Cell Wall Inhibitors

Penicillin
Class
Natural
PCN

Name

Structure

MOA

MOR

Spectrum
covered

Major clinical
use

Penicillin G

Thiazolidine
ring
Beta-lactam
ring
(activity)
Side chain

Covalent
binding to
Penicillinbinding
protein
(PBP)
Prevent
cross-linking
of
peptidoglyc
an layers
Induction of
autolytic
enzymes

Betalactamase
Class A:
susceptible
Class B:
impervious;
only
susceptible
to
Carbapene
ms
Failure of
abx to
penetrate
outer
membrane
(gramnegative)
Efflux
Low-affinity
binding

Betalactamase
susceptible

IM
Syphilis
PO
Syphilis
IV
MSSA

Penicillin V
Betalactamase
resistant
PCN

Nafcillin

Oxacillin
Dicloxacillin
Methicillin
Extendedspectrum
PCN

Ampicillin

Amoxicillin

Ticarcillin

Polar (will
not
penetrate
mammalian
cell)
Low CNS
penetrance
(only with
inflammatio
n)

Mostly renal
metabolism
(except
Nafcillin:
biliary)

Grampositive
only (due to
bulky side
chain
protection)

Grampositive and
Gramnegative

IV
MSSA
IV
MSSA
IV
MSSA
IV
w/ sulbactam
sinusitis, CA
pneumonia,
otitis
shigellosis
Neonatal
sepsis
PO
w/ sulbactam
sinusitis, CA
pneumonia,
otitis
IV
w/
tazobactam

Toxicities,
contraindications

piperacillin

antipseudom
onal
IV
w/
tazobactam
antipseudom
onal