Chemotherapy

(Antimicribial) Antibiotic Antiviral Antifungal Antihlmintic Antiprotozoal Anticancer

----------------Antibiotic---------------A) Classification according to MOA: no. 1 2

MOA

Inhibit cell wall synthesis

Inhibit plasma membrane

Inhibit nucleic acid synthesis A) inhibit DNA:

FQ

Drugs

A) -lactam group 1- polymyxin

1234penicillin cephalosporin carbapenem monobactam

2- deptomycin

B) glycopeptide
1- vancomycin 2- teicoplanin

B) Inhibit RNA:
-

(on 30S / 50S ribosomal subunit) 1- AG (on 30S) 2- Tetracycline(on 30S) 3- Macrolide(on 50S) 4- Chloramphenicol(on 50S) 5- Clindamycin(on 50S)

Inhibit protein synthesis

Inhibit metabolic pathway

1- Sulfonamide 2- trimethoprim

rifampicin

B) Classification according to the effect: A) bacteriocidal 1,2,3 NOTE: Macrolide in high kill organism without need for immune system dosecidal B) bacteriostatic 4,5 Combination of stop growth of organism SO, need immune system Sulfonamide+ trimethoprim "co-trimoxazole"cidal for eradication C) Classification according antibacterial spectrum: rd th "FQ"New g. (3 , 4 ) broad spectrum A. G-ve o Polymyxin AG not active against anaerobe o FQ monobactam not active against anaerobe o AG o monobactam vancomycin use in C.difficle"G+ve" B. G+ve o Glycopeptides infection o Deptomycin clindamycin use in anaerobe o clindamycin Macrolide less effective against G-ve C. Broad (+ve & -ve) o Penicillin sulfonamide not active against anaerobe o Cephalosporin carbapenem use in anaerobe o carbapenem tetracycline, macrolide, chloramphenicol, o rifampicin FQ: have Atypical action o tetracycline o macrolide Atypicals o chloramphenicol (Mycoplasma, Legionella, Chlamydia) o sulfonamide o trimethoprim

Clinical points: G+ve Streptococcus spp. Enterococcus spp. Staphylococcus spp. Listeria monocytogenis E coli Pseudomonas aeruginosa Klebsiella spp. Serratia spp. Enterobacter spp. G-ve Proteus spp. Haemophilus influenzae Moraxella catrarrhalis Neisseria meningitides

most suspected organism in the following cases: E.Coli UTI Klebsiella DM=UTI E.Coli, proteus mirabilis ,s.aureus Acut prostatits Prosthatic valve endocarditis S.epidermis S. pneumonae Pregnant with pneumonia pseudomonous , klebsilla Nosocomial pneumonia anaerobe ,-ve bacteria Intra abdomen infection H. influenza meningitis
In case of penicillin allergy: Type-1 hypersensitivity>>> give monobactam (only from -lactam group) , or other groups "macrolide,.." Type-2 hypersensitivity (skin rash)>>> give cephalosporin In case of immunodeficiency patient(AIDS) give bacteriocidal antibiotic bcz it's doesnt need immune system In case of drug combination>>> the 2 drugs should be act on different MOA NB: Bactericidal + Bactericidal = Synergism. Bacteristatic + Bacteristatic = Addition.