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    Antibiotics

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    محمد بن صالح
    This document discusses antibiotics, including: - Their classification based on mechanism of action and spectrum. Penicillin inhibits cell wall synthesis while quinolones inhibit DNA synthesis. Broad spectrum antibiotics like ampicillin are effective against many bacteria. - Choosing antibiotics based on clinical diagnosis, microbiological information, and pharmacological considerations for the patient like immune status, pregnancy, age, and organ function. - Developing bacterial resistance through mechanisms like enzyme production and efflux pumps, and ways to prevent it like appropriate antibiotic use and combination therapy. - Misuses of antibiotics like treating viruses and using leftover antibiotics incorrectly. Indications for prophylactic antibiotics include certain surgeries and immunosuppressed states.

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    Antibiotics

    Uploaded by

    محمد بن صالح
    15 views8 pages
    This document discusses antibiotics, including: - Their classification based on mechanism of action and spectrum. Penicillin inhibits cell wall synthesis while quinolones inhibit DNA synthesis. Broad spectrum antibiotics like ampicillin are effective against many bacteria. - Choosing antibiotics based on clinical diagnosis, microbiological information, and pharmacological considerations for the patient like immune status, pregnancy, age, and organ function. - Developing bacterial resistance through mechanisms like enzyme production and efflux pumps, and ways to prevent it like appropriate antibiotic use and combination therapy. - Misuses of antibiotics like treating viruses and using leftover antibiotics incorrectly. Indications for prophylactic antibiotics include certain surgeries and immunosuppressed states.

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    This document discusses antibiotics, including: - Their classification based on mechanism of action and spectrum. Penicillin inhibits cell wall synthesis while quinolones inhibit DNA synthesis. Broad spectrum antibiotics like ampicillin are effective against many bacteria. - Choosing antibiotics based on clinical diagnosis, microbiological information, and pharmacological considerations for the patient like immune status, pregnancy, age, and organ function. - Developing bacterial resistance through mechanisms like enzyme production and efflux pumps, and ways to prevent it like appropriate antibiotic use and combination therapy. - Misuses of antibiotics like treating viruses and using leftover antibiotics incorrectly. Indications for prophylactic antibiotics include certain surgeries and immunosuppressed states.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    15 views8 pages

    Antibiotics

    Uploaded by

    محمد بن صالح
    This document discusses antibiotics, including: - Their classification based on mechanism of action and spectrum. Penicillin inhibits cell wall synthesis while quinolones inhibit DNA synthesis. Broad spectrum antibiotics like ampicillin are effective against many bacteria. - Choosing antibiotics based on clinical diagnosis, microbiological information, and pharmacological considerations for the patient like immune status, pregnancy, age, and organ function. - Developing bacterial resistance through mechanisms like enzyme production and efflux pumps, and ways to prevent it like appropriate antibiotic use and combination therapy. - Misuses of antibiotics like treating viruses and using leftover antibiotics incorrectly. Indications for prophylactic antibiotics include certain surgeries and immunosuppressed states.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 8

    Respiratory Block

    8 Antibiotics

    Objectives:
    At the end of lecture, the students should be able to
    understand the following:
    ● Classification of antibiotics.
    ● Misuses of antibiotics.
    ● Choice of antibiotics.
    ● Bacterial resistance and ways to prevent it.
    ● General principles of chemotherapy.
    ● Indications for antibiotics prophylaxis

    Color index:
    Red: important
    Grey: Notes or extra information
    green: dr’s note
    ANTIBIOTICS
    Chemical substances produced by various microorganisms ( bacteria, fungi,
    actinomycetes) that have the capacity to inhibit or destroy other microorganisms.
    Nowadays they are chemically synthesized.
    They either kill bacteria (bactericidal) or keep more bacteria from
    growing(bacteriostatic).
    Antibiotics will not cure infections caused by viruses.

