PMP201 - Antibiotics Class & Mechanisms Part 3
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Questions and Answers

Qual class de antibioticos bloquea le translocation?

  • Tetracyclines
  • Aminoglycosides
  • Clindamycin (correct)
  • Oxazolidinones
  • Qual antibiotico ha un suffis de '-cycline' e bloquea le attachment de tRNA a site A in le ribosome?

  • Chloramphenicol
  • Aminoglycosides
  • Sulphonamides
  • Tetracyclines (correct)
  • Qual enzyma es inhibited per sulphonamides durante le synthesis de acido folico?

  • Dihydropteroate synthase (DHPS) (correct)
  • Dihydrofolate reductase (DHFR)
  • Folate transporter
  • PABA synthase
  • Qual substance es targete da trimethoprim e ha un alta affinitate pro le enzyme bacterial?

    <p>Dihydrofolate reductase (A)</p> Signup and view all the answers

    Quale class de antibioticos agisce como antimetabolites e ha un effect bacteriostatic?

    <p>Sulphonamides (A)</p> Signup and view all the answers

    Perque le bacterias non pote uptake acido folico de foris?

    <p>Bacterias sintetisa acido folicoเอง (D)</p> Signup and view all the answers

    Qual class de antibioticos causa mRNA misreading durante le translation?

    <p>Aminoglycosides (C)</p> Signup and view all the answers

    Quale de le sequenti marcatores es usate pro le diagnosi microbiologic de mycobacteria?

    <p>St_annotation acida (A), Marcage fluorescent de auramina (C)</p> Signup and view all the answers

    Quale combination de medicamentos es parte del regime terapeutico initial pro tuberculose?

    <p>Rifampicina, Isoniazida, Pyrazinamida, Ethambutol (B)</p> Signup and view all the answers

    Quale es un caractere distinctive del muros celular de mycobacteria?

    <p>Rico in acidos mycolicos (B)</p> Signup and view all the answers

    Quale explica le resistentia del mycobacteria a antibioticos?

    <p>Muralla celular robuste e hydrophobe (A)</p> Signup and view all the answers

    Quale es un tipo de tuberculose resistente a medicamentos?

    <p>Multidrug-resistant TB (MDR-TB) (A)</p> Signup and view all the answers

    Qual es le mechanism de action de metronidazole?

    <p>Generar radicales libere in bacteria (C)</p> Signup and view all the answers

    Qual es le principale efecto secundario de rifampicin?

    <p>Discoloration de fluidos corporale (B)</p> Signup and view all the answers

    Qual es le principal contraindication pro l'uso de rifampicin?

    <p>Porfirias acute (A)</p> Signup and view all the answers

    Qual microbio es specificemente targetate per metronidazole?

    <p>Protozoos e anaerobes (A)</p> Signup and view all the answers

    Que genera le metronidazole quando es reduce in cellulas?

    <p>Radicales nitroso instables (C)</p> Signup and view all the answers

    Qual es le importancia del potencial redox in le mechanism de metronidazole?

    <p>Permititir le reduction de metronidazole (C)</p> Signup and view all the answers

    Qual interaction es relevante pro rifampicin?

    <p>Inducter le cytochrome P450 (D)</p> Signup and view all the answers

    Quo resulta de le interaction de radicales libere (ROS) con le DNA?

    <p>Fragmentation del DNA (C)</p> Signup and view all the answers

    Qual non es un efecto secundario de metronidazole?

    <p>Resistencia croissante (A)</p> Signup and view all the answers

    Qual es le spectre de action de metronidazole?

    <p>Bacterias anaerobes e protozoos (B)</p> Signup and view all the answers

    Qual es le principale mechanismus de action de sulfonamidas e trimethoprim?

    <p>Blocking de la sintese de acido folico (B)</p> Signup and view all the answers

    Qual es un uso typic de co-trimoxazole?

    <p>Infection de tracto urinar (D)</p> Signup and view all the answers

    Qual es un side effect significative de co-trimoxazole?

    <p>Deficientia de folato (B)</p> Signup and view all the answers

    Qual es le mechanismus de action del fluoroquinolones?

    <p>Targeting de topoisomerases (B)</p> Signup and view all the answers

    Qual es le consequence de le uso de co-trimoxazole durante le prime trimester de gravidanza?

