The document discusses different classes of antibiotics, including their mechanisms of action, clinical uses, and resistance mechanisms. It covers beta-lactam antibiotics like penicillins, cephalosporins, carbapenems, and monobactams. It also discusses vancomycin, which inhibits cell wall synthesis, and how bacteria can become resistant. The document provides details on selecting the appropriate antibiotic based on factors like the infection site, patient history and sensitivities. It distinguishes between bactericidal and bacteriostatic antibiotics.
Antimicrobial in dentistry practice - dental pharmacologyTaha Hussein Kadi
This document discusses antimicrobial agents used for dental infections. It defines antibiotics, bactericidal agents, and bacteriostatic agents. It discusses factors in choosing antibiotics like cost and patient adherence. It describes stages of infection and organisms involved. It provides dosing guidelines for common antibiotics used like penicillin, amoxicillin, clindamycin, metronidazole, erythromycin, and azithromycin. It also discusses antifungal agents like nystatin, miconazole, and systemic azoles. Clinical case studies are presented on management of periodontitis, abscesses, and pseudomembranous colitis.
1. Antibiotics are frequently prescribed to children to treat common infections like ear infections, throat infections, and pneumonia, though they are often inappropriately prescribed leading to overuse.
2. Few antibiotics have been adequately studied for safety and efficacy in children, so dosing regimens are often extrapolated from adult studies.
3. When treating children with antibiotics, factors like organ maturation, liver and kidney function, and fluid volumes must be considered as they affect the pharmacokinetics and can differ from adults.
This document provides information on selecting appropriate antimicrobial regimens. It discusses factors to consider like the site and severity of infection, pathogen, host factors, and pharmacokinetics. Obtaining microbiology samples before treatment is important to identify the pathogen and determine antibiotic susceptibility. Combination therapy may be used for certain infections to provide synergistic effects or prevent resistance, but it increases costs and risk of drug toxicity. Careful selection of the antibiotic regimen based on these many factors is needed to effectively treat infections.
This document provides guidelines for rational antibiotic therapy. It discusses the importance of rational antibiotic use to better care for patients, combat antimicrobial resistance, and reduce costs. It outlines strategies for choosing the appropriate antibiotic based on diagnosis, likely pathogens, sensitivity patterns, and patient factors. Specific antibiotic recommendations are provided for common bacterial infections affecting various body systems like skin, ENT, respiratory, GI, urinary, CNS, and cardiovascular. It also discusses approaches for antibiotic prophylaxis and strategies to prevent antibiotic resistance.
This document discusses the evaluation, diagnosis, and treatment of orofacial infections with an emphasis on antibiotic therapy and prophylaxis. It outlines how to assess infections through medical history, exam, and identifying signs of infection. Most oral infections involve both aerobic and anaerobic bacteria. Commonly used antibiotics include penicillin, cephalosporins, metronidazole, and clindamycin. Antibiotics should be used as an adjunct to drainage and are indicated for severe infections, inadequate drainage, or compromised hosts. Prophylactic antibiotics are recommended for high-risk dental procedures in certain patients.
This document discusses various antibiotics used in the ICU, including their indications, dosages, and risks. It provides risk factors for multidrug-resistant pathogens and describes important pharmacokinetic parameters for antibiotic efficacy. Key antibiotics covered include piperacillin-tazobactam, meropenem, imipenem, teicoplanin, vancomycin, clindamycin, linezolid, colistin, polymyxin B, tigecycline, trimethoprim-sulfamethoxazole, cefepime, sulbactam, amikacin, gentamicin, and metronidazole.
Drug dosage and antibiotics in pediatric dentistryDrKhyaati
This document discusses drug dosage and antibiotics used in paediatric dentistry. It begins by outlining key differences between child and adult physiology that impact drug absorption, distribution and metabolism in children. These include decreased gastric acidity, altered gastric emptying and motility, and immature liver and kidney function in young children. The document then covers drug dosage calculations for children using various weight-based and age-based rules. Finally, it provides details on commonly used antibiotic classes in dentistry like penicillins, cephalosporins, tetracyclines, aminoglycosides and macrolides. Key information on dosage, trade names and side effects are given for individual antibiotics.
This document provides an overview of basic principles of antimicrobial therapy. It discusses key terms like antimicrobial, pharmacodynamics, pharmacokinetics and selective toxicity. It also covers topics like antibiotic resistance, restricted antibiotics, selection of antibiotics, antibiotic combinations, classification of antimicrobials by category and common drugs and their indications and adverse drug reactions. The document serves as a comprehensive reference on fundamental concepts in antimicrobial treatment and management.
Antimicrobial in dentistry practice - dental pharmacologyTaha Hussein Kadi
This document discusses antimicrobial agents used for dental infections. It defines antibiotics, bactericidal agents, and bacteriostatic agents. It discusses factors in choosing antibiotics like cost and patient adherence. It describes stages of infection and organisms involved. It provides dosing guidelines for common antibiotics used like penicillin, amoxicillin, clindamycin, metronidazole, erythromycin, and azithromycin. It also discusses antifungal agents like nystatin, miconazole, and systemic azoles. Clinical case studies are presented on management of periodontitis, abscesses, and pseudomembranous colitis.
1. Antibiotics are frequently prescribed to children to treat common infections like ear infections, throat infections, and pneumonia, though they are often inappropriately prescribed leading to overuse.
2. Few antibiotics have been adequately studied for safety and efficacy in children, so dosing regimens are often extrapolated from adult studies.
3. When treating children with antibiotics, factors like organ maturation, liver and kidney function, and fluid volumes must be considered as they affect the pharmacokinetics and can differ from adults.
This document provides information on selecting appropriate antimicrobial regimens. It discusses factors to consider like the site and severity of infection, pathogen, host factors, and pharmacokinetics. Obtaining microbiology samples before treatment is important to identify the pathogen and determine antibiotic susceptibility. Combination therapy may be used for certain infections to provide synergistic effects or prevent resistance, but it increases costs and risk of drug toxicity. Careful selection of the antibiotic regimen based on these many factors is needed to effectively treat infections.
This document provides guidelines for rational antibiotic therapy. It discusses the importance of rational antibiotic use to better care for patients, combat antimicrobial resistance, and reduce costs. It outlines strategies for choosing the appropriate antibiotic based on diagnosis, likely pathogens, sensitivity patterns, and patient factors. Specific antibiotic recommendations are provided for common bacterial infections affecting various body systems like skin, ENT, respiratory, GI, urinary, CNS, and cardiovascular. It also discusses approaches for antibiotic prophylaxis and strategies to prevent antibiotic resistance.
This document discusses the evaluation, diagnosis, and treatment of orofacial infections with an emphasis on antibiotic therapy and prophylaxis. It outlines how to assess infections through medical history, exam, and identifying signs of infection. Most oral infections involve both aerobic and anaerobic bacteria. Commonly used antibiotics include penicillin, cephalosporins, metronidazole, and clindamycin. Antibiotics should be used as an adjunct to drainage and are indicated for severe infections, inadequate drainage, or compromised hosts. Prophylactic antibiotics are recommended for high-risk dental procedures in certain patients.
This document discusses various antibiotics used in the ICU, including their indications, dosages, and risks. It provides risk factors for multidrug-resistant pathogens and describes important pharmacokinetic parameters for antibiotic efficacy. Key antibiotics covered include piperacillin-tazobactam, meropenem, imipenem, teicoplanin, vancomycin, clindamycin, linezolid, colistin, polymyxin B, tigecycline, trimethoprim-sulfamethoxazole, cefepime, sulbactam, amikacin, gentamicin, and metronidazole.
