Microbiology

• Periplasmic space: found between the

Bacteriology: Morphology outer membrane and cell wall
• Coccus – round/circular bacteria
o Diplococci CELL WALL
o Tetrad • Aka peptidoglycan (PG) layer
o Sarcina
• O antigen
o Streptococci
• Present in all bacteria EXCEPT
• Bacilli – rod shaped
Mycoplasma sp.
o Coccobacillus
o Bacillus Gram (+) Gram (-)
o Diplobacilli Gram Blue/violet Red/pink
o Streptobacilli reaction
o Palisades PG layer Thicker (7-8 Thinner (1-2
• Spirochetes- spiral shaped PG layers) PG layers)
• Pleomorphic – vary in shape Teichoic acid Present Absent
Periplasmic Absent Present
Bacterial Envelope space
-All concentrix outer layers Toxin Exotoxin Endotoxin
produced
CAPSULE • Gram staining
• Outermost layer , if present o Most used differential stain
*Encapsulated bacteria (Some Killers Have o Steps (VIAS)
Pretty Nice Capsule) Crystal Violet Primary stain
Gram’s iodine Mordant
o Streptococcus pneumoniae Alcohol Decolorizer
o Klebsiella pneumoniae Safranin O Secondary stain/
o Haemophilus influenzae counterstain
o Pseudomonas aeruginosa *GENERAL RULES
o Neisseria meningitidis
• All cocci are gram positive, except
o Cryptococcus neoformans (fungi)
(NVM)
• Virulence factor (VK): K antigen →
o Neisseria
prevents phagocytosis
o Veillonella
• Mucoid and slimy polysaccharide layer
o Moraxella
• Identification: India ink stain
• All bacilli are gram negative, except
OUTER MEMBRANE (BANSCEL MP)
o Bacillus
• Major permeability barrier for gram (-) o Actinomyces
bacteria o Nocardia
• Contains lipopolysaccharide (LPS) → o Streptomyces
endotoxin o Corynebacterium, Clostridium
o Also present in Listeria sp. (gram o Erysipelothrix
+) → not converted to endotoxin o Listeria, Lactobacillus
(accdg. to studies) o Propionibacterium
• Bacteria that cannot be seen on gram
staining
 o Thin or absent cell wall o Amphitrichous: flagella on both
▪ Mycoplasma ends
▪ Chlamydia o Flagella all over the surface
▪ Legionella pneumophila
▪ Rickettsia Internal Bacterial Structure
▪ Treponema NUCLEOID
o Thick mycolic acid layer
▪ Cryptosporidium • Aka nuclear region/body, chromatin
▪ Legionella micdadei region/body
▪ Isospora (protozoan) • Not a true nucleus due to lack of nuclear
▪ Nocardia (weakly acid membrane (“primitive nucleus”)
fast) • Circular double stranded (ds) DNA w/c
▪ Mycobacterium (gram contains essential genetic information
variable)
PLASMID
*Acid Fast Staining
• Extrachromosomal circular dsDNA w/c
Carbol-Fuschin Fuschia dye: primary contains non-essential genetic
stain information:
Carbolic acid:
o Resistance (R plasmid)
chemical mordant
o Conjugation (F plasmid – fertility)
Heat Physical mordant
o Toxin production
Acid Alcohol Decolorizer
Methylene blue Counterstain o Virulence
o Transposons (jumping genes)

CELL MEMBRANE METHODS OF GENE TRANSFER

• Phospholipid bilayer embedded • Transformation: free uptake of naked

w/protein DNA in solution
• Fxn: selective barrier for solutes, energy • Transduction: bacteriophage-mediated
metabolism (ATP production) (virus)
• Conjugation: via sex pili (F plasmid)
ATTACHMENT o Transposition: via transposons

PROTEINS RIBOSOMES
• Fimbriae: attachment to host cell • Site of protein synthesis
• Pili: attachment to another bacteria, • 70s= 30s+50s → potential sites for
conjugation (virulence factor) antibacterial agents

ORGAN OF ENDOSPORES
LOCOMOTION • Main component is calcium
dipicolinate/dipicolinic acid
• Axial Filament: corkscrew motion of • Important for survival: resistance to
spirochetes heat, chemicals, dehydration
• Flagella: forward locomotion of bacilli, H • Identification: malachite green staining
antigen o Green: spore
o Atrichous: no flagella o Red: vegetative cells
o Monotrichous: one flagellum on • Ex. Bacillus, Clostridium
one end • Processes:
o Lopothricus: tufts of flagella on o Germination: spore → vegetative
one end cell
 o Sporulation Cycle: Vegetative cell o Vibrio parahemolyticus
→ spore (seafood/oyster poisoning)

Stages of Microbial Growth Nutritional Requirements of

• Lag Phase Microbial Growth
o No replication
ENERGY SOURCE
o Inc size and synthesis
• Log Phase • Phototrophs – light
o Highest replication rate • Chemotrophs- redox potential
o Highest antibiotic susceptibility (medically important)
• Stationary Phase
o # of replication = # of death CARBON
• Dcline Phase
o # of death > # of replication REQUIREMENT
*Reasons of Microbial death: • Heterotrophs/Organotrophs – organic
carbon (medically important)
• ↓nutrients • Autotrophs/Lithotrophs – inorganic
• ↑toxins carbon

Physical Requirements of Oxygen Requirements of

Microbial Growth Microbial Growth
TEMPERATURE OBLIGATE
• Psychrophiles/Cryophiles AEROBES
o Cold temp
o Listeria monocytogenes • Require O2 for survival
• Mesophiles o Pseudomonas
o Body temp o Nocardia
o Medically important bacteria o Bacillus
• Thermophiles o Mycobacterium
o Hot temp o Corynebacterium
o Spore-formers (Bacillus,
Clostridium) OBLIGATE

pH ANAEROBES
• Acidophiles • Grow only in the absence of O2
o Acidic pH o Actinomyces
o Lactobacillus acidophilus, o Bacteroides
Lactobacillus caseine (Yakult) o Clostridium
• Neutrophiles o Eubacterium
o Neutral pH (7.2 – 7.6) o Fusobacterium
o Medically important bacteria o Prevotella
• Alkalophiles/Basophiles
MICROAEROPHILES
o Alkaline/basic pH
o Vibrio cholerae • Require ↓ O2, however ↑ O2 conc. →
toxic
OSMOTICPRESSURE o Campylobacter
• Halophiles o Helicobacter
o High salt content/ osmotic
AEROTOLERTANT
pressure
• Tolerates O2 but cannot replicate in its o Reducing Medium
presence ▪ For growth of obligate
o Lactobacillus aerobes
o Propionibacterium ▪ Thioglycolate broth: the
only reducing medium
FACULTATIVE ▪ Simple media using candle
jar/ Gas Pak – provides
ANAEROBES anaerobic environment
• Could thrive w/ or w/out O2 o Selective medium
▪ Allows selective growth of
Culture Media an organism while
selectively inhibiting the
• Nutrient material for microbial growth in
growth of others
laboratory
• Composition Culture media Selective for
o Chemically defined medium MCA, EMB Enterobacteriaceae
▪ Exact composition is Colistin-Nalidixic agar Gram (+)
known Thayer-Martin Neisseria sp
▪ For growth of autotrophs Lowenstein-Jensen Mycobacterium
tuberculosis
& chemoautotrophs Loeffler’s Serum Corynebacterium
o Complex/not chemically defined Medium, tellurite diphtheriae
medium Medium
▪ Exact composition is not Campy BAP, Skirrow’s Campylobacter jejuni
known agar
▪ For growth of most Bordet-Gengou Bordetella pertussis
Medium
medically important Thiosulfate citrate bile Vibrio sp
bacteria salts sucrose (TCBS)
o Tissue Culture o Differential Media
▪ For growth of viruses ▪ Subdivide a nig group og
• Physical State MO into categories
o Liquid – no solidifying agent ▪ Blood agar plate – for
(agar) streptococcus sp
o Semi-Solid – 0.5-1.0% agar ▪ MCA & EMB – for
o Solid- 1.5—3.0% agar Enterobacteriaceae
• Function Use
o Simple Media Organism Type of Zone of
▪ Designed for nonfastidious Hemolysis Hemolysis
α- hemolytic Partial Green
organism hemolysis
▪ Nutrient agar/broth ß - hemolytic Complete Clear
o Enriched Media hemolysis
▪ Fortified w/ vitamins, y-hemolytic Non-hemolytic Red
nutrients and other
Culture Lactose of Non-Lactose
substances needed for the Medium Fermenters Fermenters
growth of fastidious MCA Pink Colonies Colorless
oragnisms EMB Purple black Colorless
colonies
Ex E. Coli: green metallic sheen
Blood Agar Plate Require high NA
content
Milk Agar Require high
protein diet
Chocolate Agar Require Gram Positive Cocci
Plate molybdenum from
diet
• Catalase Test -differentiate the
medically important cocci (hydrogen
peroxide)
o Catalase (+) –presence of
effervesecence
▪ Staphylococcus
o Catalase (-) – absence of
effervescence
▪ Streptococcus
• Coagulase Test -Mannitol Salt Agar
(MSA)
o Inoculated the sample to rabbit or
sheep plasma
o Coagulase (+)
▪ Staphylococcus aureus
o Coagulase (-) – Novobiocin
sensitivity
▪ Sensitive: S. epidermidis
▪ Resistant: S.
