Inhibeert werking peniciline binding proteine (PBP)
Dit zorgt voor verbreken bindingen in celmembraan
Celmembraan breekt in stukken -> celdood
1
, Bactericidal antibiotcia (snel doden van bacterien)
TOEDIENINGSWIJZE
T is boven de MIC is belangrijk
Frequent doseren bij bèta latams
cloxacilline (6 x per dag)
ampicilline (6 x per dag)
penicilline (12 x per dag)
PENCILLINE
veel gebruikt bij WWOII (nog weinig resistentie)
veel gebruikt -> opbouwen resistentie (PRSA: penicilline resistente s. aureus)
eerst ziekenhuizen, daarna in gemeenschap
RESISTENTIE door bèta lactamase (enzym dat bèta lactam ring afbreekt)
CLOXACILLINE
gebruikt voor invasieve s. aureus infecties (karbukel, abscessen,..)
resistentie door PBP2a gen -> methicillin kan hier niet op hechten
dosis verhogen (kan enkel bij intermediate gevoeligheid)
meer bacterien resistent
MIC verhoogt
Hogere concentratie AB nodig voor bac te doden
Hogere dosering
( bv: s. pneumoniae moet IV ampicilline 4-6 keer per dag van 1-2 g)
toevoegen bèta lactamase inhibitor (clavulanic zuur, tazobactam)
clavulanic zuur beschermt amoxicilline van bèta lactamase
effectief in lage dosisen (250 mg/d)
zijn enkel effectief in combo met bèta lactam
andere voorbeelde,: sulbactam, tazobactam, avibactam
kiezen niet bèta lactam antibiotica
AMOXICILLINE + CLAVULANIC ZUUR
3
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