Lecture Outline

Drugs used for Infections

Dr. Thaw Zin
MBBS, MMedSc, FACTM, PhD (NSW)
Clinical Associate Professor/FMHS, UTAR
Learning Objectives
Define antibiotics and describe the conditions for which it is useful
Describe the objectives of combined chemotherapy and indicate the
untoward effects they can produce.
Explain importance of antibacterial spectrum and the difference
between bacteriostatic and bactericidal agents.
Understanding the rational use of antibiotics and its importance
Describe the underlying principles of antimicrobial resistance and how
can it be prevented.
Classify the antibiotics according to their site of action
Describe pharmacological action, therapeutic actions and side effects
of antimicrobials, antifungal and antiviral agents
Anti-infective agents
Infection
The invasion of the body tissues by pathogenic organism (bacteria,
viruses, protozoa, fungi & helminths)
Anti-infective chemotherapy (Antimicrobial chemotherapy)
Drug treatment of parasitic infections in which parasites (bacteria,
viruses, protozoa, fungi and helminths) are destroyed or inhibited
without injuring the host, by a process known as selective toxicity
Selective Toxicity
Interfering with some metabolic processes that exist only in the
infectious organisms (not in the cells of the host) by the anti-infective
agents at concentrations tolerated by the host (may be complete or
relative)
Antimicrobial Chemotherapy
Antibiotics
Chemical substances originally produced by various species of microorganisms (bacteria, fungi, actinomycetes) that in high dilution
suppress growth or cause death of other microorganisms
Objectives of Antimicrobial Therapy
For curative treatment of microbial infections:
Eradication by producing lethal effect on microorganism or by
inhibiting growth or multiplication of micro-organisms.

In the latter case, eradication is brought about by body defence

mechanisms (eg, phagocytosis).
For preventive use in some conditions to prevent infections
Combination Chemotherapy
Two or more anti-infective agents used simultaneously
Combination Chemotherapy
Objectives of Combination Therapy
To obtain potentiation
To delay development of drug resistance
To broaden the spectrum of antibacterial activity
To decrease the incidence of ADRs (reduced dose)
Superinfection (Opportunistic infection)
Defined as appearance of bacteriological & clinical evidence of a new
infection during chemotherapy of a primary one.
Superimposed infection during antimicrobial therapy, due to
suppression of normal bacteria flora (eg. vagina, lower intestine)
The normal flora normally inhibits potentially pathogenic microorganisms (e.g., Candida, Pseudomonas, Proteus, Staphylococci, E.coli)
in the body (e.g., antibiotic associated-diarrhoea, pseudomembranous
colitis, fungal infections).
Terminology
Bacteriostatic
Inhibiting the growth or multiplication of bacteria
Bactericidal
Lethal effect on mature bacteria (kill the bacteria)
Antibacterial Spectrum
List of organism which are normally susceptible to antibacterial action
of a particular agent (group or particular organisms)
Antibacterial Spectrum
Depending on range of bacterial species susceptible to its action, antimicrobials are
classified as broad-, intermediate-, or narrow- spectrum.
Broad spectrum antimicrobials are active against both Gram-positive & Gramnegative organisms (e.g. tetracyclines, chloramphenicols, fluoroquinolones,
third- & fourth-generation cephalosporins).
Narrow spectrum antimicrobials have limited activity & are primarily useful
against particular species of microorganisms (e.g. Penicillin & Bacitracin are
only effective against Gram-positive bacteria)
Polymixins are usually effective against Gram negative bacteria.
Aminoglycosides & Sulfonamides are only effective against aerobic
organisms, while nitroimidazoles are generally only effective for
anaerobes.
Antimicrobial Resistance