    <p>Formation de defectos de tubo neural (C)</p> Signup and view all the answers

    Qual es le effecto de rifampycin super le sintetisation de acidos nucleicos?

    <p>Inhibition de la transcription de RNA (B)</p> Signup and view all the answers

    In le contextu de co-trimoxazole, qui debe evitar le medicamento?

    <p>Pazientes con discrasia sanguinee (C)</p> Signup and view all the answers

    Qual es le principal causa de hyperkalaemia relacionada al uso de co-trimoxazole?

    <p>Alteration de renal function (B)</p> Signup and view all the answers

    Qual es un importante caution pro l'uso de co-trimoxazole in neonatos?

    <p>Predisposition a deficientia de folato (A)</p> Signup and view all the answers

    Qual tipo de enzima bacteriana es inhibit per fluoroquinolones?

    <p>Gyrase de ADN (C)</p> Signup and view all the answers

    Qual es un effecte secundario notabile asociato con fluoroquinolones?

    <p>Seizures (A)</p> Signup and view all the answers

    Qual grupo de bacterias es fluoroquinolones effective contra?

    <p>Gram + e Gram - (A)</p> Signup and view all the answers

    Qual fluoroquinolone es typicamente usate pro infectiones de tracto urinar?

    <p>Ciprofloxacin (D)</p> Signup and view all the answers

    Qual es le mechano de action de rifampicina?

    <p>Inhibition de la RNA polymerase (A)</p> Signup and view all the answers

    Qual est un contraindicatio pro fluoroquinolones?

    <p>Storia de dano de tendon (C)</p> Signup and view all the answers

    Qual es un effecte raro de fluoroquinolones?

    <p>Prolongation del intervalo QT (B)</p> Signup and view all the answers

    Qual es le consequence del uso excessivo de fluoroquinolones?

    <p>Desarrollo de resistencia (D)</p> Signup and view all the answers

    Qual es un uso comun de rifampicina?

    <p>Tuberculosis (C)</p> Signup and view all the answers

    Qual fluoroquinolone es asociato con tendon rupture?

    <p>Levofloxacin (B)</p> Signup and view all the answers

    Flashcards

    Nitroimidazoles

    Un antimicrobian que es activate per reducer, resultante in radicale libere (ROS) que causa fragmentation de DNA in bacterias.

    Metronidazole

    Un antimicrobian in le classe de nitroimidazoles que es usate pro tracta infectiones anaerobic e eradication de H.pylori.

    Mechanism de Action de Nitroimidazoles

    Le mechanism de action del nitroimidazoles implica reducer e crear radicale libere (ROS) que causa fragmentation de DNA.

    Radical Libere (ROS)

    Le specie active del nitroimidazoles, formate per reducer, que causa fragmentation de DNA.

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    Fragmentation de DNA

    Un producto del action de radicales libere (ROS) que conduce a le morte del bacteria.

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    Effect Bactericidal

    Un effect del nitroimidazoles que resulta in le morte del bacteria.

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    Anaerobes

    Categoria specific de organismos que es sensibile a nitroimidazoles.

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    Redox Potential

    Un factor que determina si nitroimidazoles es activate e effective.

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    Alte Redox Potential

    Un condition que impede le activation de nitroimidazoles.

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    Usos de Nitroimidazoles

    Un uso clinic de nitroimidazoles, specific pro tracta infectiones anaerobic e eradicar H.pylori.

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    Antibioticos que bloca le translocation

    Un classe de antibioticos que bloca le translocation del ribosomas, un passo crucial in le processo de traduction del proteina.

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    Antibioticos que bloca le initiation del traduction

    Un classe de antibioticos que bloca le initiation del traduction, le prime passo in le processo de traduction de proteina.

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    Antibioticos que bloca tRNA attachment al sito A

    Un classe de antibioticos que bloca le attachment de tRNA al sitio A del ribosomo, un passo crucial in le processo de traduction del proteina.

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    Antibioticos que causa le mRNA a esser mal-legit

    Un classe de antibioticos que causa le mRNA a esser mal-legit, resultante in le production de proteinas defective o premature.

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    Antibioticos que inhibi vias metabolic bacterial

    Un classe de antibioticos que inhibi le vias metabolic in bacterios sin afectar le cellulas eucaryotic, resultante in un toxicitate selective.

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    Antibioticos que inhibi le synthese del acido folic

    Un classe de antibioticos que inhibi le synthese del acido folic, un componente essential pro le production del nucleotidos in bacterios.

