Macrolides are a class of antibiotics derived from Saccharopolyspora erythraea (originally called Streptomyces erythreus), a type of soil-borne bacteria.
Macrolides are a class of antibiotics derived from Saccharopolyspora erythraea (originally called Streptomyces erythreus), a type of soil-borne bacteria.
A Power point presentation on Betalactam antibiotics suitable for undergraduate medical students. This Ppt is already presented in theory class lectures to the students of NEIGRIHMS, Shillong, Meghalaya
This presentation about cell wall inhibitors specially beta lactam antibiotics ..... that help you to understand how B-lactam antibiotics work on bacteria......
Pharmacology of Penicllins (Beta lactam antibiotics), description of their mechanism of action, mechanism of resistance, classification, indications and adverse effects
Sulfonamide (also called sulphonamide, sulfa drugs or sulpha drugs) is the basis of several groups of drugs. The original antibacterial sulfonamides are synthetic antimicrobial agents that contain the sulfonamide group.
Definition
History
Chemistry
Properties
Classification & its Generation
Pharmacokinetics
Mechanism of action
Indication
Contraindication
Therapeutic use
Adverse effect
Resistance
Comparison with penicillin
Market preparation
Broad spectrum antibiotics chloramphenicol, anaerobic,soil bacteria. Description includes Physicochemical Properties,Mechanism of action-50S ribosome ,Inhibits Bacterial protein synthesis,Resistance,Interactions,Indications of chloramphenicol-Pyogenic meningitis.
Anaerobic infections.
Intraocular infections.
Enteric fever
Drug of choice in some conditions.
Urinary tract infections
Topically In conjunctivitis & external ear Infections. Snehal chakorkar
A Power point presentation on Betalactam antibiotics suitable for undergraduate medical students. This Ppt is already presented in theory class lectures to the students of NEIGRIHMS, Shillong, Meghalaya
This presentation about cell wall inhibitors specially beta lactam antibiotics ..... that help you to understand how B-lactam antibiotics work on bacteria......
Pharmacology of Penicllins (Beta lactam antibiotics), description of their mechanism of action, mechanism of resistance, classification, indications and adverse effects
Sulfonamide (also called sulphonamide, sulfa drugs or sulpha drugs) is the basis of several groups of drugs. The original antibacterial sulfonamides are synthetic antimicrobial agents that contain the sulfonamide group.
Definition
History
Chemistry
Properties
Classification & its Generation
Pharmacokinetics
Mechanism of action
Indication
Contraindication
Therapeutic use
Adverse effect
Resistance
Comparison with penicillin
Market preparation
Broad spectrum antibiotics chloramphenicol, anaerobic,soil bacteria. Description includes Physicochemical Properties,Mechanism of action-50S ribosome ,Inhibits Bacterial protein synthesis,Resistance,Interactions,Indications of chloramphenicol-Pyogenic meningitis.
Anaerobic infections.
Intraocular infections.
Enteric fever
Drug of choice in some conditions.
Urinary tract infections
Topically In conjunctivitis & external ear Infections. Snehal chakorkar
Antibiotics and analgesics in pediatric dentistryParikshit Kadam
Antibiotics and analgesics in pediatric dentistry
almost cover all basic pharmacology and recent drugs which are used in pediatric dentistry. although it contains some not used cephalosporins but we should have some knowledge about that.
Penicillin Classification, Mechanism of Action, Structure Activity Relationship, Structure of Penicillins, penicillin-binding proteins (PBPs) functional propertiesCross-linking of the peptidoglycan by transpeptidases, Cross-linking of the peptidoglycan by transpeptidases, Shape of penicillin G Penicillin SAR AcylSide Chain Modifications Instability of β-lactams to nucleophiles
Penicillinase-Resistant Penicillins Protein Binding of Penicillins
To sum up, the risk/benefit ratio should be always weighed before prescribing antibiotics.
Appropriately selected patients will benefit from systemically administered antibiotics.
A restrictive and conservative use of antibiotics is highly recommended in endodontic practice, but indiscriminate use is contrary to sound clinical practice
Future generations will thank us for today’s conscientious and judicious use of antibiotics
CDSCO and Phamacovigilance {Regulatory body in India}NEHA GUPTA
The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
Pharmacovigilance, on the other hand, is the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. The primary aim of pharmacovigilance is to ensure the safety and efficacy of medicines, thereby protecting public health.
