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Questions and Answers
What are antimicrobial drugs primarily used for?
What are antimicrobial drugs primarily used for?
Which of the following drug classes specifically targets viral infections?
Which of the following drug classes specifically targets viral infections?
What was the source of penicillin discovered by Alexander Fleming?
What was the source of penicillin discovered by Alexander Fleming?
What is the purpose of prophylaxis in the context of antimicrobial drugs?
What is the purpose of prophylaxis in the context of antimicrobial drugs?
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What differentiates first-generation drugs from second-generation drugs?
What differentiates first-generation drugs from second-generation drugs?
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Which type of antimicrobial drug targets fungal infections?
Which type of antimicrobial drug targets fungal infections?
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What is the primary concern associated with the spread of bacterial resistance?
What is the primary concern associated with the spread of bacterial resistance?
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What distinguishes semisynthetic antimicrobial compounds?
What distinguishes semisynthetic antimicrobial compounds?
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What is the primary action of beta-lactam antibiotics?
What is the primary action of beta-lactam antibiotics?
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Which of the following classes of antibiotics contains a four-sided beta-lactam ring?
Which of the following classes of antibiotics contains a four-sided beta-lactam ring?
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Which name ending indicates a medication belonging to the penicillin group?
Which name ending indicates a medication belonging to the penicillin group?
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What is a significant consideration when administering vancomycin?
What is a significant consideration when administering vancomycin?
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Carbapenem antibiotics are particularly effective against which type of bacteria?
Carbapenem antibiotics are particularly effective against which type of bacteria?
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What is a major risk associated with the use of vancomycin?
What is a major risk associated with the use of vancomycin?
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Which statement about empiric therapy is true?
Which statement about empiric therapy is true?
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What does the term CRE stand for in relation to bacterial resistance?
What does the term CRE stand for in relation to bacterial resistance?
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What is the primary goal of antibiotic stewardship programs?
What is the primary goal of antibiotic stewardship programs?
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Which of the following is classified as an urgent threat according to the CDC?
Which of the following is classified as an urgent threat according to the CDC?
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What percentage of healthcare workers are reported to carry resistant strains on their hands or devices?
What percentage of healthcare workers are reported to carry resistant strains on their hands or devices?
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What will be the estimated annual death toll due to antimicrobial-resistant pathogens by 2050, if current trends continue?
What will be the estimated annual death toll due to antimicrobial-resistant pathogens by 2050, if current trends continue?
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Which type of bacteria is associated with the greatest concern for antimicrobial resistance?
Which type of bacteria is associated with the greatest concern for antimicrobial resistance?
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What is the primary mode of action of sulfonamides?
What is the primary mode of action of sulfonamides?
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Which of the following is NOT a common indication for GN antibiotics?
Which of the following is NOT a common indication for GN antibiotics?
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Which antibiotic is specifically effective against gram-negative bacteria and causes lysis by targeting the cytoplasmic membrane?
Which antibiotic is specifically effective against gram-negative bacteria and causes lysis by targeting the cytoplasmic membrane?
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Which common brand name medication combines sulfamethoxazole with trimethoprim?
Which common brand name medication combines sulfamethoxazole with trimethoprim?
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What is a main mechanism by which bacterial resistance to antibiotics occurs?
What is a main mechanism by which bacterial resistance to antibiotics occurs?
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Which of the following statements is true regarding daptomycin's effectiveness?
Which of the following statements is true regarding daptomycin's effectiveness?
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How does drug inactivation contribute to antibiotic resistance?
How does drug inactivation contribute to antibiotic resistance?
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Which of the following antibiotics is indicated for treating gram-negative (GN) infections?
Which of the following antibiotics is indicated for treating gram-negative (GN) infections?
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What is the primary mode of action for tetracyclines?
What is the primary mode of action for tetracyclines?
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Which of the following is NOT a common indication for macrolides?
Which of the following is NOT a common indication for macrolides?
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What precaution should be taken with fluoroquinolones?
What precaution should be taken with fluoroquinolones?
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Which of the following brand names is associated with the tetracycline group?
Which of the following brand names is associated with the tetracycline group?
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What is the primary mode of action for fluoroquinolones?
What is the primary mode of action for fluoroquinolones?
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Which of the following is a key consideration when prescribing aminoglycosides?
Which of the following is a key consideration when prescribing aminoglycosides?
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Which condition is NOT typically treated with fluoroquinolones?
Which condition is NOT typically treated with fluoroquinolones?
