Critica

Brand Presentation

Microbiology
Microbiology: Study of microorganism. Microorganism are of five types

Virus
Can only survive in a favorable condition Causes disease like common cold, AIDS, Chicken pox

Fungus
Unicellular or multi-cellular. Exmp; Candida Causes diseases like Candidiasis, Aspergillosis.

Protozoa
Unicellular. Exmp; Plasmodium sp, Endameba sp. Causes diseases like, Malaria, Amebiosis .

Bacteria
Unicellular. Exmp; E coli, S pneumoniae. Causes many diseases. Some are helpful like Lactobacillus. Can survive in Hot and Cold temp. Can multiply fast.

Algae
Unicellular or Multicellular. Usually not harmful. Exmp; Coccolithophore

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Amit Sarkar

Bacteria Classification
Shape/ Morphology Cell wall structure
Round-Cocci Streptococci. Rod-Bacilli E coli. Coiled-Spirochaete, Coma-Vibrio Vibrio cholerae Rod with tapered end-Fusoform Fusobacterium. Any shape-Pleomorphic Treponoma. Bacteria are different in terms of there cell wall structure. Different straining is used to identify bacteria. Gram staining: Gram positive- Appears in Violet color after staining. Has thick cell wall. Staphylococcus, Streptococcus. Gram negative- Appears in Red color after staining. Has thin cell wall. Has hard capsule on the top of the cell wall. E coli, Pseudomonas Ziehl Neelsen staining: Acid fast bacteria are identified through this method. They have Mycolic acid layer at the top of the cell wall. Mycobacterium tuberculosis. Atypical Bacteria: No defined cell wall. Chlamydia, Mycoplasma. Aerobic: Needs Oxygen for survival. Ex; Streptococcus pneumoniae. Anaerobic: Survives in Oxygen free medium. Ex; Peptococcus Facultative- Actually Aerobic but can survive in Oxygen free medium. Pseudomonas. Obligatory- Survives only in Oxygen free medium. Bacteroid Harmful-Pathogen, Clostridium. Helpful: Comensal Lactobacillus acidophilus

Oxygen requirement

Pathogenecity 9/17/2012

Bacteria

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Amit Sarkar

Infection:
Invasion and multiplication of Pathogenic micro organism in body.

Nosocomial infection:
Infection that occurs after 48hrs of hospital admission. Nosocomial or Hospital acquired infections are very difficult to treat as they are caused by tough pathogen. Common Hospital pathogens: Staph aureas, Klebsiella, E coli, Pseudomonus, Acinetobacter etc.

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Amit Sarkar

ICU-Intensive Care Unit

ICU: Intensive care unit, Serious and life-threatening diseases are treated in ICU.

Common ICU infections

Urinary Tract Infection(UTI), Nosocomial Pneumonia(HAP), Intra abdominal infection(IAI), Skin and skin structure infection(SSSI), Septicemia(Infection of blood) CNS infection like Meningitis, Endocarditis (infection of Heart) Febrile Neutropenia
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All hospital and ICU related infections are serious infections and should be treated with adequate antibiotic therapy to avoid mortality.

Antibiotics

Chemical substance that kills or inhibits the growth of bacteria.

Penicillin (Amoxycillin/Cloxacil lin/Piperacillin) Cephalosporins (Cefixime,Cefepime) Monobactams (Aztreonam) Carbapenems (Imepenem/ Meropenem)

Linezolid

Vancomycin Teicoplanin

Glycopepti de

Oxazolidi none

b-lactam

Colistin

Polymixin

Antibiotics

Macroli des Quinolo ne

Azithromycin Roxythromycin

Amino glycoside
Amikacin Gentamicin
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Tetracyclin es/Glycecy cline

Doxycycline AmitTigecycline Sarkar

Ciprofloxacin Gemifloxacin Levofloxacin Prulifloxacin

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DNA Synthesis inhibitors: Quinolones