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    Antibioticos que compete con PABA

    Un classe de antibioticos que compete con PABA, un precursor necessari pro le synthese del acido folic in bacterios.

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    Co-trimoxazole (Sulfamethoxazole + Trimethoprim)

    Sulfamethoxazole e trimethoprim es un combination de duo antibioticos que bloque le synthesize de acido folic in bacteria. Iste methodo es plus efficace que usar solmente un antibiotico perque le duo drogas travala in duo different passos del processo, facente le combination plus potente.

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    Effecto Synergic

    Le action del duo antibioticos in co-trimoxazole es synergic, significante que le effecto combinate es plus grande que le summa del duo effectos individual. In altere parolas, le duo drogas travala insimul pro attinger un effecto plus potente.

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    Effecto Bacteriostatic

    Co-trimoxazole es bacteriostatic, significante que is bloque le crescimento del bacteria, ma non neca le.

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    Spectrum de Action de Co-trimoxazole

    Co-trimoxazole es effective contra un varie de bacteria Gram-positive e Gram-negative.

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    Usos de Co-trimoxazole

    Co-trimoxazole es frequentemente usate pro tractar infectiones del vias urinarie (UTIs), prostatitis, e pneumonia causate per Pneumocystis jirovecii, specialmente in patientes con le immune system debil.

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    Effectos Lateral de Co-trimoxazole

    Un del major effectos lateral de co-trimoxazole es le risco de deficiente de acido folic, que pote causar problemas de sanitate, specialmente durante graviditate. In addition, co-trimoxazole pote causar nivellos alte de potassium in le sanguine, que pote esser periculose pro patientes con problemas renal.

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    Contraindicationes e Cautions de Co-trimoxazole

    Co-trimoxazole non es recommendate pro usar durante le prime trimestre de graviditate e in patientes con problemas de sanguine. Le uso de co-trimoxazole debe esser caute in patientes con porphyria acute, ancianos, neonates, e un predisposition a deficiente de acido folic.

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    Inhibitores de Synthese de Acido Nucleic - Fluoroquinolones

    Fluoroquinolones es un classe de antibioticos que bloque le replication de DNA per inhibir le function de topoisomerases, enzymes essential pro le replication de DNA.

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    Inhibitores de Synthese de Acido Nucleic - Rifamycins

    Rifamycins es un classe de antibioticos que bloque le transcription de DNA in RNA per inhibir le function de RNA polymerase, le enzyme que catalysa ille processo.

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    Le Mycobacteriumes intra le macrophages

    Le Mycobacteriumes pote etiam reproducer se intra un macrophage e lo occider.

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    Tinction acido-resistente pro Mycobacteriumes

    Le tinction acido-resistente es usate pro identificar le Mycobacteriumes. Le parietes cellular de Mycobacteriumes es ric in lipidos e resiste le decoloration con acido.

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    Le parietes cellular de Mycobacteriumes como objectivo therapeutic

    Le parietes cellular de Mycobacteriumes es un objectivo therapeutic pro le tractamento de infectiones per Mycobacteriumes.

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    Tractamento de tuberculose (TB)

    Le tractamento de tuberculose (TB) implica un combination de medicamentos pro reducer le risc de resistentia al medicamentos. Le medicamentos de prime linea include rifampicina, isoniazide, pyrazinamide e ethambutol. Le tractamento require un supervision stricte pro garantir que le patientes prene le medicamentos como prescribe.

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    Resistentia de TB al medicamentos

    Le resistentia al medicamentos es un problema crescente in le tractamento de TB. Le tuberculose multidrug-resistente (MDR-TB) es resistente a rifampicina e isoniazide, e le tuberculose extensamente drug-resistente (XDR-TB) es resistente a un numero plus grande de medicamentos.

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    Fluoroquinolones: Mecanismo de Action

    Fluoroquinolones sono un gruppo de antibioticos que inhibe le DNA gyrase e le topoisomerase IV, du enzymes essential pro le replication de DNA bacterial. Inhibendo iste enzymes, fluoroquinolones rende le DNA inaccessibile al machinas de replication bacterial, causante le morte cellular.

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    Nomines de Fluoroquinolones

    Ciprofloxacin, Levofloxacin, Moxifloxacin e Norfloxacin son exemplos de fluoroquinolones. Le suffix "-floxacin" identifica le classe de antibioticos.

