JA(
>2J2RAG C?RJ 1\ AAR2J02RA$ 0 ` C3E IRA$6AAR2J02RA$ 0 ` C3E IRA$ 0 ` C3E
Ce*alotina C(R$I 2@E C..,E Ce*ale8ina C1..E Ce*a9olina C1.'E Ce*radina C1.1E Ce*adro8ilo C1.+E Ce*uro8i a C1.QE Ce*o8itina C..'E Ce*ota8i a C1.+E Ce*tria8ona C'..E Ce*ta9idi a C1.9E Ce*o"era9ona C2.1E Ce*e"i a C(R$I 2@E C2..E Ce*tibuten C2.#E Ce*aclor C..'E Ce*"ro9il C1.+E Ce*i8i a CQ.1E Ce*"odo8i a C2.QE CAro8etilE
2\ Q\
#\
F F
Contra >ra K/ A2JG> y ADA Contra B. *ra!ilis/ D20RIJ?DAWI$5 ?D?A2J2D5 D2RIA2J2D5 0AWIAR?$5 0?D2J0?J5 (N$0AD?C?$?JA5 C$?JDAD?C?JA T C$IRAJF2J?CI$.
(. aureus y (. e"ider idis D20GR 2nterococos B. ant3racis C. =ei&eiu $isteria onocyto!enes $e!ionella "neu o"3ila 4ant3o onas alto"3ilia Ca "ylobacter =e=uni Clostridiu di**icile. 2nterobacteriacea "roductoras de ]AC
Decanis os de resistencia
Hidrolisis "or betalacta asas C"ara las 2> y Q> inducidas "or "l7s idos o cro os ica ente "or 2nterobacter5 Citrobacter *reundii5 Dor!anella5 (erratia5 Arovidencia y Aseudo onaEa resistencia a todas las Q>. Ce*e"i e es "obre inductora de estas betalacta asas5 "ero susce"tible a 3idrolisis "or ]AC y etalobetalacta asas ?nca"acidad del antibitico de lle!ar a su sitio de accin Alteraciones en la ABA Cneu ococos resistentes a Q>E
GRAM
E. COLI P. MIRABILIS @LEBSIELLA
ANAEROBIOS
CEF. 1G SI JI K6K K
CEF 1G JI K JI JI JI
ANAEROBIOS (tre"tococo s"" Ae"tococos Ae"toestre"tococo Cl. "er*rin!es Cl. tetani Cl. di**icile 2. corrodens F. nucleatu A. elanino!enicus B. *ra!ilis A. israelii
CEF 1G K K K JI JI JI K K JI JI JI
GRAM 7
ENTEROBACTERIACEAS
CEF 1G (? (? JI JI (? JI JI JI
2. coli A. irabilis (al onella (3i!ella ]. "neu oniae Itros >ra G/ A. ultocida (. onili*or e H. in*luen9ae
2(A2C0RI AJ0?D?CRIB?AJI
Bacteria 1> 2> Q> #> Ce*a9olina Ce*uro8i a Ce*ota8i a Ce*e"i a
>ra K (. Aureus CD20G(E (tr. "yo!enes (.Aneu oniae CAenG(E (tr. viridans (tr. a!alactiae C. di"3t3eriae
KKK K K K K K
KK KK KK KK KK KK
Bacteria >ra G J !onorr3oeae J enin!itidis D. catarr3alis 2. coli A. irabilis ] "neu oniae 2nterobacter A. vul!aris A. rett!eri D. or!a!ni (erratia C. diversus (al onella
1> Ce*a9olina
K K K
2> 2> Q> Ce*uro8i a Ce*o8itina Ce*ota8i a KKK KKK6C04 KK KKKK o C04 KKK KKKK KK KK KKKK KK KK KKKK KK KK KKKK KKKK KK KKKK KK KKKK KK KKKK KK KKKK KKKK KKK6C04
2(A2C0RI AJ0?D?CRIB?AJI
Bacteria 1> Ce*a9olina 2> Ce*uro8i a 2> Ce*o8itina Q> Ce*ota8i a
Anaerobios
Ae"toestre"tococos
K K K K
K K K K
B. *ra!ilis
2(A2C0RI AJ0?D?CRIB?AJI
Bacteria 1> Ce*a9olina 2> Ce*uro8i a Q> Ce*ota8i a #> Ce*e"i a
KK
KKK
Ce*tria8ona Ce*tria8ona
AA0R>2JI C2FIA2RAWIJA 2. coli #Q ]lebsiella 1' 2nterob. Cloacae ,. (erratia QA. Dirabilis #+ Arovid. (tuartii 1, Citrobacter +1 As. Aeru!inosa 1Acinet. Calcoacet. Q1 Bact. Fra!ilis 1..
