● Gram-negative bacteria
PHARMACOLOGY
TERMS
❖ pharmacology – the study of drugs and their
effect on the human body.
❖ pharmacodynamics – “what does the drug
do to the body?” study of the mechanisms
of action of drugs within the body and how
drugs produce their effects in the body.
❖ pharmacogenetics – study of drug reactions
in the body that are unanticipated or
unusual, and may have a hereditary basis
for the response.
❖ pharmacokinetics – “what does the body
do to the drug?” study of drug actions as
they move through the body; the way the
body absorbs, distributes, metabolizes and
excretes drugs; mathematical study of drugs
based on time and dose pharmacology
Study of biologically active compounds,
how they react in the body and how the
body reacts to them.
❖ pharmacotherapeutics – study of drugs used
to prevent, treat or diagnose disease
❖ pharmacy – preparation and dispensing of
drugs
❖ toxicology – study of harmful or poisonous
effects of drug
❖ Side effects - are the unintended effects of
a drug that commonly occur in patients and
are mild in nature at a therapeutic dose
❖ Adverse effects - are the unintended and
unexpected effects of a drug
MECH ANI SM OF I NFECTI ON
● Invasion
o the ability of a pathogen to grow
extremely rapidly and cause direct
damage to surrounding tissues
● Production of Toxins
o disrupt normal cellular activity and,
in extreme cases, result in death
CLASSIFICATION OF BACTERIA
● Gram-positive bacteria
o Contain a thick cell wall and retain a
purple color after staining
o Include staphylococci, streptococci,
and enterococci
o Bacteria that have thinner cell walls
will lose the violet stain
o Examples: bacteroides, Escherichia
coli, klebsiella, pseudomonas, and
salmonella.
● Based on cellular shape
o Bacilli – rod shapes
o Cocci – spherical shape
o Spirilla – spiral shape
● Based on their ability to use oxygen
o Aerobic – grows in oxygen rich
environment
Examples: Lactobacillus, Nocardia,
Mycobacterium tuberculosis
o Anaerobic – those that grow best
without oxygen
Examples: Clostridium, Bacteroides
ANTI-INFECTIVE
● Used to treat bacterial, fungal, viral, or
parasitic infections
● Term as antibiotic, antibacterial,
antimicrobial
● 2 MAJOR CLASSIFICATION:
o Chemical classes
o Pharmacologic classes
ACTIONS OF ANTI-INFECTIVE DRUGS
● Bacteriocidal – kills bacteria
Examples: aminoglycosides, beta-lactams,
vancomycin, quinolones, rifampin,
metronidazole
● Bacteriostatic – slow their growth, allowing
the body’s natural defenses to eliminate the
microorganisms
Examples: chloramphenicol, erythromycin,
clindamycin, sulfonamides, trimethoprim,
tetracyclines
RESISTANCE
● Culture and sensitivity testing – process of
growing the pathogen and identifying the
most effective antibiotic.
● Broad-spectrum antibiotic – one that is
effective against a wide variety of different
microbial species.
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 ● Narrow-spectrum antibiotic – one that is -stomach infections
effective against a smaller group of -anthrax
microbes or only the isolated species. -gas gangrene
● Superinfection
o Signs and symptoms of a
superinfection CEPHALOSPORINS
-diarrhea
● The largest antibiotic class
-bladder pain
● For gram-negative infections and who
-painful urination
cannot tolerate the less expensive penicillins
-abnormal vaginal discharges
● Are bacteriocidal and act by attaching to
GOAL OF ANTIBIOTIC THERAPY penicillin-binding proteins to inhibit bacterial
cell-wall synthesis.
⮚ To kill enough bacteria, or to slow the ● Classified by their “generation”
growth of the infection, so that natural body ● First-generation cephalosporins
defenses can overcome the invading agent o The most effective drugs in this class
are against gram-positive organisms
CONSIDERATIONS including staphylococci and
streptococci. Ex: Cefalexine
⮚ Infections of the CNS are particularly difficult
● Second generation
to treat – drugs cannot cross the blood –
o More potent
brain barrier.
o More resistant and exhibit a broader
⮚ Injury or inflammation can cause tissues to
spectrum against gram-negative
