ANTIBACTERIAL

DRUGS
 2
LEARNING OBJECTIVES

At the end of this lecture each student should be able to:

1. Describe the difference between gram +ve and gram –ve

bacteria.
2. State the different classes of antibacterial drugs.
3. Describe the mechanism of drug action, indications and
adverse effects of Antibacterial drugs.
 Gram+ vs. Gram- Cell Walls 3
❖ Gram +ve cells have a very thick, peptidoglycan.
❖ Gram -ve cells have a very thin layer of peptidoglycan plus
a thin outer layer.
Have an outer (Lipid) membrane in addition to the
cytoplasmic membrane, the space between these two
membranes is called the periplasmic space or periplasm
Gram positive Bacteria 4
Gram negative Bacteria 5
Classification Based on MoA 6
INHIBITORS OF BACTERIAL CELL WALL SYNTHESIS
7
❖ Cell wall active agents;

✓ Beta Lactams: Penicillins, Cephalosporins, Carbapenems,

Aztreonam.
 Penicillins 8
❑ Basic Structure
 Thiazolidone ring is attached to a β-lactam ring.

 Contains one alterable side chain (R group), which can confer

different antibacterial and pharmacological properties.
 9
Mechanism of action

❖ Penicillins inhibit bacterial cell wall synthesis by interfering with

transpeptidation.

❖ Penicillins are bactericidal (kill bacteria)

 Classification 10
❖ Classified as narrow or broad spectrum.

Classification

Narrow Spectrum Wide Spectrum

Very Narrow: Natural Penicillins: Extended Spectrum: Anti Pseudomonal:

❖ Meficillin ❖ Pen V ❖ Amoxicillin ❖ Piperacillin

❖ Nafcilin ❖ Pen G ❖ Ampicillin ❖ Ticarcillin
❖ Cloxacillin ❖ Carbecilin
❖ Dicloxacillin ❖ Azlocilin
❖ Flucloxacillin ❖ Mezlocilin
❖ Oxacillin
 Natural Penicillins/Narrow spectrum 11

Moderately narrow spectrum:

BENZYL PENICILLIN (PENICILLIN G)

❑ Streptococcus species, meningococcus, clostridium tetanus, clostridium
welchii, gonococcus, treponema pallidum and many other spirochetes.
❑ Inactivated by gastric acid therefore given IV or IM

PHENOXYMETHYL PENICILLIN (PENICILLIN V)

❑ Stable to gastric acid therefore given orally less active than penicillin G
❑ Penicillin G and Penicillin V are inactivated by beta lactamases
 Penicillins resistant to beta-lactamases 12

Very narrow spectrum

✓ Also called anti staphylococcal Penicillins

✓ Examples: Methicillin, Nafcilllin, Cloxacillin, Dicloxacillin,

Flucloxacillin, Oxacillin

✓ Used for treatment of beta lactamase producing staphylococci

infections
 Broad spectrum Penicillins (Amino Peni..) 13
❑ Members include: Ampicillin and Amoxicillin.
❑ Have more activity against gram -ve organisms than natural
penicillins.
❑ Easily inactivated by beta lactamases.
❑ Ampicillin and Amoxicillin can be protected from destruction
by beta-lactamases if they are co-administered with beta
lactamase inhibitors e.g. Amoxicillin + Clavulanic acid and
Ampicillin + Sulbactam
 Adverse effects 14

❖ Hypersensitivity reactions

❖ Neurotoxicity with high doses

❖ Nausea, diarrhea.
 Cephalosporins 15

Basic Structure

Similar to penicillin, they are β- lactam antibiotics

 Mechanism of action 16

 Similar to penicillins:

 Binding to specific penicillin binding proteins (PBPs) that

serve as drug receptors on bacteria

 Inhibition of cell wall synthesis by blocking transpeptidation

of peptidoglycan
 Classification of Cephalosporins 17
 Have been divided into the five major groups (generations)
depending mainly on the spectrum of anti-microbial
activity

 Broader spectrum of antibacterial activities

 More stable/resistant to β-lactamase hydrolysis

 First-Generation Cephalosporins 18

 1st Generation:
 Cephalexine, cefadroxil, cefazolin, cephaprin,
cephalotin, caphadrin.

 Active against G +ve and some G -ve

 Uses: URTI, LRTI, UTI

 Second-Generation Cephalosporins 19
2nd Generation:
 Cefuroxime cefoxitin, cefamandole, cefprozil

 Haveextended activity against GNB while retaining activity

against G +ve orgs;

 Uses: community acquired pneumonia, URTI and UTI.

 Third-Generation Cephalosporins 20

3rd Generation:
❖ Cefotaxime, ceftriazone, ceftazidime, cefpodoxime, cefixime
❖ Extended G- activities but less G+ effects

Uses: G- infections, pseudomonal infections, G- meningitis, gonorrhea, UTI,

osteomyelitis
 Fourth-Generation Cephalosporins 21
4th Generation:
 Cefepime

 More resistant by β-lactamases

 to hydrolysis
 Good activity against Pseudomonas, enterobacteria, as
well as Staph, Strept, haemophilus, and Neisseria

 Uses: Infections caused by above organisms

 Adverse effects of Cephalosporins 22

 Local irritation after intramuscular injection

 Thrombophlebitis after intravenous injection
 Pseudomembranous colitis.
 Allergic reactions: Similar to penicillin
 Interstitial nephritis
 Renal tubular necrosis
 Bleeding disorders
 Other Beta-lactam drugs 23

Monobactams
 Example: Aztreonam

 Resistant to beta-lactamases and active against gram-

negative rods (including pseudomonas & serratia)

 Have no activity against gram-positive bacteria or

anaerobes
 Carbapenems 24

 Examples: Imipenem, Meropenem.

