Anti Microbial
Anti Microbial
Anti Microbial
The history of antimicrobials begins with the observations of Pasteur and Joubert,
who discovered that one type of bacteria could prevent the growth of another. They
did not know at that time that the reason one bacterium failed to grow was that the
other bacterium was producing an antibiotic. Technically, antibiotics are only those
substances that are produced by one microorganism that kill, or prevent the
growth, of another microorganism. Of course, in today's common usage, the term
antibiotic is used to refer to almost any drug that attempts to rid your body of a
bacterial infection. Antimicrobials include not just antibiotics, but synthetically
formed compounds as well.
The discovery of antimicrobials like penicillin and tetracycline paved the way for
better health for millions around the world. Before penicillin became a viable
medical treatment in the early 1940's, no true cure for gonorrhea, strep throat, or
pneumonia existed. Patients with infected wounds often had to have a wounded
limb removed, or face death from infection. Now, most of these infections can be
cured easily with a short course of antimicrobials.
Chemical structure
Vc èulfonamides and related drugs: èulfadiazine and other, èulfones ±
Dapsone(DDè), Paraaminaosalicyclic (PAè)
Vc Diaminopyrimidines: Trimethoprim, Pyrimethamine.
Vc uinolones: Nalidixic acid, Norfloxacin, Ciprofloxacin etc.
Vc -lactam antibiotics: Penicillins, Cephalosporins, Monobactams,
Carbapenems.
Vc Tetracyclines: Oxytetracycline, Doxycycline etc.
Vc Nitrobenzene derivative: Chloramphenicol
Vc Aminoglycosides: ètreptomycin, Gentamicin, Neomycin etc.
Vc Macrolide antibiotics: Erythromycin, Roxithromycin, Azithromycin etc.
Vc Polypepetide antibiotics: Polymyxin-B, Colistin, Bacitracin, Tyrothricin.
Vc Nitrofuran derivatives: Nitrofurantoin, Furazolidone.
Vc Nitroimidazoles: Metronidazole, Tinidazole.
Vc Nicotinic acid derivatives: Isoniazid, Pyrazinamide, Ethionamide.
Vc Polyene antibiotics: Nystatin, Amphotericin-B, Hamycin.
Vc Imidazole derivatives: Miconazole, Clotrimazole, Ketoconazole, Fluconazole.
Vc Others: Rifampin, Lincomycin, Clindamycin, èpectinomycin, Vancomycin,
èod. Fusidate, Cycloserine, Viomycin, Ethambutol, Thiacetazone,
Clofazimine, Griseofulvin.
MECHANIèM OF ACTION
Vc Inhibit cell wall synthesis: Penicillins, Cephalosporins, Cycloserine,
Vancomycin, Bacitracin.
Vc Cause leakage from cell membranes:
*c Polypeptides : Polymyxins, Colistin, Bacitracin
*c Polyenes ± Amphotericin B, Nystatin, Hamycin.
Vc Inhibit protein synthesis: Tetracyclines, Chloramphenicol, Erythromycin,
Clindamycin.
Vc Cause misreading of m-RNA code and affect permeability: Aminoglycosides ±
ètreptomycin, Gentamicin etc.
Vc Inhibit DNA gyrase: Fluoroquinolones ± Ciprofloxacin.
Vc Interfere with DNA function: Rifampin, Metronidazole.
Vc Interfere with DNA synthesis: Idoxuridine, Acyclovir, Zidovudine.
Vc Interfere with intermediary metabolism: èulfonamides, èulfones, PAè,
Trimethoprim, Pyrimethamine, Ethambutol.
TYPE OF ACTION
Vc PRIMARILY BACTERIOèTATIC:
Vc èulfonamides, Tetracyclines, Chloramphenicol, Erythromycin, Ethambutol
Vc PRIMARILY BACTERICIDAL: Penicillins, Aminoglycosides, Polypeptides,
Rifampin, Cotrimoxazole, Cephalosporins, Vancomycin, Nalidixic acid,
Ciprofloxacin, Isoniazid.
HYPERèENèITIVITY REACTIONè:
Vc Practically All AMAs.
Vc Unpredictable and unrelated to dose.
Vc Reactions from rashes to anaphylactic shock.
Vc Penicillins, cephalosporins, sulfonamides.
DRUG REèIèTANCE:
Vc Natural resistance: always resistance.
Vc Pencillin G ± Gram ±ve bacilli.
Vc Tetracyclines ± M.tuberculosis
Vc Acquired resistance: develop resistance
Vc rapid acquisition ± staphylococci, coliforms, tubercle bacilli.
Vc ètrep.pyogenes & spirochetes ± penicillin when >40 years.
Vc Gonococci ± quick to sulfonamides but low to penicillin.
Vc Resistance may be developed by mutation or gene transfer
Vc MUTATION:
Vc 1. èingle ètep: high degree of resistance, emerges rapidly ± e.g. Enterococci to
streptomycin
Vc E.Coli and ètaphylococci to Rigampin
Vc ù. Multistep: Resistance to erythromycin, tetracyclines and chloramphenicol
Vc Low grade penicillin resistant gonococci have decreased virulence.
ètaphylococci to rifampin.
Vc Gene transfer (infectious resistance) from one organism to another can occur
by:
*c Conjugation: R ± factor (Resistance transfer factor (RTF)).
Chloramphenicol resistance of typhoid bacilli, streptomycin resistance of
E.coli, Penicillin resistance of Haemophilus and gonococci.
*c Transduction: Penicillin, erythromycin and Chloramphenicol ± phage
mediated.
*c Tranformation: Pneumococcal resistance to penicillin G due to altered
penicillin binding protein.
Vc 4. èuperinfection ( èuprainfection)
Vc Appearance of a new infection as a result of antimicrobial therapy.
Vc The normal flora contributes to host defence by elaborating substances called
bacteriocins which inhibit pathogenic organisms.
Vc èuperinfections are more common when host defence is compromised, as in:
Vc Corticosteriod therapy
Vc Leukemias and other malignancies (WBC count)
Vc Acquired immunodeficiency syndrome (AIDè)
Vc Agranulocysis
Vc Diabetes, disseminated Lupus Erythematosus.
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