In India, pharmacovigilance activities are monitored by the Pharmacovigilance Programme of India (PvPI), which works closely with CDSCO to collect, analyze, and act upon data regarding adverse drug reactions (ADRs). Together, they play a critical role in ensuring that the benefits of drugs outweigh their risks, maintaining high standards of patient safety, and promoting the rational use of medicines.
Title: Sense of Smell
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 primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
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!
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
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.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
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.
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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
5. • Dentists prescribe medications for the
management of a number of oral conditions,
mainly orofacial infections.
• Since most human orofacial infections
originate from odontogenic infections, the
prescribing of antibiotics by dental practitioners
has become an important aspect of dental
practice.
• For this reason, antibiotics account for the vast
majority of medicines prescribed by dentists.
5
6. Greek word
Anti - against
Bios - life
Definition:
“Antibiotics are substances produced by
microorganisms, which selectively suppress the
growth of or kill other micro-organisms at very low
concentrations.”
6
7. • The term antibiotic was given by Waksman in
1941.
• He described antibiotics as chemical
substances produced by microorganisms
having the property of inhibiting the growth or
destroying other microorganisms in high
dilution
• Chemotherapy treatment of systemic infections
with specific drugs that selectively suppress the
infecting microorganism without significantly
affecting the host.
7
9. • Early History
During ancient times;
• Greeks and Indians used moulds and other
plants to treat infections.
• In Greece and Serbia, mouldy bread was
traditionally used to treat wounds and
infections.
• Warm soil was used in Russia by peasants to
cure infected wounds.
• Sumerian doctors gave patients beer soup
mixed with turtle shells and snake skins.
9
10. • Babylonian doctors healed the eyes using a
mixture of frog bile and sour milk.
• Sri Lankan army used oil cake (sweetmeat) to
server both as desiccant and antibacterial.
10
11. MODERN HISTORY
• 1640 - John Parkington recommended using
mould for treatment in his book on
pharmacology.
• 1870 - Sir John Scott Burdon-Sanderson
observed that culture fluid covered with mould
did not produce bacteria.
• 1871 - Joseph Lister experimented with the
antibacterial action on human tissue on what
he called Penicillium glaucium.
• 1875 - John Tyndall explained antibacterial
action of the Penicillium fungus to the Royal
Society.
11
12. • 1877 - Louis Pasteur postulated that bacteria
could kill other bacteria (anthrax bacilli).
• 1897 - Ernest Duchesne healed infected guinea
pigs from typhoid using mould (Penicillium
glaucium).
• 1928 - Sir Alexander Fleming discovered
enzyme lysozyme and the antibiotic substance
penicillin from the fungus Penicillium notatum.
• 1932- Gerhard Domagk discovered
Sulfonamidochrysoidine (Prontosil ).
12
13. • During 1940's and 50's streptomycin,
chloramphenicol, and tetracycline were
discovered and Selman Waksman used the
term "antibiotics" to describe them (1942).
13
14. Sir Alexander Fleming
• Sir Alexander Fleming, a Scottish biologist,
defined new horizons for modern antibiotics
with his discoveries of enzyme lysozyme (1921)
and the antibiotic substance penicillin (1928).
• It was in 1928 when he observed while
experimenting on influenza virus that a
common fungus, Penicillium notatum had
destroyed bacteria in a staphylococcus culture
plate.
14
15. • Upon subsequent investigation, he found out
that mould juice had developed a bacteria-free
zone which inhibited the growth of
staphylococci.
• This newly discovered active substance was
effective even when diluted up to 800 times.
• He named it penicillin.
15
17. Classification of Antibiotics
Based on
mode of Action
Bacteriostatic Bactericidal
Based on their
spectrum of
action
Broad-spectrum
Narrow
Spectrum
17
18. Spectrum of Activity:
1.) Narrow Spectrum:
e.g. Penicillin G, Streptomycin,
Erythromycin.
2.) Broad Spectrum:
e.g. Tetracyclines, Chloramphenicol.
