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REPUBLICA BOLIVARIANA DE VENEZUELA ANUAL 2014UNIVERSIDAD DEL ZULIAFACULTAD DE MEDICINAESCUELA DE MEDICINADEPARTAMENTO DE CIENCIAS FISIOLOGICASCTEDRA DE FARMACOLOGA

CEFALOSPORINASLas Cefals!"#$as s$ %&!'es(s ses#$()(#%s *'e se +(#e$e$ !" la a,#%#-$ ,e %a,e$asla(e"ales al $.%le +/s#% +(e$#, ,e la Cefals!"#$a C ,es%'+#e"(a !" B"(' e$ 143 ,el%'l(# ,e Cephalosporium acremonium &,#f#%a%#$es *'e 5a$ "es'l(a, e$ la !",'%%#-$ ,e '$a6"a$ ,#e"s#,a, ,e a6e$(es %$ a%(##,a, a$(#%"+#a$a fa"&a%%#$)(#%a 7 fa"&a%,#$/%asa"#a+le8

ESTRUCTURA QUMICA8

P" 5#,"-l#s#s /%#,a ,e la Cefals!"#$a C se +(#e$e el /%#, 9:a$:%efals!"/$#% ;9:AC

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E?(e$,#, ;BLEE!na $?@='8

Cefe!#&a ;IV:G< 7 las %efals!"#$as ,e III:G %$ e?%e!%#-$ ,e %ef!e"a$a 7 las ,ea,$#s("a%#-$ "al al%a$a$ %$%e$("a%#$es efe%(#as e$ LCR ;&a7"&e$(e Cef(a?#&a 7Cef("#a?$a

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Ce!"i#in Ceepima&RAM POSITI+OSS.aureus (Met-S) Str. pyogenes Str. pneumoniae Str. bovis Str. viridans Str. agalactiae C. diphtheriae &RAM NE&ATI+OSN. gonorrhoeae Cei"ima N. meningitidis CFT ! CT M. catarrhalis E. coli P. mirabilis K. pneumoniae Enterobacter Proteus vulgaris Providencia Morganella Serratia Citrobacter diversus Citrobacter reundii Salmonella !. enterocol"tica.

#cinetobacter Ce#a>i-ima Ps. aeruginosa Ce#a>i-ima

Ce!pera>!

na

$. inluen%ae

ANAEROBIOS*Streptococcus Cl. perringes Cl. tetani &. nucleatum P. melaninogenicus '. ragilis

C$s#,e"a%#$es #&!"(a$(es "es!e%( al es!e%(" a$(#%"+#a$ ,e las Cefals!"#$as>

18 T,as las %efals!"#$as s$ ,e AMPLIO ESPECTRO8

28 Las Cefals!"#$as ,e I G s$ las ,e &a7" a%(##,a, %$("a S. aureus (Met-S) y entre estasCefal(#$a 7 Cefal#$a s$ las &/s es(a+les a la 5#,"-l#s#s !" la !e$#%#l#$asa8 S#$ e&+a"6 se!"ef#e"e a la Cefal#$a %& !"((#! ,e es(a 6e$e"a%#-$ !" s' &e,#a #,a &/s la"6a l *'ee?(#e$,e el #$(e"al ,e a,$#s("a%#-$8 Las %efals!"#$as ,e 2,a7 @e"aG e$ "eal#,a, (#e$e$ &a7"a%(##,a, *'e I G s+"e ("s %%s 6"a&!s#(#s ;e?%e!( Enterococcus %$("a el %'al $#$6'$a%efals!"#$a es a%(#a

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@8 A &e,#,a *'e se aa$a e$ las 6e$e"a%#$es se a&!l#a el es!e%(" 7 a'&e$(a la a%(##,a, %$("a6"a&$e6a(#s ae"-+#%s 7 fa%'l(a(#s ;Neisseria $aemophilus Moraella Enterobacteriacease$("e ("as S. aureus ;MET:R S.pneumoniae (Pen,- y Pen,-)7 $. inluen%ae (#MP-)8

8 Cefe!#&a ,e 4(a6e$e"a%#-$ ,e+e "ese"a"se !a"a #$fe%%#$es !" %""6a$#s&s !",'%("es,e +e(ala%(a&asas ,e es!e%(" e?(e$,#, ;BLEE< 7 B's5 (#! 18

