Antibiotics

What do class do the following drugs belong to?

• Penicillin G

• Penicillin V

• Amoxicillin

• Cephazolin

• Cephalexin

• Ceftriaxone

• Vancomycin

a) DNA synthesis inhibitors

b) Cell wall synthesis inhibitors

c) Protein synthesis inhibitors

b)

What do class do the following drugs belong to?

• Doxycycline (30S)

• Erythromycin (50S)

a) DNA synthesis inhibitors

b) Cell wall synthesis inhibitors

c) Protein synthesis inhibitors

c)

What do class do the following drugs belong to?

• Ciprofloxacin

• Sulfamethoxazole + Trimethoprim

a) DNA synthesis inhibitors

b) Cell wall synthesis inhibitors

c) Protein synthesis inhibitors

a)

Which of the following is a protein synthesis inhibitor drug for 30S?

a) Erythromycin

b) Doxycycline

c) Ciprofloxacin

d) Ceftriaxone

b)

Which of the following is a protein synthesis inhibitor drug for 50S?

a) Erythromycin

b) Doxycycline

c) Ciprofloxacin

d) Ceftriaxone

a)

Goal of Chemotherapy?

Kill or Inhibit a pathogenic organism without harming the patient

What are the different types of chemotherapy?

• Antimicrobial agents

• Antineoplastic agents

History of Chemotherapy:

• What did Ancient China use?

a) Chaulmoogra oil to treat leprosy

b) Chenopodium to treat intestinal worms

c) Cinchona bark for fevers

d) Moldy soybean curd on boils

e) Mercury for syphilis

d)

History of Chemotherapy:

• What did Ancient India use?

a) Chaulmoogra oil to treat leprosy

b) Chenopodium to treat intestinal worms

c) Cinchona bark for fevers

d) Moldy soybean curd on boils

e) Mercury for syphilis

a)

History of Chemotherapy:

• What did 16th century Greece use?

a) Chaulmoogra oil to treat leprosy

b) Chenopodium to treat intestinal worms

c) Cinchona bark for fevers

d) Moldy soybean curd on boils

e) Mercury for syphilis

e)

History of Chemotherapy:

• What did 17th century use?

a) Chaulmoogra oil to treat leprosy

b) Chenopodium to treat intestinal worms

c) Cinchona bark for fevers

d) Moldy soybean curd on boils

e) Mercury for syphilis

c)

Development of ______ to _____ and characterize microbes and mammalian cells

dyes to stain

• Arsenical agents

  • Atoxyl for sleeping sickness

  • Arsphenamine in 1906

  • Neoarsphenamine in 1909 for syphilis

if certain dyes could selectively stain microbes, could they could also be selectively toxic to these organisms.

Who said this?

a) Paul Ehrlich

b) Gerhard Domagk

a)

In 1935, _____ demonstrates antibiotic properties of Prontosil, a sulfonamide dye, in pyogenic infection.

a) Paul Ehrlich

b) Gerhard Domagk

b)

Do we need the whole structure? the PABA and the dye?

No! Active moiety is para-amino benzene sulfonamide

______ was the first sulfonamide to be marketed in 1938.

Sulfapyridine

Different ways of Organizing Antimicrobials:

• Chemical structure

  • Azide, sulfonamide, etc.

• Mechanism of action

  • Receptor inhibitor, enzyme inhibitor, cell wall disruptor, etc.

• Target organisms

  • Bacteria, viruses, fungi, etc.

• Spectrum of activity

  • Narrow, extended, broad

• Effect on the microbe

  • -cidal (kills the bug) or static (stops bug growth)

• Drug source/origin

  • Bacteria, fungi, plant, synthesized

Antibiotics Go Hand In Hand with Bugs and Infections:

Which of the following is best described?

• Classification

• Genetics

• Pathogenesis

• Diagnostic Techniques

a) Infectious Diseases

b) Antibiotics

c) Bacteria

c)

Antibiotics Go Hand In Hand with Bugs and Infections:

Which of the following is best described?

