This summarizes guidelines for treating melioidosis, a potentially fatal infection caused by the bacteria Burkholderia pseudomallei. Treatment involves a two-phase approach. Phase 1 uses intravenous antibiotics like ceftazidime or meropenem to treat acute infection over 2-4 weeks. Phase 2 uses oral combinations of co-trimoxazole and doxycycline for 12-20 weeks to eliminate residual infection and prevent relapse. Other adjunctive therapies are being studied but antibiotics remain the primary treatment. Unresolved issues include the high cost of optimal treatment, assessing response during the long eradication phase, and developing post-exposure prophylaxis guidelines.
This document discusses the development and clinical trials of the drug bortezomib for the treatment of multiple myeloma. It summarizes that:
1) Bortezomib is a proteasome inhibitor that showed promise in preclinical studies for inhibiting multiple myeloma cell growth and inducing apoptosis.
2) Phase 1, 2 and 3 clinical trials demonstrated that bortezomib had significant anti-tumor activity and increased response rates, time to progression, and survival outcomes compared to other treatments in patients with relapsed or refractory multiple myeloma.
3) Combination trials using bortezomib with other drugs, such as dexamethasone, produced even higher response rates, suggesting
1) Three studies showed lower mortality for patients with bacteremic pneumococcal pneumonia treated with antibiotic combination therapy compared to monotherapy.
2) Combination therapy including a beta-lactam plus macrolide is recommended for critically ill patients and those with bacteremic pneumococcal pneumonia based on evidence showing lower mortality compared to fluoroquinolone combinations or monotherapy.
3) The optimal duration of combination therapy for bacteremic pneumococcal pneumonia is unclear but guidelines recommend limiting it to 3-5 days once the pathogen is identified.
This word document deals with the drug profile of albendazole. Important headings, with respect to its pharmacology, along with a note on important drug-related counselling tips for patients and health-care professionals have also been mentioned, with reference to standard textbooks, guidelines and relevant articles.
With newer biologics enriching the armentarium of Dermatologists almost everyday,it is often difficult to recollect all the information at a time.This powerpoint helps to summarise the pathogenesis of psoriasis as well asdifferent aspects of use of biologics in a nutshell.
This presentation focuses on appropriate selection of antibiotics in the ICU and discusses different strategies to optimize this selection with the aim to decrease resistance and improve appropriateness.
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.
Inappropriate Prescribing Of AntimicrobialsMmorshed217
This document discusses inappropriate combinations of antimicrobial agents. It begins by listing common resistant nosocomial pathogens such as Staphylococcus aureus and Pseudomonas aeruginosa. It then examines different classes of antimicrobials and why certain combinations should be avoided. These include combining two beta-lactams which results in therapeutic duplication, or combining a beta-lactam with a carbapenem which can have an antagonistic effect. Other inappropriate combinations discussed are fluoroquinolones with macrolides due to additive QT prolongation effects, and dual anti-anaerobic coverage with metronidazole and clindamycin. The document provides alternatives and references several clinical trials.
This document discusses the role of antibiotics in dental surgery (exodontics). It covers the history of antibiotics, definitions, classifications, mechanisms of action, factors influencing efficacy, rational antibiotic usage, choices of antibiotics, and prevention of misuse and abuse. The key points are:
1. Antibiotics are substances that kill or inhibit the growth of microorganisms. They are classified based on their source, family, spectrum, effect, and gram-positive/negative activity.
2. Antibiotics work by altering bacterial cell membranes, inhibiting cell wall synthesis, and interfering with protein and nucleic acid synthesis. Their efficacy depends on drug binding, bacterial load, host defenses, and ability to reach the infection site.
This document discusses the development and clinical trials of the drug bortezomib for the treatment of multiple myeloma. It summarizes that:
1) Bortezomib is a proteasome inhibitor that showed promise in preclinical studies for inhibiting multiple myeloma cell growth and inducing apoptosis.
2) Phase 1, 2 and 3 clinical trials demonstrated that bortezomib had significant anti-tumor activity and increased response rates, time to progression, and survival outcomes compared to other treatments in patients with relapsed or refractory multiple myeloma.
3) Combination trials using bortezomib with other drugs, such as dexamethasone, produced even higher response rates, suggesting
1) Three studies showed lower mortality for patients with bacteremic pneumococcal pneumonia treated with antibiotic combination therapy compared to monotherapy.
2) Combination therapy including a beta-lactam plus macrolide is recommended for critically ill patients and those with bacteremic pneumococcal pneumonia based on evidence showing lower mortality compared to fluoroquinolone combinations or monotherapy.
3) The optimal duration of combination therapy for bacteremic pneumococcal pneumonia is unclear but guidelines recommend limiting it to 3-5 days once the pathogen is identified.
This word document deals with the drug profile of albendazole. Important headings, with respect to its pharmacology, along with a note on important drug-related counselling tips for patients and health-care professionals have also been mentioned, with reference to standard textbooks, guidelines and relevant articles.
With newer biologics enriching the armentarium of Dermatologists almost everyday,it is often difficult to recollect all the information at a time.This powerpoint helps to summarise the pathogenesis of psoriasis as well asdifferent aspects of use of biologics in a nutshell.
This presentation focuses on appropriate selection of antibiotics in the ICU and discusses different strategies to optimize this selection with the aim to decrease resistance and improve appropriateness.
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.