Resistance (acquired) of microorganisms to anti-infective agent can occur as

a result of:
Enzymatic inactivation: Production of microbial enzymes which destroy
the drugs (eg. Penicillins & b lactamases)
Decrease access to target: Reduced permeability of antimicrobial
agents into cell wall of microorganisms &/or increasing active efflux
(pump out) of drugs across cell surface)
Development of altered metabolic pathways: (other than the one
originally inhibited by the drug) in microorganisms 9eg. Sulphonamides
& PABA)
Development of altered site of action of drug in microorganisms (de
novo target) alteration of pen-binding protein (eg. Methi-cillin
resistant Steph aureus)
Genetic resistance (chromosomes and plasmids are transferred by
transduction, transformation, conjugation, translocation or
transposition)
Classification (based on Mechanism of Action)
1. Drugs that the synthesis of bacterial cell walls
Penicillin
Carbapenems
Cephalosporins
Imidazole antifungal agents (e.g., Clotrimazole)
Cycloserine
Ristocetin
Bacitracin
Vancomycin
2. Agents that act directly on the cell membrane (i.e. increasing
permeability leading to leakage of intracellular compounds)
Polyene antifungal agents _ (Nystatin, Amphotericin)
Detergents (eg, Polymyxin), Daptomycin
3. Drugs inhibiting microbial protein synthesis by their effect on
bacterial ribosomes
(a) Agents that disrupt the function of 30S or 50S ribosomal subunits to
reversibly inhibit protein synthesis (mainly bacteriostatic)
Streptomycin
Lincosamines
(Clindamycin,
Lincomycin)
Tetracycline
Macrolides
(Erythromycin)
Chloramphenicol
Linezolid
(b) Agents that bind irreversible to 30s ribosomal subunit (mainly
bactericidal)
Aminoglycosides (eg, Gentamicin)
4. Drugs that affect nucleic acid metabolism

Rifampicin (inhibit RNA polymerase)

Fluoroquinolones (inhibit topoisomerases)
Griseofulvin
Metronidazole
5. Drugs affecting the intermediary metabolism which are essential to
micro-organisms
Sulfonamides
Trimethoprim
Para-aminosalicylic acid
Pyrimethamine
(PAS)
6. Antiviral Agents - Bind to viral enzymes that are essential for DNA
synthesis thus inhibiting viral replication
Nuclelic acid analogs
selectively inhibit DNA polymerase acyclovir, ganciclovir
inhibit reverse transcriptase zidovudine, lamivudine
Non-nucleoside reverse transcriptase inhibitors
nevirapine, efavirenz
Inhibitors of essential viral enzymes
inhibitors of HIV protease (indinavir, ritonavir) or influenza
neuraminidase
Fusion inhibitor
enfuvirtide
Penicillin
Pharmacological Action
All -lactam antibiotics interfere with the synthesis of bacterial cell wall
peptidoglycan
After attachment to penicillin-binding proteins on bacteria, they inhibit
transpeptidase enzyme that cross-link peptide chains attached to the
backbone of the peptidoglycan
Final bactericidal event is inactivation of an inhibitor of autolytic
enzymes in cell wall, leading to lysis of bacterium
Classification
1. Penicillin G or Benzyl Penicillin
2. Penicillin V (oral)
3. Penicillinase-resistant Penicillins (Antistephylococcal penicillins)
4. Broad Spectrum Penicillins
Untoward effects - remarkably non-toxic
Hypersensitivity reactions include anaphylactic shock, serum sick-ness
type reaction (now rare) urticaria, fever, joint swelling, angioneuroticoedema, intense puritus, hypotension, skin rash, oral lesions,
fever interstitial nephritis & vasculitis
Nausea, vomiting, diarrhea due to superinfection (common with oral
penicillin), larger dose pseudomembranous colitis (with Ampicillin)
Interstitial nephritis (especially with Methicillin)

