TJPRC: International Journal of Pharmacology and Physiology (TJPRC: IJPP) Vol. 1, Issue 1, Jun 2015, 1-16 © TJPRC Pvt. Ltd.
SURVEY ON ANTIBIOTICS AND BACTERIA RESISTANCE
NAGHAM MAHMOOD ALJAMALI 1, SAHER MAHMOOD JWAD 2 & ASEEL MAHMOOD JAWAD 3 1Associate Professor Chemistry Department, College of Education, Iraq 2Associate Professor Biology Department, College of Education, Iraq 3Research Scholar Student in Medicine, Medicine College, Iraq
ABSTRACT
Antibiotics are powerful medicines that fight bacterial infections . If used properly, antibiotics can save lives. They either kill bacteria or keep them from reproducing. An antibiotic acts on the bacteria causing the infection, but it also affects the "good" bacteria that we all have and need in our bodies (such as the bacteria in our gastrointestinal tract). That's why it's important to only use antibiotics when your doctor prescribes them for the treatment of a bacterial infection. Taking an antibiotic when you don't have a bacterial infection doesn't treat your illness and can set off a chain of events that can lead to the development of resistant bacteria. So it's vital that we use these drugs appropriately to help slow the rate at which bacteria develop resistance to antibiotics.
KEYWORDS: Develop, Explanation, Treat
INTRODUCTION
The first antibiotic was penicillin. Such penicillin-related antibiotics as ampicillin, amoxicillin and benzylpenicilllin are widely used today to treat a variety of infections - these antibiotics have been around for a long time.
There are several different types of modern antibiotics and they are only available with a doctor's prescription in most countries.
How to use Antibiotics
Antibiotics are usually taken by mouth (orally); however, they can also be administered by injection, or applied directly to the affected part of the body.
Most antibiotics start having an effect on an infection within a few hours. It is important to remember to complete the whole course of the medication to prevent the infection from coming back.
If you do not complete the course, there is a higher chance the bacteria may become resistant to future treatments - because the ones that survive when you did not complete the course have had some exposure to the antibiotic and may consequently have built up a resistance to it. Even if you are feeling better, you still need to complete the course.
Some antibiotics should not be consumed with certain foods and drinks. Others should not be taken with food in your stomach - these would normally be taken about an hour before meals, or two hours after. It is crucial that you follow the instructions correctly if you want the medication to be effective. If you are taking metronidazole do not consume alcohol.
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Antibiotics Fight Bacteria, Not Viruses
Antibiotics are meant to be used against bacterial infections. For example, they are used to treat strep throat, which is caused by streptococcal bacteria, and skin infections caused by staphylococcal bacteria.
Although antibiotics kill bacteria, they are not effective against viruses. Therefore, they will not be effective against viral infections such as colds, most coughs, many types of sore throat, and influenza (flu).
Using antibiotics against viral infections
• will not cure the infection
• will not keep other individuals from catching the virus
• will not help a person feel better
• may cause unnecessary, harmful side effects
• may contribute to the development of antibiotic-resistant bacteria
Patients and health care professionals alike can play an important role in combating antibiotic resistance. Patients should not demand antibiotics when a health care professional says the drugs are not needed. Health care professionals should prescribe antibiotics only for infections they believe to be caused by bacteria.
As a patient, your best approach is to ask your health care professional whether an antibiotic is likely to be effective for your condition. Also, ask what else you can do to relieve your symptoms.
Follow Directions for Proper Use
When you are prescribed an antibiotic to treat a bacterial infection, it's important to take the medication exactly as directed. Here are more tips to promote proper use of antibiotics.
• Complete the full course of the drug. It's important to take all of the medication, even if you are feeling better. If treatment stops too soon, the drug may not kill all the bacteria. You may become sick again, and the remaining bacteria may become resistant to the antibiotic that you've taken.
• Do not skip doses. Antibiotics are most effective when they are taken regularly.
