The document describes common bacteria found at different sites of infection in the human body. For the mouth, common bacteria include Peptococcus, Peptostreptococcus, and Actinomyces. For the skin and soft tissues, common bacteria are S. aureus, S. pyogenes, and S. epidermidis. For bones and joints, common bacteria are S. aureus, S. epidermidis, streptococci, N. gonorrhoeae, and gram-negative rods. For the abdomen, common bacteria are E. coli, Proteus, Klebsiella, Enterococcus, and Bacteroides species. For the urinary tract, common bacteria are E. coli,
This ppt discusses pharmacological actions, toxic effects and clinical applications of corticosteroids. It also mentions precations to be taken while using steroids
The current slide include the pharmacology og cephalosporins.
Contents
Introduction to Cephalosporins
Classification of Cephalosporins
Cefazolin
Cephalexin
Cefuroxime
Cefuroxime axetil
Cefotaxime
Cefixime
Cefpodoxime proxetil
Cefepime
Adverse effects of Cephalosporins
Uses of Cephalosporins
This ppt discusses pharmacological actions, toxic effects and clinical applications of corticosteroids. It also mentions precations to be taken while using steroids
The current slide include the pharmacology og cephalosporins.
Contents
Introduction to Cephalosporins
Classification of Cephalosporins
Cefazolin
Cephalexin
Cefuroxime
Cefuroxime axetil
Cefotaxime
Cefixime
Cefpodoxime proxetil
Cefepime
Adverse effects of Cephalosporins
Uses of Cephalosporins
By Dr. Vishal Pawar, MD pharmacology
considering the complex nature of this topic, i am hereby providing a comprehensive review of prostaglandins and its various effects in the body, which after a through go through should be enough for simplifying the understanding of prostaglandins
By Dr. Vishal Pawar, MD pharmacology
considering the complex nature of this topic, i am hereby providing a comprehensive review of prostaglandins and its various effects in the body, which after a through go through should be enough for simplifying the understanding of prostaglandins
Antibiotic policy and trends in antibiotic policy,
References
Infection control: Basic concepts and practices, 2nd edn.
www.cdc.org
Antibiotics guide: choices for common infections
Chennai Declaration
Antibiotics,antibiotics resistances,classification of antibiotics,misuse of antibiotics details discussed here. for more information visit my blog helpful for pharmacy and medical student.thanks.
http://mydreamlan.wordpress.com/category/education/
abscess advanced trauma life support anterio advanced trauma life support antibiotics apically repositioned flap dental diseases dr dr shabeel drshabeel’s face eye trauma lidocaine anodontia management medical medicine misuse and abuse orthodontics teeth braces pharmacy pn preparation dental students for community based ed presentations s abscess abscess tooth active orthodonti shabeel shabeel"s shabeel’s shabeelpn trends of antimicrobial usage in dental practice View all
’s abscess abscess advanced trauma life support anterio abscess tooth active orthodontics adolescent advanced trauma life support aesthetic dentistry airway management alignment of teeth amalgam anesthesia in dentistry anesthetics in dentistry anterior open bite antibiotic resistanace antibiotics antibiotics and leukopenia aphthous ulcers apically repositioned flap apicoectomy appliances arch dental arch form orthodontics braces arch length orthodontics braces arch wire orthodontist braces ayurvedha baby teeth bloger boil books braces braces teeth cancer canker sore pain cavity preparation children community based learning congenitally missing teeth cosmetic dentistry csf leaks dental dental anesthetics dental restorations dental teeth dento alveolar fractures disease
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
Follow us on: Pinterest
Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Evaluation of antidepressant activity of clitoris ternatea in animals
Antibioticreview
1. Common Bacteria by Site of Infection
Mouth
Peptococcus
Peptostreptococcus
Actinomyces
Skin/Soft Tissue
S. aureus
S. pyogenes
S. epidermidis
Pasteurella
Bone and Joint
S. aureus
S. epidermidis
Streptococci
N. gonorrhoeae
Gram-negative rods
Abdomen
E. coli, Proteus
Klebsiella
Enterococcus
Bacteroides sp.
