antibiotics. introduction contents 1. sulfonamides 2. penicillin's 3. cephalosporin's 4. macrolides...

Antibiotics

Introduction Contents 1. Sulfonamides 2. Penicillin's 3. Cephalosporin's 4. Macrolides 5. Quinolones/Fluoroquinolones 6. Aminoglycosides 7. Tetracycline's 8. Miscellaneous Drugs

Continue Antibiotics are drugs of pertaining ability to destroy or interfere with the development of a living organism. Antibiotics can be classified into: 1. Bacteriostatic 2. Bactericidal

Sulfonamides Sulfonamides are chemically related group of antibiotics that are all synthetic derivatives of sulfonamide. They were one of the first group of drugs used as antibiotics and some of the more commonly prescribed agents.

Continue These antibiotics achieve very high concentration in kidneys through which they are eliminated. There fore they are primarily used for the treatment of urinary tract infections (UTI). Sulfonamides are also used in the treatment of rheumatoid arthritis, in addition they may be combined with other antibiotics to increase their antibiotic potency.

Drugs Sulfadiazine Sulfamethiazole Sulfamethoxazole Sulfisoxazole Sulfadimidine Sulfametopyrazine

Chemistry

Sulfapyridine

Mechanism of action Sulfonamides donot actually destroy bacteria but inhibit their growth. They inhibit the growth of susceptible bacteria by preventing the synthesis of folic acid. The enzyme dihydrofolic acid DHF, synthase converts para- amino benzoic acid PABA to DHF, which subsequently converts into tetrahydrofolic acid THF.

Therapeutic Uses Sulfonamides are used for the treatment of: 1. Urinary tract infections caused by, enterobacter spp, klebsiella spp, proteus vulgaris, & staphylococcus aureus. 2. Nocardiosis 3. Infected burns and leg ulcers (silver sulfadiazine) 4. Inflammatory bowel disease (sulfasalazine)

Side-effects Headache Convulsion Aplastic anemia Nausea Vomiting Diarrhea Toxic nephrosis

Sulfamethoxazole Sulfamethoxazole is an intermediate acing sulfonamide antibiotic. Because it is eliminated by means of kidneys and reaches very high concentrations there, it is commonly used to treat urinary tract infections caused by susceptible organisms. It is combined phenazopyridine (analgesic) that affects the mucosa of UTI.

Continue Sulfamethoxazole by it self comes as a 500mg/5ml oral suspension and 500mg tablet. It is a pregnancy category C.

Co-trimaxazole Co-trimaxazole is a combination of Sulfamethoxazole and Trimethoprim. The optimum synergistic in vitro effect against most susceptible bacteria is achieved with 5: 1 ratio of Sulfamethoxazole and trimethoprim. Has an half life of 10 hour. Used for UTI caused by susceptible bacteria, pneumocystis carinii pneumonia. Used for ear infection (otitis media) Used for bronchitis Used for STD including gonorrhea and syphilis.

Continue Available 40mg/5ml oral suspension Available 80mg trimethoprim & 400mg Sulfamethoxazole= 480mg co-trimaxazole. Available 180mg trimethoprim & 800mg Sulfamethoxazole = 980mg co-trimaxazole. Available 16mg/ml trimethoprim & 80mg/ml Sulfamethoxazole= 96mg/ml injection.

Sulfisoxazole Sulfisoxazole is a short acting sulfonamide antibiotic that is primarily used urinary tract infections. Used for ear infection (otitis media) in small children. It is a pregnancy category C agent. Available 500mg tablet & 500mg/5ml suspension.

Penicillin's The penicillin's are very large group of chemically related antibiotics that are derived from a fungus or mold, often seen on bread or fruit. The penicillin's may also be called beta-lactam, a term which refers to their chemical structure.

Continue The penicillin's was first introduced on the market in the early 1940 and to this day they have remained very effective and safe antibiotics. They are bactericidal and can kill a wide variety of gram positive bacteria Half life of penicillin's is 2h approximately.

Classification of drugs The penicillin's can be divided into: 1. Natural penicillin's 2. Penicillinase resistant penicillins 3. The amino-penicillins 4. The extended spectrum penicillin's

Mechanism of action Penicillin's involves several steps that together result in the inhibition of bacterial cell wall synthesis. They block penicillin binding proteins (PBP), by inhibiting peptidoglycan in the cell wall bacteria.

