Your SlideShare is downloading. ×
Antibiotics basics for clinicians
Antibiotics basics for clinicians
Antibiotics basics for clinicians
Antibiotics basics for clinicians
Antibiotics basics for clinicians
Antibiotics basics for clinicians
Antibiotics basics for clinicians
Antibiotics basics for clinicians
Antibiotics basics for clinicians
Antibiotics basics for clinicians
Antibiotics basics for clinicians
Antibiotics basics for clinicians
Antibiotics basics for clinicians
Antibiotics basics for clinicians
Antibiotics basics for clinicians
Antibiotics basics for clinicians
Antibiotics basics for clinicians
Antibiotics basics for clinicians
Antibiotics basics for clinicians
Antibiotics basics for clinicians
Antibiotics basics for clinicians
Antibiotics basics for clinicians
Antibiotics basics for clinicians
Antibiotics basics for clinicians
Antibiotics basics for clinicians
Antibiotics basics for clinicians
Antibiotics basics for clinicians
Antibiotics basics for clinicians
Antibiotics basics for clinicians
Antibiotics basics for clinicians
Antibiotics basics for clinicians
Antibiotics basics for clinicians
Antibiotics basics for clinicians
Antibiotics basics for clinicians
Antibiotics basics for clinicians
Antibiotics basics for clinicians
Antibiotics basics for clinicians
Antibiotics basics for clinicians
Antibiotics basics for clinicians
Antibiotics basics for clinicians
Antibiotics basics for clinicians
Antibiotics basics for clinicians
Antibiotics basics for clinicians
Antibiotics basics for clinicians
Antibiotics basics for clinicians
Antibiotics basics for clinicians
Antibiotics basics for clinicians
Antibiotics basics for clinicians
Antibiotics basics for clinicians
Antibiotics basics for clinicians
Antibiotics basics for clinicians
Antibiotics basics for clinicians
Antibiotics basics for clinicians
Antibiotics basics for clinicians
Antibiotics basics for clinicians
Antibiotics basics for clinicians
Antibiotics basics for clinicians
Antibiotics basics for clinicians
Antibiotics basics for clinicians
Antibiotics basics for clinicians
Antibiotics basics for clinicians
Antibiotics basics for clinicians
Antibiotics basics for clinicians
Antibiotics basics for clinicians
Antibiotics basics for clinicians
Antibiotics basics for clinicians
Antibiotics basics for clinicians
Antibiotics basics for clinicians
Upcoming SlideShare
Loading in...5
×

Thanks for flagging this SlideShare!

Oops! An error has occurred.

×
Saving this for later? Get the SlideShare app to save on your phone or tablet. Read anywhere, anytime – even offline.
Text the download link to your phone
Standard text messaging rates apply

Antibiotics basics for clinicians

2,025

Published on

Published in: Health & Medicine
0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total Views
2,025
On Slideshare
0
From Embeds
0
Number of Embeds
1
Actions
Shares
0
Downloads
102
Comments
0
Likes
0
Embeds 0
No embeds

Report content
Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
No notes for slide