Urinary Tract
E. coli, Proteus
Klebsiella
Enterococcus
Staph saprophyticus
Upper Respiratory
S. pneumoniae
H. influenzae
M. catarrhalis
S. pyogenes
Lower Respiratory
Community
S. pneumoniae
H. influenzae
K. pneumoniae
Legionella pneumophila
Mycoplasma, Chlamydia
Lower Respiratory
Hospital
K. pneumoniae
P. aeruginosa
Enterobacter sp.
Serratia sp.
S. aureus
Meningitis
S. pneumoniae
N. meningitidis
H. influenza
Group B Strep
E. coli
Listeria
4. -Lactams
Adverse Effects
• Hypersensitivity – 3 to 10 %
Higher incidence with parenteral administration
or procaine formulation
Mild to severe allergic reactions – rash to
anaphylaxis and death
Antibodies produced against metabolic by-
products or penicillin itself
Cross-reactivity exists among all penicillins and
even other -lactams
Desensitization is possible
5. -lactams
Pharmacology
• Absorption: Variable depending on product
• Distribution
Widely distributed into tissues and fluids
Pens only get into CSF in the presence of inflamed
meninges; parenteral 3rd and 4th generation cephs,
meropenem, and aztreonam penetrate the CSF
• Elimination
most eliminated primarily by the kidney, dosage adj
required in the presence of renal insufficiency
Nafcillin, oxacillin, ceftriaxone-eliminated by the liver
ALL -lactams have short elimination half-lives except for
a few cephalosporins (ceftriaxone)
6. -Lactams
Adverse Effects
• Neurologic – especially with penicillins and
carbapenems (imipenem and meropenem)
Especially in patients receiving high doses in
the presence of renal insufficiency
Irritability, confusion, seizures
• Hematologic
Leukopenia, neutropenia, thrombocytopenia –
prolonged therapy (> 2 weeks)
7. -Lactams
Adverse Effects
• Gastrointestinal
Increased LFTs, nausea, vomiting, diarrhea,
pseudomembranous colitis (C. difficile diarrhea)
• Interstitial Nephritis
Cellular infiltration in renal tubules (Type IV
hypersensitivity reaction – characterized by
abrupt increase in serum creatinine; can lead to
renal failure
Especially with methicillin or nafcillin
8. Natural Penicillins
(penicillin G, penicillin VK)
Gram-positive Gram-negative
pen-susc S. pneumoniae Neisseria sp.
Group A/B/C/G strep Anaerobes
viridans streptococci Above the diaphragm
Enterococcus Clostridium sp.
Other
Treponema pallidum (syphilis)
10. Aminopenicillins
(ampicillin, amoxicillin)
Developed to increase activity against
gram-negative aerobes
Gram-positive Gram-negative
pen-susc S. aureus Proteus mirabilis
Pen-susc streptococci Salmonella,
viridans streptococci some E. coli
Enterococcus sp. L- H. influenzae
Listeria monocytogenes
11. Carboxypenicillins
(carbenicillin, ticarcillin)
Developed to further increase activity
against resistant gram-negative aerobes
Gram-positive Gram-negative
marginal Proteus mirabilis
Salmonella, Shigella
some E. coli
L- H. influenzae
Enterobacter sp.
Pseudomonas aeruginosa
12. Ureidopenicillins
(piperacillin, azlocillin)
Developed to further increase activity
against resistant gram-negative aerobes
Gram-positive Gram-negative
viridans strep Proteus mirabilis
Group strep Salmonella, Shigella
some Enterococcus E. coli
L- H. influenzae
Anaerobes Enterobacter sp.
Fairly good activity Pseudomonas aeruginosa
Serratia marcescens
some Klebsiella sp.
