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  • Snapshot
    • A 28-year-old woman presents to her primary care physician due to dysuria. Her symptoms began approximately 2-3 days ago and have progressively worsened. She has a past medical history of mild asthma. She is allergic to penicillin, which causes her to have a severe skin rash and shortness of breath. Her symptoms are associated with urinary urgency and frequency. Physical examination demonstrated tenderness to palpation of the suprapubic region. A urinalysis and urine culture are ordered, which demonstrates Proteus mirabilis infection. She is treated with aztreonam.
  • Introduction
    • Mechanism of action
      • a monobactam that binds to penicillin-binding proteins 3 (PBP-3), which inhibits transpeptidation
        • impairs peptidoglycan synthesis, a needed component of cell wall biosynthesis
        • no cross-allergy with penicillins
    • Mechanism of resistance
      • altered PBP-3
    • Clinical use
      • gram-negative rods only
        • especially in patients who are allergic to penicillins or intolerable to aminoglycosides
    • Adverse effects
      • gastrointestinal upset (occasional)
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