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Antimicrbial agent 3 (2).ppt
1. Ministry Of Higher Education
& Scientific Research
Alzaiem Alazhari University, Sudan
Faculty of Medical Laboratory Sciences
(MLS)
8 February 2023 1
2. Antimicrobial agents and
Chemotherapy
Prepared by:
Mohamed Ahmed Ibrahim Holie
AL-ZAIEM ALA-zhari University
Faculty of Medical Laboratory Sciences
Holie2330@yahoo.com
8 February 2023 2
3. Definitions of Antibiotics
• OLD: An antibiotic is a chemical substance
produced by various species of
microorganisms that is capable in small
concentrations of inhibiting the growth of
other microorganisms
• NEW: An antibiotic is a product produced by
a microorganism or a similar substance
produced wholly or partially by chemical
synthesis, which in low concentrations,
inhibits the growth of other microorganisms
8 February 2023 3
4. Disadvantages from taking
medication without doctor guide
Emergency of Resistance.
Drug toxicity.
Cost.
Drug dose.
Interaction of the drug with other disease.
Susceptibility of the pathogenes to the
drug.
Time consuming.
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5. Antimicrobial agents:
Chemical and therapeutic agents that acts
against bacteria, viruses, fungi and
parasite.
Antibiotic ------ Natural product from
microorganism.
Chemotherapy ------ Chemically synthetic
or semi synthetic agent.
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6. 6
Antibacterials can be classified into:
a. By their activity level action:
1. Bacteriostatic: they arrest the growth &
replication of bacteria
e.g. Sulfonamides, Chloramphenicol
2. Bactericidal: kills the bacteria
e.g. Penicillins
8 February 2023
7. 7
b. Spectrum of activity:
1. extended spectrum of antibiotic: active
against types of bacteria G- & G+
2. Narrow spectrum antibiotic: active against
single or limited # of M.O
3.broad spectrum: active against a wide
variety of microbial species
8 February 2023
8. 8
Combination of antimicrobials
Advantages:
1. Delay the development of resistance.
2. To broaden the spectrum of activity.
3. Potentiation of action of one another.
indifferent
Combination of antibiotics either synergism
antagonism
A 60% bacterial inhibition
A+B 80% synergism
A+C 40% antagonism
A+D 60% indifferent
8 February 2023
9. 9
Prophylaxis antibiotics:
Definition
A prophylaxis is a measure taken to maintain
health and prevent the spread of disease.
Antibiotic prophylaxis is refers to the use of
antibiotics to prevent infections as:
1.Treatment prior to surgical procedures as bowel
surgery, joint replacement to prevent infection.
2.prevention of tuberculosis or meningitis in
individuals who are close contact with infected
patients.
8 February 2023
10. 10
3. Suppression of existing infection before it cause a
disease, e.g. animal bite.
4. Prevention of streptococcal infection in patients with
history of rheumatic heart disease.
5. prevention of opportunistic infection →infective
endocarditis.
8 February 2023
11. By their Mechanisms of Action Antibacterials
can be classified into:
Inhibition of cell wall synthesis.
Inhibition of Cell membrane synthesis.
Inhibition of protein synthesis.
Inhibition of Nucleic acid synthesis.
Metabolic antagonism.
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14. 1. -Lactam containing Antibiotics
Penicillin:
From Penicillium notatum.
Discovered at 1928 and used at 1938.
Active part is β-lactam ring.
Inter through penicillin binding proteins.
Resistant by:
Production of β-lactamase.
Lack or alteration of PBPs.
Failure in activation of autolytic enzyme.
Failure in synthesis of peptidoglycan (Mycoplasma).
Side effect:
Penicillin allergy.
Types:
Penicillin G Acid sensitive (IV and IM).
Penicillin V Acid Resistant (Oral)
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15. Ampicillin:
Broad spectrum antimicrobial (G+ve and some G-ve).
Acid tollerant.
Amoxicillin:
Have wide range of activity against G+ve G-ve and some
Anaerobe)
Could be taken orally.
Amoxicillin-Clavulinic acid (Augmentin or Amoclan):
More penicillinase resistant antimicrobial
Monobactam:
IV or IM antimicrobial that active against G-ve bacteria and resist β-
lactamase (e.g.: Aztreonam).
