State the ideal features of an antimicrobial agent?
- Selectively Toxic (onlt targets that bacteria)
- Long Half Life (infrequent dosing improves compliance)
- No interference with other drugs
- Few adverse effects
- Reach site of infection (ef penetration of CSF)
- Oral/IV formulation
How do B-lactams act as an antibacterial agent?
- Bind to penecillin binding protein and prevent cross-linking of peptidoglycan cell wall
- Bacterium looses structural integrity and dies
How do glycopeptides act as an antibacterial agent?
- Competitively block cell wall linking enzymes and prevent cross linking of peptidoglycan cell wall
- Bacterium looses structural integrity
Name a beta-lactam
-Penicillin
Name a glycopeptide
-Vancomycin
How do quinolones exert their action?
- Inhibition of nucleic acid synthesis and repair
- Bind to enzymes involved in DNA replication (such as topoisomerase) and inhibit it.
- Without DNA replication the cell will die
What are the 4 classes of antimicrobial agents?
- Antibacterial
- Antiviral
- Anti fungal
- Antiprotozoal
Name a quinolone
- Fluoroquinolone
- Trimethaprim
- Rifampicin
What are the 3 main mechanisms of resistance?
- Drug inactivating enzymes eg b-lactamases
- Altered Target site eg target enzyme has lower affinity for drug
- Altered uptake eg decreased permeability or increased efflux
What are the two genetic basis of antibiotic resistance?
- Horizontal gene transfer
- Chromosomal gene mutation
What are the three mechanisms of horizontal gene transfer?
- Conjugation
- Transduction by phages
- Transformation (introduction, uptake and expression of free foreign DNA)
How can antibiotic sensitivity be measured in a laboratory?
- Antibiotic disc sensitivity
- Minimum inhibitory concentration
What are the four groups of B-lactams?
- Penicillins
- Cephalosporins
- Carbapenems
- Monobactams
Why is flucloxacillin used in staph infections?
-Staph often have b-lactamases which flucloxacillin can resist
What is the most common cephalosporin?
-Ceftriaxone
What is penicillin mainly active against?
-Streptococci
Why is amoxicillin more broad spectrum than penicillin?
-Also active against some gram negative bacteria as well as gram pos
Why is there reason for concern with ceftriaxone?
-Associated with C.difficile infections
Can you give carbapenem to a penicillin-allergic patient?
- Get history of reaction of penicillin allergy
- Generally safe to give unless anaphylactic
What is the target bacteria for vancomycin?
-Active against most gram positive eg staph and strep (not gram neg)
How must vancomycin be administered?
- It is not absorbed so given in IV (oral for C.diff)
Why must you be careful when using vancomycin?
-It has a very narrow therapeutic window
Which antimicrobials act by inhibiting protein synthesis?
- Tetracyclines eg doxycycline
- aminoglycosides eg gentamycin
- macrolides eg erythromycin
What is the target bacteria for tetracyclines?
- Broad spectrum ie both gram pos and gram neg
- Also used in atypical pneumonia, chlamydia and some protozoa
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Week 1 - Overview23
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Antimicrobials43
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Week 2 - Infection model9
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Week 3 - Acute sepsis in the ED20
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Week 3 - Innate immunity17
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Week 4 - Healthcare infections27
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Week 4 - Adaptive immunity38
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Week 5 - Travel related infections53
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Week 6 - Blood Borne Viruses34
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Week 6 - Case studies15
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Week 7 -> infections on a surface28
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Week 7 - Allergy16
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Week 8 - Infection prevention and microbial stewardship26
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Week 9 - Chronic disease and infections12
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Week 10 - Immunocomprimised host27