Drug dosage and antibiotics in pediatric dentistryDrKhyaati
This document discusses drug dosage and antibiotics used in paediatric dentistry. It begins by outlining key differences between child and adult physiology that impact drug absorption, distribution and metabolism in children. These include decreased gastric acidity, altered gastric emptying and motility, and immature liver and kidney function in young children. The document then covers drug dosage calculations for children using various weight-based and age-based rules. Finally, it provides details on commonly used antibiotic classes in dentistry like penicillins, cephalosporins, tetracyclines, aminoglycosides and macrolides. Key information on dosage, trade names and side effects are given for individual antibiotics.
This document provides an overview of basic principles of antimicrobial therapy. It discusses key terms like antimicrobial, pharmacodynamics, pharmacokinetics and selective toxicity. It also covers topics like antibiotic resistance, restricted antibiotics, selection of antibiotics, antibiotic combinations, classification of antimicrobials by category and common drugs and their indications and adverse drug reactions. The document serves as a comprehensive reference on fundamental concepts in antimicrobial treatment and management.
This document discusses antibiotic therapy in the intensive care unit. It covers various classes of antibiotics including beta-lactams, aminoglycosides, protein synthesis inhibitors, and others. It discusses parameters for determining antibiotic activity like minimum inhibitory concentration, peak serum level, and time above MIC. It also addresses dosing strategies, antibiotic resistance, stewardship, and treatment approaches for common infections like pneumonia and skin/soft tissue infections.
Ppts of general consideration of chemotherapy (2)drnutan goswami
This document provides information on antimicrobial drugs including their history, classification, mechanisms of action, problems that arise with their use such as toxicity and drug resistance, and considerations for their proper use and choice. It discusses how antimicrobials are classified based on their chemical structure, spectrum of activity, mechanism of action, and organisms they primarily target. It also covers topics like superinfection, prevention of resistance, prophylactic use, and combined antimicrobial therapy.
This presentation reviews the evaluation, diagnosis, and treatment of orofacial infections with an emphasis on antibiotic therapy and prophylaxis. It discusses assessing patients for local and systemic signs of infection. Common causative microorganisms are usually mixed aerobic and anaerobic bacteria. First-line empiric antibiotic therapy includes penicillin, cefazolin, and gentamicin. Indications for antibiotic use include infection severity, ability to drain pus, and patient immune status. Prophylactic antibiotics are recommended for certain high-risk dental procedures.
This document provides guidelines for antibiotic use, including for severe sepsis, septic shock, and other infections. It discusses evaluation of systemic inflammatory response syndrome and organ dysfunction. Choice of antibiotics depends on the suspected causative organism and its susceptibility. Reserve antibiotics like carbapenems and linezolid require meeting certain criteria. The document recommends measures to control multi-drug resistant organisms and emphasizes rational antibiotic use to reduce antimicrobial resistance.
1.Antibiotics and analgesics in pediatric dentistryAminah M
This document discusses the use of antibiotics in dentistry. It begins with a quick review of pediatric physiology and important considerations for dosing antibiotics in children. It then covers the classification, mechanisms of action, pharmacokinetics, and uses of various classes of antibiotics commonly used in dentistry, including beta-lactam antibiotics like penicillins and cephalosporins. The document concludes with sections on antibiotic resistance, newer antimicrobials, guidelines for antibiotic usage and prophylaxis, managing drug allergies and toxicity.
This document discusses antibiotic use in dentistry. It covers principles of therapy and antibiotic selection including using the most specific antibiotic, proper administration, and patient monitoring. It then describes common antibiotic classes used in dentistry like beta-lactams (penicillins, cephalosporins), tetracyclines, vancomycin, macrolides, nitroimidazoles, and quinolones. It provides examples of antibiotics used to treat maxillofacial infections and conditions. Finally, it discusses antibiotic prophylaxis for dental procedures in patients with conditions like cardiac abnormalities or compromised immunity.
Biologics in psoriaisis – monitoring guidelines and special scenariosSandeep Lal V
1. Biologics are recombinant proteins or monoclonal antibodies that target specific proteins involved in psoriasis like TNF and IL-17.
2. Guidelines recommend biologics be initiated and monitored by specialists experienced in psoriasis and to consider both psoriasis and psoriatic arthritis if a patient has both.
3. Special considerations are required when using biologics in patients with hepatitis B, hepatitis C, or HIV due to risks of viral reactivation or worsening that require monitoring and physician collaboration.
This document provides an overview of antibiotics commonly used in the intensive care unit in 2015. It defines key terms like minimum inhibitory concentration and pharmacodynamics. It then summarizes the mechanisms of action, dosing, and clinical pearls of various antibiotic classes including vancomycin, linezolid, daptomycin, aminoglycosides, cephalosporins, piperacillin-tazobactam, carbapenems, tigecycline, fluoroquinolones, macrolides, and tetracyclines. It highlights factors like spectrum of coverage, dosing adjustments for renal impairment, and monitoring parameters for optimal antibiotic use.
1. Current therapy for tuberculosis (TB) follows several basic principles including using more than one drug, taking drugs at the appropriate dose and regularly, and continuing drugs for a sufficient period of time.
2. Directly observed therapy (DOT) is the best way to ensure patients complete appropriate TB treatment. Studies show DOT is associated with lower rates of drug resistance and relapse compared to standard self-administered therapy.
3. Treatment of drug-resistant TB requires using at least four effective drugs, including a parenteral agent. Management requires careful review of previous medications and regimens to determine effective treatment.
The document discusses strategies for selecting antibiotics based on patient factors and the causative organism. It provides examples of rational antibiotic selection for a pregnant woman with a UTI and a hospitalized man on warfarin taking antibiotics for a UTI. The document also discusses antibiotic policies, pre-treatment considerations like duration and route of administration, superinfections, and different types of hypersensitivity tests including skin prick, intradermal, and patch testing. It validates the use of cephalosporin skin testing to predict immediate hypersensitivity but notes negative tests do not rule out the possibility of hypersensitivity upon intravenous administration.
This document discusses various classes of antibiotics including aminoglycosides, carbapenems, cephalosporins, erythromycins, and penicillins. It provides details on the mechanism of action, spectrum of activity, therapeutic uses, and precautions for each class. The main classes of antibiotics covered are defined by their chemical structure and each class generally has a different range of antibacterial activity. Common examples of drugs within each class are also listed along with their dosages and routes of administration.
This document discusses factors to consider when selecting an antimicrobial regimen. It covers obtaining microbiology samples before initiating therapy, host and drug factors, and the pros and cons of combination therapy. Key signs of infection discussed include fever, white blood cell count, local signs, and organ-specific symptoms. Gram stain results are provided for 3 example patients presenting with respiratory infection. Host factors like age, pregnancy status, organ function, genetic factors, concomitant diseases and medications must all be considered when selecting the appropriate antimicrobial regimen.
The document discusses the classification and problems arising from antimicrobial agents. It classifies antimicrobials based on their chemical structure, mechanism of action, type of organism acted on, and more. It also discusses various problems that can arise from antimicrobial use, including toxicity, resistance (both natural and acquired), superinfections, and more. Choosing the appropriate antimicrobial considers patient factors, the organism, and drug properties.
This word document deals with the drug profile of amikacin. Important headings, with respect to its pharmacology, along with a note on important dosage regimens and antimicrobial spectrum, have also been mentioned, with reference to standard textbooks, guidelines and relevant articles.
Antibiotics & Analgesic in pediatric dentistryHasanin Alkendi
This document discusses various antibiotics used in pediatric dentistry, including penicillins, cephalosporins, erythromycin, metronidazole, cotrimoxazole, tetracycline, aminoglycosides, and chloramphenicol. It describes the classification, mechanisms of action, uses, and important considerations for each antibiotic class. The document emphasizes the importance of appropriate antibiotic usage and outlines golden rules for prescribing antibiotics such as using narrow spectrum antibiotics when possible and not prolonging therapy unnecessarily.
This document discusses principles of antibiotic use in critical care. It notes that up to 50% of antibiotics prescribed are inappropriate and outlines consequences like increased resistance. The key principles for appropriate use are described as using the right antibiotic, at the right time, duration and dose based on the patient's condition and likely pathogens. Factors affecting pharmacokinetics and pharmacodynamics in critical illness are also reviewed to optimize dosing for better outcomes.
