抗生素英文课件精品Antimicrobial _2.pptVIP

When to use carbapenems? Life threatening polymicrobial infections Intra abdominal sepsis in ICU esp nosocomial in origin Gram negative/ nosocomial pneumonia in intubated patient Monotherapy of febrile neutropenia (high risk patients) What are the beta-lactamase inhibitors? Clavulanate (with amoxicillin or ticarcillin) Tazobactam (with piperacillin) What additional bugs do they cover? S. aureus H. influenzae Neisseria sp. Bacteroides fragilis E. coli and Klebsiella Not better for Pseudomonas or Enterobacter Inhibitors of protein synthesis Ribosomes are the site of protein synthesis many classes of antibiotics inhibit protein synthesis by binding to the ribosome binding may be reversible or irreversible Macrolides, ketolides, lincosamides, streptograminsTetracyclinesAminoglycosides Inhibitors of protein synthesis Macrolides (erythromycin, clarithromycin, azithromycin) - primarily gram positive, mycoplasma, chlamydia - bacteriostatic, time dependent killing Lincosamides (clindamycin) - gram positive, anaerobic activity Resistance (acquisition of a gene) - M phenotype: macrolides only efflux - MLSB phenotype: macrolides, lincosamides, streptogramins target site modification constitutive, inducible Inhibitors of protein synthesis Aminoglycosides: gentamicin, tobramycin, amikacin - excellent gram negative, moderate gram positive - bactericidal, concentration dependent ResistancePrimarily due to aminoglycoside modifying enzymes Inhibitors of nucleic acid synthesis Fluoroquinolones (ciprofloxacin, norfloxacin, levofloxacin, moxifloxacin)- bactericidal, concentration dependent- bind to 2 essential enzymes required for DNA replication- DNA gyrase and topoisomerase IV- gram pos and gram neg- atypical bacteria, some have anaerobic activity Resistance - altered permeability (porin channels) - altered target site - efflux Inhibitors of metabolic pathways Trimethopri