Anti microbials

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Anti microbials

  1. 1. Anti-Microbial Therapy Antibiotic Drug Classes Major Indications Therapeutic Effect Adverse Reactions
  2. 2. What are Microbes? <ul><li>Microorganisms (Moos) </li></ul><ul><li>Bacteria </li></ul><ul><li>Mycoplasms </li></ul><ul><li>Spirochetes </li></ul><ul><li>Fungi </li></ul><ul><li>Viruses </li></ul>
  3. 5. What are bacteria? <ul><li>Got Oxygen? </li></ul><ul><ul><li>Aerobic -need O2 </li></ul></ul><ul><ul><li>Anaerobic –no O2 </li></ul></ul><ul><li>Shape Up! </li></ul><ul><ul><li>Round cocci </li></ul></ul><ul><ul><li>Rod-like bacilli </li></ul></ul><ul><ul><li>Spiral spirochetes </li></ul></ul><ul><li>Gram’s stain </li></ul><ul><ul><li>Gram positive </li></ul></ul><ul><ul><li>Gram negative </li></ul></ul>
  4. 6. A bit o’history <ul><li>2000BC Here eat this root. </li></ul><ul><li>1000AD That root is heathen, say this prayer. </li></ul><ul><li>1850AD That prayer is superstition, drink this potion. </li></ul><ul><li>1920AD That potion is snake oil, swallow this pill. </li></ul><ul><li>1945AD That pill is ineffective, take this penicillin. </li></ul><ul><li>1955AD Oops, bugs mutated, take this tetracycline. </li></ul><ul><li>1960-1999AD 39 more mutations, take this more powerful antibiotic. </li></ul><ul><li>2000AD The bugs have won ! Here eat this root. </li></ul>
  5. 7. Organs of the Immune System <ul><li>The organs of the immune system are stationed throughout the body. </li></ul><ul><ul><li>Tonsils & Adenoids </li></ul></ul><ul><ul><li>Thymus </li></ul></ul><ul><ul><li>Lymph nodes </li></ul></ul><ul><ul><li>Spleen </li></ul></ul><ul><ul><li>Appendix </li></ul></ul><ul><ul><li>Bone marrow </li></ul></ul>
  6. 8. The Immune Response <ul><li>Inflammation </li></ul><ul><ul><li>Protective mechanism of body tissues </li></ul></ul><ul><ul><li>Histamine, prostaglandins, leukotrienes </li></ul></ul><ul><li>Fever </li></ul><ul><ul><li>Increase thermostat set point </li></ul></ul><ul><ul><ul><li>Body  vasoconstriction, goose flesh, shiver (heat conservation) </li></ul></ul></ul><ul><ul><li>Re-establish normal set point </li></ul></ul><ul><ul><ul><li>Body  increase cutaneous blood flow, sweating (heat loss) </li></ul></ul></ul>
  7. 10. Moo’s Anatomy cell wall -determines permeability/rigid/barrier cell membrane -controls structure/synthesis of enzymes for cell metabolism chromosome -storage site of genetic info governs cell processes, metabolism & division cytoplasm -metabolic machinery protein syn & metabolism
  8. 11. Resistance Gene Exchange <ul><li>Target Molecule </li></ul><ul><ul><li>Alter drug receptor </li></ul></ul><ul><li>Alter Entry/Removal of drug/pollutant </li></ul><ul><li>Inactivate/decompose drug/pollutant </li></ul><ul><ul><li>Destruction </li></ul></ul><ul><li>Sequester/by-pass </li></ul><ul><ul><li>Develop alternate pathways to circumvent AB </li></ul></ul>bacteriophage plasmids chromosome other moos
  9. 12. Mutant Species Development <ul><li>Spontaneous Mutation </li></ul><ul><ul><li>DNA change/adapt </li></ul></ul><ul><li>Microbial Sex </li></ul><ul><ul><li>Transduction </li></ul></ul><ul><ul><ul><li>To lead across </li></ul></ul></ul><ul><ul><li>Transformation </li></ul></ul><ul><ul><ul><li>Change condition or function </li></ul></ul></ul><ul><li>Jumping Genes </li></ul><ul><ul><li>Conjugation/Acquired </li></ul></ul><ul><ul><ul><li>Union, fusion 2 gametes for reproduction </li></ul></ul></ul>
  10. 13. Four Antibiotic RULES <ul><li>Finish the bottle </li></ul><ul><li>Don’t be tempted by leftovers </li></ul><ul><li>Work with your health care provider </li></ul><ul><li>Don’t skip doses </li></ul>
  11. 14. Antibiotic Action <ul><li>Inhibit cell wall synthesis </li></ul><ul><li>Inhibit protein synthesis </li></ul><ul><li>Prevent folic acid synthesis </li></ul><ul><li>Interfere with DNA synthesis </li></ul>
  12. 15. Inhibitors of Cell Wall Synthesis <ul><li>Beta Lactam Compounds </li></ul><ul><ul><li>Penicillin's </li></ul></ul><ul><ul><li>MOA & Uses </li></ul></ul><ul><ul><li>Agents </li></ul></ul><ul><ul><ul><li>Penicillin V </li></ul></ul></ul><ul><ul><ul><li>Dicloxacillin, Methicillin </li></ul></ul></ul><ul><ul><ul><li>Ampicillin, Amoxicillin-Clavulanate </li></ul></ul></ul><ul><ul><ul><li>Mezlocillin, Ticarcillin </li></ul></ul></ul>