Side-effects Anemia Lethargy Bone-marrow depression Hallucination Nausea Vomiting Sore throat Abdominal pain

Natural Penicillin's Natural penicillin's are: 1. Pen G 2. Pen V 3. Pen M 4. Pen N 5. Pen X 6. Pen F

Penicillin G

Penicillin V

Penicillin G Penicillin G consists of: 1. Benzathine 2. Potassium 3. Sodium 4. Procaine

Penicillin G Benzathine Given IM injection Long acting drug Expected to work over the course for several days.

Penicillin G K + & Na Commonly administered IV for the treatment of life threatening illnesses such as: 1. Septicemia 2. Meningitis 3. Pericarditis 4. Severe pneumonia

Aminopenicillins There are three aminopenicillins: 1. Amoxicillin 2. Ampicillin 3. Bacampicillin Because of the presence of a free amino group on the penicillin's nucleus, the aminopenicillins have enhanced activity against gram negative bacteria.

Continue Amoxicillin is an analogue of ampicillin and becampicillin is a prodrug of ampicillin. The aminopenicillins are contraindicated: 1. Hypersensitivity They are rated in a pregnancy category B drugs.

Amoxicillin

Ampicillin

Ampicillin is the prototypical amino penicillin, that has amino group. It is available in three different forms: 1. Anhydrous 2. Trihydrate 3. Sodium Anhydrous and trihydrate Ampicillin are administered orally.

Continue Ampicillin sodium is given parenterally. Available 250mg, 500mg capsules, 250mg/5ml suspension, 125, 250, 500, 1000, 2000, 10,000mg vial for injection. Adult dosage is PO: 250mg- 500mg Qid, IM/IV: 250mg- 500mg Qid.

Penicillinase Resistant Penicillin's These congeners have side chains that protect the beta-lactam ring from attack by staphylococcal penicillinase. However this also partially protects the bacteria from the beta lactam ring. Their only indication is infectious caused by penicillinase producing staphylococci, for which they are the drugs of choice except in areas where methicillin resistant staph aureus (MRSA) has become prevalent.

Methicillin It is highly penicillinase resistant but not acid resistant, must injected. it is also an inducer of penicillinase production. The MRSA have altered PBPs which donot bind penicillins. The drug of choice for these organisms is vancomycin/linezolid, but ciprofloxacin can also be used. Haematuria, albuminuria, and nephritis are the side effects of methicillin.

Cloxacillin It has an isoxazolyl side chain and is highly penicillinase as well as acid resistant. It is more active than methicillin against penicillinase producing staph. Cloxacillin is incompatibly but dependably absorbed from oral route, especially if taken in empty stomach. Plasma half life is about 1 hour. Elimination occurs primarily by kidney, also partly by liver. It is available 0.25g, 0.5g cap and injections.

PROCAINE PENICILLIN ALLERGIC REACTION ID/CC: A 21 year old male comes to the health clinic because of the development of fever, marked itching all over his body, generalized rash with joint swelling and difficulty breathing. HPI: he just returned from a trip abroad, where he had developed a purulent urethral discharge and went to a local doctor who gave him two pills of procaine penicillin. PE: mild hypotension, mild cyanosis and difficulty breathing. Imaging: CXR is normal

Continue Treatment: Subcutaneous epinephrine, oxygen, hydrocortisone, antihistamines. Maintain airway and provide assisted ventilation if necessary. Severe reactions may result in laryngeal obstruction, hypotension and death.

Continue Discussion: Penicillins are antimicrobial drugs that block cell wall synthesis by inhibiting peptidoglycan cross linking; they are bactericidal for gram positive cocci and rods, gram negative cocci. Most adverse reactions to penicillin are allergic reactions that result when one of it is metabolites acts as hapten. Anaphlytic reaction involves antigen reacting with IgE on presensitized mast cells and basophils, it is usually severe and immediate.

METHICILLIN RESISTANCE STAPHYLOCOCCUS AUREUS (MRSA) ID/CC: A 25 year old male presents with spiking fevers, malaise, left sided chest pain and cough. HPI: His symptoms started two weeks ago and have progressively worsened despite a full course of oral antibiotics. He also reports a history of prior IV drug abuse. PE:VS: Fever (39 centigrade), tachycardia (HR 105), tachypnea. PE: amphoric, breath sounds heard over left lower lobe; S1 & S2 normally heard without murmurs, gallops or rubs. Labs: induced sputum cultures grew methicillin resistant staphylococcus aureu. Imaging: XR, chest: 2 by 3cm cavity in left lower lobe of lung with air fluid level. CT, chest: confirmed a left lower lobe lung abscess.