Inappropriate Prescribing Of AntimicrobialsMmorshed217
This document discusses inappropriate combinations of antimicrobial agents. It begins by listing common resistant nosocomial pathogens such as Staphylococcus aureus and Pseudomonas aeruginosa. It then examines different classes of antimicrobials and why certain combinations should be avoided. These include combining two beta-lactams which results in therapeutic duplication, or combining a beta-lactam with a carbapenem which can have an antagonistic effect. Other inappropriate combinations discussed are fluoroquinolones with macrolides due to additive QT prolongation effects, and dual anti-anaerobic coverage with metronidazole and clindamycin. The document provides alternatives and references several clinical trials.
This document discusses the role of antibiotics in dental surgery (exodontics). It covers the history of antibiotics, definitions, classifications, mechanisms of action, factors influencing efficacy, rational antibiotic usage, choices of antibiotics, and prevention of misuse and abuse. The key points are:
1. Antibiotics are substances that kill or inhibit the growth of microorganisms. They are classified based on their source, family, spectrum, effect, and gram-positive/negative activity.
2. Antibiotics work by altering bacterial cell membranes, inhibiting cell wall synthesis, and interfering with protein and nucleic acid synthesis. Their efficacy depends on drug binding, bacterial load, host defenses, and ability to reach the infection site.
Constance A. Benson, MD, director of the UC San Diego AntiViral Research Center, presents "New Drugs and Novel Approaches to Treatment Shortening for Drug-Susceptible and Drug-Resistant TB" for AIDS Clinical Rounds at UC San Diego
1. Tuberculosis is treated using a combination of drugs to cure the patient, prevent death and disability, prevent relapse, and prevent transmission.
2. The typical drug regimen includes isoniazid, rifampin, pyrazinamide, and ethambutol over two phases - an intensive initial phase and a continuation phase.
3. Drug-resistant tuberculosis including MDR-TB (resistant to at least isoniazid and rifampin) and XDR-TB (resistant to additional drugs) require specialized treatment regimens.
The document summarizes information about a new drug called Sirturo (bedaquiline) that was approved by the FDA for treating multi-drug resistant tuberculosis. Sirturo is the first new tuberculosis drug approved in over 40 years. It works by inhibiting the ATP synthase of Mycobacterium tuberculosis, depleting its energy supply. Clinical trials showed Sirturo was effective in clearing M. tuberculosis from patients' sputum more quickly than placebo. The FDA approval of Sirturo provides an important new treatment option for multi-drug resistant tuberculosis.
Metronidazole benzoate 200mg per 5ml oral suspension smpc taj pharmaceuticalsTaj Pharma
Metronidazole benzoate - Drug Information - Taj Pharma, Metronidazole benzoate dose Taj pharmaceuticals Metronidazole benzoate interactions, Taj Pharmaceutical Metronidazole benzoate contraindications, Metronidazole benzoate price, Metronidazole benzoate Taj Pharma Metronidazole benzoate 200mg/5ml Oral Suspension SMPC- Taj Pharma . Stay connected to all updated on Metronidazole benzoate Taj Pharmaceuticals Taj pharmaceuticals Hyderabad.
pharmmacovigilance case of Meropenem induced Neutropenia Pranesh Pawaskar
This case report describes a 13-year-old male who developed neutropenia after treatment with meropenem for pyomyositis with sepsis and pyogenic meningitis. The patient's neutrophil count decreased after initiation of meropenem therapy and recovered after the drug was discontinued. Based on the Naranjo causality assessment scale, the neutropenia was determined to be a possible adverse drug reaction to meropenem. Meropenem is known to rarely cause neutropenia through its mechanism of inhibiting granulocyte production in the bone marrow.
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.
This document discusses principles of antibiotic use in the ICU. It begins by providing background on the development of antibiotics starting in the 1930s-1940s. It then defines antibiotics and lists qualities of good antibiotic agents. The document focuses on the main classes of antibiotics used in the ICU, including beta-lactams, fluoroquinolones, macrolides, aminoglycosides, glycopeptides, and others. It also covers classification of antibiotics, appropriate timing and duration of therapy, and provides guidelines for empirical antibiotic therapy based on site of infection.
This document provides information on antibiotics and analgesics used for periodontal diseases. It defines antibiotics as agents that destroy or inhibit the growth of microorganisms. Various antibiotics discussed that are used for periodontal diseases include tetracyclines, metronidazole, penicillins, cephalosporins, clindamycin, ciprofloxacin, and macrolides. It also discusses local delivery methods for antibiotics. Analgesics are defined as drugs that selectively relieve pain. The classes discussed include non-opioid types like aspirin, acetaminophen, ibuprofen and opioid types like morphine, codeine, synthetic opioids, and their mechanisms and side effects.
Overview and classification of chemotherapeutic agents and theorySaurabh Gupta
This document provides an overview of chemotherapy. It discusses key figures in the development of chemotherapy like Paul Ehrlich and Sidney Farber. It describes different classes of chemotherapeutic agents including alkylating agents, antimetabolites, antitubulins, topoisomerase inhibitors, antibiotics, and their mechanisms and uses for treating various cancers. Side effects of different drug classes are also outlined.
This document summarizes aminoglycoside antibiotics including their structure, mechanism of action, spectrum of activity, pharmacokinetics, uses, toxicity and dosing. Aminoglycosides are bactericidal antibiotics that bind to the bacterial ribosome and inhibit protein synthesis. They are effective against many aerobic gram-negative bacilli and some gram-positives. Common examples discussed are amikacin, gentamicin and tobramycin. Toxicities include nephrotoxicity and ototoxicity. Proper dosing and monitoring of drug and renal function levels can reduce toxicity while optimizing treatment.