1> Ce*alotina Ce*a9olina ?DG2@ 15' Ce*adrina IG?DG2@ 151 Ce*adro8ilo IG?DG2@ 15+ Ce*ale8ina IG?DG2@ .59
' , 12 ,
C$A(?F?CAC?RJ T FARDACIC?JV0?CA >eneracin @. de Ad . 0` ?ntervalo $CR 28c. C3E dosis C3E Cc!6 lE ' , ' 12 15renal renal renal renal
2> Ce*uro8i a ?DG2@ 15Ce*o8it)n ?DG2@ .5Ce*aclor Iral .5Ce*"ro9il Iral 15Q
@. de 0` ?nterv $CR 28crec. Ad . C3E dosis Cc!6 lE ?DG2@ ?DG2@ ?DG2@ ?DG2@
IG?DG2@
Iral Iral
151 #G' +5,G## renal '5. 12G2# 152GQ9 biliar KK 15' 'G12 .5+GQ. renal 251 12G2# biliarKKK 25. 12 renal renal Q5+ 12G2# renal 252 12
C$A(?F?CAC?RJ T FARDACIC?JV0?CA >eneracin #> Ce*e"i a 2@ 25. 12 (? renal @. de Ad . 0` ?ntervalo $CR 28c. C3E dosis C3E Cc!6 lE
C2FA$I(AIR?JA( C?JV0?CA
D?(0R?BNC?RJ/ F Alcan9an concentraciones e*ectivas en $.C.R. Q>/ Ce*ota8i a Ce*tria8ona. Ce*ta9idi a #>/ Ce*e"i a. F Altas concentraciones en bilis/ Q> / Ce*o"era9ona Ce*tria8ona
C2FA$I(AIR?JA( C?JV0?CA
D20ABI$?(DI/
$a ayor)a no son etaboli9adas. $as que "oseen un radical acetilo en "osicin R2 son "arcial ente desacetiladas ori!inando etabolitos activos de t` 7s lar!a. 2=/ Ce*alotina y Ce*ota8i a.
C2FA$I(AIR?JA( C?JV0?CA
24CR2C?RJ/
F
tubularE. F Al!unas son e8cretadas en alto "orcenta=e "or v)a biliar/ C2FIA2RAWIJA C-+HE C2F0R?A4IJA C#+HE.
C2FA$I(AIR?JA(
2F2C0I( AD@2R(I(
?RR?0AC?RJ D2 DN(CN$I I @2JA CF$2B?0?(E/ e*ecto adv. 7s *recuente. H?A2R(2J(?B?$?DAD/ cru9ada entre s) y con otros XG$act7 icos. CCe*ta9idi a es"ecial ente con A9treona E J2FRI0I4?C?DAD/ solas no. Dayor ries!o en des3idratacin5 ?R5 3i"o&ale ia5 y si se ad inistran otras dro!as ne*rot8icas. (NA2R?JF2CC?IJ2(/ C7ndida5 enterococo5 Cl. di**icile.
C2F0AW?D?DA
AW0R2IJAD
C2FA$I(AIR?JA(
2F2C0I( AD@2R(I(
AND2J0I D2 0RAJ(AD?JA(A(5 FI(FA0A(A A$CA$?JA. J2N0RIA2J?A 0RAJ(?0IR?A. >?/ Jauseas5 v itos5 diarrea. 2F2C0I 0?AI D?(N$F?RAD/ C2FADAJDI$5 C2FIA2RAWIJA.
