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Microbiology
Mechanism of action of Antibiotic:
1) Inhibit cell wall synthesis:-
- Bacitracin -penicillin -vancomycin -cephalosporin -carbapenems

2) Inhibit cell membrane formation:-

-Amphotericin -Nystatin -polymyxin

3) Inhibit protein synthesis:-

Chloramphenicol

Aminoglycosides as *gentamycin *amikacin

*tobramycin *streptomycin (deafness or cochlear damage)

*kanamycin *Neomycin

Macrolide as *erythromycin *clarithromycin

*lincomycin *azithromycin

Tetracyclines as tetracycline, doxycyclin ,demeclocycline ,minocycline & tigecycline

4) Inhibit Nucleic acid:-

-Sulfa + Trimethoprine -Rifampicine (inh DNA dependent RNA polymerase)

-Griseofulvin -actinomycin

-Nalidixic acid -pyrimethamine

-Fluroquinolone (eg ciprofloxacin & levofloxacin)

-floxacilline , norfloxacilline , ofloxacilline & moxifloxacin (inh. ATP dependent DNA gyrase)

*Mechanism of action of sulfa drugs: folic acid synthesis pathway

PABA sulfamethoxazole H2F trimethoprine H4F (Folic acid)

Pus contain high amount of PABA

Anti-malarial drugs:

Pyrimethamine Sulfadoxine Fansidar

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chloroquine Mafloquine primaquine Quinine

Anthelmintics :

-mebendazole -pyrontal pamoate

-Niclosamide -pyrivinium pamoate

-piprazine citrate

Penicillins

*penicillinase labile (secreted by staph &psedm.) *penicillinase resistant

- Acid labile (parentral) -Ac stable (oral) -Acid stable -Ac labile

Cryst . pen. (pen G) .Ampicillin .oxacillin .methicillin

procaine pen. .Amoxicillin .cloxacillin

Benzathine pen .phenoxy methyl penicillin .dicloxacillin

Carbenicillin penicillin (pen V) .Naficillin

Ticarcillin

Diseases in other names

-ST. vitus disease cholera

- Downs syndrome mongolism

-Honsens disease leprosy treated with Dapson (anti TB &anti-Leprosy)

Drugs which pass BBB (blood brain barrier)

*penicillin *sulfonamides

*chloramphenicol *tetracyclines

*streptomycin (in meningitis only)

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NOTES
*viruses & Rickettsia:

They differ from bacteria that they cannot survive outside a living tissue.

*Mumps incubation periods is 14 – 21 days

*chloroquine : used in malaria prophylaxis one week before exposure & 4-6 weeks after
leaving endemic area (also quinine & primaquine)

*Interferon: glycoprotein complex that inhibit virus replication

*Epstein – Barr virus "EB virus" (lysteria monocytogens):

a herpes virus which is the etiology agent of mononucleosis (increase number of monocytes)

* AMES test: is a biological assay to assess the mutagenic test for carcinogen by salmonella
growth (it require histidine for growth)

*rheumatic fever: is caused by streptococcus (B hemolytic)

* Diagnostic agents for: syphilis colloidal Hg

Paresis (weakness of voluntary movement) colloidal Gold

Cancer Colloidal Cu

Germicides Colloidal Ag

*Schick test: test used to determine whether or not a person is susceptible to diphtheria

*Mantoux (Tuberculin test): is a screening tool for tuberculosis (TB).

*Localize brain tumors Chormerodrin

*typhoid carrier: common location of s. typhi is gall bladder

*Hook warm: is Ancyclostoma doudenalis , a parasite capable of entering the body through
intact skin

*Community acquired pneumonia is treated with Doxycycline

*Niclosamide: an anthelmintic drug effective against Beef & pork tape warm

* Hepa filters: are used to remove particles from air & also bacteria (<0.22micro grams), tested with:

- Smoke test -DOP test (di octyl phthalate) - microbial test

*vancomycin: effective against gm +Ve cocci particularly staph, clostridia, sever infection &
pseudomonas. (vancomycin enema for Cl. Dificil colitis)

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*chloramphenicol: make grey baby syndrome in neonates

*lyophilization: sterilization by freeze drying

*sterilization of Hormones is by radiation or filtration

*limulus test: is used to test for pyrogen

*EO ethylene oxide sterilization: for syringe sterilization

* Ciprofloxacin side effects: -peripheral neuropathy -heart problems -rhabdomyolysis

-stephen jhon's syndrome

*the bacterial cell wall

Gm +ve : consists of peptidoglycan & teichoic acid

Gm –ve : consists of peptidoglycan, lipoprotein, outer membrane &

lipopolysaccharide layer.

*Methenamine: Urinary antiseptic (decompose in water and give formaldehyde)

*Anti TB -pyrazinamide side effect: increase gout (arthralgia), malaise, fever & GI upset

-Ethambutol side effect: red – green color blindness

-Rifapentine mechanism of action inhibit DNA dependant RNA polymerase

*Anti HIV: Didanosin (reverse transcriptase inh.), Retrovir,Lopinavir & Saquinavir

*Purine analogues (adenine &guanine): Mercaptopurine , thioguanine & pentostatin

*Pyrimidine analogues (thymine, cytocine &uracil): Fluorouracil, cytarabine & floxuridine

*Psoriasis management:-Ingram's regimen (anthralin +UVb)

-goeckerman regimen (coal tar + UVb)

-Tazarotene (for psoriasis and acne)

-Methotrexate -psoralen(UVa)

-etretinate(VIT A analogue) -calcipotriene(VIT D3)

* Sucrose > 65% retard microorganism growth

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Helicobacter pylori(H. pylori): is a gastro intestinal infection that cause peptic ulcers.