This document discusses drug therapy for tuberculosis. It begins by defining different types of TB cases such as drug sensitive TB, multidrug resistant TB, and extensively drug resistant TB. It then outlines the objectives and approaches to TB treatment, including using a combination of four anti-TB drugs over an intensive and continuation phase. Specific drug regimens are provided for new cases and previously treated cases, including categories and timelines. Guidelines for multidrug resistant and extensively drug resistant TB treatment are also summarized, including new drugs available.
Lymphoma which chemotherapy protocol and whygalileotdb
Lymphoma is the most common hematologic cancer in dogs. The current standard of care is a doxorubicin-based combination chemotherapy protocol like CHOP, which provides the longest period of disease control and survival of approximately 12-13 months. Single agent protocols provide shorter remission periods of 1-7 months and are lower cost options for some owners. The article reviews various chemotherapy protocols ranging from prednisone to CHOP to help clinicians determine the best treatment plan for each patient and owner situation.
This document provides an overview of the management of drug-resistant tuberculosis (DR-TB). It defines different types of DR-TB including mono-resistant TB, poly-resistant TB, multidrug-resistant TB (MDR-TB), and extensively drug-resistant TB (XDR-TB). It discusses the epidemiology, mechanisms of drug resistance, clinical features, diagnosis, and treatment regimens for MDR-TB and XDR-TB according to WHO guidelines. The treatment regimens involve the use of second-line drugs including fluoroquinolones, aminoglycosides, ethionamide, cycloserine, linezolid, and others. Strict adherence to treatment is important to prevent the development
Vancomycin is the drug of choice for MRSA infections. Clindamycin can be used in this case since the culture showed sensitivity to clindamycin. Clindamycin is an acceptable alternative to vancomycin for skin and soft tissue infections caused by MRSA.
Antibiotics /certified fixed orthodontic courses by Indian dental academy Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
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.
5 aminoglycosides,macrolides, anti tb dentalIAU Dent
This document discusses various classes of antibiotics including aminoglycosides, macrolides, and antitubercular drugs. It provides details on specific antibiotics within each class, including their mechanisms of action, uses, and adverse effects. It notes that aminoglycosides include gentamicin and tobramycin which can be used both locally and systemically. Macrolides discussed include erythromycin, clarithromycin, and azithromycin which bind the 50S ribosomal subunit. Common first-line antitubercular drugs are isoniazid, rifampicin, pyrazinamide, and ethambutol which are used in combination for short course chemotherapy to rapidly kill tuberculosis organisms.
Clinical Pharmacology MCQS
PART CHEMOTHERAPY . Chemotherapy are part of clinical pharmacoloy deal with the infections. this learn about the medicine curing viral infection , bacterial infection , and other parasites such as ascaris , trichomonas etc,.....It ie better that this kind ofmedicne are handled carefully and used properly since the misuse of them cause many socialproblemof death increasing due to the resistance of microbe .
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 antimycobacterial drugs used to treat tuberculosis and other mycobacterial infections. It provides information on various first-line drugs including isoniazid, rifampin, pyrazinamide, ethambutol, and streptomycin. It notes that combinations of two or more drugs are required to treat mycobacterial infections due to slow growth and potential drug resistance. Treatment must be prolonged, typically for months to years, to eliminate both actively dividing and dormant bacteria. Second-line drugs are discussed for treatment of multi-drug resistant infections. Worldwide tuberculosis statistics and drug regimens are also summarized.
Constance A. Benson, MD, director of the UC San Diego AntiViral Research Center, presents "New Drugs and Novel Approaches to Treatment Shortening for Drug-Susceptible and Drug-Resistant TB" for AIDS Clinical Rounds at UC San Diego
1. Tuberculosis is treated using a combination of drugs to cure the patient, prevent death and disability, prevent relapse, and prevent transmission.
2. The typical drug regimen includes isoniazid, rifampin, pyrazinamide, and ethambutol over two phases - an intensive initial phase and a continuation phase.
3. Drug-resistant tuberculosis including MDR-TB (resistant to at least isoniazid and rifampin) and XDR-TB (resistant to additional drugs) require specialized treatment regimens.
The document summarizes information about a new drug called Sirturo (bedaquiline) that was approved by the FDA for treating multi-drug resistant tuberculosis. Sirturo is the first new tuberculosis drug approved in over 40 years. It works by inhibiting the ATP synthase of Mycobacterium tuberculosis, depleting its energy supply. Clinical trials showed Sirturo was effective in clearing M. tuberculosis from patients' sputum more quickly than placebo. The FDA approval of Sirturo provides an important new treatment option for multi-drug resistant tuberculosis.
Metronidazole benzoate 200mg per 5ml oral suspension smpc taj pharmaceuticalsTaj Pharma
Metronidazole benzoate - Drug Information - Taj Pharma, Metronidazole benzoate dose Taj pharmaceuticals Metronidazole benzoate interactions, Taj Pharmaceutical Metronidazole benzoate contraindications, Metronidazole benzoate price, Metronidazole benzoate Taj Pharma Metronidazole benzoate 200mg/5ml Oral Suspension SMPC- Taj Pharma . Stay connected to all updated on Metronidazole benzoate Taj Pharmaceuticals Taj pharmaceuticals Hyderabad.
pharmmacovigilance case of Meropenem induced Neutropenia Pranesh Pawaskar
This case report describes a 13-year-old male who developed neutropenia after treatment with meropenem for pyomyositis with sepsis and pyogenic meningitis. The patient's neutrophil count decreased after initiation of meropenem therapy and recovered after the drug was discontinued. Based on the Naranjo causality assessment scale, the neutropenia was determined to be a possible adverse drug reaction to meropenem. Meropenem is known to rarely cause neutropenia through its mechanism of inhibiting granulocyte production in the bone marrow.