13. -Lactamase Inhibitor Combos
(Unasyn, Augmentin, Timentin, Zosyn)
Developed to gain or enhance activity against -
lactamase producing organisms (some better than
others). Provides some or good activity against:
Gram-positive Gram-negative
S. aureus (MSSA) H. influenzae
E. coli
Anaerobes Proteus sp.
Bacteroides sp. Klebsiella sp.
Neisseria gonorrhoeae
Moraxella catarrhalis
14. Classification and Spectrum of
Activity of Cephalosporins
• Divided into 4 major groups called
“Generations”
• Are divided into Generations based on
antimicrobial activity
resistance to beta-lactamase
15. First Generation Cephalosporins
Best activity against gram-positive aerobes,
with limited activity against a few gram-
negative aerobes
Gram-positive Gram-negative
meth-susc S. aureus E. coli
pen-susc S. pneumoniae K. pneumoniae
Group A/B/C/Gstreptococci P. mirabilis
viridans streptococci
16. Second Generation Cephalosporins
Spectrum of Activity
Gram-positive Gram-negative
meth-susc S. aureus E. coli
pen-susc S. pneumoniae K. pneumoniae
Group A/B/C/G strep P. mirabilis
viridans streptococci H. influenzae
M. catarrhalis
Neisseria sp.
17. Second Generation Cephalosporins
Spectrum of Activity
The cephamycins (cefoxitin and cefotetan)
are the only 2nd generation cephalosporins
that have activity against anaerobes
Anaerobes
Bacteroides fragilis
Bacteroides fragilis group
18. Third Generation Cephalosporins
Spectrum of Activity
• In general, are even less active against gram-
positive aerobes, but have greater activity
against gram-negative aerobes
• Ceftriaxone and cefotaxime have the best
activity against gram-positive aerobes,
including pen-resistant S. pneumoniae
19. Third Generation Cephalosporins
Spectrum of Activity
Gram-negative aerobes
E. coli, K. pneumoniae, P. mirabilis
H. influenzae, M. catarrhalis, N. gonorrhoeae (including
beta-lactamase producing); N. meningitidis
Citrobacter sp., Enterobacter sp., Acinetobacter sp.
Morganella morganii, Serratia marcescens, Providencia
Pseudomonas aeruginosa (ceftazidime and cefoperazone)
20. Fourth Generation Cephalosporins
• 4th generation cephalosporins for 2 reasons
Extended spectrum of activity
gram-positives: similar to ceftriaxone
gram-negatives: similar to ceftazidime, including
Pseudomonas aeruginosa; also covers beta-lactamase
producing Enterobacter sp.
Stability against -lactamases; poor inducer of
extended-spectrum -lactamases
• Only cefepime is currently available
21. Carbapenems
(Imipenem, Meropenem and Ertapenem)
• Most broad spectrum of activity of all antimicrobials
• Have activity against gram-positive and gram-
negative aerobes and anaerobes
• Bacteria not covered by carbapenems include
MRSA, VRE, coagulase-negative staph, C. difficile,
Nocardia
• Additional ertapenem exceptions:
• Pseudomonas and Enterococcus
22. Monobactams
Spectrum of Activity
Aztreonam bind preferentially to PBP 3 of
gram-negative aerobes; has little to no
activity against gram-positives or anaerobes
Gram-negative
E. coli, K. pneumoniae, P. mirabilis, S. marcescens
H. influenzae, M. catarrhalis
Enterobacter, Citrobacter, Providencia, Morganella
Salmonella, Shigella
Pseudomonas aeruginosa
23. Fluoroquinolones
• Novel group of synthetic antibiotics
developed in response to growing resistance
• The fluorinated quinolones (FQs) represent
a major therapeutic advance:
Broad spectrum of activity
Improved PK properties – excellent
bioavailability, tissue penetration, prolonged
half-lives
Overall safety
• Disadvantages: resistance, expense
24. FQs Spectrum of Activity
Gram-positive – newer FQs with
enhanced potency
• Methicillin-susceptible Staphylococcus aureus
• Streptococcus pneumoniae (including PRSP)
• Group A/B/C/G and viridans streptococci –
limited activity
• Enterococcus sp. – limited activity
25. FQs Spectrum of Activity
Gram-Negative – all FQs have excellent
activity (cipro=levo>gati>moxi)
• Enterobacteriaceae – including E. coli,
Klebsiella sp, Enterobacter sp, Proteus sp,
Salmonella, Shigella, Serratia marcescens, etc.
