MG - infectious diseases and oncology 1

Introductory lecture

what was the first antibiotic that was used?

salversan

why is salversan not used anymore?

toxic, too much work to create, which was also toxic and dangerous for the doctor preparing it, unstable

what is the mechanism of a bactericide?

they kill bacteria at safe plasma concentration levels

what is the mechanism of bacteriostatic?

inhibit, bacterial growth and the immune mechanisms eliminate the bacteria

what is a unique pathway/target?

This is only found in the pathogen

what is a similar pathway?

this is also found in humans, but there are some differences.

what is the target with the same pathway?

there is the same pathway but there is a different significance

what is the cell wall synthesis inhibition an example of?

unique pathway

what is the folic acid synthesis inhibition an example of?

unique pathway

what is the ergosterol synthesis inhibition an example of?

unique pathway

what is the binding to the membrane ergosterol mechanism an example of?

unique pathway

what is HIV protease inhibition an example of?

unique pathway

what pathway is targeted with neuraminidase inhibtion?

unique pathway

what pathway is targeted with the dihydrofolate reductase inhibtion?

similar pathway / same pathway

what pathway is targeted with the topoisomerase inhibition?

similar pathway

what pathway is the protein synthesis inhibition an example of?

similar pathway

what pathway is the DNA/RNA polymerase inhibition an example of?

similar pathway

what pathway is anti-metabolite nucleotides an example of?

same pathway

what pathway is DNA polymerase inhibition an example of?

same pathway

what are the questions asked to determine if the antimicrobial therapy is waarented for a given patient?

indicated, clinical specimens have been obtained, etiologic agentes, prevent further exposure, clinical evidence

What are the questions asked when there are is a specific species found?

narrower-spectrum agent, combination, optimal dose and duration, specific tests, adjunctive measures.

What are the principles of antimicrobial therapy?

proper dose ffor a proper time with a proper schedule

define empiric antimicrobial therapy

based on experience with particular clinical entity, when it is hard to identify specific pathogen

when are emperic antibiotic therapies indicated?

when there is significant risk of serious morbidity or mortality if withheld OR for public health reasons

what is the efficacy related to with time-dependent antibiotics?

to the time the concentration of a drug remains above the MIC

what is the efficacy related to with concentration dependent antibiotics?

to the peak concentration/minimum inhibitory concentration ratio

what is the post antibiotic effect(PAE)?

suppression of bacterial growth after brief antimicrobial exposure to microorganisms

What are possible mechanisms of PAE?

slow recovery, persistance of drug at binding site, unknown

which drugsposses concentration-dependent PAEs and with that can be given at high dose, once a day?

aminoglycosides, quinolones

what are pharmacokinetic considerations?

IV administration, distribution, TDM

What is the TDM approach?

personalized, but as that would be too invasive and only feasible in hospital there is Bayesian simulations

what are the reasons for the combination of drugs?

seriously ill, polymicrobial infections, decrease resistant strains, decrease dose-related toxicity, enhance inhibition or killing

what is important to prevent tolerance development

misuse of AB therapy: use it for viruses and patient compliance

What are mechanisms of obtained resistance?

mutation resulting in selection: enzyme production, change in target binding spot, decreased accumulation, correction of damage/decrease in apoptosis

what is another mechanism of tolerance between bacteria?

there can be tranfer between humans and between bacteria via plasmids

What are the nosocomial ESKAPE pathogens?

no treatment: Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, Enterobacter species.

what are the superbugs?

multidrug resistance: MRSA, ESBL, MDRAB, VRE, CRE, CRAB

what is not true about therapeutic drug monitoring

a disadvantage is that it requires a high amount and frequent patient samples

in what cases is a bactericide therapy required?

endocarditis, meningitis, infections of immunocompromised patients

choose the true statement for bactericide agents

the main therapeutic effect is that they kill bacteria at safe plasma concentration levels

what is not a unique pathway that is targeted by some antimicrobial agents

dihydrofolate reductase inhibitors

what is PAE

suppression of bacterial growth after brief antimicrobial exposure to microorganisms

why is it extremely important that the patients adhere to the prescribed antimicrobial therapeutic regimen?

to avoid tolerance, to achieve proper therapeutic effects, to minimize side effects

what is the difference between gram positive and gram negative

positive has a thick peptidoglycan layer, negative has an outer membrane

what type of bacteria is Staphylococcus aureus

gram positive cocci: skin and wound infections, osteomyelitis, endocarditis

what type of bacteria is Streptococcus pyogenes

gram positive cocci: skin and wound infections, tonsillopharyngitis, scarlet fever

what type of bacteria is Streptococcus pneumonia?

gram positive cocci(Pneumococcus): respiratory infections

what type of bacteria is Streptococcus viridans group?

gram positive cocci: dental infections, caries(tooth decay), endocarditis

what type of bacteria is the Enterococcus?

gram positive cocci: urinary infections, endocarditis

what type of bacteria is corynebacterium diphtheria

gram positive bacillus: diphtheria

what type of bacteria is neisseria meningitidis

gram negative cocci: meningitis

what type of bacteria is Neissseria gonorrhoeae

gram negative cocci

what type of bacteria is Moraxella catarrhalis

gram negative cocci: respiratory infections

what type of bacteria is the Haemophilus influenza

gram negative: respiratory infections

what type of bacteria is the Helicobacter pylori?

gram negative : gastric ulcer

What type of bacteria are E. coli and Salmonella

gram negative

what type of bacteria is the pseudomonas aeruginosa

gram negative

what type of bacteria is the clostridium ssp.

anaerobe gram positive bacillus

what type of bacteria is the Bacteriodes fragilis?

anaerobe gram negative bacillus

wha type of bacteria is the propionibacter acnes

anaerobe gram negative

what are mycobacteria

they have cell walls with a waxy lipid-rich outer layer

what is true for gram positive bacteria

they have a thicker peptidoglycan layer, crystal violet gram staining

choose the pathogen of Lyme disease

Borrelia burgdorferi

which of the following bacteria might cause mainly respiratory infections?

Haemophilus influenzae, Streptococcus pneumonia, Moraxella catarrhalis