become acidic or anaerobic and to have
organisms than the first-generation
poor circulation.
drugs. Ex: Cefuroxime
⮚ Excessive pus formation or hematomas can
● Third generation
block drugs from reaching their targets.
o Broader spectrum against gram-
⮚ Allergic reactions can occur without
negative bacteria than the second-
previous incidents. Penicillins are the class of
generation agents
antibacterials having the highest incidence
o Generally have a longer duration of
of allergic reactions.
action
⮚ Some antibiotics cross the placenta (e.g.,
o Drugs of choice against infections by
tetracyclines taken by the mother can
Pseudomonas, Klebsiella, Neisseria,
cause teeth discoloration in the newborn;
Salmonella, and H. influenza. Ex:
aminoglycosides can affect the infant’s
Ceftriaxone
hearing).
● Fourth generation
⮚ Patients with a deficiency of the enzyme
o Effective against that have
glucose-6-phosphate dehydrogenase
developed resistance to earlier
(G6PD) should not receive sulfonamides,
cephalosporins
chloramphenicol, or nalidixic acid >>> their
o Are capable of entering the
erythrocytes may rupture.
cerebrospinal fluid (CSF) to treat CNS
PENICILLINS infections
● Most FREQUENT adverse effect:
● Kill bacteria by disrupting their cell walls. o Allergic reactions
● Indicated for Gram-positive bacteria o Skin rashes are a common sign of
● For the treatment of allergy
- Pneumonia ● COMMON adverse effects:
- Skin, bone, and joint infections o GI complaints
- blood and valve infections
- tetanus
- sickle-cell anemia in infants
-meningitis
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TETRACYCLINES
● Gram-negative and gram-positive
organisms
o Act by inhibiting bacterial protein
synthesis. By binding to the bacterial
ribosome, the tetracyclines slow
microbial growth and exert a
bacteriostatic effect.
o Drugs of choice for diseases: Rocky
mountain spotted fever, typhus,
cholera, Lyme disease, peptic ulcers
cause by Helicobacter pylori, and
chlamydial infections
● Common adverse effects: Gastric distress
Manage: taken with food
● SHOULD not be taken with milk or iron
supplements.
Calcium and iron can decrease the drug’s
absorption by as much as 50%
● Direct exposure to sunlight can result in
severe photosensitivity during therapy.
● Patients younger than 8 years old should
NOT be given
o May cause permanent yellow-brown
discoloration of the permanent teeth
o Also affect fetal bone growth and
teeth development
o They should be avoided during
pregnancy
o The risk for superinfection is relatively
high (Broad spectrum)
Manage: should observe for signs of
a secondary infection when
administered parenterally or in high
doses.
- can cause hepatotoxicity,
especially in patients with preexisting
liver disease
MACROLIDES
● Inhibit protein synthesis by binding to the
bacterial ribosome
● At low doses, this inhibition produces a
bacteriostatic effect. At higher doses, and in
susceptible species, macrolides may be
bacteriocidal.
● Effective against most gram-positive
bacteria and many gram-negative species.
● Common indications: whooping cough,
legionnaires’ disease, and infections by
streptococcus, H. influenza, and
Mycoplasma pneumoniae
*insert picture of macrolide Uses*
● Clarithromycin is one of several antibiotics
used to treat peptic ulcer disease, due to its
activity against H. pylori
● Erythromycin, azithromycin
● The macrolides exhibit few serious adverse
effects:
o Mild GI upset (nausea, vomiting),
diarrhea, and abdominal pain (most
frequent adverse effects).
o Dry skin or burning (topical route)
o Hepatotoxicity
o Ototoxicity
o Macrolides are broad-spectrum
agents, superinfections may occur.
MACROLIDE ANTIBIOTICS COULD CAUSE SIDE
EFFECTS SUCH AS ABDOMINAL PAIN, NAUSEA,
VOMITING, OR DIARRHEA
Drug List - MACROLIDES
▪ Azithromycin (Zithromax, Z-PAK)
▪ Clarithromycin (Biaxin)
▪ Dirithromycin (Dynabac)
▪ Erythromycin base (Eryc, Ery-Tab)
▪ Erythromycin ethylsuccinate (E.E.S.,
EryPed)
▪ Erythromycin lactobionate (Erythrocin)
▪ Erythromycin stearate (Erythrocin)
▪ Erythromycin-sulfisoxazole (Pediazole)
AMINOGLYCOSIDES
● Are bacteriocidal and act by inhibiting