• H. influenzae, M. catarrhalis, Neisseria sp.
• Pseudomonas aeruginosa – significant resistance
has emerged; ciprofloxacin and levofloxacin with
best activity
26. FQs Spectrum of Activity
Atypical Bacteria – all FQs have excellent
activity against atypical bacteria including:
• Legionella pneumophila - DOC
• Chlamydia sp.
• Mycoplasma sp.
• Ureaplasma urealyticum
Other Bacteria – Mycobacterium tuberculosis,
Bacillus anthracis
27. Fluoroquinolones
Pharmacology
• Concentration-dependent bacterial killing
• Absorption
Most FQs have good bioavailability after oral
administration
Cmax within 1 to 2 hours; coadministration with food
delays the peak concentration
• Distribution
Extensive tissue distribution – prostate; liver; lung;
skin/soft tissue and bone; urinary tract
Minimal CSF penetration
• Elimination – renal and hepatic; not removed by HD
28. Fluoroquinolones
Adverse Effects
• Gastrointestinal – 5 %
Nausea, vomiting, diarrhea, dyspepsia
• Central Nervous System
Headache, agitation, insomnia, dizziness, rarely,
hallucinations and seizures (elderly)
• Hepatotoxicity
LFT elevation (led to withdrawal of trovafloxacin)
• Phototoxicity (uncommon with current FQs)
More common with older FQs (halogen at position 8)
• Cardiac
Variable prolongation in QTc interval
Led to withdrawal of grepafloxacin, sparfloxacin
29. Fluoroquinolones
Adverse Effects
• Articular Damage
Arthopathy including articular cartilage damage,
arthralgias, and joint swelling
Observed in toxicology studies in immature dogs
Led to contraindication in pediatric patients and
pregnant or breastfeeding women
Risk versus benefit
• Other adverse reactions: tendon rupture,
dysglycemias, hypersensitivity
30. Macrolides
• Erythromycin is a naturally-occurring macrolide
derived from Streptomyces erythreus – problems
with acid lability, narrow spectrum, poor GI
intolerance, short elimination half-life
• Structural derivatives include clarithromycin and
azithromycin:
Broader spectrum of activity
Improved PK properties – better bioavailability, better
tissue penetration, prolonged half-lives
Improved tolerability
31. Macrolides
Mechanism of Action
Inhibits protein synthesis by reversibly binding
to the 50S ribosomal subunit
Suppression of RNA-dependent protein synthesis
Macrolides typically display bacteriostatic
activity, but may be bactericidal when present
at high concentrations against very susceptible
organisms
Time-dependent activity
32. Macrolide Spectrum of Activity
Gram-Positive Aerobes – erythromycin and
clarithromycin display the best activity
(Clarithro>Erythro>Azithro)
• Methicillin-susceptible Staphylococcus aureus
• Streptococcus pneumoniae (only PSSP) – resistance is
developing
• Group A/B/C/G and viridans streptococci
• Bacillus sp., Corynebacterium sp.
33. Macrolide Spectrum of Activity
Gram-Negative Aerobes – newer macrolides
with enhanced activity
(Azithro>Clarithro>Erythro)
• H. influenzae (not erythro), M. catarrhalis,
Neisseria sp., Campylobacter jejuni, Bordetella
pertussis
• Do NOT have activity against any
Enterobacteriaceae or Pseudomonas
34. Macrolide Spectrum of Activity
Anaerobes – activity against upper airway anaerobes
Atypical Bacteria – all macrolides have excellent
activity against atypical bacteria including:
• Legionella pneumophila - DOC
• Chlamydia sp.