Transcript

  • 1. Dr. LokeshGargM.B.B.S. M.D.
  • 2.  One of the most commonly used group of drugs. A medical doctor has to know the definite clinical pharmacologyof antibiotics, how to select & use them rationally.- Avoid adverse effects on the patient- Avoid emergence of antibiotic resistance- Avoid unnecessary increases in the cost of health care
  • 3.  DefinitionAntibiotics are substances that kill or inhibit the growthof micro-organisms. BacteriostaticBactericidal
  • 4. Based on their mechanism ofaction, antibiotics can be dividedinto the following classes: Inhibitors of Cell Wall synthesis Inhibitors of Protein synthesis Inhibitors of Nucleic Acid synthesis
  • 5. This class includes: Penicillin Cephalosporin Carbapenems Monobactams Vancomycin Beta lactamase inhibitorsB – lactamantibiotics
  • 6. Category Parenteral Agents Oral AgentsNatural Penicillins Penicillin G Penicillin VAntistaphylococcalpenicillinsNafcillin, oxacillin DicloxacillinAminopenicillins Ampicillin Amoxicillin andAmpicillinAminopenicillin + β-lactamase inhibitorAmpicillin-sulbactam Amoxicillin-clavulanateExtended-spectrumpenicillinPiperacillin, ticaricillin CarbenicillinExtended-spectrumpenicillin + β-lactamaseinhibitorPiperacillin-tazobactam,ticaricillin-clavulanateTHE PENICILLINS
  • 7. Class Examples Routes ofadministrationFirst generation Cephalexin/cefadroxilCefazolinOrali.v.SecondgenerationCefuroximeCefoxitinOral/ i.v.Third generation CefiximeCeftriaxone/cefotaximCeftazidimeOrali.v.i.v.FourthgenerationCefipime i.v.
  • 8.  Adverse Effects Allergic reactions: itch, rash,fever, angioedema, rarelyanaphylactic reaction GI upset and diarrhoea Interstitial nephritis andincreased renal damage incombination withaminoglycosidesPharmacokinetics Bactericidal Safe in pregnancy Dosage needs to bereduced in cases ofimpaired renal function.
  • 9. This class includes:- Macrolides- erythromycin, clarithromycin, azithromycin Lincosamides- clindamycin Aminoglycosides- gentamicin, tobramycin, amikacin,netilmicin,neomycin, streptomycin. Tetracyclines- tetracycline, doxycycline,minocycline Chloramphenicol
  • 10. Pharmacokinetics: Bacteriostatic Dose adjustment in renalfailure is not necessaryAdverse Effects : GI upset Cholestatic jaundice Prolongation of QT interval(erythromycin) Theophylline, oral anticoagulantscannot be administeredsimultaneously
  • 11. PharmacokineticsPharmacokinetics Bectericidal Negligible oral absorption Dose adjustment iscritical in renalimpairmentAdverse Effects Ototoxic (permanent)Avoid concurrent use ofother ototoxics drugs for eg.Lasix , minocycline Nephrotoxic ( reversible):use cautiously with othernephrotoxic drugs
  • 12. PharmacokineticsBacteriostaticBest oral absorption in fastingstate Adverse Effects Contraindicated in renal failure(except doxycycline and minocycline) Nausea, diarrhoea Binds to metallic ions in bones and teeth (tobe avoided in children andin pregnancy) Phototoxic skin reactions
  • 13. This group includesThis group includes :: Sulphonamides: Sulfamethoxazole, sulfadoxine Trimethoprim Quinolones: Ciprofloxacin, levofloxacin, pefloxacin, ofloxacin, norfloxacin,gatifloxacin, moxifloxacin, sparfloxacin RifampicinAzoles: This group includes- Antibacterial- Metronidazole, secnidazole, tinidazole, Antihelminth- Albendazole, Mebendazole, thiabendazole
  • 14. Pharmacokinetics Bactericidal Well absorbed orally withgood bioavailability Dose reduction necessary inrenal failureAdverse Effects Fatal marrow dysplasia andhaemolysis in G6PDdeficiency Skin and mucocutaneousreactions: Stevens- Johnsonsyndrome Contraindicated inpregnancy
  • 15. Pharmacokinetics Bectericidal Well absorbed after oraladministration Dose adjustment requiredin renal impairment(except moxifloxacin and trovafloxacin) These two drugs arecontraindicated in hepaticAdverse Effects GI side effects CNS effects such as restlessness,headache, insomnia, confusion andseizures in the elderly Rare skin reactions Should be avoided in pregnancy Not routinely recommended for use inpatients under 18 yearsof age
  • 16. Pharmacokinetics Almost completelyabsorbed after oraladministration (60% afterrectal administration).Adverse Effects Metallic taste Severe vomiting if taken withalcohol (disulfiram likesyndrome )
  • 17.  CNS: Meningitis, brain abscess etc Respiratory: URTI, Pneumonia, Lung abscess, Bronchiectasis CVS: Acute rheumatic fever, Infective endocarditis GIT and HBS: Cholera, Bacillary dysentery, Enteric fever,gastroenteritis, peritonitis,liver abscess Genitourinary: UTI, pyelonephritis, STDs Skin : Cellulitis necrotizing fascitis Musculoskeletal: Osteomyelitis, Septic arthritis Mycobacterial Infections: Tuberculosis, Leprosy Chlamydial Infections Systemic Infections: Sepsis syndrome
  • 18.  62 year old male presents to your clinic with c/o: Cough withexpectoration x 4days◦ Intermittent fever, measured to 100.8◦ Chest pain – Rt side PMHx◦ Healthyo No H/O hospitalization in recent pasto not on any medication Drink socially , non smoker
  • 19.  ExamVS – temp 100.3, P 92, RR 18, Spo2 - 96% on room air, BP123/75HEENT – normalNeck – normal w/o palpable LN or TMGLungs – Bronchial breath sound in I/S , I/A on Rt side, clear atbases,CV – normalLegs – no edema