Convulsion due to high dose in patient with renal failure or intrathecal

injection
Neutropenia or haemolyticanaemia (Nafcillin)
Hepatitis (Oxacillin)
K+ containing preparation in renal insufficiency hyperkalaemia
Rash (Ampicillin & Amoxicillin), not allergic in nature
Cephalosporins
Pharmacological Action
Obtained from fungus Cephalosporium.
It is closely resembles to penicillin but more stable to many bacterial lactamase.
It contains -lactam ring and 7-aminocephalosporanic acid.
Variation in side chains widens the antimicrobial spectrum and
pharmacokinrtics.
Mechanism of action is similar to penicillin, bactericidal, inhibit
bacterial cell wall synthesis
First Generation Cephalosporins
Antibacterial Spectrum
Good activity again Gram-positive cocci (pneumococci, strepto-cocci,
staphylocci) (except enterococci, Methicillin-resistant Staph aureus &
Staph epidermidis)
Modest activity against Gram-negative bacteria. Some lactamase
strains (e.g., Staphylococcus)
Oral cavity anaerobic cocci are susceptible, Bacillus fragilis is not
sensitive
Therapeutic Uses
Upper & lower respiratory tract infection, urinary tract infection
Cefazolin is drug of choice for surgical prophylaxis because of its well
penetration to tissue & is lease toxic.
Skin & soft tissue infections due to Staph aureus & Strep pyogens
Second Generation Cephalosporins
Antibacterial Spectrum
Increased activity against Gram-negative bacteria (H. influenza,
Enterobacter species, Proteus, E. coli, Klebsiella) but less active than
third generation Cephalosporins
Ecfoxitin, Cefmetazole & Cefotetan are active against anaerobes
(Bacteroides fragillis)
Not as active against gram-positive organisms as first generation
agents, but more resistant to lactamase
Therapeutic Uses
Respiratory tract infection (oral)

G (-)ve bacterial & anaerobic infection (pelvic inflammatory disease,

intra-abdominal infection, diabetes foot infection) Cefoxitin,
Cefotetan
Third Generation Cephalosporins
Antibacterial Spectrum
More active against Gram-negative bacteria than second generation
Less active against Gram-positive bacteria than first-generation
Much more active against Enterobacteriaceae & -lactamase
producing strains, H. influenza & Neisseria
Some are active against P. aerugenosa (only 2 drugs Ceftazidime,
Cefoperazone)
Therapeutic Uses
Drug of choice for serious infections cause by Klebsiella, Enterobater,
Proteus, Providencia, Serratia & Haemophillilus (septicaemia,
pneumonia & meningitis)
Ceftriaxone for all form of gonorrhea & severe Lymes disease
Drug of choice for meningitis (Cefotaxime or Ceftriaxone)
Enteric fever (Ceftriaxone)
Fourth Generation Cephalosporins
Antibacterial Spectrum
More active than third generation agents and resist -lactamase
Effective against G(+)ve microorganisms, enterobacteriaceae &
pseudomonas (nosocomial infection)
Therapeutic Uses
Empirical treatment of nosocomial infections
Macrolide Antibiotic (Erythromycin Grp)
Includes:
Erythromycin
Clarithromycin
Oleandomycin
Troleandomycin
Azithromycin
Spiramycin
Roxithromycin
Pharmacological Action
Bacteriostatic agents that inhibit protein synthesis by binding
reversably to 50S ribosomal subunit of sensitive microorganisms
Antibacterial activity closely resembles to penicillin but also effective
against Mycoplasma, Chlamydia trachomatis, Legionella
Staphylococcus & Listeria monocytogenes.
Drug of choice for Chlamydial infections & Mycoplasma pneumonia
Lincosamines (Erythromycin Grp)
Includes:
Lincomycin & Clindamycin
Lincosamines have bacteriostatic action

Bind reversibly to 50S ribosomal subunit of bacterial ribosomes &

suppress protein synthesis
Although Lincosamines & macrolide antibiotics are not structurally
related they all act at sites within close proximity
Binding of one of these antibiotics to same subunit of ribosomes may
inhibit interaction with others
Should not be used concurrently as there is no synergism
Antibacterial Activity
Anaerobic bacteria (Bacteroides species, clostridium)
More effective on Gram-positive bacteria (Staph aureus)
Lesser effect on Gram-negative bacteria
Therapeutic Uses
Anaerobic infections (e.g., peritonitis, pelvic inflammation)
Bony infection (e.g., osteomyelitis, periosteitis, sinusitis)
Aspiration pneumonia,
Lung abscess
Dose: Lincomycin 500 mg, 8 hourly (oral, IV)
Aminoglycosides
Include
Gentamycin
Tobramycin
Streptomyci
n
Kanamycin

