Antibiotics Presentation

8/19/2019 Antibiotics Presentation

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Antibiotics

Cyrus Talwar


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Bacteria

• Gram stain identifes bacteria undermicroscope:

• Gram +ve (purple/blue)• Gram –ve (red)


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Gram !ositive

" G+ bu#s ($ cocci% &rods)

') treptococcus Cocci$) tap ylococcus

*)Bacillus

&)Clostridium ods

,)Corynebacterium


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Gram ne#ative

').eisseria

$) 0Coli*) !roteus

&)1lebsiella

,) !suedomonas

") almonella


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treptococci (catalyse )

• trep vs tap 2 CATA-A T T todi3erentiate

') Group A strep: ( trep0 !yo#enes) ! aryn#itis-) Cellulitis/ 4in in5ections (necrotisin#

5asciitis)-) To6ic oc4 yndrome-)

Also causes delayed antibodymediated 7 and Glomerulone ritis


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treptococci

$) Group B trep:- $,8 o5 women carry t ese bu#s

va#inally- Cause neonatal menin#itis%

pneumonia and sepsis

*) 9ididans Group trep:- ental in5ections-

ndocarditis


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&) Group strep (enterococci and nonenterococci)-

i;cult to treat due to resistance o5ampicillin and vancomycin

,) trep !neumoniae

Bacterial pneumonia menin#itis in adults

otitis media in c ildren


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tap ylococci (catalase +)

') tap Aureus-) !roduces 5 > CT or#an invasion can cause

pneumonia% ?enin#itis% endocarditis%

4in in5ections% sepsis% @T>


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$) tap pidermis

Compromised ospital patients witurine cat eters/ >09 lines can becomein5ected w en t is or#anism mi#rates

5rom t e s4in alon# t e tubin#- eart valve and prost etic in5ections

*) tap ylococcus saprop yticus

-eadin# cause o5 @T> in 5emales


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To6ins

6oto6ins !roteins release by G+ andG 0 >ncludes .euroto6ins% nteroto6ins(causes diarr oea by .aCl release)0

Causes >.7 CT>=@ >A = A and7== !=> =.>.G

ndoto6ins lipid A w ic is outermembrane piece o5 G bacteria0 9eryto6ic so antibiotics can ma4e patientsworse initially due to release o5endoto6in


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Gram bacteria

• .eisseria ?enin#itidis causesmenin#ococcal menin#itis 0Causespetic eal ras

• -e#ionella !neumonia ( atypical

pneumoniaD) Eell aerated water (airconditionin# units% water stora#e)


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E at are antibiotics2

- Compounds t at act a#ainst bacteria(FAntimicrobials viruses% parasites%5un#i)

4ill (bacteriacidal) or in ibit(bacteriostatic)

administered as oral% parenteral ortopical

resistance may rapidly develop


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Antibiotics t at inter5ere

wit cell wall') !enicillins$) Cep alosporins B lactams

*) Carbapenams

&) Glycopeptides


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') !enicillinHs

• !enicillin G (benpen) #iven >0?/>09( trep0 !neumoniae)

•

Aminopenicillins(Ampicillin/Amo6icillin) Broaderspectrum% more G cover0 >ncreasin#resistance

• !enicillinase resistant(?et icillin/7luclo6acillin) – used 5orG+% #ood a#ainst stap aureus

•


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B lacamase in ibitors

• Given in combination wit penicillinHs• >n ibitors o5 b lacamase

Amo6icillin + Clavulanic acidICoamo6iclav

!ipericillin + TaJobactam I TaJocin


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$) Cep alosoporins

• ?ore resistant to b lactamaseenJymes t an penecillin

•

'st Gen: G+ covera#e• $nd Gen: use5ul in CA!• *rd Gen: G covera#e0 @se5ul in

nosocomial in5ections% menin#itis and@T>s0 as best C 7 penetration0

• ome cross reactivity in patients witpenicillin aller#y


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*) Carbapenams

• Broadest spectrum b lacatams• as anaerobic cover

• -owers seiJure t res old


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&) Glycopeptides

• Glycopeptides bacteriocidal: inter5erewit cell wall – #ram +ves only

9ancomycin/teicoplanin• ? A treatment•

.ep roto6ic (don t #ive wit #entamicin)

• .eed to monitor levels – B re#ime L


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• .arrow spectrum: BenJyl pen andpen 9 5or streptococci% neisseria%clostridia

• Amo6 and ampicillin e6tend spectrumto enterococci% listeria% emop ilus

•

Amo6 clavulanic acid e6tendsspectrum to stap ylococci% coli5orms%anaerobes

•

7luclo6acillin 5or ? A


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Antibiotics t at in ibit

protein synt esis') ?acrolides$) Amino#lycosides

*) Tetracyclins&) =t ers

(c loramp enicol/clindamycin/5usidic acid)


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') ?acrolides

• ryt romycin% clarit romycin• Alternative to penicillin

• Clindamycin can causepseudomembranous colitis as itdestroys natural #ut Mora

• ?ainly act a#ainst G+


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$) Amino#lycosides

• Gentamycin% streptomycin• ?ust enter cell wall to wor4 so o5ten

used wit penicillinHs• 1ill G or#anisms• .arrow t erapeutic window• .ep roto6ic and ototo6ic