bacterial protein synthesis
● More toxic than other antibiotic classes
● For the treatment of aerobic gram-negative
bacteria, mycobacteria, and some
protozoans
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 ● They are normally reserved for serious
systemic infections cause by aerobic gram-
negative organisms, including those caused
by E. coli, Serratia, Proteus, Klebsiella, and
Pseudomonas
● Given parenterally because they are poorly
absorbed from the GI tract.
● They are occasionally given orally for their
local effect on the GI tract to sterilize the
bowel prior to intestinal surgery
● Examples: Neomycin, Streptomycin Sulphate
Meiji, Kanamycin, Tobramycin, Neo-fradin,
Gentamicin, Amikin
ADVERSE EFFECTS: Ototoxicity and
Nephrotoxicity
o Damage to the inner ear: hearing
impairment, dizziness, loss of
balance, persistent headache, and
ringing in the ears
o Because permanent deafness may
occur, aminoglycosides are usually
discontinued when symptoms of
hearing impairment first appear.
o Nephrotoxicity: abnormal urinary
function tests (serum creatinine or
BUN). Nephrotoxicity is usually
reversible.
FLUOROQUINOLONES
● Fluoroquinolones were once reserved only
for UTIs because of their toxicity
● Indicated against gram-negative
pathogens and gram-positive microbes
● Are bacteriocidal and affect DNA synthesis
by inhibiting two bacterial enzymes: DNA
gyrase and topoisomerase IV.
● Clinical applications include infections of
the respiratory, GI, and genitourinary tracts,
and some skin and soft-tissue infections.
● Ciprofloxacin (Cipro) – most widely used
● An agent of choice for the post-exposure
prophylaxis of bacillus anthracis (anthrax)
● Should be taken with food
● Should not be taken with multivitamins or
mineral supplements because calcium,
magnesium, iron, or zinc ions can reduce
the absorption of some fluoroquinolones by
as much as 90%
● Most common adverse effects: nausea,
vomiting, and diarrhea
● Most serious adverse effects: dysrhythmias
(gatifloxacin and moxifloxacin)
● Central nervous system effects: dizziness,
headache, and sleep disturbances
● Fluoroquinolones have been associated
with an increased risk of tendonitis and
tendon rupture, particularly of the Achilles
tendon. The risk of tendon rupture is
increased in patients over age 60 and those
receiving concurrent corticosteroids.
● Clinical studies have suggested that
fluoroquinolones affect cartilage
development >> these drugs are not
approved for children underage 18
● Use in pregnancy or in lactating patients
should be avoided
FIRST GENERATION
▪ Cinoxacin
▪ Nalidixic acid
SECOND GENERATION
▪ Ciprofloxacin (Cipro)
▪ Norfloxacin (Noroxin)
▪ Ofloxacin (Floxin)
⮚ Nausea, diarrhea, vomiting, rash,
headache, restlessness,
THIRD GENERATION
▪ Galifloxacin (Zymar)
▪ Levofloxacin
⮚ pain and inflammation at the injection site,
local burning, stinging, corneal irritation
FOURTH GENERATION
▪ Gemifloxacin
▪ Moxifloxacin
⮚ Anaphylaxis, tendon rupture, superinfection,
photosensitivity, seizure, peripheral
neuropathy, hepatotoxicity
SULFONAMIDE Antibiotics
● Sulfonamide antibiotics (Sulfa meds):
1. Sulfamethoxazole (Bacterium, Resprim,
& Septrin )
2. Sulfadiazine (Silvazine cream, Flamazine
cream & tablets)
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 3. Sulfadoxine (for malaria) o The most effective drug for treating
4. Sulfacetamide (Bleph-10 eye drop) MRSA infections
5. Sulfapyridine which is part of o MANAGEMENT:
Sulfasalazine (Pyralin, Salazopyrin) - because of the drug’s ototoxicity,
● If you had an allergic reaction to Bactrim, hearing must be evaluated
there is no way of knowing whether the frequently throughout the course of
allergy was to sulfamethoxazole or to therapy
trimethoprim, therefore you should avoid - also cause nephrotoxicity, leading
trimethoprim (Alprim, Triprim) as well as to uremia
sulfonamide antibiotics (Sulfa meds)
● Adverse effects:
o The formation of crystals in the urine
o Hypersensitivity reactions
o Nausea and vomiting
o Potentially fatal blood abnormalities:
-aplastic anemia
-acute hemolytic anemia
-agranulocytosis

