Glycyclines-The Management Of Nosocomial Infections

By Priyanka G
K.V.S.R SCOPS

Nosocomial Infections
"nosus" = disease "komeion" = to take care of Infections that occur during hospitalization but are not present nor incubating upon hospital admission

Known Nosocomial Infections

Venticular associated pneumonia Hospital acquired pneumonia Gastroenteritis Tuberculosis Urinary tract infections * Commonly transmitted to * Personnel in hospitals with improper hygiene, * Hospitalised people & to * People with weak immune system.

 Most common bacteria that cause these infections are

MRSA (Methicilin resistant Staphylococcus aureus) Gram positive bacteria Helicobacter species ( Gram negative) Klebsiella pneumonia

In the era of increasing antimicrobial resistance There is a growing need for anti microbial agents & Drugs with novel mechanism of action.

Development Of Glycyclines
Glycyclines are a new class of antiiotics derived

from TETRACYCLINE.

Specially designed to overcome two common mechanisms of tetracycline resistance 1) Resistance mediated by acquired efflux pump
2) Ribosomal protection by binding to 30s subunit.

* Presently there is only one glycycline antibiotic for clinical use i.e TIGECYCLINE

Introduction of Tigecycline
Tigecycline: TygacilTM First member of glycylcyclines
9-t-butylglycylamido derivative of MINOCYCLINE

Resistant to the two common mechanism leading to bacterial resistance to tetracycline

In vitro antibacterial specturm of tigecycline[2,3,4]

Gram-positive

Staphylococcus aureus
Staphylococcus epidermidis Streptococccus spp.

Gram-negative

Citrobacter freundii
Citrobacter koseri Klebsiella oxytoca

Enterococcus faecalis

Klebsiella pneumoniae

Anaerobic

Atypical

Bacteroides spp.

Mycobacterium spp.
Chlamydia pneumoniae Chlamydia trachomatis

Clostridium perfringes
Clostridium difficile Peptostreptococcus

 They lack

activity against pseudomonas Proteus & Providencia species.

PSEUDOMONAS

Pharmacology of Tigecycline

Generally, bacteriostatic agent
Bacteriocidal agent for S. pneumoniae and H.

influenzae
Post-antibiotic effect: 3-4 hours for S. aureus; 2-3 hours for E. coli

Conc-dependent killing
AUC/MIC is the most important parameter
Breakpoint: 5 10 for gram-positive; 7 for

Eneterobacteriaceae & anaerobes (high tissue level should be considered)

Breakpoint: 12.5 for CSSI

Pharmacokinetics & clinical efficacy

Volume of distribution: 7.2 ~ 8.6 L/kg Primary route: Biliary excretion: 59%, Urinary excreation: 33% T1/2: 42.4 hours
Used to treat complicated skin infections Intra abdominal infections Bacteraemia Hospital acquired & ventilator associated pneumonia.

CELLULITIS
ONLY ADMINISTERED PARENTRALLY

Side effects & Precautions

1) Diarrhoea i.e wattery/bloody
2) Fast heart rate 3) Severe pain in upper stomach, headache, 4) Increased sweating
Inform your doctor if you are tetracycline allergic
Should not use for children <18 yrs & for pregnant

women
This drug may make sun sensitive So avoid sun

exposure
This drug may make you dizzy - So donot drive

Sterilization
Isolation

Handwashing and gloving

Surface sanitation

Antimicrobial surfaces

Aprons

Advanced Decontamination System

GLOSAIR

Eliminate potential sources for hospital acquired infections with the GLOSAIR 400 and 600. These full room decontamination systems use 5% hydrogen peroxide mist to kill pathogens in every nook and cranny of your OR. GLOSAIR eliminates bacteria and viruses on hard nonporous surfaces and can eliminate MRSA from hospital furniture and upholstered chairs1.

REFERENCES

Kasbekar N. Am J Health-System Pharmacy 2006

Schafer JJ, Goff DA. Expert Rev Anti Infect Ther 2008

Slover CM, Rodvold KA, Danziger LH. Annals Pharmacother 2007 Bhattacharya M, Parakh A, Narang M. J Postgrad Med 2009