Continue Treatment: Intravenous Vancomycin therapy, add aminoglycoside for synergistic bactericidal effect. Discussion: Antibiotic resistant is continuing to increase in both the hospital and the community. Major resistant nosocomial organisms include s.aureus, klebsiella, and pseudomonas. MRSA is becoming widespread in a number of communities and is more commonly seen in IV drug abusers, patients with recent hospitalizations.

Cephalosporin's The cephalosporin's are semi-synthetic antibiotic derivatives of cephaloporin C. These chemically altered derivatives of this fungus are broadly referred to as cephalosporin's and they are structurally and pharmacologically related to the penicillin's. Cephalosporin's have a broad spectrum of bacteria.

Continue The safety profiles, contraindications and pregnancy ratings of cephalosporin's are very similar to those of penicillin's. Because of cephalosporin's are chemically very similar to penicillin's, a person who has had an allergic reaction to penicillin's have also allergic reaction in cephalosporin's, this is referred to as cross sensitivity.

Continue Cephalosporin's of all generations are very safe agents that are categorized as pregnancy category B agents. They are contraindicated: 1. Hypersensitivity 2. Younger than 1 month old

Classification of Drugs Cephalosporin's can be classified into: 1. First generation 2. Second generation 3. Third generation 4. Fourth generation

First Generation Drugs 1. Cefazolin sodium 2. Cephalothin 3. Cephalexin 4. Cephradine 5. Cephapirin

Continue First generation are usually active against gram positive bacteria and have limited activity against gram negative bacteria. They are available both parenteral and oral.

Cefazolin sodium First generation of cephalosporin Excellent coverage against gram positive and poor coverage of gram negative. Only available in parenteral formulation that comes 500- 1000mg vials for IM or IV injection. Adult dosage is IM/IV: 250mg-1g q8h-q12h.

Second Generation Drugs 1. Cefamandole 2. Cefoxitin 3. Cefuroxime 4. Cefonicid 5. Ceforanide 6. Cefmetazole 7. Cefaclor 8. Cefprozil

Continue The second generation cephalosporin's have similar coverage against gram positive organisms but enhanced gram negative bacteria. They include both parenteral and oral formulations. The second generation cephalosporin's are also excellent prophylactic antibiotics.

Continue The qualities that make them excellent prophylactic agents are: 1. Safety profile 2. Broad range of organisms they can kill 3. Relatively low cost

Cefoxitin It is a parenteral second generation cephalosporin. Cefoxitin has been used extensively as a prophylactic antibiotic in patients undergoing such surgical procedures especially in abdominal and colorectal operations. It is rated pregnancy category B. Available only in parenteral formulations 1,2, 10g vials for injection

Third Generation Drugs 1. Cefoperazone 2. Cefotaxime 3. Ceftizoxime 4. Ceftriaxone 5. Ceftazidime 6. Cefixime

Continue Third generation cephalosporin's are the most potent in fighting gram negative bacteria.

Ceftriaxone Ceftriaxone is a parenterally administered third generation cephalosporin that differs from the other agents in that it has a very long half life that allows it to be given once a day. It can be given both intravenously and intramuscularly. It can easily pass meningitis and BBB, making it an excellent agent for the treatment of CNS infection.

Continue Available 250, 500mg, 1, 2, 10 gram vials. Adult dosage is: IM/IV 1-4 g/day as a single dose or divided doses.

Tetracycline's The tetracycline's are small chemically related group of five antibiotics, three of which are naturally occurring and two of which are semi-synthetic. They are derivatives of streptomyces organisms. Tetracycline's can only inhibit the growth of bacteria, they cannot kill bacteria, therefore they are considered bacteriostatic.

Chemistry of Tetracycline

Continue The three naturally occurring tetracycline's are: 1. Tetracycline 2. Demeclocycline 3. Oxytetracycline The two semi-synthetic tetracycline's are: 1. Doxycycline 2. Minocycline

Mechanism of action Tetracycline's work by inhibiting protein synthesis 30S in susceptible bacteria.

Therapeutic uses Chlamydia Syphilis Lyme Rickettisiae Protozoa Acne Cholera Shigellosis Mycoplasma pneumonia

Side-effects Discoloration of teeth Tooth enamel hypoplasia Retard fetal skeletal development Photosensitivity Alteration of the intestinal flora Diarrhea Gastric upset Reduced bacterial vitamin K synthesis

Doxycycline Doxycycline is a semi synthetic tetracycline antibiotic. Doxycycline comes in the following three different salt forms: 1. Calcium 2. Hyclate 3. Monohydrate

Continue It is useful in the treatment of rickettsial infections, gonorrhea and many gram negative infections. It comes orally as a 25 and 50mg/5ml oral suspension, 50, 100mg capsules and 100, 200mg per ml injections. It is rated in a pregnancy category D drug.