Paromomyci
n
Gentamycin
Neomycin
Sisomycin
Amikacin

Netilmicin
Framyceti
n
Spectiomy
cin

Pharmacological Action
Bactericidal action - binds irreversible to 30S ribosomal subunit &
interferes with initation of protein by fixing the 30S-50S ribosomal
complex at the start codon (AUG) of mRNA.
Blocks initiation of protein synthesis
Block further translation & elicits premature termination
Causes incorporation of incorrect amino acid
Antibacterial Spectrum
Mainly active against Gram-negative bacteria (Pseudomonas, Shigella,
E.coli, Proteus, Haemophilus, Brucella, Klebsiella, Pasteurella)
Active against some Gram-positive bacteria
Mycobacteria (Streptomycin, Amikacin, Netilmicin, Kanamycin)
Anaerobic bacteria are resistant to aminoglycosides
Therapeutic Uses
Gram-negative bacillary infections
Untoward Effects

Ototoxicity - largely irreversible & results from progressive destruction

of vestibular or cochlear sensory cells
Vestibular dysfunction (Gentamycin, Streptomycin, Netilmicin)
Intense headache, vertigo, dizziness, nystagmus, ataxia, loss of
equilibrium
Auditory dysfunction (Kanamycin, Amikacin),
Tinnitus, fullness in the ear, deafness (potent diuretics potentiate
ototoxicity).
Tobramycin affects both equally and netilmicin is less ototoxic than
others
Nephrotoxicity
Neuromuscular blockade (reversible)
Other Untoward Effects
Vague feelings paraesthesia of lips or circumoral region
Prolong use superinfection, diarrhea, malabsorption
Rare-hypersensitive reactions
Can occur with neomycin
Tetracyclines
Pharmacological Action
Bacteriostatic action - inhibit bacterial protein synthesis by binding to
30S bacterial ribosome, & preventing access of amino acyl-tRNA to
acceptor site on mRNA-ribosome complex
Antibacterial Spectrum
Broad spectrum antibiotic:
Wide range of G (+ve) & G (-ve) bacteria, Rickettsiae, Mycoplasma,
Chlamydia, Vibrio cholerae. Yersinia pestis Less effect on
Staphylococcus, Meningococcus, Streptococcus. Not effective against
Pseudomonas, Proteus, Salmonnella
Spirochetes (Treponema, Leptospira, Borrelia)
Parasites- amoeba (E. histolytica), malaria parasite
Therapeutic Uses
Drug of choice for Rickettsia, Mycoplasma pneumonia, Chalamydial
infection, plague & anthrax
Trachoma, nonspecific urethritis, sexually transmitted diseases
Syphillis (non-preganant, penicillin allergic patients)
Bacillary infections- cholera, brucellosis, tularemia
Combination regimens to treat gastric and duodenal disease caused by
Helicobacter pylori
Treatment and prophylaxis of leptospirosis (leptospira), Lyems disease
(B. burgsorferi), & relapsing fever (B. recurrentis)