• Do not save antibiotics. You might think that you can save an antibiotic for the next time you get sick, but an antibiotic is meant for your particular infection at the time. Never take leftover medicine. Taking the wrong medicine can delay getting the appropriate treatment and may allow your condition to worsen.
• Do not take antibiotics prescribed for someone else. These may not be appropriate for your illness, may delay correct treatment, and may allow your condition to worsen.
• Talk with your health care professional. Ask questions, especially if you are uncertain about when an antibiotic is appropriate or how to take it.
It's important that you let your health care professional know of any troublesome side effects.
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What FDA Is Doing
FDA combating antibiotic resistance through activities that include
• Labeling regulations addressing proper use of antibiotics. Antibiotic labeling contains required statements in several places advising health care professionals that these drugs should be used only to treat infections that are believed to be caused by bacteria. Labeling also encourages health care professionals to counsel patients about proper use.
• Partnering to promote public awareness. FDA is partnering with the Centers for Disease Control and Prevention (CDC) on "Get Smart: Know When Antibiotics Work," a campaign that offers Web pages, brochures, fact sheets, and other information sources aimed at helping the public learn about preventing antibiotic-resistant infections.
• Encouraging the development of new antibiotics. FDA is actively engaged in developing guidance for industry on the types of clinical studies that could be performed to evaluate how an antibacterial drug works for the treatment of different types of infections.
What Are the Side-Effects Of Antibiotics
Below is a list of the most common side-effects of antibiotics:
• Diarrhea researchers from Stanford University School of Medicine found that a rise in sugars in the gut following antibiotic treatment allows harmful bacteria to get a foothold and cause infection. Harmful bacteria thrive on sugar.
• Feeling and being sick.
• Fungal infections of the mouth, digestive tract and vagina.
• Below is a list of rare side-effects of antibiotics:
• Formation of kidney stones (when taking sulphonamides).
• Abnormal blood clotting (when taking some cephalosporins).
• Sensitivity to sun (when taking tetracyclines).
• Blood disorders (when taking trimethoprim).
• Deafness (when taking erythromycin and the aminoglycosides).
Some patients, especially elderly ones, may experience inflamed bowels (a type of colitis) which can lead to severe diarrhea. Clindamycin, an antibiotic used for the most serious infections, commonly has this side effect. However, although much less common, penicillins, cephalosporins and erythromycin might do too
Antibiotic resistance occurs when an antibiotic has lost its ability to effectively control or kill bacterial growth; in other words, the bacteria are "resistant" and continue to multiply in the presence of therapeutic levels of an antibiotic.
With the discovery of antimicrobials in the 1940s, scientists prophesied the defeat of infectious diseases that had plagued humankind throughout history. However, the remarkable healing power of antibiotics invites widespread and
www.tjprc.org [email protected] 4 Nagham Mahmood Aljamali , Saher Mahmood Jwad & Aseel Mahmood Jawad often inappropriate use. This misuse and overuse of antibiotics leads to antibiotic resistance among bacteria and consequent treatment complications and increased healthcare costs.
Antimicrobial resistance has cast a shadow over the medical miracles we take for granted, undermining every clinical and public health program designed to contain infectious diseases worldwide. Limited access to medical care and effective treatments, the common practice of self-medication, and the availability of counterfeit drugs have exacerbated drug resistance in the developing world. In affluent nations, infections acquired in settings such as hospitals and nursing homes are a major source of illness and death. In addition, community-acquired infections are emerging, both as independent epidemics and as primary sources of resistance in hospitals. If resistance to treatment continues to spread, our interconnected, high-tech world may find itself back in the dark ages of medicine, before today’s miracle drugs ever existed.
