Penicillins  inhibit the formation of the bacterial cell wall. They inhibit the enzyme transpeptidase, also known as penicillin-binding proteins (PBPs), which are responsible for cross-linking the peptidoglycan chains in the bacterial cell wall. This weakens the cell wall structure, leading to cell lysis and bacterial death.

• Oral infections
• Otitis media
• Cellulitis
• Respiratory tract infections
• Pneumonia

• Hypersensitivity reactions (1-10%), including rare anaphylaxis (<0.05%).
• Common maculopapular rash and diarrhoea, especially with ampicillin and amoxicillin.
• Rare but serious CNS toxicity, potentially leading to encephalopathy.
• Cross-sensitivity among penicillins in allergic patients, particularly those with atopic allergies.
• Delayed rashes occurring 72 hours post-administration are typically not allergic reactions.
• Diarrhoea and antibiotic-associated colitis are common with broad-spectrum antibiotics.
• Resistance may develop due to beta-lactamase-producing organisms.
• Penicillins should be taken on an empty stomach, ideally an hour before food or 2 hours after.

Cephalosporins 

Contraindications: Avoid co-amoxiclav or penicillin if there’s a history of jaundice or liver problems associated with these medications.

Cholestatic jaundice may develop during or shortly after co-amoxiclav use. It’s more prevalent in men and individuals over 65, with rare occurrences in children. Treatment duration should not surpass 14 days. Typically, jaundice resolves on its own and is seldom fatal.

Pregnancy: Not known to be harmful. Avoid in preterm prelabour rupture of the membranes (PPROM)—possible increased risk of necrotising enterocolitis in the neonate.

Breastfeeding: Trace amounts in milk but deemed safe

Hepatic disorders such as cholestatic jaundice and hepatitis are exceptionally rare, possibly manifesting up to two months after treatment. Prolonged treatment exceeding 2 weeks and advancing age pose as risk factors. Healthcare providers are advised that:

• Flucloxacillin must be avoided in patients with a history of hepatic dysfunction linked to the drug.
• Flucloxacillin should be administered cautiously in patients with liver impairment.

Pregnancy: Not known to be harmful

Breastfeeding: Trace amounts in milk

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