 Have very broad spectrum of antimicrobial activity.

 Active against many aerobic & anaerobic gram-positive

and gram-negative organisms. Pseudomonas rapidly
develops resistance.
 Glycopeptide: Vancomycin 25

 Vancomycin is active only against gram-positive

microorganisms.

 Acts by inhibiting cell wall synthesis. Inhibits biosynthesis

of peptidoglycan

 Peptidoglycan: Major structural component of bacterial

cell wall
 Adverse effects 26

 Nephrotoxicity
 Pain and thrombophlebitis with IV route
 Ototoxicity
 Occasional mild hematuria, proteinuria, azotemia, casts in urine

–Hypotensive reaction associated with rapid IV administration

–Hypersensitivity
 PROTEIN SYNTHESIS INHIBITORS 27
Bacteriostatic Agents: Bind to and interfere with bacterial
ribosomal function

 Tetracylines, Chloramphenicol, Macrolides, Clindamycin

 Aminoglycosides, Spectinomycin
 Protein Synthesis Inhibitors 28

 50S ribosome inhibitors

-Macrolides
-chloramphenicol

 30S ribosome inhibitors

-Aminoglycosides
-Tetracyclines
 Tetracycline 29

Specific drugs
✓ Doxycycline
✓ Minocycline
✓ Tetracycline
 Activity: 30

 Broad spectrum & Bacteriostatic

 Many G + and G – orgs, rickettsia, mycoplasma, and

chlamydia

 Bacteria concentrate antibiotic internally

 Clinical Uses of Tetracyclines 31

 Treatment of infections caused by

Rickettsia,
Mycoplasma,
Chlamydia
Spirochetes
Gram + and gram - organisms
Side effects/ Adverse drug reactions 32

 Tooth enamel dysplasia and possible reduction in bone

growth in children.(avoid)

 Impaired liver function during pregnancy.(avoid)

 Sensitivity to light (photosensitivity) – doxycycline

 Superinfection leading to candidiasis or colitis

 Aminoglycosides 33

They are bactericidal drugs

 Examples include;
✓ Streptomycin,
✓ Kanamycin,
✓ Gentamicin,
✓ Tobramycin,
✓ Amikacin, and
✓ Neomycin (topical)
 Mode of action 34

 They act by blocking bacterial protein synthesis by

binding to the 30S ribobosomal subunit
 Clinical Uses 35

 Treatment of infections caused by susceptible organisms

 With penicillins to treat enterococcal endocarditis

 Treatment of meningitis

 Topical preparations for burns, wounds, eye infections, etc

 Adverse Effects 36

 Nephrotoxicity (Neomycin, Kanamicin, Amikacin)

 Ototoxicity; Induces deafness (Neomycin, Tobramycin,

Gentamycin)
 Macrolides 37

 Macrolide antibiotics have an antibacterial spectrum

similar but not identical to that of penicillin.

 Examples
✓ Erythromycin
✓ Azithromycin
✓ Clarithromycin
 Mechanism of action 38

 Macrolides bind to bacterial 50S ribosomes and inhibit

protein synthesis.

 Produce bacteriostatic.
 Activity 39

 Broad spectrum of antimicrobial activity against;

✓ Gram positive cocci
✓ Atypical organism (mycoplasma, chlamydia
✓ Legionella pneumophilia
✓ H.pylori- treatment of ulcers due to h.pylori
✓ Treponema
✓ Mycobacteriam avium
 Clinical Uses 40

 Useful for treatment of:

✓ Community acquired pneumonia

✓ Staphylococcal infections
✓ Chlamydial infection: eyes, respiratory tract,
genitals
 Chloramphenicol 41

 Broad spectrum antimicrobial and penetrates tissue

very well.
 It is bacteriostatic but is extremely effective against
streptococci and staphylococi. It is curently a backup
drug for infections due to salmonella typhi, rickettsia
and possibly in bacterial meningitis

MoA
 Inhibits 50S ribosomal subunit of bacteria
 Specifically inhibits peptide bond formation
 Clinical Uses & ADR 42

 Bacterial meningitis
 Eye and ear infections
 Typhoid fever

 Nausea, vomiting and diarrhea

 Predispose to Candida infections (oral and
vaginal)
 Dose related myelosuppression
 Aplastic anemia
 43
TOPOISOMERASE INHIBITORS; Quinolones
 Inhibition of topoisomerases II(DNA gyrase) and
prevents replication or transcription of DNA.
 Quinolones cont’ 44

 Nalidixic acid, Norfloxacin – active against G- orgs

 Ciprofloxacin, Levofloxacin, Ofloxacin – active against G-

and G+

 Moxifloxacin – better G+.

 45
Quinolones: Therapeutic Uses

 Lower respiratory tract infections

 Bone and joint infections
 Infectious diarrhea
 Urinary tract infections
 Skin infections
 Sexually transmitted diseases
 TB treatment
 Adverse Effects 46

 Well tolerated
 GIT related
 ECG abnormalities
 Destruction of cartilage in growing children –
arthropathy
 Tendonitis (adults)
 Avoid in pregnancy
 END.
47

THANK YOU

Any questions?
 FURTHER READING 48

Rang H. P, Dale M. M, Ritter J. M, Flower R. J, Henderson G. Rang

& Dale’s Pharmacology, 7th ed. Ch.50. Churchill-Livingstone

Katzung B. G. Basic & Clinical Pharmacology,12th ed. Ch. 43–46.

McGraw-Hill.