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Antibiotics
Cyrus Talwar
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Bacteria
• Gram stain identifes bacteria undermicroscope:
• Gram +ve (purple/blue)• Gram –ve (red)
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Gram !ositive
" G+ bu#s ($ cocci% &rods)
') treptococcus Cocci$) tap ylococcus
*)Bacillus
&)Clostridium ods
,)Corynebacterium
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Gram ne#ative
').eisseria
$) 0Coli*) !roteus
&)1lebsiella
,) !suedomonas
") almonella
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treptococci (catalyse )
• trep vs tap 2 CATA-A T T todi3erentiate
') Group A strep: ( trep0 !yo#enes) ! aryn#itis-) Cellulitis/ 4in in5ections (necrotisin#
5asciitis)-) To6ic oc4 yndrome-)
Also causes delayed antibodymediated 7 and Glomerulone ritis
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treptococci
$) Group B trep:- $,8 o5 women carry t ese bu#s
va#inally- Cause neonatal menin#itis%
pneumonia and sepsis
*) 9ididans Group trep:- ental in5ections-
ndocarditis
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&) Group strep (enterococci and nonenterococci)-
i;cult to treat due to resistance o5ampicillin and vancomycin
,) trep !neumoniae
Bacterial pneumonia menin#itis in adults
otitis media in c ildren
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tap ylococci (catalase +)
') tap Aureus-) !roduces 5 > CT or#an invasion can cause
pneumonia% ?enin#itis% endocarditis%
4in in5ections% sepsis% @T>
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$) tap pidermis
Compromised ospital patients witurine cat eters/ >09 lines can becomein5ected w en t is or#anism mi#rates
5rom t e s4in alon# t e tubin#- eart valve and prost etic in5ections
*) tap ylococcus saprop yticus
-eadin# cause o5 @T> in 5emales
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To6ins
6oto6ins !roteins release by G+ andG 0 >ncludes .euroto6ins% nteroto6ins(causes diarr oea by .aCl release)0
Causes >.7 CT>=@ >A = A and7== !=> =.>.G
ndoto6ins lipid A w ic is outermembrane piece o5 G bacteria0 9eryto6ic so antibiotics can ma4e patientsworse initially due to release o5endoto6in
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Gram bacteria
• .eisseria ?enin#itidis causesmenin#ococcal menin#itis 0Causespetic eal ras
• -e#ionella !neumonia ( atypical
pneumoniaD) Eell aerated water (airconditionin# units% water stora#e)
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E at are antibiotics2
- Compounds t at act a#ainst bacteria(FAntimicrobials viruses% parasites%5un#i)
4ill (bacteriacidal) or in ibit(bacteriostatic)
administered as oral% parenteral ortopical
resistance may rapidly develop
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Antibiotics t at inter5ere
wit cell wall') !enicillins$) Cep alosporins B lactams
*) Carbapenams
&) Glycopeptides
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') !enicillinHs
• !enicillin G (benpen) #iven >0?/>09( trep0 !neumoniae)
•
Aminopenicillins(Ampicillin/Amo6icillin) Broaderspectrum% more G cover0 >ncreasin#resistance
• !enicillinase resistant(?et icillin/7luclo6acillin) – used 5orG+% #ood a#ainst stap aureus
•
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B lacamase in ibitors
• Given in combination wit penicillinHs• >n ibitors o5 b lacamase
Amo6icillin + Clavulanic acidICoamo6iclav
!ipericillin + TaJobactam I TaJocin
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$) Cep alosoporins
• ?ore resistant to b lactamaseenJymes t an penecillin
•
'st Gen: G+ covera#e• $nd Gen: use5ul in CA!• *rd Gen: G covera#e0 @se5ul in
nosocomial in5ections% menin#itis and@T>s0 as best C 7 penetration0
• ome cross reactivity in patients witpenicillin aller#y
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*) Carbapenams
• Broadest spectrum b lacatams• as anaerobic cover
• -owers seiJure t res old
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&) Glycopeptides
• Glycopeptides bacteriocidal: inter5erewit cell wall – #ram +ves only
9ancomycin/teicoplanin• ? A treatment•
.ep roto6ic (don t #ive wit #entamicin)
• .eed to monitor levels – B re#ime L
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• .arrow spectrum: BenJyl pen andpen 9 5or streptococci% neisseria%clostridia
• Amo6 and ampicillin e6tend spectrumto enterococci% listeria% emop ilus
•
Amo6 clavulanic acid e6tendsspectrum to stap ylococci% coli5orms%anaerobes
•
7luclo6acillin 5or ? A
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Antibiotics t at in ibit
protein synt esis') ?acrolides$) Amino#lycosides
*) Tetracyclins&) =t ers
(c loramp enicol/clindamycin/5usidic acid)
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') ?acrolides
• ryt romycin% clarit romycin• Alternative to penicillin
• Clindamycin can causepseudomembranous colitis as itdestroys natural #ut Mora
• ?ainly act a#ainst G+
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$) Amino#lycosides