saprophyticus
 Blood agar plate
o α-hemolytic – partial hemolysis
o Quellung rxn (swelling)
o Optochin sensitivity
▪ Sensitive: S. pneumoniae
▪ Resistant: viridans s.
o ß-hemolytic
o bacitracin sensitivity
▪ Sensitive: S. pyogenes
▪ Resistant: S.agalactiae
o Y-hemolytic
o 6.5%NaCl
▪ (+): Enterococcus sp
▪ (-): S. bovis
STAPHYLOCOCCUS
 Staphylococcus aureus
o Pathogenic
o MSA: golden yellow colonies
o VF:
▪ Lipase: causes boils,
furuncle, carbuncle
(clusters)
▪ Exfoliatin: causes
staphylococcal scalded
skin syndrome (SSS)
▪ Enterotoxin B: causes food
poisoning, toxic shock
syndrome (SSSS +
hypotension)
▪ ß-lactamase/penicillinase:
antibiotic resistance
o Treatment:
▪ Antistaphylococcal
penicillins (Methicillin,
Nafcillin, Oxacillin)
▪ For MRSA: vancomycin
▪ For VRSA: Linezolid,
streptogramins
 Staphylococcus epidermidis
o MSA: porcelain white colonies
o Normal flora of the skin
o Presentation: bacterial
endocarditis in px w/ prosthetic
heart valves (observed post-op)
 Staphylococcus saprophyticus
o MSA: colorless colonies
o Normal flora of the vagina
o Presentation: UTI in women
o Tx: Fluoroquinolones
STREPTOCOCCUS
 Streptococcus pneumoniae
o Pneumococcus
o Lance-shaped diplococci
o VF: capsule (quelling rxn)
o MCC
▪ Community acquired
pneumonia (CAP) -2nd/3rd
gen of Cephalosporins +
extended macrolides
▪ Meningitis in elderly – 3rd
gen cephalosporins
▪ Otitis media – penicillin
o Prevention: PCV (important for
elderly)
 Viridans Streptococcus
o S. mutans: normal flora of the
mouth
▪ Overgrowth may cause
dental caries
o Presentation: subacute bacterial
endocarditis px w/prosthetic
heart valves
 Streptococcus pyogenes (GABHS)
o Suppurative (fast forming)
▪ Respi tract: pharyngitis
(strep throat)
▪ Skin: Cellulitis, Impetigo
▪ Erysipelas: painful red
rash w/orange peel
consistency
 o Non-suppurative ▪ Mucous membranes → GI
o Exotoxin A anthrax
▪ Scartlet fever/2nd dse: ▪ Respi tract → inhalational
sandpaper rash, anthrax
strawberry tongue
▪ Toxic shock syndrome Presentation
(less severe) Cutaneous Anthrax Papule → vesicle
→necrotic ulcer
o M protein (type III
→eschar
hypersensitivity) GI anthrax Causes bowel
▪ Rheumatic heart fever ulceration → sepsis
(RHF) Inhalational Anthrax Woolsorter’s disease
▪ Post-streptococcal -pulmonary
glomerulonephritis (PSGN) hemorrhage (fatal)
 Streptococcus agalactiae (GBS)  Bacillus cereus
o Normal flora of the vagina o Presentation: food poisoning
o Presentation: cause neonatal Emetic Form Diarrheal
sepsis and meningitis Form
o Tx: Ampicillin + Gentamicin Implicated Fried rice Meat,
 Enterococcus food vegetables
o Normal flora of the GIT Symptoms Vomiting, Diarrhea,
o Presentation: abdominal abdominal
cramps cramps
Nosocomial/hospital-acquired
o Self-limiting
infections: meningitis,
 Clostridium
endocarditis
o Obligate anaerobe
o ESKAPE PATHOGEN: Associated
o All are motile, except C.
w/ antimicrobial resistance
perfringens
▪ Enterococcus faecium
o Subterminal spores: C.
▪ Staphylococcus aureus
perfringens (club-shaped)
▪ Klebsiella pneumoniae
o Spherical and terminal spores:
▪ Acinetobacter baumanii
C.tetani (tennis racket/drumstick
▪ Pseudomonas aeruginosa
appearance)
▪ Enterobacter sp.
 Clostridium tetani
o TX: Vancomycin
o Spherical and terminal spore:
o For VRE: linezolid,
tennis racket/ drumstick
streptogramins
appearance
Gram Positive Bacilli o MOT: skin penetration from soil
contaminated objects (habitat)
SPOREFORMERS o VF: tetanospasmin
 Bacillus ▪ MOA: inhibits release of
o Obligate aerobe inhibitory NT agents
o All are motile, except B. anthracis (glycine, GABA) →
o Some members could be sources important to initiate
of antibiotics muscle relaxation →
tetanic contraction
Antibiotic Source →spastic paralysis
Bacitracin Bacillus subtilis o Presentation
Polymixin B Bacillus polymyxa ▪ 1st sign: trismus/lockjaw
 Bacillus anthracis ▪ Triad: spastic paralysis,
o MOT: entry of spores via opisthotonos, sardonic
▪ Injured skin → cutaneous smile
anthrax
 ▪ Tetanus neonatorum: from
cutting the umbilical cord
w/ unsterile equipment
(non-institutional/home
delivery) → spastic
paralysis
▪ COD: paralysis of respi
muscle
o Tx:
Metronidazole, Penicillin,
▪ ▪ Hemorrhage & red-black
tetanus toxoid + tetanus
▪ discoloration
antitoxin
▪ Spasmolytic agents
(diazepam)
o Prevention: DPT
 Clostridium botulinum
o VF: Botulinum toxin (Botox)
▪ MOA: inhibits release of
Ach from presynaptic
neuron → flaccid paralysis
▪ Destroyed by heating at
100°C for 20 mins
▪ C/A: treatment of wrinkles
o Adult botulism
▪ MOT: Ingestion of
preformed toxins from
infected canned goods
▪ Presentation: N&V,
diarrhea, flaccid paralysis
▪ COD: paralysis of respi
muscle
▪ Prevention: heat canned
good at 100°C for 20 mins
▪ Discard defective/bulging
canned goods
o Infant botulism
▪ MOT: ingestion of spores
from infected honey
▪ Presentation: flaccid
paralysis → floppy baby
syndrome
▪ Prevention: avoid honey
during 1st day of life
 Clostridium perfringens
o VF:
▪ Enterotoxin: clostridial
food poisoning
▪ α-toxin (lecithinase) and
Θtoxin (hemolysin)
• necrotizing &
hemolytic effects
• produces
target/double
hemolysis on BAP
▪ Σ toxin: neurotoxic (animal
studies) → bioterrorism
o Presentation:
▪ Clostridial myonecrosis
▪ Severe muscular infection
w/gas gangrene
▪ Usually seen in diabetic px
▪ Foul-smelling discharge:
mixed infection
▪ Complication: sepsis →
death
o TX
▪ Penicillin
▪ Surgical
debridement/amputation
 Clostridium difficile
o Normal flora in the large intestine
o Associated w/ chronic antibiotic
use:
▪ Clindamycin
▪ Amoxicillin, ampicillin
o Pseudomembranous colitis
▪ Overgrowth of C. difficile
produce biofilm/
pseudomembrane →
diarrhea
o Tx:
▪ Most important mgmt.:
stop the above antibiotics!