18
19. Types of Antibiotics
(Based on their mode of action)
Bacteriostatic
Antibiotics
• Tetracyclines
• Spectinomycin
• Sulphonamides
• Macrolides
• Chloramphenicol
• Trimethoprim
Bactericidal Antibiotics
• Penicillins
• Cephalosporins
•Fluoroquinolones
(Ciprofloxacin)
• Glycopeptides (Vancomycin)
• Monobactams
• Carbapenems
19
21. Antibiotics: Mode of Action
21
• Inhibitors of DNA synthesis
• Inhibitors of bacterial protein synthesis
• Inhibitors of bacterial cell wall synthesis
• Interference with metabolism
• Impairment of nucleic acids
27. • Peptidoglycan is a carbohydrate composed of
alternating units of NAMA and NAGA.
• The NAMA units have a peptide side chain
which can be cross linked from the L-Lys
residue to the terminal D-Ala-D-Ala link on a
neighboring NAMA unit.
27
30. •The cross linking reaction is
catalyzed by a class of
transpeptidases known as penicillin
binding proteins
•A critical part of the process is the
recognition of the D-Ala-D-Ala
sequence of the NAMA peptide
side chain by the PBP. Interfering
with this recognition disrupts the
cell wall synthesis.
•β-lactams mimic the structure of
the D-Ala-D-Ala link and bind to the
active site of PBPs, disrupting the
cross-linking process.
Transpeptidase Enzyme
30
36. How do they work?
1. The β-lactam binds to Penicillin Binding
Protein (PBP).
2. PBP is unable to crosslink peptidoglycan
chains.
3. The bacteria is unable to synthesize a stable
cell wall.
4. The bacteria is lysed.
36
37. Mechanism of β-Lactam Drugs
• The amide of the β-lactam ring is unusually
reactive due to ring strain and a conformational
arrangement which does not allow the lone pair of
the nitrogen to interact with the double bond of the
carbonyl.
• β-Lactams acylate the hydroxyl group on the serine
residue of PBP active site in an irreversible
manner.
• This reaction is further aided by the oxyanion hole,
which stabilizes the tetrahedral intermediate and
thereby reduces the transition state energy.
37
38. Mechanism of β-Lactam Drugs
The hydroxyl attacks the amide and forms a tetrahedral
intermediate.
38
39. Mechanism of β-Lactam Drugs
The tetrahedral intermediate collapses, the amide bond is broken,
and the nitrogen is reduced.
39
40. Mechanism of β-Lactam Drugs
The PBP is now covalently bound by the drug and cannot perform
the cross linking action.
40
43. Penicillin G
• It is a drug of choice for infections caused by streptococci,
meningococci, enterococci, penicillin - susceptible pneumococci,
non-β-lactamase-producing staphylococci, T. pallidum and many
other spirochetes, clostridium species, actinomyces, and other
Gram - positive rods and non-β-lactamase-producing Gram-
negative anaerobic organisms.
43
44. Adverse effects
•The main hazard with the penicillins is allergic reaction.
•These include itching, rashes (eczematous or urticarial), fever, and
angioedema.
•Rarely (about 1 in 10 000) there is anaphylactic shock which can be
fatal (about 1 in 50 000 – 100 000 treatment courses).
44
45. • Allergies are least likely when penicillins are given orally and
most likely with local application.
• Metabolic opening of the β-lactam ring creates a highly
reactive penicilloyl Group which polymerizes and binds with
tissue Proteins to form the major antigenic determinant.
• The anaphylactic reaction involves specific IgE
antibodies which can be detected in the plasma of susceptible
persons. 45
47. PENICILLIN G
1. Sod. Penicillin G (crystalline penicillin) injection.
0.5-5 MU i.m/i.v 6-12 hourly. Available as dry
powder to be dissolves with sterile water at the
time of injection.
2. Procaine penicillin G inj.
0.5-5 MU i.m/i.v 12-24 hourly.
3. Benzathine penicillin G
o.6-2.4 MU i.m. every 2-4 weeks as aqueous
suspensions.
47
48. Penicillin V (Phenoxymethylpenicillin)
EFFECTIVE AGAINST:
• Gram positive + Less effective
against Gram negative
bacteria
TREATMENT FOR:
• Tonsillitis
• Anthrax
• Rheumatic fever
• Streptococcal skin infections
CHARACTERISTICS:
• Narrow spectrum
• Should be given orally
• Prone to beta-lactamase 48
49. Jarisch – Herxheimer Reaction
• Pencillin is injected into a syphilitic patient.
• May produce shivering, fever, myalgia,
exacerbation of the lesions and even vascular
collapse.
