第三十七章章内酰胺类抗生素和其他作用于细胞壁抗生素.pptVIP

* * * * * * * 含有甲基四氮唑侧链结构的头孢菌素可干扰维生素K在体内的循环，增加出血倾向。所有的广谱头孢菌素均可因抑制肠道细菌而使维生素K的合成减少而影响凝血功能。 * * * * * * * * PBP-3对细菌细胞中隔形成和细菌分裂有重要作用 * * English: Diagram depicting the action of the antibiotic vancomycin and one way bacteria have evolved resistance to it. Background: The bacterial cell wall consists of strands of repeating N-acetylglucosamine (NAG) and N-acetylmuramic acid (NAM) subunits. The NAM subunits have short peptide chains attached to them. (The exact composition of these can vary. The proximal alanine is usually L-ala and the distal two are usually D-ala.) These peptide chains are involved in forming cross-links between the strands of the cell wall. These cross-links are essential to a functioning cell wall. 1. Vancomycin is added to the bacterial environment while it is trying to synthesize new cell wall. Here, the cell wall strands have been synthesized, but not yet cross-linked. 2. Vancomycin recognizes and binds to the two D-ala residues on the end of the peptide chains. However, in resistant bacteria, the last D-ala residue has been replaced by a D-lactate, so vancomycin cannot bind. 3. In resistant bacteria, cross-links are successfully formed. However, in the non-resistant bacteria, the vancomycin bound to the peptide chains prevents them from interacting properly with the cell wall cross-linking enzyme. 4. In the resistant bacteria, stable cross links are formed. In the sensitive bacteria, cross-links cannot be formed and the cell wall falls apart * sepsis 英 [?seps?s] 美 [seps?s] n. 脓毒病; 脓毒疾 * * Furosemide Gentamicin ototoxicity 英 [??t??t?ks?s?t?] 美 [o?to?t?ks?s?t?] [释义] 耳毒性 phlebitis 英 [fl??ba?t?s] 美 [fl?ba?t?s] n. 静脉炎 * 4. ?－内酰胺酶抑制剂 N O OH H OH O H O 克拉维酸 (棒酸, clavulanic acid) 广谱?-lactamase 抑制剂，抗菌谱广, 活性低； 复方制剂: 奥格门汀(augmentin): 克拉维酸+阿莫西林 泰门汀(timentin): 克拉维酸+替卡西林 * 舒巴坦(青霉烷砜,sulbactam) 特点: 对金葡菌、G-杆菌产生的 ?-lactamases有强而不可逆的抑制作用。 与其它 ?-lactams合用可增强抗菌作用、扩大抗菌谱，使耐药菌变得敏感。 复方： 舒巴酮（sulperazone) :舒巴坦+头孢哌酮 优立新（unasyn): 舒巴坦+氨苄西林 第五节 万古霉素 * Vancomycin Active