▪ DOC: metronidazole,
vancomycin
NON SPOREFORMERS
 Actinomycyetes
o Formerly classified under
kingdom fungi
o Branching & filamentous under
the microscope
 Actinomyces israelii
o Anaerobic actinomycetes
o Normal flora of the skin and oral
cavity
o Presentation
▪ Actinomycosis/Lumpy Jaw
▪ Granulomatous abcess
usually in the mandible
 o Tx: Penicillin ▪ May extend to
 Nocardia asteroids larynx/ trachea (bull
o Aerobic actinomycetes neck appearance)
o Weakly acid fast → obstruction
o Presentation: Nocardiosis
o TX: Erythromycin + Diphtheria
(pneumonia)
antitoxin
o Tx: TMP-SMZ
o Prevention: DPT
 Actinomadura madurae
 Erysipelothrix rhusopathiae
o Aerobic actinomycetes
o H2S producing (Triple Sugar Iron
o Presentation: mycetoma
Medium
▪ Bacterial: actinomycetoma
o H2S (-): no black ppt formed
▪ Fungi: eumycetoma
o H2S (+): black ppt formed
o Causes blockade of lymphatic
o Zoonotic infection
vessels → SC swelling → madura
o Risk: fishermen, fish handlers,
foot butchers (meat/fish vendor dse)
o TX: Ketoconazole (bacteria), o Presentation:
Amputation (fungal) o Erysipeloid/whale finger/ seal
 Streptomyces finger
 Sources of antibiotics ▪ Raised violaceous lesion
Organism Antibiotic on the finger w/out pus
S. erythreus Erythromycin o TX: penicillin
S. griseus Streptomycin  Listeria monocytogenes
S.lincolnensis Lincomycin o ID:
S.orientalis Vancomycin ▪ Microscopy: tumbling
S. roseosporus Daptomycin
motility
S. venezulae Chloramphenicol
S. orchidaceus Cycloserine ▪ Motility medium: umbrella
S.nodosus Amphotericin B growth pattern
S. nousei Nystatin o Important food borne pathogen:
 Corynebacterium diptheriae can survive
o Non-motile, club-shaped bacilli ▪ Refrigerator temp
Chinese character arrangement/ ▪ Low pH
palisades ▪ ↑salt content
o ID: o Presentation
▪ Loeffler’s agar slant: for ▪ Listeriosis
visualization ▪ Adult Human
metachromatic Babes- ✓ Bacteremia
Ernst granules (asymptomatic)
▪ BAP: gray colonies ▪ Perinatal
▪ Elek test ▪ Early onset syndrome
o Diagnosis: Dacron swab ✓ Stillbirth
o VF: Diphtheria toxin ✓ Neonatal sepsis
▪ MOA: Frag A → inhibits ▪ Late onset syndrome
protein synthesis by ✓ Neonatal meningitis
inhibiting elongation factor o Tx: Ampicillin + Gentamicin
2 → cell death
o Presentation Gram Negative Cocci &
▪ Cutaneous Diphtheria: Coccobacilli
necrotic skin lesions  Neisseria
▪ Pharyngeal Diphtheria:  Gen characteristics:
▪ Dirty gray o Kidney-shaped diplococci
pseudomembrane o Catalase (+)
 o Oxidase (+)
 Differentation:
o Carbohydrate utilization/
Fermentation test
o N. gonorrhea – glucose only
o N. meningitidis – glucose &
maltose
 Isolation:
o For sterile specimen (ex. CSF):
Chocolate agar plate (CAP) →
black colonies
o For non-sterile specimen (ex.
Genital discharge); Thayer-Martin
= CAP + VCN [Vanco (+),Colistin (-
), Nystatin (fungi)}
o Modified Thayer-Martin = CAP+
VCN + Trimethoprim (Proteus sp)
 Neisseria gonorrhea
o Gonococcus
o VF:
▪ Pili
▪ ß-lactamase
(penicillamine-producing
N. gonorrhea)
▪ Lipooligosaccharides:
endotoxin
o Presentation:
▪ Genital gonorrhea (tulo)
▪ Males: penile discharge,
dysuria, urethritis
▪ Female: asymptomatic →
ascending infection
▪ Complication: Pelvic
Inflammatory Dse →
scarring → infertility
▪ Tx: Ceftriaxone IM single
dose + Doxycycline BID for
7 days
✓ Doxycycline for
concomitant
Chlamydia infection
✓ Also treat the
asytmptomatic
partner
▪ Ophthalmia Neomatorum
✓ Acquired via
passage through
infected vaginal
canal
✓ Prophylaxis: Silver
nitrate,
erythromycin
▪ Disseminated Gonococcal
Infection
✓ Arthritis, dermatitis
 Neisseria meningitidis
o Meningococcus
o VF:
▪ Capsule: A, C, Y, W-135
(pathogenic serogroups)
▪ Lipooligosaccharide (very
potent)
o Presentation
▪ Meningitis – most common
in teenagers & young
adults
▪ Prevention:
meningococcal vaccine
(A, C, Y, W-135)
▪ Meningococcemia – flu-like
symptoms
▪ Widespread thrombosis →
disseminated
intravascular coagulation
(DIC) → bleeding
▪ Waterhouse-Friderichsen
syndrome: hemorrhage to
the adrenals
▪ Shock
(septic/hypovolemic) →
death
▪ TX: Penicillin,
Chloramphenicol, 3rd gen
cephalosporin
▪ Prophylaxis: Rifampicin &
Ciprofloxacin
 Haemophilus
o Blood-loving
o Isolation: CAP
▪ Nutrient needed are inside
RBC
 Haemophilus influenza
o Pfeiffer’s bacillus
o MOT: respi droplets
o VF: Capsule: type b → most
pathogenic
o Prevention: Hib vaccine
o Presentation
▪ Community Acquired
Pneumonia
-2nd/3rd gen cephalosporins
+ extended macrolides
 ▪ Meningitis in infants & o Zoonotic infection
toddlers o MOT: contact w/ rabbits (Francis
-3rd gen cephalosporins the rabbit), bite of ticks
▪ Otitis media – Amoxicillin o Presentation: tularemia/rabbit
▪ Acute bacterial epiglottitis fever
-3rd gen cephalosporins o Tx: Streptomycin
(Ceftriaxone)  Pasturella multocida
o MOT: dog or cat scratch
Most Common Cause of meningitidis by age o More common w/ cats “Papa the
group
Cat”
Neonates GBS
E. coli o Presentation: Pasteurellosis/ Dog
L. monocytogenes or Cat scratch disease
Infants & Toddlers H. influenzae o Tx: Penicillin
Teenagers & Young N. meningitidis  Bordetella pertussis
adults o VF: pertussis toxin →causes
Elderly S. pneumoniae
lymphocytosis
 Haemophilus aegypticus
o Isolation Bordet – Gengou media:
o Koch-Week’s bacillus
pearl-like colonies
o Presentation: Purulent
o Presentation: Whooping cough/
conjunctivitis
pertussis
o Tx: topical sulfonamide
o Tx: macrolides
 Haemophilus ducreyi
o Prevention: DPT
o Presentation: Chancroid → soft
painful chancre (genital ulcer)
Gram Negative Bacilli
o Vs. T. pallidum → hard painless
 Enterobacteriaceae
chancre o All are facultative anaerobes,
o “You cry w/ ducreyi” oxidase (-)
o Tx: o All are motile, except shigella,
▪ Azithromycin PO single klebsiella, yersinia
dose o H2S producing\
▪ Ceftriaxone IM single dose ▪ Salmonella
 Brucella ▪ Proteus
o Zoonotic infection ▪ Citrobacter fruendii
o B. abortus: cow (most common: ▪ Edwardsiella
“Bruce the cow”) o Rapid Lactose Fermenters
▪ Binds to fetal bovine ▪ Klebsiella
protein erythritol → ▪ Escherichia
abortion (not present in ▪ Enterobacter
humans) o Late Lactose fermenters
o B. melitensis: goat, sheep ▪ Citrobacter
o B. suis: pigs ▪ Serratia
o B. canis: dogs ▪ Salmonella arizonae
o MOT: ▪ Shigella sonnei
▪ Ingestion of ▪ Yersinia enterocolitica
unpasteurized dairy o Non-Lactose fermenters
products ▪ Pathogenic pathogens
▪ Direct contact (high risk: ✓ Salmonella
butchers, veterinarian) ✓ Shigella
