The document presents a case study of a 26-year-old male patient diagnosed with acute bronchitis, acute sinusitis, and hypersensitivity symptoms. Laboratory tests including a typhidot test and complete blood count were performed. The case study does not provide any details on the treatment plan or outcome for the patient.
Aminoglycosides(medicinal chemistry by p.ravisankar)Dr. Ravi Sankar
Aminoglycosides,Aminocyclitols,Source,Structures of streptomycin,Dihydrostreptomycin,A mention of other aminoglycoside antibiotics,Acid hydrolysis,Mechanism of action,SAR,Dihydrostreptomycin and its importance,therapeutic uses, toxicity.
macrolide antibiotics with detailed description of classification and individual drug with mechanism of action, pharmacokinetics, adverse effect, uses for undergraduates and post graduates
Aminoglycosides(medicinal chemistry by p.ravisankar)Dr. Ravi Sankar
Aminoglycosides,Aminocyclitols,Source,Structures of streptomycin,Dihydrostreptomycin,A mention of other aminoglycoside antibiotics,Acid hydrolysis,Mechanism of action,SAR,Dihydrostreptomycin and its importance,therapeutic uses, toxicity.
macrolide antibiotics with detailed description of classification and individual drug with mechanism of action, pharmacokinetics, adverse effect, uses for undergraduates and post graduates
These are antibiotics having a macrocyclic
lactone ring with attached sugars. Erythromycin
is the first member discovered in the 1950s,
Roxithromycin, Clarithromycin and Azithromycin
are the later additions. Antimicrobial spectrum is narrow,
includes mostly gram-positive and a few gramnegative
bacteria, and overlaps considerably with
that of penicillin G. Erythromycin is highly active
against Str. pyogenes and Str. pneumoniae, N.
gonorrhoeae, Clostridia, C. diphtheriae and
Listeria, but penicillin-resistant Staphylococci
and Streptococci are now resistant to erythromycin
also.
All cocci readily develop resistance
to erythromycin, mostly by acquiring the
capacity to pump it out. Resistant Enterobacteriaceae
have been found to produce an erythromycin
esterase. Alteration in the ribosomal binding
site for erythromycin by a plasmid encoded
methylase enzyme is an important mechanism of
resistance in gram-positive bacteria. All the above
types of resistance are plasmid mediated. Change
in the 50S ribosome by chromosomal mutation
reducing macrolide binding a
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.
Tetracyclines slide contains full information about uses, adverse effect, marketed preparation, precaution, route of drug administration, antimicrobial spectrum, mechanism of action, pharmacokineticks and pharmacodynamics of tetracyclines. This slide is very helpful for pharmacy and pharmacology student for the study about tetracyclines.
History, Classification, Antibacterial spectrum, Mechanism of action, Bacterial resistance, Pharmacokinetics, Toxicities like ototoxicity and nephrotoxicity, Therapeutic uses of Amioglycoside.
Macrolides are a class of antibiotics derived from Saccharopolyspora erythraea (originally called Streptomyces erythreus), a type of soil-borne bacteria.
These are antibiotics having a macrocyclic
lactone ring with attached sugars. Erythromycin
is the first member discovered in the 1950s,
Roxithromycin, Clarithromycin and Azithromycin
are the later additions. Antimicrobial spectrum is narrow,
includes mostly gram-positive and a few gramnegative
bacteria, and overlaps considerably with
that of penicillin G. Erythromycin is highly active
against Str. pyogenes and Str. pneumoniae, N.
gonorrhoeae, Clostridia, C. diphtheriae and
Listeria, but penicillin-resistant Staphylococci
and Streptococci are now resistant to erythromycin
also.
All cocci readily develop resistance
to erythromycin, mostly by acquiring the
capacity to pump it out. Resistant Enterobacteriaceae
have been found to produce an erythromycin
esterase. Alteration in the ribosomal binding
site for erythromycin by a plasmid encoded
methylase enzyme is an important mechanism of
resistance in gram-positive bacteria. All the above
types of resistance are plasmid mediated. Change
in the 50S ribosome by chromosomal mutation
reducing macrolide binding a
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.
Tetracyclines slide contains full information about uses, adverse effect, marketed preparation, precaution, route of drug administration, antimicrobial spectrum, mechanism of action, pharmacokineticks and pharmacodynamics of tetracyclines. This slide is very helpful for pharmacy and pharmacology student for the study about tetracyclines.
History, Classification, Antibacterial spectrum, Mechanism of action, Bacterial resistance, Pharmacokinetics, Toxicities like ototoxicity and nephrotoxicity, Therapeutic uses of Amioglycoside.
