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Infection medications Types
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Infection medications Types

All want to have SELECTIVE TOXICITY (kill intruder without harming host tissues)
Bacteria are single cell organisms
Bacteria have more rigid cell membrane (higher internal pressure)
Bacteria have different ribosomes
Bacteria have different nucleic acid metabolism

Each of these differences is an opportunity for medication to selectively attack bacteria
Drugs that inhibit cell wall synthesis
Bacteria have peptidoglycans
--These are supporting structures along the cell membrane
--Certain agents will pierce a hole in the membrane, others impair building of the membrane

Penicillin - impair production of peptidoglycans (which build the cell membrane)
(Vancomycin and Cephalosporin as well)

Others act as a wreaking ball to damage cell wall
Colistin and Polymixin B do this
Inhibition of protein synthesis
These meds work on the ribosomes of bacteria
Some agents bind onto the bacteria ribosome to stop creation of new proteins


Inhibit dna/rna synthesis
Certain drugs decrease DNA synthesis by inhibiting Folic acid synthesis
Others directly inhibit this process

Sulfa drugs (Sulfonamides)
Antibiotic terms
Some medications are:

bactericidal - directly kill the cell

Others are bacteriostatic - they slow down reproduction, allowing the body to kill it

Broad spectrum - kills many types of bacteria
Narrow spectrum - kills only a specific type of bacteria
Antibiotic resistance
Some bacteria develop immunity (resistance) to specific antibiotics

Common resistant strains

There are bacteria which we have NO treatments for!
Sensitivity and resistance
Not all antibiotics will kill all bacteria

Broad-spectrum antimicrobials will destroy a broader spectrum of bacteria

Need to do culture and sensitivity - Identify if the infection is sensitive to the drug, or resistant to the drug
Types of resistant bacteria
MRSA: Methicillin-resistant staph aureus
Doesn't respond to penicillins

May cause cellulitis, osteomyelitis, abcesses
Can be treated with Bactroban, or ZYVOX
This can be up to $75 per pill!
Another resistant strain
VRE (vancomycin-resistant enterococci)
Emerged in US in 1989

No longer sensitive to vancomycin

Found in surgical wounds, and urinary tract
Critically ill, immunosuppresed, prolonged hospital stay are at risk for these infections

Treated with ampicillin-amoxicillin
Newer superbug (just making news 2013)
Initial case 2001

Carbapenem-Resistant Enterobacteriaceae

Enterobacteria are GI, fecal oral bacteria
States need to start tracking universally

**Bacteria can lurk (asymptomatically) until host is medically compromised
New Delhi metallo-beta-lactamase, which is an enzyme that destroys beta-lactam antibiotics including the penicillins, cephalosporins, and carbapenems

First cases in US in June 2010

Most strains are resistant to all commonly used antibiotics.

Common to bacteria that live in the gut

Also found in some of India's water supply

Sensitive to colistin (older, more toxic antibiotic)
Klebsiella pneumoniae carbapenemase (KPC)—is a deadly infection that can cause pneumonia, sepsis and urinary tract infections

bacteria tends to live in the intestines, on the skin and in the mouth

Found often in ventilator tubes
How do we prevent this? (infection/antibiotics)
Antibacterial stewardship
Need to limit how often we use antibiotics (especially broad spectrum which allows a few cells to survive, they then proliferate, and create a new colony which is basically immune to that antibiotic)
Have patients ALWAYS complete their antibiotic prescription
Only give antibiotics when needed

Can give a 2nd medication along with the antibiotic
Antibiotics side effects
UV light sensitivity

GI distress (diarrhea as antibiotics kill normal flora of the GI tract)

Fluoroquinolones can damage tendons (in large weight bearing tendons mostly)

Risks increase with age, renal failure, history of tendinopathy

85% of these cases occur within 1 month of treatment

Rashes (allergic reaction)

Difficulty breathing with allergy to the medication