o Presentation: Brucellosis/ Bang’s ✓ Yersinia
dse/ Malta fever/Undulant fever ▪ Opportunistic pathogens
o Tx: Tetracycline + Gentamicin ✓ Proteus
 Francisella ✓ Providencia
 ✓ Morganella • Chronic carrier
✓ Edwardsiella state: gallbladder
 Escherichia coli (Typhoid Mary)
o Colon bacillus o Tx:
o Most abundant aerobic flora of ▪ Ceftriaxone, Ciprofloxacin
the colon (Philippines)
▪ Most common flora of the ▪ Chloramphenicol (Int’l
colon: anaerobes literatures)
(bacteroides,  Shigella
fusobacterium) o S. dysenteriae: Group A – most
o Common indicator of the fecal common
contamination of water (water o S. flexneri: Group B – endemic in
ptability) the Philippines
▪ EMB: green metallic sheen o S.boydii: Group C
o Presentation: o S. sonnei: Group D – late lactose
▪ MCC: UTI fermenter
▪ TX: nitrofurantoin, o VF: Shiga toxin
Fosfomycin, ▪ Neurotoxic: seizures
fluoroquinolones ▪ Enterotoxic: dysentery
▪ Cytotoxic:Tenesmus/Painf
ETEC Enterotoxigenic Traveler’s Diarrhea
EPEC Enteropathogenic Infantile diarrhea
ul defecation
EIEC Enteroinvasive Produces Shigella- o TX: self-limiting, if severe may
like dysentery give:
EAEC Enteroaggregative Persistent watery ▪ Ciprofloxacin (adults)
diarrhea ▪ Azithromycin (children)
EHEC Enterohemorrhagic VF:  Yersinia enterocolitica
- Shiga-like toxin
(STEC)/verotoxin
o MOT: fecal-oral route
(VTEC) o Presentation: enterocolitis
-o157:H7 strain – ▪ Sometimes mistaken for
produces severe appendicitis
disease o TX: self-limitng, may give
-Presentation:
doxycycline
dysentery
Hemolytic-uremic  Yersinia pestis
syndrome (UHS): o Zoonotic infection
Renal failure, o MOT: bite of rat or flea (Yeye the
Anemia, rat)
Thrombocytopenia o Presentation: Plague
Tx:
Fluoroquinolones ▪ Bubonic Plague –
 Salmonella typhi presence of enlarged
o Reservoir: poultry & dairy suppurative lymph nodes
products in the groin and/or axilla
o Diagnosis: widal test, typhidot (buboes)
o Presentation ▪ Septicemic plague -
▪ Enterocolitis: Most hemorrhage (fingers, toes,
common manifestation nose) – black death
(constipation/diarrhea) ▪ Pneumonic plague – either
▪ Enteric Fever/Typhoid from septic emboli or
fever – prolonged high- airborne
grade fever o Tx: Aminoglycosides,
• Rose spots: rose- Tetracyclines
colored rash on the  Vibrio
torso (rare) o Oxidase (+), motile
 o Comma-/curve-shaped o Tx: supportive, may give
o Halophilic, except V. cholerae macrolides or fluoroquinolones
 Pseudomonas aeruginosa
Organism TCBS Disease
o Colonies emit a fruity smell
V. cholerae Yellow Cholera
colonies o Inhabits soil, water, vegetation
V. Green Seafood/Oyster o VF:
parahemolyticus colonies poisoning ▪ Capsule
V. vulnificus Blue-green Oyster ▪ Exotoxin A: major VF,
colonies poisoning inhibits protein synthesis
 Vibrio cholerae ▪ Pigments:
o VF: cholera toxin →↑cAMP →↑ • Pyocyanin: blue
movement of water & sodium into pigment, stimulates
the intestinal lumen → rice inflammatory
watery diarrhea → dehydration response
o Tx: fluid replacement, • Pyoverdin:
Tetracycline fluoresces in tissue
 Helicobacter pylori • Pyorubin: dark red
o Oxidase (+), motile pigment
o Spiral shaped bacilli • Pyomelanin: black
o VF: Urease → liberates ammonia pigment
→ neutralizes gastric acid o Presentation: Nosocomial
o Diagnosis: urea breath test infection: sepsis, meningits
o Presentation: Halitosis ▪ Hot tub folliculitis (jacuzzi)
▪ Peptic ulcer dse o TX: antipseudomonal penicillins &
▪ Chronic gastritis cephalosporins, aminoglycosides
▪ RF for gastric cancer  Calymmatobacterium granulomatis
o Tx: o Formerly Klebsiella granulomatis
▪ Triple therapy: OCA/OCM o Presentation:
• Omeprazole/any PPI ▪ Donovanosis/ Granuloma
• Clarithromycin Inguinale
• Amoxicillin ▪ Genital ulcer w/ beefy
• Metronidazole base
▪ Quadruple Therapy: TOMB ▪ Pseudobuboes;
• Tetracycline/Amoxi nonsuppurative enlarged
cillin lymph nodes
• Omeprazole ▪ !NOTE! ; donovanosis is
• Metronidazole not caused by Leishmania
• Bismuth donovani
subsalicylate o Tx: Azithromycin
 Campylobacter jejuni  Gardnerella vaginalis
o Oxidase (+) o Normal flora of the vagina
o Comma-, S-, or gull wing-shaped o Presentation: Bacterial vaginosis
bacilli ▪ Foul-smelling whitish
o Cultur: Skirrow/Butzler vaginal discharge (fishy
o Reservoir: Dogs odor)
o Presentation o Diagnosis: clue cells (vaginal
▪ Like shigellosis cells embedded w/bacteria)
▪ Crampy abdominal pain o Tx: metronidazole
▪ Bloody diarrhea
▪ Complication: Guillain- Bacteria cannot be seen in
Barre syndrome Gram Staining
 Mycoplasma pneumoniae ▪ Tx: doxycycline
o No cell wall, pleomorphic  Chlamydia pneumoniae
o Smallest free-living organism o Formerly known as Taiwan acute
(mollicutes) respiratory (TWAR) agent
o ID o Presentation:
▪ Microscopy: Diene’s stain ▪ Atypical pneumonia
→ fried egg colonies ▪ RF for atherosclerosis
o Presentation: atypical o Tx: Macrolides
pneumonia/walking pneumonia  Chlamydia psittaci
▪ Mild symptoms only o MOT: inhalation from dried bird
o Tx: Macrolides excrement
 Ureaplasma urealyticum o Presentation
o Presentation ▪ Psittacosis: parrots
▪ Non-gonococcal urethritis (parrot fever)
in males ▪ Ornithosis: other birds
▪ Salpingitis & post-partum o Tx: Macrolides
fever in females  Legionella pneumophila
▪ Associated w/ lung dse in o MOR: droplet transmission
premature infants of low o May spread through air
birth weight conditioning units that use water
 Chlamydia to cool air
o Obligate intracellular parasite o Presentation
o Forms ▪ Pontiac fever – less severe
▪ Elementary body: • Acute flu-like
extracellular, symptoms → self-
metabolically inert, limiting
infective form ▪ Legionnaire’s
▪ Reticulate body: Dse/Leigionellosis
intracellular reproductive • Atypical pneumonia
form o Tx: Macrolides
 Chlamydia trachomatis  Rickettsia
o Presentation o Obligate intracellular parasite
o Eye infection o Vectortransmitted
▪ Neonatal inclusion o Diagnosis: Weil-Felix reaction
conjunctivitis: passage o Presentation: triad of
through infected birth ▪ Fever
canal ▪ Rashes
▪ Adult inclusion ▪ Headache
conjunctivitis; acute o Tx: tetracycline, chloramphenicol
infection
▪ Trachoma: chronic Spotted Disease Vector
follicular → blindness Fever
R.rickettsi Rocky Tick
o Genital Infection Mountain
▪ Males: penile discharge, spotted fever
dysuria, urethritis R. akari Rickettsial pox Mite
▪ Females: asymptomatic Typhus
▪ Lymphogranuloma R. prowazeki Epidemic Louse
venerum typhus