Howdobacteriabecomeresistant? Some bacteria are naturally resistant to certain types of antibiotics. However, bacteriamay also become resistant in two ways: 1) by a genetic mutation or 2) by acquiring resistance from another bacterium. Mutations, rare spontaneous changes of the bacteria's genetic material, are thought to occur in about one in one million to one in ten million cells. Different genetic mutations yield different types of resistance. Some mutations enable the bacteria to produce potent chemicals (enzymes) that inactivate antibiotics, while other mutations eliminate the cell target that the antibiotic attacks. Still others close up the entry ports that allow antibiotics into the cell, and others manufacture pumping mechanisms that export the antibiotic back outside so it never reaches its target.Bacteria can acquire antibiotic resistance genes from other bacteria in several ways. By undergoing a simple mating process called "conjugation," bacteria can transfer genetic material, including genes encoding resistance to antibiotics (found on plasmids and transposons) from one bacterium to another. Viruses are another mechanism for passing resistance traits between bacteria. The resistance traits from one bacterium are packaged into the head portion of the virus. The virus then injects the resistance traits into any new bacteria it attacks. Bacteria also have the ability to acquire naked, "free" DNA fromtheirenvironment[1-6]. Any bacteria that acquire resistance genes, whether by spontaneous mutation or genetic exchange with other bacteria, have the ability to resist one or more antibiotics. Because bacteria can collect multiple resist acnetraitsover.time,theycanbecomeresistanttomanydifferentfamiliessoantibiotics. Howdoesantibioticresistancespread ? Genetically, antibiotic resistance spreads through bacteria populations both "vertically," when new generations inherit antibiotic resistance genes, and "horizontally," when bacteria share or exchange sections of genetic material with other bacteria. Horizontal gene transfer can even occur between different bacterial species. Environmentally, antibiotic resistance spreads as bacteria themselves move from place to place; bacteria can travel via airplane, water and wind. People can pass the resistant bacteria to others; for example, by coughing or contact with un was hed hands Can bacteria lose their antibiotic resistance? Yes, antibiotic resistance traits can be lost, but this reverse process occurs more slowly. If the selective pressure that is applied by the presence of an antibiotic is removed, the bacterial population can potentially revert to a population of bacteria that responds to antibiotics. list of antibiotics sorted by target bacteria.
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Table 1
Antibiotics By Class Brand Possible Side Mechanism Of Generic Name Common Uses[2] Names Effects[2] Action
Amino Glycosides Amiki
Amikacin n Infections caused by Gram- Binding to the Garam negative bacteria, such bacterial 30S riboso Gentamicin mal subunit(some ycin as Escherichia coli and Klebsiellaparticularl work bybinding to Kantre the 50S subunit), Kanamycin y Pseudomonas aeruginosa.
x Effective against Aerobic inhibiting the Neo- bacteria (not Hearing loss translocation of the Vertigo peptidyl-tRNA Neomycin Fradin[ obligate/facultative 3 ] 3] anaerobes) and tularemia. Kidney from the A-site to All aminoglicocydes are damage the P-site and also Netro causing misreading Netilmicin ineffective to be taken
mycin orally. Intravenous, of mRNA, leaving the bacterium Tobramycin Nebcin intramuscular and topical unable to Humati should be applied.
Paromomycin synthesize proteins n vital to its growth.
Streptomycin Tuberculosis
Trobici
Spectinomycin(Bs) Gonorrhea n n
Ansamycins
Geldanamycin Experimental, as antitumor antibiotics Herbimycin
Xifaxa Traveler's diarrhea caused
Rifaximin n n by E. coli
Carbacephem prevents bacterial Lorabi cell division by
Loracarbef Discontinued
d inhibiting cell wall synthesis.