This document provides an overview of drugs and bugs in the ICU, including microbiology issues and antimicrobial drug therapy. It discusses types of organisms that can cause infection, emerging resistant strains, local resistance patterns, common antimicrobial drugs used in the ICU, and indications for their use. It also covers risk factors for nosocomial infection, prevention measures, definitions of infection vs colonization, and requirements for microbiological surveillance. The document provides scenarios of common infections encountered in the ICU and reviews potential targets for antimicrobial drugs as well as how resistance can develop and spread.
Rational use of antibiotics & problem of antibiotic resistenseVirendra Hindustani
Rational use of antibiotics and combating antibiotic resistance is important. [1] Unnecessary antibiotic use creates selective pressure for bacteria to become resistant. [2] Fleming warned in 1945 about antibiotic resistance developing from exposure to sublethal drug doses. [3] Factors like environmental conditions, drug properties, patient factors, and prescribing practices influence antibiotic resistance.
This document discusses the rational use of antibiotics. It notes that 50% of antibiotics are used inappropriately and that many infections like diarrhea and bronchitis are viral, not bacterial. It provides details on different classes of antibiotics, factors to consider when choosing an empiric antibiotic like the infection severity and patient characteristics, advantages of oral over IV antibiotics, and the importance of using antibiotics appropriately and limiting unnecessary combination therapy to reduce resistance and costs.
This document provides an overview of antimicrobial drugs used to treat and prevent infections. It begins with objectives of reviewing key concepts of antimicrobial therapy. It then discusses mechanisms of action for different classes of antimicrobials including why antibiotics only target bacterial cells. The remainder of the document covers specific classes of antimicrobial drugs like beta-lactams, macrolides, and vancomycin. It provides details on indications, mechanisms of action, and important nursing considerations for each drug class.
The document discusses various topics related to antibiotics including their history, definitions, classifications, mechanisms of action, and guidelines for use. Some key points:
- Antibiotics are drugs produced by microorganisms that inhibit or destroy other microorganisms. They can be naturally occurring, semisynthetic, or synthetic.
- Major classifications include based on chemical structure, mechanism of action, type of organism targeted, and spectrum of activity.
- Penicillin was the first antibiotic to be used clinically in 1941. Extended-spectrum penicillins like ampicillin are broad-spectrum and cover both gram-positive and gram-negative bacteria commonly causing dental infections.
- Guidelines emphasize accurate diagnosis, appropriate antibiotic selection
This document discusses antibiotic therapy in the intensive care unit. It covers various classes of antibiotics including beta-lactams, aminoglycosides, protein synthesis inhibitors, and others. It discusses parameters for determining antibiotic activity like minimum inhibitory concentration, peak serum level, and time above MIC. It also addresses dosing strategies, antibiotic resistance, stewardship, and treatment approaches for common infections like pneumonia and skin/soft tissue infections.
Ppts of general consideration of chemotherapy (2)drnutan goswami
This document provides information on antimicrobial drugs including their history, classification, mechanisms of action, problems that arise with their use such as toxicity and drug resistance, and considerations for their proper use and choice. It discusses how antimicrobials are classified based on their chemical structure, spectrum of activity, mechanism of action, and organisms they primarily target. It also covers topics like superinfection, prevention of resistance, prophylactic use, and combined antimicrobial therapy.
This presentation reviews the evaluation, diagnosis, and treatment of orofacial infections with an emphasis on antibiotic therapy and prophylaxis. It discusses assessing patients for local and systemic signs of infection. Common causative microorganisms are usually mixed aerobic and anaerobic bacteria. First-line empiric antibiotic therapy includes penicillin, cefazolin, and gentamicin. Indications for antibiotic use include infection severity, ability to drain pus, and patient immune status. Prophylactic antibiotics are recommended for certain high-risk dental procedures.
This document provides guidelines for antibiotic use, including for severe sepsis, septic shock, and other infections. It discusses evaluation of systemic inflammatory response syndrome and organ dysfunction. Choice of antibiotics depends on the suspected causative organism and its susceptibility. Reserve antibiotics like carbapenems and linezolid require meeting certain criteria. The document recommends measures to control multi-drug resistant organisms and emphasizes rational antibiotic use to reduce antimicrobial resistance.
1.Antibiotics and analgesics in pediatric dentistryAminah M
This document discusses the use of antibiotics in dentistry. It begins with a quick review of pediatric physiology and important considerations for dosing antibiotics in children. It then covers the classification, mechanisms of action, pharmacokinetics, and uses of various classes of antibiotics commonly used in dentistry, including beta-lactam antibiotics like penicillins and cephalosporins. The document concludes with sections on antibiotic resistance, newer antimicrobials, guidelines for antibiotic usage and prophylaxis, managing drug allergies and toxicity.
This document discusses antibiotic use in dentistry. It covers principles of therapy and antibiotic selection including using the most specific antibiotic, proper administration, and patient monitoring. It then describes common antibiotic classes used in dentistry like beta-lactams (penicillins, cephalosporins), tetracyclines, vancomycin, macrolides, nitroimidazoles, and quinolones. It provides examples of antibiotics used to treat maxillofacial infections and conditions. Finally, it discusses antibiotic prophylaxis for dental procedures in patients with conditions like cardiac abnormalities or compromised immunity.
Biologics in psoriaisis – monitoring guidelines and special scenariosSandeep Lal V
1. Biologics are recombinant proteins or monoclonal antibodies that target specific proteins involved in psoriasis like TNF and IL-17.
2. Guidelines recommend biologics be initiated and monitored by specialists experienced in psoriasis and to consider both psoriasis and psoriatic arthritis if a patient has both.
3. Special considerations are required when using biologics in patients with hepatitis B, hepatitis C, or HIV due to risks of viral reactivation or worsening that require monitoring and physician collaboration.
This document provides an overview of antibiotics commonly used in the intensive care unit in 2015. It defines key terms like minimum inhibitory concentration and pharmacodynamics. It then summarizes the mechanisms of action, dosing, and clinical pearls of various antibiotic classes including vancomycin, linezolid, daptomycin, aminoglycosides, cephalosporins, piperacillin-tazobactam, carbapenems, tigecycline, fluoroquinolones, macrolides, and tetracyclines. It highlights factors like spectrum of coverage, dosing adjustments for renal impairment, and monitoring parameters for optimal antibiotic use.
1. Current therapy for tuberculosis (TB) follows several basic principles including using more than one drug, taking drugs at the appropriate dose and regularly, and continuing drugs for a sufficient period of time.
2. Directly observed therapy (DOT) is the best way to ensure patients complete appropriate TB treatment. Studies show DOT is associated with lower rates of drug resistance and relapse compared to standard self-administered therapy.
3. Treatment of drug-resistant TB requires using at least four effective drugs, including a parenteral agent. Management requires careful review of previous medications and regimens to determine effective treatment.
The document discusses strategies for selecting antibiotics based on patient factors and the causative organism. It provides examples of rational antibiotic selection for a pregnant woman with a UTI and a hospitalized man on warfarin taking antibiotics for a UTI. The document also discusses antibiotic policies, pre-treatment considerations like duration and route of administration, superinfections, and different types of hypersensitivity tests including skin prick, intradermal, and patch testing. It validates the use of cephalosporin skin testing to predict immediate hypersensitivity but notes negative tests do not rule out the possibility of hypersensitivity upon intravenous administration.
This document discusses various classes of antibiotics including aminoglycosides, carbapenems, cephalosporins, erythromycins, and penicillins. It provides details on the mechanism of action, spectrum of activity, therapeutic uses, and precautions for each class. The main classes of antibiotics covered are defined by their chemical structure and each class generally has a different range of antibacterial activity. Common examples of drugs within each class are also listed along with their dosages and routes of administration.