  • 20. Case 1
  • 21.  Community –acquired Pneumonia (CAP) Recent onset of- Fever- Productive cough- TLC- CXR Why CAP- Healthy adult with no H/O hospitalization in recent past& was not taking any antibiotics
  • 22. Common Outpatient Bacterial Etiologies
  • 23. AntibioticsAntibiotics Oral macrolide Erythromycin Azithromycin ClarithromycinThis patient’s pneumonia is mildPreviously healthyNo antibiotics in past 3 months
  • 24.  In patients who are older, have comorbid illnessesLevofloxacin Moxifloxacin In patients treated with antibiotics within the last 90 days. Respiratory quinolonesMoxifloxacinLevofloxacinGemifloxacinor B- lactamAmoxicillin + ClavunateCefuroxime
  • 25.  Beta-lactam + macrolideCeftriaxone or cefotaximeErythromycin, azithromycin, or clarithromycinOR Fluoroquinolone with antistreptococcal activityLevofloxacin or moxifloxacin
  • 26. Trimethoprim/sulfamethoxizole x 3 dayswomen with risk factors, complicated UTIFluoroquinolone x 3 days: Ciprofloxacin Norfloxacin OfloxacinNitrofurantoin x 7 days
  • 27.  Initial drug selections:FluoroquinolonesCiprofloxacinLevofloxacinCephalosorinCeftriaxoneCefotaxime+ Amikacin
  • 28.  57 years male painful rash on his right leg. 5 daysago he developed a blister on his foot after wearing anew pair of shoes.c/o fever with chills PMHx – COPD, high cholesterolSocial – stopped tobacco two years ago.
  • 29.  Exam Temp 101.2 otherwise stable , APPP Exam unremarkable except for Lungs – few inspiratory rales Right leg …
  • 30.  Outpatient Treatment: non-MRSAAntistaphylococcal penicillinDicloxacillinFirst-generation cephalosporinCephalexin Inpatient Treatment: non-MRSA Amoxicillin + Clavunate Clindamycin is a good alternate with penicillin allergy Surgical opinion
  • 31.  A 43 year old male presents with 10 days of purulentrhinorrhea, subjective fevers, and facial headaches. PMHx – HTN, high cholesterol Meds – lisinopril/HCTZ FamHx – noncontributory
  • 32. Exam HEENT – VS normal tenderness over right maxillary sinus Exam otherwise unremarkable Diagnosis? Sinusitis
  • 33. Mild Acute Bacterial Sinusitis (ABS)AmoxicillinAmoxicillin/clavulanateCefuroxime axetilCefpodoximeOrantistrep. fluoroquinolones:LevofloxacinMoxifloxacin
  • 34.  Drug option in the case of allergies to penicillinand cephalosporin with Mild ABS:◦ Doxycycline◦ Trimethoprim/sulfamethoxizole◦ Azithromycin◦ Clarithromycin
  • 35.  Drug option in the case of allergies to penicillin andcephalosporin with Moderate to Severe ABS:◦ Antipneumococcal fluoroquinolone: Levofloxacin Moxifloxacin
  • 36. 42 years male with 5 days of progressive diffuseheadache, mildly stiff neck,fever vomiting, confusion.PMHx – none knownPSHx - none
  • 37. Exam VS: T 100.9, Pulse 96, RR 16, BP 138/82 Gen: mildly ill appearing Mental status: orientation to place & person not time HEENT: mild photophobia Neck: mild pain with flexion (kernig sign +ve ) Skin: no rash
  • 38.  Lab.- TLC - 16000 DLC - N80 L18 CECT Head - normal study CSF - TLC – 412DLC – N 96 L4protein – 110mg/dlsuger - 23 mg/dl
  • 39.  Adults(<55years) and children>3 months old: High dose ceftriaxone or cefotaxime+ Vancomycin 1gm IV BD Adults > 55years of age , patient with alcoholismor other debilitating illness High dose ceftriaxone /cefotaxime+ Vancomycin 1gm IV BD+ Ampicillin 2gm/ 4horly2gm IV BD
  • 40. Cholera:Tetracycline 250 mg 6-hourly for 3 days,Doxycycline 300 mg single dose or Ciprofloxacin 1g in adultsBacillary Dysentery:Ciprofloxacin 500 mg 12-hourly for 3 daysHelicobacter pylori Infection:Two antibiotics (from amoxicillin, clarithromycinand metronidazole) for 7 days
  • 41. Aetiology: Salmonella typhi and Salmonella paratyphi A and BCiprofloxacin 500 mg 12-hourlyOfloxacin 400 mg every 12 hourlyCeftriaxone 2gm IV BDAzithromycin 1gm once daily x 5 daysTreatment should be continued for minimum 10 days.Or5 days after resolution of fever
  • 42.  Aetiology (pyogenic): E.coli, various streptococci(amoebic): Entamoeba histolytica Management:o Pyogenic: Combination of antibiotics e.g3rd gencephalosporin, gentamicin and metronidazoleo Amoebic: Metronidazole (800 mg 8-hourly for 10 days)or tinidazole (2 g daily for 3 days)Luminal amoebicide-diloxanide furoate (500 mg 8-hourly for 10 days)
  • 43. Gastro-Intestinal:Ancylostoma, Ascaris:Albendazole 400 mg single dose or Mebendazole 100mg 12 hourly for 3 daysTissue parasite:Filariasis: Caused by Wuchereria bancrofti Treatment: Diethylcarbamazine 6 mg/kg body wt.orally in 3 divided doses for 12 days.
  • 44.  Avoid tetracycline Staining of teeth and bones in babies Acute yellow atrophy of lever , pancreatitis in mother Avoid sulfa drugs in the third trimester May be associated with kernicterus Avoid aminoglycosides Kidney toxicities Can cause foetal ear damage FluoroquinolonesConcerns about cartilage development
  • 45.  Treat the Mother first and the baby will appreciate it  Penicillins and cephalosporins are generally safe inpregnancy. Macrolides are generally safe- They may increase nausea early on
  • 46. Is antibiotic necessaryWhat is the mostappropriate antibioticH/OAllergyPregnancyRenal dysfunctionLiver DiseaseDose/Frequency/Route/DurationMonitor side effects

×