Carbapenems
Ertapenem Invanz Bactericidal for both Gram-positive Doriba
Doripenem and Gram-negative Gastrointestinal upset
x organisms and and diarrhea Primax therefore useful for Nausea Imipenem/Cilastatin Inhibition of cell in empiric broad- Seizures wall synthesis spectrum Headache antibacterial Rash and allergic Merre coverage. (Note reactions Meropenem m MRSA resistance to this class.) Cephalosporins (First generation) Durice Gastrointestina Same mode of Cefadroxil Good coverage against f l upset and action as Gram-positive infections. diarrhea other beta-lactam Cefazolin Ancef
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Keflin( Nausea (if antibiotics: disrupt Cefalotin or Cefaloth discont alcohol taken the synthesis of in in inued) concurrently) thepeptidoglycan la Allergic yer of bacterial cell
Cefalexin Keflex reactions walls. Cephalosporins (Second generation) Distacl
Cefaclor
or Mando l(disco
Cefamandole Gastrointestina Same mode of ntinued l upset and action as ) ) diarrheaNause other beta-lactam Less Gram-positive cover, Mefoxi a (if alcohol antibiotics: disrupt improved Gram-negative n(disco taken the synthesis of
Cefoxitin cover. ntinued concurrently) thepeptidoglycan la ) ) Allergic yer of bacterial cell reactions walls.
Cefprozil Cefzil Ceftin,
Cefuroxime Zinnat( UK) Cephalosporins (Third generation) Cefixime (antagonist
ic with Suprax Chloramphenicol)[4] Omnic
Cefdinir ef, Cefdiel Spectra
Cefditoren cef, Gastrointestina Same mode of Meiact Improved coverage of Gram- l upset and action as negative organisms, Cefoperazone [Unlik diarrheaNause other beta-lactam except Pseudomonas. e most third- a (if alcohol antibiotics: disrupt Reduced Gram-positive generation agents, taken the synthesis of cover. But still not cefoperazone is concurrently) thepeptidoglycan la coverMycoplasma and Chla active Allergic yer of bacterial cell againstPseudomonas mydia Cefobi reactions walls. aeruginosa], d(disco combination ntinued Cefoperazone ) ) withSulbactam make s more effective antibiotic, because Sulbactam avoid degeneration of Cefoperazone Cephalosporins (Fourth generation) Same mode of 1-strointestinal upset action as Covers and diarrhea2-Nausea (if Maxipi other beta-lactam
Cefepime pseudomonal alcohol taken
me antibiotics: disrupt infections. concurrently) 3-Allergic the synthesis of reactions thepeptidoglycan la
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yer of bacterial cell walls. Cephalosporin’s (Fifth generation) Same mode of action as other beta-lactam Gastrointestinal upset antibiotics: disrupt
Ceftaroline fosamil Teflaro Used to treat MRSA and diarrhea the synthesis of Allergic reaction thepeptidoglycan la yer of bacterial cell walls. Used to treat MRSA (methici Same mode of llin- action as resistantStaphylococ Gastrointestinal upset other beta-lactam cus aureus), and diarrhea antibiotics: disrupt
Ceftobiprole Zeftera penicillin- Nausea (if alcohol the synthesis of resistantStreptococcu taken concurrently) thepeptidoglycan la s Allergic reactions yer of bacterial cell pneumoniae, Pseudo walls. monas aeruginosa, and enterococci
Glycopeptides Targoc
Teicoplanin id (UK) Active against aerobic and Vanco
Vancomycin anaerobic Gram-positive
cin bacteria including MRSA; inhibiting peptidogl
Telavancin Vibativ Vancomycin is used orally ycan synthesis for the treatment of C. Dalvan
Dalbavancin difficile
ce Orbacti
Oritavancin
v
Figure 1
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Figure 2
Bacteria can develop resistance to antibiotics by mutating existing genes (vertical evolution), [6,7] or by acquiring new genes from other strains or species (horizontal gene transf er).[8,9] The sharing of genes between bacteria by horizontal gene transfer occurs by many different mechanisms. Mobile genetic elements, including phages, plasmids and transposons mediate thi s transfer, and in some circumstances the presence of low levels of the antibiotic in the environment is the key signal that promotes gene transfer, [10] perhaps ensuring that the whole microbi al community is protected from the antibiotic.[11] Antibiotic Resistance: A Global Threat*
Table 2 Treatmen t Options (as Antibiotics Determined Based o n Current and Emerging Representative Clinical Type Associated with Culture & Sensitivity, Resistant Bacteria Infections Resistance Local Guidelines, Clinical Presentation) beta-lactam vancomycin skin/soft tissue antibiotics (eg.,
