第39章-抗菌药概论(黄仁彬).ppt

Chapter 39 抗菌药物概论 General Consideration of Antimicrobial agents ;Key concept (1);The mechanisms of action of antimicrobial agents include: (1) Inhibition of cell wall synthesis, (2)Inhibition or modification of protein synthesis, (3)Modification of synthesis or metabolism of nucleic acids,(4) Interference with folic acid metabolism, (5)Damage to the cell membrane 抗微生物药的作用机制: (1)抑制细菌细胞壁的合成,(2)抑制或影响蛋白质的合成,(3)影响核酸的合成与代谢,(4)干扰叶酸的代谢,(5)破坏细胞膜 ;The mechanisms of bacterial resistance include: production of enzymes, alteration of the target site for the drug, decreased uptake of the drug, or increased metabolism or inactivation of the drugs. 细菌的耐药机制有：产生灭活抗菌药物的酶、抗菌药物作用靶位的改变、减少药物的吸收、增加药物的代谢与灭活。;The principles which are important for the selection of the appropriate antibiotic, the use of antibiotics combinations and the indication for chemotherapeutic prophylaxis are discussed in this chapter. 本章主要讨论抗菌药物的适应证、抗菌药的联合应用、抗菌药物的预防应用。;Drug; 常用术语1.化学治疗(chemotherapy)：细菌和其它微生物,寄生虫以及癌的药物治疗2.抗菌药(antimicrobial drugs): 是一类能抑制或杀灭机体内病原微生物的药物(抗生素、人工合成抗菌药)3. 抑菌药(bacteriostatic drugs) : 仅能抑制微生物生长繁殖而无杀灭作用的药物4. 杀菌药(bactericidal drugs) : 能抑制和杀灭微生物的药物;5.抗菌谱（antibacterial spectrum）: 抗菌药物的抗菌范围。广谱抗菌药：对多种病原微生物有效的抗菌药窄谱抗菌药：仅对一种细菌或少数几种细菌有抗菌作用的抗菌药6.最低抑菌浓度（minimum inhibitory concentration, MIC）：能抑制培养基内细菌生长的最低浓度7.最低杀菌浓度（minimum bactericidal concentration, MBC）: 能够杀灭培养基内细菌最低浓度;8.化疗指数(chemotherapeutic index,CI,治疗指数)＝LD50 / ED50 9. 耐药性(抗药性, drug resistance): 细菌对药物的敏感性降甚至消失10. 抗生素后效应(post antibiotic effect，PAE): 指细菌与抗生素短暂接触，当抗生素浓度下降，低于MIC或消失后，细菌生长仍受到持续抑制的效应; Section 2 抗菌药作用机制 ;Staphylococcus;Bacteric structrue;Classifications of antibacterial agents and action mechanisms ; 抗菌药作用机制1. 抑制细胞壁粘肽的合成(inhibition of synthesis of cell wall): 青霉素,头孢菌素2. 影响细胞膜的通透性(interfered the permeability of the plasmamembrane): 多粘菌素, 制霉菌素, 两性霉素B3. 抑制蛋白质的合成(inhibition of protein synthesis ): 氨基甙类,四环素类, 大环内酯类 , 氯霉素, ;4. 抗叶酸代谢: 抑制FH2合成酶: 磺胺类; 抑制FH2还原酶: TMP5. 抑制核酸代