Macrolides are a class of antibiotics derived from Saccharopolyspora erythraea (originally called Streptomyces erythreus), a type of soil-borne bacteria.
Microbiology is the study of microorganisms.
The overall theme of the Microbiology course is to study the relationship between microbes and our lives.
Microorganisms (microbes) are organisms that are too small to be seen with the unaided eye, and usually require a microscope to be seen.
This relationship involves harmful effects such as diseases and food spoilage as well as many beneficial effects.
this slides includes overview of antimicrobial drugs, their classifications, antimicrobial resistance, adverse effects and toxicity, choice of antimicrobial drugs and its uses
Antibiotics Resistance is a new issue in Microbiology-Medicine aspects, taken from Lange Review of Medical Microbiology, this purpose is for education only
antibiotics that inhibit synthesis of the bacterial cell wall. includes tetracyclines, aminoglycosides, macrolides and ketolides , chloramphenicol among others. this presentation highlights the clinical uses, adverse effects, common contraindications modes of action and susceptibility scores
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...GL Anaacs
Contact us if you are interested:
Email / Skype : kefaya1771@gmail.com
Threema: PXHY5PDH
New BATCH Ku !!! MUCH IN DEMAND FAST SALE EVERY BATCH HAPPY GOOD EFFECT BIG BATCH !
Contact me on Threema or skype to start big business!!
Hot-sale products:
NEW HOT EUTYLONE WHITE CRYSTAL!!
5cl-adba precursor (semi finished )
5cl-adba raw materials
ADBB precursor (semi finished )
ADBB raw materials
APVP powder
5fadb/4f-adb
Jwh018 / Jwh210
Eutylone crystal
Protonitazene (hydrochloride) CAS: 119276-01-6
Flubrotizolam CAS: 57801-95-3
Metonitazene CAS: 14680-51-4
Payment terms: Western Union,MoneyGram,Bitcoin or USDT.
Deliver Time: Usually 7-15days
Shipping method: FedEx, TNT, DHL,UPS etc.Our deliveries are 100% safe, fast, reliable and discreet.
Samples will be sent for your evaluation!If you are interested in, please contact me, let's talk details.
We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stockrebeccabio
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stock
Telegram: bmksupplier
signal: +85264872720
threema: TUD4A6YC
You can contact me on Telegram or Threema
Communicate promptly and reply
Free of customs clearance, Double Clearance 100% pass delivery to USA, Canada, Spain, Germany, Netherland, Poland, Italy, Sweden, UK, Czech Republic, Australia, Mexico, Russia, Ukraine, Kazakhstan.Door to door service
Hot Selling Organic intermediates
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!
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
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.
How to Give Better Lectures: Some Tips for Doctors
Macrolides
1. Submitted to: Sir Dr. Narendar
Sharma
Presenter: Mohammad Waqas
Mairaj
2K16/PHA/56(Morning)
4TH Prof: Pharm-D, University of
Sindh faculty of Pharmacy,
Jamshoro
Date of submission:
1st April, 2019
2. Topics Slide #
INTRODUCTION 3
GENERAL MECHANISM OF ACTION OF MACROLIDES 4
RESISTANCE 6
SAFETY IN PREGNANCY AND BREAST FEEDING 9
DRUGS INTERACTIONS 10
CLASSIFICATION OF MACROLIDES 12
KETOLIDES 13
FLUOROKETOLIDES 14
NON-ANTIBIOTIC MACROLIDES,
ANTIFUNGAL MACROLIDES,
TOXIC MACROLIDES.
15
ERYTHROMYCIN 16
CLARITHROMYCIN 22
AZITHROMYCIN 25
CASE STUDY 28
REFERENCES 32
3. The Macrolides are a class of antibiotics possessing a
large lactone ring to which sugars are attached.
Macrolides are protein synthesis inhibitors.
They are bacteriostatic in nature.
Macrolides terminate protein synthesis by inhibiting
the 50S ribosome via specific binding with the 23S
ribosomal subunit and various proteins.
4. Inhibition of bacterial protein
biosynthesis, and they are thought to do
this by preventing peptidyl transferase
from adding the growing peptide
attached to tRNA to the next amino acid
Another potential mechanism is
premature dissociation of the peptidyl-
tRNA from the ribosome.
Macrolide antibiotics do so by binding
reversibly to the P site on the 50S
subunit of the bacterial ribosome. This
action is considered to be
bacteriostatic.