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.
This document discusses principles of antibiotic use in the ICU. It begins by providing background on the development of antibiotics starting in the 1930s-1940s. It then defines antibiotics and lists qualities of good antibiotic agents. The document focuses on the main classes of antibiotics used in the ICU, including beta-lactams, fluoroquinolones, macrolides, aminoglycosides, glycopeptides, and others. It also covers classification of antibiotics, appropriate timing and duration of therapy, and provides guidelines for empirical antibiotic therapy based on site of infection.
This document provides information on antibiotics and analgesics used for periodontal diseases. It defines antibiotics as agents that destroy or inhibit the growth of microorganisms. Various antibiotics discussed that are used for periodontal diseases include tetracyclines, metronidazole, penicillins, cephalosporins, clindamycin, ciprofloxacin, and macrolides. It also discusses local delivery methods for antibiotics. Analgesics are defined as drugs that selectively relieve pain. The classes discussed include non-opioid types like aspirin, acetaminophen, ibuprofen and opioid types like morphine, codeine, synthetic opioids, and their mechanisms and side effects.
Overview and classification of chemotherapeutic agents and theorySaurabh Gupta
This document provides an overview of chemotherapy. It discusses key figures in the development of chemotherapy like Paul Ehrlich and Sidney Farber. It describes different classes of chemotherapeutic agents including alkylating agents, antimetabolites, antitubulins, topoisomerase inhibitors, antibiotics, and their mechanisms and uses for treating various cancers. Side effects of different drug classes are also outlined.
This document summarizes aminoglycoside antibiotics including their structure, mechanism of action, spectrum of activity, pharmacokinetics, uses, toxicity and dosing. Aminoglycosides are bactericidal antibiotics that bind to the bacterial ribosome and inhibit protein synthesis. They are effective against many aerobic gram-negative bacilli and some gram-positives. Common examples discussed are amikacin, gentamicin and tobramycin. Toxicities include nephrotoxicity and ototoxicity. Proper dosing and monitoring of drug and renal function levels can reduce toxicity while optimizing treatment.
This document discusses drug therapy for tuberculosis. It begins by defining different types of TB cases such as drug sensitive TB, multidrug resistant TB, and extensively drug resistant TB. It then outlines the objectives and approaches to TB treatment, including using a combination of four anti-TB drugs over an intensive and continuation phase. Specific drug regimens are provided for new cases and previously treated cases, including categories and timelines. Guidelines for multidrug resistant and extensively drug resistant TB treatment are also summarized, including new drugs available.
Lymphoma which chemotherapy protocol and whygalileotdb
Lymphoma is the most common hematologic cancer in dogs. The current standard of care is a doxorubicin-based combination chemotherapy protocol like CHOP, which provides the longest period of disease control and survival of approximately 12-13 months. Single agent protocols provide shorter remission periods of 1-7 months and are lower cost options for some owners. The article reviews various chemotherapy protocols ranging from prednisone to CHOP to help clinicians determine the best treatment plan for each patient and owner situation.
This document provides an overview of the management of drug-resistant tuberculosis (DR-TB). It defines different types of DR-TB including mono-resistant TB, poly-resistant TB, multidrug-resistant TB (MDR-TB), and extensively drug-resistant TB (XDR-TB). It discusses the epidemiology, mechanisms of drug resistance, clinical features, diagnosis, and treatment regimens for MDR-TB and XDR-TB according to WHO guidelines. The treatment regimens involve the use of second-line drugs including fluoroquinolones, aminoglycosides, ethionamide, cycloserine, linezolid, and others. Strict adherence to treatment is important to prevent the development
Vancomycin is the drug of choice for MRSA infections. Clindamycin can be used in this case since the culture showed sensitivity to clindamycin. Clindamycin is an acceptable alternative to vancomycin for skin and soft tissue infections caused by MRSA.
Antibiotics /certified fixed orthodontic courses by Indian dental academy Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
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.
5 aminoglycosides,macrolides, anti tb dentalIAU Dent
This document discusses various classes of antibiotics including aminoglycosides, macrolides, and antitubercular drugs. It provides details on specific antibiotics within each class, including their mechanisms of action, uses, and adverse effects. It notes that aminoglycosides include gentamicin and tobramycin which can be used both locally and systemically. Macrolides discussed include erythromycin, clarithromycin, and azithromycin which bind the 50S ribosomal subunit. Common first-line antitubercular drugs are isoniazid, rifampicin, pyrazinamide, and ethambutol which are used in combination for short course chemotherapy to rapidly kill tuberculosis organisms.
Clinical Pharmacology MCQS
PART CHEMOTHERAPY . Chemotherapy are part of clinical pharmacoloy deal with the infections. this learn about the medicine curing viral infection , bacterial infection , and other parasites such as ascaris , trichomonas etc,.....It ie better that this kind ofmedicne are handled carefully and used properly since the misuse of them cause many socialproblemof death increasing due to the resistance of microbe .
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 antimycobacterial drugs used to treat tuberculosis and other mycobacterial infections. It provides information on various first-line drugs including isoniazid, rifampin, pyrazinamide, ethambutol, and streptomycin. It notes that combinations of two or more drugs are required to treat mycobacterial infections due to slow growth and potential drug resistance. Treatment must be prolonged, typically for months to years, to eliminate both actively dividing and dormant bacteria. Second-line drugs are discussed for treatment of multi-drug resistant infections. Worldwide tuberculosis statistics and drug regimens are also summarized.