• Classification

• MOA

• Spectrum

• PK/PD

• Side effects

• Clinical uses

a) Infectious Diseases

b) Antibiotics

c) Bacteria

b)

Antibiotics Go Hand In Hand with Bugs and Infections:

Which of the following is best described?

• Presentation

• Diagnosis

• Management

a) Infectious Diseases

b) Antibiotics

c) Bacteria

a)

Common Infections:

Which of the following is best described?

• Infective endocarditis

• Bone and joint

• Bacterial meningitis

• Derm/soft tissue infections

a) Mostly Gram (+)

b) Mostly Gram (-)

a)

Common Infections:

Which of the following is best described?

• Pneumonia

• UTI

• STI (plus protozoa, spirochetes, viruses)

• Bacterial meningitis

a) Mostly Gram (+)

b) Mostly Gram (-)

b)

Biological Approaches:

Which is best described?

• Bacitracin, Vancomycin, Daptomycin, Streptogramins, Linezolid

• Mostly used for ____: PCNs

a) G (+) only

b) G (-) only

c) Broad-spectrum

d) Bactericidal

a)

Biological Approaches:

Which is best described?

• Aztreonam

• Mostly used for ____:

  • Extended-spectrum PCNs, 3rd gen cephalosporins, Aminoglycosides

a) G (+) only

b) G (-) only

c) Broad-spectrum

d) Bactericidal

b)

Biological Approaches:

Which is best described?

• Carbapenems, Tetracyclines, Macrolide, Chloramphenicol, Clindamycin, anti-folates, Quinolones

a) G (+) only

b) G (-) only

c) Broad-spectrum

d) Bactericidal

c)

Biological Approaches:

Which is best described?

• Cell wall inhibitors, Tigecycline, Aminoglycosides, Streptogramins, TMP/SMZ, Quinolones

a) G (+) only

b) G (-) only

c) Broad-spectrum

d) Bactericidal

d)

Empiric Therapy:

• Treatment plan based on _______, _____ lab results confirming the identity of the microbial pathogen

a) infection type, before/ prior to lab results

b) infection type, after lab results

a)

Empiric Therapy:

• Pneumonia: ______

a) Cell wall inhibitor

b) Cell wall inhibitor + Protein synthesis inhibitor

c) Anti-folate

d) Cell wall inhibitor, viral DNA polymerase inhibitor

b)

Empiric Therapy:

• Infectious Endocarditis: ______

a) Cell wall inhibitor

b) Cell wall inhibitor + Protein synthesis inhibitor

c) Anti-folate

d) Cell wall inhibitor, viral DNA polymerase inhibitor

b)

Empiric Therapy:

• Bone and Joint: ______

a) Cell wall inhibitor

b) Cell wall inhibitor + Protein synthesis inhibitor

c) Anti-folate

d) Cell wall inhibitor, viral DNA polymerase inhibitor

a)

Empiric Therapy:

• UTI: ______

a) Cell wall inhibitor

b) Cell wall inhibitor + Protein synthesis inhibitor

c) Anti-folate

d) Cell wall inhibitor, viral DNA polymerase inhibitor

c)

Empiric Therapy:

• STD: ______

a) Cell wall inhibitor

b) Cell wall inhibitor + Protein synthesis inhibitor

c) Anti-folate

d) Cell wall inhibitor, viral DNA polymerase inhibitor

d)

Empiric Therapy:

• Bacterial meningitis: ______

a) Cell wall inhibitor

b) Cell wall inhibitor + Protein synthesis inhibitor

c) Anti-folate

d) Cell wall inhibitor, viral DNA polymerase inhibitor

a)

Empiric Therapy:

• Skin infections: ______

a) Cell wall inhibitor

b) Cell wall inhibitor + Protein synthesis inhibitor

c) Anti-folate

d) Cell wall inhibitor, viral DNA polymerase inhibitor

a)

Case Example: Treating Pneumonia in Adults

• Common pathogens: Strep (+), Hemophilus, Moraxella

• Atypical bacteria: Legionella, Mycoplasma, Chlamydia, Pseudomonas

• Mainly ______

Mainly cell wall inhibitors (block transpeptidase/PBP) ± protein synthesis inhibitor (30S/50S)