MISCELLANEOUS ANTIBACTERIALS

● Clindamycin
o effective against both gram-positive
and gram-negative bacteria
o most severe adverse effect:
▪ antibiotic-associated
pseudomembranous colitis
(AAPMC)
o Adverse effects: diarrhea, rashes,
difficulty breathing, itching, difficulty
swallowing should be reported to the
HCP.
● Metronidazole (Flagyl)
o Effective against anaerobes that
cause abscesses, gangrene,
diabetic skin ulcers, and deep
wound infections.
o For the treatment of H. pylori
infections of the stomach associated
with peptic ulcer disease
o Adverse effect:
▪ Nausea, dry mouth, and
headache
▪ High doses can produce
neurotoxicity
● Vancomycin (Vancocin)
o For severe infections from gram-
positive
o It is often used after bacteria
become resistant to other antibiotics

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DRUG USED TO TREAT I NFECTION (PART 2)
TUBERCULOSIS
ANTIFUNGAL DRUGS
● A highly contagious infection caused by
Mycobacterium Tubercle.
● It is treated with multiple anti-infectives for a
period 6 months to 1 year, or 24 months.
● 2 broad categories of antitubercular agents
A. PRIMARY (First line) drugs, which are
generally the most effective and best
tolerated by patients.
B. SECONDARY (Second line) drugs, more
toxic and less effective than the first-line
agents are used when resistance
develops.
❖ INITIAL PHASE: 2 months of daily therapy with
isoniazid, rifampicin, pyrazinamide, and
ethambutol.
o If laboratory test results show that the
strain is sensitive to the initial phase
drugs, ethambutol is dropped from
therapy
❖ CONTINUATION PHASE: 4 months of therapy
with isoniazid and rifampin, 2 to 3x /week
o Drugs are extremely used for preventing
the disease in addition to treating it.
● Therapy usually begins immediately after a
patient receives a positive AFB sputum test.
● CHEST X-ray
● Mantoux test (Tuberculin test)
HANSEN’S DISEASE
● Mycobacterium leprae
● Multiple drugs, usually begins with Dapsone
(DDS)
MAC
● Mycobacterium avium complex (MAC)
● Causes an infection of the lungs, most
commonly observed in AIDS patients.
● The most effective drugs against MAC are
the macrolides azithromycin ( Zithromax)
and darithromycin (Biaxin).
● Fungi are single-celled or multicellular
organisms whose primary role on the planet
is to serve as decomposers of dead plants
and animals, returning their elements to the
soil for recycling
● Most exposure to pathogenic fungi occurs
through inhalation of fungal spores or by
handling contaminated soil. Thus, many
fungal infections involve respiratory tract,
the skin, hair, and nails. In additions, the
lungs serve as a route for invasive fungi to
enter the body and infect internal organs.
An addition common source of fungal
infections, especially of the mouth or
vagina, is overgrowth of normal flora.
● Fungi grows slowly, and infections may
progress for many months before symptoms
for many months before symptoms develop.
Fungi cause disease by replication: only a
few secrete toxins
● Fungal infections are not readily transmitted
through casual contract
❖ Classification of Mycoses
o Superficial mycoses affect the scalp,
skin, nails, and mucous membranes such
as the oral cavity and vagina
● Systemic mycoses are those affecting
internal organs, typically the lungs, brain,
and digestive organs.
● Mycoses of this type require aggressive oral
or parenteral medications that produce
more adverse effects than the topical
agents.
● Mechanism of action:
o Cholesterol is essential for animal cell
membranes, ergosterol is present in fungi
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 o The largest class of antifungal drugs, the
azoles, inhibits ergosterol biosynthesis,
causing the fungal plasma membrane
to become porous or leaky.
o Ex. Amphotericin B (Fungizone),
Terbinafine (lamisil), and Nystatin
(Myrostatin)
● AZOLES
o Consist of two different chemical
classes
o The imidazoles and the triazoles
o Interfere with the biosynthesis of
ergosterol, which is essential for
fungal cell membranes. Depleting
fungal cells of ergosterol impairs their
growth.
o Fluconazole (Diflucan), Itraconazole
(Sporanox), ketoconazole (Nizoral),
and Voriconazole (Viend)
o Ketoconazole is available only orally,
and is the most hepatotoxic of the
azoles
o The most common adverse effects
of the systemic azoles are nausea
and vomiting.
PROTOZOAN INFECTIONS
● Protozoa are single-celled organisms that
inhabit water, soil, and animal hosts
● Inhabit where sanitation and personal
hygiene are poor and population density is
high
● Often occur in patients who are
immunocompromised (advanced stages of
AIDS) or who are receiving antineoplastic
drugs
● Protozoans can form cysts that allow the
pathogen to survive in harsh environments,
and infect other hosts.
● Cysts makes the parasite resistant to
pharmacotherapy
● Antibiotic, antifungal, and antiviral drugs are
ineffective against protozoans
● Malaria is caused by four species of the
protozoan Plasmodium (Anopheles
mosquito)
1. infected mosquito bites person
2. Plasmodium travels to liver
3. Merozoites divide inside hepatocytes
4. Merozoites are released to
bloodstream causing fever and chills
5. Merozoites enter red blood cells
6. Mosquito bites person and becomes
infected to restart cycle
● Goals of antimalarial therapy:
o Prevention of the disease:
Chloroquine (Aralen) is the drug of
choice. (Prophylaxis)
o Treatment of acute attacks:
o Prevention of relapse: Primaquine
Phosphate
o Artemether/Lumefantrine (Coartem)
● Nonmalarial Protozoan Infections
o Amebiasis, toxoplasmosis, giardiasis,
cryptosporidiosis, Trichomoniasis
o Trypanosomiasis, and leishmaniasis
o Entamoeba hystolytica
✔ Dysentery – a severe form of
diarrhea
✔ Metronidazole (flagyl) drug of
choice for nonmalarial
protozoan infections.
DRUGS FOR HELMINTHIC INFECTIONS
● Helminths consist of various species of
parasitic worms.
● Helminths classification:
o Roundworms (nematodes)
o Flukes (trematodes)
o Tapeworms (cestodes) – the most
common
● Ascariasis (caused by roundworm Ascaris
lumbricoides)
o Primarily infects children aged 3 to 8
years
o Oral mebendazole (Vermax) for 3
days
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 ● Complications caused by extensive - sexual activity (oral, anal, or
infestations vagina) or
- physical obstruction in the intestine - contract of infected fluids (broken
- malabsorption skin, mucous membranes. Or needle
- increased risk for secondary bacterial sticks)
infections o Newborn can receive the virus
- severe fatigue during birth or from breast-feeding