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What is a common risk associated with taking tetracyclines?
What is a common risk associated with taking tetracyclines?
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Which of these medications is categorized under macrolides?
Which of these medications is categorized under macrolides?
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What advice is important when taking medications ending in '-mycin'?
What advice is important when taking medications ending in '-mycin'?
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Antimicrobial drugs can be categorized based on the type of ______ they target.
Antimicrobial drugs can be categorized based on the type of ______ they target.
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Prophylaxis is a process that prevents ______ or disease in a person at risk.
Prophylaxis is a process that prevents ______ or disease in a person at risk.
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Penicillin was derived from the mold species ______ rubens.
Penicillin was derived from the mold species ______ rubens.
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First-generation drugs represent the ______ round of chemical modification.
First-generation drugs represent the ______ round of chemical modification.
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Antiviral drugs specifically target ______ infections.
Antiviral drugs specifically target ______ infections.
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Semisynthetic antimicrobial compounds are the result of ______ modification.
Semisynthetic antimicrobial compounds are the result of ______ modification.
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Antifungal drugs are used to treat ______ infections.
Antifungal drugs are used to treat ______ infections.
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Antiparasitic drugs are designed to treat ______ and helminthic infections.
Antiparasitic drugs are designed to treat ______ and helminthic infections.
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Beta-lactam antibiotics prevent cross-linking of ______.
Beta-lactam antibiotics prevent cross-linking of ______.
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Vancomycin disrupts ______ synthesis.
Vancomycin disrupts ______ synthesis.
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Daptomycin is classified as a ______ antibiotic.
Daptomycin is classified as a ______ antibiotic.
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The class of antibiotics that includes penicillins is known for having names that end in ______.
The class of antibiotics that includes penicillins is known for having names that end in ______.
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Cephalosporins typically have names that begin with ______.
Cephalosporins typically have names that begin with ______.
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Carbapenems are effective against multidrug-resistant ______ bacteria.
Carbapenems are effective against multidrug-resistant ______ bacteria.
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The acronym CRE stands for Carbapenem Resistant ______.
The acronym CRE stands for Carbapenem Resistant ______.
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Empiric therapy is commonly started to protect the ______.
Empiric therapy is commonly started to protect the ______.
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β -lactamases are enzymes that will cut (hydrolyze) the beta-lactams so they no longer work, leading to β -lactam ______.
β -lactamases are enzymes that will cut (hydrolyze) the beta-lactams so they no longer work, leading to β -lactam ______.
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Horizontal Gene Transfer (HGT) occurs in three ways: transformation, transduction, and ______.
Horizontal Gene Transfer (HGT) occurs in three ways: transformation, transduction, and ______.
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Mutated ______ can prevent certain drugs from entering bacterial cells.
Mutated ______ can prevent certain drugs from entering bacterial cells.
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Efflux pumps are mechanisms that ______ drugs out of the bacterial cell, reducing their effectiveness.
Efflux pumps are mechanisms that ______ drugs out of the bacterial cell, reducing their effectiveness.
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Transformation involves the uptake of new ______ from the environment by bacterial cells.
Transformation involves the uptake of new ______ from the environment by bacterial cells.
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Sulfonamides inhibit folic acid ______ to prevent bacterial growth.
Sulfonamides inhibit folic acid ______ to prevent bacterial growth.
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Daptomycin targets the plasma ______ of bacteria, leading to lysis.
Daptomycin targets the plasma ______ of bacteria, leading to lysis.
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Common brand names for sulfonamides include ______ and Septra.
Common brand names for sulfonamides include ______ and Septra.
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Beta-lactam resistance can occur when bacteria have a mutated form of ______.
Beta-lactam resistance can occur when bacteria have a mutated form of ______.
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The main indication for daptomycin is treatment of drug-resistant ______ infections.
The main indication for daptomycin is treatment of drug-resistant ______ infections.
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Inhibition of folic acid synthesis is a key mechanism of action for ______.
Inhibition of folic acid synthesis is a key mechanism of action for ______.
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The ______ concentration inside the cell can be reduced as a mechanism of antimicrobial resistance.
The ______ concentration inside the cell can be reduced as a mechanism of antimicrobial resistance.
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Common key generics for GN infections include ______, Gentamicin, and Tobramycin.
Common key generics for GN infections include ______, Gentamicin, and Tobramycin.
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Tetracyclines inhibit ______ synthesis, leading to inhibition of bacterial cell growth.
Tetracyclines inhibit ______ synthesis, leading to inhibition of bacterial cell growth.