TETRACYCLINE RASH ID/CC: A 19 year old red haired female visits her dermatologist at a local clinic because of a rash that appeared after she spent the sunny weekend hiking without sun block protection. HPI: Two months ago, her dermatologist put her on the low dose tetracycline to prevent acne. PE: Normal Labs: Mild proteinuria

Continue Treatment: Sun protection, both mechanical and pharmacological, while taking tetracycline. Discussion: Tetracyclines are bacteriostatic antibiotics that bind to 30s ribosomal subunit, blocking synthesis of protein. If they are taken with alkaline foods such as milk and antacids, GI absorption is decreased. Tetracyclines are used therapeutically and prophylactically for chylamdial infections, lyme disease, acne and cholera.

Aminogylcosides Aminoglycosides are group of natural and semi-synthetic antibiotics that destroy bacteria, rather than inhibit their growth, so they are bactericidal. They are derived from streptomyces organisms. They are not given orally because of their poor oral absorption.

Continue They can kill both gram positive and gram negative bacteria but are customarily used to kill gram negative such as, pseudomonas, E. coli and klebsiella. The aminogylcosides work in a way that is similar to that of tetracycline's in that they also bind to ribosomes and thereby prevent protein synthesis in bacteria.

Continue The aminogylcosides have been shown to cross the placenta and cause fetal harm when administered to pregnant women. The pregnancies categories of the various aminogylcosides are as follows: 1. Gentamycin, neomycin: pregnancy category C 2. Tobramycin,Amikicin,kanamycin:pregnancy D 3. Streptomycin: pregnancy category B

Drugs Gentamycin Tobramycin Amikacin Kanamycin Neomycin Streptomycin

Mechanism of action Aminoglycosides kill bacteria by binding and disrupting protein synthesis in bacteria specifically they do this by binding to both 30s and 50s ribosomal subunit.

Side-effects Renal failure Hearing loss (Ototoxicity) Nausea Vomiting Proteinuria Increase serum creatinine level

Gentamycin Gentamycin is a naturally occurring aminoglycoside that is obtained from cultures of micromonospora purpurae. It is one of the Aminoglycosides most commonly used in clinical practice today. It is classified pregnancy category C. Available 10, 40mg/ml injection IM/IV, 10, 60, 80 mg per ml intravenous infusion.

Continue Available 3% solution or ointment for ophthalmic. Comes also 0.1% ointment for topical application on: 1. Superficial skin infection 2. Burns 3. Skin ulcers

GENTAMICIN SIDE EFFECTS ID/CC: A 34 year old women presents with her family practitioner complaining of hearing loss, vertigo and inability to walk properly due to lack of balance. HPI: she took IV Gentamicin for 10 days PE: Well hydrated, oriented and cooperative Imaging: normal

Continue Treatment: Discontinuation of the drug, supportive therapy. Discussion: Gentamicin is an aminoglycoside and thus shares the Ototoxicity and Nephrotoxicty of streptomycin, kanamycin, Amikacin, and tobramycin. Ototoxicity is mainly cochlear and marked by ataxia and vertigo. Nephrotoxicity is minimized if care is taken to hydrate the patient and keep serum levels therapeutic.

Quinolones The quinoline antibiotics are very potent broad spectrum antibiotics. They are bactericidal The first of these agents to come available were: 1. Cinoxacin 2. Nalidixic acid

Continue The newer quinoline antibiotics include: 1. Norfloxacin 2. Ciprofloxacin 3. Enoxacin 4. Ofloxacin 5. Lomefloxacin 6. Perfloxacin

Continue A fluorine atom was added on to the basic quinolone structure to create these newer agents and increased their anti-bacterial activity. Because of chemical, these agents are sometimes called fluoroquinolones.

Continue The fluoroquinolones are active against a wide variety of gram negative and selected gram positive bacteria. Fluoroquinolones are primarily excreted by the kidneys, which contain a high percentage of unchanged drug, this makes them good for treating of UTI.

Continue Their use in children is not currently recommended because they have been shown to suppress growth in laboratory animals.