Carpenems:
Active against G+ve and G-ve bacteria and anaerobes except
bacteroides.
Could reach CSF.
Side effects:
Skin rash, diarrhoea, vomiting, and Hypersensitivity.
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16. Cephalosporins:
Same as penicillin in action.
Resistance:
Poor permeation of bacteria (No entry).
Lack or alteration of PBPs.
β-lactamase production.
Side effects:
Hypersensitivity.
Thrombocytopenia.
1st generation:
Active against G+ve cocci except enterococci,
moderate active against E.coli, Klebsiella, proteus
and some anaerobic.
Cephalexin and Cephradin given orally.
Could be used in UTI and RTI.
Cephalexin used as post operative prophylaxis.
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17. 2nd generation:
Active against G+ve and G-ve (except
pseudomonas) and some anaerobe.
3rd generation:
Less active against G+ve, but active
against G-ve and moderate action
against pseudomonas.
Have the ability to reach the CSF.
4th generation:
Act against G-ve including enterobacter
and Citrobacter Pseudomonas and
moderate sensitive against G+ve.
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18. 2. Bacitracin:
From B. subtilus.
Inhibit early cell wall synthesis in cell
membrane (inhibit lipid carrier).
Poor absorbance from GIT.
Very active against G+ve bacteria.
Used as ointment.
Side effect:
Kidney damage.
Nitrogen retention.
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19. 3. Vancomycin:
From S. orientalis
Bind with peptide chain inhibiting
transpeptidation.
Side effects:
Skin rash.
Kidney damage.
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20. Inhibition of cell membrane:
Polymexin B:
Disrupt plasma membrane structure.
Bacteriocidal for G-ve and G+ve.
High toxic used as Ointment.
Side effects:
Nephrotoxic.
Neurotoxic.
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21. Inhibition of Protein synthesis:
Inhibition of 30 S rRNA:
Aminoglycoside.
Tetracyclins
Inhibition of 50 S rRNA:
Chloramphenicol.
Lincosamide (Lincomycin and clindamycin).
Macrolides (Erythromycin, Clarithromycin).
Fusidic acid Affect Elongation factor G.
8 February 2023 21
22. Aminoglycoside:
Streptomycin, Neomycin, Kanamycin, Amikacin,
Gentamicin, and tobramycin.
Bacteriostatic inhibit 30 S rRNA.
Active at alkaline PH.
Broad spectrum (G+ve and G-ve and Mycobacterium).
Give synergistic effect with penicillin.
In blood culture aminoglycoside inhibited by Na polyanithol
sulfonate.
Resistance by:
Deficiency in Ribosomal receptor.
Lack of permeability to the drug (transportation is oxygen
dependent).
Side effect:
Nephrotoxic and Ototoxic.
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23. Doxycyclins and Tetracyclins:
Inhibit G+ve, G-ve, Rickettsia, Chlamydia,
Mycoplasma, Brucella, Yersinea and Vibreo.
Bacteriostatic in action.
Have poor penetration to CSF.
Side effects:
Gastrointestinal upset (Nausea, Vomiting, and
Diarrhoea).
Skin rash.
Deposition in bone structures and teeth particularly in
fetus.
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24. Chloramphenicol:
From S. vensuelae (Now synthesized).
Wide distributed in all body fluid including CSF.
Inactivated in liver and secreted in urine in inactive
form.
Bacteriostatic in action.
Resistant by production of Chloramphenicol acetyl
transferase.
Side effects:
GIT upset.
Aplastic anaemia.
Gray fetal syndrome. (Have no develop liver so No
inactivation).
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25. Lincosamide (Lincomycin and
Clindamycin):
From S. licolnsis.
Very active against bacteroides and
other anaerobes.
Cause Pseudomembranous colitis.
Acid stable.
Cold not penetrate CSF.
8 February 2023 25
26. Macrolides (Erythromycin,
azithromycin and Clarythromycin):
From S. erythrus.
Resistance by alteration of rRNA receptor.
Active at alkaline PH.
Active at G+ve, G-ve, Chlamydia,
Mycoplasma and Legionella.
Side effects:
GIT upset.
Fever.
Affect liver cells causing hepatitis.