CONTD:
5. IMMUNOMODULATION
E.g: Diffuse pan bronchiolitis
The macrolide antibiotics erythromycin, clarithromycin, and
roxithromycin have proven to be an effective long-term treatment for the
idiopathic, Asian-prevalent lung disease Diffuse pan bronchiolitis (DPB).
controlling symptoms through immunomodulation (adjusting the immune
response), with the added benefit of low-dose requirements.
suppression of not only neutrophil granulocyte proliferation but also
lymphocyte activity and obstructive secretions in airways.
CONTD:
6. Resistance
1. RIBOSOMAL METHYLATION: THE MLSB RESISTANCE PHENOTYPE
It is secondary to the acquisition of an erm gene (erythromycin ribosome methylase).
This gene encodes a ribosomal methylase which dimethylates pneumococcal 23S rRNA at a single site, adenine
at position 2058.
The modification markedly reduces the affinity of erythromycin for its target, probably by preventing direct
access to the target or by modifying the conformation of the binding site.
Transposition occurs from chromosome to chromosome of strains of S. pneumonia.
Regulation of ERM(B) expression and the MLSB resistance phenotype
The methylase encoded by erm(B) may be constitutively or inducibly synthesized.
When expression is constitutive, the erm(B) mRNA is active, and its translation by the ribosomes allows
constitutive methylation of the ribosomes,
When resistance is inducible, erm(B) mRNA is synthesized, but in an inactive conformation, and becomes active
only in the presence of inducing macrolides.
For a given erm gene, the inducing capacity of the macrolides depends on the antibiotic structure. The global
structure of the drug, rather than the number of atoms in the lactone ring, determines the inducing capacity of a
macrolide.
Example, erythromycin is an inducer for the production of most Erm methylases, whereas ketolides, which have
a similar lactone ring, are not. For erm(B), the commercially available macrolides (including the 14-, 15-, and 16-
membered macrolides), lincosamides, and streptogramin B antibiotics are inducers of methylase synthesis to
various degrees, leading to cross-resistance to these antimicrobial agents.
7. The gene responsible for efflux was initially called mefE and was subsequently assigned to the
mef(A) gene class because of its close relatedness to the mefA gene in S. pyogenes. The Mef(A)
pump belongs to the major facilitator superfamily class. It contains 12 transmembrane domains
spanning the cytoplasmic membrane, and efflux is driven by the proton motive force.
Resistance appears to be induced with erythromycin and is expressed at moderate levels, with
erythromycin MICs of between 1 and 64 µg/ml (generally between 8 and 32 µg/ml).
Physiological pumps conferring erythromycin resistance by efflux have been described for several
gram-positive organisms, such as Cmr from Corynebacterium glutamicum, which belongs to the
major facilitator superfamily class of pumps, but not for S. pneumoniae.
Because the 16-membered macrolides, the lincosamides, and the streptogramin B antibiotics are
not substrates of the pump, these antimicrobial agents remain active, even after induction with
erythromycin.
8. In vitro selection of E. coli mutants
highly resistant to erythromycin
has been of considerable value for
characterization of the site of
binding of this antibiotic to the
ribosome.
The clinical importance of this
mechanism was recognized several
years ago for microorganisms such
as Helicobacter pylori and
Mycobacterium avium but only
recently for pneumococci
9. Erythromycin, roxithromycin and azithromycin are safe to use while breast feeding,
clarithromycin is considered safe to use while breast feeding.
(* Australian Therapeutic Goods Administration Pregnancy Categories)
Category A Erythromycin
Category B1 Roxithromycin
Category B2 Azithromycin
Category B3 Clarithromycin
10. Drugs
interactions
• Potent hepatic
cytochrome P450
enzyme inhibitors.
• They also have an
inhibitory effect on
transporter
proteins.
• Effects
gastrointestinal
flora and gastric
emptying time.
If possible, it is
recommended
that the
interacting
medicine be
withheld, or
the dose
reduced during
the course
11. Amiodarone, Methadone, Lithium, Amitriptyline
and Citalopram, Verapamil + Erythromycin.
increased risk of QT interval prolongation.
Warfarin + Clarithromycin and Erythromycin. increased anticoagulant properties,
Dabigatran + Clarithromycin and Erythromycin. signs of bleeding. This effect may be more
pronounced in elderly people, or when renal
function is reduced
Simvastatin and atorvastatin + macrolides
inhibiting CYP3A4 enzymes۔
statin-induced rhabdomyolysis.
Digoxin + clarithromycin. digoxin toxicity.
Other medicines that may have significant interactions with macrolides in elderly people or those
with significant co-morbidities include; benzodiazepines, carbamazepine, cimetidine, clozapine,
colchicine and theophylline.