This document discusses multi-drug resistant tuberculosis (MDR TB). It begins with an introduction to TB and definitions of key terms like MDR and XDR TB. It then describes first and second line anti-TB drugs, mechanisms of drug resistance, and factors contributing to acquired resistance. The document outlines methods for diagnosing drug resistance including genetic detection and drug sensitivity testing. It concludes with a brief overview of treatment approaches for MDR TB.
This document discusses antiprotozoal agents used to treat common protozoal infections in humans. It begins by listing common protozoal infections such as amoebiasis, giardiasis, malaria, and toxoplasmosis. It then covers the life cycles of Entamoeba histolytica and Giardia lambia. The document classifies antiamoebic drugs as tissue amoebicides or luminal amoebicides. It provides details on nitroimidazoles, alkaloids, chloroquine, diloxanide furoate, and other drugs. For giardiasis, it recommends nitroimidazoles like metronidazole and tinid
The document summarizes chemotherapy for tuberculosis. It discusses first and second line drugs used to treat TB, including isoniazid, rifampin, pyrazinamide, ethambutol, and streptomycin. It describes the mechanisms of action, dosages, and categories of TB treatment, which involve a two-month intensive initial phase followed by a four to six-month continuation phase. Guidelines are provided for treating different TB cases based on disease severity and drug resistance.
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.
Pharmacotherapy Of Tuberculosis infection.pptxdrsriram2001
Tuberculosis (TB) is a contagious infectious disease caused by the bacterium Mycobacterium tuberculosis. It primarily affects the lungs but can also affect other parts of the body, such as the brain, kidneys, or spine. Here's a four-step explanation of tuberculosis:
Cause and Transmission: Tuberculosis is caused by the bacterium Mycobacterium tuberculosis. When an infected person with active TB coughs, sneezes, or talks, they release droplets containing the bacteria into the air. Another person can become infected by inhaling these droplets. TB is primarily transmitted through the air, making close and prolonged contact with an infected individual the main risk factor for transmission.
Symptoms: TB can manifest differently depending on whether it's active or latent. Latent TB infection occurs when the bacteria are present in the body but are not causing symptoms or spreading to others. Active TB disease occurs when the bacteria are actively multiplying and causing symptoms. Common symptoms of active TB include a persistent cough, chest pain, coughing up blood, fatigue, weight loss, fever, and night sweats.
Diagnosis: Diagnosis of TB involves several steps. Firstly, a medical history and physical examination are conducted to assess symptoms and risk factors. Following this, diagnostic tests such as the tuberculin skin test (TST) or interferon-gamma release assays (IGRAs) are used to determine if a person has been infected with TB bacteria. If these tests are positive, further tests such as chest X-rays, sputum tests, or cultures may be performed to confirm active TB disease and determine the most effective treatment.
Treatment and Prevention: Treatment for TB usually involves a combination of antibiotics taken for several months. Commonly used antibiotics include isoniazid, rifampin, ethambutol, and pyrazinamide. It's essential to complete the full course of treatment to prevent the development of drug-resistant strains of TB. Additionally, preventive measures such as vaccination with the Bacillus Calmette-Guérin (BCG) vaccine, good ventilation in living and working spaces, and early identification and treatment of active cases can help control the spread of TB.
This research report compares the pharmacodynamics of intermittent and prolonged infusions of piperacillin/tazobactam using Monte Carlo simulations and pharmacokinetic data from hospitalized patients. The authors found that prolonged infusion regimens of 3.375 g or more every 8 hours achieved excellent target attainment against common gram-negative pathogens like E. coli and Enterobacteriaceae with MICs up to 16 μg/mL, using lower daily doses than standard intermittent regimens. However, none of the regimens tested provided optimal coverage against Pseudomonas aeruginosa and Klebsiella pneumoniae.
This document provides information on broad spectrum antibiotics chloramphenicol and tetracyclines. It discusses their mechanisms of action, resistance mechanisms, pharmacokinetics, therapeutic uses, and adverse effects. Chloramphenicol and tetracyclines are bacteriostatic and inhibit bacterial protein synthesis. Their overuse led to many resistant bacterial strains. Recent interest in their clinical use has increased due to fewer resistant bacteria. The document also introduces tigecycline, a newer glycylcycline antibiotic derivative of minocycline active against resistant bacteria.
Cyclosporine is an immunosuppressive drug that was originally isolated from fungi in 1970 and approved by the FDA for transplant rejection in 1983. It is a cyclic polypeptide consisting of 11 amino acids that acts by inhibiting T cell activation through the calcineurin/NFAT pathway. It has since been approved for treating various dermatological conditions like psoriasis, atopic dermatitis, and pyoderma gangrenosum. While effective, cyclosporine use can cause nephrotoxicity, hypertension, and increased risk of infection and skin cancer with long term use. It can also interact with various other drugs that are metabolized through the CYP3A4 pathway.
Doxycycline 100mg capsules smpc taj pharmaceuticalsTaj Pharma
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- Macrolides are a class of antibiotics that are produced by Streptomyces bacteria and contain a macrocyclic lactone ring. Erythromycin was the first macrolide discovered in 1952.
- Macrolides work by attaching to the 50S subunit of bacterial ribosomes and inhibiting protein synthesis. They are bacteriostatic and have selectivity for bacterial over mammalian cells.
- Common macrolides include erythromycin, clarithromycin, roxithromycin, and azithromycin. They are effective against many gram-positive bacteria and some gram-negatives. Azithromycin has the broadest spectrum of activity.