• Occurs due to sudden release of spirochetal
lytic products.
• Effects last for 12 – 72 hours.
• Intake of Aspirin and sedation cause relief of
symptoms.
49
54. Methicillin
EFFECTIVE AGAINST:
• Gram positive bacteria
TREATMENT FOR:
• Cellulitis
• Also for life threating diseases
such as pneumonia,
endocarditis, bacteremia and
meningitis.
CHARACTERISTICS:
• Very narrow Spectrum
• Should be given parenterally
SIDE-EFFECT:
• Interstitial nephritis 54
55. Oxacillin
EFFECTIVE AGAINST:
• Gram positive bacteria
TREATMENT AGAINST:
• penicillin-resistant Staphylococcus
aureus
CHARACTERISTICS:
• Very narrow Spectrum
• Should be given parenterally
SIDE-EFFECT:
• Hypersensitivity and local reactions
• In high doses, renal, hepatic, or
nervous system effects can occur
55
56. Nafcillin
EFFECTIVE AGAINST:
• Gram positive bacteria
TREATMENT AGAINST:
• Staphylococcal infections
CHARACTERISTICS:
• Very narrow Spectrum
• Should be given parenterally
SIDE-EFFECT:
• Allergic reactions
• Nausea and vomiting
• Abdominal pain
56
58. Dicloxacillin
EFFECTIVE AGAINST:
• Gram positive bacteria +
Staphylococci that produce beta-
lactamase
CHARACTERISTICS:
• Very narrow Spectrum
• Should be given orally
SIDE-EFFECT:
• Allergic reaction
• Diarrhoea, nausea, rash, urticaria
pain and inflammation at injection
site
58
59. Flucloxacillin
EFFECTIVE AGAINST:
• Gram positive bacteria +
Staphylococci that produce beta-
lactamase
CHARACTERISTICS:
• Very narrow Spectrum
• Should be given orally
SIDE-EFFECT:
• Allergic reaction
• Diarrhoea, nausea, rash, urticaria
pain and inflammation at injection
site
59
66. • These has been conventionally classified into four generations
based on Generation system.
• This is based on chronological sequence of development, but
more importantly, takes into consideration the overall
antibacterial spectrum as well as potency.
• First-generation cephalosporins are predominantly active
against Gram-positive bacteria, and successive generations
have increased activity against Gram-negative bacteria (albeit
often with reduced activity against Gram-positive organisms).
66
67. CEPHALOSPORINS
•The nucleus of the cephalosporins, 7-aminocephalo- sporanic acid,
bears a close resemblance to 6-amino- penicillanic acid.
•The intrinsic antimicrobial activity of natural cephalosporins is low,
but the attachment of various R1 and R2 groups has yielded
hundreds of potent compounds of low toxicity.
•Cephalosporins can be classified into four major groups or
generations, depending mainly on the spectrum of their antimicrobial
activity. 67
69. Cephalosporins are similar to penicillins, but more stable
to many bacterial beta-lactamases and therefore have a
broader spectrum of activity.
Klebsiella pneumoniae
69
70. • However, strains of E. coli and Klebsiella species
expressing extended-spectrum beta-lactamases that
can hydrolyze most cephalosporins are becoming a
problem.
• Cephalosporins are not active against enterococci
and Listeria monocytogenes.
70
72. • These drugs are very active against Gram-positive cocci
(such as pneumococci, streptococci, and Staphylococci).
Cephalosporins are not active against methicillin-
resistant strains of staphylococci.
72
73. • E. coli, K. pneumoniae, and P. mirabilis are often
sensitive. Anaerobic cocci (e.g., peptococcus,
peptostreptococcus) are usually sensitive, but
Bacteroides fragilis is not.
73
77. • In general, they are active against organisms inhibited by first-
generation drugs, but in addition they have extended Gram-
negative coverage.
• Klebsiellae (including those resistant to cefalothin) are usually
sensitive. Cefamandole, cefuroxime, and cefaclor are active
against H. influenzae but not against serratia or B. fragilis.
77
78. • In contrast, cefoxitin, and cefotetan are active against B. fragilis
and some serratia strains but are less active against H.
influenzae. As with first-generation agents, none is active against
enterococci or P. aeruginosa.
78
82. • Compared with second-generation agents, these drugs have
expanded Gram-negative coverage.