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    DNA Gyrase: Un objectivo de fluoroquinolones

    Le DNA gyrase es un enzyme essential pro le replication de DNA bacterial, e es presente solmente in bacteria, non in humanos. Fluoroquinolones bloca le DNA gyrase, rendente le DNA inaccessibile al machinas de replication bacterial. Isto es un mecanismo importante contra bacteria gram-negative.

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    Topoisomerase IV: Un objectivo de fluoroquinolones

    Topoisomerase IV es un enzyme que participa in le replication de DNA bacterial, e es presente in ambes bacteria gram-positive e gram-negative. Le topoisomerase IV human es inhibite a doses alte de fluoroquinolones. Fluoroquinolones bloca le topoisomerase IV, rendente le DNA inaccessibile al machinas de replication bacterial.

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    Spectrum de Action de Fluoroquinolones

    Fluoroquinolones ha un spectrum de action ample, significante que illos es effective contra un large varietate de bacteria, incluente bacteria gram-positive e gram-negative, como H. influenzae, P. aeruginosa, e E. coli. Fluoroquinolones es usate pro tratar un varietate de infectiones, como infectiones respiratorie basse (CAP), infectiones del pelle e tissu mol, e infectiones del vias urinarie.

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    Administration de Fluoroquinolones

    Fluoroquinolones es disponibile in forma oral e intravenose. Illos es ben absorbite oralmente e ha un vita media longa.

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    Effectos Secundari de Fluoroquinolones

    Le effectos secundari de fluoroquinolones include distresso gastrointestinal, tendinitis e ruptura del tendines, debilesse muscular, dolor articular, prolongation del intervallo QT, convulsiones, e neuropatia periferic. Le overuse de fluoroquinolones pote contribuer al rapide development de resistencia.

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    Contraindicationes e Cautiones pro Fluoroquinolones

    Patients con un historia de damnos del tendines o que prende corticosteroides debe evitar fluoroquinolones. Cautiones debe esser usate in patients con factores de risco pro prolongation del intervallo QT, in epilepsia, disordines psychiatric, patients con impairment hepatic, e exposure al lumine solar.

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    Rifampicin: Mecanismo de Action

    Rifampicin es un antibiotico que inhibe le initiation del transcription de DNA bacterial, bloccante le activita del RNA polymerase bacterial. Isto resulta in un effecto bactericida.

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    Spectrum de Action de Rifampicin

    Rifampicin ha un spectrum de action ample, es effective contra bacteria gram-positive e gram-negative, e es usate pro tratar tuberculosis e infectiones causate per Neisseria meningitidis e Haemophilus influenzae.

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    Study Notes

    PMP201 - Infection ISU: Antibiotics - Drug Classes and Mechanisms - Part 3

    • Course: Infection Immunology
    • Date: 6th November 2024
    • Lecturer: Dr. Giulio Nannetti
    • Topic: Antibiotics - Drug Classes and Mechanisms - Part 3

    Previous & Complementary Knowledge

    • Health, Disease, and Patient (PMP101): 2023/24
    • Microbiology Lectures: Bacteria composition
    • Bacterial Growth
    • Patient-Centred Learning I (PMP201): 2024/25
    • Antibiotics Overview 1: Dr. Guirguis
    • Antibiotics Overview 2 & 3: Dr. Guirguis
    • Antibiotic Chemistry: Dr. Padalino

    Learning Outcomes

    • Outline antibacterial mechanism, effect, and properties of the main types of antimetabolite antibiotics
    • Outline antibacterial mechanism, effect, and properties of inhibitors of nucleic acids synthesis
    • Outline antibacterial mechanism, effect, and properties of antibiotics acting with an alternative mechanism of action
    • Identify therapeutic agents for tuberculosis

    Mechanisms of Action - RECAP

    • 1. Inhibition of cell wall synthesis:
      • Beta-lactams (penicillins, cephalosporins, monobactams, carbapenems)
      • Glycopeptides (vancomycin)
    • 4. Inhibition of nucleic acids synthesis:
      • Fluoroquinolones (ciprofloxacin, levofloxacin, moxifloxacin)
      • Rifamycins (rifampin)
    • 2. Inhibition of protein synthesis:
      • Aminoglycosides
      • Tetracyclines
      • Macrolides
      • Lincosamides
      • Chloramphenicol
      • Oxazolidinones
    • 3. Acting as antimetabolites:
      • Sulfonamides
      • Trimethoprim
      • Mycolic acid synthesis inhibitors (isoniazid)

