microbial caused tx sore throat QG.pdf

Microbial causes and management of sore throat Marcos Ortega, PhD Farzana Alam, PhD Learning Objectives A we Dont use anti viral Management of sore throat Pharmacology of Beta-lactam and Beta-lactamase inhibitor Sore throat management Causes...

Microbial causes and management of sore throat Marcos Ortega, PhD Farzana Alam, PhD Learning Objectives A we Dont use anti viral Management of sore throat Pharmacology of Beta-lactam and Beta-lactamase inhibitor Sore throat management Causes Allergies Bacteria Viruses Over the counter drug Pain medications Demulcents Acetaminophen Throat lozenges i ricola Ibuprofen/ Naproxen Cough drops Numbing medication Sore throat and cough pops Throat spray Antihistamines Diphenhydramine benadryl Loratadine Numbing medication contain Cetirizine ingredients- Fexofenadine Benzocaine Levocetirizine Menthol Products containing Chlorpheniramine Phenol Consideration before taking pain medication Only by MD X Gc i 1 beans I apro en Antibiotics Strep throat, caused by bacteria, is one type of sore throat that can be treated. It isn't handled in the same way as sore throats caused by colds and other viruses, so your doctor will likely do what’s called a “rapid strep test” to be sure it's strep. Common microbial agents: Streptococcus Mycoplasma Haemophilus influenzae Corynebacterium diphtheriae Neisseria gonorrhoeae  Which mechanism is targeted to treat Therapeutic intervention: Strep-throat To kill the group A Streptococcus bacteria that cause strep throat. They will work only on bacteria. They have no effect on sore throats caused by viruses. Advantages: Help your child get better faster Make it less likely it will be spread to others Help prevent complications such as sinus and tonsil infections, and more serious things such as rheumatic fever  Antibiotics used: Penicillin Amoxicillin Amoxicillin + Clavulanic acid Augmentin Kids or adults who are allergic to penicillin may be able to take one of these antibiotics instead : Azithromycin (Zithromax, Zmax, Z-Pak) micro lids Clarithromycin (Biaxin) J Cephalosporins, including cefixime (Suprax), cefuroxime (Ceftin), and cephalexin (Keflex) Clindamycin (Cleocin) can't u re bas they have same mech as penicillin Most antibiotic treatments for strep throat last about 10 days  penicillin resembles PBPstructure Beta-lactam antibiotics penicillin binding penicillin release protein is that transpeptid inhibits activation of by Vanspeptidase  results in weak Beta-lactam antibiotics cell wall The β-lactam antibiotics inhibit this last step in peptidoglycan synthesis by acylating the transpeptidase via cleavage of the –CO–N– bond of the β- lactam ring (transpeptidation). The transpeptidase targets for the actions of β-lactam antibiotics are collectively termed penicillin-binding PBPis a kindof transpeptidase proteins (PBPs). is beingtargeted inhibited bas  3cross I s linkages Penicillin: Mechanism of action Penicillins structurally resemble the terminal portion of the peptidoglycan strand, they compete for and bind to penicillin- binding proteins (PBPs), which catalyze transpeptidase and facilitate cross-linking of the cell wall. The result is the formation of a weakened cell wall and ultimately cell death. For this reason, penicillins are regarded as bactericidal and work in a time- dependent fashion. kills bacteria  Penicillin drugs Adverse Effects i trade name Pen G surfixicillin PenV Amoxicillin Ampicillin Contra-indications and precautions Penicillins are contraindicated in patients with a history of hypersensitivity to penicillin or the cephalosporins. Penicillins should be used cautiously in patients with renal disease, asthma, bleeding disorders, gastrointestinal (GI) disease, pregnancy (pregnancy category C) or lactation (may cause diarrhea or candidiasis in the infant), and history of allergies. Drug-drug interactions penicillin kills both but well predominately King Gct how Antimicrobial spectrum Martin works Factors determining PBP susceptibility to these antibiotics include size, charge, and hydrophobicity of the particular β- lactam antibiotic. In general, gram-positive microorganisms have cell walls that are easily traversed by penicillins, and, therefore, in the absence of resistance, they are susceptible to these drugs. Gram-negative microorganisms have an outer lipopolysaccharide membrane surrounding the cell wall that presents a barrier to the water-soluble penicillins. have proteins inserted in the lipopolysaccharide layer that act as water- filled channels (called porins) to permit transmembrane entry. Beta-lactamase Bacteria also can inactivate β-lactam antibiotics enzymatically via the action of β-lactamases. Thousands of different β-lactamases have been variously characterized by according to their molecular class or functional characteristics (Bush and Jacoby, 2010). Their substrate specificities can be relatively narrow or can extend to almost all β-lactams.  In general, gram-positive bacteria produce and secrete a large amount of β-lactamase, typically narrow-spectrum penicillinases. In gram-negative bacteria, β-lactamases are found in lower quantities, but their location in the periplasmic space between the inner and outer membranes provides maximal protection of the microbe. Beta-lactamase inhibitor Because of the key role that β-lactamases play in conferring resistance to β-lactams, an increasing number of β-lactams are coformulated with molecules whose role is to “protect” the β-lactam from the β- lactamase. These β-lactamase inhibitors bind to β-lactamases and prevent the enzymes from hydrolyzing β-lactam agents in the vicinity. prevents the bacteria from degrading penicillin ***Clavulanic Acid, Sulbactam, tazobactam, Avibactam, Relebactam, vaborbactam  Clavulanic Acid penicillin T Fidelity amoxicillin Clavulanic acidaugmentin has poor intrinsic antimicrobial activity but is an irreversible mechanism-based inhibitor that binds β- lactamases produced by a wide range of gram-positive and gram-negative microorganisms. It is combined with amoxicillin as an oral preparation (Augmentin®) and with ticarcillin as a parenteral preparation (ticarcillin/clavulanate, not available in the U.S.).