Cell wall synthesis inhibitors b-lactams Glycopeptides

DNA Cell Wall Cell membrane Folic Acid Ribosome

Protein synthesis inhibitors Macrolides Aminoglycosides Tetracyclines Oxazolidinone Chloramphenicol
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Damage cell membrane Polymixins

Folic acid synthesis inhibitors Co-trimaxazole

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Bacterial Cell
Amit Sarkar

Some common aspects on Antibiotics

Spectrum of coverage: The ability of an antibiotic to kill or inhibit a
particular type of pathogen. oNarrow spectrum: Effective only against either Gm+ve or Gm-ve. oBroad spectrum: Effective against both Gm+ve and Gm-ve oExtended Spectrum: Effective against Gm+ve,Gm-ve, Anaerobes.

Tissue concentration: It signifies the amount of the drug which reaches

the tissue. MIC90: Minimum inhibitory concentration. Minimum amount of drug required to inhibit the 90% growth of bacteria. Often called as MIC90. PAE: Post Antibiotic Effect: Effect of antibiotic after the last dose, even after the drug concentration falls below MIC.
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Drug Resistance:
When bacteria are able to survive even in the presence of Antibiotics. Bacteria cause resistance through different mechanisms like producing enzymes. Exmp: Bacteria produces b-lactamase enzyme in presence of blactam antibiotic.

ESBL:
Extended spectrum b-lactamase that makes the 3rd Gen Cephalosporin and Monobactam ineffective.

b-lactamase inhibitors:
Clavulanic acid, Sulbactam, Tazobactam.
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Some common terminologies

oMDR: Multi drug resistant pathogen that is resistant to 3 or more number of antibiotics. oXDR: Extreme drug resistance. Bacteria that are resistant to most of the Antibiotics. oPan Drug Resistant: Bacteria that are resistant to almost all the Antibiotics.

Some common Resistant pathogen:

MRSA (Methicillin resistant Staphylococcus aures). Resistant to all b-lactam antibiotics. VRSA (Vancomycin resistant Staphylococcus aures). VRE Vancomycin resistant Enteroccocci MDRSP Multi drug resistant Streptococcus pneumoniae MDRAB Multi drug resistant Acenetobacter baumanni CRKP Carbapenem resistant Klebsiella pneumoniae Amit Sarkar

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Category

b-lactam antibiotic ;Carbapenem group Inhibits bacterial cell wall synthesis Nosocomial pneumonia including VAP, Complicated Intra-abdominal infection, UTI including pyelonephritis. 500gm/day 8hrly 250/500 vial Superior activity against Ps aruginosa PAE almost 2hrs against Ps aruginosa Intensivist, surgeon, CPs, ICU specialist. Sudopen: Ranbaxy, Dorikem: Alkem
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Mechanism of action
Indications Dosage Packing USPs Target Drs Competitors
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Category

b-lactam antibiotic ;Carbapenem group

Mechanism of action
Indications Dosage Packing USPs Target Drs Competitors
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Imipenem Inhibits bacterial cell wall synthesis. Cilastatin inhibits DHP-1 enzyme and stops the degradation of Imipenem.
LRTI, Bacterial septicemia, IAI, polymicrobial infection, UTI, SSSI, Gynecological infection, Endocarditis, Bone & joint infection 1.5-2gm/day in three divided doses 250/500 vial Better microbiological result than Ceftazidime and Piperacillin+Tazobactam. Stringent quality control measures to ensure the world class quality product with every batch Intensivist, surgeon, gynecologist, CPs, ICU specialist. Cilanem: Ranbaxy, Zinem: MSD, Ime-Cila: Abbott Truecare, Tinem: MSD, Ivnem: VHB
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Category

