The document discusses various topics related to microbiology and antibiotic therapy including: - Types of microbes such as bacteria, fungi, and viruses - Characteristics of bacteria like their shape and whether they require oxygen - Organs of the immune system and how the immune system responds to threats - How microbes can develop resistance through mechanisms like spontaneous mutation, gene transfer, and developing alternative pathways - Classes of antibiotics including those that inhibit cell wall synthesis, protein synthesis, folic acid production, and DNA synthesis as well as common examples and their mechanisms of action

1. Anti-Microbial Therapy Antibiotic Drug Classes Major Indications Therapeutic Effect Adverse Reactions

2. What are Microbes? Microorganisms (Moos) Bacteria Mycoplasms Spirochetes Fungi Viruses

5. What are bacteria? Got Oxygen? Aerobic -need O2 Anaerobic –no O2 Shape Up! Round cocci Rod-like bacilli Spiral spirochetes Gram’s stain Gram positive Gram negative

6. A bit o’history 2000BC Here eat this root. 1000AD That root is heathen, say this prayer. 1850AD That prayer is superstition, drink this potion. 1920AD That potion is snake oil, swallow this pill. 1945AD That pill is ineffective, take this penicillin. 1955AD Oops, bugs mutated, take this tetracycline. 1960-1999AD 39 more mutations, take this more powerful antibiotic. 2000AD The bugs have won ! Here eat this root.

7. Organs of the Immune System The organs of the immune system are stationed throughout the body. Tonsils & Adenoids Thymus Lymph nodes Spleen Appendix Bone marrow

8. The Immune Response Inflammation Protective mechanism of body tissues Histamine, prostaglandins, leukotrienes Fever Increase thermostat set point Body  vasoconstriction, goose flesh, shiver (heat conservation) Re-establish normal set point Body  increase cutaneous blood flow, sweating (heat loss)

10. Moo’s Anatomy cell wall -determines permeability/rigid/barrier cell membrane -controls structure/synthesis of enzymes for cell metabolism chromosome -storage site of genetic info governs cell processes, metabolism & division cytoplasm -metabolic machinery protein syn & metabolism

11. Resistance Gene Exchange Target Molecule Alter drug receptor Alter Entry/Removal of drug/pollutant Inactivate/decompose drug/pollutant Destruction Sequester/by-pass Develop alternate pathways to circumvent AB bacteriophage plasmids chromosome other moos

12. Mutant Species Development Spontaneous Mutation DNA change/adapt Microbial Sex Transduction To lead across Transformation Change condition or function Jumping Genes Conjugation/Acquired Union, fusion 2 gametes for reproduction

13. Four Antibiotic RULES Finish the bottle Don’t be tempted by leftovers Work with your health care provider Don’t skip doses

14. Antibiotic Action Inhibit cell wall synthesis Inhibit protein synthesis Prevent folic acid synthesis Interfere with DNA synthesis

15. Inhibitors of Cell Wall Synthesis Beta Lactam Compounds Penicillin's MOA & Uses Agents Penicillin V Dicloxacillin, Methicillin Ampicillin, Amoxicillin-Clavulanate Mezlocillin, Ticarcillin

16. Cell Wall Inhibitors cont. Bacteriocidal Allergy/Resistance Pharmacokinetics Cephalosporins Cephalexin/Cefadroxil Ceftriazone (Rocephin) Other Inhibitors of Cell Wall Synthesis Vancomycin

17. Inhibitors of Microbial Protein Synthesis (Bacteriostatic) Chloramphenicol Tetracycline Minocycline Macrolides Azithromycin Clarithromycin Erythromycin Clindamycin Amino glycosides Aerobic gram negative microorganisms Streptomycin Tobramycin Gentamycin Miscellaneous Metronidazole Anaerobic bacteria Protozoa

18. Anti-Folate DNA Gyrase Sulfonamides “ Sulfas” Sulfasoxazole Single agent Bacteriostatic Trimethoprim / Sulfamethoxazole Septra DS Bactrim DS Double agents Bacteriocidal Fluoroquinolones “ FLOXACINs Ciprofloxacin Levofloxacin

19. Clinical Implications Use Misuse Patient demand Misdiagnosis Counterfeits Agricultural Use International Travel Super infection 2% of persons TX w/AB

20. Serious Drug Interactions Increase risk of bleed PCN & warfarin PCN & NSAIDs Cephal & warfarin Cephal & NSAIDs Oto & nephrotox Vancomycin & AG Two or more AG Antabuse reaction Metronidazole/Etoh Metronid/disulfiram

21. Summary Slide Organs of the Immune System The Immune Response Moo’s Anatomy & Resistance Four Antibiotic RULES Inhibitors of Cell Wall Synthesis Inhibitors of Microbial Protein Synthesis (Bacteriostatic)

22. Summary Slide (cont.) Anti-Folate DNA Gyrase Serious Drug Interactions

23. Case Study Antibiotics TL is a 29-year-old female, 59 kg, who presents at clinic with a 2-week history of abdominal pain, nocturia and frequency of urination. PE is unremarkable except some lower abdominal tenderness. A clean catch midstream urine sample is collected. The results are 10-25 WBC/HPF with a few gram-positive cocci in clusters and gram negative rods. She is empirically started on Macrobid 100mg bid x 7 days. TL returns to clinic 3 days later with a productive cough, wheezing, and heaviness on her chest and shaking chills. She is severely nauseous. Her breathing is labored with rales and wheezing. Pregnancy results are positive .

24. Points to Ponder Discuss her symptoms and relate them to a possible health problem. Discuss the antibiotic empiric treatment. Should it be changed? Consider the relationship between pregnancy and UTI. What respiratory therapy would you consider?