NMLE step I: Infectious Diseases

NL: Infectious disease I Antibiotics

.. (MED26)

Encoded by 04 and 27 MED34

Proof by 32 MED34

infection
Host

DM, thalassemia, chronic renal failure

Burkholderia pseudomallei
encapsulated organism S.pneumoniae H.influenza

complement system deficiency C6-C9

Neisseria meningitidis

infection

infection
identify microorganism

S. auereus
antibiotic cloxacillin dicloxacillin
Klebsila pnuemoniae antibiotic 3 generation
rd

cephalosporin ceftriazone

drug resistance

fever 2-3
replication influenza

septic arthritis most common S. aureus rheumatic

NMLE step I: Infectious Diseases

heart disease hematogenous spread Timing

timing 2 2 slow
growing TB
pulse

pulse (relative bradycardia) typhoid fever Salmonella

spp.

Infection
pneumonia; stiffneck positive
meningitis; ( focal neurodeficit)
Brain abscess; (orthopnea)
acute rheumatic fever infective endocarditis;
acute pyelonephritis;
septic arthritis


common Acute

bacterial meningitis common S.pneumoniae;

common immunity acquired pneumonia S.pneumoniae;
common septic arthritis S. auereus; common
peritonitis E.coli; common UTI E.coli

common

empirical antibiotic gram stain
culture

NMLE step I: Infectious Diseases

NMLE step I: Infectious Diseases

anthrax

(Bacillus

anthraxis) malleoidosis
leptospirosis

rabies Pasturella sp.

immune function phagocytic activity

streptococci staphylococci

fungus

NMLE step I: Infectious Diseases

mucor DM sinusitis
rhinocerebral mucormycosis

penicillin -lactam cross reaction
immunocompromised host antibiotic

cell
bacteriocidal
wall cell membrane immune
bacteriostatic cidal
Antibiotic metabolism

hepatic function renal function
-lactam 2
ceftriaxone cloxacillin
dose
antibiotic term In
vivo In vitro test In vitro effect

(In vivo) In vitro In vivo
volume of distribution
In vitro blood concentration
dose
In vivo tissue concentration

tissue

Macrolide

NMLE step I: Infectious Diseases

Quinolone

intracellular

organism

Mycoplasma

pneumoniae tissue concentration

antibiotic

drugs resistance mechanism

o Intracellular drug concentration pump
cell; outer membrane permeability
cytoplasmic membrane transporter

o Inactivation enzyme
-lactamase

modifying enzyme

aminoglycoside

o Target modification quinolone

gyrase structure gyrase

quinolone

-lactam

protein

binding penicillin binding protein cell wall

antimicrobial factor
1. Spectrum
2. Mechanism
3. Pharmacokinetic
absorption, diffusion, metabolism,
elimination

NMLE step I: Infectious Diseases

drug
4. Pharmacodynamic
interaction side effect

Main Mechanisms of antibiotics

inhibit

cell

wall

synthesis

bactericidal -lactam, cyclopeptide

gram positive gram positive cell wall

peptidoglycan

inhibit

macrolide,

clindamycin, chloramphenicol, tetracycline aminoglycoside

bacteriostatic

NMLE step I: Infectious Diseases

bactericidal aminoglycoside clindamycin

bactericidal

inhibit nucleic acid quinolone, co-

trimoxazole metronidazole bactericidial

Penicillin

Penicillin

Natural penicillin Pen V Pen G

cover gram positive

Penicillin cover gram positive S.pneumoniae

acute bacterial meningitis pneumonia

gram positive Enterococcus Enterococcus fecalis

subacute bacterial endocarditis

antibiotic penicillin

NMLE step I: Infectious Diseases

Penicillin cover gram negative Neisseria

meningitidis cover anaerobe Diaphragm

aspirate pneumonia

right lobe antibiotic of choice

PGS high dose

Treponema pallidum syphilis

primary, secondary tertiary Primary

syphilis chancre (

Haemophilus Ducreyi chancroid ()

gram stain gram

negative coccobacilli) antibiotic of choice syphilis
penicillin

Leptospira

spp.

leptospirosis

organ failure Weils syndrome
antibiotic of choice penicillin
Aminopenicillin amino group cover
gram

negative

H.influenza

amoxicillin () ampicillin ()
enzyme penicillin penicilinase
S. auereus

NMLE step I: Infectious Diseases

10

Aminopenicillin ampicillin amoxicillin activity

gram negative Samonella, E.coli , H.influenza Salmonella

typhoid fever

wbc (leukopenia) Peyers

patch terminal ilium right lower quadrant pain
Peyers patch rupture GI bleeding
skin sign Salmonella
(rosette form)