R. typhi Endemic Flea
• Self-limited genital typhus
ulcer Scrub Typhus
• Swelling of inguinal Orientia Scrub Typhus Chigger mite
lymph nodes tsutsugamushi
 Coxiella burnetti
o Previously under Rickettsia
o Vector: ticks
o Presentation: Q fever
▪ Fever, rashes & heacge
o Tx: Tetrecycline, Ciprofloxacin
 Treponema pallidum
o Treponema – Greek for “coiled
hair”
o Stages:
o Primary Syphilis
▪ Hard, painless chancre
▪ Self-limting
▪ Diagnosis: dark field
microscopy
o Secondary Syphilis
▪ Condylomata lata: wart-
like lesions on the genitals
▪ Diagnosis: serological
testing
▪ Non-treponemal tests –
used for screening
• VDRL (Venereal
Disease Research
Laborator)
• RPR (Rapid Plasma
Reagin)
▪ Treponemal Tests:
confirmatory test
• FTAA: Fluorescent
Treponemal
Antibody
Absorption
• MHA:
Microhemagglutinat
ion
o Tx: Penicillin (DOC),
Erythromycin
▪ Jarisch-Herxheimer rxn:
due to antigen released by
dead T. pallidum →
neutropenia, hypotension
o Latent Syphilis
▪ Asymptomatic stage, lasts
for around 10 years
o Tertiary Syphilis
▪ Rare manifestation after
the advent of penicillin
▪ Gumma (granulomatous
lesions)
▪ Systemic manifestations:
neurosyphilis, aortic
aneurysm
o Congenital Syphilis
▪ Acquired during 1st
trimester of pregnancy
▪ Presentation:
• Intrauterine death
• Congenital
abnormalities at
birth: Hutchinson’s
triad:
o Hutchinson’s
teeth
o Interstitial
keratitis
o CN VIII
deafness
• Saber chin
• Scaphoid scapula
• Saddle nose
• Silent infection; may
not be apparent
until 2 years old
 Leptospira interrogans
o MOT: through mucous
membranes or breaks in the skin
coming in contact to water w/
infected urine (rodents, cats,
dogs, humans)
o Presentation:
▪ Leptospiremia,
Leptospiruria
▪ Anicteric Leptospirosis:
mild, flu-like symptoms
▪ Icteric
Leptospirosis/Weil’s dse:
• Meningitis, renal
failure, liver failure
• COD: pulmonary
hemorrhage
o Prophylaxis: Doxycycline 200mg
OD for 3-5 days
o Tx:
▪ Mild: doxycycline
▪ Moderate to severe:
Penicillin
 Borrelia burgdorferi
o Vector: Ixodes tick
o Presentation: Lyme dse
 ▪ Bull’s eye rash/ erythema
chronicum migrans:
expanding rash
 Borrelia burgdorferi
o Presentation: relapsing fever
(recurrent fever)
▪ Endemic form: Tick bite
(rodent host)
▪ Epidemic form: Body louse
(human host)
 Mycobacterium tuberculosis
o Koch’s bacillus
o 8th leading cause of morbidity in
th PH (as of 2010)
o VF: tuberculin & mycolic acid –
stimulates type IV
hypertensivity/cell-mediated
immunity → immune system
causing damage to the body
o MOT: airborne transmission
o Pathogenesis
▪ Primary infection: initial
infection usually during
childhood → bacilli walled
of by cardinal lymph nodes
▪ Secondary infection
▪ Reactivation:
immunocompromised
state usually in adulthood
▪ Pulmonary tuberculosis
(PTB): classic apical
infiltrates
▪ Extrapulmonarty (EPTB)
• CNS: tuberculous
meningitis
• Vertebral column:
Pott’s disease
o Presentation:
▪ Cough ≥2 weeks: most
important clinical finding
▪ Hemoptysis
▪ Weight loss
▪ Night sweats Cell-mediated
▪ Easy fatigability
▪ Dyspnea Lepromin skin
▪ Chest/back pain test (same as
o Diagnosis
o Sputum Microscopy
▪ Gold standard for
diagnosis presentation
▪ 2 sputum samples: at
meast 1 out of 2 must be
positive
o Tuberculin skin test (TST)/
Purified Protein derivative (PPD)/
Mantoux test
▪ Positive result: wheal or
erythema ≥10mm after 48-
72 hours
▪ International literatures:
≥15mm is positive, but
note that in endemic
countries (PH) the cut-off
is ≥10mm
o Culture: Lowenstein – Jensen
medium
o 5 Pillars of DOTS
▪ Political Commitment: LGU
Support
▪ Case detection: Sputum
microscopy
▪ Treatment partners:
Nurses, RPh, BHWs
▪ Steady drug supply: HRZE
▪ Recording & evaluation
 Mycobacterium avium-intracellulare
complex
o 2 combined species
o Presentation: cause TB in AIDS
px (AIDS-defining illness: usually
seen in px w/ advanced HIV/AIDS
o Tx: Macrolides + RE
 Mycobacterium leprae
o Hansen’s bacillus
o Obligate intracellular parasite
w/predisposition to cooler parts
of the body (ex. Skin, nerves)
o Isolation: armadillo foot pad
o MOT: nasal discharge from
untreated lepromatous leprosy
patients
Leprosy Tuberculoid Lepromatous
Strong Weak
immunity
Positive Negative
TST)
# of bacilli ↓ ↑
paucibacillary multibacillary
Clinical Hyposthetic Leonie facies,
hypopigmented saddle nose,
skin lesions nodular skin
lesions
 Treatment Rifampicin + Rifampicin +
Dapsone Dapsone +
Clofazimine
Antibacterial
CELL WALL
SYNTHESIS INHIBITORS
BETA -LACTAM INHIBITORS
 Penicillin
o Chemistry:
▪ Thiazolidine ring is
attached to a ß-lactam ring
▪ 6-aminopenicillanic acid
nucleus
o MOA: interfering w/ the
transpeptidation reaction
o PK: rapidly excreted by the
kidnet (90%)
o AE: hypersensitivity reactions
Examples Spectrum of Activity
Natural Penicillins: Active against all ß-
Benzylpenicillin (Pen hemolytic streptococci
G), Phenoxymethyl & most other species;
penicillin (Pen V) limited activity against
staphylococci; active
against meningococci
& most gram (+)
anaerobes; poor
activity against aerobic
& anaerobic gram (-)
rods
Penicillinase- resistant Similar to the natural
penicillins: methicillin, penicillins, except
nafcillin, oxacillin, enhanced activity
cloxacillin, dicloxacillin against staphylococci
Broad-spectrum Activity against gram
penicillins: ampicillin, (+) cocci equivalent to
amoxicillin the natural penicillins;
active against some
gram (-) rods
ß-lactam w/ ß- Activity similar to
lactamase inhibitor natural ß-lactams, plus
(ampicillin-sulbactam, improved activity
amoxicillin-clavulanate, against ß-lactamase –
ticarcillin-clavulanate, producing
piperacillin- staphylococci &
tazobactam) selected gram (-) rods;
not all ß-lactamase are
inhibited;
piperacillin/tazobactam
is the most active
 Cephalosporin
o Chemistry
▪ Dihydrothiazine ring
attached to ß-lactam ring
▪ 7-aminocephalosporanic
acid nucleus
o MOA: interfering w/the
transpeptidation reaction
o A/E:
▪ Hypersensitivity rxn
▪ Hypoprothrombinemia
(methylthiotetrazole
group)
▪ Disulfiram-like rxn
(methylthiotetrazole
group)
Examples Spectrum of Activity
1st Generation Streptococci, S. aureus
Cefazolin (Ancef)
Chepalexin mohydrate
(Keftab)
Cefadroxil (Duracef)
Cephadrine (Velosef)
2nd Generation E. coli, Klebsiella,
Cefuroxime (Zinacef) Proteus, H. influenzae,
Cefuroxime axetil M. catarrhalis. Not as
(Ceftin) active against gram (+)
Cefprozil (Cefzil) organisms as 1st gen
Cefmetazole agents.
