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Antimicrobials IT12021
Antimicrobials IT12021
IT1 96006
Dr Helen Benson
BPharm PhD AACPA MPS Adv PP(II)
Consultant Pharmacist
Be able to describe
• the role of antimicrobial therapy in the
treatment of infections
• Understand the factors involved in selecting
an appropriate antimicrobial
Learning • List commonly used anti-bacterials and their
classes
Outcomes • Identify antibiotics which should be used in
infections
• Understand information on specific groups of
antibiotics
Principles of antimicrobial use
Classes
Lecture Antibacterials
Outline Antifungals
Antivirals
Clinical applications
Principles
• Microbes
• Fungi, yeasts, moulds (example
tinea)
• Bacteria (example, bacterial
pneumonia)
• Viruses, (examples, Herpes simplex,
influenza, COVID-19)
Normal Flora
• Normal flora reside throughout the
body
• Flora are known as ‘commensal’
meaning to the benefit of one organism
without effecting the other
• They protect the body from infection,
prevent pathogens penetrating
endothelium, help absorption of vitamins
and can digest fatty acids in the gut.
• Movement of normal flora from its
home location to another location in the
body can cause infection.
Pathways to infection
• Ingestion
• Inhalation
• Internal perforation
• Trauma
• Iatrogenic
• Surgical intervention
• Barrier nursing/ hand washing failure
• Communal wards
Vulnerable
populations
• Which patients do you think are more
prone to infection?
• Length of treatment
• Single dose?
• Short Course< 5days?
• Longer Course 5-10 days
• Extended Course> 10 days
Antibiotics
Substances that kill or inhibit the
growth of bacteria
Considerations
when choosing
antibiotics
Bacterial Drug Targets
Gram-negative
Bordetella Cocci B.pertusis Whooping cough
Campylobacter Spiral rods C.jejuni Food poisoning
Escherichia Rods E.coli Septicaemia, wounds, UTIs
Pseudomonas Flagellated rods P.aeruginosa Septicaemia,
respiratory tract, UTIs
Gram positive
Staphylococcus cocci S.Aureus Wound, boils, septicaemia
Streptococci Cocci S.pneumonia Pneumonia, meningitis
cocci S.pyogenes Scarlet fever,
rheumatic fever,
cellulitis
organism Transmission Outcome
Gram positive S.pneumoniae inhalation Typical
pneumonia
Different S.Pyogenes inhalation Typical
pneumonia
clinically pneumonia,
anthrax
similar
Gram negative M.catarrhallis inhalation Typical
pneumonia
K.Pneumonia aspiration Typical
infections P.Aeroginosa Inhalation
pneumonia
Typical
or pneumonia
aspiration
Bacterial Spectrum
• Broad spectrum-active against a
range of organisms (gram positive and
gram negative)
• Bacteriostatic-inhibit or delay
bacterial growth and replication
Source: http://amrls.cvm.msu.
edu/pharmacology/ant
imicrobials/
Antibacterial drug
targets
Three main targets for antibacterial
drugs
Cell wall synthesis
Nucleic acid synthesis
Protein Synthesis
• Polymixins
• Outer cell wall membrane
structure
Benzylpenicillin Gram positive Bacterial meningitis
(penicillin G) Some gram negative Skin and soft tissue
phenoxymethylpenicillin (strep or staph)
(penicillin V) Pharyngitis (S.pyogenes)
Source: www.blad.co.in
• Inhibit synthesis of bacterial cell wall
peptidoglycan
• Bind penicillin-binding proteins
• Inhibit transpeptidation enzyme
• Inactivate autolytic enzyme inhibitor
•
Beta lactam
Cell lysis
• Bactericidal
Gram positive
Beta-lactams and gram
Resistance an issue
negative,
Carbapenems anaerobes
May be
combined Similar adverse effects to other beta lactams
with cilastin
Aztreonam
• Parenteral only
Beta-lactams • Gram negative aerobes only
Monobactams N.meningitis, H. influenza
Antibacterials chloramphenicol
that affect
protein
aminoglycosides
synthesis
macrolides
• Inhibit protein synthesis
• Bacteriostatic
• Administered via oral and parenteral routes
• issues with oral absorption for some agents
• Doxycycline and minocycline well absorbed
Tetracyclines orally
• Broad spectrum
• Adverse effects
• sepsis
Adverse effects
Aminoglycosides
• Serious and dose related
• ototoxicity
• nephrotoxicity
TDM important
Macrolides
Erythromycin, Clarithromycin, Clindamycin, Azithromycin,
Roxithromycin
• macrolide structure
Source:tmedweb.tula ne.edu
• affect ribosomal translocation
• compete with choramphenicol and
clindamycin to bind 50s subunit- can’t use
together
• spectrum: varied
• erythromycin similar to penicillin
• renal excretion
Chemical inactivation by Al3+ and Mg2+