This document discusses factors to consider when selecting an antimicrobial regimen. It covers obtaining microbiology samples before initiating therapy, host and drug factors, and the pros and cons of combination therapy. Key signs of infection discussed include fever, white blood cell count, local signs, and organ-specific symptoms. Gram stain results are provided for 3 example patients presenting with respiratory infection. Host factors like age, pregnancy status, organ function, genetic factors, concomitant diseases and medications must all be considered when selecting the appropriate antimicrobial regimen.
The document discusses the classification and problems arising from antimicrobial agents. It classifies antimicrobials based on their chemical structure, mechanism of action, type of organism acted on, and more. It also discusses various problems that can arise from antimicrobial use, including toxicity, resistance (both natural and acquired), superinfections, and more. Choosing the appropriate antimicrobial considers patient factors, the organism, and drug properties.
This word document deals with the drug profile of amikacin. Important headings, with respect to its pharmacology, along with a note on important dosage regimens and antimicrobial spectrum, have also been mentioned, with reference to standard textbooks, guidelines and relevant articles.
Antibiotics & Analgesic in pediatric dentistryHasanin Alkendi
This document discusses various antibiotics used in pediatric dentistry, including penicillins, cephalosporins, erythromycin, metronidazole, cotrimoxazole, tetracycline, aminoglycosides, and chloramphenicol. It describes the classification, mechanisms of action, uses, and important considerations for each antibiotic class. The document emphasizes the importance of appropriate antibiotic usage and outlines golden rules for prescribing antibiotics such as using narrow spectrum antibiotics when possible and not prolonging therapy unnecessarily.
This document discusses principles of antibiotic use in critical care. It notes that up to 50% of antibiotics prescribed are inappropriate and outlines consequences like increased resistance. The key principles for appropriate use are described as using the right antibiotic, at the right time, duration and dose based on the patient's condition and likely pathogens. Factors affecting pharmacokinetics and pharmacodynamics in critical illness are also reviewed to optimize dosing for better outcomes.
This document provides an overview of drugs and bugs in the ICU, including microbiology issues and antimicrobial drug therapy. It discusses types of organisms that can cause infection, emerging resistant strains, local resistance patterns, common antimicrobial drugs used in the ICU, and indications for their use. It also covers risk factors for nosocomial infection, prevention measures, definitions of infection vs colonization, and requirements for microbiological surveillance. The document provides scenarios of common infections encountered in the ICU and reviews potential targets for antimicrobial drugs as well as how resistance can develop and spread.
Rational use of antibiotics & problem of antibiotic resistenseVirendra Hindustani
Rational use of antibiotics and combating antibiotic resistance is important. [1] Unnecessary antibiotic use creates selective pressure for bacteria to become resistant. [2] Fleming warned in 1945 about antibiotic resistance developing from exposure to sublethal drug doses. [3] Factors like environmental conditions, drug properties, patient factors, and prescribing practices influence antibiotic resistance.
This document discusses the rational use of antibiotics. It notes that 50% of antibiotics are used inappropriately and that many infections like diarrhea and bronchitis are viral, not bacterial. It provides details on different classes of antibiotics, factors to consider when choosing an empiric antibiotic like the infection severity and patient characteristics, advantages of oral over IV antibiotics, and the importance of using antibiotics appropriately and limiting unnecessary combination therapy to reduce resistance and costs.
This document provides an overview of antimicrobial drugs used to treat and prevent infections. It begins with objectives of reviewing key concepts of antimicrobial therapy. It then discusses mechanisms of action for different classes of antimicrobials including why antibiotics only target bacterial cells. The remainder of the document covers specific classes of antimicrobial drugs like beta-lactams, macrolides, and vancomycin. It provides details on indications, mechanisms of action, and important nursing considerations for each drug class.
The document discusses various topics related to antibiotics including their history, definitions, classifications, mechanisms of action, and guidelines for use. Some key points:
- Antibiotics are drugs produced by microorganisms that inhibit or destroy other microorganisms. They can be naturally occurring, semisynthetic, or synthetic.
- Major classifications include based on chemical structure, mechanism of action, type of organism targeted, and spectrum of activity.
- Penicillin was the first antibiotic to be used clinically in 1941. Extended-spectrum penicillins like ampicillin are broad-spectrum and cover both gram-positive and gram-negative bacteria commonly causing dental infections.
- Guidelines emphasize accurate diagnosis, appropriate antibiotic selection
antibiotics are necessary to treat infections and chemotherapeutic agents are also used for this purpose. Chemotherapeutic agents are also used in the treatment of cancers. These therapeutic agents have limitations, specific action and a set mode of action. We can say that they are selective. The antibiotics are natural as well as synthetic in nature and have specificity for action against the microorganisms. Chemotherapeutic agents are chemical in nature and are synthesised in labs. They are less selective in action.
This document discusses beta-lactam antibiotics, including penicillins, cephalosporins, carbapenems, monobactams, and beta-lactamase inhibitors. It describes their mechanism of action as inhibiting bacterial cell wall synthesis. Penicillins were the first antibiotics developed from Penicillium fungi. Cephalosporins are derived from fungi and inhibit bacterial cell wall synthesis like penicillins. Beta-lactamase inhibitors prevent bacterial resistance by inhibiting beta-lactamase enzymes from breaking down the beta-lactam antibiotic ring structure.
ANTIBIOTICS for medical student presentation24.pdfabdulqudus23
This document provides an overview of antibiotics. It begins by defining antibiotics and describing their sources. It then discusses the ideal features of antibiotics and different classification schemes based on their type of action, spectrum of activity, chemical structure, and mechanism of action. The main mechanisms of action covered are cell wall synthesis inhibitors, protein synthesis inhibitors, disruption of cell membranes, and inhibition of nucleic acid function. Specific classes of antibiotics discussed in more detail include penicillins, cephalosporins, and carbapenems. For each class, examples are given along with descriptions of mechanisms of action, pharmacokinetics, uses, and adverse effects.
This document summarizes key information about various classes of anti-infective drugs including their mechanisms of action, spectrum of activity, common adverse effects, and examples within each class. It covers penicillins, cephalosporins, and aminoglycosides - describing their therapeutic uses, contraindications, and implications for nursing care including monitoring patients and providing education.
This document provides an overview of various classes of antibiotics, including their mechanisms of action, therapeutic uses, adverse effects, and nursing considerations. It discusses penicillins, cephalosporins, aminoglycosides, macrolides, lincosamides, and tetracyclines. For each class, it describes how they work, common drugs in the class, indications, contraindications, side effects, interactions, and the nursing process for safe administration.
This document discusses different classes of antibacterial drugs, focusing on penicillins and cephalosporins. It describes the mechanisms of action, classifications, clinical uses and resistance mechanisms. Gram-positive bacteria have thick cell walls allowing large antibiotics to pass through, while gram-negatives have an outer membrane blocking many antibiotics. Penicillins work by inhibiting cell wall synthesis and include natural, anti-staphylococcal, and broad-spectrum types. Cephalosporins have similar mechanisms of action and are classified in generations based on spectrum of activity. Carbapenems and monobactams like aztreonam also inhibit cell wall synthesis but have even broader spectra than cephalosporins.
Beta lactams- History, Current Trend and Recent AdvancesAnkitaNegi32
This document provides an overview of beta-lactam antibiotics including their history, current trends, and recent advances. It discusses the classes of beta-lactams such as penicillin, cephalosporins, carbapenems, and monobactams. The mechanisms of action and increasing bacterial resistance are also reviewed. Recent research highlights potential new applications of beta-lactams in cancer and neurological disorders as well as development of novel agents to address resistance.
6- Introduction to antibiotics .ppt treatmentssuser4d911a
This document provides an introduction to antibiotics, including their classification, mechanisms of action, appropriate use and misuse. It discusses how antibiotics work, how they are classified based on their spectrum and mechanisms of action. It also summarizes the appropriate choice of antibiotic based on clinical diagnosis, pharmacology considerations and microbiological information. Furthermore, it outlines the causes of bacterial resistance and ways to prevent it, including proper use and dosage of antibiotics.