Mechanism of action Quinolone antibiotics destroy bacteria by altering DNA and they accomplish this by interfering with DNA gyrase, enzyme necessary for the synthesis of bacterial DNA, if bacteria cannot produce DNA they die.

Side-effects Dizziness Insomnia Fatigue Nausea Rash Fever Blurred vision

Ciprofloxacin Ciprofloxacin was one of the first potent fluoroquinolones to come available. First marketed in an oral form and advantage of convenience of oral preparation plus excellent bioavailability. Effective against to kill gram negative bacteria. Orally comes 250, 500, 750mg tablet, parenterally comes 200, 400mg. The common dosage is 250mg-750mg Tid, Bid.

FLUOROQUINOLONE SIDE EFFECTS ID/CC: A 21 year old college baseball player restarted his training 3 days ago, running 1600 meters a day in preparation for the upcoming state tournament, yesterday he hit a home run and started off to first base when he suddenly fell to the ground and couldnt work due to acute pain. HPI: He had spent 4 weeks in the hospital recovering from perforated appendicitis where he received IV ciprofloxacin for 2 weeks due to surgical wound infection with pseudomonas aeruoginosa that was resistant to all other antibiotics.

Continue PE: Surgical wound completely healed with no evidence of infection or postincisional hernia; penrose drain orifice within normal limits; inability to plantarflex left foot; Achilles tendon completely severed. Labs: CBC: no leukocytosis; no anemia. SMA-7 normal. UA: normal. Imaging: CXR/KUB: within normal limits. Micro Pathology: Achilles tendon shows inflammatory neutrophilic infiltrate with areas of heamorrhage and necrosis.

Continue Treatment: Surgical repair. Discussion: Fluoroquinolones such as ciprofloxacin and Norfloxacin are bactericidal antibiotics that are active against gram negative rods, including pseudomonas; they are also active against Neisseria and some gram positive organisms. They act by binding DNA gyrase. Side-effects include damage to cartilage, tendonitis, and tendon rupture; they also produce gastric upset and nausea and may cause super infection.

Macrolides The Macrolides are a large group of antibiotics that first came available in the early 1950s with the introduction of erythromycin. Macrolides have a macrocyclic lactone. Macrolides are considered bacteriostatic but in high concentration may be bactericidal in some susceptible bacteria. Macrolides are POM drugs. Macrolides are rated pregnancy category C.

Drugs Azithromycin Clarithromycin Erythromycin Troleandomycin Roxithromycin

Erythromycin

Clarithromycin

Azithromycin

Mechanism of action They bind 50s ribosomal subunit inside the cells of bacteria and by doing so prevent the production of the bacterial protein needed for bacteria to grow, with the result that bacteria eventually will die.

Antibacterial spectrum It is narrow, includes mostly gram positive and a few gram negative bacteria. It is highly active in the following bacteria's: 1. str. pyogenes 2. Str. Pneumoniae 3. N. gonorrhoeae 4. Clostridia 5. C. dipthteriae

Uses 1. As an alternative to penicillin: streptococcal pharyngitis, tonsillitis, community acquired respiratory infections caused by pneumococci and H. influenzae, however many bacteria resistant to penicillin are also resistant to erythromycin. 2. Diphtheria: erythromycin 250mg Qid, acute stage as well as for carriers 7 day treatment, antitoxin is the primary treatment.

Continue 3. Tetanus: erythromycin 500mg is given Qid for 10 days to eradicate clostridium tetani. 4. Syphilis and gonorrhea 5. Atypical pneumonia caused by mycoplasma pneumoniae 6. Whooping cough: 1 to 2 week course of erythromycin is the most effective treatment for eradicating Pertussis from upper respiratory tract.

Continue 7. Chlamydia trachomatis infection of urogenital tract: erythromycin 500mg QID for 7. 8. Penicillin resistant staphylococcal infections 9. Helicobacter pylori infection: Clarithromycin 500mg in combination in Omeprazole 20mg, and amoxicillin 1g each administered twice a day for 10 to 14 days, is effective for the treatment of peptic ulcer disease. 10. Mycobacterial infection: Azithromycin or Clarithromycin are recommended for the first line of prophylaxis and treatment of pulmonary disease. E.g AIDS.

Side-effects Headache Dizziness Palpitation Heart burn Nausea Anorexia Vomiting Rash Hearing loss

Drug-Drug Interactions Clarithromycin and erythromycin inhibit CYP3A4. erythromycin potentiates the effects of Carbamazepine, corticosteroids, digoxin, Theophylline, Warfarin.