13. Ketolides are a class
of antibiotics that are
structurally related
to the macrolides.
Indications
They are used to
treat respiratory tract
infections caused by
macrolide-resistant
bacteria.
Ketolides are
especially effective,
as they have two
ribosomal binding
sites.
Ketolides include:
Telithromycin - the
first and only
approved ketolide
Cethromycin Solithromycin
TELITHROMYCIN
14. Fluoroketolides
are a class of
antibiotics that
are structurally
related to the
ketolides.
The
fluoroketolides
have three
ribosomal
interaction sites.
Fluoroketolides
include:
Solithromycin -
the first and
currently the only
fluoroketolide (not
yet approved)
17. Antibacterial action of
erythromycin maybe
inhibitory, bactericidal,
particularly at higher
concentrations.
Absorption:
• Activity is enhanced at
alkaline Ph.
• Must be administered
with enteric coating
• Food interferes with
absorption
• Absorbed in body tissues
and fluids except CSF.
Distribution:
• Oral dosage of 2g/day
results in serum
concentration of
2mcg/ml.
• 500mg IV erythromycin
results in peak level of
10mcg/ml after 1 hour of
dosing.
• Serum half life is 1.5
hours normally, 5 hours
in anuria patients.
Metabolism:
• Metabolized in Phase
II of glucourinadation
pathway.
Excretion:
• Excreted in the
bile, and lost in
feces with 5% in
urine.
Pharmacokinetics
18. • Corynebacterial infections (diphtheria, sepsis, erythrasma)
• Chlamydial infections (genital, neonatal, respiratory, ocular)
• Community acquired pneumonia.
1st line treatment
• Endocarditis during dental procedures in individuals with valvular heart disease.
Prophylaxis
Erythromycin is also useful as a substitute in penicillin-
allergic individuals with infections caused by
staphylococci, streptococci or pneumococci.
19. Gastro-
intestinal
effects
anorexia, vomiting,
nausea, diarrhea
due to direct
stimulation of gut
motility.
Liver
toxicity
Estolate
erythromycins
can cause acute
cholestasis
hepatitis, fever,
eosinophilia,
rashes.
Drug
interactio
ns
Erythromycins
inhibits CYP450,
inhibiting the
metabolism of
theophylline, oral
anticoagulants,
cyclosporine and
methyl
prednisolone.
Adverse reactions:
20. Erythromycin
Topical:
Topical ointments
2%
Topical pads 2%
Topical solution
2%
Topical gel 2%
Erythromycin
stearate Tablet: 250mg PO Q6H 500mg PO Q12H Amebiasis:
500mg PO 16H for
10-14 days
Legionnaires
disease:
1-4g/day PO in
divided doses for
21 days
Urethritis
caused by C
trachomatis or
U urealyticum:
500mg PO Q6H
for 7 days;
alternatively
333mg PO Q8H
for 7 days
Syphilis:
30-40mg PO in
divided doses for
10-15 days
Renal
imapairment:
Dose adjustment
is not necessary.
22. • Similar as erythromycin except that it is more active
against
• Mycobacterium avium complex.
• Also has activity against Toxoplasma gondii, M leprae.
Antibacterial
spectrum:
• A 500mg dose produces serum concentrations of 2-3 mcg/ml.
• Has half life of 6 hours, so given Q12H.
• Recommended dosage is 250-500mg Q12H or 1000mg of
extended release formulation once daily.
• Improved oral absorption as compared to erythromycin.
• Metabolized in liver, eliminated in urine.
• Dose reduction unto 250mg once or twice daily is
recommended in patients with creatinine clearance <30ml/min.
Pharmacokinetics:
• Similar as erythromycins.Drug interactions:
23. Oral
suspension:
125mg/5ml 250mg/5ml Tablet: 250mg
500mg
Tablet,
extended
release
500mg
Mycobacterial
infection
500mg PO Q12H
for 7-14 days; use
in combination
with ethambutol
Peptic ulcer
disease
500mg PO Q8-
12H for 10-14
days
Pharyngitis,
Tonsillitis
250mg PO Q12H
for 10 days
Community
acquired
Pneumonia
250mg PO Q12H
for 7-14 days
Skin/Skin
structure
infection
500mg PO twice
daily for 7 days
25. Antibacterial spectrum
• Its spectrum and
clinical uses are
identical to those of
erythromycin.
• It is active against M
avium complex and T
gondii.
• It is slightly less
active against
staphylococci,
streptococci
• More active against H
influenza and
chlamydia.
Pharmacokinetics
• Well absorbed orally.
