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    6 - Introduction To Antibiotics

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    maxwell amponsah
    This document provides an introduction to antibiotics, including: 1. It classifies antibiotics based on their mechanism of action and spectrum, such as inhibiting cell wall synthesis or protein synthesis. 2. It discusses the proper choice of antibiotic based on the clinical diagnosis, pharmacological considerations of the patient, and microbiological information when available. 3. It describes some common misuses of antibiotics and ways to prevent bacterial resistance, such as only using antibiotics when needed and for the full treatment period.

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    6 - Introduction To Antibiotics

    Uploaded by

    maxwell amponsah
    31 views8 pages
    This document provides an introduction to antibiotics, including: 1. It classifies antibiotics based on their mechanism of action and spectrum, such as inhibiting cell wall synthesis or protein synthesis. 2. It discusses the proper choice of antibiotic based on the clinical diagnosis, pharmacological considerations of the patient, and microbiological information when available. 3. It describes some common misuses of antibiotics and ways to prevent bacterial resistance, such as only using antibiotics when needed and for the full treatment period.

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    6- Introduction to antibiotics

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    This document provides an introduction to antibiotics, including: 1. It classifies antibiotics based on their mechanism of action and spectrum, such as inhibiting cell wall synthesis or protein synthesis. 2. It discusses the proper choice of antibiotic based on the clinical diagnosis, pharmacological considerations of the patient, and microbiological information when available. 3. It describes some common misuses of antibiotics and ways to prevent bacterial resistance, such as only using antibiotics when needed and for the full treatment period.

    Copyright:

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

    6 - Introduction To Antibiotics

    Uploaded by

    maxwell amponsah
    This document provides an introduction to antibiotics, including: 1. It classifies antibiotics based on their mechanism of action and spectrum, such as inhibiting cell wall synthesis or protein synthesis. 2. It discusses the proper choice of antibiotic based on the clinical diagnosis, pharmacological considerations of the patient, and microbiological information when available. 3. It describes some common misuses of antibiotics and ways to prevent bacterial resistance, such as only using antibiotics when needed and for the full treatment period.

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    © All Rights Reserved
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    Download as ppt, pdf, or txt
    of 8

    Introduction to Antibiotics

    Objectives:
    • Classification of antibiotics.
    • Misuses of antibiotics.
    • Choice of antibiotics.
    • Bacterial resistance and ways to prevent it.
    • General principles of chemotherapy.
    • Indications for antibiotics prophylaxis

    ‫و اعلموا ان مهمتكم ليست في ورقة‬


    ‫تناولونها ولكن مهمتكم في امة تحيونها‬
    Titles
    Very important
    Extra information
    Doctor’s notes

    1
    Definition:
    Antibiotics: Chemical substances produced by various
    microorganisms ( bacteria, fungi, actinomycetes) that have the
    capacity to inhibit or destroy other microorganisms.

    *they are chemically synthesized


    *They either kill bacteria (bactericidal) or keep more bacteria
    from growing (bacteriostatic).
    *Antibiotics will not cure infections caused by viruses.

    Classificaton:
    They can be classified according to:

    :Mechanism of action-1 Spectrum-2


    A-Inhibition of CELL WALL SYNTHESIS A-Narrow spectrum (Acting on one
    e.g. Penicillins, Cephalosporin group either Gram +ve or Gram –ve)
    e.g. Penicillin G (Acts on Gram +ve)
    B-Inhibition of PROTIEN SYNTHESIS
    e.g. Macrolides, Tetracyclines
    Aminoglycosides (Act on Gram -ve)

    B-Broad spectrum (Acting on both Gram


    C-Inhibition of DNA SYNTHESIS
    +ve or Gram –ve)
    e.g. Quinolones.
    e.g. Ampicillin , Amoxicillin
    D-Inhibition of FOLATE METABOLISM (Usually used if you don’t know which
    e.g. Sulphonamides, Trimethoprim bacteria caused the infection and it’s
    called embiric treatment which means:
    E-Inhibition of RNA SYNTHESIS (by Using the antibiotic before knowing the
    binding to RNA polymerase) type of bacteria).
    e.g. Rifampicin.

    2
    Choice of Antibiotic:
    1-Clinical diagnosis:
    It means you can know the only disease by clinical diagnosis.
    e.g. Syphylis : (‫)الُز هري‬Its symptoms are known and it is caused by
    (Treponema pallidum) which is sensitive to penicillin, So you can prescribe
    it.