Case Example: Treating Pneumonia in Adults

• Common pathogens: Strep (+), Hemophilus, Moraxella

• Atypical bacteria: Legionella, Mycoplasma, Chlamydia, Pseudomonas

• Mainly cell wall inhibitors (block transpeptidase/PBP) ± protein synthesis inhibitor (30S/50S)

• Empiric treatment approach:

  • Community: ______

a) Piperacillin/Tazo ± vancomycin ± gentamicin

b) Ceftriaxone + Azithromycin

b)

Case Example: Treating Pneumonia in Adults

• Common pathogens: Strep (+), Hemophilus, Moraxella

• Atypical bacteria: Legionella, Mycoplasma, Chlamydia, Pseudomonas

• Mainly cell wall inhibitors (block transpeptidase/PBP) ± protein synthesis inhibitor (30S/50S)

• Empiric treatment approach:

  • Hospital-acquired: ____

a) Piperacillin/Tazo ± vancomycin ± gentamicin

b) Ceftriaxone + Azithromycin

a)

Case Example: Treating Pneumonia in Adults

• Empirical therapy: cover ______

G (+) and G (-)

Case Example: Treating Pneumonia in Adults

• Empirical therapy: cover G (+) and G (-)

• G (-) cocci: Moraxella, Hemophilus= ______

2nd/ 3rd gen cephalosporins

Case Example: Treating Pneumonia in Adults

• Empirical therapy: cover G (+) and G (-)

• G (-) cocci: Moraxella, Hemophilus= 2nd/ 3rd gen cephalosporins

• Atypical bacteria (Mycoplasma, Chlamydia): ______

Doxycycline (30S inhibitor)

Case Example: Treating Pneumonia in Adults

• Empirical therapy: cover G (+) and G (-)

• G (-) cocci: Moraxella, Hemophilus= 2nd/ 3rd gen cephalosporins

• Atypical bacteria (Mycoplasma, Chlamydia): Doxycycline (30S inhibitor)

• Legionella: _____

Azithromycin (50S inhibitor)

Case Example: Treating Pneumonia in Adults

• Empirical therapy: cover G (+) and G (-)

• G (-) cocci: Moraxella, Hemophilus= 2nd/ 3rd gen cephalosporins

• Atypical bacteria (Mycoplasma, Chlamydia): Doxycycline (30S inhibitor)

• Legionella: Azithromycin (50S inhibitor)

• Pseudomonas: _______

Anti-pseudomonal PCN + Beta-lactamase inhibitor (cell wall inhibitor) + aminoglycoside (30S inhibitor)

Case Example: Treating Pneumonia in Adults

• Empirical therapy: cover G (+) and G (-)

• G (-) cocci: Moraxella, Hemophilus= 2nd/ 3rd gen cephalosporins

• Atypical bacteria (Mycoplasma, Chlamydia): Doxycycline (30S inhibitor)

• Legionella: Azithromycin (50S inhibitor)

• Pseudomonas: Anti-pseudomonal PCN + Beta-lactamase inhibitor (cell wall inhibitor) + aminoglycoside (30S inhibitor)

• PCN allergy: use ______

Quinolones (DNA gyrase inhibitors)

Case Example: Bacterial Meningitis in Adults

• Common pathogens:

  • _______

• N. meningitis (Gram-negative cocci)

• Streptococcus pneumoniae (Gram-positive cocci)

• H. influenza (Gram-negative coccobacillus)

• Listeria (Gram-positive bacillus)

• P. aeruginosa (Gram-negative rod)

Case Example: Bacterial Meningitis in Adults

• Common pathogens:

  • N. meningitis (Gram-negative cocci)

  • Streptococcus pneumoniae (Gram-positive cocci)

  • H. influenza (Gram-negative coccobacillus)

  • Listeria (Gram-positive bacillus)

  • P. aeruginosa (Gram-negative rod)

• Mainly ______

  • Empiric

    • Community: _______

• Mainly cell wall inhibitors

  • Empiric

    • Community: Ceftriaxone + Vancomycin