    1- Inhibitors of Cell Wall Synthesis - RECAP

    • Cell wall inhibitors:
      • β-lactams, penicillins, cephalosporins, monobactams
      • Carbapenems
      • Glycopeptides
      • Vancomycin

    β-Lactam and Non β-Lactam Classes Inhibiting Cell Wall Synthesis - RECAP

    • β-lactams (bactericidal):
      • Target transpeptidase enzymes (mimicking their substrate).
      • Structurally diverse chemical classes (with a β-lactam ring)
      • Penicillins
      • Cephalosporins
      • Carbapenems
      • Monobactams
    • Non β-lactams (Glycopeptide): (Vancomycin) (bactericidal)
      • No β-lactam ring
      • Target transpeptidase's substrate
      • Shared mechanism of action

    Patient Centred Integration

    • Human Biology
    • Clinical Pharmacy
    • Cellular & Molecular Bioscience
    • Pharmacology & Therapeutics
    • Pharmaceutical Chemistry
    • Pharmacy Practice
    • Pharmaceutics

    3) Antibiotic Classes Acting as Antimetabolites

    • Inhibit bacterial metabolic pathways (eukaryotic cells have different pathways)
    • Selective toxicity
    • Target key enzymatic steps in folic acid synthesis (essential for nucleotide production)
    • Bacteriostatic effect

    3a) Sulphonamides (Sulfamethoxazole)

    • Mechanism:
      • Folic acid is key for producing purines (nucleotides)
      • Bacteria cannot absorb folic acid externally
      • Bacteria synthesize folic acid starting from PABA
      • Sulphonamides compete with PABA for the first enzyme: DHPS
    • In human bodies: Folic acid (Vitamin B9) obtained through the diet

    3b) Trimethoprim

    • Mechanism:
      • DHFR (dihydrofolate reductase) targeted
      • Present in human cells (for folic acid activation)
      • 100,000x greater affinity for bacterial DHFR over human counterpart

    3a+b) Sulphonamides + Trimethoprim

    • Sequential blocking mechanism: Both block folic acid synthesis at various steps.
    • Synergistic effect: Combined action potentiates antibacterial effect
    • Bacteriostatic effect: Inhibits bacterial growth.
    • Spectrum: Broad-spectrum (Gram-positive & Gram-negative)

    3a+b) Sulphonamides + Trimethoprim (Co-trimoxazole) - Side Effects & Cautions

    • Side effects:
      • Folic Acid Deficiency (esp. pregnant women)
      • Hyperkalaemia (high potassium, renal monitoring)
      • Hypersensitivity; rash and anaphylaxis
    • Contraindications:
      • First trimester of pregnancy
      • Patients with blood dyscrasias (e.g., decreased blood cell counts)
      • Acute porphyria
      • Elderly and neonates
      • Increased risk of folate deficiency

    4) Inhibition of Nucleic Acids Synthesis

    • Inhibitors of DNA synthesis:
      • Fluoroquinolones (ciprofloxacin, levofloxacin, moxifloxacin)
    • Inhibitors of RNA synthesis:
      • Rifamycins (rifampin)

    4) Nucleic Acid Synthesis Inhibition

    • Fluoroquinolones: Target DNA topoisomerases, crucial for replication
    • Rifamycins: Inhibit RNA polymerase, disrupting mRNA transcription.
    • Bactericidal effect
    • Lower selective toxicity due to similarities in bacterial and eukaryotic processes.

    4a) Fluoroquinolones

    • Mechanism:
      • Inhibit bacterial topoisomerases (DNA replication disruption).
      • DNA gyrase inhibition in Gram-negative bacteria.
      • Topoisomerase IV inhibition in some Gram-positive bacteria (at higher doses)
    • Spectrum:
      • Broad-spectrum (including H. influenzae, P. aeruginosa).
    • Uses:
      • Serious RTIs (CAP), skin/soft tissue infections, UTIs
    • Side effects:
      • GI distress
      • Tendonitis/rupture (-2%)
      • Muscle weakness/joint pain
      • QT prolongation (rare)/aortic aneurysm (very rare)
      • Seizures (rare) /peripheral neuropathy
    • Cautions / Contraindications:
      • History of tendon damage
      • Corticosteroid use
      • QT prolongation risk factors
      • Epilepsy, psychiatric disorders
      • Renal impairment
      • Exposure to sunlight