β-Lactam antibiotics such as penicillin, cephalosporins, monobactams, and carbapenems contain a β-lactam ring. Penicillin was the first antibiotic discovered and is effective against streptococcal infections, syphilis, and diphtheria. It works by inhibiting bacterial cell wall synthesis. Resistance can arise via β-lactamase production or altered penicillin binding proteins. Semisynthetic penicillins like ampicillin and amoxicillin are acid stable and have a broader spectrum of activity against gram-negative bacteria. They are used to treat a variety of infections affecting the respiratory tract, skin, and urinary tract.
The document discusses various classes of anti-infective agents including antibacterial agents. It summarizes the characteristics of different generations of beta-lactam antibiotics (penicillins and cephalosporins) which work by inhibiting bacterial cell wall synthesis. Penicillins are categorized based on their spectrum of activity and susceptibility to beta-lactamases. First and second generation cephalosporins have activity against gram-positive bacteria while later generations have improved gram-negative coverage. Resistance can develop through beta-lactamase production or changes to drug targets or membrane permeability.
This document provides an overview and review of various antibiotics. It is organized into sections on antibacterials and antifungals. The antibacterial section covers different classes of antibiotics including beta-lactams such as penicillins and cephalosporins. It describes the spectrum, indications, and key points about each drug. The document provides a detailed yet concise reference for clinicians on appropriate antibiotic selection and considerations.
Antimicrobial chemotherapy & bacterial resistance dr. ihsan alsaimarydr.Ihsan alsaimary
This document discusses antimicrobial chemotherapy and antibiotic principles. It covers the major classes of antibiotics including cell wall active agents, protein synthesis inhibitors, nucleic acid synthesis inhibitors, and metabolic pathway inhibitors. It describes their mechanisms of action, spectra of activity, and common resistance mechanisms. Key points covered include the importance of appropriate antibiotic usage to prevent resistance, factors influencing antibiotic choice, and definitions of antibiotic properties.
Antimicrobial chemotherapy & bacterial resistance dr. ihsan alsaimarydr.Ihsan alsaimary
This document discusses antimicrobial chemotherapy and antibiotic resistance. It provides definitions and principles related to antimicrobial agents, including their spectrum of activity, mechanisms of action against bacteria, and factors that influence antibiotic choice. The document addresses various classes of antibiotics like beta-lactams, glycopeptides, macrolides and their mechanisms. It also discusses concepts like minimum inhibitory concentration, combination therapy, and factors that can accelerate the development of antibiotic resistance.
Antimicrobial chemotherapy & bacterial resistance dr. ihsan alsaimarydr.Ihsan alsaimary
This document discusses antimicrobial chemotherapy and antibiotic principles. It covers the major classes of antibiotics including cell wall active agents, protein synthesis inhibitors, nucleic acid synthesis inhibitors, and metabolic pathway inhibitors. It describes their mechanisms of action, spectra of activity, and common resistance mechanisms. Key points covered include the importance of appropriate antibiotic usage to prevent resistance, factors influencing antibiotic choice, and definitions of antibiotic properties.
This document provides an overview of antimicrobial therapy including classifications, mechanisms of action, and principles of administration for various classes of antibiotics, antifungals, and antivirals. It discusses categories such as beta-lactam antibiotics, macrolides, sulfonamides, quinolones, aminoglycosides, antifungals, metronidazole and antivirals; covering their spectra of activity, indications, mechanisms of action, toxicities and drug interactions. The document also addresses antimicrobial selection, prophylaxis, and special considerations in pregnancy, lactation and for pediatric patients.
Here are the step-by-step solutions to the math problems:
1) A dose of 200 mcg is ordered. The strength available is 0.3 mg in 1.5 mL.
- Convert mg to mcg: 0.3 mg = 300 mcg
- Set up ratio: 200 mcg/300 mcg = X mL/1.5 mL
- Cross multiply: 200 * 1.5 = 300X
- Solve for X: 300X/300 = 1.5/1.5 = X = 1 mL
2) A dosage of 0.7 g has been ordered. Available is a strength of 1000 mg in 1.5 mL.
- Convert g to mg
Beta-lactam antibiotics like penicillin and cephalosporins act by inhibiting the synthesis of peptidoglycan in the bacterial cell wall. They do this by binding to penicillin-binding proteins and blocking the final cross-linking step of peptidoglycan synthesis. Bacteria can develop resistance through beta-lactamase production or modifications of penicillin-binding proteins. Newer drugs and beta-lactamase inhibitors have been developed to counteract resistance mechanisms. Common side effects include diarrhea and hypersensitivity reactions.
Bronchiolitis is a viral infection of the bronchioles most commonly caused by RSV in children under 2 years old. It typically causes nasal congestion, cough and respiratory distress. CXR may show hyperinflation and infiltrates. Treatment focuses on hydration, humidified air and respiratory monitoring in hospital if distressed. Children are at increased risk of developing asthma.
Abdominal aortic aneurysm (AAA) is a localized dilation of the aorta below the renal arteries. Risk factors include smoking, age over 55, atherosclerosis, hypertension, and family history. Patients may be asymptomatic or experience back pain; a pulsating abdominal mass may also be present. Screening with ultrasound is recommended for men aged 65-75 with a smoking history. Treatment involves monitoring smaller aneurysms with ultrasound and surgical repair for larger or symptomatic aneurysms to prevent rupture.
Atrial fibrillation (Afib) is an irregular heartbeat caused by disorganized electrical impulses from the atria. Risk factors include pulmonary disease, coronary artery disease, hypertension, and others. Patients may be asymptomatic or
The document discusses various types of fungi and fungal infections. It describes the characteristics of fungi and differentiates them from bacteria. It then covers several types of mycoses or fungal infections including systemic mycoses, cutaneous mycoses, opportunistic fungal infections, and notes on treatment. Specifically, it provides details on four types of systemic dimorphic fungi that can cause pneumonia and disseminate infection: Histoplasmosis, Blastomycosis, Coccidioidomycosis, and Paracoccidioidomycosis. It also discusses several common cutaneous fungal infections including Tinea infections and Pityriasis versicolor.
This document appears to be notes from a medical education session on taking patient histories and performing physical examinations. It includes headings for topics that would be covered in a history and physical exam such as health history, chief complaint, and present illness. However, the content under each heading only contains placeholder text in the form of series of emoji symbols instead of actual information about a patient. The document was created by Dr. Harith Alawadi and is based on Bates' Pocket Guide to Physical Examination and History Taking.
This document contains lecture notes from Dr. Harith Alawadi on the topics of microbiology and bacterial classification. It discusses the different types of microorganisms studied in microbiology such as bacteria, viruses, fungi and parasites. It also covers various methods for bacterial classification including morphology, staining techniques and growth characteristics. Specific types of bacteria are listed under different morphological classifications. Different culture media and their uses are also mentioned.