This document discusses tetracycline antibiotics. It notes that tetracyclines reversibly bind to the 30S ribosome and inhibit aminoacyl-tRNA binding. They are broad spectrum antibiotics active against most bacteria except Proteus and Pseudomonas. Resistance can develop through decreased cell permeability, increased drug efflux, ribosomal protection, or enzymatic inactivation. Common tetracyclines include doxycycline, minocycline and tetracycline itself. Adverse effects include gastrointestinal issues, renal impairment, hepatotoxicity and tooth discoloration in children. Drug interactions and contraindications are also discussed.
This document discusses the appropriate use of antibiotics in emergency settings. It begins with an introduction on the need for early empiric antibiotic therapy in some infections. It then outlines the indications and spectrum of activity of commonly used antibiotics for conditions like UTI, meningitis, pneumonia, and soft tissue infections. It emphasizes that delays in administering antibiotics in conditions like meningitis and sepsis are associated with worse outcomes.
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Melioid 2010
1. Pharmaceuticals 2010, 3, 1296-1303; doi:10.3390/ph3051296
OPEN ACCESS
pharmaceuticals
ISSN 1424-8247
www.mdpi.com/journal/pharmaceuticals
Review
The Treatment of Melioidosis
Timothy J.J. Inglis 1,2,3
1
Division of Microbiology & Infectious Diseases, PathWest Laboratory Medicine WA, QEII
Medical Centre, Nedlands, WA 6009, Australia; E-Mail: tim.inglis@health.wa.gov.au;
Tel.: +61-8-9346-3461; Fax: +61-8-9381-7139
2
Microbiology & Immunology, School of Biomedical, Biomolecular and Chemical Sciences, Faculty
of Life & Applied Sciences, University of Western Australia, Crawley, WA 6009, Australia
3 School of Pathology and Laboratory Medicine, Faculty of Medicine & Dentistry, University of
Western Australia, Crawley, WA 6009, Australia
Received: 19 January 2010; in revised form: 29 March 2010/ Accepted: 20 April 2010 /
Published: 27 April 2010
Abstract: Melioidosis is a complex bacterial infection, treatment of which combines the
urgency of treating rapidly fatal Gram negative septicaemia with the need for eradication of
long-term persistent disease in pulmonary, soft tissue, skeletal and other organ systems.
Incremental improvements in treatment have been made as a result of multicentre
collaboration across the main endemic region of Southeast Asia and northern Australia.
There is an emerging consensus on the three main patterns of antimicrobial chemotherapy;
initial (Phase 1) treatment, subsequent eradication (Phase 2) therapy and most recently post-
exposure (Phase 0) prophylaxis. The combination of agents used, duration of therapy and
need for adjunct modalities depends on the type, severity and antimicrobial susceptibility of
infection. New antibiotic and adjunct therapies are at an investigational stage but on
currently available data are unlikely to make a significant impact on this potentially fatal
infection.
Keywords: melioidosis; treatment; antibiotics; adjunct therapy
1. Introduction
Melioidosis is a potentially fatal infection caused by the Gram negative bacillus, Burkholderia
pseudomallei, following an encounter with contaminated soil or surface water. Like other
environmental bacteria, B. pseudomallei is highly resistant to many antibiotics. The antibiotics
2. Pharmaceuticals 2010, 3 1297
normally used for first line treatment of Gram negative septicaemia (e.g., ampi-/amoxycillin,
aminoglycosides, ceftriaxone) are ineffective in the treatment of melioidosis, highlighting the need for
recognition of melioidosis when presumptive antimicrobial therapy is commenced. In other words, the
decision to treat melioidosis and the choice of antimicrobial agent may have to be taken before any
laboratory results are available to guide clinical decision-making. Lengthy courses of treatment are
required, including a prolonged eradication phase.
Table 1. Melioidosis treatment summary.
Application Agent Amount * Route Frequency Duration Variations References
Phase 0: post-exposure prophylaxis
Within 24 hr trimethoprim- 320:1600 p.o. 12 hourly 3 weeks a amoxicillin/ [30,31]
of high- sulphamethoxazole mg clavulanic acid if
probability allergic to
exposure a trimethoprim-
sulpha-methoxazole
Phase 1: acute & severe infection, induction stage
Alternative Ceftazidime 2g i.v. b 8 hourly 14 days 4-8 weeks for deep [1,2,3,5]
agents for OR Meropenem 1g (2g for i.v. 8 hourly 14 days infection [2,6]
primary C.N.S.
therapy infection
OR Imipenem 1g i.v. 8 hourly 14 days [5]
Adjunct AND 320:1600 p.o. c 12 hourly 14 days for neurological, [1,2,3]
therapy for trimethoprim- mg prostatic, bone,
deep-seated sulphamethoxazole joint infections
focal infection
AND folic acid 5 mg p.o. daily
AND consider 263 μg s.c. daily 3 days Within 72 hrs of [20, 21]
G-CSF d admission
Step-down Ceftazidime 6 g in 240 i.v. 24 hour 2-4 weeks For hospital in the [9]
combination mL Normal infusion home (HITH)
for outpatient saline
or extension AND 320:1600 p.o. 12 hourly
clinic use trimethoprim- mg
sulphamethoxazole
Phase 2: eradication stage
2 of , in order trimethoprim- 320;1600 p.o. 12 hourly 3 monthse Subject to antibiotic [13]
of preference, sulphamethoxazole mg susceptibility
after Phase 1 doxycycline 100 mg p.o. 12 hourly 3 months [13]
or for primary amoxicillin/ 500/125 mg p.o. 8 hourly 3 months [14,15]
use in clavulanic acid
superficial
infections
folic acid 5 mg p.o. daily 3 months With trimethoprim- [30]
sulphamethoxazole
* doses may require adjustment in renal failure a suggested by expert consensus, but lacks trial-
based clinical evidence; b doses provided as guide only based on 70kg male; c i.v. = intravenous,
p.o. = oral, d G-CSF = granulocyte- colony stimulating factor; e some recommend 5 months
eradication therapy.