• Mycoplasma sp.
• Ureaplasma urealyticum
Other Bacteria – Mycobacterium avium complex
(MAC – only A and C), Treponema pallidum,
Campylobacter, Borrelia, Bordetella, Brucella.
Pasteurella
35. Macrolides
Pharmacology
Absorption
Erythromycin – variable absorption (15-45%);
food may decrease the absorption
• Base: destroyed by gastric acid; enteric coated
• Esters and ester salts: more acid stable
Clarithromycin – acid stable and well-absorbed,
55% bioavailable regardless of presence of food
Azithromycin –acid stable; 38% bioavailable; food
decreases absorption of capsules
36. Macrolides
Pharmacology
Distribution
Extensive tissue and cellular distribution – clarithromycin
and azithromycin with extensive penetration
Minimal CSF penetration
Elimination
Clarithromycin is the only macrolide partially eliminated by
the kidney (18% of parent and all metabolites); requires
dose adjustment when CrCl < 30 ml/min
Hepatically eliminated: ALL
NONE of the macrolides are removed during hemodialysis!
Variable elimination half-lives (1.4 hours for erythro; 3 to 7
hours for clarithro; 68 hours for azithro)
37. Macrolides
Adverse Effects
• Gastrointestinal – up to 33 %
Nausea, vomiting, diarrhea, dyspepsia
Most common with erythro; less with new agents
• Cholestatic hepatitis - rare
> 1 to 2 weeks of erythromycin estolate
• Thrombophlebitis – IV Erythro and Azithro
Dilution of dose; slow administration
• Other: ototoxicity (high dose erythro in
patients with RI); QTc prolongation; allergy
38. Macrolides
Drug Interactions
Erythromycin and Clarithromycin ONLY–
are inhibitors of cytochrome p450 system in
the liver; may increase concentrations of:
Theophylline Digoxin, Disopyramide
Carbamazepine Valproic acid
Cyclosporine Terfenadine, Astemizole
Phenytoin Cisapride
Warfarin Ergot alkaloids
39. Aminoglycosides
Mechanism of Action
• Multifactorial, but ultimately involves
inhibition of protein synthesis
• Irreversibly bind to 30S ribosomes
– must bind to and diffuse through outer membrane
and cytoplasmic membrane and bind to the
ribosome
– disrupt the initiation of protein synthesis,
decreases overall protein synthesis, and produces
misreading of mRNA
• Are bactericidal
40. Aminoglycosides
Spectrum of Activity
Gram-Positive Aerobes
most S. aureus and coagulase-negative staph (but not DOC)
viridans streptococci (in combination with a cell-wall agent)
Enterococcus sp. (only in combination with a cell-wall agent)
Gram-Negative Aerobes (not streptomycin)
E. coli, K. pneumoniae, Proteus sp.
Acinetobacter, Citrobacter, Enterobacter sp.
Morganella, Providencia, Serratia, Salmonella, Shigella
Pseudomonas aeruginosa (amik>tobra>gent)
Mycobacteria
– tuberculosis - streptomycin
– atypical - streptomycin or amikacin
41. Aminoglycosides
Pharmacology
• Absorption - poorly absorbed from gi tract
• Distribution
– primarily in extracellular fluid volume; are widely
distributed into body fluids but NOT the CSF
– distribute poorly into adipose tissue, use LBW for dosing
• Elimination
– eliminated unchanged by the kidney via glomerular
filtration; 85-95% of dose
– elimination half-life dependent on renal fxn
normal renal function - 2.5 to 4 hours
impaired renal function - prolonged
42. Aminoglycosides
Adverse Effects
Nephrotoxicity
– nonoliguric azotemia due to proximal tubule damage;
increase in BUN and serum Cr; reversible if caught early
– risk factors: prolonged high troughs, long duration of
therapy (> 2 weeks), underlying renal dysfunction, elderly,
other nephrotoxins
Ototoxicity
– 8th cranial nerve damage - vestibular and auditory toxicity;
irreversible and saturable
– vestibular: dizziness, vertigo, ataxia
– auditory: tinnitus, decreased hearing
– risk factors: same as for nephrotoxicity
43. Vancomycin
Mechanism of Action
• Inhibits bacterial cell wall synthesis at a site
different than beta-lactams
• Inhibits synthesis and assembly of the second
stage of peptidoglycan polymers
• Binds firmly to D-alanyl-D-alanine portion of
cell wall precursors
• Bactericidal (except for Enterococcus)
44. Vancomycin
Spectrum of Activity
Gram-positive bacteria
– Methicillin-Susceptible AND Methicillin-Resistant S.