(Zefazone) Inferior activity against
Loracarbef (Lorabid) S. aureus compared to
cefuroxime but w/
added activity against
B. fragilis & other
bacteroides spp.
3rd Generation Enterobacteriaceae, P.
Cefotaxime (Clarofan) aeruginosa, Serratia,
Ceftriaxone (Rocephin) N. gonorrhea; activity
Cefdinir (Omnicef) for S. aureus, S.
Cefditoren pivoxil pneumoniae, & S.
(Spectracef) pyogenes comparable
Ceftibuten (Cedax) to 1st gen. Activity
Cefpodoxime proxetil against Bacteroides
(Vantin) spp. inferior to that of
Ceftizoxime (Cefizox) cefoxitin & cefotetan
Cefoperazone
(Cefobid) Activity against
Ceftazidime (Fortaz) Pseudomonas
4th Generation Comparable to 3rd gen
Cefepime (Maxipine) but more resistant to
Cefpirome some ß-lactamases
5th Generation
Ceftaroline fosamil
 Carbapenem
o Ex: Doripenem, Ertapenem,
Imipenem (inactivated by
dehydropeptidase; combined w/
Cilastatin)
 o PK:
▪ Penetrate body tissues &
fluids well, including CSF
(except ertapenem)
▪ Ertapenem has the longest
half-life (4 hrs, OD dosing)
o C/A:
Infections caused by
▪ ▪
susceptible organisms
that are resistant to other
available drugs
▪ Enterobacter infections
(DOC)
▪ Infections caused by
extended spectrum ß-
lactamase-producing G (-)
bacteria
o A/E (more common w/ Imipenem)
▪ Nausea, vomiting,
diarrhea, skin rashes & rxn
at the infusion sites
 Monobactam
o Chemistry: monocyclic ß-lactam
ring
o Ex. Aztreonam
o Spectrum of Activity:
▪ Aerobic Gram (-)
organisms (including P.
aeruginosa)
▪ Gram (-) spectrum is
similar to that of the 3rd
generation cephalosporins
(structural similiraties to
ceftazidime)
o PK: penetrates well into the CSF
GLYCOPEPTIDES
 Vancomycin
o Chemistry: Glycopeptide
o MOA: binding firmly to the D-Ala-
D-Ala terminus of nascent
peptidoglycan pentapeptide
o PK
▪ Poorly absorbed from the
intestinal tract
▪ Only P.O. for the treatment
of colitis caused by C.
difiicile
o C/A:
▪ Bloodstream infections &
endocarditis caused by
methicillin-resistant
staphylococci
▪ Tx of colitis by C. difficile
(severe cases)
o A/E:
▪ Phlebitis at the site of inj
(Red Man’s Syndrome)
Ototoxicity (rare)
▪ Nephrotoxicity
 Teicoplanin
o Chemistry: glycopeptide
o Similar to vancomycin in MOA &
antibacterial spectrum
o Route: IM/IV
o PK: long half-life (45-70 hrs), OD
dosing
 Telavancin
o Chemistry: semisynthetic
lipoglycopeptide derived from
vancomycin
o MOA:
▪ Inhibits cell wall synthesis
by binding to the D-Ala-D-
Ala terminus of
peptidoglycan
▪ Disrupts the bacterial cell
membrane potential &
increases membrane
permeability
o PK: t1/2 = 8 hrs (OD dosing)
o A/E:
▪ Nephrotoxicity
▪ Teratogenicity
o C/A:
▪ Complicated skin & soft
tissue infections
▪ Hospital-acquired
pneumonia
 Dalbavancin & Oritavancin
o Chemistry: semisynthetic
lipoglycopeptide derived from
teicoplanin
o MOA
▪ Same w/ Vancomycin &
Teicoplanin
▪ Disruption of cell
membrane permeability &
inihibition of RNA
synthesis ( additional MOA
of oritavancin)
o PK:t1/2 = >10 days (once a week
IV dosing)
 o C/A
▪ Soft tissue infection
LIPOPEPTIDE
 Daptomycin
o Chemistry: cyclic lipopeptide
o MOA: bind to the cell membrane
via calcium-dependent insertion
of its lipid tail\
o PD properties
▪ Similar to that of
vancomycin except that it
may be active against
vancomycin-resistant
strain of enterococci & S.
aureus.
▪ In clinical trials,
daptomycin was non
inferior in efficacy to
vancomycin (effective
alternative for
vancomycin)
o A/E:
▪ Myopathy (creatine
phosphokinase levels
should be monitored
weekly)
▪ Pulmonary surfactant
antagonizes daptomycin
(C/I:tx of pneumonia)
CYCLIC PEPTIDE
 Bacitracin
o Chemistry: Cyclic peptide
o MOA: interfering w/
dephosphorylation in cycling of
the lipid carrier that transfer
peptidoglycan subunits to the
growing cell wall
o Route: topical (ointment base)
o PK: poorly absorbed
systematically\
o A/E:
▪ Nephrotoxicity
o C/A: tx of infections due to mixed
bacterial flora in surface lesions
(active against gram + MO)
 Cycloserine
o Chemistry: structural analog of D-
alanine
o MOA: inihibiting alanine
racemase, w/c converts L-alanine
to D-alanine, & d-alanyl-d-alanine
ligase
o A/E: dose-related CNS toxicities
o C/A:
▪ Treatment of TB caused by
strains of Mycobacterium
tuberculosis resistant to
1st line agents
o C/A:
▪ Tx of uncomplicated lower
UTI in women
PROTEIN SYNTHESIS
INHIBITORS
30S RIBOSOMAL SUBUNIT INHIBITORS
 Tetracycline
o Ex: Minocycline, Demeclocycline,
Doxycycline, Tigecycline
(glycylcycline)
o Chemistry: congeners of
polycyclic naphthacene
carboxamide
o MOA: blocking the binding of
aminoacyl-tRNA to the acceptor
site on the mRNA-ribosome
complex → prevent addition of
amino acids to the growing
peptide
o Spectrum
▪ Gram (+) & Gram (-)
▪ Anaerobes
▪ Rickettsiae
▪ Chlamydiae
▪ Mycoplasmas
o A/E:
▪ GI disturbances (nausea &
vomiting)
▪ Teeth & bone
abnormalities (CI: </ = 8
years old & pregnant
women)
▪ Hepatotoxicity
▪ Nephrototoxicity (RTA,
Fanconi-like syndrome)
▪ Ototoxicity (assoc. w/
minocycline)
 Aminoglycoside
o Chemistry
 ▪ Consists of 2 or more
amino sugars joined in
glycosidic linkage to a
hexose nucleus (either
streptidine or 2-
deoxystreptamine)
▪ Except spectinomycin, w/c
does not contain amino
sugars
o Ex. Kanamycin, amikacin,
gentamicin, neomycin,
tobramycin, streptomycin
o Property: bactericidal inhibitors
of protein synthesis
o MOA:
▪ Interference w/ the
initiation complex
▪ Misreading of mRNA
▪ Breakup of polysomes into
nonfunctional
o PK:
▪ Concentration-dependent
killing
▪ Post-antibiotic effect
▪ Synergistic killing
Ototoxicity Vestibulotoxicity Nephrotoxicity
Kanamycin Streptomycin Neomycin
Amikacin Gentamicin Gentamicin
Neomycin Tobramycin
o C/A:
▪ Aerobic gram (-) bacteria
▪ Combination w/ a ß-lactam
antibiotic (potential
synergism)
o Specific uses
▪ Streptomycin- 2nd line for
TB
▪ Gentamicin/Tobramycin –
same spectrum
▪ Amikacin – organisms
resistant to gentamicin &
tobramycin
▪ Neomycin/Kanamycin/Par
onomomycin – same
spectrum
✓ Paromomycin –
visceral
leishmaniasis;
intestinal E.