infections, UTI, oxacillin, alternatives: linezolid; Methicillin-resistant bacteremia , toxic shock penicillin, gram (+) cli ndamycin (confirm Staphylococcus aureus syndrome, pneumonia, nafcillin, cocci with D-test); (MRSA) [2] osteomyelitis, amoxicillin, and daptomycin; TMP -SMX; endocarditis, meningitis; most quinupristine - assoc. with IV catheters cepholosporins) dalfopristin [2] [3] erythromycin vancomycin; beta - lactam antibiotics skin/soft tissue (eg., oxacillin, Vancomycin inter - infections, UTI, linezolid; clindamycin; penicillin, mediate and resistant gram (+) bacteremia , toxic shock daptomycin; TMP -SMX; nafcillin, Staphylococcus aureus cocci syndrome, pneumonia, quinupris tine-dalfopristin amoxicillin, and (VISA/hVISA/VRSA)[4] osteomyelitis, [4] most endocarditis, meningitis cepholosporins) erythromycin necrotizing pneumonia; beta-lactam skin infections, boils, antibiotics (eg., abcesses (seen in IV drug doxycycline or Community-acquired oxacillin, abusers, athletes who minocycline; methicillin-resistant gram penicillin, share equipment, day clindamycin (confirm Staphylococcus aureus (+)cocci amoxicillin, and care centers, military with D-test); linezolid; (cMRSA) [2] most perso nnel; prisons); TMP-SMX [2] cepholosporins, drainage of abscess is erythromycin primary treatment; treat
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with antibiotic only if needed[2] for multi-drug resistance consider: multi-drug vancomycin +/- rifampin; pneumonia, otitis media, resistanc e; fluoroquinolone Streptococcus gram sinusitis, bronchitis, penicillin G, (gemifloxacin, pneumoniae (multi-drug (+)diplo - bacteremia, peritonitis, cephalosporins, moxifloxacin), resistant) [5] [6] coccus cellulitis, meningitis, TMP-SMX, levofloxacin) arthritis [5] erythromycin, doxycycline [7] alternatives: linezolid; clindamycin[8]; imipenem/cilastatin Escherichia coli (E. Coli) Oral Fosfomycin [10], - CTX-M extended cephalosporins, nitrofurantoin, gram (-)rod UTIs spectrum beta-lactamases TMP/SMX, ertapenem, doripenem, (ESBL) [9] fluoroquinolones imipenem/cilastatin Enterococcus faecium (E. vancomycin; meningitis, UTI, faecium) streptomycin; linezolid; quinupristine - gram bacteremia (central vancomycin resistant gentamicin; dalfopristin; daptomycin, (+)cocci venous catheter-related), enterococci (VRE)[11] penicillin; fosfom ycin (for UTI) endocarditis [12] ampicillin imipenem/cila - statin, mero - Pseudomonas aeruginosa UTIs, pneumonias, skin colistin, polymyxin B penem, non - (multidrug resistant gram (-)rod and soft-tissue infections, (for multidrug resistant antipseudo-monal strains) [13] endocarditis, meningitis strains) penicillins, oral cephalosporins, 2nd, 3rd Klebsiella pneumoniae pneumonias, UTIs, upper generation -extended spectrum beta - respiratory tract imipenem; meropenem; gram (-)rod cephalosporins; lactamases (ESBL)[14] infections, surgical colistin aztreonam; [15] wound infections carbapenems multiple agents requiredfor treatme nt: aminoglycoside (amikacin or kanamycin) or polypeptide antibiotic (capreomycin) + multi-drug resistant isoniazid; antimycobacterials Mycobacterium tuberculosis (lung acid-fast rifampin; possibly (pyrazinamide + tuberculosis (MDR - infection) streptomycin ethambutol) + TB) [16] [17] fluorquinolone (moxifloxacin) + rifabutin; other agents may need to be substituted based on drug availability immunocompromised patients: pneumonia imipenem; (commonly ventilator - meropenem; ampicillin - Acinetobacter associated), UTI, antipseudomonal gram (-)rod sulbactam [19]; baumanii [18] septicemia, central agents, colistin [20] [21] venous catheter-related fluoroquinolones, infections, traumatic carbapenems wound infections Staphylococcus bacteremia, catheter, penicillin, vancomycin gram (+) epidermidis (methicillin implant, and prostheses - amoxicillin
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resistant) [22] [23] [24] related infection (biofilm if infected implant, [25] [26] formations), endocard itis surgical removal or replacement may be required; vancomycin +/ - (rifampin + gentamicin)
alternative regimens if vancomycin resistant: daptomycin, linezolid UTI = urinary tract infection
Why is Antibiotic Resistance so Important?