• Third-generation drugs are active against Citrobacter, Serratia
marcescens, and Providencia.
• They are also effective against β-lactamase-producing strains
of Haemophilus and Neisseria.
82
83. Like the second-generation drugs, third-generation
cephalosporins are hydrolyzable by constitutively
produced beta-lactamase, and they are not reliably active
against enterobacter species.
83
84. Third-generation cephalosporins are used to treat a wide
variety of serious infections caused by organisms that
are resistant to most other drugs.
84
88. • Carbapenems are a class of beta-lactam antibiotics with a broad
spectrum of antibacterial activity.
• They have a structure that renders them highly resistant to beta-
lactamases.
• Carbapenem antibiotics were originally developed from
thienamycin, a naturally-derived product of Streptomyces cattleya.
88
89. Carbapenems common uses
• Imipenem
• Broad spectrum, covers Gram-positive, Gram-negative
(including ESBL-producing strains), Pseudomonas and
anaerobes
• Meropenem
• Less seizure-inducing potential, can be used to treat CNS
infections
• Ertapenem
• Lacks activity against Acinetobacter and Pseudomonas
• Has limited activity against penicillin-resistant pneumococci
89
90. Imipenem
EFFECTIVE AGAINST:
• Aerobic and anaerobic, Gram
positive and gram negative
bacteria
CHARACTERISTICS:
• Broad Spectrum
• Intravenous
• Resistant to beta-lactamase
enzymes
SIDE-EFFECT:
• Seizuregenic at high doses
90
94. Aztreonam
EFFECTIVE AGAINST:
• Gram positive +Gram
negative+Anaerobic bacteria
CHARACTERISTICS:
• Broad Spectrum
• Intravenous
• Resistant to beta-lactamase
enzymes
• Not active against MRSA
SIDE-EFFECT:
• Diarrhoea
• Nausea
• Vomiting
94
95. BETA-LACTAMASE INHIBITORS
• Resemble β-lactam antibiotic structure.
•
• Bind to β-lactamase and protect the antibiotic from destruction.
• Most successful when they bind the β-lactamase irreversibly.
• Three important in medicine:
• Clavulanic Acid
• Sulbactam
• Tazobactam 95
97. Resistance-The Global Battle.!!!
What is Resistance?
•Drug resistance refers to unresponsiveness of a
microorganism to an antimicrobial agent.
•Drug resistance are of two types:
---Natural Resistance
---Acquired Resistance
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98. Natural Resistance
• Some microbes have always been resistant to certain anti-
microbial agent.
• They lack the metabolic process or the target side that is
affected by particular drug.
E.g: Gram negative bacilli are normally unaffected by Penicillin G.
• M. tuberculosis is insensitive to Tetracyclines.
• This type of resistance does not pose significant clinical
problem.
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99. Acquired Resistance
• It is the development of resistance by an organism which was
sensitive before due to the use of antimicrobial agent over a
period of time.
• This can happen with any microbe and is a major clinical
problem.
• However, the development of resistance is dependent on the
microorganism as well as the drug.
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102. • Anaphylaxis:
Anaphylaxis occurs in about 1 in 10,000 patients using
penicillin, accounting for approximately 300 deaths per
year in the United States.
.
103. • Management:
While the triggering agent of an acute allergic reaction is variable,
the approach to handling the emergency is similar in most cases.
The dentist's primary responsibility in an allergic emergency is to
stabilize the patient until he or she can be transferred to an
emergency facility or until assistance arrives.
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104. Guidelines for sequencing of antibiotic
therapy
• Supplemental, subgingivally applied, broad-spectrum antiseptic
agents may be used.
• Periodontal abscesses may develop if systemic antibiotics are
administered without mechanical debridement.
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105. Prescription of drugs
• Prescription drugs are the fastest growing component of personal
health expenditures.
• Contributing to this are the increased FDA approvals of expensive
and new drugs.
• Antibiotics should be prescribed judiciously rather than zealously.
• Judicious use of antimicrobial therapy mandates restrained rather
than indiscriminate prescribing.
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106. Antibiotic sensitivity cultures…
• Aim is to measure susceptibility of an isolate two range of
antibiotics at the individual patient level for effective prescribing
but also to assess emerging bacterial resistance patterns.
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107. Overprescribing….
• Excessive prescribing or over prescribing unnecessarily exposes
the patient to increased financial costs as well as substantial risk
of antibiotic complications and increased number of antibiotic
resistant organisms in the general population.