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Common key generics for tetracyclines include Minocycline and ______.
Common key generics for tetracyclines include Minocycline and ______.
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Macrolides are known to inhibit ______ synthesis.
Macrolides are known to inhibit ______ synthesis.
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Azithromycin and Erythromycin are brand names for ______.
Azithromycin and Erythromycin are brand names for ______.
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Fluoroquinolones interfere with enzymes necessary for ______ replication.
Fluoroquinolones interfere with enzymes necessary for ______ replication.
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The common key generics for fluoroquinolones include Ciprofloxacin and ______.
The common key generics for fluoroquinolones include Ciprofloxacin and ______.
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One consideration when taking Tetracyclines is to take them ______ food.
One consideration when taking Tetracyclines is to take them ______ food.
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A significant concern when administering Aminoglycosides is that they are super ______.
A significant concern when administering Aminoglycosides is that they are super ______.
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Vancomycin-resistant enterococci are often referred to as ______.
Vancomycin-resistant enterococci are often referred to as ______.
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Skin infections and atypical infections are common ______ for Tetracyclines.
Skin infections and atypical infections are common ______ for Tetracyclines.
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Study Notes
Antimicrobial Drugs
- Antimicrobial drugs are therapeutic compounds that kill microbes or inhibit their growth.
- Prophylaxis is the process of preventing infection or disease in a person at risk.
- Alexander Fleming discovered penicillin in 1928 from the mold Penicillium rubens.
- Penicillin was mass-produced in the 1940s.
Antibiotic Classes
- Antibiotic classes are categorized based on the type of pathogen they target.
- Antibacterial drugs (antibiotics) treat bacterial infections.
- Antiviral drugs target viral infections.
- Antifungal drugs target fungal infections.
- Antiparasitic drugs treat protozoan and helminthic (worm) infections.
Beta-Lactam Antibiotics
- Beta-lactam antibiotics contain a four-sided beta-lactam ring.
- These antibiotics prevent cross-linking of peptidoglycan which is essential for bacterial cell wall formation.
- Examples include penicillins, cephalosporins, and carbapenems.
Vancomycin
- Vancomycin disrupts cell wall synthesis, it is not a beta-lactam antibiotic.
- It is a glycopeptide class of antibiotic.
- Vancomycin is super toxic, infusion rate is monitored to avoid Red Man’s syndrome which is characterized by flushing, itching, and a rash.
- Growing resistance to vancomycin has led to the emergence of Vancomycin-resistant S.Aureus (VRSA) and Vancomycin-resistant Enterococci (VRE).
Tetracyclines
- Tetracyclines inhibit protein synthesis by binding to the bacterial ribosome, inhibiting bacterial cell growth.
- Should be taken without food and avoid sun exposure.
- Common generic names end in "cycline."
Macrolides
- Macrolides inhibit protein synthesis by binding to the bacterial ribosome, inhibiting bacterial cell growth.
- Should be taken without food.
- Common generic names end in "mycin."
- Not every "-mycin" is a macrolide.
Fluoroquinolones
- Fluoroquinolones interfere with enzymes for DNA replication, preventing bacterial cell growth.
- Should be taken without food and avoid sun exposure.
- Common generic names contain "fl-."
Aminoglycosides
- Aminoglycosides are powerful inhibitors of protein synthesis by binding to the bacterial ribosome.
- Super toxic! Dosage is critical, monitor for toxicity.
- Common generic names end in “-cin.”
Sulfonamides
- Sulfonamides inhibit folic acid synthesis, which is needed for RNA/DNA , and protein synthesis in bacteria, inhibiting bacterial cell growth.
- Common name is Sulfamethoxazole-Trimethoprim (Bactrim, Septra).
Daptomycin
- Daptomycin targets the plasma membrane, disrupting it and leading to cell lysis.
- Effective against Gram-negative bacteria only.
- It is not effective against Gram-positive bacteria because it cannot penetrate their thick cell wall.
- Only available as an IV or injection.
Mechanisms of Antimicrobial Resistance
- The text details three major mechanisms of antimicrobial resistance: target alteration, drug inactivation, and reducing drug concentrations in the cell.
Target Alteration
- Bacteria develop mutations, leading to changes in their proteins which become resistant to the drug.
- For example, some bacteria have a mutated form of PBP, called PBP2a.
- This prevents beta-lactam antibiotics from binding to the target, making the bacteria resistant to the drug.