  13. 16. Cell Wall Inhibitors cont. <ul><ul><li>Bacteriocidal </li></ul></ul><ul><ul><li>Allergy/Resistance </li></ul></ul><ul><ul><li>Pharmacokinetics </li></ul></ul><ul><li>Cephalosporins </li></ul><ul><ul><li>Cephalexin/Cefadroxil </li></ul></ul><ul><ul><li>Ceftriazone (Rocephin) </li></ul></ul><ul><li>Other Inhibitors of Cell Wall Synthesis </li></ul><ul><ul><li>Vancomycin </li></ul></ul>
  14. 17. Inhibitors of Microbial Protein Synthesis (Bacteriostatic) <ul><li>Chloramphenicol </li></ul><ul><li>Tetracycline </li></ul><ul><ul><li>Minocycline </li></ul></ul><ul><li>Macrolides </li></ul><ul><ul><li>Azithromycin </li></ul></ul><ul><ul><li>Clarithromycin </li></ul></ul><ul><ul><li>Erythromycin </li></ul></ul><ul><li>Clindamycin </li></ul><ul><li>Amino glycosides </li></ul><ul><ul><li>Aerobic gram negative microorganisms </li></ul></ul><ul><ul><ul><li>Streptomycin </li></ul></ul></ul><ul><ul><ul><li>Tobramycin </li></ul></ul></ul><ul><ul><ul><li>Gentamycin </li></ul></ul></ul><ul><li>Miscellaneous </li></ul><ul><ul><li>Metronidazole </li></ul></ul><ul><ul><ul><li>Anaerobic bacteria </li></ul></ul></ul><ul><ul><ul><li>Protozoa </li></ul></ul></ul>
  15. 18. Anti-Folate DNA Gyrase <ul><li>Sulfonamides </li></ul><ul><li>“ Sulfas” </li></ul><ul><ul><li>Sulfasoxazole </li></ul></ul><ul><ul><ul><li>Single agent Bacteriostatic </li></ul></ul></ul><ul><ul><li>Trimethoprim / Sulfamethoxazole </li></ul></ul><ul><ul><ul><li>Septra DS </li></ul></ul></ul><ul><ul><ul><li>Bactrim DS </li></ul></ul></ul><ul><ul><ul><li>Double agents Bacteriocidal </li></ul></ul></ul><ul><li>Fluoroquinolones </li></ul><ul><li>“ FLOXACINs </li></ul><ul><ul><li>Ciprofloxacin </li></ul></ul><ul><ul><li>Levofloxacin </li></ul></ul>
  16. 19. Clinical Implications <ul><li>Use </li></ul><ul><li>Misuse </li></ul><ul><ul><li>Patient demand </li></ul></ul><ul><ul><li>Misdiagnosis </li></ul></ul><ul><ul><li>Counterfeits </li></ul></ul><ul><ul><li>Agricultural Use </li></ul></ul><ul><ul><li>International Travel </li></ul></ul><ul><li>Super infection </li></ul><ul><ul><li>2% of persons TX w/AB </li></ul></ul>
  17. 20. Serious Drug Interactions <ul><li>Increase risk of bleed </li></ul><ul><ul><li>PCN & warfarin </li></ul></ul><ul><ul><li>PCN & NSAIDs </li></ul></ul><ul><ul><li>Cephal & warfarin </li></ul></ul><ul><ul><li>Cephal & NSAIDs </li></ul></ul><ul><li>Oto & nephrotox </li></ul><ul><ul><li>Vancomycin & AG </li></ul></ul><ul><ul><li>Two or more AG </li></ul></ul><ul><li>Antabuse reaction </li></ul><ul><ul><li>Metronidazole/Etoh </li></ul></ul><ul><ul><li>Metronid/disulfiram </li></ul></ul>
  18. 21. Summary Slide <ul><li>Organs of the Immune System </li></ul><ul><li>The Immune Response </li></ul><ul><li>Moo’s Anatomy & Resistance </li></ul><ul><li>Four Antibiotic RULES </li></ul><ul><li>Inhibitors of Cell Wall Synthesis </li></ul><ul><li>Inhibitors of Microbial Protein Synthesis (Bacteriostatic) </li></ul>
  19. 22. Summary Slide (cont.) <ul><li>Anti-Folate </li></ul><ul><li>DNA Gyrase </li></ul><ul><li>Serious Drug Interactions </li></ul>
  20. 23. Case Study Antibiotics <ul><li>TL is a 29-year-old female, 59 kg, who presents at clinic with a 2-week history of abdominal pain, nocturia and frequency of urination. PE is unremarkable except some lower abdominal tenderness. A clean catch midstream urine sample is collected. The results are 10-25 WBC/HPF with a few gram-positive cocci in clusters and gram negative rods. She is empirically started on Macrobid 100mg bid x 7 days. TL returns to clinic 3 days later with a productive cough, wheezing, and heaviness on her chest and shaking chills. She is severely nauseous. Her breathing is labored with rales and wheezing. Pregnancy results are positive . </li></ul>
  21. 24. Points to Ponder <ul><li>Discuss her symptoms and relate them to a possible health problem. </li></ul><ul><li>Discuss the antibiotic empiric treatment. Should it be changed? </li></ul><ul><li>Consider the relationship between pregnancy and UTI. </li></ul><ul><li>What respiratory therapy would you consider? </li></ul>

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