histolytica
✓ Kanamycin – MDR-
TB
✓ Neomycin – topical
use combined w/
polymyxin-
bacitracin
▪ Spectinomycin – alt tx for
gonorrhea
50 RIBOSOMAL SUBUNIT INHIBITORS
 Lincosamides
o Clindamycin, Lincomycin
o Binding site on the 50S subunit is
identical w/ what for
erythromycin
o PK:
▪ Penetrates well into the
abscesses & is actively
taken up & conc by
phagocytic cells
▪ 90% protein bound
o C/A:
▪ Skin & soft tissue
infections caused by by
streptococci &
staphylococci
▪ Used in conjunction w/ pen
G to treat TSS or
necrotizing fasciitis
caused by Group A
streptococcus
▪ Infections caused by
susceptible Bacteriodes
sp & other anaerobes
▪ Alt to TMP-SMX for. P.
jiveroci pneumonia.
(Clindamycin +
primaquine)
▪ Alt to sulfadiazine –
pyrimethamine for
toxoplasmosis
(clindamycin +
pyrimethamine)
o ADR’s
▪ Diarrhe/colitis
▪ Nausea
▪ Rashes
 Chloramphenicol
o Chemistry: nitro group attached
to its ring (toxicity)
o MOA: inhibits peptidyltransferase
→ peptide bond formation is
inhibited
o PK
 ▪ Widely distributed in all
tissues & body fluids
▪ Metabolism: either through
glucuronidation or
reduction to inactive aryl
amines
o C/A:
▪ Alt treatment for rickettsial
infection
▪ Alt to ß-lactam for
treatment of meningitis
o ADR’s
▪ Dose-related reversible
suppression of RBC
production (>50mg/kg/d x
1-2 weeks)
▪ Aplastic anemia
(irreversible)
▪ Grey baby syndrome
• Occurs at a dose
>50mg/kg/d (FT) or
>25 mg/kg/d (PT)
• SSx: vomiting,
flaccidity,
hypothermia, gray
color, shock, &
vascular collapse
▪ Enzyme inhibition
 Macrolides
o Chemistry: macrocyclic lactone
ring
o Ex: erythromycin, clarithromycin,
azithromycin
o MOA: prevents by blocking of the
polypeptide exit tunnel →
peptidyl-tRNA is dissociated from
the ribosome
o PK
▪ Erythromycin base is
destroyed by stomach acid
▪ t1/2, clarithromycin >
erythromycin
▪ Azithromycin penetrates
most tissues (except
cerebrospinal fluid) &
phagocytic cells extremely
well
▪ Azithromycin does not
inactivate CYP450
enzymes
o C/A:
▪ Erythromycin DOC in
corynebacterial infections
▪ Erythromycin is useful as a
penicillin substitute in
penicillin-allergic
individuals
▪ Clarithromycin,
azithromycin has same
spectrum 9e.g both are
active against MAC)
o ADR
▪ GIT tolerance (most
common)
▪ Acute cholestatic hepatitis
(erythromycin estolate)
▪ Erythromycin inhibits
CYP450 enzymes
▪ Azithromycin prolongs QT
interval (resulting to TDP
arrhythmia)
 Streptogramins
o Quinupristin (streptogramin B),
dalfopristin (streptogramin A) –
combined in 30:70 ration
o MOA: same binding site w/
macrolides & clindamycin
o PK
▪ Elimination: fecal route
▪ Enzyme inhibition
(CYP3A4)
o C/A
▪ VR E. faecium not E.
faecalis
▪ MRSA/MRSE
o ADR: Infusion-related AE (since it
is via IV route)
 Oxazolidinones
o Linezolid, Tedizolid
o MOA: binding to the 23S
ribosomal RNA of the 50S subunit
o AM activity: primarily a
bacteriostatic agent but is
bactericidal against streptococci
o PK
▪ 100% BA orally
▪ Highly protein bound
(tedizolid > linezolid)
o C/A:
▪ VR: E. faceium
▪ MRSA/MRSE
▪ HCAP/CAP
 ▪ Skin & soft tissue infection -Nalidixic Acid (but not
secondary to G (+) (Negram) Pseudomonas
bacteria -Cinoxacin sp.)
(Cinobac)
▪ Thrombocytopenia (most 2nd Gen Gram (-) Uncomplicated
common) -Norfloxacin organisms & complicated
(Norflox) (including UTI &
NUCLEIC ACID -Lomefloxacin Pseudomonas pyelonephritis,
(Maxaqin) sp.), some STD,
SYNTHESIS INHIBITORS -Enoxacin gram (+) prostatitis,
(Penetrex) organisms skin & soft
 Quinolones/Fluoroquinolones -Ofloxacin (including S. tissue
o Chemistry (Floxin) aureus but not infections
▪ Carboxylic acid moiety at -Ciprofloxacin S.
(Cipro) pneumoniae)
position 3 at the primary 3rd Gen Same as 2nd Acute
ring structure -Levofloxacin gen agent + exacerbations
▪ Fluorine substituent at (Levaquin) expanded of chronic
position 6 -Sparfloxacin gram (+) bronchitis,
▪ Piperazine moiety at (Zagam) coverage community –
-Gatifloxacin (penicillin & acquired
position 7
(Tequin) penicillin- pneumonia
o MOA: inhibiting bacterial -Moxifloxacin resitant S.
topoisomerase II (DNA gyrase) & (Avelox) pneumoniae)
topoisomerase IV & expanded
o PK activity
▪ Oral absorption is against
atypical
impaired by divalent & pathogens
trivalent cations 4th Gen Same as for 3rd Same as 1st ,
▪ Elimination is primary -Trovafloxacin gen agent + 2nd, 3rd gen
renal (except, (Trovan) broad agents
moxifloxacin) anaerobic (excluding
coverage complicated
o C/A:
UTI &
▪ UTI pyelonephritis)
▪ Bacterial diarrhea + intra-
▪ Infections of soft tissues, abdominal
bones & joints and in intra- infections,
abdominal & RTI (except nosocomial
pneumonia,
norfloxacin) pelvic
▪ Anthrax (DOC: infections
ciprofloxacin) o ADR
▪ PTB, 2nd line agents ▪ GI disturbance (most
(ciprofloxacin, common)
levofloxacin, moxifloxacin) ▪ Photosensitivity
▪ LRTI (respi FQ: (Lomefloxacin, pefloxacin)
Levofloxacin, ▪ Prolongation of QTc
Gemifloxacin, interval (gatifloxacin,
Moxifloxacin) levofloxacin, Gemifloxacin,
▪ Alt for urethritis & & moxifloxacin)
cervicitis ( Gemifloxacin + ▪ Hyperglycemia/hypoglyce
Azithromycin) mia (gatifloxacin)
Agents Antimicrobial General • C/I: 18 y/o
spectrum Clinical ▪ Tendinitis
Indiciations
1st Gen: Gran (-) Uncomplicted
 Antifolate drugs
organisms UTI  Sulfonamides
 o Chemistry: structural similarity to ANTIMYCOBACTERIALS
p-aminobenzoic acid (PABA)
o MOA: inhibition of DRUGS USED FOR PTB
dihydropteroate synthase – dec.