VIRAL INFECTION Entry in the body

● Viruses are nonliving agents that infect

The virus attaches to its preferred
bacteria, plants, and animals
target – the CD4 receptor on T4
● Intracellular parasites
(helper) lymphocytes
● Many viral infections, (rhinoviruses –
common cold), are self-limiting, they resolve
Enters the cell
in 7-10 days, with no permanent effects in a
healthy person
The RNA strands are converted to
● Some viral infection, require drugs to
DNA by the viral enzyme reverse
prevent infection or to alleviate symptoms
transcriptase.
✔ HIV
✔ Hepatitis B virus
Enters the nucleus of the T
● 3 basic strategies in antiviral
lymphocytes
pharmacotherapy:
o Prevent viral infections through the
Eventually incorporated to the host’s
administration of vaccines
DNA
o Treat active infections with drugs
such as Acyclovir (Zovirax) that
Multiply
interrupt replication cycle
o For long-term infections, use drugs
As a final step, the viral enzyme
that boost the patient’s immune
protease cleaves some of the
response (immunostimulants)
proteins associated with the HIV
● HIV-AIDS
DNA, enabling the virion to infect
Acquired immune-deficiency syndrome
other T4 lymphocytes.
(AIDS) is characterized by profound
immunosuppression that leads to
o The CD4 T-lymphocyte is the primarily
opportunistic infections and malignancies
cell coordinating the immune
not commonly found in patients with
response
healthy immune defenses.
o An HIV-infected patients may
o Antiretroviral drugs slow the growth
produce as many as 10 billion new
of the causative agent for AIDS the
virions every day, and the patient’s
human immunodeficiency virus (HIV)
devastated immune system is unable
to remove them.