Tetracycline antibiotic; Glycecycline group Inhibits bacterial protein synthesis. cIAI, cSSSI, CAP 100 mg is given first, followed by 50 mg every twelve hours after that. Slow intravenous infusion (30 to 60 minutes). Low dose for Liver impairment. Tigebax 50mg Vial Broad spectrum antibiotics against Gm+ve, Gm-ve and MDR pathogen Intensivist, surgeon, CPs, ICU specialist. Tigercin RD: VHB, Tgcin RD: VHB, Tevran: Ranbaxy, TIGI: Natco, TIGEZ: Lupin, Tygacil : Wyeth
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Mechanism of action
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Category

b-lactam antibiotic; 4th generation Cephalosporin with b-lactamse inhibitor

Mechanism of action
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Cefepime: Inhibits bacterial cell wall synthesis Tazobactam: b-lactamase inhibitor

Treatment failure, relapse of infection, late resolution of infection, increasing risk of drug resistance by ESBL producing pathogens. cUTI, cSSTI, post surgical and bone and joint inf. 1-2g BID for 7-10 days, 2g TID in case of Fabrile neutropenia, Mild to moderate uncomplicated UTI : ,500mg-1g BID for 7-10days. 1.125g vial Better overall response rates compared to Pip/Taz as an initial empirical regimen Synergistic combination Intensivist, surgeon, gynecologist, CPs, ICU specialist. Tazopime: Alembic, Cefi-T: Abbott Truecare, SCUD XP: Zuventas , Actamase:Astra Zeneca, Magnova: Lupin, IviPime TZ: VHB, Megapime XP: Alkem
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Category

Polymixin antibiotic Damages bacterial cell membrane Infection of Gm-ve origin, Pseudomonas infection Upto 60kg:50,000-75,000 units/kg/day in 3 divided dosage. Over 60kg: 1-3 million in 3 divided dosage. Max dose- 6million. 1 million I.U. vial Drug of choice in the infection due to PDR Gm-ve pathogens ATS/IDSA guideline suggest Colistin for VAP Intensivist, surgeon, gynecologist, CPs, ICU specialist. Xylistin: Cipla
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Mechanism of action
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Category

Glycopeptide antibiotic. Inhibits bacterial cell wall synthesis. Crush injuries, Grade-iii compound fracture with infections, prosthetic joints/implant infection, Osteomyelitis, Septic arthritis, Prophylactic therapy in clean surgeries. Standard doses of 200mg and 400mg correspond to 3mg/kg and 6mg/kg respectively 200mg & 400mg vial. Better tolerated than Linezolid Reduces the risk of nephrotoxicity as compared to Vancomycin. Surgeons, CPs, Intensivists. Targocid-Sanofi, Ticogem- Lupin, Ticocin- Cipla, Tiecaz- VHB, Ticobact-Gland Pharma, Trueplan- Abbott, Ticotic- Life Medicare, Texoplan- Samarth Pharma.
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Mechanism of action
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Category

Antifungal drug Inhibits fungal cell membrane synthesis Invasive aspergillosis, Candida infection, Esophageal candidiasis, Scedosporiosis, IV: 6mg BID as loading dose followed by 3-4mg/kg BID, Oral: 200mg BID. 200mg tab, 4s pack and 200mg vial. Safe and effective for secondary prophylaxis. Patients can switch over to oral therapy Intensivist, surgeon, gynecologist, CPs, ICU specialist. V-fend:pfizr, Vorozol:Natco, Voritrol:Lupin, Voraze:Sun, Voritek: Cipla, Vorzu: Ranbaxy, Vorifit: MSD
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Mechanism of action
Indications Dosage Packing USPs Target Drs Competitors
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Category

Antifungal drug Inhibits fungal cell wall synthesis Empirical therapy in FN, Non neutropenic patients with renal insufficiency. Candida infections (intra-abdominal abscesses, peritonitis, pleural space Esophageal candidiasis, Invasive aspergillosis in patients who are refractory or intolerant of other therapies. 70mg as loading dose followed by 50mg OD. The only echinocandin approved for both Aspergillosis and Candidiasis Most azole-resistant Candida spp. are susceptible to caspofungin Intensivist, surgeon, gynecologist, CPs, ICU specialist. Cancidas:MSD, Casporan: Ranbaxy
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Mechanism of action

Indications

Dosage USPs Target Drs Competitors

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