Drug Inactivation
- Bacteria produce enzymes that directly in activate the drug before it can reach its target.
- An example is beta-lactamases which break down the beta-lactam ring in beta-lactam antibiotics, rendering them ineffective.
Reducing Drug Concentration
- Bacteria can reduce drug concentrations inside the cell through several mechanisms.
- One way is by reducing the permeability of the cell wall, preventing the drug from entering the cell.
- Another way is by increasing the efflux of the drug from the cell, pumping the drug out before it can reach its target.
Spread of Bacterial resistance
- Bacteria can transfer resistance genes to other bacteria, which can contribute to the spread of resistant strains.
- This horizontal gene transfer can be a significant source of resistance, and includes three main mechanisms:
- Transformation: bacteria take up DNA from their environment.
- Transduction: DNA is transferred between bacteria via bacteriophages, viruses that infect bacteria.
- Conjugation: bacteria directly exchange DNA through a pilus.
Antibiotic Stewardship
- Antibiotic stewardship is a coordinated program that promotes the appropriate use of antibiotics.
- It aims to reduce microbial resistance and the spread of multidrug-resistant microbes.
Resistant Microbes of greatest concern
- The CDC has classified microbes based on their threat levels:
- Urgent threats: Clostridioides difficile, Carbapenem-resistant Enterobacteriaceae (CRE), and Drug-resistant Neisseria gonorrhoeae.
- Serious threats: Methicillin-resistant Staphylococcus aureus (MRSA), Vancomycin-resistant Enterococcus (VRE), and several others.
Learning Objectives
- Define empiric therapy and prophylaxis
- Identify cellular target (mode of action) and whether each drug class is bacteriostatic or bactericidal.
- Identify the three drug classes that are considered beta-lactam drugs.
- Explain the significance of MRSA, VRSA, and CRE.
- Describe the three mechanisms by which antibiotic resistance may develop
- Define horizontal gene transfer and describe the 3 ways it occurs in bacteria.
Antimicrobial Drugs
- Antimicrobial drugs dramatically changed modern medicine by providing clinicians with tools to effectively treat various infections.
- They are classified based on their target pathogens.
- Antibacterials (antibiotics) combat bacterial infections.
- Antivirals target viral infections.
- Antifungals combat fungal infections.
- Antiparasitics treat protozoan and helminthic infections.
- Prophylaxis refers to the preventive measures taken to avoid infection or illness in at-risk individuals.
Discovery and Modification of Antibiotics
- In 1928, Alexander Fleming discovered the antibiotic properties of penicillin, produced by the mold Penicillium rubens.
- Penicillin was mass-produced starting in the 1940s.
- Antibiotic compounds can be chemically modified to create new antibiotic drugs.
- Semisynthetic alterations involve chemical modifications of the original antibiotic.
- First-generation drugs represent the initial chemical alteration of a compound.
- Second-generation drugs are produced by further chemical modification of the original and first-generation compounds.
- Drugs in later generations expand on the capabilities of earlier generations.
Empiric Therapy
- Empiric therapy uses initial broad-spectrum antibiotic treatments to protect patients before the specific causative organism is identified.
- This allows for early treatment while waiting for culture results.
Antibiotic Classes
- Different classes of antibiotics target specific cellular components of bacteria.
- The various classes are differentiated by their mechanisms of action.
Beta-Lactams
- Beta-lactam antibiotics include penicillins, cephalosporins, and carbapenems.
- They all contain a four-sided beta-lactam ring structure.
- Beta-lactams inhibit the formation of bacterial peptidoglycan, a key component of the bacterial cell wall.
- Examples of penicillins include amoxicillin and penicillin G.
- Cephalosporins are divided into generations, with each generation possessing an expanded spectrum of activity.
- Common examples include cefazolin, ceftriaxone, and cefepime.
- Carbapenems are highly effective against multidrug-resistant bacteria.
- They are often reserved for severe infections caused by resistant strains.
- CRE stands for Carbapenem-resistant Enterobacteriaceae.
Vancomycin
- Vancomycin is a glycopeptide antibiotic that inhibits peptidoglycan synthesis.
- It is not a beta-lactam antibiotic.
- Commonly used for treating infections caused by methicillin-resistant Staphylococcus aureus (MRSA).
- Vancomycin administration can lead to Red Man's syndrome, a potentially serious reaction.
- Vancomycin-resistant Staphylococcus aureus (VRSA) and vancomycin-resistant enterococci (VRE) pose significant challenges.