• Should be administered 1 hour before
or 2 hour after meal.
• A 500mg dose of azithromycin
produces serum concentrations of
approx. 0.4mcg/ml.
• It can penetrate into most tissues
except CSF.
• Its tissue concentration exceeds its
serum concentration by 10-100 folds
(high bioavailability).
• Its elimination half life is 2-4 days.
• Community acquired pneumonia can
be treated with 500mg dose loading
dose, followed by 250mg single daily
dose for next 4 days.
Drug
interactions
• Doesn’t
inactivates
CYP450
enzyme, so it is
free from drug
interactions.
26. Suspension 500mg 2.5g
Suspension
reconstituted
100mg/5ml
200mg/5ml Packet 1g Tablet 250mg, 500mg,
600mg
Acute otitis
media
500mg PO
once, then
250mg once
daily for 4 days
Acute
bacterial
sinusitis
500mg/day PO
for 3 days or 2g
PO once
Genital ulcer
disease
1g PO once
Pharyngitis/
Tonsillitis
500mg PO
once, then
250mg once
daily for 4 days
Uncomplicated
Gonococcal
infections
Ceftriaxone
250mg IM once
+ Azithromycin
1g PO once.
30. DRUG ALLERGIES:
Allergic to Sulfa groups
Penicillin allergic
PAST MEDICATIONS:
NA
PRESENT MEDICATIONS:
Fexofenadine 60mg OD.
Paracetamol 1g BID.
AZITHROMYCIN dehydrate
250mg q12h.
Seven seas OD.
Montelukast sodium 10mg
OD.
31. THERAPEUTIC
INTERVENTIONS:
Azithromycin
should be
prescribed as
500mg once as
loading dose
and then
continued as
250mg q24h.
Azithromycin is
used as a
prophylaxis
therapy of
typhoid, so it
must be stopped
after Typhidot
report to avoid
GI disturbance.
For the
symptomatic
treatment of
non-productive
of cough,
Dextromethorp
han syrup must
be prescribed.Patient
compliance
maybe an issue
in this regimen,
dosage forms
must be
changed.
Proper
counselling
must be done,
wearing a mask
to avoid
pollution and
dust can
improve the
conditions.
32. INTRODUCTION, GENERAL
MECHANISM OF ACTION
OF MACROLIDES,
CLASSIFICATION OF
MACROLIDES,
(KETOLIDES,
FLUOROKETOLIDES, NON-
ANTIBIOTIC MACROLIDES,
ANTIFUNGAL
MACROLIDES, TOXIC
MACROLIDES).
https://en.wikipedia.org/w
iki/Macrolide
RESISTANCE TO
MACROLIDES:
https://aac.asm.org/conte
nt/46/9/2727
SAFETY IN PREGNANCY
AND BREAST FEEDING,
DRUGS INTERACTIONS:
https://bpac.org.nz/bpj/20
12/may/macrolides.aspx
REFERENCES:
1.(similarly to chloramphenicol as well as inhibiting ribosomal translation.
2. Summarize protein synthesis.
3. Macrolides are actively concentrated within leukocytes, and thus are transported into the site of infection.
Wordly meaning of immunomodultion.?
Tell about which organism cause this.?
This is evident, as the treatment dosage is much too low to fight infection, and in DPB cases with the occurrence of the macrolide-resistant bacterium Pseudomonas aeruginosa, macrolide therapy still produces substantial anti-inflammatory results.
Cat:A:-- safe to use, but consider an alternative in the first trimester (unconfirmed reports of an association with congenital cardiac malformations).
Cat:B1 B2:-- considered safe.
Cat:B3:-- uncertain safety in pregnancy, consider an alternative.
Erythromycin and clarithromycin are more commonly associated with medicine interactions than other macrolides. Elderly people and those with renal or liver impairment are more likely to be affected by medicines interacting with macrolides.
1. short-term risk of hypotension or shock amongst elderly people.
2. Warfarin may need to be temporarily stopped or the dose reduced if there is no alternative. The INR should be monitored if warfarin and macrolides are taken at the same time.
3. macrolides inhibiting CYP3A4 enzymes. This can result in an increased risk of statin-induced rhabdomyolysis. Azithromycin interacts less with CYP3A4 enzymes, however, there have also been occasional reports of rhabdomyolysis in patients taking azithromycin, Pravastatin is not significantly metabolised by CYP3A4, therefore is less likely to be affected by concurrent macrolide use.
4. digoxin dose should be reduced by half and the patient monitored for symptoms of toxicity.
Solithromycin, the first and currently the only fluoroketolide (not yet approved).