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*) Tetracyclins

• o6ycycline• use5ul activity a#ainst c lamydiae%

mycoplasmas% ric4ettsias andCo6iella burnetii as well asstap ylococci% streptococci and someGram ne#ative rods

• T ey must not be used in pre#nancy%in c ildren or in renal impairment0


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Antibiotics t at in ibit .A

syt esis• Nuinolones (CiproMo6acin)• >n ibit .A #yrase

• CiproMo6acin is a #ram ne#ativeantibiotic wit no activity a#ainstpneumococcus


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?etronidaJole

• >n ibits .A synt esis• Causes metallic taste and intolerance

to alc ol• Good 5or anaerobes• !er5oration o5 bowel /bowel sur#ery L

metronidaJole and coOamo6iclav• 'st line C0di3 treatment


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ulp onamides

• 0# trimet roprim• >n ibit 5olate synt esis

• @se5ul in @T>• ulp onamides can ave nasty side

e3ects e0#0 tevens Po nson

syndrome Q bone marrow aplasia0


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Condition Drug

UTI-Uncomplicated 'st: .itro5urantoin –$nd: Trimet oprim –*rd: Ce5ale6in –? A –nitro5urantoin andtrimet oprim and do6ycycline

Acute Prostatitis 'st: CiproMo6acin

$nd: Trimet oprim*rd: Tetracycline

Pyelonephritis (andcomplicated UTI’s)

'st: CiproMo6acin / ce5uro6ime$nd: Co amo6iclav>9 – #entamycin

Genital bacterial in ections(General)

?etronidaJole

PID ?etronidaJole o6ycycline

Chlamydia o6ycycline

Gonorrhoea CiproMo6acin% Amo6icilin% !robenicid

!aginal ungal in ections ClotrimaJole pessary

Antibiotics 5or urolo#yconditions


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Antibiotics 5or respiratory

conditionsCondition Drug"o#er respiratory tractin ection ("$TI)

Amo6icillinryt romycin

C%PD acute e&acerbation Amo6icillin R Clarit ro i5 pen aller#y

Co amo6iclavCiproMo6acin

'ronchiectasis Amo6icillino6ycyclin

Pneumonia S – Amo6icillin (clarit ro)

' – Amo6icillin + clarit ro0$ >9 Amo60 + clarit ro0* , – >9 au#mentin + clarit


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Antibiotics 5or .T

conditionsCondition Drug%titis edia Amo6icillin

ryt romycinCo amo6iclav

Dental in ections Penicillin ! A*D Chlorohe&idine mouth#ash+rythromycin

etronida,ole

Pharyngitis !enicillin 9ryt romycin

%ral candidiasis .ystatin (can be pastille orsuspension) 7luconaJole (tablet)


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Antibiotics 5or G> conditions

Condition Drug

Peritonitis Amo6icillin – A. –Gentamycin – A. –?etronidaJole9ancomycin (instead o5 amo6icillin

epsis TaJocinGentamicin


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Be5ore prescribin# A6 0

-oo4 5or si#ns o5 in5ection:

• Pain• .e/er•

#elling• $edness• tachycardia• ri ors


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• Antibiotics s ould only be #ivenw en t ere is proven or stron#lysuspected bacterial in5ection

• (or w en t ere is a possibility o5bacterial in5ection and t e patient isso sic4 you cannot a3ord not to treatt at small possibility)


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@r#ent re uirements 5orantibiotics

• ?enin#ococcal disease• =t er bacterial menin#itis

• epsis• evere pneumonia• .ecrotisin# 5asciitis• = B-== C@-T@ U


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ystemic inMammatory

response syndrome• Temperature V*W or X*"• !ulse VYS

• espiratory rate V$S or pC=$ X &0*

• ECC V '$SSS or X &SSS


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efnitions

• epsis I > due to in5ection• evere sepsis I sepsis + or#an

dys5unction• eptic s oc4 I sepsis + re5ractory

ypotension


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epsis

Clinically:• 7ever

• Tac ycardia• .i# t sweats• To6ic% Mus ed ( vasodilated )• i# w ite cell count• -ocalisin# symptoms and si#ns

Complications


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?enin#itis

?ost causes are community ac uired• Neisseria meningitidis

• Streptococcus pneumoniae • Haemophilus infuenzae• Listeria monocytogenes • >n neonates: Group B streptococci

and Gram ne#ative bacilli as well as

listeria


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?enin#itis

• tart A6 immediately(Ce5ota6ine/Ce5tria6one)

•

Acyclovir i5 viral• >5 not yet in ospital #ive '0$G >?

BenJylpenecillin


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C 7 fndin#WCC

/mm3roteing/L

!lucosemmol/L

Normal Z,lymp ocytes

S0', S0&, $0W &0$V'/$ blood #lucose

"acterial $SS *SSS(neutrop ils)

S0, $0S X'/* blood #lucose(X$0,)

#iral 'S 'SS(lymp ocytes)

S0& S0W V'/$ blood #lucose

$" ,S ,SS(lymp ocytes)

S0, *0S X'/* blood #lucose


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emember

• Classes o5 antibiotics• ow t ey wor4

• E ic or#anisms t ey cover• >mportant in5ections and 6• on t 5or#et Blood culturesU

Antibiotics Presentation

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