The document discusses various anti-fungal drugs, describing their mechanisms of action and clinical uses. There are 5 classes of anti-fungals: 1) lanosterol synthesis inhibitors like terbinafine, 2) cell wall synthesis inhibitors like echinocandins, 3) cell membrane integrity inhibitors like polyenes including amphotericin B and nystatin, 4) nucleic acid synthesis inhibitors like flucytosine, and 5) ergosterol synthesis inhibitors like azoles. Specific drugs are described in more detail, such as amphotericin B for serious systemic mycoses, nystatin for topical use, and flucytosine used with amphotericin B
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Adhd Medication Shortage Uk - trinexpharmacy.comreignlana06
The UK is currently facing a Adhd Medication Shortage Uk, which has left many patients and their families grappling with uncertainty and frustration. ADHD, or Attention Deficit Hyperactivity Disorder, is a chronic condition that requires consistent medication to manage effectively. This shortage has highlighted the critical role these medications play in the daily lives of those affected by ADHD. Contact : +1 (747) 209 – 3649 E-mail : sales@trinexpharmacy.com
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the 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 lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
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. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Kat...rightmanforbloodline
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kol...rightmanforbloodline
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Versio
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Version
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Version
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
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Antimicrobial or antibiotics
There are the following antibiotic groups according to the
mechanism of action
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1-cell wall synthesis inhibitors: they can be
-Peptidoglycans synthesis inhibitors: they are Glycopeptides
(vancomycin, bacitracin)
-Peptidoglycan-cross-linking inhibitors: they include
1-Penicillinase-sensitive penicillin’s: penicillin G,V and ampicillin,
amoxicillin
2-Penicillinase-resistant penicillin’s: oxacillin, nafcillin,
dicloxacillin
3-Antipseudomonals: ticarcillin and piperacillin
4-Cephalosporins(I-V):1st
-cefazolin, 2nd
-cefoxitin, 3rd
-ceftriaxon,
4th
-cefepime, 5th
-ceftaroline
5-Carbapenems: imipenem, meropenem, ertapenem,
doripenem.
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6-Monobactams: aztreonam
2-cell membrane destruction: by daptomycin and Amphotericin
B etc.
3-folic acid synthesis and reduction: in the cells, there is PABA
(para aminobenzoic acid), which is very important for the
formation of DHF (dihydrofolic acid) and then THF
(tetrahydrofolic acid) and those are important for DNA synthesis
*The formation of DHF can be blocked by Sulfonamides which
include (sulfamethoxazole, sulfisoxazole, sulfadiazine)
*The formation of THF can be blocked by: Trimethoprim
4-DNA integrity: can be destroyed by Metronidazole
5-mRNA synthesis (RNA polymerase) can be blocked by
Rifampin
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6-DNA gyrase: it’s important to cuts the DNA strands while dna
replications it can be blocked by
-Fluoroquinolones: ciprofloxacin, levofloxacin
-Quinolone: nalidixic acid
7-protein synthesis can be blocked by 2 ways:
-50S subunits inhibitors which include:
*chloramphenicol, clindamycin, linezolid
*Macrolides: azithromycin, clarithromycin, erythromycin
*Streptogramins: quinupristin, dalfopristin
-30S subunits inhibitors which include:
*Aminoglycosides: gentamicin, neomycin, amikacin,
tobramycin, streptomycin
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*Tetracyclines: tetracycline, doxycycline, minocycline
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How to select the prober antibiotic?
1-you should be able to recognize the source of infection
2-you should be able to know the site of infection
3-select the safest drug according to the patient situation
4-you should carefully know the history of the patient to
prevent anaphylaxis (opposite reaction of the body against the
drug) by asking or testing about history of allergy
5-you should know the situation of kidney and liver, if a woman,
you have to know if she is a pregnant or not and you should ask
about the history of recent operations
*Prophylaxis drug: a drug which is given to people who have a
close contact with patients will infectious disease such as TB.
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*Drug resistance: when the drug isn’t affective against the
particular microorganism, such as in case of beta-lactamase
which is produced by that microorganism and it cleaves the
beta-lactam drugs, so they are called resistant bacteria
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-Bactericidal drugs: they kill the bacteria directly and include:
1-aminoglycosides, 2-penicillins, 3-cyclosporine, 4-vancomycin,
5-fluroquinolones, 6-carbapenems, 7-cephalosporines
*they are mostly cell wall synthesis inhibitors
-Bacteriostatic drugs: they slow the growth or the reproduction
of the bacteria and include:
1-chloramphenicol, 2-riferantoin, 3-clindamycin, 4-tetracycline,
5-erythromycin, 6-trimethoprine, 7-lincomycin
*they are mostly protein synthesis inhibitors
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β lactams
β. lactams contain 7 groups, 5 are penicillin groups, the difference
between them is in the R group of their chemical structure.
- penicillin groups:
1- Natural penicillin: penicillin G (IM, IV) and penicillin V(oral)
- Mechanism: block transpeptidase (which connects the peptides of
peptidoglycans, they are called (D-ala D-ala).
- These drugs make pore in the wall of the bacteria, then it activates
autolytic enzymes.
- Clinical use: gram+ (streptococcus pyogens, streptococcus
pneumonia, actinomyoces)
Gram – cocci (N. meningitides), spirochetes (T. pallidum)
- Adverse effects: hypersensitivity1, direct coomb’s + hemolytic
anemia
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- Resistance mechanism: penicillinase in bacteria (an enzyme that
destroy the beta lactam ring in penicillin)
*jarisch-herxheimer reaction allergic reaction appears in syphilis
patients after treating with penicillin G (flue like symptoms such as
headache, fever, myalgia) due to killed bacteria because some
killed bacteria have toxins in their wall.
2- penicillinase sensitive penicillin:
Aminopenicillins (amoxicillin and ampicillin)
- Mechanism: same as penicillin, wider spectrum, penicillinase
sensitive. Also combine with clavulanic acid to protect against
destruction by β-lacatamase.
- Clinical use: extended spectrum penicillin. H. influenza, H. pylori, E.
coli, listeria monocytogenes, proteus mirabilis, salmonella,
shigella, enterococci.
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*aminopenicillins HHELPSS to kill Enterococci used as mnemonic
for the bacteria that is treated by this antibiotic.
- Adverse effects: hypersensitivity reaction, rash,
pseudomembranous colitis.
- Mechanism of resistance: penicillinase in bacteria cleaves beta
lactam ring.
*beta lactamase inhibitors: clavulanic acid, sulbactam,
tazobactam
*combinations: Augmentin= amoxicillin + clavulanic acid
Unasyn= ampicillin + sulbactam
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3- penicillinase resistant penicillin
Anti-staphylococcus aureus. Dicloxacillin, nafcillin, oxacillin,
methicillin) *NAF to kill STAPH
- Mechanism: same as penicillin narrow spectrum,
penicillinase resistant because of bulky R group block
access of beta lactamase to beta lactam ring.
- Clinical use: staph. Aureus except (MRSA resistant because
of altered penicillin binding protein target site)
- Adverse effects: hypersensitivity reaction, interstitial
nephritis
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Antipseudomonal penicillin’s:
Piperacillin, ticarcillin
Mechanism: same as penicillin, extended spectrum.
Clinical use: pseudomonas spp. And gram – rods, susceptible to
penicillinase, use with beta lactamase inhibitors.
Adverse effects: hypersensitivity reaction.
*combination: timentin = ticarcillin + clavulanic acid
Zosyn = piperacillin + tazobactam
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Beta lactamase inhibitors:
Include Clavulanic Acid, Sulbactam, Tazobactam.
*often added to penicillin antibiotics to protect the antibiotic
from destruction by beta lactamase (penicillinase)
*mnemonic CAST
Cephalosporins(I-V)
Mechanism: beta-lactam. Inhibit cell wall synthesis, but less
susceptible to penicillinase.