Protozoal infection (e.g., Entamoeba histolytica or Plasmodium

falciparum
Treatment of acne
Staphylococcal & streptococcal infection uncomplicated skin soft tissue
infections (Doxycycline)
Urinary tract infections no longer recommended because E.coli are
usually resistant
Local application
Minocycline sustained-released microspheres for sub-gingival
administration in dentistry
Eye ointment
Untoward effects
Most adverse effects are due to direct toxicity of the drug or to
alternation of microbial flora.
Gastrointestinal adverse effects
Nausea, vomiting, diarrhea are most common reasons for
discontinuing medication
Pseudomenbranous enterocolitis caused by Clostridium difficile
Bony structures & teeth (if used during the pregnancy & age under 12
years)
Permanent brown discoloration of teeth & enamel dysplasia
Deformity & growth inhibition of bone
Liver toxicity especially with higher dose >4 g/day in pregnant
women and patients with liver diseases.
Kidney toxicity
Fanconi syndrome renal tubular acidosis & other renal injury
resulting in nitrogen retention due to administration of expired
tetracyclines
Tetracycline given along with diuretic may produce nitrogen
retension
Local tissue toxicity intravenous injection can lead to venous
thrombosis.
IM injection produces painful irritation & should be avoided
Photosensitization induce sensitivity to sunlight or ultraviolet light,
particularly in fair skinned persons (Demeclocycline)
Vestibular reactions dizziness, vertigo, nausea & vomiting
(Minocycline, Doxycycline)
Chloramphenicol
Pharmacological Action
Bacteriostatic action: binds to the 50S ribosomal subunit at the
peptidyletransferase site and inhibits the transpeptidation reaction

Choloramphenical binds to the 50S ribosomal subunit near the site of

action of lincosamines and the macrolide antibiotics
These agents interfere with the binding of choloramphenical and
interfere with each others action if given concurrently
Antimicrobial Activity
Broad spectrum antibiotic: - a wide range of Gram- positive and Gramnegative bacteria
Salmonella typhi, Haemophilusinfluenzoe, Bordetella pertussis,
Shigella, Brucella, Vibriocholerae, Rickettsiae, Bacteroides, anaerobic
bacteria
Less effect on Staphylococcus
Therapeutic Uses
Chloramphenicol must be limited to infections where benefits of drug
significantly outweight risks of potential toxicities.
If other antibiotics can be equally effective & less toxic are available,
they should be used.
Enteric fever (3rd generation Cephalosporin, eg, ceftriaxone &
quinolones, eg, ciprofloxacin are the drug of choice)
Bacterial meningitis caused by H influenza, Neisseria meningitides &
Strep pneumoniae (alternative to -lactam antibiotics)
Anaerobic infections, including bacteroides infection (intra-abdominal
infection & brain abscess).
Rickettsial infections (typhus fever, Q fever, rickettsial pox ) &
brucellosis (if tetracycline is contraidicated)
Opthalmic infection
Untoward effects
Less selective toxicity; may inhibit protein synthesis of mammalian
tissues (esp. haemopoietic tissue)
Haematological toxicity- bone marrow depression
Grey (gray) syndrome (Gray baby syndrome)
Hypersensitivity (rare)
Superinfection (oral or vaginal candidiasis) may occur due to alteration
of normal microbial flora
Encephalopathy, optic neuritis (rare)
Haemolysis in G6PD deficient patient (dose-related)
Dose:
50-100 mg/kg/day in 3 or 4 divided doses, orally (or)
250-500 mg, 6-8 hrly; 1g every 6 hours x wks in enteric fever
Fluoroquinolones
First Generation Quinolones
Nalidixic/A

Oxolinic
acid

Cinoxacin

Second Generation Quinolones

Norfloxaci
Ciprofloxa
n
cin
Lomefloxa
Sparfloxac
cin
in
Enoxacin
Rosoxacin
Pefloxacin
Flexofloxa
cin
Newer fluoroquinolones
Moxifloxac
Sitafloxaci
in
n

