Antimicrobial medicines

Principles of chemotherapy Antibiotics

Disinfection
is the process that reduces the number of potential pathogens on a material until they no longer represent a hazard.

Asepsis
asepsis refers to any practice that prevents the entry of infectious agents onto sterile tissues and thus prevent infection

Antisepsis
is the complex of procedures of growth inhibition and reproduction potential pathogenic microorganisms on skin of mucous membrane

Categories antimicrobial agents based on their appsication

Term Disinfectant Description
Agent that kills microorganisms on inanimate objects

Examples
Hypochlorite, formaldehyde

Antiseptic
Sanitizer Preservative Antibiotic

Agent that kills of prevents the growth of Soap, hydrogen microorganisms on lining tissues peroxide, iodine, ethanol
A disinfectant that is used to reduce numbers of bacteria to levels judged safe by public health officials Agents that prevents microbial growth: often added to products such as foods and cosmetics to prevent microbial growth Ethanol

Lactic acid, benzoic acid, sodium chloride

Agent produced by microorganisms that Penicillin, tetracycline inhibits or kills other microorganisms

The action of antimicrobial agents

Term
Bactericide Biocide Fungicide

Action
Agent that kills bacteria Agent that kills living organisms Agent that kills fungi

Examples
Chlorhexidine, ethanol Hypochlorite Ethanol

Chemical agent that Germicide (microbicide) specifically kills pathogenic

microorganisms

Formaldehyde, silver, mercury

Glutaraldehyde Cationic detergents

Sporicide Virucide

Agent that kills bacterial endospores Inactivates viruses so that they lose the ability to replicate

Antimicrobial agents
Disinfectants Can kill or inhibit growth and and antiseptics development majority of microorganisms in space around patient, and microorganisms that are on human body surface Chemotherape Can kill or inhibit reproduction of utic medicines agents of disease in the patient organism. Have selective influence upon microorganisms.

Classification of disinfectants based on their mode of action

Mode of action Type of disinfectant

Coagulate proteins

Oxidize proteins

Destroys cell membrane

Formaldehyde, glutaraldehyde, alcohols, dyes, mercurials, acids Halogens: iodine, iodophors, chlorine, chlorine compoynds Phenolics, quaternary ammonium compounds (surface-active agents)

Chemotherapy
is a method of therapy of infectious disease and cancer with chemical agents chemotherapeutic medicines

Chemotherapeutic index
Maximal tolerated dose
Minimal curative dose

> 3

Maximal tolerated dose is the most quantity of

drug that not cause harmful effect in a patient.

Minimal curative dose is the least dose of drug

that kill of inhibit reproduction of microorganisms

Paul Ehrlichs principles of chemotherapy

Receptor interaction of drug and microorganism Changing of chemical structure of drug causes change of its activity Changing of drug structure can occur in microorganisms cell, therapeutic effect can slacken or intensify during it Microbes can develop drug resistance to medicine The drug can be used only if its chemotherapeutic index is not less three.

Community interactions

Mutualism

Commensalism

Parasitism

Antagonism (competition)
Synergism Predation

Antagonism (ammensalism)
Antagonism is a form interaction between organisms when one microorganisms inhibits development of others

Mechanisms of antagonism:
Competition for nutrient substrate (different spread of growth) Excretion of acids, alcohols, ammonia by microorganismsantagonist Excretion antibiotics, bacteriocines by microorganismsantagonist Predation

Antibiotic
Chemotherapeutic preparation produced by living organisms or their synthetic analogs that can selectively inhibit disease agents or inhibit growth tumor cells in patient organism

Characteristics of successful antimicrobial drugs

Great activity against microbes Selectively toxic to the microbe but nontoxic to host cells Microbicidal rather than mocrobistatic Relatively soluble and functions even when highly diluted in body fluids Remains potent long enough to act and is not broken down or excreted prematurely Not subject to the debelopment of antimicrobial resistance Complements or assists the activities of the hosts defenses Remains active despite the presence of large volumes of organic materials It is readily delivered to the site of infection Does not disrupt the hosts health by causing allergies or predisposing the host to other infections