    Classification of antibiotics
    according to their mechanism of action
    Inhibition of cell wall e.g. Penicillin,
    synthesis Cephalosporin

    e.g. Macrolides, Inhibition of protein


    Tetracyclines synthesis

    Inhibition of DNA
    e.g. Quinolones
    synthesis

    e.g. Rifampicin Inhibition of RNA


    synthesis

    Inhibition of folate
    e.g. Sulfonamides,
    metabolism Trimethoprim

    Classification of antibiotics according to Spectrum

    Broad Spectrum Narrow Spectrum


    e.g: Ampicillin, e.g : Penicillin G
    Amoxicillin ,Aminoglycosides
    Choice of Antibiotics
    1- Clinical diagnosis :
    e.g. syphilis . The symptoms of syphilis are known, the causing agent is also known
    “Treponema pallidum” , the best antimicrobial agent is usually penicillin . In this case, you
    can go ahead and prescribe.

    2- Microbiological information

    Advantages Disadvantages

    •The exact antibiotic to be used, through •The bacteria isolated (and cultured in
    studying the sensitivity of the infecting microbiology lab) may not be the prime
    organisms to antibiotics cause of the disease.
    •Do not take in consideration the site of
    •The most effective & reject the one with infection. in vitro, they choose the
    little or no activity concentration of the antibiotic as it is
    proper in plasma, this doesn’t apply to
    •The least toxic infections in other sites in the body e.g.
    bone, urinary tract.
    •The cheapest •Some bacteria can not be cultivated or
    take time to grow ( M. leprae, M.
    tuberculosis )
    •Bacteriological services are not available
    at all hospitals, due to the high expenses.

    3- Pharmacological consideration

    Drug Factors Patient factors


    a) Immune status ( Alcoholism, diabetes,
    a- Site of infection HIV)
    b) Genetic factors Patients with G-6-PD
    b- Mode of administration deficiency with sulfonamides or
    chloramphenicol
    c- Potential Side Effects (Drug safety) c) Pregnancy and Lactation
    Chloramphenicol ( aplastic anaemia) (contraindicated)
    Flouroquinolones ( cartilage damage ) Aminoglycosides ( hearing loss )
    Tetracyclines( bone deformity )
    d- The cost of therapy d) Age : Old patients tend to have
    decreased renal functions; infants have
    poorly detoxification mechanisms
    e) Renal Disease ( contraindicated)
    e.g. Aminoglycosides ( renal failure )
    f) Hepatic disease (contraindicated)
    e.g. Erythromycin (hepatic failure)
    General Principles of Chemotherapy

    When apparent cure achieved , Administer drug in full dose, at


    continue antibiotic for about 3 proper interval and by the best
    days further to avoid relapse route

    Skipping doses may decrease effectiveness of


    antibiotic & increase the incidence of bacterial
    resistance.

    In some infections bacteriological proof of cure is


    desirable. ( e.g. TB, UTI )

    Measurement of plasma conc. of antibiotics is seldom


    needed, except for systemic aminoglycosides(e.g.,
    streptomycin, gentamicin, etc.).

    Two or more antimicrobials should not be used without good


    reason, e.g.:
    ● Mixed bacterial (polymicrobial) infections
    ● Desperately ill patient of unknown etiology
    ● To prevent emergence of resistance (e.g. TB )
    ● To achieve synergism
    ○ e.g: piperacillin+gentamicin(pseudomonas
    aeruginosae)

    Disadvantages of multiple antibiotics


    ● Increased risk of sensitivity or toxicity
    ● Increased risk of colonization with a resistant bacteria
    ● Possibility of antagonism
    ● Higher cost
    Bacterial resistance
    Concentration of antibiotic required to inhibit or kill the bacteria is greater than the
    concentration that can safely be achieved in the plasma.

    When does bacterial resistance emerge? One result of the widespread use of antibiotics
    has been the emergence of resistant pathogens that have been sensitive in the past.