PRIMERAS ELECCIONES8/era generacin> P"f#la?#s *'#"."6#%a ;CEFAZOLINA$. inluen%ae;(#(#s &e,#a s#$'s#(#s $e'&$aS. pneumoniae Pe$G:R ;$e'&$a (#(#s s#$'s#(#s a"("#(#sCT CFTS. pneumoniaePe$G:RI ;e$,%a",#(#s &e$#$6#(#sCT CFTS. pneumoniaePe$G:R ;e$,%a",#(#s &e$#$6#(#s CT CFTVa$%%#$a Te#%!la$#$a RIF8N. gonorrhoeae> CT Cef#?#&a8

E$(e"+a%(e"#a%eas>E. coli> /era 1-a3era6e$e"a%#-$K. pneumoniae> /era 1-a3era6e$e"a%#-$P. vulgaris M. morgagni> 3era6e$e"a%#-$P. rettgeri P. stuartii> Ceepima

Serratia> 3

era

6e$e"a%#-$Salmonella typhi> CT

O("s +a%#ls 6"a& $e6a(#s>Ps. aeruginosa;ITU Ce#a>i-ima CeepimaPs. aeruginosa;$e'&$a +a%(e"#ea Ce#a>i-ima ! Ceepima $T!:ramicina'$. inluen%ae;(#(#s &e,#a s#$'s#(#s $e'&$a 1-a3era6e$e"a%#-$$. inluen%ae;&e$#$6#(#se!#6l(#(#s CT CFT

4

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$. ducreyi> CT

Es!#"*'e(as> '. burdorgeri> CT*

5#ageneracin> Es(/$ !a"(#%'la"&e$(e #$,#%a,as e$ el ("a(ae$( ,e #$fe%%#$es ,e+#,as a +a%#lsae"+#s 7 fa%'l(a(#s 6"a&$e6a(#s "es#s(e$(es a las ,e (e"%e"a 6e$e"a%#-$ !" la !",'%%#-$ ,eBLEE 7 B's5 T#! 1 (ales %& las !",'%#,as !" Enterobacter P. vulgaris P. rettgeri M.morgagni P. stuartii Serratia P. aeruginosa.

EFECTOS AD+ERSOS*Las %efals!"#$as (#e$e$ '$ !e"f#l ,e (?#%#,a, al(a&e$(e fa"a+le e$ %&!a"a%#-$ %$ ("sa$(#%"+#a$s8 C$ !%as e?%e!%#$es ls efe%(s a,e"ss s$ s#la"es !a"a (, el 6"'!8

/* Reacci!ne. -e 2iper.en.i:i4i-a-> efe%( a,e"s &/s %&.$8 N +s(a$(e las "ea%%#$esa$af#l/%(#%as '"(#%a"#as &e,#a,as !" I6E se !"ese$(a$ "a"as e%es es!e%#al&e$(e %$ las ,ese6'$,a 7 (e"%e"a 6e$e"a%#-$ e$ f"e%'e$%#a &'7 #$fe"#" a la +se"a,a %$ Pe$#%#l#$a G8 E?a$(e&a%'(/$e %$ s#$ f#e+"e %'""e e$ 1 a @J ,es!')s ,e !e"#,s a"#a+les ,e (e"a!#a8 La !",'%%#-$,e $ef"#(#s #$(e"s(#%#al %& "ea%%#-$ ,e 5#!e"se$s#+#l#,a, es "a"a8

La "ea%(##,a, %"'a,a e$("e !e$#%#l#$as 7 %efals!"#$as %$(#$.a a.$ s#$ se" a%la"a,a8 A$#eles %l$#%s se 5a #$f"&a, *'e la f"e%'e$%#a ,e "ea%%#-$ al)"6#%a %"'a,a !a"a !a%#e$(es %$5#s("#a ,e ale"6#a a la Pe$#%#l#$a es ,el @:9 J s#$ e&+a"6 se %$s#,e"a *'e +a= $#$6.$ %$%e!(,e+e$ '(#l#a"se es(s a$(#%"+#a$s s# se 5a$ !"ese$(a, !"e#a&e$(e "ea%%#$es see"as;a$af#la?#a< %$ la a,$#s("a%#-$ ,e !e$#%#l#$as8