Eg: For healthy patients prophylactic antibiotics for routine
periodontal surgery or extractions.
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108. Wrong choice of antibiotics
• Prescribing a broad spectrum antibiotic when a narrow spectrum
one would be sufficient or prescribing unnecessarily long courses
of antibiotic therapy increases the risk of resistant bacterial strain
development.
• Bacterial resistance to a single antibiotic or to multiple groups
frequently results from genetic transfer abilities of bacteria which
allow them to create pathogens with antibiotic resistant genes.
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109. Antibiotics in periodontal therapy
Conditions that may call for systemic antimicrobial periodontal
therapy are:
• Medical conditions that predispose patients to periodontitis.
• Acute periodontal infections (periodontal abscess, acute
necrotizing ulcerative gingivitis/periodontitis).
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110. Antibiotics in endodontic therapy
• It has been well documented that infected root canals are
polymicrobial in nature with several predominant anaerobic
microorganisms.
• The key to successful management of infections of endodontic
origin is the chemomechanical debridement of the infected root
canal system and drainage from both soft and hard tissues.
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111. Antibiotics for oral and
maxillofacial infections
Antibiotic prophylaxis
• It is not possible to make recommendations regarding
antibiotic prophylaxis for all clinical situations.
• Antibiotic prophylaxis is the administration of antibiotics
to patients who have no known infection for the purpose
of preventing microbial colonozation and reducing the
potential for post operative complications.
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115. • They play a very important role in :
• Patients at risk of bactereamia-induced infections.
• Patients with Pregnancy
• Breast feeding patients
• Secondary infections
• Or any other medically compromised patients .
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116. • It is therefore important for the clinicians to have proper
knowledge, ability monitor the effectiveness of prescribed
antibiotics and consider changing the drug or the method of
therapeutic management with antibiotics.
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117. Bibliography
• K.D. TRIPATHI text book of pharmacology.
• Antibiotic and antimicrobial use in dental practice: 2nd edn,
Michael G. Newman.
• Pharmacology an introductory text: Mary Kaye Asperheim, 6th
edn.
• Text book of pharmacology, 1st edn, H.L. Sharma.
• Anti microbial therapy in periodontics. Slots J.
• Text book of Peridontology: Carranza.
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Adding the oxygen decreases the nucleophilicity of the carbonyl group, making penicillin V acid stable and orally viable
Ampicillin is active against Gram-(+) bacteria including Streptococcus pneumoniae, Streptococcus pyogenes, Staphylococcus aureus (but not methicillin-resistant strains), and some Enterococci
Ampicillin is relatively non-toxic. Its most common side effects include rash, diarrhea, nausea and vomiting.[4] In very rare cases it causes severe side effects such as anaphylaxis and Clostridium difficile diarrhea.
Side effects are similar to those for other β-lactam antibiotics, including nausea, vomiting, rashes, and antibiotic-associated colitis. Loose bowel movements (diarrhea) may also occur. Rarer side effects include mental changes, lightheadedness, insomnia, confusion, anxiety, sensitivity to lights and sounds, and unclear thinking.
Dicloxacillin is insensitive to beta-lactamase (also known as penicillinase) enzymes secreted by many penicillin-resistant bacteria. The presence of theisoxazolyl group on the side chain of the penicillin nucleus facilitates the β-lactamase resistance, since they are relatively intolerant of side-chain steric hindrance. Thus, it is able to bind to penicillin-binding proteins (PBPs) and inhibit peptidoglycan crosslinking, but is not bound by or inactivated by β-lactamases.
Dicloxacillin is insensitive to beta-lactamase (also known as penicillinase) enzymes secreted by many penicillin-resistant bacteria. The presence of theisoxazolyl group on the side chain of the penicillin nucleus facilitates the β-lactamase resistance, since they are relatively intolerant of side-chain steric hindrance. Thus, it is able to bind to penicillin-binding proteins (PBPs) and inhibit peptidoglycan crosslinking, but is not bound by or inactivated by β-lactamases.
Ticarcillin's antibiotic properties arise from its ability to prevent cross-linking of peptidoglycan during cell wall synthesis, when the bacteria try to divide, causing cell death.
Reistance by efflux mechanism
Inactivated by ESBL(Extended Spectrum beta-lactamases