Ofloxacin
Levofloxac
in
Acrofloxac
in

Pharmacological Action
Bactericidal - block bacterial DNA synthesis by inhibiting bacterial
topoisomerase ll (DNA gyrase) & topoisomerase IV
Inhibiting of DNA gyrase prevent relaxation of positively super-coiled
DDNA that is required for normal transcription & replication
Inhibition of topoiso-merase IV, interferes with separation of replicated
chromosomal DNA into respective daughter cells during cell division
Antibacterial Spectrum
Potent bactericidal agents against- E.coli, Samonella, Shigella,
Enterobacter & Neisseria
Ciprofloxacin is more active against P.aeruginosa
Fluoroquinolones have good activity against staphylococci, but not
against methicillin-resistant strains
Levofloxacin, gatifloxacin & moxifloxacin are active against
streptococci
Chalmydia, Mycoplasma, Legionella, Brucella & Myobacterium
Ofloxacin, Pefloxacin are active in animal models of leprosy (used)
New fluoroquinolones (garenoxacin & gemifloxacin) have active against
anaerobic bacteria
Resistance is observed in C. jejuni, Samonella, N. gonorrhoeae & Strep
pneumoniae
Untoward Effects
Generally well tolerated
Nausea, abdominal discomfort, diarrhea, headache, dizziness,
hypersensitivity (fetal), photosensitivity
Cartilaginous erosion in foetus and children (arthropathy) and
tendonitis
Limited used in children age under 18 years and pregnant mother
except pseudomonal infection in these patients with cystic fibrosis
Increased blood urea and creatinine, transient increased in liver
enzymes and bilirubim

Disturbances in vision, taste, smell, risk of haemolysis in G6PD

deficient patients
Therapeutic Uses
Generally well tolerated
Urinary tract infections (norfloxacin)
Prostatitis (Norfloxacin, Ciprofloxacin, Ofloxacin)
Sexually transmitted diseases
Lack activity of Treponema pallidum but activity against in vivo
against Nesseria gonorrhoes, C. trachomatis & H. ducreyi
Gastrointestinal && abdominal infections
Travellers diarrhea
Shigellosis (Norfloxacin, Ciprofloxacin, Ofloxacin)
Enteric fever (Ciprofloxacin, Ofloxacin)
Bone, joint & soft tissue infections
Osteomyelitis caused by Staphyococci & Gram negative rods
Respiratory tract infection
Other infections
Widely used for prophylaxis of anthrax, tularaemia
Multidrug-resistant tuberculosis & atypical mycobacterial
infection as well as Myco avium complex infection in AIDS
Drug Interactions
Ciprofloxacin, Grepafloxacin, Pefloxacin & enoxacin inhibit the
metabolism of theophylline
Enoxacin and NSAIDs (fenbufen) cause CNS stimulation (seizure)
Rifampicin
Pharmacological Action
Potent bactericidal agent acting on nucleic acid synthesis of bacteria
Refer anti-tuberculosis agents
Antibacterial Spectrum
Many strains of mycobacteria
Most Gram-positive bacteria
many Gram-negative bacteria (e.g., Esch. Coli, Pseudomonas, Proteus,
Klebsiella)
Staphylococcus aureus
Highly active against Nesseria meningitides, H. influenza
Nitroimidazoles/Metronidazole
Pharmacological Action
Include - Metronidazole, Niridazole, Tinidazole
Act by inhibiting DNA synthesis
Antibacteria
All anaerobic cocci

Anaerobic Gram-negative bacilli including Bacteroides species

Anaerobic spore forming Gram-positive bacilli (e.g., Clostridium)
Antiparasitic
Trichomonas vaginalis
Entamoeba hystolitica
Giardia lamblia, Leishmaniae
Sulfonamides
Pharmacological Action
Bacteriostatic act by competitive inhibition of dihydropteroate
synthetase which is responsible for incorporation of PABA essential for
the formation of folic acid (pteroyglutamic acid)
Folic acid is essential for bacterial growth & proliferation
Antibacterial Spectrum
Both Gram-positive & Gram-negative bacteria, Neisseria, coliforms
(except pseudomonas, proteus)
Chlamydia Trachoma
Protozoa Toxoplasma, malaria parasite
Nocardia & Actinomycetes
Classification
Agents absorbed & excreted rapidly
Sulfadiazine, sulfamethoxazole, sulfisoxazole
Agents absorbed very poorly orally active in bowel lumen
Sulfasalazine, pthalylsulfathalazole
Agents mainly used topically
Sulfacetamide, mafenide& silver sulfadiazine
Long acting sulfacetamides, absorbed rapidly but excreted slowly
Sulfadoxine
Therapeutic Uses
Urinary tract infection
Gram-positive & negative infection (allergic to penicillin)
Prophylaxis for HIV associated opportunistic infections
Prophylaxis for rheumatic fever
Malaria (Pyrexine = Sulfadoxine +Pyrimethamine).
Local infections:
Trachoma/inclusion conjunctivitis (Sulfacetamide eye drops)
Intestinal infections Phthalylsulfathiazole
Ulcerative colitis - Sulfasalazine
Burns - Sulfamylon, silver sulfadiazine
Dermatitis - Sulfapyridine
Co-trimoxazole
Antimicrobial Spectrum
Sulfamethoxazole (400 mg) + Trimethoprim (80 mg) - wider spectrum

