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Cell wall inhibitor ind to PP so inhibit cew synthesis & f autolysin, Penicillin pass placenta & inflamed CSE & exereted by urine & propencil interfere exeretion so action Resist > mo produce B-lactamase enzyme. P~ aeruginosa is penicillin resistant due to restrictive porine Amoxicillin used for endocatditis & dental use But not used for tt shigella & salmonella enteritis as it f absorbed Ampicillin is D.O.C ut gm-ve bacilli & Klebsiella ~ Natural penicillin (G-V) / extend (A.A) /antistaphyllo (m.n,0,4) / Antipseudomonal (p,.). = Penicillin combination with aminoglysoide But not together due to interact het #ve & -ve charge Forming inactive complex. Depot fiom of penicillin ex. Procaine & benzathine. Penicillin used for renal patient naficillin —oxacillin ~ dicloxaeillin. = SE cation toxicity (penicillin G-> 1 k & ticareilin > | Na) & pseudo memberance colitis Generation: a effect PJE.K include celuzoline > bone & cephalexin > pharyngitis, S 2 effect H.E.N include cefuroxime Na > bronchitis & pencumonia / cefuroxime axetil > B lactamase produging \\ \ >. ¥¥cotiawone > pass CSF, bone, & Ut gononea cefotaxime > CSF cfiinir/eetaridime Y Perugmos4) SS “‘celipime > P.acruginosa a = Celazoline > it bone infeotion & orthopedic surgery & surgery eae = Ceftriaxone > used for renal patient Carbapenam Ex Meropenem & imipenem. 7 TImipenem used with saint protect it om metabo WK dase enzyme to toxie from. Pawest wp tem menage NOE NS Monubactam . O \ Fx havea ee Parcuginosa See SY 1 Effect liver fmetion = Used for penicitim iyi a Sis pain Bactamase inhibitor Ex Clavulanie acid ~ sulbactam ~ tazobactam Vancomycin f ~ fleet MRSA, MRSE but not effect VRE ge Pass C {Cause Bashing ced man sy) Protein synthesis protein synthesis. "mated ef ~~ = Doxyeyeline & minocyeline absorbed orally. = Doxyeyeline pass in stl (used foe 3%. + Minoeyeline pass CSF & saliva T.C bind with Ca"? {abgorption.\W, + Cancenterated in gasrie eareinoma Moaolized byliter to ghiguronoid Bekebth vestibulatproblem — phototoxicty— Azotema MOA bacteriostatic, Risistane : \\ Ex. Tigeeyeline, waingey oie Os, Tind to SOS wiboSeinal yuPunit & inhibit protein synthesis = Wsof tissue, inraabdominal infection, Aminoglycosi nize cell by O2 — dependent system — bind to 30 S subunite so inhibit protein synthesis. Resistance Acetyl transferase ~ phosphotranse — uncleotidyl transferase Neomyein used mainly topically, also intraventricular & intrathecal SE: Nephrotoxieity, ootoxicity, neuromuscular paralysis, Macrolide Ex Erythromycin — clarithromycin — azithromycin — telithromycin (act against gm+ve resistance macrolide), MOA ~ Blind to 50 $ ribosomal subunite so inhibit protein synthesis also inhibit wanspeptidation, Orally erythromycin break by gastic avidity so used as esterform or enteric coated. IV erythromyein cause thrombophlebitis, = Passo liver & C's Macrolide inhibite cyp 450 so | other drugs metabolism-> toxic SLE : epigastric distress — Jaundice —ototoxicity + Telithromycin CI in renal, myasthenia gravis. Prolonged Qte patient = Macrolide effect flora so } digoxin absorption & toxicity BioAssay Toxicology Bind to 50 S subunit of ribosome & inhibit protein synthesis 1 dose effect mitochondrial ribosome of human & cause bone marrow toxicity Not effect P-aeruginose & chlamydia ass normal CSF Pass in urine & breast milk hemolytic anemia (|G6PD), Gray baby syndrome (| renal & hepatic function). Chloramphenicol | liver enzyme so [toxicity of warfarin — tolbutaminde ~ chloropropamide. Clindamyein : = Blind to 50 $ ribosomal subnunit so inhibit protin synthesis = Act against MRSA. = Cross resistance bet clindamycin & erythromycin, = Pass bone & CSF = S.E :pseudomemance colitis tt by vancomycin or metronidazole, Bind to 50 S subunit of ribosome & inhibit formation of 70 S ribosome so inhibite protein synthesis = Effect VRE not effect MRSA bacteremia, = Secreted in bile & urine. ~ SE :optic neuritis (blindness), neuropathy, thrombocytopenia. Inzolid don’t use with tyramine or SSRI to avoid serotonin syndrome as DNA inhibitors Hlouroaulnolone: oroqunolove is more act guns tp fom oT nlx ad & 2ecpofionse,ooxacin . © 3 levofloxacin, . © dM moxionacn (not concentrated in wing not wed Norfloxacin low orally absorbed. » Oran pn CS \ Moxifolsain, ofloxacin | theophyline metbo AYR Levofloxacin tt prostatitis amd gonorrhea /xoftnasis & mbxilleacin > tt peumonia, iprofloxacin > tranthnx Stypooi fale’ io, nor evo > jana 5 mg/kg/dialy Then 4 months > wh 15 mg/kg trifampin 10 mg’kg twice Weekly, Inhibit hebaie enzyme. SE optic neuritis, seizure. ampin “More active than INH. = Rifampin & INH is most potent ant, MOA inhibit RNA synthesis. = Dose s 600 mg/dl (Ihr belo 2h es eal = Pass body Mud (salva, Tear...) & cause orange red cor. = Wheyp4s0 = SEoptie neu, {vista aguiy, | detimiaton het WN wen color an gute Ethionamide : Z \ ~ Inhibit mycobacterial arabinoglactan cell wall. A . - Backteriostai < <_temml iseeove roned arest reg AN = Secreted by kidney E optic neuritis, J visual aeuty, -dlserimination debved nai poate Pyrazinamde : ( Pyrazinamide yyrazinoic ac tm ingot Rua synth 1 gene So inhibit my colic acid synthesis. Tore active at ail FRADE pore act on inuaee Mas Bacieca Cl during pregnangyrazinamidas QYN SE polyathalzia, hyperuricemia, myalgig ‘Streptomycin Q ~ Inhibit acter protein synths = Cidal WY Streplomyn re cia > nadpamitadn open = Dose bvice daly ax not more SA mont SS = Clin pregnancy. \ yy = SLE : vestibular roxio vertigo, hgfseky Cochlear oxiity, face paresthesia 2nd line Q Ethionamide; >< stRialSanc OFINU inhibit mye dis acid synthesis, effect inta and eata cellular infeton Pass CSE SE neuropathy, optic bacteria, PASA: Q = Inhibit syntheSIQOFSHP (as su. PASA ct on mycobacteria not other bacteria Capreomycin : ~ Use Im, inhibit protein synthesis -SENephno, oto toxicity. Cyeloserine = Tubetealostai. = Pass CSF = Bxereted in urine SLE: seizure & neuropathy (tt by pyridoxine “vt BO") n & clarithromycin - Used with ethambutol & rifampin for tt m-avium. n used in HIV patient as don’t interfere with antiretroviral srug Linzolide ‘act on intracelhular TB, #4 drug regimen for ttt. : T. IN2. 2.Rifumpin, 3. Pyrazinamide. 4, Ethambutol or streptomycin, Toxicology