Overuse and misuse of antibiotics worldwide is leading to the global health care issue of antibiotic resistance. Antibiotic resistant infections may occur, and in the worse-case scenario, there may be no antibiotics that are effective for the infection. This situation can be life-threatening in a serious infection.One reason bacteria are becoming resistant is because antibiotics may be inappropriately used for an illness caused by a virus. Antibiotics cannot kill viral illnesses.
Bactericidal and Bacteriostatic Antibiotics
Some antibiotics are bactericidal, meaning that they work by killing bacteria. Other antibiotics are bacteriostatic, meaning that they work by stopping bacteria multiplying.
Each different type of antibiotic affects different bacteria in different ways. For example, an antibiotic might inhibit a bacterium's ability to turn glucose into energy, or its ability to construct its cell wall. When this happens, the bacterium dies instead of reproducing.
Broad-Spectrum and Narrow-Spectrum Antibiotics
Some antibiotics can be used to treat a wide range of infections and are known asbroad-spectrum antibiotics. Others are only effective against a few types of bacteria and are called narrow-spectrum antibiotics.
Antibiotics Classification
Although there are several classification schemes for antibiotics, based on bacterial spectrum (broad versus narrow) or type of activity (bactericidal vs. bacteriostatic), the most useful is based on chemical structure. Antibiotics within a structural class will generally have similar patterns of effectiveness, toxicity, and allergic potential.
The Main Classes of Antibiotics Are:
• Beta-Lactams
• Penicillins
• b- Cephalosporins
• Fluoroquinolones
• Tetracyclines
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• Aminoglycosides
Most commonly used types of antibiotics are: Aminoglycosides, Penicillins, Fluoroquinolones, Cephalosporins, Macrolides, and Tetracyclines. While each class is composed of multiple drugs, each drug is unique in some way.
CEPHALOSPORIN
Cephalosporins have a mechanism of action identical to that of the penicillins. However, the basic chemical structure of the penicillins and cephalosporins differs in other respects, resulting in some difference in the spectrum of antibacterial activity. Like the penicillins, cephalosporins have a beta-lactam ring structure that interferes with synthesis of the bacterial cell wall and so are bactericidal. Cephalosporins are derived from cephalosporin C which is produced from Cephalosporium acremonium. Cephalosporins are used to treat pneumonia, strep throat, staph infections, tonsillitis, bronchitis, otitis media, various types of skin infections, gonorrhea, urinary tract infections Cephalosporin antibiotics are also commonly used for surgical prophylaxis. Cephalexin can also be used to treat bone infections.Cephalosporins are among the most diverse classes of antibiotics, they are grouped into "generations" by their antimicrobial properties. Each newer generation has a broader spectrum of activity than the one before.
