• Disruption of bacterial cell wall
• Inhibition of an enzyme unique to bacteria
• Disruption of bacterial protein synthesis

narrow vs. broad

bacteriostatic vs. bactericidal

• allergic reactions
• pain
• sensory and mortor dysfunction
• neurotoxicity

• Inability of penicillins to reach their targets
• Inactivation of penicillins by bacterial enzymes
• Production of penicillin-binding proteins (PBPs) that have a low affinity for penicillins

• Narrow-spectrum penicillins
• Pencillinase-sensitive
• Narrow-spectrum penicillins
• Pencillinase-resistant
• Broad-spectrum penicillins
• Extended-spectrum penicillins

• Immediate (reaction in 2 to 30 minutes)
• Accelerated (reaction in 1 to 72 hours)
• Late (reaction takes days or weeks to develop)
• Anaphylaxis
• Laryngeal edema
• Bronchoconstriction
• Severe hypotension

• Epinephrine
• Respiratory support
• Prevention – skin testing

• Most widely used group of antibiotics
• Beta-lactam antibiotics
• Similar to penicillin structure
• Bactericidal
• Usually given parenterally
• Toxicity is low

• Broad-spectrum antibiotics
• Inhibit protein synthesis
• Increasing bacterial resistance has emerged

• Rickettsial disease
• Chlamydia trachomatis
• Brucellosis
• Cholera
• Mycoplasma pneumoniae
• Lyme disease
• Anthrax
• Helicobacter pylori
• Acne
• Peptic ulcer disease
• Periodontal disease

Red man's

ototoxicity

renal toxicity

• More effective drugs make hospitalization generally unnecessary.
• Always treat with two or more drugs.
• Direct observation of drug administration is considered standard care.
• Treatment is considered effective when no mycobacteria are observed in sputum and no colonies are present in culture.

• First drugs available for systemic treatment of bacterial infections
• More effective and less toxic drugs now available
• Inhibit the synthesis of folic acid (folate)
• Mammalian cells do not manufacture their own folate (not affected like bacteria are affected)

• Primary use now – for urinary tract infections
• Other uses: nocardiosis, Chlamydia trachomatis, conjunction therapy for toxoplasmosis/malaria, ulcerative colitis

• Hypersensitivity reactions – Stevens-Johnson syndrome
• Hematologic effects
• Kernicterus
• Renal damage from crystalluria
• Drug interactions
•  Metabolism-related interactions
• Allergy-inducing drugs

• Some infecting bacilli inherently resistant
• Some develop resistance over course of treatment
• Resistance to one drug versus many drugs
• Infection with resistant TB acquired through:
• Contact with someone who harbors resistant bacteria
• Repeated ineffectual courses of therapy

resistant to:

• isoniazid and rifampin
• all fluoroquinolones
• at least one of the injectable second line drugs

ALWAYS treat tb with two or more drugs!!

minimum 6mo for drug sensitive TB

up to 24mo for MDR or HIV/AIDS Tb infections

• Isoniazid, rifampin
• Rifapentine, rifabutin, pyrazinamide, and ethambutol

• Absorption reduced by:
• Aluminum antacids
• Magnesium antacids
• Iron salts
• Zinc salts
• Sucralfate
• Milk and dairy products

• Protozoal infections
• Infections caused by obligate anaerobes
• Helicobacter pylori

• Treatment can be difficult.
• Infections often resist treatment.
• Treatment may require prolonged therapy with drugs that frequently prove toxic.

• Opportunistic
• Immunocompromised host
• Candidiasis, aspergillosis, cryptococcosis, mucormycosis
• Nonopportunistic
• Can occur in any host
• Sporotrichosis, blastomycosis, histoplasmosis, coccidioidomycosis

Candidiasis

Dermatophytes

1. Polyene antibiotics
2. azoles
3. echinocandins
4. pyrimidine analogs

• Our ability to treat viral infections remains limited
• Viruses use biochemical machinery of host cells to reproduce
• Difficult to suppress viral replication without doing significant harm to the host
• Antivirals suppress biochemical processes unique to viral reproduction

• Five types of antiretroviral drugs
• Inhibit enzymes required for HIV
• Reverse transcriptase inhibitors
• Integrase inhibitors
• Protease inhibitors
• Block viral entry into cells
• Fusion inhibitors
• CCR5 antagonists

Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTI's)

• Differ from the NRTIs in structure and mechanism of action
• NNRTIs bind to the active center of reverse transcriptase and cause direct inhibition
• Active as they are administered

• Among the most effective antiretroviral drugs available
• Used in combination with NRTIs – can reduce viral load to an undetectable level

• Same principles that guide antiretroviral therapy in nonpregnant adults
•  Mother-to-child transmission HIV
• Occurs primarily during labor and delivery
• Risk for transmission can be greatly reduced by ART, which minimizes maternal viral load
• The same general principles also apply to children

Applied to objects

too harsh for living tissue

applied most frequently to instrumetns and facilities