1st Line Agents (Hrze)
folate production (except for
Rickettsiae, anaerobes,  Isoniazid
Pseudomonas spp.) o Chemistry
o DI: sulfonamides + ▪ Isonicotinic hydrazide
pyrimethamine/trimethoprim (INH)
(synergistic effect) ▪ Structurally related to
o C/A: pyridoxine, pyrazinamide
▪ DOC: P. jiroveci o Most active drug for the tx of PTB
pneumonia (Co- o MOA: inhibits synthesis of
trimoxazole) mycolic acids
▪ DOC for toxoplasmosis o PK:
(Sulfadiazine + ▪ Readily absorbed
pyrimethamine optimally on an empty
[Daraprim]) stomach
▪ 2nd line tx for malaria ▪ Metabolism: acetylation
(Sulfadoxine + (via N-AT)
pyrimethamine [Fansidar]) ▪ Known inhibitor of CYP450
enzymes
Oral Oral (non Topical
(absorbable) absorbable) o C/A:
Sulfamethoxazole Sulfasalazine Sulfacetamide ▪ Latent tuberculosis, 9 mos
Sulfadiazine Mafenide o ADR:
Sulfadoxine acetate
Silver
▪ Hepatotoxicity (most
sulfadiazine common)
oADRs ▪ SLE (drug-induced)
▪ Dermatological ADRs ▪ Peripheral neuropathy
(e.g., SJS) • More likely to occur
▪ Crystalluria in slow acetylators
▪ Blood dyscrasias 7 px w/
▪ Hemolytic rxn in G6PD predisposing
deficiency conditions
 Trimethoprim/Pyrimethamine • Secondary to
o MOA: selectively inhibits pyridoxine
bacterial dihydrofolic acid deficiency
reductase  Rifamycin
o C/A: o Rifampicin (Rifampin), Rifabutin,
▪ UTI (trimethoprim alone Rifapentine
100mg BID) o MOA: binds to the ß-subunit of
o ADRs: bacterial DNA-dependent RNA
▪ Bone marrow suppression polymerase
(prymethamine) o PK
• Mx: Leucovorin ▪ Highly protein bounds
(folinic acid), 10mg (CSF conc is only achieve
OD if there is meningitis)
▪ Folic-acid deficiency ▪ Induces CYP450 enzymes
anemia (rifabutin is less potent)
• Mx: Leucovorin o C/A:
(folinic acid), 10mg ▪ PTB/leprosy
OD
 ▪ Prophylaxis for Kanamycin Used for treatment of
meningococcal exposure TB caused by
▪ Prophylaxis for HiB streptomycin-resistant
strains
exposure Amikacin MDR-TB; atypical
o ADRs mycobacteria;
▪ Red-orange discoloration streptomycin resistant
of body fluids (harmless) TB
▪ Cholestatic jaundice FQ (Ciprofloxacin, -Atypical mycobacteria
Levofloxacin, (moxifloxacin is the
▪ Flu-like symptoms
Gatifloxacin & most active in vitro)
 Pyrazinamide Moxifloxacin -WHO recommends
o Chemistry: relative of using moxifloxacin or
nicotinamide levofloxacin
o MOA: converted to pyrazinoic Linezolid MDR-TB
acids (active form) by Rifamycin -Rifabutin: alt to
rifampicin for HIV
mycobacterial pyrazinamidase → patients taking ARVs
disrupts mycobacterial cell (enzyme inhibitors)
membrane metabolism & -Rifapentine: active for
transport functions MTB & MAC
o C/A: used in conjunction INH/RIF Bedaquiline 1st drug w/ a novel MOA
against M. tuberculosis
in short-course (ie, 6-months)
regimens as a “sterilizing” agent
MISCELLANEOUS ANTIMICROBIAL
o ADR:
▪ Hepatotoxicity (most
AGENTS
hepatotoxic)  Nitroimidazoles
▪ Hyperuricemia → gouty o Metronidazole, Tinidazole
arthritis o MOA: nonenzymatically reduced
 Ethambutol by reacting w/ reduced
o MOA: inihibits mycobacterial ferredoxin → formation of toxic
arabinosyl transferases metabolites → taken into
o PK bacterial DNA
▪ Good BA o PK
▪ Crosses the BBB only ▪ Well absorbed P.O., I.V.
when the meninges are o C/A:
inflamed ▪ Anaerobic or mixed intra-
o ADR’s abdominal infection
▪ Retrobulbar neuritis → ▪ Protozoal infections
loss of visual acuity, red- o ADR:
green color blindness ▪ Disulfiram-like effect when
(25mg/kg/d) combined w/ alcohol
2nd Line Agents ▪ Metallic-after taste
 Fidaxomixicin
Drugs Properties o Chemistry: macrocyclic antibiotic
Streptomycin Most active AG for PTB o Spectrum: G(+) aerobes &
Ethionamide Related to INH anaerobes
Capreomycin Strains of MTB
o MOA: binding to the stigma
resistant to
streptomycin are subunit of RNA
susceptible to this o Clinical use:
agent ▪ C. difficile infection in
Cycloserine CW synthesis inhibitor adults
Aminosalicylic Acid Similar MOA w/  Rifaximin
(PAS) sulfonamides; folate
synthesis antagonist
o Chemistry: derivative of rifampin
 o Spectrum: gram (+), gram (-) ▪ C/A: alt oral agent for tx of
aerobes & anaerobes uncomplicated UTI
o MOA: binding to the ß-subunit of oADRs
DNA-dependent ▪ Anorexia, N/V
o RNA polymerase ▪ Neuropathies/ pulmo
o PK: not thought to be associated toxicities (in px’s w/ renal
w/ CYP450-mediated drug- insufficiency)
interactions (limited absorption) ▪ Hemolytic anemia (in
o C/A: G6PD deficient px’s)
▪ Hepatic encephalopathy  Methenamine
▪ Irritable bowel syndrome o MOA: below pH 5.5, methenamine
w/ dirrhea releases formaldehyde
▪ Adjunct in cases of o C/A: prevent UTI
recurrent or refractory C. o DI: sulfonamides (forms insoluble
difficile infection in adults compounds w/ formaldehyde)
 Topical antimicrobial agents
 Mupirocin
o Chemistry: pseudomonic acid
o Natural substance produced by
Pseudomonas fluorescens
o MOA: inihibits staphylococcal
isoleucyl tRNA synthetase
o C/A:
▪ Minor skin infections, such
as impetigo
▪ Temporarily eliminates, S.
aureus nasal carriage by
px or HCWs
 Polymixins
o Polymyxin B & plymyxin E
(colistin)
o Chemistry: cationic detergents
o MOA: attach to & disrupt
bacterial cell membranes
o Route: Topical
o C/A: applied to infected
superficial skin lesions
 Urinary antispetics
 Nitrofurantoin
o MOA: conversion to highly
reactive intermediates by
bacterial reductases → react
nonspecifically w/ many
ribosomal proteins & nucleic
acids
o PK
▪ Well absorbed after oral
ingestion
▪ Renally excreted (CI: renal
insufficiency)
▪ Desirable to keep urinary
ph below 5.5