aureus and coagulase-negative staphylococci
– Streptococcus pneumoniae (including PRSP), viridans
streptococcus, Group A/B/C/G streptococcus
– Enterococcus sp.
– Corynebacterium, Bacillus. Listeria, Actinomyces
– Clostridium sp. (including C. difficile), Peptococcus,
Peptostreptococcus
No activity against gram-negative aerobes or
anaerobes
45. Vancomycin
Pharmacology
• Absorption
– absorption from GI tract is negligible after oral
administration except in patients with intense colitis
– Use IV therapy for treatment of systemic infection
• Distribution
– widely distributed into body tissues and fluids, including
adipose tissue; use TBW for dosing
– inconsistent penetration into CSF, even with inflamed
meninges
• Elimination
– primarily eliminated unchanged by the kidney via
glomerular filtration
– elimination half-life depends on renal function
46. Vancomycin
Clinical Uses
• Infections due to methicillin-resistant staph
including bacteremia, empyema, endocarditis,
peritonitis, pneumonia, skin and soft tissue
infections, osteomyelitis
• Serious gram-positive infections in -lactam
allergic patients
• Infections caused by multidrug resistant bacteria
• Endocarditis or surgical prophylaxis in select cases
• Oral vancomycin for refractory C. difficile colitis
47. Vancomycin
Adverse Effects
Red-Man Syndrome
– flushing, pruritus, erythematous rash on face and
upper torso
– related to RATE of intravenous infusion; should be
infused over at least 60 minutes
– resolves spontaneously after discontinuation
– may lengthen infusion (over 2 to 3 hours) or
pretreat with antihistamines in some cases
48. Vancomycin
Adverse Effects
• Nephrotoxicity and Ototoxicity
– rare with monotherapy, more common when
administered with other nephro- or ototoxins
– risk factors include renal impairment, prolonged
therapy, high doses, ? high serum concentrations,
other toxic meds
• Dermatologic - rash
• Hematologic - neutropenia and
thrombocytopenia with prolonged therapy
• Thrombophlebitis
49. Oxazolidinones
• Linezolid (Zyvox®) is the first available
agent which received FDA approval in April
2000; available PO and IV
• Developed in response to need for agents
with activity against resistant gram-positives
(MRSA, GISA, VRE)
50. Linezolid
Mechanism of Action
• Binds to the 50S ribosomal subunit near to
surface interface of 30S subunit – causes
inhibition of 70S initiation complex which
inhibits protein synthesis
• Bacteriostatic (cidal against some bacteria)
51. Linezolid
Spectrum of Activity
Gram-Positive Bacteria
– Methicillin-Susceptible, Methicillin-Resistant AND
Vancomycin-Resistant Staph aureus and coagulase-
negative staphylococci
– Streptococcus pneumoniae (including PRSP), viridans
streptococcus, Group streptococcus
– Enterococcus faecium AND faecalis (including VRE)
– Bacillus. Listeria, Clostridium sp. (except C. difficile),
Peptostreptococcus, P. acnes
Gram-Negative Aerobes – relatively inactive
Atypical Bacteria
– Mycoplasma, Chlamydia, Legionella
52. Linezolid
Pharmacology
• Concentration-independent bactericidal
activity
• Absorption – 100% bioavailable
• Distribution – readily distributes into well-
perfused tissue; CSF penetration 70%
• Elimination – both renally and nonrenally, but
primarily metabolized; t½ is 4.4 to 5.4 hours;
no adjustment for RI; not removed by HD
53. Linezolid
Adverse Effects
• Gastrointestinal – nausea, vomiting,
diarrhea (6 to 8 %)
• Headache – 6.5%
• Thrombocytopenia – 2 to 4%
– Most often with treatment durations of > 2
weeks
– Therapy should be discontinued – platelet
counts will return to normal
54. Linezolid (Zyvox®)
Drug–Drug/Food interactions
Linezolid is a reversible, nonselective inhibitor of
monoamine oxidase. Tyramine rich foods, adrenergic
drugs and serotonergic drugs should be avoided due to the
potential drug-food and drug-drug interactions. A
significant pressor response has been observed in normal
adult subjects receiving linezolid and tyramine doses of
more than 100 mg. Therefore, patients receiving linezolid
need to avoid consuming large amounts of foods or
beverages with high tyramine content.