-I generation: cefazolin, cefalexin
*for Gram (+) cocci, proteus, E. coli, K. pneumoniae
*given pre-surgical to prevent staph. Aureus wound infections
-II generation: cofactor, cefoxitin, cefuroxime
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*for Gram (+) cocci, H.influnzae, Enterobacter aerogenes,
Neisseria spp., Serratia macescens, proteus, E. coli,
K.pneumonia
-III generation: ceftriaxone, cefotaxime, ceftazidime
*for serious Gram (-) bacteria resistant to other beta-lactams
-IV generation: cefepime
*for Gram (-) with high activity to pseudomonas
Note: all those 4 generations can’t treat LAME {Listeria, Atypical
(mycoplasma, Chlamydia), MRSA, Enterococcus}
-V generation: ceftroline
*broad spectrum {Gram(+),Gram(-)including MRSA}, but it
doesn’t treat pseudomonas
-Adverse effects: hypersensitivity 1, autoimmune hemolytic
anemia, disulfiram like reaction, vitamin k deficiency,
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nephrotoxicity with aminoglycosides, exhibit penicillin cross
reactivity: it means, if the patient is sensitive to penicillin, he or
she is also sensitive to cephalosporins
-high penicillin sensitivity: don’t give the drug
-low penicillin sensitivity: you can give the drug
*resistance of bacteria: the bacteria make transpeptidase with
different structure, so the cephalosporins can’t recognize it and
the bacteria become resistant
Carbapenems
They include imipenem, meropenem, ertapenem, doripenem
-mechanism: Imipenem is a broad spectrum, beta-lactamase
resistant carbapenem. Always administered with Cilastatin
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(inhibitor of renal dehydropeptidase I) to lower the inactivation
of drug in renal tubules
-clinical use: Gram (+) cocci, Gram (-) rods and anaerobic. Wide
spectrum but significant side effects limit use to life threatening
infections of after drugs have failed.
*meropenem has low risk of seizures and is stable to
dehydropeptidase I.
-adverse effect: GI distress, and CNS toxicity(seizures)at high
plasma levels
Note: ertapenem+doripenem are limited pseudomonas
coverage.
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Monobactam
They include 1 drug Aztreonam
-mechanism: less susceptible to beta-lactams
Prevents peptidoglycan cross linking by binding to
penicillin-binding protein 3.
Synergistic with aminoglycosides.
No cross allergenicity with penicillin
-clinical use: Gram (-) rods only. No activity against Gram (+)
rods or anaerobes
*for penicillin allergic patients and those with renal
insufficiency who can’t tolerate aminoglycosides.
-adverse effects: usually nontoxic, occasional GI upset.
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Vancomycin
-mechanism: inhibits cell wall peptidoglycan formation by
binding D-ala D-ala protein of cell wall precursors.
*bactericidal against most of bacteria, (bacteriostatic against C.
difficile)
-clinical use: Gram (+) bugs only-serious, multidrug resistant
organisms including MRSA, S. epidermidis, sensitive
enterococcus species, and clostridium difficile(oral dose for
pseudomembranous colitis)
-adverse effects: well tolerated in general, but not trouble free,
nephrotoxicity, ototoxicity, thrombophlebitis, diffuse flushing-
red man syndrome (can largely prevented by pretreatment with
antihistamines and slow infusion rate)
-mechanism of resistance: occurs in bacteria through acid
modification of D-ala D-ala to D-ala D-alc” pay back 2D-
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alas(dollars)for Vandalizing (Vancomycin)”
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Protein synthesis
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The process starts by transcription to form mRNA, which is the base for
ribosomes, the 30S and 50S attach to it and also the initiator
tRNA(which contain an amino acid as a base for the attachment of A,P
and E), then the initiation complex formation starts by entering of tRNA
through A, then the new amino acid attach to the already founded on P
, by peptidyl transferase then the empty tRNA moves to E and goes out
of the machinery by translocation process then the process is repeated
by entrance of a new tRNA containing a new amino acid and so on...
• The attachment of 50S can be blocked by linezolid (bacteriostatic)
• The initiation complex formation can be blocked by
aminoglycosides. 30S = bactericidal
• The peptidyl transferase can be blocked by chloramphenicol (50S)
bacteriostatic
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• The translocation can be blocked by macrolides 50S and
clindamycin 50S= bacteriostatic
• The A site tRNA binding (the repetition of the process) van be
blocked by tetracycline 30S= bacteriostatic
Aminoglycosides
They include: gentamicin, neomycin, amikacin, tobramycin,
streptomycin.
-mechanism: bactericidal, irreversible inhibition of initiation
complex through binding of 30S subunit. Can cause misreading
of mRNA. Also block translocation. Require O2 for uptake,
therefore ineffective against anaerobes.
-clinical use: severe Gram (-) rod infections. Synergistic with
beta-lactam antibiotics(monobactams).
*neomycin is used for bowel surgery.
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-adverse effect: nephrotoxicity, neuromuscular blockade,
ototoxicity {especially when used with loop diuretics
(furosemide, torsemide)}, teratogen.
-mechanism of resistance: bacterial transferase inactivates the
drug by acetylation, phosphorylation or adenylation
Tetracyclines
Tetracycline, doxycycline, minocycline
-mechanism: Bacteriostatic, bind to 30S and prevent
attachment of aminoacyl-tRNA. Limited CAN penetration.
Doxycycline is eliminated with feces and can be used in renal
failure. Do not take tetracycline with milk (Ca+2), antacids
(Ca+2, Mg+2) or iron- containing preparations because divalent
contains inhibit drug absorption in the gut.
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-clinical use: borrelia burgdorferi, M. pneumonia, drug’s ability
to accumulate intracellularly makes them very effective against
rickettsia and Chlamydia. Also used to treat acne
-adverse effects: GI distress, discoloration of the teeth and
inhibition of bone growth in children, photosensitivity
*contraindicated in pregnancy
-mechanism of resistance: decrease uptake or increase efflux
out of bacterial cells by plasmid-encoded transport pumps.
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Chloramphenicol
-mechanism: block peptidyl transferase at 50S ribosomal
subunit. Bacteriostatic
-clinical use: meningitis (H. influnzae, Neisseria meningitides,
strept. pneumonia), rocky mountain spotted fever(rickettsia
rickettsia). Limited use owing but often still used in developing
countries because of low cost.
-adverse effect: anemia (dose dependent), aplastic anemia
(dose dependent), gray baby syndrome (in premature infants
because of lack liver UDP-glucaronyl transferase)
-mechanism of resistance: plasmid encoded acetyl transferase
inactivates the drug.
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Clindamycin
-mechanism: block peptide transfer(translocation) at 50S
ribosomal subunit. Bacteriostatic
-clinical use: anaerobic infections (Bacteroides ssp., clostridium
perfringens) in aspiration pneumonia, lung abscesses and oral
infections. Also effective against group A streptococcal
infection.
-Adverse effects: pseudomembranous colitis (C.difficile
overgrowth), fever, diarrhea.
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Oxazolidinones
Linezolid
-mechanism: inhibit protein synthesis by binding to 50s subunit
and preventing formation of the initiation complex.
-clinical use: gram (+) species including MRSA (Methicillin
Resistant Staphylococcus Aureus and VRE (Vancomycin
Resistant Enterococcus).
-Adverse effects: bone marrow suppression (especially
thrombocytopenia), peripheral neuropathy, serotonin
syndrome.
-mechanism of resistance: point mutation of ribosomal RNA
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Macrolides
Azithromycin, clarithromycin, erythromycin
-mechanism: inhibit protein synthesis by blocking translocation
(“MACRO slides”) bind to the 23s rRNA of the 50s ribosomal
subunit. Bacteriostatic
-clinical use: atypical pneumonia (mycoplasma, Chlamydia,
legionella), STIs (Chlamydia), Gram (+) cocci (streptococcal
infection in patients allergic to penicillin) and B. pertussis.
-adverse effect: MACRO, GI Motility issues, Arrhythmia caused
by prolonged QT interval, acute Cholestatic hepatitis, Rash,
eosinophilia, increase serum concentration of theophylline, oral
anticoagulants
*clarithromycin erythromycin inhibits cytochrome p.450
-mechanism of resistance: methylation of 23s rRNA-binding site
binding of the drug.
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Folic acid synthesis in bacteria
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1-The process start with PABA (para aminobenzoic acid)
+pteridine is converted into dihydropteroic acid by
dihydropteroate synthase (can be blocked by sulfonamide and
dapsone)
2-Then the dihydropteroic acid is converted into dihydrofolic
acid
3-dihydrofolic acid is converted into tetrahydrofolic acid by
dihydrofolate reductase (can be blocked by trimethoprim and
pyrimethamine)
4-tetrahydrofolic acid will give: purines (DNA, RNA), thymidine
(DNA), methionine(protein)
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Sulfonamides
Sulfamethoxazole (SMX), sulfisoxazole, sulfdiazine
-mechanism: inhibit dihydropteroate synthase, thus inhibiting
folate synthesis.
