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antibiotics and their usages

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by

Tatsuki Abe

on 25 June 2013

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Transcript of antibiotics and their usages

Antibacterials
Classes and Clinical Uses

what are antibiotics?
compounds that can inhibit the growth / destroy micro-organisms

can be natural / synthetic

this Prezi will divide the classes of antibiotics by mechanisms of action ;
inhibitors of cell wall synthesis
inhibitors of protein synthesis
inhibitors of nucleic acid synthesis
action on cell membranes
protein synthesis inhibitors
penicillins
cephalosporins
carbapenems
monobactams
benzyl - penicillins
beta-lactamase stable penicillins
broad-spectrum penicillins
Beta-lactum & betalactamase inhibitor combo
Very effective antibiotic against staphylococci, streptococci, spirochaetes
Destroyed by beta-lactamase
Clinical Uses
Streptococcal infections
eg pharyngitis, skin infections
Pneumococcal pneumonia
Syphilis, leptospirosis

Cloxacillin, flucloxacillin

Treatment of beta-lactamase producing Staphylococcus aureus (MSSA or methicillin-sensitive Staphylococcus aureus)

Cloxacillin is
MORE EFFECTIVE than vancomycin for MSSA infections

Ampicillin and amoxicillin
Active against Gram positives but also Gram negatives like E. coli, Salmonella, Shigella, Haemophilus
Destroyed by beta-lactamases
Clinical uses
Uncomplicated urinary tract infections
Acute exacerbations of COPD and mild community acquired pneumonias
Uncomplicated bacterial sinusitis and otitis media
Enteric fever
Helicobacter infection

Augmentin (amoxycillin-clavulanate),
Unasyn (ampicillin-sulbactam),
Tazocin (Piperacillin-tazobactam)
Augmentin and Unasyn
Mild to moderate community acquired pneumonias
Urinary tract infections
Bacterial sinusitis and otitis media
Skin and soft tissue infections including diabetic foot
Tazocin
Serious gram-negative nosocomial infections

1st Gen
2nd Gen
3rd Gen
4th Gen
primarily Gram positive activity with some Gram-negative activity
eg
Cephalexin

(urinary tract infections)

Gram-positive and Gram negative activity but no anti-pseudomonal action
eg
Cefuroxime
Urinary infections
Respiratory infections

Good gram-negative activity including Pseudomonas aeruginosa but less Gram positive action

Cefotaxime,
cefoperazone,
ceftazidime,
ceftriaxone


Clinical uses
Serious Gram negative nosocomial infections
Moderate to serious community acquired pneumonia (ceftriaxone)
Biliary infections (cefoperazone)
Bacterial meningitis (cefotaxime and ceftriaxone)
Melioidosis (ceftazidime)
Good gram-negative and gram-positive activity –

cefepime

For serious nosocomial infections eg febrile neutropaenics

the issue with cephalosporins
Much abuse of cephalosporins resulting in emergence of resistance

ESBL (extended spectrum betalactamase) is a major problem

No activity against Enterococcus and MRSA

Imipenem,
meropenem,
ertapenem
doripenem


Clinical use : severe gram negative nosocomial infections
Very broad spectrum :
Gram positive, Gram negative and anaerobes
(ertapenem not active against Ps aeruginosa)

Stable to ESBLs


cell wall synthesis inhibiters
glycopeptides
Vancomycin, teicoplanin

Mainly Gram-positive activity

Clinical uses
Infections caused by MRSA (Methicillin-resistant Staphylococcus aureus) and methicillin-resistant coagulase-negative staphylococci

Clostridium difficile infection (oral administration)


Need to monitor levels to ensure clinical efficacy and to avoid toxicity
Aminoglycosides

Macrolides
Lincosamides
Tetracyclines
Broad spectrum parenteral antibiotics
Ototoxicity and nephrotoxicity

Serious nosocomial infections
Active against staphylococci and gram negative rods including Pseudomonas aeruginosa
Often used in combination with a beta-lactam antibiotic
Monitor serum levels to ensure effectiveness and avoid toxicity
Amikacin,
gentamicin,
tobramycin
netilmicin
Streptomycin
Anti-tuberculosis agent
Spectinomycin
Gonorrhoea

Gram-positive bacteria like staphylococcus, streptococcus
Gram negatives like Neisseria, Haemophilus, Bordetella, Moraxella and Campylobacter but NOT against Enterobacteriaceae or Pseudomonas
Legionella, Mycoplasma and Chlamydia
Treponema pallidum
Wide spread resistance is encountered

Erythromycin
Atypical pneumonias
Mild skin and soft tissue infections
Whooping cough
Syphilis (penicillin allergy)
Campylobacter infections
Azithromycin, Clarithromycin
As for erythromycin but preferred because of less adverse effects and more convenient dosing regimen

Active against Gram-positive bacteria and anaerobic bacteria
Clindamycin
Anti-MRSA agent
Anaerobic infections
Oral administration
Associated with pseudomembranous colitis due to Clostridium difficile

Broad spectrum
Gram positive
Gram negative
Rickettsia, chlamydia, mycoplasma, legionella
Spirochaetes
Protozoa eg Plasmodium
Resistance is common but fortunately not in the pathogens where tetracyclines are the drug of choice

Tetracycline
Mild skin and soft tissue infections

Acne vulgaris
Doxycycline
Scrub typhus
Leptospirosis
Melioidosis (maintenance phase)
Malaria
Tigecycline
A glycylcycline, compound related to tetracycline
Active against many resistant nosocomial pathogens
like
MRSA, ESBL producing Klebsiella and resistant Acinetobacter baumanii
Used for serious nosocomial infections due to resistant organisms

Inhibitors of Nucleic Acid Synthesis
Inhibitors of DNA replication

Inhibitors of synthesis of precurosrs

Inhibitors of RNA polymerase

Quinolones
Synthetic compounds with broad spectrum of activity
Ciprofloxacin
Active against Gram negatives including Ps aeruginosa
Active against Staph aureus (resistance emerge readily) but less activity against streptococci and enterococci
Wide range of clinical uses including urinary infections,
gastrointestinal infections (including typhoid fever), hepatobiliary infections, gram negative blood stream infections and osteomyelitis
Not recommended for staphylococcal or streptococcal infections
Overuse has led to
emergence of resistance
Levofloxacin, moxifloxacin, gatifloxacin
Enhanced activity against Streptococcus pneumoniae
Also be used in respiratory infections including pneumonia

Rifampicin
Activity against Gram-positive organisms and Mycobacterium
Main clinical use in
tuberculosis
Also used for
MRSA infections
but in combination with another anti-staphylococcal agent

Sulphonamides
Trimethoprim

Fixed ratio combination (1 : 5) of trimethoprim and sulphamethoxazole (a sulphonamide)
Broad spectrum of activity but resistance is now common
Main clinical uses
Urinary tract infections
Enteric fever
Pneumocystitis carinii
Stenotrophomonas maltophilia (ICU pathogen associated with overuse of carbapenems)

Cotrimoxazole
Metronidazole
Interact and break up cell’s DNA
Anti-anaerobic and anti-protozoal agent
Clinical uses
Anaerobic infections
Clostridium difficile infection
Amoebiasis
Trichomoniasis
Giardiasis

Polymyxins
Act on cell membrane of bacteria
High toxicity : neuro- and nephrotoxic
Active against Gram-negative bacteria including multi-resistant strains
Not uncommon to now encounter strains of
Acinetobacter and Ps aeruginosa
that are resistant to all antibiotics except the polymyxins
Used to treat multi-resistant gram negative infections mainly in ICUs
Full transcript