55. Linezolid and Tyramine
cont
Foods high in tyramine content include those that may have
undergone protein changes by aging, fermentation,
pickling, or smoking to improve flavor, such as aged
cheeses (0 to 15 mg tyramine per ounce); fermented or air-
dried meats such as pepperoni (0.1 to 8 mg tyramine per
ounce); sauerkraut (8 mg tyramine per 8 ounces); soy
sauce (5 mg tyramine per 1 teaspoon); tap beers (4 mg
tyramine per 12 ounces); red wines (0 to 6
mg tyramine per 8 ounces). The tyramine content of any
protein-rich food may be increased if stored for long
periods or improperly refrigerated.
56. Clindamycin
Mechanism of Action
Inhibits protein synthesis by binding
exclusively to the 50S ribosomal subunit
Binds in close proximity to macrolides –
competitive inhibition
Clindamycin typically displays bacteriostatic
activity, but may be bactericidal when present
at high concentrations against very susceptible
organisms
57. Clindamycin
Spectrum of Activity
Gram-Positive Aerobes
• Methicillin-susceptible Staphylococcus
aureus (MSSA)
• Methicillin-resistant Staphylococcus
aureus (MRSA) – some isolates
• Streptococcus pneumoniae (only PSSP) –
resistance is developing
• Group and viridans streptococci
58. Clindamycin
Spectrum of Activity
Anaerobes – activity against Above the Diaphragm
Anaerobes (ADA)
Peptostreptococcus some Bacteroides sp
Actinomyces Prevotella sp.
Propionibacterium Fusobacterium
Clostridium sp. (not C. difficile)
Other Bacteria – Toxoplasmosis gondii, Malaria
59. Clindamycin
Pharmacology
Absorption – available IV and PO
Rapidly and completely absorbed (90%); food with
minimal effect on absorption
Distribution
Good serum concentrations with PO or IV
Good tissue penetration including bone; minimal CSF
penetration
Elimination
Clindamycin primarily metabolized by the liver; half-
life is 2.5 to 3 hours
Clindamycin is NOT removed during hemodialysis
60. Clindamycin
Adverse Effects
• Gastrointestinal – 3 to 4 %
Nausea, vomiting, diarrhea, dyspepsia
• C. difficile colitis – one of worst offenders
Mild to severe diarrhea
Requires treatment with metronidazole
• Hepatotoxicity - rare
Elevated transaminases
• Allergy - rare
61. New Guys on the Block
• Tigecycline (Tygacil®)
• Daptomycin (Cubicin®)
63. Tigecycline
Spectrum of Activity
Broad spectrum of activity
• Treatment of complicated skin and skin structure
infections caused by susceptible organisms,
including methicillin-resistant Staphylococcus
aureus and vancomycin-sensitive Enterococcus
faecalis; treatment of complicated intra-
abdominal infections
64. Tigecycline
Pharmacokinetics
• Metabolism: Hepatic, via glucuronidation, N-
acetylation, and epimerization to several metabolites,
each <10% of the dose
• Half-life elimination: Single dose: 27 hours;
following multiple doses: 42 hours
• Excretion: Urine (33%; with 22% as unchanged
drug); feces (59%; primarily as unchanged drug) –
No dose adjustment required in renal dysfunction
66. Daptomycin
Mechanism of Action
Daptomycin binds to components of the cell
membrane of susceptible organisms and causes
rapid depolarization, inhibiting intracellular
synthesis of DNA, RNA, and protein.
