Glycyclines-The Management Of Glycyclines-The Management Of Nosocomial InfectionsNosocomial Infections

- By Priyanka G

K.V.S.R SCOPS

Nosocomial Infections

"nosus" = disease

"komeion" = to take care of

Infections that occur during hospitalization but are not present nor incubating upon hospital admission

Known NosocomialKnown Nosocomial InfectionsInfections

Venticular associated pneumoniaVenticular associated pneumonia Hospital acquired pneumoniaHospital acquired pneumonia GastroenteritisGastroenteritis TuberculosisTuberculosis Urinary tract infectionsUrinary tract infections

* Commonly transmitted to –* Commonly transmitted to –

* Personnel in hospitals with improper hygiene,* Personnel in hospitals with improper hygiene,

* Hospitalised people & to * Hospitalised people & to

* People with weak immune system.* People with weak immune system.

Most common bacteria that cause these infections are—

MRSA (Methicilin resistant Staphylococcus aureus)

Gram positive bacteria

Helicobacter species ( Gram negative)

Klebsiella pneumonia

In the era of increasing antimicrobial resistance –

There is a growing need for anti microbial agents &

Drugs with novel mechanism of action.

Development Of Glycyclines

Glycyclines are a new class of antiiotics derived from TETRACYCLINE.

Specially designed to overcome two common mechanisms of tetracycline resistance

1) Resistance mediated by acquired efflux pump

2) Ribosomal protection by binding to 30s subunit.

* Presently there is only one glycycline antibiotic for clinical use i.e TIGECYCLINE

Introduction of TigecyclineIntroduction of Tigecycline

Tigecycline: TygacilTM

First member of glycylcyclines

• 9-t-butylglycylamido derivative of MINOCYCLINE

Resistant to the two common mechanism leading to bacterial resistance to tetracycline

In vitro antibacterial specturm of In vitro antibacterial specturm of tigecycline[tigecycline[2,3,4]2,3,4]

Gram-positive Gram-negative

Anaerobic Atypical

• Staphylococcus aureus

• Staphylococcus epidermidis

• Streptococccus spp.

• Enterococcus faecalis

• Citrobacter freundii

• Citrobacter koseri

• Klebsiella oxytoca

• Klebsiella pneumoniae

• Bacteroides spp.

• Clostridium perfringes

• Clostridium difficile

•Peptostreptococcus

• Mycobacterium spp.

• Chlamydia pneumoniae

•Chlamydia trachomatis

They lack activity against pseudomonas Proteus & Providencia species.

PSEUDOMONAS

Generally, bacteriostatic agent Bacteriocidal agent for S. pneumoniae and H.

influenzae Post-antibiotic effect:

3-4 hours for S. aureus; 2-3 hours for E. coli Conc-dependent killing

AUC/MIC is the most important parameter Breakpoint: 5 – 10 for gram-positive; 7 for

Eneterobacteriaceae & anaerobes (high tissue level should be considered)

Breakpoint: 12.5 for CSSI

Pharmacology of Tigecycline

Volume of distribution: 7.2 ~ 8.6 L/kgVolume of distribution: 7.2 ~ 8.6 L/kg Primary route:Primary route:

• Biliary excretion: 59%, Biliary excretion: 59%, • Urinary excreation: 33%Urinary excreation: 33%

TT1/21/2: 42.4 hours: 42.4 hours

Pharmacokinetics & clinical efficacy

•Used to treat complicated skin infections

• Intra abdominal infections

• Bacteraemia

• Hospital acquired & ventilator associated pneumonia.

CELLULITIS

ONLY ADMINISTERED PARENTRALLY

Side effects & Precautions1) Diarrhoea i.e wattery/bloody

2) Fast heart rate

3) Severe pain in upper stomach, headache,

4) Increased sweating

• Inform your doctor if you are tetracycline allergic

• Should not use for children <18 yr’s & for pregnant women

• This drug may make sun sensitive – So avoid sun exposure

• This drug may make you dizzy - So donot drive

• Sterilization

• Isolation

• Handwashing and gloving

• Surface sanitation

• Antimicrobial surfaces

• Aprons

Eliminate potential sources for hospital acquired infections with the GLOSAIR 400 and 600. These full room decontamination systems use 5% hydrogen peroxide mist to kill pathogens in every nook and cranny of your OR. GLOSAIR eliminates bacteria and viruses on hard nonporous surfaces and can eliminate MRSA from hospital furniture and upholstered chairs1.

GLOSAIR

Advanced Decontamination System

Kasbekar N. Am J Health-System Pharmacy 2006

Schafer JJ, Goff DA. Expert Rev Anti Infect Ther 2008

Slover CM, Rodvold KA, Danziger LH. Annals Pharmacother 2007

Bhattacharya M, Parakh A, Narang M. J Postgrad Med 2009

REFERENCES