2. Therapeutic Guidelines
There have been several attempts to formulate clinical guidelines for clinicians faced with patients
who might have melioidosis [1,2]. One in particular reviewed the then available literature for evidence
of efficacy, and addressed the more difficult dilemmas in clinical therapeutics including duration of
3. Pharmaceuticals 2010, 3 1298
treatment, the value of combination therapy, the need for prolonged eradication therapy and the role of
other treatment modalities [1]. The key recommendations were use of the cephalosporin Ceftazidime
or a carbapenem antibiotic for initial treatment of acute infection over 2-4 weeks and a combination of
co-trimoxazole and doxycycline for eradication over a 12-20 week period. Broadly similar
recommendations set in the context of diagnostic and clinical review of Australian experience were
adapted for use in the emerging disease setting of South and Central America [2]. More recently, those
recommendations were updated by an Australian group noted for clinical trials on melioidosis therapy
[3]. The key features of these guidelines and other recommendations reviewed here are summarized in
Table 1.
3. Antibiotic Choice
The antibiotics used to treat melioidosis fall into two distinct categories: (a) those suitable for the
treatment of the acute septicaemia phase of disease (phase 1), and (b) those used in the subsequent
eradication phase of therapy, previously known as "maintenance" therapy (phase 2).
3.1. Phase 1, acute infection
The principal choice of agents used in the first phase comprises a cephalosporin, usually
Ceftazidime, or a carbapenem, usually Meropenem. Alternatives such as cefepime and imipenem have
both been proposed for acute therapy, and Imipenem has been successfully used in clinical practice
[4,5]. There has been a recent shift from Ceftazidime to Meropenem in some centres [6] due to
concerns over the risk of Ceftazidime resistance and poor cellular bioavailability, compared with the
good intracellular penetration of carbapenem antibiotics. Though reduced intracellular efficacy was
demonstrated in an in vitro model [7], laboratory studies do not yet indicate a high level of antibiotic
resistance in B. pseudomallei to any of the agents used to treat the acute phase (phase 1) of infection
[8]. Ceftazidime can be administered as a continuous infusion via an elastomeric device, and has
produced satisfactory outcomes when used to continue Phase 1 therapy of acute melioidosis as
outpatient therapy in remote Australian communities [9]. Concerns about early relapse of septicaemic
infection have led some to recommend combination of co-trimoxazole with Ceftazidime to augment
the latter’s bactericidal effect. This has been shown to be unnecessary [10], and there is a case report
of the combination having a potentially antagonistic effect on intracellular B. pseudomallei [11]. The
same report highlights a possible additive effect of simultaneous use of a Carbapenem and a
fluoroquinolone agent, such as Ciprofloxacin, subject to initial antimicrobial susceptibility testing.
Where decisions on use of co-trimoxazole are likely to be informed by antimicrobial susceptibility
testing, susceptibility should be assessed in the laboratory by an MIC method such as e-test, rather
than disk diffusion or break point. No prospective randomised trial of Ceftazidime versus meropenem
has been conducted yet, so the question of which antimicrobial agent has superior efficacy in acute
infection remains open. What is a little more clear is the duration of treatment, which needs to be a
minimum of two weeks in patients with a positive blood culture [1,7], though such a short course
would be exceptional and restricted to patients without any of the recognised invasive disease-
promoting co-morbidities of diabetes, chronic renal failure and alcoholic liver disease or any indicators
of deep-seated infection, secondary dissemination or predictably slow response to therapy. More
4. Pharmaceuticals 2010, 3 1299
commonly, patients receive 3-4 weeks of intravenous therapy and close monitoring of their clinical
progress. At the other extreme, patients with disease severe enough to require intensive care (e.g.
multiple organ systems failure) may need longer intravenous antibiotic therapy, and can be cured of
life-threatening septicaemia with multiple organ failure by aggressive and co-coordinated
management [11].
3.2. Phase 2, eradication therapy
Conversion to eradication antibiotic therapy needs careful supervision because this is the point at
which some patients are at risk of septicaemic relapse [12]. It is common practice to briefly overlap
initial intravenous and eradication antibiotic therapy in order to assess tolerance of the oral eradication
agents, though this dual approach is unnecessary if co-trimoxazole has been used throughout Phase 1.
