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Chapter 6   inhibitors of cell wall synthesis
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Chapter 6 inhibitors of cell wall synthesis

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  • 1. Inhibitors of Cell Wall Synthesis Penicillin  Natural penicillins  Semisynthetic penicillins  Extended-spectrum penicillins
  • 2. Penicillins Low toxicity Effective derivatives created from manipulating drug’s basic molecular structure Kills bacteria by preventing them from forming the rigid cell wall Because human cells do not have cell walls, they are not affected
  • 3. Therapeutic Uses of Penicillins Abscesses Beta-hemolytic streptococcus Meningitis Otitis media Pneumonia Respiratory infections Tooth and gum infections Venereal diseases (syphilis and gonorrhea) Endocarditis due to streptococci
  • 4. Penicillins’ Side Effects Diarrhea Allergies in 7% to 10% of populationPenicillins’ Dispensing Issues Take on an empty stomach  Food slows absorption  Acids in fruit juices or colas could deactivate the drug
  • 5. The Structure of Penicillins
  • 6. The Structure of Penicillins
  • 7. Retention of Penicillin G
  • 8. The Effect of Penicillinase onPenicillins
  • 9. b-Lactam Antibiotics Penicillin  Penicilinase-resistant penicillins  Penicillins + b- lactamase inhibitors Carbapenems  Substitute a C for a S, add a double bond Monobactam  Single ring
  • 10. Inhibitors of Cell Wall Synthesis Cephalosporins  First-generation: Narrow spectrum, gram- positive  Second-generation: Extended spectrum includes gram-negative  Third-generation: Includes pseudomonads; injected  Fourth-generation: Oral
  • 11.  First-generation  Similar to penicillinase-resistant penicillins with greater gram-negative coverage  Used for  community-acquired infections  mild to moderate infections Second-generation  Increased activity, especially against Haemophilus influenzae  Used for  Otitis media in children  Respiratory infections  UTIs Third-generation  Active against a wide spectrum of gram-negative organisms  Long half-life, so once-a-day dosing for some  Used for  Ambulatory patients  Children (dosing before or after school)
  • 12. Inhibitors of Cell Wall Synthesis Polypeptide antibiotics  Bacitracin  Topical application  Against gram-positives  Vancomycin  Glycopeptide  Important "last line" against antibiotic-resistant S. aureus
  • 13. Comparison of Cephalosporin andPenicillin
  • 14. The Inhibition of Protein Synthesisby Antibiotics
  • 15. Inhibitors of Protein Synthesis Chloramphenicol  Broad spectrum  Binds 50S subunit; inhibits peptide bond formation
  • 16. Inhibitors of Protein Synthesis Aminoglycosides  Streptomycin, neomycin, gentamycin  Broad spectrum  Changes shape of 30S subunit
  • 17. Inhibitors of Protein Synthesis
  • 18. Inhibitors of Protein Synthesis Streptogramins  Gram-positives  Binds 50S subunit; inhibits translation
  • 19. Inhibitors of Protein Synthesis
  • 20. Inhibitors of Protein Synthesis Oxazolidinones  Linezolid  Gram-positives  Binds 50S subunit; prevents formation of 70S ribosome
  • 21. Inhibitors of Nucleic Acid Synthesis Rifamycin  Inhibits RNA synthesis  Antituberculosis Quinolones and fluoroquinolones  Nalidixic acid: Urinary infections  Ciprofloxacin  Inhibits DNA gyrase  Urinary tract infections
  • 22. Quinolones Strong, rapid bactericidal action against most gram- negative and many gram-positive bacteria Antagonize the enzyme responsible for coiling and replicating DNA, causing DNA breakage and cell deathQuinolones’ Dispensing Issues Not to be given with theophylline Antacids interfere with absorption Avoid exposure to sun
  • 23. Therapeutic Uses of Quinolones Bone and joint infections caused by gram-negative organisms Infectious diarrhea Ophthalmic infections Some sexually transmitted diseases Upper respiratory infections UTIs
  • 24. Quinolones’ Side Effects Primarily gastrointestinal, with nausea and vomiting Dizziness Unpleasant taste Can cause joint problems such as swelling and malformations Patients taking them have a tendency to injure tendons
  • 25. Rifamycin any of a family of antibiotics biosynthesized by a strain of Streptomyces mediterranei, effective against a broad spectrum of bacteria, including gram-positive cocci, some gram-negative bacilli, and Mycobacterium tuberculosis and certain other mycobacteria; used for the treatment of tuberculosis and the prophylaxis of meningococcal infections.
  • 26. Adverse reactions CNS: ataxia, confusion, drowsiness, fatigue, headache, asthenia, psychosis, generalized numbness EENT: conjunctivitis; discolored tears, saliva, and sputum GI: nausea, vomiting, diarrhea, abdominal cramps, dyspepsia, epigastric distress, flatulence, discolored feces, anorexia, sore mouth and tongue, pseudomembranous colitis GU: discolored urine Hematologic: eosinophilia, transient leukopenia , hemolytic anemia, hemolysis, disseminated intravascular coagulation (DIC), thrombocytopenia Hepatic: jaundice Metabolic: hyperuricemia Musculoskeletal: myalgia, joint pain Respiratory: dyspnea, wheezing Skin: flushing, rash, pruritus, discolored sweat, erythema multiforme, toxic epidermal necrolysis, Stevens-Johnson syndrome Other: flulike symptoms, hypersensitivity reactions including vasculitis
  • 27. prophylaxis refers to medical or public healthmeasures taken in order to prevent disease or healthproblems, rather than to treat or cure an existingcondition. Prophylaxis is also a way to stem anoutbreak of disease, or minimize the symptoms ofsomeone who has been exposed to a disease or virus.