H.influenza gram negative coccobacilli

neonatal meningitis, respiratory tract infection rhinositis

pneumonia COPD

Neisseria meningitidis

acute bacterial meningitis clinical

Waterhouse-Friderichsen syndrome severe sepsis
acute adrenal insufficiency adrenal gland hemorrhage
typical purpura


antibiotic prophylaxis
Enzyme lactamase -lactamase inhibitor
sulbactam, clavulanate, tazobactam
Augmentin (Amoxicillin/clavulanate)

NMLE step I: Infectious Diseases

11

Cloxacillin cloxacillin
dicloxacillin
staphylococci
Cloxacillin dicloxacillin cover strep staph.

staph. soft tissue infection S. auereus

skin and soft tissue infection cellulites

S. auereus acute infective
endocarditis,

septic

arthritis,

osteomyelitis

enterotoxin food poisioning strep.

soft tissue and skin infection S. pyogenes

soft tissue and skin infection, erysipelas, cellulitis,

necrotizing fasciitis ( strep flesh-eating
bacteria) pharyngitis

acute rheumatic fever poststreptococcal glomerulonephritis

antibiotic

carboxypenicillin

piperacillin board spectrum cover gram positive-negative,

Pseudomonas aueruginosa anaerobic

Carbapenem imipenem

meropenem activity cover gram positive-

NMLE step I: Infectious Diseases

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negative anaerobes community-acquired

nosocomial infection
Imipenem

cilastin

inhibit

renal

dihydropeptidase I imipenem

aztronam

Cephalosporin

Cephalosporin 4 generation
1 generation cefazolin cefa spectrum
st

penicillin cover gram + cover gram -

cloxa enterobacteriaceae
2

nd

generation cefoxitin cefuroxime

Bacteroides fragilis intraabdominal abcess

gangrene cefoxitin activity
3

rd

generation cefotaxime, ceftriaxone, cefoperazone,

ceftazidime ceftriaxone cefotaxime cover Gram positive

negative ceftazidime cefoperazone cover
Gram negative

Pseudomanas aeruginosa

Burkholderia pseudomallei ceftazidime drug of

choice melioidosis

NMLE step I: Infectious Diseases

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4 generation cefepime cefpirome cover Gram

th

positive ceftriazone cover Gram negative

Pseudomanas aeruginosa spectrum cefoperazone

Quinolone

Quinolone design treat gram negative

4 generation generation nalixidic acid

nd

generation Ofloxacin, Norfloxacin, Ciprofloxacin

Norfloxacin
GI tract
infective diarrhea Ofloxacin
UTI

Ciprofloxacin quinolone

Pseudomonas aeruginosa

Quinolone cove r gram negative

generation cover gram positive

respiratory tract infection S.pneumoniae

atypical pathogen quinolone

cell
tissue
atypical pneumonia Mycoplasma

pneumonia cell quinolone
Levofloxacin

NMLE step I: Infectious Diseases

rd

14

4 generation quinolone cover

th

gram positive S.aureus S.pneumoniae

gram negative quinolone excellent activity

cover respiratory tract organism

H.influenza Moraxella catarrhalis Moraxella catarrhalis

gram negative diplococci COPD

H.influenza
gram-ve diplococci

specimen sputum Moraxella catarrhalis

urethral discharge Neisseria gonorrhea
CSF Neisseria meningitides

Atypical bacteria Mycoplasa pneumonia

walking pneumonia

consolidation bacteria
pathology
interstitial

AIHA

antibody

infect

IgM

tympanic membrane
skin lesion Erythema multiforme Target
lesion ()
Mycoplasma

quinolone activity
intracellular

organism

Mycobacterium

Mycobacterium tuberculosis Mycobacterium-avium

NMLE step I: Infectious Diseases

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complex HIV pneumonia

quinolone

Macrolide

erythromycin side effect

3
roxithromycin, clarithromycin, azithromycin

Macrolide design penicillin

Gram +ve Gram +ve penicillin

shift macrolide cover
Gram ve atypical pathogen
Gram+ve erythromycin clarithromycin
best activity Gram -ve respiratory tract infection