Tetracyclines
- Tetracyclines interfere with bacterial protein synthesis by blocking the attachment of tRNA molecules to mRNA.
- They can be used to treat various bacterial infections.
- Commonly administered without food.
- Individuals taking tetracyclines should avoid sun exposure due to the risk of photosensitivity.
- Some commonly used tetracyclines include minocycline, doxycycline, and tetracycline.
Macrolides
- Macrolides also inhibit bacterial protein synthesis.
- Macrolides can be used to treat a variety of bacterial infections, including respiratory infections, sexually transmitted infections, and otitis media.
- They are typically administered without food.
- Examples include azithromycin, clarithromycin, and erythromycin.
- The “-mycin” ending in drugs does not always indicate a macrolide, so it is essential to refer to the class for proper classification.
Fluoroquinolones
- Fluoroquinolones inhibit bacterial DNA replication by targeting enzymes involved in the process.
- They are often effective against resistant bacteria.
- Fluoroquinolones are reserved for patients with severe infections or those unresponsive to other antibiotics.
- They are commonly used to treat pneumonia, urinary tract infections, and infections caused by Mycobacterium tuberculosis.
- Examples include ciprofloxacin and levofloxacin.
Aminoglycosides
- Aminoglycosides are powerful inhibitors of bacterial protein synthesis.
- They are primarily used for infections caused by gram-negative bacteria (GN).
- Aminoglycosides are associated with significant toxicity, so their use requires careful monitoring.
- Examples include amikacin, gentamicin, neomycin, and tobramycin.
Sulfonamides
- Sulfonamides inhibit the synthesis of folic acid, which is essential for bacterial growth.
- They are commonly used to treat urinary tract infections.
- A well-known example is sulfamethoxazole-trimethoprim, often prescribed under the brand names Bactrim or Septra.
Daptomycin
- Daptomycin disrupts the bacterial cell membrane, leading to lysis.
- It is effective against gram-negative bacteria.
- Daptomycin is administered intravenously or by injection.
- It is typically reserved for infections caused by drug-resistant bacteria.
Mechanisms of Antibiotic Resistance
- Antibiotic resistance develops through a variety of mechanisms that allow bacteria to evade the effects of antibiotics.
- Three primary mechanisms:
- Target alteration
- Drug inactivation
- Reducing drug concentrations
Target Alteration
- This involves mutations in bacterial proteins, leading to altered targets that no longer bind to the antibiotic effectively.
- For example, β-lactam antibiotics typically bind to bacterial transpeptidases (PBPs), but some bacteria have developed mutated PBPs (like PBP2a) that do not bind to the antibiotics.
Drug Inactivation
- Some bacteria produce enzymes, like β-lactamases, that break down antibiotics.
- Example: β-lactamases degrade beta-lactam antibiotics, rendering them ineffective.
Reducing Drug Concentrations
- Bacteria can develop resistance by reducing the amount of antibiotic that enters the cell or by actively pumping out the antibiotic.
- Mutated porins, which are channels that allow molecules to pass through the bacterial cell membrane, can restrict antibiotic entry.
- Efflux pumps actively remove antibiotics from the cell.
Spread of Antibiotic Resistance
- Antibiotic resistance spreads primarily by horizontal gene transfer, where genes related to antibiotic resistance are transferred between bacteria.
- This transfer occurs in three main ways:
Horizontal Gene Transfer Mechanisms
- Transformation: The direct uptake of free DNA from the environment.
-
Transduction: Bacteria acquire new genes through bacteriophages (viruses) that transfer genetic material.
- Conjugation: Direct DNA transfer through a sex pilus, forming a physical connection between bacteria.
Antibiotic Stewardship
- Antibiotic stewardship is a comprehensive approach to using antibiotics responsibly and effectively.
- Its aim is to optimize antibiotic use, minimize unnecessary exposures, and prevent the development and spread of antibiotic resistance within healthcare settings and communities.
Key Points
- The inappropriate use of antibiotics significantly contributes to the rise of antibiotic resistance.
- The overuse of antibiotics is a major concern.
- Only use antibiotics when genuinely necessary and under a healthcare provider's guidance.
- Proper antibiotic administration plays a crucial role in preventing the emergence of resistant strains.
- The spread of antibiotic resistance poses a significant public health threat.
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Description
This quiz covers the essential aspects of antimicrobial drugs, including their discovery, classification, and function. It explores various antibiotic classes and specific types, such as beta-lactam antibiotics and vancomycin. Test your knowledge on how these crucial compounds combat infections.