    Mechanisms of Acquired Antibiotic Resistance


    ● Inactivation by enzyme produced by bacteria.Bacterial β-lactamase inactivates
    penicillins & cephalosporins by cleaving the β-lactam ring of the drug.
    ● Bacteria develops an altered receptor for the drug.
    ● Bacteria develops an altered metabolic pathway.
    ● Reduced bacterial permeability to antibiotic through cell membrane.
    ● Actively transporting the drug out of the bacterial cell.

    Prevention of Resistance
    ● Use antibiotics only when absolutely required
    ● Use antibiotics in adequate dosage for sufficient period of time
    ○ Not too brief therapy1
    ○ Not too prolonged therapy2 ( exceptions, e.g. TB )
    ● Combination of antibiotics may be required to delay resistance ( e.g. TB )

    1
    :Even after symptoms disappear, bacteria mayn’t have eradicated completely. Thus, patient should
    continue the course of treatment to avoid relapse & resistance.

    2
    :Prolonged therapy may cause eradication of healthy bacteria or opportunistic infection by C. difficile
    (Pseudomembranous colitis)
    Misuses of Antibiotics

    ○ Treatment of diseases caused by viruses.


    ○ Improper dosage.
    ○ Therapy of fever of unknown origin.
    ○ Presence of pus or necrotic tissue , or blood at the surgical site.
    ○ Excessive use of prophylactic antibiotics in travelers.
    ○ Lack of adequate bacteriological information.
    ○ Overuse as growth promoters in animals and agriculture.
    ○ Patients do not take them according to their doctor’s instructions.
    ○ Some patients save unused antibiotics for another illness, or pass to others.

    Indications for antibiotics prophylaxis


    Surgical prophylaxis Immunosuppressed Dental extraction
    patients

    bowel surgery, joint very old, very young, In patient with total joint
    replacement, and some diabetic, Anaemics, AIDS replacement And patients
    gynecological intervention and cancer patients with cardiac abnormalities
    to prevent postoperative
    infections.
    MCQs
    1. Which of the following agents is considered a narrow spectrum antibiotic?
    a. Ceftriaxone.
    b. Ciprofloxacin.
    c. Aminoglycosides.
    d. Imipenem.
    2. A 58-year-old male with a history of hepatitis C, cirrhosis, and ascites presents with
    spontaneous bacterial peritonitis. Which of the following antibiotics requires close
    monitoring and dosing adjustment in this patient given his liver disease?
    a. Penicillin G.
    b. Tobramycin.
    c. Erythromycin.
    d. Vancomycin.
    3. In the treatment of a urinary tract infection in a patient known to have a deficiency
    of glucose-6-phosphate dehydrogenase, it would not be advisable to prescribe
    which of the following?
    a. Sulfonamide
    b. Amoxicillin
    c. Cephalexin
    d. Ciprofloxacin
    4. Which of the following inhibit RNA synthesis?
    a. Rifampicin
    b. Quinolones
    c. Macrolides
    d. Aminoglycosides
    5. Which of the following inhibit folate metabolism
    a. Tetracyclines
    b. Trimethoprim
    c. Ampicillin
    d. Cephalosporin

    SAQs
    1. A 52-year-old man came to the ENT doctor. He has a sore throat, cough, runny nose
    and sneeze. The doctor examines him and finds out that it’s a normal cold, and the
    patient incest to take antibiotics. The doctor prescribes him antibiotics for 5 days.

    a. What is the most probable organism that cause his condition?


    b. What could happen as a result?

    2. A 63-year-old man with a renal failure what antibiotic should be avoided ?


    B 5.
    A 4.
    Aminoglycosides 2.
    A 3.
    b. The bacteria can acquire antibiotic resistance
    C 2. a. Virus
    C 1. 1.

    Answers: Answers:

    Good Luck &


    Thank you !
    Team members
    Yazeed Abdullah Alkhayyal

    Faiz Aldarsoni

    Bader Altamimi

    Ahmed Lateef Alanzi

    Faisal Alhotan

    Adel Alorainey

    Team Leaders

    Rahaf AlShammari

    Yazeed AlHarbi

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