Lecture 4.1 - Introduction to Antibiotics and Antimicrobials PDF

Summary

This lecture introduces different types of antibiotics, their mechanisms of action, and resistance mechanisms. It covers antibacterial, antifungal, antiviral, and antiprotozoal agents, and discusses various antibiotic classes and their considerations in therapy.

Full Transcript

Antimicrobials - classification: ◦Antibacterial, antifungal, antiviral and antiprotozoal agents ◦Antibacterial agents can be classified: ‣ Bactericidal (kill off straight away) or bacteriostatic (stop them from replicating) ‣ Spectrum - 'broad' (act against both gram...

Antimicrobials - classification: ◦Antibacterial, antifungal, antiviral and antiprotozoal agents ◦Antibacterial agents can be classified: ‣ Bactericidal (kill off straight away) or bacteriostatic (stop them from replicating) ‣ Spectrum - 'broad' (act against both gram positive and negative, and both aerobic and anaerobic) vs 'narrow' (more specific) ‣ Target site (mechanism of action) ‣ Chemical structure (antibacterial class) Ideal features of antimicrobial agents: ◦Selectively toxic ◦Few adverse effects ◦Reach site of infection ◦Oral/IV formulation ◦Long half-life (infrequent dosing) ◦No interference with other drugs Classes of antibacterials and their mechanims of action: ◦Bacterial cell - prokaryote Mechanisms of resistance: ◦Drug inactivating enzymes (denature, kill or destroy the bacteria) ‣ E.g. beta-lactamases, aminoglycoside enzymes ◦Altered target ‣ Target has lowered affinity for antibacterial e.g. resistance to methicillin, macrolides and trimethoprim ◦Altered uptake ‣ Decreases permeability ‣ Or increases efflux ◦Biofilm mode of growth (made out of polysaccharides) ‣ Hence why it’s hard to treat infections on joint replacements Genetic mechanisms of resistance: Measuring antibiotic activity: Disc sensitivity testing: ◦Sensitive ◦Intermediate ◦Resistant Antibiotic sensitivity by Etest: ◦Minimum inhibitory concentration (MIC) as mg/L Automated antibiotic sensitivity testing: ◦Minimum inhibitory concentration (MIC) as mg/L Considerations for antibiotic therapy: ◦Severity/cause of infection - antibiotics are ineffective against viral infections. ◦Consider patient's medical history, other drugs and allergy to antibiotics ◦Taking samples (e.g. swab, blood, urine sample, tissue or bone sample) before start of antibiotic therapy ◦Broad spectrum antibiotics should be used if there is an urgency and the causative organism has not been identified - kills a lot of bacteria ◦Route of administration taking tablets is easier than intravenous routes. ◦Dose of antibiotics ◦Longevity of therapy ◦Combination therapy ◦Prophylaxis Selection of antibiotics for treatment: ◦Empirical therapy initially ◦Isolate and identify the organism ◦Determine its sensitivity ◦Treat with an appropriate antibiotic Beta-lactams: Penicillins: ◦Penicillin - mainly active against streptococci ◦Amoxicillin - also some activity against Gram-negatives ◦Flucloxacillin - active against staphylococci and streptococci (used a lot in cellulitis) ◦Beta-lactamase inhibitor combinations ‣ Amoxicillin/clavulanate (all of the above + anaerobes + gram-negative bacteria) Amoxicillin is able to carry on its task as clavulanate breaks down bacteria ‣ Piperacillin/tazobactam (as above + gram negative, including Pseudomonas species) Cephalosporins: ◦Broad-spectrum but no anaerobe activity ◦Cetriaxone has good activity in the CSF ◦Concern over association with C.difficile ◦Ceftazidime + avibactam and ceftlozane + tazobactam used for multidrug resistant Gram negative infections Carbapenems: ◦Carbapenems: imipenem, meropenum and ertapenem ‣ Very broad spectrum (including anaerobes) ‣ Active against most (not all) gram negatives ‣ Generally safe in penicillin allergy ◦Imipenem + relebactam ‣ Serious gram negative infections (including anaerobes) ◦Meropenem + vaborbactam ‣ Complicated gram negative UTI Glycopeptides: ◦Vancomycin: ‣ Active against most gram positive (not gram negative) ‣ Some enterococci resistant (VRE) ‣ Resistance in staphs rare ‣ Not absorbed (oral for C.difficile only) ‣ Therapeutic drug monitoring (TDM) required (narrow therapeutic window) ◦Teicoplanin: ‣ Similar activity to vancomycin ‣ Easier to administer ◦Dalbavancin and telavancin: ‣ Acute gram positive skin infections ‣ MRSA pneumonia Tetracyclines: ◦Tetracycline and doxycycline: ‣ Similar spectrum, both oral only. ‣ Broad-spectrum but specific use in penicillin allergy, usually for gram positive ‣ Active in atypical pathogens in pneumonia (useful in older patients with chest infections) ‣ Active against chlamydia and some protozoa ‣ Should not be given to children

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