1*Reacci!ne. 2ema#!4gica.> Es#$f#l#a ;1:10J A las ,s#s 's'ales "a"a e s$ $ef"(-?#%as e?%e!( e$ a$%#a$s 7 ("as%$,#%#$es ;,es5#,"a(a%#-$ 5#!Halea #$s'f#%#e$%#a "e$al !"ee?#s(e$(e

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* S7perinecci!ne.; A,e&/s ,e la !s#+#l#,a, ,e !",'%#" %l#(#s !se',&e&+"a$sa !"Cl.diicile !'e,e$ !"ese$(a"se ("as s'!e"#$fe%%#$es !" %""6a$#s&s "es#s(e$(es %& !"e=e&!l %a$,#,#as#s8

?* Reacci!ne. 4!ca4e.> T"&+fle+#(#s %'a$, se a,$#s("a$ !" a EV8 Dl" e$ el s#(# ,e#$7e%%#-$ IM es f"e%'e$(e !e" !'e,e ,#s$'#"se a6"e6a$, l#,%a$a al ,#l'e$(e8 La &e="(le"a,a !" a IM es la Cefal#$a8

CARBAPENEMICOS

Pe"(e$e%e$ a es(e 6"'!> DORIPENEM ERTAPENEM IMIPENEM 7MEROPENEM8A ,#fe"e$%#a ,e ls ("s +e(ala%(/%s s' a%(##,a, +a%(e"#%#,a es ,e!e$,#e$(e ,e %$%e$("a%#-$ 7se 5a ,e&s("a, '$ efe%( !s(a$(#+#-(#% s#6$#f#%a(# (a$( s+"e +a%(e"#as 6"a&!s#(#as %&6"a&$e6a(#as8

E.pec#r!> S$ ls +e(ala%(/%s ,e &a7" es!e%("8 A&!l# es!e%(" %$ +'e$a a%(##,a, %$("a&'%5s +a%#ls 6"a&$e6a(#s #$%l'#, P. aeruginosa %""6a$#s&s 6"a&!s#(#s 7

a$ae"+#s8 D"#!e$e& 7 &e"!e$e& (#e$e$ a%%#-$ l#6e"a&e$(e &a7" %$("a ae"+#s6"a&$e6a(#s 7 '$ !% &e$" %$("a 6"a&!s#(#s ;&e"!e$e& (#e$e &a7" a%(##,a, %$("aPse',&$a *'e #!e$e& N/'seas -(s ,#a""ea e?a$(e&as 7 "ea%%#$es e$ ls s#(#s ,ea,$#s("a%#-$ ;&/s f"e%'e$(es %$ I!e$e&

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E.pec#r!> a%(##,a, l#(a,a a ls +a%#ls 6"a&$e6a(#s ae"+#s ;#$%l'7e$, Pseudomona 1:25 se !"l$6a e$ !"ese$%#a ,e #$s'f#%#e$%#a"e$al8 Pe$e("a +#e$ LCR8

Eec#!. a-9er.!.; E?a$(e&as elea%#-$ ,e ("a$sa$asas8 Ls al)"6#%s a las !e$#%#l#$as l(le"a$ e$ !a%#e$(es %$ a$(e%e,e$(e ,e a$af#la?#a !" !e$#%#l#$a se !'e,e '(#l#a"8 T#e$e s#l#(',es("'%('"al %$ la Cef(a#,#&a ;%efals!"#$a ,e @e"aG18 Fl"e 8 Fa"&a%l6a '&a$a8 (a e,#%#-$8 Else#e" Mass$8 2003828 B"'$($ L8 G,&a$ &G#l&a$8 Ma$'al ,e fa"&a%l6a 7 (e"a!)'(#%a8 12 e,#%#-$8 M%G"a#ll8 20118@8 Ka('$6 B8 Fa"&a%l6a B/s#%a 7 Cl$#%a8 11 e,#%#-$8 M%G"a#ll8 200848 G#l+e"( D 7 %l8 T5e Sa$f", G'#,e ( a$(#%"+#al (5e"a!78 44ae,#%#-$8 20148

D#%#e&+"e 2014

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