Antibiotics simplified

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Antibiotics simplified

  1. 1. Antibiotics By : Abdullah Taskin -4th year med. Student - BY : Abdullah Taskin 4th y.
  2. 2. • Classified according to their MOA into : BY : Abdullah Taskin 4th y.
  3. 3. BY : Abdullah Taskin 4th y.
  4. 4. BY : Abdullah Taskin 4th y.
  5. 5. Penicillin's 1. 2. 3. 4. 5. 6. 7. 8. Benzyl penicillin Aminopenicillin (ampicillin IV - amoxicillin PO) Isoxozoyl penicillin (cloxacillin, methicillin, ) Ureidopenicillin ( piperacillin ) Lactamase Inhibitors (Augmentin – tazobactam ) Cephalosporins ( 1 , 2 , 3 & 4 ) Carbapenems (imipenem ) Vancomycin (Vancocin®) BY : Abdullah Taskin 4th y.
  6. 6. Coverage : GP except Staphylococcus, Enterococcus Oral anaerobes (except Bacteroides, Treponema) penicillin MOA : Bactericidal: β-lactam inhibits (PBP) and prevents crosslinking of peptidoglycans BY : Abdullah Taskin 4th y. Indications: actinomycosis, streptococcal pharyngitis, streptococcal skin and soft tissue infections, syphilis Contraindications: Hypersensitivity to penicillin
  7. 7. Coverage : sam as B.penicillin MOA : sam as B.penicillin Contraindications: Hypersensitivity to penicillin Aminopenicillin ( Amoxicillin ) Indications: bacterial meningitis , endocarditis , streptococcal , part of H. pylori treatment, UTI BY : Abdullah Taskin 4th y.
  8. 8. Coverage : sam as B.penicillin Isoxozoyl penicillin (methicillin ) MOA : sam as B.penicillin Contraindications: Hypersensitivity to Penicillin & > Interstitial nephritis Indications ( only diff. ) : also cover some staph.a BY : Abdullah Taskin 4th y.
  9. 9. Coverage : sam as B.penicillin MOA : sam as B.penicillin Ureidopenicillin (Tazocin®) Indications : Same as penicillin & GN: Pseudomonas Anaerobes Contraindications: Hypersensitivity to penicillin Enterococcus BY : Abdullah Taskin 4th y.
  10. 10. Coverage : sam as B.penicillin Lactamase Inhibitors (Augmentin®) MOA : sam as B.penicillin Contraindications: Hypersensitivity to Penicillin & jaundice or hepatic dysfunction Indications : Same as penicillin +/& Staphylococcus H. influenzae Enterococcus BY : Abdullah Taskin 4th y.
  11. 11. Cephalosporins ( 1 , 2 , 3 & 4 ) widely used BY : Abdullah Taskin 4th y.
  12. 12. Coverage : GP except Enterococcus Ceph.S. 1st (cephalexin , cefazolin) & GN except E. coli, Klebsiella, Proteus MOA : same as penicillin (B-lactam) Indications: GP “more” & GN Contraindications: Hypersensitivity to Penicillin or ceha.S. & Nephrotoxicity BY : Abdullah Taskin 4th y.
  13. 13. Coverage : GP week & GN & anaerobes MOA : same as penicillin (B-lactam) Ceph.S. 2nd (Ceftin®) , Cefprozil (Cefzil®)) Contraindications: Hypersensitivity to Penicillin or ceha.S. BY : Abdullah Taskin 4th y.
  14. 14. Coverage : GP Staph & strep. & GN broad + pseudomonas MOA : same as penicillin (B-lactam) Ceph.S. 3rd (cefixime, ceftriaxone , cefotaxime & ceftazidime ) Indications: RTI, gonorrhea (use cefixime), meningitis, septicemia, abdominal infections Contraindications: Hypersensitivity to Penicillin or ceha.S. BY : Abdullah Taskin 4th y.