Daptomycin is bactericidal in a concentration-
dependent manner
67. Daptomycin
Spectrum of Activity
Gram-Positive Aerobes
Treatment of complicated skin and skin
structure infections caused by susceptible
aerobic Gram-positive organisms;
• Staphylococcus aureus bacteremia, including right-
sided infective endocarditis caused by MSSA or MRSA
68. Daptomycin
Pharmacokinetics
• Absorption – available IV only
• Half-life elimination: 8-9 hours (up to 28 hours in
renal impairment)
• Excretion: Urine (78%; primarily as unchanged
drug); feces (6%)
• Dosage adjustment in renal impairment:
– Clcr <30 mL/minute: Administer dose q48hr
70. FDA Categorization of Antibiotics in Pregnancy
• Category A
– Controlled studies in women fail to demonstrate a risk to the fetus in the first trimester (and there is no
evidence of a risk in later trimesters), and the possibility of fetal harm appears remote.
• Category B
– Either animal-reproduction studies have not demonstrated a fetal risk but there are no controlled studies in
pregnant women, or animal-reproduction studies have shown an adverse effect (other than a decrease in
fertility) that was not confirmed in controlled studies in women in the first trimester (and there is no
evidence of a risk in later trimesters).
• Category C
– Either studies in animals have revealed adverse effects on the fetus (teratogenic or embryocidal or other)
and there are no controlled studies in women, or studies in women and animals are not available. Drugs
should be given only if the potential benefit justifies the potential risk to the fetus.
• Category D
– There is positive evidence of human fetal risk, but the benefits from use in pregnant women may be
acceptable despite the risk (e.g., if the drug is needed in a life-threatening situation or for a serious disease
for which safer drugs cannot be used or are ineffective).
• Category X
– Studies in animals or human beings have demonstrated fetal abnormalities, or there is evidence of fetal
risk based on human experience or both, and the risk of the use of the drug in pregnant women clearly
outweighs any possible benefit. The drug is contraindicated in women who are or may become pregnant.
71. Antibiotics in Pregnancy
FDA Category Antibiotics in Category
A
B Penicillins, Cephalosporins, Carbapenems (except Imipenem),
Daptomycin, Vancomycin (oral), Clindamycin, Erythromycin,
Azithromycin, Metronidazole (avoid first trimester),
Nitrofurantoin, Acyclovir, Amphoterocin B, Ethambutol
C Quinolones, Chloramphenicol, Clarithromycin, Imipenem,
Linezolid, Trimethoprim/Sulfa (D if used near term),
Vancomycin (IV), Rifampin, INH, PZA, PAS, Fluconazole,
Caspofungin
D Tetracyclines (Doxy, Tige, Mino), Voriconazole,
Aminoglycosides (some put gentamicin as a category C)
X Ribavarin
72. Antibiotics Penetration into Eucaryotic Cells (esp.
Macrophages)
Antibiotic Class Intracellular
Accumulation Ratio
Predominant
Subcellular Localization
Beta Lactams <1 Cytosol
Glycopeptides
(Vancomycin)
8 (after 24 hrs) Lysosomes
Oxazolidinones
(linezolid)
1 Unknown
Aminoglycosides 2-4 (after several days) Lysosomes
Macrolides 4-300 Lysosomes/cytosol
Fluoroquinolones 4-10 Cytosol
Clindamycin 5-20 Unknown
Tetracyclines 1-4 Unknown
Antibiotics in bold print are generally considered most
effective for intracellular organisms