Antibiotics

From Prof. Dr. Hussien Khairy Lectures

ByMohamad Alasmar

Oral

Penicillin VLong Acting

Benzathine Penicillin● 2-4 weeks● Ttt of lymphoedema

Broad Spectrum

Amoxicillin +clavulanic Acid =

Augmentin

Ampicillin +Sulbactam =

Unasyn

The Prototype

Crystalline Penicillin● Benzyle Penicillin● Penicillin G

Reversed Spectrum

SelexidIn UTI

AntiPsodomonal

CarbinicllinTicaracillin +clavulanic Acid =

Timentin

PipracillinAnti Beta Lactamase

FlucxacillinFlucluxacillin

Spectrum Side Effects

Very Safe● So used in long term Prophylaxis● Allergy● Enceph;opathy● Electrolytes load

Route

Parentral

Excretion

KidneyBy Tubular Secretion

Mechanism of Action

Cell WallCidal

SpirocheatsG +ve

NOTG –ve

● E Coli● Shigella● Salmonella● Psodomona

s

Anaerobs

First Generation

CephradineVelosef ®Third Generation

Cefoprazone Cefobid®CefotoximeMeningitis

Ceftriaxone Rocephen®Long half lifeOnce A day

Orilox ®oral

Second Generation

MefoxineEffective against anaerobes

Forth Generation

Maxipime®

SpectrumSide Effects

Safe● Allergy may present

Share Pinicillins in allergy in 10% of cases

● HypoprothrombinaemiaRoute

Oral • Parentral1st • 2nd • 3rd • 4th

1. Resist beta lactamase2. Parenteral3. G –ve effective4. Broader spectrum

Excretion

KidneyBy Tubular Secretion

Mechanism of Action

Cell wallCidalLike Pinicillins

G+veG –veSome against anaerobes

Mefoxine

Imipenim + CilastitinEnzyme InhibitorInhibit distruction by Kidney

= Tienam ®● The broadest spectrum ever● Parentral

AztreonamAzactam ®

● Very narrow spectrum● G –ve onle● Parentral

Clavulanic Acid+ Amoxicillin •Augmantin+Ticaracillin •Tementin

Sulbactam+ Cephoperazon •Sulperazon+Ampicillin •Unasyn

Tazobactam

Erythromycin● Like Pinicillin● Used in Pinicillin Allergy● Bowel Preparation

ClarythromycinAntiHelicobacter pylori

AzithromycinZithromax ®Long Half life1 tablet dailyUsed in chest infectionHaemophilus influenza

Spectrum Side Effects

GIT upsets

Route

Oral

Excretion

BiliaryHepatic

Mechanism of Action

Ptn SynthesisStatic •CidalAccording to the dose

NOT G-veG +veAnaerobes

● Bowel Preparation● Like Pinicillin

TobramycinNebcin ®The safest

AmikacinAmikin ®Broadest Spectrum

Garamycin● Very potent● Very toxic● Very cheep

StreptomycinIn TB

Kanamycin● Very toxic● Very old

Neomycin● Bowel Preparation with

Metronidazol

SpectrumSide Effects

NephrotoxicOtotoxicityNeurotoxcity

Route

ParentralNot absorbed by bowel

Excretion

KidneyBy GFNot by excretionSo lower the dose in cases with renal impairment

Mechanism of Action

Ptn SynthesisCidalShould enter the cellNeeds energy = O2So can not act on anaerobes

G +veG –veNOT effective against

anaerobes

CeprofloxacinDrug of Choice in

● Entric Infection● UTI● Prostatitis

OfloxacinTarvid ®

● UTI● Typhoid

LevofloxacinTavanic ®

● Pneumococci● G +ve

Spectrum Side Effects

SafeMusculoskeletal Side Effects

● Young Age • Arthropathy● Old Age • Tendonitis

Not recommended in young ageRoute

Oral & Parentral

Excretion

KidneyBy GF

Mechanism of Action

DNA SynthesisGyrase InhibitorTopoisimerase InhibitorRelax supercoils of DNA to be duplicated

Cidal

G +veG –ve● UTI● Enteric

InfectionBetter than AminoGlycosid Because its less side efects

Side Effects

AntiBiotic Associated colitis =Psudomembranous colitisBy Cl. Difficilttt

● Vencomycin● Metronidazol

Spectrum

Route

ParentralMechanism of Action

Ptn SynthesisExcretion

Kidney

Side Effects

Metallic tasteNeurotoxicNauseaAlcohol • Disulfuram like

Spectrum

●Amebiasis●Trichomonas●Giardia●Anaerobs●Hilicobacter

pylori

Route

OralIV expensiveSuppositories

Excretion

Kidney

Route

OralMRSAMethicillin resistent staph. AureusProduced By Fluxacillin & Flucluxacillin

Pseudomembranous colitisProduced By ClindamycinCl. Difficile

Endocarditis

Mechanism of Action

Cell Wall Synthesis

●Metronidazole●Penicillins●Erythromycin●Tienam●Clindamycin●Mefoxine