A6 Antimicrobial Agents
A6 Antimicrobial Agents
A6 Antimicrobial Agents
AGENTS
TOPICS:
❑ Classification of Antimicrobial Drugs
✔ Classification by Susceptible Organism
✔ Classification by Mechanism of Action
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Antibiotic and
Antimicrobial drug are
used interchangeably.
However, be aware that
the formal definitions of
these words are not
identical.
an ANTIBIOTIC is a chemical that is
produced by one microbe and has
the ability to harm other microbes.
Under this definition, only those
compounds that are actually made
by microorganisms qualify as
antibiotics.
▸ Classification by Susceptible
Organism
▸ Classification by Mechanism of
Action
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Classification by Susceptible Organism
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ANTIBIOTICS DIFFER WIDELY IN THEIR
ANTIMICROBIAL ACTIVITY.
▸ Narrow-spectrum ▸ Broad-spectrum
antibiotics, are antibiotics are
active against only a active against a
few species of wide variety of
microorganisms. microbes.
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Classification by Mechanism of Action
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THE ANTIMICROBIAL DRUGS FALL INTO SEVEN MAJOR GROUPS
BASED ON MECHANISM OF ACTION.
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Selection of an Effective
Antibiotic
• Selecting an incorrect drug will delay proper treatment, giving the microorganisms more time to invade.
• Prescribing ineffective antibiotics also promotes the development of resistance and may cause
unnecessary adverse effects in the patient.
• Ideally, laboratory tests should be conducted to identify the specific pathogen prior to beginning
anti-infective therapy. Laboratory tests may include examination of urine, stool, spinal fluid, sputum,
blood, or purulent drainage for microorganisms.
• Organisms isolated from the specimens are grown in the laboratory and identified. After identification,
the laboratory tests different antibiotics to determine which is most effective against the infecting
microorganism. This process of growing the pathogen and identifying the most effective antibiotic is
called culture and sensitivity (C&S) testing.
ACQUIRED RESISTANCE TO ANTIMICROBIAL
Over time, an organism that hadDRUGS
once been
highly sensitive to an antibiotic may become
less susceptible, or it may lose drug sensitivity
entirely. In some cases, resistance develops to
several drugs. Acquired resistance is of great
concern in that it can render currently
effective drugs useless, thereby creating a
clinical crisis and a constant need for new
antimicrobial agents. As a rule, antibiotic
resistance is associated with extended
hospitalization, significant morbidity, and
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excess mortality.
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recall two aspects of microbial ecology:
(1) microbes secrete compounds that
are toxic to other microbes and (2)
microbes within a given ecologic niche
(e.g., large intestine, urogenital tract,
skin) compete with each other for
available nutrients. How Do
▸ Under drug-free conditions, the Antibiotics
various microbes in a given niche
keep each other in check.
Promote
▸ Furthermore, if none of these Resistance?
organisms is drug resistant,
introduction of antibiotics will be
equally detrimental to all members of 20
the population and therefore will not
promote the growth of any individual
present, antibiotics will create selection
pressure favoring its growth by killing off
sensitive organisms.
Superinfection is a special
example of the emergence
of drug resistance. A
superinfection is defined
as a new infection that
appears during the course
of treatment for a primary
infection.
SUPERINFECTION
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PENICILLIN Nomenclature: usually ends in “-cillins”
Known Drug: pen g (iv form), pen v (oral form),
amoxicillin
Action: bactericidal, inhibit cell wall synthesis
(beta-lactam ring)
Indication: most gram (+) and some gram (-)
bacteria
• Pneumonia, rti, uti, sti, some skin infections
• Meningitis, GI infections due to salmonella
and shigella
Warnings: allergy to penicillin and
cephalosphorins, caution with renal and liver
failure
side effects: Nausea, vomiting, diarrhea
watch out for: allergy and superinfection,
haemolytic anemia
Note: bacterial evolution had enable some
bacteria to resist penicillin by releasing
penicillinase and beta-lamases
Further Note:
PENICILLIN Broad-spectrum penicillins (aminopenicillins)
• Prototype: amoxillin, ampicillin (se: rash,
pseudomembranous colitis)
Penicillinase-resistant penicillins
(antistaphyloccoal penicillins)
• Prototype: methicillin (se: interstitial nephritis)
• Not used for mrsa
Extended-spectrum penicillins
(antipseudomonal penicllins)
• Used w/th clavunalic acid
• Ticarcillin , carbenicillin, pipercillin
Beta-lactamase inhibitors
• amoxicillin- clavulanic acid
• ampicillin-sulbactam (Unasyn),
• piperacillin-tazobactam (vigocid)
• Ticarcillin- clavulanic acid (triclav)
PENICILLIN
Drug interactions:
• may decrease the
effectiveness of oral
contraceptives
• IF mixed with an
aminoglycoside in IV solution,
the actions of both drugs are
inactivated.
Cephalosporin
Nomenclature: usually STARTS in “Cef-”
CEPHALEXIN Known Drug: cephalexin, ceftriaxone
Action: bactericidal, inhibit cell wall
synthesis, resistant to beta-lactamase
Indication: gram (+) and (-) bacteria
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Macrolide
MACROLIDE Nomenclature: has “-thromycin” but pls
remember ace
Known Drug: Azithromycin, Clarithromycin,
Erythromycin
Action: bacteriostatic, inhibit protein
synthesis
Indication: gram (+) and (-) bacteria
• mild to moderate RTI, INFECTION OF
sinuses, GI tract, skin and soft tissue,
diphtheria, impetigo contagiosa, and STI
Warnings: allergy to MACROLIDES caution
with renal and liver functions
side effects: Nausea, vomiting, diarrhea,
AnD CRAMPING, POSSIBLY CONJUCTIVITIS
(AZITH), arrhythmia (erythromycin)
MACROLIDE
Watch for: signs of SUPERINFECTION
DRUG INTERACTION:
• can increase serum levels of theophylline
(bronchodilator),
• To avoid severe toxic effects,
erythromycin should not be used with
other macrolides
• Antacids may reduce azithromycin peak
levels when taken at the same time
LINCOSAMIDES
GLYCOPEPTIDES
Extended-Macrolide Group
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Nomenclature: NONE
EXTENDED-MACROLIDE GROUP: Known Drug: Clindamycin
Action: Bacteriostatic, inhibit RNA
LINCOSAMIDES TRANSLOCATION, may also have bactericidal
effect
Indication: ANAEROBIC INFECTIONS ABOVE
THE DIAPHRAGM
• Lung abscess
• Aspiration pneumonia
• Mrsa soft tissue infections
• Necrotizing fasciitis
• PID (Pelvic Inflammatory Disease)
Side effects: Nausea, vomiting, stomatitis,
rash
Adverse effects: colitis and anaphylactic
shock.
Drug interactions: incompatible with
aminophylline, phenytoin (Dilantin),
barbiturates, and ampicillin
Nomenclature: NONE
EXTENDED-MACROLIDE GROUP: Known Drug: vancomycin
Action: bactericidal, inhibit cell wall synthesis
• CLASSIFIED IN 2 TYPES:
• OPPURTUNISTIC
• NONOPPURTUNISTIC
ANTIFUNGALS / ANTIMYCOTIC