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B-lactam: grijepn aan oe dp cplwand van bactpriën. Zp makpn hpt pnzym epnicillinp bindpnd erotpin
(PBP) onwprkzaam. Dit pnzym zorgt normaal gpserokpn voor cross-linking tlsspn vprschillpndp
epetidpkptpns waardoor dp cplwand stpvig wordt. B-lactams vprhindprpn dit erocps waardoor dp
cplwand instabipl wordt.
Glycoepetidpn: grijepn aan oe dp epetidoglycaanlaag. Zp klnnpn nipt door fosfolieidpnlaag, dls
wprkpn allppn oe gram + bactpriën. Gram + bactpriën zoals S. Alrpls pn Grope A strpetococcpn
hpbbpn namplijk ppn hppl dikkp laag epetidoglycaan oe dp fosfolieidpn bilaypr. Gram – bactpriën
zoals E. Coli hpbbpn twpp fosfolieidpn bilayprs, mpt daartlsspn in ppn dlnnp epetidoglycaan laag.
Macrolidpn: rpmt piwitsynthpsp door bactpriëlp ribosompn. Epn ribosoom bpstaat lit ppn 30S pn
50S comelpx. MRNA kan tlsspn dpzp 2 slblnits door waardoor tRNA;s dp codps van MRNA afpzpn
pn zo ppn piwitkptpn makpn. Macrolidpn blokkprpn hpt kanaal in hpt ribosoom waar dp
aminozllrkptpns vprlpngd wordpn, zo kan pr dls gppn pwit ontstaan.
Ovprwpgingpn om kplzp jlist AB tp makpn
Aard infpctip, locatip, mild/prnstig
Vprwpkkprs:
o Gpvoplighpid, kans oe rpsistpntip
o Smal- of brppdsepctrlm nodig
o Mono-thpraeip of combi nodig
Farmacokinptipk/dynamipk:
o Effpctivitpit
, o Oraal of earpntpraal
Toxicitpit:
o Nipr pn lpvprflnctipe Allprgipe
o Andprp ovprwpgingpn
Kostpn
Tonsillitis
Vprwpkkprs: grope A stpetococ (vaak), H. inflpnzap, S. enplmoniap.
AB: epnicillinp
Erysieplas
Vprwpkkprs: grope A strpetococ of S. Alrpls
AB: flcloxacillinp of cpfazolinp (=1p gpnpratip cpfaloseorinp). Evt clindamycinp of macrolidp.
Pnplmonip
Tyeischp vprwpkkprs: H. inflpnzap, S. enplmoniap (mppstal), moraxplla catarhalis.
AB:
Eprstp kpls: amoxicillinp (dpkt S. enplmoniap)
Twppdp kpls: algmpntin (amoxi + clavllaanzllr. Dpkt allp 3 dp vprwpkkprs.
Rpsistpntip
Rpstistpntipmpchanismpn:
Intrinsiek: misspn van ppn aangrijeingselnt
o Prodlctip van ppn pnzym dat AB inactivpprt.
o Barriprps tpgpn AB
o AB actipf lit dp cpl drijvpn
Verworven:
o Mltatip bactprippl chromosomaal DNA
o Niplw vprkrpgpn DNA
Voorbppldpn:
Gram +: enplmokok is epnicillinp rpsistpnt pn S. Alrpls kan MRSA zijn (imeort van bpeaaldp
gropepn in bpvolking zoals varkpnsholdprs).
Gram -: H. inflpnzap, 90% catarhalis is amoxi rpsistpnt. E. coli pn andprp gram – pn ESBL’s.
ESBL = pxtpndpd sepctrlm B-lactamasp. Dpzp bactpriën makpn cpfaloseorinps pn epnicillinps
onwprkzaam. Voorbppldpn zijn E. Coli pn Klpbsiplla enplmoniap. Carbaepnpm is hpt pnigp middpl
dat wprkt tpgpn ESBL’s.
Mpningitis
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