Download - Anti microbials
Anti-Microbial Therapy
Antibiotic Drug ClassesMajor IndicationsTherapeutic EffectAdverse Reactions
What are Microbes?
Microorganisms (Moos) Bacteria Mycoplasms Spirochetes Fungi Viruses
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
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.
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
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)
Moo’s Anatomy
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
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
Four Antibiotic RULES
Finish the bottle Don’t be tempted
by leftovers Work with your
health care provider
Don’t skip doses
Antibiotic Action
Inhibit cell wall synthesis Inhibit protein synthesis Prevent folic acid synthesis Interfere with DNA synthesis
Inhibitors of Cell Wall Synthesis
Beta Lactam Compounds Penicillin's MOA & Uses Agents
Penicillin V Dicloxacillin, Methicillin Ampicillin, Amoxicillin-Clavulanate Mezlocillin, Ticarcillin
Cell Wall Inhibitors cont.
Bacteriocidal Allergy/Resistance Pharmacokinetics
Cephalosporins Cephalexin/Cefadroxil Ceftriazone (Rocephin)
Other Inhibitors of Cell Wall Synthesis Vancomycin
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
Anti-Folate DNA Gyrase
Sulfonamides “Sulfas”
Sulfasoxazole Single agent
Bacteriostatic Trimethoprim /
Sulfamethoxazole Septra DS Bactrim DS Double agents
Bacteriocidal
Fluoroquinolones “FLOXACINs
Ciprofloxacin Levofloxacin
Clinical Implications
Use Misuse
Patient demand Misdiagnosis Counterfeits Agricultural Use International Travel
Super infection 2% of persons TX w/AB
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
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)
Summary Slide (cont.)
Anti-Folate DNA Gyrase Serious Drug Interactions
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.
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?