• The First Generation
cephalosporins include: Their spectrums of activity are quite similar. They possess generally excellent coverage against most gram-positive pathogens and variable to poor coverage against most gram negative pathogens. The first generation includes:
• cephalothin
• cefazolin
• cephapirin
• cephradine
• cephalexin
• cefadroxil
• The Second Generation
cephalosporins. In addition to the gram positive spectrum of the first generation cephalosporins, these agents have expanded gram negative spectrum. Cefoxitin and cefotetan also have good activity against Bacteroides fragilis. Enough variation exists between the second generation cephalosporins in regard to their spectrums of activity against most species of gram negative bacteria, that susceptibility testing is generally required to determine sensitivity. The second generation includes:
• cefaclor
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• The Third Generation
cephalosporins have much expanded gram negative activity. However, some members of this group have decreased activity against gram-positive organisms. They have the advantage of convenient administration, but they are expensive. The third generation includes:
• cefdaloxime
• cefixime
• cefoperazone
• The Fourth Generation
cephalosporins are extended-spectrum agents with similar activity against gram-positive organisms as first- generation cephalosporins. They also have a greater resistance to beta-lactamases than the third generation cephalosporins. Many fourth generation cephalosporins can cross blood brain barrier and are effective in meningitis. The fourth generation includes:
• cefclidine
• cefepime
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FLUOROQUINOLONESS
Fluoroquinolones (fluoridated quinolones) are the newest class of antibiotics. Their generic name often contains the root "floxacin". They are synthetic antibiotics, and not derived from bacteria. Fluoroquinolones belong to the family of antibiotics called quinolones. The older quinolones are not well absorbed and are used to treat mostly urinary tract infections. The newer fluoroquinolones are broad-spectrum bacteriocidal drugs that are chemically unrelated to the penicillins or the cephalosporins. Because of their excellent absorption fluoroquinolones can be administered not only by intravenous but orally as well.
Fluoroquinolones are used to treat most common urinary tract infections, skin infections, and respiratory infections (such as sinusitis, pneumonia, bronchitis).
Fluoroquinolones inhibit bacteria by interfering with their ability to make DNA. This activity makes it difficult for bacteria to multiply. This effect is bacteriocidal.
Fluoroquinolone grope includes:
• levofloxacin
• clinafloxacin
TETRACYCLINES
Tetracyclines got their name because they share a chemical structure that has four rings. They are derived from a species of Streptomyces bacteria.
Tetracycline antibiotics are broad-spectrum bacteriostatic agents and work by inhibiting the bacterial protein synthesis. Tetracyclines may be effective against a wide variety of microorganisms, including rickettsia and amebic parasites.
Tetracyclines are used in the treatment of infections of the respiratory tract, sinuses, middle ear, urinary tract, skin, intestines. Tetracyclines also are used to treat Gonorrhoea, Rocky Mountain spotted fever, Lyme Disease, typhus. Their most common current use is in the treatment of moderately severe acne and rosacea.
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Tetracycline antibiotics are:
• tetracycline
• doxycycline
• minocycline
PENICILLINS
The penicillins are the oldest class of antibiotics. Penicillins have a common chemical structure which they share with the cephalosporins.
Penicillins are generally bactericidal, inhibiting formation of the cell wall. Penicillins are used to treat skin infections, dental infections, ear infections, respiratory tract infections, urinary tract infections, gonorrhea.
There are four types of penicillins:
Figure 3
• The Natural Penicillins
Are based on the original penicillin-G structure. Penicillin-G types are effective against gram-positive strains of streptococci, staphylococci, and some gram-negative bacteria such as meningococcus.
• Penicillinase-Resistant Penicillins,
Notably methicillin and oxacillin, are active even in the presence of the bacterial enzyme that inactivates most natural penicillins.
Such as ampicillin and amoxicillin have an extended spectrum of action compared with the natural penicillins. Extended spectrum penicillins are effective against a wider range of bacteria.
REFERENCES
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2011;52(3):e18-55.
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17. Centers for Disease Control and Prevention (CDC). Treatment of tuberculosis. MMWR Recommendations and
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Reports. June 20, 2003 / 52(RR11);1-77 ,8, 2011
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