    4b) Rifamycins (Rifampicin)

    • Mechanism:
      • Inhibit bacterial mRNA synthesis by blocking the bacterial RNA polymerase.
    • Bactericidal effect
    • Uses:
      • Tuberculosis, meningitis (N. meningitidis/H. influenzae), related infections
    • Side effects:
      • GI distress
      • Minor hepatotoxicity
      • Body fluid discoloration (urine/sweat turns orange - harmless)
      • Many drug interactions (cytochrome P450 inducer)
    • Contraindications:
      • Patients with acute porphyrias

    5) Alternative Mechanisms

    • Nitroimidazoles: (Metronidazole, Nitrofurantoin)
      • Generate reactive free radicals, disrupting DNA and other bacterial components
      • Bactericidal effect
      • Spectrum: Mainly against anaerobic bacteria & some Gram-positives(e.g., E. coli)
    • Uses:
      • Treating anaerobic bacterial infections, H. pylori eradication; UTIs (Nitrofurantoin is a significant component).

    5a) Nitroimidazoles (Metronidazole)

    • Mechanism: Generating free radicals in anaerobic bacteria.
    • Spectrum: Only anaerobes (including protozoa). Requires low redox potential. Aerobic bacteria have high redox potential.
    • Uses: Treating anaerobic infections, H. pylori eradication.

    5b) Nitrofurantoin

    • Mechanism: Generates reactive free radicals, interfering with RNA, DNA, and protein synthesis.
    • Spectrum: Effective against most Gram-positive & some Gram-negative bacteria (E. coli)
    • Uses: Treating and preventing uncomplicated acute UTIs.

    Treatment for Tuberculosis (TB)

    • 10.6 million new TB cases and 1.6 million deaths due to TB reported in 2021 globally.
    • TB caused by Mycobacterium tuberculosis organisms.
    • Infection can be pulmonary (lungs) or extrapulmonary (other organs).
    • TB can occur in latent (asyptomatic) or active (symptomatic) forms.
    • Microbiologically diagnosed using acid-fast staining (lipid-rich cell wall) or auramine fluorescent staining (mycolic acid).

    Mycobacterium tuberculosis

    • Gram-positive and aerobic (oxygen requirement)
    • Complex and unique cell wall: Thick, hydrophobic, waxy (lipids) – preventing antibiotics entry
    • Virulence factors: Survive and replicate within macrophages.
    • Therapeutic target: Cell wall components (e.g., mycolic acids, arabinogalactan).

    Cell Wall of Mycobacteria

    • Unique components: Glycolipids (TDM, GPL, PDIM), mycolic acids, arabinogalactan, peptidoglycan
    • Thick, hydrophobic barrier: Impedes antibiotic penetration.
    • The nature of the cell wall renders mycobacterium highly resistant to traditional antibiotics

    Treatment for Tuberculosis (TB) - First-Line Drugs (RIPE)

    • Rifampicin (RNA polymerase inhibitor)
    • Isoniazid (inhibitor of mycolic acid synthesis)
    • Pyrazinamide (interferes with fatty acid synthesis)
    • Ethambutol (interferes with the synthesis of arabinogalactans)

    Treatment for Tuberculosis (TB) - Drug Resistance

    • Newly diagnosed TB: RIPE (6 months) and subsequent continuation (RI), 4 additional months.
    • Re-treatment of TB: RIPE and streptomycin (2 months) & a continuation with ethambutol (5 months)
    • Drug-Resistant TB (MDR-TB, XDR-TB): Rifampicin and Isoniazid resistance, and other second-line drug resistances. Treatment is tailored for resistance; Supervision is emphasized to meet patient compliance.

    Quizzes

    • Trimethoprim Target: Folic acid synthesis
    • Not a First Line TB Drug: Amoxicillin

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    Antibiotics Part 3 PDF

    Description

    Este quiz explora le classes de antibioticos e lor mecanismos de action in detail. In particular, us considerara le antimetabolitos e inibitores del synthesis de acidos nucleicos. Se preparara pro examinar le therapias pro tuberculose e alios aspectos critical del immunologia de inflection.

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