Classification based on type of antibiotic action

Microbistatic (bacteriostatic, fungistatic) agents prevent the growth of microorganisms (bacteria, fungi) Microbicidal agent (bactericide, virucide, fungicide) kills microorganisms (bacteria, viruses, fungi)

Categories based on group of organisms that produce of antibiotics

Producers Bacteria
Fungi

Antibiotics Polmyxyn
Penicillin, cephalosporin

Actinomycetes
Plants Animals

Streptomycin, tetracycline Imanin, salvin,

Lysocim

Classification of antibiotics based on spectrum of action

Narrow-spectrum agents are effective
against a limited array of different microbial types (examples: bacitracin inhibit certain grampositive bacteria)

Broad-spectrum agents are active

against a wider range of different microbes

(example tetracycline that affect upon grampositive and gram-negative bacteria, rickettsias, mycoplasmas)

Primary sites of action of antimicrobic drugs

Modes of action of antimicrobial medicines

Mechanism of action
Inhibition of cell wall synthesis Inhibition of protein synthesis

Drugs
Penicilins, cephalosporins Chloramphenicol, erythromycin Sulfonamides, trimethoprim Quinolones Rifampin Polymyxin Amphotericin B, nystatin

Inhibition of nucleic acid synthesis

Inhibition of nucleotide synthesis Inhibition of DNA synthesis Inhibition of RNA synthesis

Alteration of cell membrane function

Antibacterial activity Antifungal activity

Types of cell wall synthesis inhibition

Inhibit polymerization of peptidoglican
Penicillins Cephalosporins Carbapenems Monobactams

Inhibit the synthesis of dipeptide

Cycloserine

Inhibit transport of murein components to the assembly place

Bacitracin

Block the formation of precursors subunit (muramic acid, pentapeptide, and slucosamine)
Vancomycin

Inhibition of cell wall synthesis

Mode of action of antibiotics that inhibit protein synthesis

Mode of action of antibiotics that inhibit protein synthesis

Riboso- Mode of action mal subunit
30 S Blocks functioning of initiation complex and causes misreading of mRNA Blocks tRNA binding to ribosome Blocks peptidyltransferase Blocks translocation Blocks peptide bond formation

Type of action
Bactericidal

Example

Aminoglycosides

30 S 50 S 50 S 50 S

Bacteriostatic Tetracyclines Both Chloramphenicol

Primarily Erythrobacteriostatic mycin Primarily Clindamibacteriostatic cin

Alteration of cell membrane function

Polymyxin

Membrane

Cytoplasm
The detergent action of polymyxin

Microbial resistance to drugs

is a possibility of microorganisms to grow in presence of antibiotic

Specific mechanisms of drug resistance

Synthesis of enzymes that inactivate the drug (a) Decrease in cell permeability and uptake of the drug Change in the number or affinity of the drug receptor sites Modification of an essential metabolic pathway (b)

Types of drug resistance

Natural Acquired
Mutation Recombination Transferred with plasmids and transposons

Natural selection and drug resistance

Suppression and alteration of the normal microflora by antimicrobics

Method of testing for the drug susceptibility of microorganisms

Qualitative. Diffusion methods Quantitative. Method of serial dilutions

Diffusion test for investigation of susceptibility of microorganisms to antibiotics

Tube dilution test

Minimal inhibitory dose (MID) is a lowest concentration

of drug that inhibits the growth of the microorganisms.

Antiviral therapy
Virus
Cytomegalovirus

Medication
Ganciclovir, foscarnet

Hepatitis B or C
Herpes simplex Human immunodeficiency Influenza A Respiratory syncytial

-interferon
Acyclovir, foscarnet Dideoxyinosine, zidovudine Amantadine Ribavarin

Modes of action of antiviral medicines

Medicine
Amantadine -interferon Foscarnet Acyclovir, ribavarin, ganciclovir

Mode of action
Prevents assembly of the viral core protein Inhibits function of viral mRNA or degrades mRNA Inhibits reverse transcriptase by attaching to its phosphate receptors Inhibit viral DNA synthesis by reacting with DNA polymerases