The therapeutic goals for the pharmacotherapy of

HIV-AIDS:

● Reduce HIV-related morbidity and prolong

o Infection with HIV occurs by survival
exposure to contaminated ● Improve the quality of life
-body fluids (blood or semen) ● Restore and preserve immunologic function
o Transmission ● Promote maximum suppression of viral load

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 ● Prevent the transmission from mother to
child in HIV infected pregnant patients
● 2 laboratory tests used to guide
pharmacotherapy
✔ Absolute CD4 T-cell count
✔ Measurement of the amount of HIV
RNA in the plasma
● Performed every 3 to 6 months to assess the
degree of success of antiretroviral therapy.
Classification of Drugs for HIV-AIDS
● Highly active antiretroviral therapy (HAART)
● The goal of HAART is to reduce the plasma
HIV RNA to its lowest possible level
INFLUENZA
Classification (mechanism of action)
● Nucleoside reverse transcriptase inhibitor
(NRTI)
● Nonnucleoside reverse transcriptase
inhibitor (NNRTI)
● Protease inhibitor (PI)
● Nucleotide reverse transcriptase inhibitor
(NNRT) – Tenofovir
● Fusion (entry) inhibitor – Enfuvirtide (Fuzeon)
● HIV integrase inhibitor – Raltegravir
(Isentress)
HERPES VIRUSES
● Herpes simplex viruses (HSVs) are a family of
DNA viruses that cause repeated blister-like
lesions on the skin, genitals, and other
mucosal surfaces
● MOT:
- direct physical contact (infected person)
- infected mothers to their newborns,
sometimes resulting in severe CNS disease
● HSV-1 primarily causes infections of the eye,
mouth, and lips
● HSV-2 causes genital infections
● Cytomegalovirus (CMV) affects multiple
body systems in immunosuppressed patients
● Varicella-zoster virus (VZV) causes shingles
(zoster) and chicken pox (varicella)’
● Epstein – Barr virus (EBV) results in
mononucleosis and Burkitt’s lymphoma
(Cancer)
● Herpesvirus-6 causes roseola in children and
hepatitis or encephalitis immunosuppressed
patients
● The pharmacologic goals for the
management of herpes infections are
twofold:
o To relieve acute symptoms
o To prevent recurrences
● Antiviral drugs used to treat herpes viruses
do not cure patients; the virus remains in
patients for the remainder of their lives.
● Acyclovir (Zovirax)
● Famciclovir (Famvir)
● Valacyclovir (Valtrex)
● Adverse effect: Nephrotoxicity
● Influenza is a viral infection characterized by
acute symptoms that include sore throat,
sneezing, coughing, fever, and chills
● Spread via airborne droplets
● Influenza viruses are designated with the
letters A, B, or C
● Viral hepatitis is a common infection caused
by a number of different viruses
● All hepatitis viruses cause inflammation and
necrosis of the liver cells
● Acute symptoms
o Fever, chills, fatigue, anorexia,
nausea, and vomiting
● Chronic symptoms
o Prolonged fatigue, jaundice, liver
cirrhosis, hepatic failure
❖ Hepatitis A virus (HAY) is spread by the oral-
fecal route
● Prevention is the best treatment
● Therapy for acute HAV infection is
symptomatic
● No specific drugs are indicated, the
infection is self-limiting
o HAV vaccine (Havrix)
❖ Hepatitis B virus (HBV)
● MOT: Exposure to contaminated blood and
body fluids
● Major risk factors for HBV infection
● Injected drug abuse
● Sex with an HBV-infected partner, and sex
between mean
● Perinatal route
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 ● Health care workers (accidental exposure to
HBV-contaminated needles or body fluids)
● Treatment of acute HBV infection is
symptomatic – no specific therapy is
available
● Lifelong immunity to HBV – acquired
following resolution of the infection
● The final stage of the infection is hepatic
cirrhosis. (Chronic HBV infections are
associated with an increased risk of
hepatocellular carcinoma).

Best treatment for HBV infection – prevention

through immunization

Recombivax HB, Engerix-B, Twinrix (combi HA/BV)

- 3 doses of the vaccine provide up to 90% of

patients with protection against HBV following
exposure to the virus.

❖ The hepatitis C, D, E, and G viruses – referred

to as non A- non B viruses
● Hepatitis C has the greatest clinical
importance
● HCV is the most common cause of
liver transplants
● No vaccine is available for Hep C
● MOT: infected blood or body fluids

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