    2-Pharmacological Consideration:
    A-Site of infection. )e.g. in the brain we need drug cross BBB)
    B. Host factors:
    *Immune system :
    e.g. Alcoholism, diabetes, HIV, malnutrition, advanced age (higher than
    usual doses or longer courses are required). (‫)يعني اللي مناعتهم ضعيفه‬
    * Genetic factors:
    e.g. Patients with G-6-PD deficiency treated with sulfonamides (G-6-P is an
    enzyme that protect the RBC from getting destroyed, So any oxidizing
    drug will interfere with its function and result in Hemolysis)
    *Pregnancy and Lactation :
    Aminoglycosides may cause (hearing loss) and Tetracyclines may cause
    (bone deformity)
    *Extreme Age (Neonates and elderly) (‫)عشان الكبد و الكلي ماتشتغل زين عندهم‬
    *Renal function (‫هذا النوع من االدوية تطلع عن طريق‬
    e.g. Aminoglycosides (renal failure) ‫الكلى مب الكبد عشان كذا اللي عندهم‬
    ‫) مشكلة في الكلى تزيد السمية في الدم‬
    *Liver function
    e.g. Erythromycin (hepatic failure) (‫)نفس فكرة اللي قبل‬
    C. Drug Allergy(eg. penicillin (parenteral) we
    need to do skin test) .

    3
    3-Microbiological information: (Bacteriological information)
    In case you don’t know the bacteria or you know the bacteria but you don’t
    know the sensitivity.
    :Advantages :Disadvantages

    *The bacteria isolated may not be the prime


    *The exact antibiotic to be used
    cause of the disease.
    *The most effective and reject the one with *Do not take in consideration site of
    infection
    little or no activity
    *Some bacteria cannot be cultivated or take
    *The least toxic time to grow. e.g. M. Leprae, M.
    Tuberculosis.
    *The cheapest
    *Bacteriological services are not available at
    all hospitals.

    Misuses of antibiotics:
    *Treatment of diseases caused by viruses.
    *Improper dosage. (The dose is not enough or it didn’t take enough time)
    *Therapy of fever of unknown origin.
    *Presence of pus or necrotic tissues , or blood at the surgical site
    (The pus could block the antibiotic so first we need to remove the pus then give the
    antibiotic)
    *Excessive use of prophylactic antibiotics in travelers.
    *Lack of adequate bacteriological information.
    *Over use as growth promoters in animals and agriculture.
    *Patients do not take them according to their doctor’s instructions.
    ( Usually the symptoms went before the bacteria die so the patient stop taking the
    antibiotic then it came back again with resistance)
    *Some patients save unused antibiotics
    for another illness, or pass to others.

    4
    Reasons for Misuses of Antibiotics :
    1-Availabity of a very wide selection.
    2-Limitation of physician’s time.
    3-physician shortage and expenses.
    4-availability without Rx in pharmacies.
    5-public demand (pressure to prescribe).

    Bacterial Resistance :
    One result of the widespread use of antibiotics has been the
    emergence of resistant pathogens that have been sensitive in the past.
    Definition: Conc. of antibiotic required to inhibit or kill the bacteria is
    greater than the conc. that can safely be achieved in the plasma.

    Mechanisms of Acquired Antibiotic Resistance :


    1. Inactivation by enzyme produced by bacteria .
    Bacterial β-lactamase inactivates penicillins & cephalosporins by cleaving
    the β-lactam ring of the drug. )‫(البكتيريا تفرز انزيمات تثبط المضادات الحيوية‬
    2. Bacteria develops an altered receptor for the drug .
    3. Bacteria develops an altered metabolic pathway
    4. Reduced bacterial permeability to antibiotic .
    5. Actively transporting the drug out of
    the cell . ) ‫(تمنع التاثير عن طريق اخراج المضاد خارج البكتيريا‬

    5
    Prevention of Resistance :
    *Use antibiotics only when absolutely required (‫)في حاالت البكتيريا‬
    *Use antibiotics in adequate dosage for sufficient period of time.
    “Not too brief therapy, Not too prolonged therapy”
    ( exceptions, e.g. TB )(‫)تحتاج وقت طويل للعالج‬
    *Combination of antibiotics may be required to delay resistance ( e.g. TB )
    )‫(األفضل ان يستخدم نوع واحد من المضادات لكن في حاالت خاصة نحتاج اكثر من نوع للقضاء على البكتيريا‬

    General Principles of Chemotherapy:


    Administer drug in full dose, at proper interval and by the best route.

    When apparent cure achieved , continue antibiotic for about 3 days further to avoid
    relapse.

    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(‫( نادر‬needed, except for systemic


    aminoglycosides(e.g., streptomycin, gentamicin, etc.)

    6
    General Principles of Chemotherapy (cont.) :
    Two or more antimicrobials should not be used without good reason
    due to its risky disadvantages :-
     Increased risk of sensitivity or toxicity
     Increased risk of colonization with a resistant bacteria
    Possibility of antagonism
    Higher cost
    However, sometimes we need to use multiple antibiotics , 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 used for (p.aeruginosae)).

    Indications for antibiotics prophylaxis:


    Surgical prophylaxis bowel surgery, joint replacement , etc. to prevent
    postoperative infections.

    Immunosuppressed Very old, Very young , Diabetics, Anaemics , AIDS ,Cancer


    Patients pts.

    Dental extractions Pts with total joint replacements.


    Pts with cardiac abnormalities.

    7
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    ‫‪8‬‬

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