H.influenza Moraxella catarrhalis new macrolide

azithromycin

treat

atypical

pathogen

Mycobacterium-avium complex, Campylobacter, Treponema

pallidum intracellular organism

Aminoglycoside

Aminoglycoside design cover Gram -ve

amino group
GI tract

NMLE step I: Infectious Diseases

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aminoglycoside

Streptomycin,

Neomycin

Tobramycin Gentamycin Amikacin cover gram-ve

gram +ve In vitro
gram +ve aminoglycoside infective
endocarditis penicillin group aminoglycoside
synergistic penicillin group cell wall cell wall

aminoglycoside 30S
ribosome

Vancomycin

Vancomycin design cover gram+ve

vancomycin

methicillin-resistant Staphylococcus aureus (MRSA)
MRSE coagulase ve staphylococcus (Staph 2
species

S.aureus

coagulase

+ve

S.epidermidis skin catheter

coagulase ve)

Clindamycin

NMLE step I: Infectious Diseases

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Clindamycin design cover gram +ve

anaerobe

Metronidazole

Metronidazole cover anaerobe diaphragm

Clostridium difficile drug of choice metronidazole

anaerobe
diaphragm

anaerobe diaphragm 2 PGS

clindamycin

metronidazole cover protozoa

Trichomonas vaginalis ( strawberry vaginitis), Entamoeba

histolytica ( dysentery amoebic liver abscess),

Giardia lamblia ()

Drug interaction

interaction

antibiotic

antibiotic

drug

quinolone group tetracycline doxycycline drug

interaction Zn Al Ca Mg Fe
alum milk
antibiotic

NMLE step I: Infectious Diseases

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Theophylline drug interaction

theophylline overdose

erythromycin inhibit metabolism theophylline

Erythromycin, clarithromycin cimetidine inhibit

cytochrome P450 metabolize P450
theophylline, cyclosporine, phenytoin ( phenytoin
overdose nystagmus ataxia), warfarin (overdose
bleeding PT prolong), digoxin (overdose arythmia heart
block digoxin overdose hypokalemia )
Metronidazole anaerobe GI
K wafarin K
bleeding metronidazole disulfulam-like effect
alcohol BP drop metronidazole
Li Li toxicity
DI

Side effect

Side effect

-lactam

hypersensitivity

anaphylactic shock
BP drop lung wheezing
anaphylaxis
adrenaline

hypersensitivity

NMLE step I: Infectious Diseases

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immune immunopathology autoantibody

normal cell WBC, RBC side effect -lactam
acute interstitial nephritis
UA eosinophil -lactam 2
weeks
High dose ( impenem) seizure
impenem add cilastin enzyme
impenem toxic metabolite
Cefoperazone vitamin K
GI normal flora bleeding
Quinolone side effect GI upset
Macrolide side effect N/V erythromycin

Aminoglycoside side effect 3
o NMJ blockage underlying
Myasthenia gravis NMJ disorder

o Nephrotoxicity direct renal tubule toxicity

injury immune complex reversible early
detect off

NMLE step I: Infectious Diseases

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o Ototoxicity vesibular
toxicity irreversible vertigo ataxia

scenario
1. 25

erytrymatous

antibiotic ?
-

cellulites

clarify

S.aureus

border

S.pyogenes S.aureus antibiotic of choice

cloxacillin skin and soft tissue infection

2. 45 renal failure hemodialysis

crepitation

NMLE step I: Infectious Diseases

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of both lung pansystolic murmur apex antibiotic

?
- Clinical heart failure acute infective

endocarditis S.aureus
cloxacillin

antibiotic

3. 50


3 5
antibiotic of choice ?
- leptospira antibiotic of choice Penicillin
4. 25 dyspnea 3
x-ray diffuse interstitial infiltration severe hypoxia
ARDS antibiotic of choice ?

- Pneumocystis jiroveci antibiotic of choice

co-trimoxazole

5. 20 xray interstitial infiltration 1 antibiotic of choice

?
- mycoplasma lab
cold agglutinin mycoplasma IgM
IgM antibiotic of choice
macrolide roxithromycin

NMLE step I: Infectious Diseases

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6. 25

hepatosplenomagaly

right

upper

quadrant

- thalassemia
abscess melioidosis antibiotic of choice ceftazidime
7. 40
tender hepatomagaly single
lesion antibiotic ?
- amebic liver abscess antibiotic of choice
metronidazole
8. 25
hypovolemic shock antibiotic of
choice?

- Vibrio cholerae antibiotic tetracycline