  15. 15. Coverage : Ceph.S. 4th (cefepime) (good for gram +ve and –ve) & pseudomonas “penetrates the CSF” MOA : same as penicillin (B-lactam) Contraindications: Hypersensitivity to Penicillin or ceha.S. BY : Abdullah Taskin 4th y.
  16. 16. Cephalosporins (β-Lactam) : a) Renal elimination b) Ceftriaxone & Cefoperazone biotransformation in the liver. c) Thrombocytopenia associated with cefamandole and cefoperazone NOT cefotetan!! d) Pyrogenic (highest rates of drug induced fever) BY : Abdullah Taskin 4th y.
  17. 17. Coverage : GN only & work with aminoglycosides MOA : (B-lactam) Monobactams β-Lactam Aztreonam Indications: patients who are allergic to penicillins or cephalosporins Contraindications: Not allergic . BY : Abdullah Taskin 4th y.
  18. 18. Coverage : GP except Enterococcus, MRSA GN including Pseudomonas + Enterobacter Anaerobes MOA : (B-lactam) Carbapenams β-Lactam: (Imipenam ) Indications: LARGEST SPECTRUM OF ACTIVITY of any B-lactam Rx: Septicemia of unknown origin Major disadvantages: metabolize by kidney > cause decreased urinary concentration. SE: seizers ,rash so IMIPENAM + CILASTATIN (inhibitor of enzyme) are given together. BY : Abdullah Taskin 4th y.
  19. 19. Coverage : GP except Enterococcus, MRSA GN including Pseudomonas + Enterobacter Anaerobes Carbapenams β-Lactam: (meropenem ) Major disadvantages: not need CILASTATIN & Less seizures MOA : (B-lactam) BY : Abdullah Taskin 4th y.
  20. 20. Coverage : NON β-Lactam: ( VANCOMYCIN ) GP (strong) MOA : Indications: GP: (RESISTANT to methicillin) e.g. MRSA & MRSE must be given IV NO GI Glycopeptide stearically inhibits addition of peptidoglycan subunits Major disadvantages: Red Man Syndrome , Nephrotoxicity , Ototoxicity , Neutropenia, Thrombocytopenia BY : Abdullah Taskin 4th y.
  21. 21. NON β-Lactam: (FOSFOMYCIN ) Coverage : Gram +ve and – ve spectrum MOA : Indications: SINGLE DOSE Of uncomplicated UTI : treatment of ONLY IN FEMALES!! inhibit cell wall BY : Abdullah Taskin 4th y.
  22. 22. Contraindicated in pregnancy 1. Aminoglycosides 2. Erythromycin 3. Clarithromycin 4. Tetracyclines 5. Fluoroquinolones BY : Abdullah Taskin 4th y.
  23. 23. Protein synthesis inhibitors : BY : Abdullah Taskin 4th y.
  24. 24. 50 S A- Macrolides Protein synthesis inhibitors B- Lincosamides 1) Erythromycin 1) clindamycin 2) clarithromycin 2) Chloramphenico 3) azithromycin 3) linezolid BY : Abdullah Taskin 4th y. 30 S 1- Aminoglycosides 2- Tetracyclines
  25. 25. Macrolides Coverage : GP except Enterococcus & GN “Atypicals” MOA : inhibit 50 S Indications: Clarithromycin = H.pyloric Azithromycin = Co-drug of choice for Chlamydia & Safe in pregnancy . Major disadvantages: GI upset , acute cholestatic hepatitis Prolonged QT Hypersensitivity BY : Abdullah Taskin 4th y.
  26. 26. clindamycin Coverage : GP except Enterococcus & Anaerobes MOA : inhibit 50 S clindamycin =Pseudomembranous colitis Chloramphenicol= Aplastic anemia & Grey baby syndrome linezolid = HTN , myelosuppression optic neuropathy, peripheral neuropathy BY : Abdullah Taskin 4th y.
