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CHEMOTHERAPY
chemotherapeutic agents
Definitions:
- Antimicrobial chemotherapeutic agents:
chemically synthesized substances that are used to
treat infectious diseases by killing or inhibiting the
growth of microorganisms.
- Antibiotics:
antimicrobial substances that are produced as
secondary metabolites by certain groups of
microorganisms (Streptomyces, Bacillus, few moulds
as penicillum and Cephalosporium).
organisms.
Semisynthetic antibiotics: by chemical
modification of certain antibiotics to achieve the
desired properties.
Fully synthetic antibiotics: higher generations.
Selective toxicity
The ability of an antimicrobial agent to
harm a pathogen without harming the
host. It may be a function of:
1- A specific receptor or target (found in
microbe but not in human body)
2- Inhibition of a biochemical reaction
(essential for microbe but not for the host)
MECHANISMS OF ACTION OF
ANTIMICROBIAL DRUGS
1- Inhibition of bacterial cell wall
synthesis
2- Interference with the cell membrane
function.
3- Inhibition of bacterial protein
synthesis.
4- Inhibition of bacterial nucleic acid
synthesis (DNA or RNA).
toxicity.
Members: a - -lactam antibiotics
b - Glycopeptides
c - Cycloserine and bacitracin
- -lactams inhibit the last steps of PG synthesis, while
Glycopeptides & cycloserine inhibit the early steps.
- Tetracycline
- Aminoglycosides (gentamycin, streptomycin, amikacin)
Agents acting on the 50S subunit:
Disc Diffusion
method
E test method
Empiric therapy
It is the
Indications:
1- In seriously ill patients empiric therapy should be started
without delay but after collecting specimens for culture.
2- In closed lesions where there is no available sample.
Combined Therapy
- Definition:
the use of more than one antibiotic in order to
achieve successful clinical response.
- N.B.: The rule in treatment is monotherapy.
Complications of Chemotherapy
1- Toxicity:
- tetracycline may cause staining of teeth in infants.
- Streptomycin may affect the 8th cranial nerve.
- Aminoglycosides may cause nephrotoxicity.
- Chloramphenicol can cause bone marrow depression.
2- Allergy (hypersetivinsity):
- Penicillin may cause urticaria, anaphylactic shock.
- Local application of sulphonamides may result in contact dermatitis.
4- Superinfection:
- Occurs as a result of outgrowth of resistant members of normal
flora when the sensitive ones are eradicated during antibiotic therapy.
processes in bacteria:
(1) Mutation: the more frequent the exposure to the
antibiotic, the greater the potential resistance.
(2) Exchange of genes between strains and species that can
be encoded on plasmid, phage or others.
PLASMID
Extrachromosomal, small,
cicular, double-stranded DNA
Function:
Antibiotic resistance
ANTIMICROBIAL CHEMOPROPHYLAXIS
- Definition:
Administration of an effective antimicrobial agent to
prevent infection with a certain microbe.
- Indications:
1- Examples of Surgical indications:
Preoperative in some surgical operations.
2- Examples of Medical indications:
a- In rheumatic fever.
b- In meningococcal meningitis.
c- In subacute bacterial endocarditis.