Erythromycin Most frequently prescribed macrolide antibiotic. It comes in several different salt and dosage forms that were developed to circumvent some of the drawbacks it has chemically. The absorption of oral erythromycin is enhanced if it is taken on an empty stomach, but because of the high incidence of stomach irritation, many of the agents are taken after meal or snack.

Continue Dosage range is: 1. children: 30-100mg/kg/day divided dose 2. Adult: 500mg as single dose or Bid

Miscellaneous Drugs Vancomycin Clindamycin Metronidazole Chloramphenicol

Vancomycin It is a natural bactericidal antibiotic structurally unrelated to any other commercially available antibiotics. It is a glycopeptide antibiotic discovered in 1956. It destroys bacteria by binding to the bacterial cell wall producing immediate inhibition of cell wall synthesis and death. It is the antibiotic of choice for the treatment of MRSA.

Vancomycin

Continue The parenteral form is indicated for the treatment of bone and joint infections and bacterial blood stream infections caused by staphylococcus spp. Classified pregnancy category B. Caution use: 1. Renal dysfunction 2. Hearing loss 3. Elderly patients

Continue Contraindicated for hypersensitivity Available 125, 250mg capsules and 500mg, 1g for intravenous infusions. Adult dosage is 0.5-2g per day in Tid for 7-10 days.

Mechanism of action Vancomycin inhibits the cell wall synthesis by binding with high affinity, D-alanyl D-alanine. Vancomycin is a bactericidal.

Toxicity Systemic toxicity of Vancomycin is high. It can cause plasma concentration dependant nerve deafness which may be permanent. Kidney damage is also dose related. Skin allergy and fall of blood pressure during IV injection. Rapid IV injection has caused chills, fever and intense flushing-Red man syndrome (an adverse anaphlytical reaction to Vancomycin therapy causing pruritis, flushing of the head and the upper part of the body, the condition is caused by the release of histamine).

Uses MRSA Bacterial meningitis combination therapy with Ceftriaxone or Cefotaxime. Used for dialysis patients Those undergoing chemotherapy for cancer patients. Penicillin allergic patients

Chloramphenicol Chloramphenicol was initially obtained from streptomyces venezuelae in 1947. It was soon synthesized chemically and the commercial product now is all synthetic. It has a nitrobenzene substitution, which is probably responsible for the antibacterial activity and it is intensely bitter taste.

Chloramphenicol

Mechanism of action Chloramphenicol inhibits bacterial protein synthesis by interfering with transfer of the elongating peptide. It specifically attaches 50S ribosome.

Pharmacokinetics Chloramphenicol is rapidly and completely absorbed after oral ingestion. Chloramphenicol is primarily conjugated with glucuronic acid in the liver and little is excreted unchanged in urine. Plasma half life of chloramphenicol is 3-5 hours in adults. It is increased only marginally in renal failure.

Therapeutic Uses Enteric fever- Typhoid Pyogenic meningitis: Chloramphenicol 50-75mg/kg per day may be used after the third generation of cephalosporin's. Anaerobic infections: Wound infections, pelvic and brain infections. Intraocular infections: Chloramphenicol is given systemically.

Adverse Effects Bone marrow depression Hypersensitivity reactions like, fever, rashes, glossitis, Nausea Vomiting Diarrhea Pain on injection Gray baby syndrome: the baby stop feeding, vomited, hypothermic, abdomen distended, respiration become irregular and gray cyanosis occur.

CHLORAMPHENICOL SIDE EFFECTS ID/CC: A 31 year old truck driver visits a health clinic in Buroa Togdheer region, complaining of recurrent infections, excessive bleeding, weakness and anemia. HPI: He travels the border of Ethiopia daily and eats and sleeps there. He has had a typhoid fever three times over the past five years, for which he has been treated with high dose of chloramphenicol. PE: Normal Labs: Anemia

Continue Treatment: Blood transfusions, cyclosporin for bone marrow transplantation. Discussion: Chloramphenicol is a bacteriostatic antibiotic that acts by inhibiting peptidyl transferase in the 50s ribosomal unit. It is active against anaerobes and riclettsiae as well as against typhoid fever and meningococcal. In infants they produce gray baby syndrome. Owing to its potentially fatal side-effect of Aplastic anemia, chloramphenicol is used primarily for serious infections or acute salmonella typhi infection.

antibiotics. introduction contents 1. sulfonamides 2. penicillin's 3. cephalosporin's 4. macrolides...

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chemistry slide

sulfapyridine slide

bactericidal slide

miscellaneous drugs

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