There has been considerable discussion of the best combination of agents. Co-trimoxazole and
doxycycline is a suitable combination therapy for eradication [13], and co-trimoxazole alone has been
used successfully for eradication therapy in the Northern Territory of Australia. Co-amoxyclav has
been widely used in combination with one or more of the others but is unsuitable for single use and is
may be counterproductive, particularly when given at suboptimal dose intervals [14]. Consensus
guidelines for use of amoxicillin/clavulanic acid as a second line agent have been developed recently
[15]. Previous use of the term 'maintenance therapy' to describe this phase of melioidosis
chemotherapy was misleading. The aim is better rendered by describing it as “eradication”, since the
purpose is to completely remove any residual infection that might relapse at a later date. The
mechanism of relapse after prolonged sequestration or dormancy of B. pseudomallei in tissue
macrophages and other privileged sites is poorly understood. A proportion of these infections may in
fact be due to re-infection, rather than relapse [16]. Nevertheless, application of an aggressive two-
phase approach to treatment reduces the risk of relapse occurring, as was shown recently in Malaysia
where a state melioidosis registry had the unexpected effect of reducing the relapse rate [17]. A period
of 12-20 weeks eradication therapy is now widely used with good evidence for efficacy [18], but a
small number of patients may require a longer period of Phase 2 eradication treatment. These are
patients with extensive underlying co-morbidity in which complete eradication is an unrealistic goal,
particularly when the disease is multifocal and unresponsive to antimicrobial chemotherapy. Some of
these patients may in fact have re-infections rather than true relapses. Given the potential implications
for patient management of these two possible explanations for a second B. pseudomallei infection, a
scoring system has been proposed to help distinguish melioidosis relapse from re-infection [19].
4. Other Therapeutic Agents
The baseline melioidosis mortality rate of 35% reported in Thailand and 19% in Australia has led
some centres to consider the use of complementary, non-antibiotic interventions in severe septicaemic
infections [1,3,11]. Granulocyte colony stimulating factor (G-CSF) has been tried as an early
intervention in severe acute melioidosis in an uncontrolled retrospective study performed in Northern
Australia [20]. Disappointing results were demonstrated in a recent randomised controlled trial of G-
CSF for the treatment of septicaemic melioidosis in Thailand, although longer survivals were observed
in individual cases [21]. Other potential adjunctive agents for which there is less clinical efficacy data
5. Pharmaceuticals 2010, 3 1300
include human recombinant activated protein C [22], which has been used in other forms of Gram
negative septicaemia, in order to modify the host response to overwhelming infection. There is
growing interest in a potential role for statins in the management of acute melioidosis, following the
incidental observation that patients with systemic bacterial infection fare better if they receive statin
treatment [23]. In vitro studies into statin activity on B. pseudomallei are at an early stage. There is as
yet no published clinical experience specific to melioidosis. A recent critical review of clinical trials of
statin use in sepsis found a modest and inconsistent effect on clinical outcome [24], and highlights how
difficult it will be to assess the impact of this family of non-antibiotic agents on the early stages of a
sporadic infection. It is likely that statins will find a place in the treatment of melioidosis only after a
more extensive theoretic and in vitro case has been built for their use and assessed in the setting of
randomized clinical trials.
5. Unresolved Issues
Treatment of melioidosis is a challenge even where there are adequate resources to support patients
with multiple organ failure and extensive clinical experience. In resource-poor settings, the cost of
optimal Phase 1 and 2 therapy imposes severe restraints and is a likely contributor to unsuccessful
clinical outcomes. The duration of the phase 1 of antimicrobial therapy is longer than for most other
infections. Pressure on hospital bed occupancy has led to evaluation of a hospital-in-the-home
approach which has been successfully used in northern Australia [9]. However, the longer phase 2 of
treatment has its own specific challenges, such as compliance and monitoring. Clinical progress
assessment and laboratory tests suitable for the first phase of treatment are not as helpful by this stage.
C-reactive protein has been used in this role for many years [25], but is unreliable as a sole indicator of
imminent relapse [26]. If the earlier phase of initial therapy has been successful, disease will be
subclinical; its persistence entirely at a tissue and cellular level. This partly explains the preference
some authorities have for longer courses of Phase 2 eradication therapy. The approach taken by the
Pahang Melioidosis Registry [17] will in future permit an evaluation of adherence to the 12-20 week
phase two treatment and its long term impact on late relapse.
A specific issue raised by the emphasis on biosecurity is a need for post-exposure prophylaxis [27].
Though this has not been required for treatment of first responders to a bioterrorism incident involving
B. pseudomallei, there are occasional accidental exposures in the clinical laboratory [28], and during
field investigations of outbreaks when high bacterial concentrations may be encountered [29].
Consensus guidelines have been developed and rely on a combination of prompt risk assessment after
the event, susceptibility testing of bacterial isolates, post-exposure prophylaxis with one or more of the
preferred agents, and careful clinical monitoring [30]. Laboratory experiments with an animal model
indicate that there is a 48hr window for administration of post-exposure prophylaxis [31]. However,
this has probably done little more than slow disease progression in laboratory animals. There is
therefore no reliable evidence to support the use or choice of Phase 0 prophylaxis regimens
The search for improvements in melioidosis treatment continues with the release of new
antimicrobial agents. The new carbapenem Doripenem and the cephalosporin Ceftobiprole have both
been shown to have bactericidal activity against B. pseudomallei in laboratory studies [32,33], but
have yet to evaluated in clinical trials. Other promising new agents that may have a role in the
6. Pharmaceuticals 2010, 3 1301
treatment of melioidosis in future include Ceftalorine and Iclaprim, but assessment of their efficacy is
at an earlier stage.
6. Conclusions
Melioidosis is a difficult infection to manage, not least because of its capacity to cause a rapidly
fatal outcome despite the use of appropriate antibiotics. There has been modest progress in the last two
decades, though mainly in the details of treatment delivery. At present, a universally effective and
inexpensive treatment remains outside our grasp.
Acknowledgements
I thank the colleagues who encouraged and developed my interest in clinical aspects of melioidosis,
particularly Bart Currie, and Rob Norton, David Dance, Ronan Murray and Chris Heath. I am grateful
to Ronan Murray for his advice on this article prior to submission.
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22 Tan, C.K.; Chan, K.S.; Yu, W.L.; Chen, C.M.; Cheng, K.C. Successful treatment of life-
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