  27. 27. Aminoglycosides Coverage : GN & psudomonas MOA : inhibit 30 S Indications: G - & no alternatives . Major disadvantages: Nephrotoxicity Ototoxicity BY : Abdullah Taskin 4th y.
  28. 28. Coverage : GP Anaerobes Atypicals: Chlamydophila, Mycoplasma, Treponema prophylaxis MOA : inhibit 30 S Tetracyclines Indications: Rickettsial infections, Chlamydophila, acne malaria prophylaxis (doxycycline). Major disadvantages: Hepato-renal toxicity, Fanconi’s syndrome, Photosensitivity, Teratogenic, Yellow teeth and stunted , Taskin 4th y. growth in children,( not in preg.) bone BY : Abdullah
  29. 29. Coverage : Poor GP activity GN Atypicals FIncludes anaerobes No Pseudomonas coverage TOPOISOMERASE INHIBITORS : Fluoroquinolones Indications: Only use when necessary to prevent resistance except : ciprofloxacin MOA : Inhibits DNA gyrase Dysglycemia Major disadvantages: Allergy , Seizures , Prolonged QT BY : Abdullah Taskin 4th y.
  30. 30. Coverage : GPC N. meningitidis H. influenza Mycobacteria MOA : Inhibits RNA polymerase TOPOISOMERASE INHIBITORS : Rifampin Indications: TB , latent TB , Endocarditis & prophlaxis N. meningitides exposure Major disadvantages: Hepatic dysfunction, P450, Orange tears/saliva/urine & Jaundice BY : Abdullah Taskin 4th y.
  31. 31. Coverage : Anaerobes Protozoa MOA : Forms toxic metabolites in bacterial cell which damage microbial DNA TOPOISOMERASE INHIBITORS : Metronidazole (Flagyl®) Indications: Protozoal infections (trichomonas, amebiasis, giardiasis), bacterial vaginosis, anaerobic bacterial infections Major disadvantages: Seizures Peripheral neuropathy , BY : Abdullah Taskin 4th y.
  32. 32. Coverage : GP GN: enteric Nocardia Other: Pneumocystis, Toxoplasmosis MOA : Inhibits folic acid production (TMP inhibits DHFR and SMX is a competitive inhibitor of PABA) ANTI-METABOLITE: Trimethoprim- Sulfamethoxazole (TMP/SMX) Major disadvantages: Hepatitis , Stevens Johnson syndrome TMP: - Megaloblastic anemia - Leuko/granulocytopenia - Hyperkalemia SMX: - Hypersensitivity - Interstitial nephritis - BM suppression BY : Abdullah Taskin 4th y.
  33. 33. Remain : • Antimyobacterial ( rifampicin covered above ) BY : Abdullah Taskin 4th y.
  34. 34. Appendix BY : Abdullah Taskin 4th y.
  35. 35. Basic : G.ngative vs. G.positive BY : Abdullah Taskin 4th y.
  36. 36. BY : Abdullah Taskin 4th y.
  37. 37. Properties of penicillin : • All penicillin has Beta lactam ring . • Trans-peptidase or (penicillin-binding protein) • Function : Synthesis of peptidoglycan layer . • To be effective Penicillin must : I. Penetrate cell layer II. Keeps it beta lactam ring intact III.Bind to Trans-peptidase . BY : Abdullah Taskin 4th y.
  38. 38. How bacteria defended from penicillin ? In three ways : 1) G. negatives prevent penetration of cell layers by alteration of porins. 2)G. negatives destroy beta-lactam in periplasmic space . 3) Bacteria inhibit binding of B.lactam to transpeptidase by altering structure of Trans-peptidase . BY : Abdullah Taskin 4th y.
  39. 39. References : • Ananthanarayan & Pinker’s 8th edition . • Clinical Microbiology Made Ridiculously Simple – 3rd edition BY : Abdullah Taskin 4th y.
  40. 40. Thank you … BY : Abdullah Taskin 4th y.
  41. 41. BY : Abdullah Taskin 4th y.

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