Anti-viral agents (DNA viruses):

Anti-viral Mechanism Uses Precautions & DI
Acyclovir Incorporated into Herpes Oral: NVD & headache.
(Disadv. viral simplex viral IV: nephrotoxicity, neurologic effects,
5 doses per day) DNA, infections hypotension, phlebitis.
inhibit (herpes, Topical: pruritis.
viral replication. chickenpox, Probenecid & zidovudine increase blood
varicella, conc.
Valacyclovir shingles). Only oral forms.
(pro-drug of Nausea, vomiting, headache.
acyclovir)
Famciclovir NVD & headache, fatigue.
(pro-drug for Probenecid increases its level.
penciclovir)
Ganciclovir Herpes, EBV, Neutropenia, anemia, and thrombocytopenia
CMV Probenecid increases Gan level, Zidovudine
& cytotoxic drugs increase neutropenia,
Imipenem-cilastatin increases seizures
Amantadine Interfere with Prophylaxis & CNS: Ataxia, nightmares, insomnia,
viral attachment treatment of depression, confusion, headache,
& uncoating Influenza A Anti-Cholinergic SE.
Rimantadine infection May increase incidence of seizures, CNS SE
but less than amantadine.
Oseltamivir Neuraminidase Treatment of Not approved for children < 18 years or in
inhibitor, inhibit Influenza A & pregnancy.
viral replication B. SE: nausea, vomiting, vertigo & insomnia.
Zanamavir Use in Not approved for children < 11 years or in
(by oral prophylaxis is pregnancy.
inhalation) off-label. SE: NVD.

Foscarnet Inhibit enzymes CMV retinitis Highly nephrotoxic, electrolyte imbalance

involved in DNA Broad (Ca, Mg, Phosphate) & seizures.
synthesis. spectrum, used IV pentamidine increases risk of renal
in cases of toxicity & hypocalcemia.
acyclovir or Probenecid inhibits excretion.
ganciclovir Concurrent nephrotoxic drugs increase risk
resistance. of renal damage.
Cidofovir Inhibit viral DNA CMV retinitis Hypersensitivity (sulfa)
synthesis (not curative) Nephrotoxicity & granulocytopenia.
Probenecid must be administered with each
dose of cidofovir.
Ribavirin (by Inhibit DNA & RSV & Cardiac arrest, deterioration of pulmonary
aerosol) RNA synthesis. influenza A & function, bacterial pneumonia & apnea. Not
B in children. indicated in adults due to teratogenic
potential

Anti-malarial drugs:
Drug Use
Chloroquine Drug of choice except
for P. falciparum
resistant strains
Side Effects
C: pruritis, vomiting, headache.
UC: hair, skin, corneal opacity,
myopathy, blood dyscrasias.

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Hydroxy Alternative to R: nerve deafness, retinopathy,

chloroquine choloroquine photophobia.
Primaquine Cure relapses of C: hemolysis with G6PD def.
P.vivax & P.ovale UC: GI upset (take with food).
Pyrimethamine Chloroquine-resistant In high doses: agranulocytosis,
P.falciparum, in megaloblasic anemia, aplastic
combination with anemia & thrombocytopenia.
sulfonamide or a Stevens-Johnson syndrome,
sulfone nausea, vomiting.
Quinine Acute malaria caused Hypersensitivity, visual &
by chloroquine hearing disturbance, GI, fever,
resistant strains syncope. CI: in G6PD def.,
tinnitus & optic neuritis.
Fansidar Prophylaxis of Hypersensitivity, cutaneous
chloroquine resistant effects, hematologic & hepatic
P.falciparum effects.
Mefloquine ttt of acute malaria & C: dizziness, NVD, headache,
prevention of bradycardia, nightmare, anxiety
P.falciparum & P.vivax UC: hair loss, skin rash.
R: seizure & psychosis.
DI: Mefloquine + quinine, quinidine & βBlockers: ECG
abnormalities or cardiac arrest.
Mefloquine + quinine or chloroquine: risk of convulsions.

Amebicides & trichomonacides:

Drug Comment
Diloxanide Given in combination for extra-intestinal amebiasis.
Treat asymptomatic carriers of amebic & giardic cysts.
Emetine High toxicity (cardio & neuro), used only if other agents fail.
Metronidazole Preferred drug for amebic dysentery, anaerobes, C. difficile.
SE: GIT, metallic taste, disulfiram like reaction, urine
darkening, occasional neurologic reactions.
Quinacrine Giardiasis & tapeworm treatment, may cause seizures,
headache, NV, may exacerbate psoriasis.
Iodoquinol Intestinal amebiasis, high long term use may cause optic
neuritis or peripheral neuropathy.
Paromomycin Not absorbed, aminoglycoside

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Anthelmintics:

Drug Spetrum SE & Comments

Mebendazole Broad spectrum GI, myelosuppression
with high doses
Albendazole Taenia solium (Pork tape Hepatotoxicity (16%),
worm), & dog tape worm rare cytopenias.
Diethylcarbamazine Filariasis (Wuchereria Headache, malaise,
bancrofti) severe allergy.
Loiasis (Loa loa)
Pyrantel Roundworm, pinworm, Anorexia, NVD,
hookworm headache.
Thiabendazole Broad spectrum GI & rare CNS
Piperazine Rounworms & pinworms GI & CNS
Quinacrine Cestodes (T. solium, T. Used with caution in
saginata) hepatic disease, may
cause psychosis
Niclosamide T. saginata & other tape Nausea, vomiting,
worms (except T. solium) dizziness, drowsiness
Oxamniquine Schistosoma mansoni Convulsions, Nausea,
vomiting, dizziness,
drowsiness
Praziquantel Schistosomiasis, flukes, Mild, headache,
cestodes malaise, dizziness.

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