• Gentamycin% streptomycin• ?ust enter cell wall to wor4 so o5ten
used wit penicillinHs• 1ill G or#anisms• .arrow t erapeutic window• .ep roto6ic and ototo6ic
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*) Tetracyclins
• o6ycycline• use5ul activity a#ainst c lamydiae%
mycoplasmas% ric4ettsias andCo6iella burnetii as well asstap ylococci% streptococci and someGram ne#ative rods
• T ey must not be used in pre#nancy%in c ildren or in renal impairment0
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Antibiotics t at in ibit .A
syt esis• Nuinolones (CiproMo6acin)• >n ibit .A #yrase
• CiproMo6acin is a #ram ne#ativeantibiotic wit no activity a#ainstpneumococcus
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?etronidaJole
• >n ibits .A synt esis• Causes metallic taste and intolerance
to alc ol• Good 5or anaerobes• !er5oration o5 bowel /bowel sur#ery L
metronidaJole and coOamo6iclav• 'st line C0di3 treatment
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ulp onamides
• 0# trimet roprim• >n ibit 5olate synt esis
• @se5ul in @T>• ulp onamides can ave nasty side
e3ects e0#0 tevens Po nson
syndrome Q bone marrow aplasia0
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Condition Drug
UTI-Uncomplicated 'st: .itro5urantoin –$nd: Trimet oprim –*rd: Ce5ale6in –? A –nitro5urantoin andtrimet oprim and do6ycycline
Acute Prostatitis 'st: CiproMo6acin
$nd: Trimet oprim*rd: Tetracycline
Pyelonephritis (andcomplicated UTI’s)
'st: CiproMo6acin / ce5uro6ime$nd: Co amo6iclav>9 – #entamycin
Genital bacterial in ections(General)
?etronidaJole
PID ?etronidaJole o6ycycline
Chlamydia o6ycycline
Gonorrhoea CiproMo6acin% Amo6icilin% !robenicid
!aginal ungal in ections ClotrimaJole pessary
Antibiotics 5or urolo#yconditions
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Antibiotics 5or respiratory
conditionsCondition Drug"o#er respiratory tractin ection ("$TI)
Amo6icillinryt romycin
C%PD acute e&acerbation Amo6icillin R Clarit ro i5 pen aller#y
Co amo6iclavCiproMo6acin
'ronchiectasis Amo6icillino6ycyclin
Pneumonia S – Amo6icillin (clarit ro)
' – Amo6icillin + clarit ro0$ >9 Amo60 + clarit ro0* , – >9 au#mentin + clarit
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Antibiotics 5or .T
conditionsCondition Drug%titis edia Amo6icillin
ryt romycinCo amo6iclav
Dental in ections Penicillin ! A*D Chlorohe&idine mouth#ash+rythromycin
etronida,ole
Pharyngitis !enicillin 9ryt romycin
%ral candidiasis .ystatin (can be pastille orsuspension) 7luconaJole (tablet)
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Antibiotics 5or G> conditions
Condition Drug
Peritonitis Amo6icillin – A. –Gentamycin – A. –?etronidaJole9ancomycin (instead o5 amo6icillin
epsis TaJocinGentamicin
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Be5ore prescribin# A6 0
-oo4 5or si#ns o5 in5ection:
• Pain• .e/er•
#elling• $edness• tachycardia• ri ors
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• Antibiotics s ould only be #ivenw en t ere is proven or stron#lysuspected bacterial in5ection
• (or w en t ere is a possibility o5bacterial in5ection and t e patient isso sic4 you cannot a3ord not to treatt at small possibility)
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@r#ent re uirements 5orantibiotics
• ?enin#ococcal disease• =t er bacterial menin#itis
• epsis• evere pneumonia• .ecrotisin# 5asciitis• = B-== C@-T@ U
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ystemic inMammatory
response syndrome• Temperature V*W or X*"• !ulse VYS
• espiratory rate V$S or pC=$ X &0*
• ECC V '$SSS or X &SSS
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efnitions
• epsis I > due to in5ection• evere sepsis I sepsis + or#an
dys5unction• eptic s oc4 I sepsis + re5ractory
ypotension
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epsis
Clinically:• 7ever
• Tac ycardia• .i# t sweats• To6ic% Mus ed ( vasodilated )• i# w ite cell count• -ocalisin# symptoms and si#ns
Complications
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?enin#itis
?ost causes are community ac uired• Neisseria meningitidis
• Streptococcus pneumoniae • Haemophilus infuenzae• Listeria monocytogenes • >n neonates: Group B streptococci
and Gram ne#ative bacilli as well as
listeria
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?enin#itis
• tart A6 immediately(Ce5ota6ine/Ce5tria6one)
•
Acyclovir i5 viral• >5 not yet in ospital #ive '0$G >?
BenJylpenecillin
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C 7 fndin#WCC
/mm3roteing/L
!lucosemmol/L
Normal Z,lymp ocytes
S0', S0&, $0W &0$V'/$ blood #lucose
"acterial $SS *SSS(neutrop ils)
S0, $0S X'/* blood #lucose(X$0,)
#iral 'S 'SS(lymp ocytes)
S0& S0W V'/$ blood #lucose
$" ,S ,SS(lymp ocytes)
S0, *0S X'/* blood #lucose
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emember
• Classes o5 antibiotics• ow t ey wor4
• E ic or#anisms t ey cover• >mportant in5ections and 6• on t 5or#et Blood culturesU