Bacteriostatic (bactericidal when combine with
trimethoprim)
-clinical use: gram (+), gram (-), nocardia, Chlamydia
SMX: for simple UTI
-adverse effects: hypersensitivity, hemolysis if G6PD deficient,
nephrotoxicity (tubulointerstitial nephritis), photosensitivity,
kernicterus in infants, displace other drugs from
albumin(warfarin).
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-mechanism of resistance: altered enzyme (bacterial
dihydropteroate synthase), decrease uptake or increase PABA
synthesis.
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Dapsone
Mechanism: similar to sulfonamides, but structurally distinct
agent
Clinical use: leprosy (lepromatous and tuberculoid),
pneumocystis jirovecii.
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Adverse effects: hemolysis if G6PD is deficient.
Trimethoprim
-mechanism: inhibit bacterial dihydrofolate reductase.
Bacteriostatic
-clinical use: used in combination with
sulfonamides(trimethoprime+sulfamethoxazole) =(TMP-SMX).
Causing sequential block of folate synthesis
*combination used for UTIs, shigella, salmonella, pnemocytis
jiroveci pneumonia treatment and prophylaxis, toxoplasmosis
prophylaxis.
-adverse effects: megaloblastic anemia, leukopenia,
granulocytopenia (may alleviate with supplemental folic acid).
*TMP: Treat Marrow Poorly
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Fluoroquinolones
Ciprofloxacin, norfloxacin, levofloxacin, ofloxacin, moxifloxacin,
Gemifloxacin, enoxacin
Mechanism: inhibit prokaryotic enzymes topoisomerase II (DNA
gyrase) and topoisomerase IV. Bactericidal. Must not be taken
with antacids.
Clinical use: gram – rods of urinary and GI tracts (including
pseudomonas), Neisseria, some gram + organisms.
Adverse effects: GI upset, super infections, skin rashes,
headache, dizziness, less commonly can cause leg cramps. And
myalgias. Contraindicated in pregnant woman, nursing mothers
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and children less than 18 years old due to possible damage to
cartilage. Some may prolong QT interval. May cause tendonitis
or tendon rupture in people more than 60 years old and in
patients taking prednisone.
Mechanism of resistance: chromosome encoded mutation in
DNA gyrase. Plasmid mediated resistance efflux pumps.
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Daptomycin
Mechanism: lipopeptide that disrupts cell membrane of gram +
cocci
Clinical use: S. aureus skin infections (especially MRSA),
bacteremia, endocarditis, VRE.
*not used for pneumonia (avidly binds to and is surfactant)
Adverse effects: myopathy, rhabdomyolysis
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Metronidazole
mechanism: forms toxic free radical metabolites in the bacterial
cell that damage DNA. Bactericidal, anti-protozoal
Clinical use: treats giardia, Entamoeba, trichomonas,
Gardnerella vaginalis, anaerobes (Bacteroides, C difficile). Used
with proton pump inhibitor and clarithromycin for triple therapy
against H. pylori.
Adverse effects: disulfiram-like reaction (severe flushing,
tachycardia, hypotension) with alcohol, headache, metallic
taste.
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Antimycobacterial drugs
*in general the mycobacteria contain in the cell wall mycolic
acid (can be blocked by isoniazid) and arabinogalactan which is
the precursor for the formation of mycolic acid(can be inhibited
by ethambutol)and inside the cell, the RNA polymerase which is
important in RNA polymerization is blocked by(rifambutin or
rifampin)and there is also pyrazinamide which has unclear
mechanism.
bacterium prophylaxis Treatment
M.tuberculosis isoniazid Rifampin, Isoniasid,
Pyrazinamide, Ethambutol
(RIPE for treatment)
M.avium-
intracellulare
Azithromycin,
rifabutin
More drug resistance than
M. tuberculosis
Azithromycin or
clarithromycin+ethambutaol
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can add rifabutin or
ciprofloxacin
M.leprae NA Long term treatment with
dapsone and rifampin for
tuberculoid form. Add
clofazimine for lepromatous
form.
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Rifamycin
Rifampin, rifabutin
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-mechanism: inhibit DNA-dependent RNA polymerase
-clinical use: M. tuberculosis, delay resistance to dapsone when
used for meningococcal prophylaxis and chemoprophylaxis in
contact of children with H. influnzae type B
-adverse effects: minor hepatotoxicity and drug interaction
(increases cytochrome P-450). orange body fluids (non-
hazardous side effect).rifabutin is favored over rifampin in
patients with HIV infection due to less cytochrome P-450
stimulation.
-mechanism of resistance: mutations reduce drug binding to
RNA polymerase. Monotherapy rapidly leads to resistance.
Pyrazinamide
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-mechanism: uncertain mechanism, it is a prodrug. That is
converted to the active compound pyrazinoic acid. Works best
in acidic PH (in host phagolysosomes)
-clinical use: M. tuberculosis
-adverse effect: hyperuricemia, hepatotoxicity
Ethambutol
-mechanism: decrease carbohydrate polymerization of
mycobacterium cell wall blocking arabinosyl transferase
-clinical use: M. tuberculosis
-adverse effects: Optic neuropathy (red-green color blindness).”
pronounce a eyethembutal”.
Streptomycin
-mechanism: interferes with 30S component of ribosome
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-clinical use: M. tuberculosis (2nd
line)
-adverse effects: tinnitus, vertigo, ataxia, nephrotoxicity
Isoniazid(B6)
-mechanism: decrease synthesis of mycolic acid. Bacterial
catalase-peroxidase (encoded by KatG) needed to convert INH
(IsoNicotinoyl Hydrazide) to active metabolite.
-clinical use: M. tuberculosis. The only agent used as solo
prophylaxis against TB. Also used as monotherapy for latent TB.
-adverse effects: hepatotoxicity, P-450 inhibition, drug induced
SLE (systemic lupus erythromatous), vitamin B6 deficiency
(peripheral neurotherapy, sideroblastic anemia) administers
with pyridoxine(B6).
-mechanism of resistance: mutations leading to under
expression of KatG.
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Antimicrobial prophylaxis:
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Prophylaxis in HIV patients:
Clinical scenario medication
High risk for endocarditis and undergoing
surgical or dental procedures
Amoxicillin
Exposure to gonorrhea Ceftriaxone
History of recurrent UTIs TMP-SMX
Exposure to meningococcal infection Ceftriaxone, ciprofloxacin or
rifampin
Pregnant woman carrying group B strep. Intrapartum penicillin G or ampicillin
Prevention of gonococcal conjunctivitis in
newborn
Erythromycin ointment on eye
Prevention of post surgical infections due
to S. aureus
cefazolin
Prophylaxis of strep pharyngitis in
children with prior rheumatic fever
Benzathine penicillin G or oral
penicillin V
exposure to syphilis Benzathine penicillin G
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Cell count Prophylaxis Infection
CD4less than 200 cells/mm3 TMP-SMX Pneumocysitis
pneumonia
CD4 less than 100 cells/mm3 TMP-SMX Pneumocysitis
pneumonia and
toxoplasmosis
CD4 less than 50 cells/mm3 Azithromycin or
clarithromycin
Mycobacterium avium
complex
Treatment of highly resistant bacteria:
MRSA: vancomycin, daptomycin, linezolid, tigecycline,
ceftaroline.
VRE: linezolid and streptogramins (quinupristin, dalfopristin).
*multi drug resistance P. aeruginosa multi drug resistance
Acinetobacter baumanii. Polymyxins B and E (colistin).
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65. G.S.M MEDICAL LECTURES /ANTIBIOTICS DR HARITH ALAWADI
LECTURES
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G.S.M MEDICAL EDUCATION
G.S.M
MEDICAL EDUCATION
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