C$A(?F?CAC?RJ D2 AJ0?D?CRIB?AJI(
?. ?JH?B2J (SJ02(?( D2 AAR2D C2$N$AR T
AC0?@AJ AN0I$?(?JA(. A. B20A$AC0UD?CI(/ 1E Aenicilinas 2E ?n3ibidores de Glacta asas QE Ce*alos"orinas #E Carba"en1 icos +E Donobacta icos B. >$?CIAVA0?DI/ @anco icina. C. $?AI>$?CIAVA0?DI(/ 0eico"laninaGDalbavancin
0iena icinas
CARBAA2J2D?CI(
?D?A2J2D D2RIA2J2D 2R0AA2J2D
2(0AB?$?DAD A DHAG1
2(0AB?$?DAD A DHAG1
>ra
?D?A2J2D
K I K K I I K K K K I I K K K
(. Aureus CDetG(E (. Aureus CDetGRE (tr. A5B5C5>5 @iridans 2. *aecalis 2. *aeciu C. =ei&eiu $. onocito!enes >RAD G Jeisserias y Dora8ella 2J02RIBAC02R?AC2A( As. aeru!inosa B. ce"acia (. alto"3ilia Acinetobacter H. in*luen9ae AJA2RIB?I( B. Fra!ilis y otros
>ra
?D?A2J2D
0 O 0 0 O O 0 0 0 0 O O 0 0 0
D2RIA2J2D
0 O 0 06 O O 0 0 0 0 0 O 0 0 0
(. Aureus CDetG(E (. Aureus CDetGRE (tr. A5B5C5>5 @iridans 2. *aecalis 2. *aeciu C. =ei&eiu $. onocito!enes >RAD G Jeisserias y Dora8ella 2J02RIBAC02R?AC2A( As. aeru!inosa B. ce"acia (. alto"3ilia Acinetobacter H. in*luen9ae AJA2RIB?I( B. Fra!ilis y otros
>ra
?D?A2J2D
K I K K I I K K K K I I K K K
D2RIA2J2D
K I K K6G I I K K K K K I K K K
2R0AA2J2D
K I K K6G I I K K K I I I I K K
(. Aureus CDetG(E (. Aureus CDetGRE (tr. A5B5C5>5 @iridans 2. *aecalis 2. *aeciu C. =ei&eiu $. onocito!enes >RAD G Jeisserias y Dora8ella 2J02RIBAC02R?AC2A( As. aeru!inosa B. ce"acia (. alto"3ilia Acinetobacter H. in*luen9ae AJA2RIB?I( B. Fra!ilis y otros
AJA2RIB?I(
Reco endado CsE Alternativas Clinda icina DI4? DI4? 0a bi1n e*ectivo CsE
@AJCI5 DI4?5 2R?0RI 0?C o A?A5 Ce*o8itina CARB5 2R?0RI5 C$IR
(tre"t. Anaerobios A2J?C?$?JAG> Clostridiu "er*rin!es Clostridiu Cl. di**icile Bacteroides *ra!ilis
2i&enella corrodens A2J?C?$?JAG> K6G C$?JDAD?C?JA
tetani
A2J?C?$?JAG> D20RIJ?DAWI$
D20RIJ?DAWI$ C@IE @AJCI CoralE D20RIJ?DAWI$ A2J?C?$?JAG> ADA?C?$?JA5 AD6C$ A2J?C?$?JAG> C$?JDAD?C?JA ?DA6D2R62R0A D20RIJ?DAWI$ Clinda icina
0DA6(D4 C2FI4?0?J5 CF05 $2@I5 >A0?5 ?DA6D2R62R0A DI4? DI4? Detronida9ol C2FG1> 0CGC$5CF45 Clinda icina
Ce*o8itina5 CARB
DI4?5 C$IR5 2R?0RI6AW?0RI
ADG(B5 A?AG0W
CARBAA2J2DI( C?JV0?CA
AJ0?B?R0?CI ? i"ene 6 Dero"ene @)a de Ad .6 dsis ..+G1 !r ?.@. c6,G'3 ..+G1 !r ?.@. c6'3 Hasta 2 !r ?.@. c6'3 "ara enin!itis 1 !r ?.@.6?.D.
Clidoca)naE c62#3
t` C3E 1 1
H $CR6(an!re
28crecin
'.+ d2
2rta"ene
21
>ra
?D?A2J2D
K I K K I I K K K K I I K K K
CF06C04
K I K I I I I K K I I I K K I
A?AG0W
K I K K I I K K K K I I K K K
(. Aureus CDetG(E (. Aureus CDetGRE (tr. A5B5C5>5 @iridans 2. *aecalis 2. *aeciu C. =ei&eiu $. onocito!enes >RAD G Jeisserias y Dora8ella 2J02RIBAC02R?AC2A( As. aeru!inosa B. ce"acia (. alto"3ilia Acinetobacter H. in*luen9ae AJA2RIB?I( B. Fra!ilis y otros