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27. Quinolones:
Block DNA gyrase.
E.g.: Nalidixic acid, Oxolinic acid,
Ciprofloxacin, Ofloxacin, Norfloxacin,
Pefloxacin, and Nitrofurantoin.
Used in UTI.
Active against G-ve, G+ve, Haemophilus,
Pseudomonas and Mycobacterium.
Side effect:
Nausea, headache, and dizziness.
Skin rash.
Impaired liver function.
Inhibition of Nucleic acid:
8 February 2023 27
28. Rifampin:
Active against some G+ve, G-ve, Enteric
cocci, Mycobacterium, Chlamydia and pox
virus.
Bind with RNA polymerase (inhibit RNA
synthesis).
Could penetrate inside phagocytic cells.
Side effects:
Orange pigment in urine and sweat.
Skin rash.
Thrombocytopenia.
Impaired liver function.
8 February 2023 28
29. Metabolic antagonistic:
Bacteriostatic for some G+ve and G-ve bacteria.
Inhibit folic acid synthesis.
Synergistic effect obtained from Cotrimoxazole
(Trimethoprim and Sulphomethoxazole).
Side effects:
Hypersensitivity.
Fever and skin rash.
GIT disturbances.
Depression of bone marrow.
Liver and kidney function abnormality.
Sulphonamide and trimethoprim:
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30. Antimicrobial susceptibility
pattern:
Kirby Bauer agar disk diffusion
methods:
Aim:
To perform standard sensitivity test on agar
media.
Test requirements:
Media: Muller & Hinton agar
and Broth media
Antimicrobial disks: Multi or single disks
STD turbidity tube: McForland tube (Bacl2 +
H2So4)
Pure culture from organism under test.
8 February 2023 30
33. Test Procedure:
Make a suspension by touching more than 10 colonies and emulsify
on M&H broth.
Incubate for 30 min in water bath.
Compare the turbidity with 0.5 McForland tube (contain 0.05 ml of
1.16% Bacl2 + 9.95 ml of 1% H2SO4).
Streak on M&H agar using Ca++ alignment swab 3 times inverting the
plate 60 each time.
For H influenzae, S. pneumoniae, and Neisseria we use M&H
supplemented with Heated sheep Blood and for Streptococci we use
Blood agar.
Put the disk on the center of the plate allowing 1.5 cm distances from
the edge of the plate and 1 cm between each disks (the plate take
about 8 disks).
Incubate at 37C for exactly 18 hours.
Read the diameter of the disk using ruler and compare it with a STD.
Report your results as HS, MS, SS, R.
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40. Same plate comparative
methods (Stoke)
We culture control strain on the center
of the plate and tested organism on
the two edges. Put the disks between.
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41. Dilution methods:
This used to detect antimicrobial susceptibility to
slow growing M.O and anaerobic.
It could be carried out on Microtiter plate or test
tube.
Also it used to detect MIC to antimicrobials
We make serial dilution of antimicrobials and add
5 drops from 106 bacterial suspension and
incubate at 37 C, then read about turbidity
which indicate resistance and clearance which
indicate sensitivity, and detect the MIC.
8 February 2023 41
43. Factors affect antimicrobial agar disk
diffusion method:
Type of the medium.
Depth of the medium (4 mm)
Surface of the medium
Supplement in the medium (mg and ca) and Blood
Moisture of the medium
pH of the medium
Source and expiry date of antimicrobial agents
Concentration of antimicrobials in the disk
Distribution of disks on the surface of the medim.
Nature of organism
Inoculum size.
Incubation temperature.
Incubation condition.
Incubation time.
8 February 2023 43
49. Antimicrobial Resistant test:
β lactamase test:
Cefinase β lactamase disk:
Using disks contain nitrocefin, we add suspension of
Microorganism and see the development of Pink-Brown color
within 10 min indicating β lactamase production.
Acidimetric technique:
Using citrate buffered penicillin and phenol red. Penicillin
destroyed by the enzyme to give penicilloic acid which
change the color from red into yellow.
Iodometric technique:
Using phosphate buffered penicillin and starch-iodine
complex, penicilloic acid prevent binding of starch with
penicillin which convert the color from blue to colorless.
8 February 2023 49