Streptococci, Staphylococci, Neisseria, E. coli, Enterobacter sps.

Salminella, Shigella, Proteus, Klebsiella, Pasterurella, Yersinia,
Nocardia, Chlamydia, Pneumocystic carinil.
Therapeutic uses
Urinary tract infections
Gonococcal infection
Respiratory tract infections
Enteric fever
Brucellosis
Pneumocystis jiroveci infection in AIDS patients
Untoward effects
Kidney, Liver, Gi side effects
Neurological side effects
Haemopoietic reactions
Allergic reactions
Steven-Johnson syndrome
Incidence of syntemic untoward effects is higher with the long acting
sulfonamides
Co-trimoxazole
Untoward effects
Same as long acting sulfonamides
Megaloblasticanaemia with prolong therapy
Polypeptides
Antimicrobial Spectrum
A, B , C, D, E - Polymyxin B, Polymyxin E (Colistin) sulfficient margin of
safety
Gram (-)ve bacteria Haemophilus, Klebsiella, Pasteurella, Esch. Coli,
Salmonella, Shigella, Vibrio;
Many strains of Pseudomonas
Baitracin
Active against Gram-positive cocci
Penicillinase producing staphylococci
Others - Neisseria, H.influenzae, T. pallidum, Actinomycetes
Not effective against Pseudomonas
Antifungal Agents
Classification
Systemic antifungal agents (given orally or parenterally)
Amphotericin B (IV)
Flucytosine (5 Flurocytosine) (orally)

Imidazoles & Triazoles Ketoconazole, Itraconazole, Fluconazole

(orally)
Terbinafine
Griseofulvin (for superficial fungal infections) (orally)
Topical antifungal agents
Griseofulvin
Imidazoles & Triazoles
Clotrimazole
Myconazole
(CANESTEN)
Sulconazole
Ketoconazole
Butoconazole
Terconazole
Econazole
Polyene antifungal antibiotics
Nystatin , natamycin, Amphotricin B
Ciclopiroxolamine group
Ciclopiroxolamine
Haloprogin

Oxiconazole

Tolnaftate
Naftifine
Terbinafin

Miscellaneous antifungal agents

Whitfields ointment (6% Benzoic acid and 3% Salicylic acid)
Antiviral Agents

When is Antibiotic Necessary?

Antibiotics are generally only useful for the treatment of bacterial infections.
Important to remember that not all fevers are due to infections & not all
infections are caused by bacteria.
Majority of infections seen in general practice are of viral origin & antibiotics
can neither treat viral infections nor prevent secondary bacterial infections in
these patients.
Even in bacterial infections, an antibiotic may not be always necessary. Many
bacterial infections resolve spontaneously.
Minor superficial skin infections may be more suitably treated with a
local antiseptic.
Collections of pus should be drained surgically & if drainage is
adequate, antibiotics are often not required.
Causes of Non-response to Antibiotics
A patient may fail to respond to an antibiotic for a number of reasons which
include:

Etiologic agent is resistant to antibiotic

Incorrect diagnosis
Wrong choice of antibiotics
Choice of antibiotic is correct but the dose &/or route of
administration is wrong
Antibiotic cannot reach the site of infection
Collection of pus that should be drained surgically or a foreign
body/devitalized tissue that should be removed
Secondary infection, immuno-compromised patients, cancer,
diabetes, steroid drugs etc.
Non-compliance of the host
Antibiotic fever