Antimikroba
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Transcript of Antimikroba
Definition
• Chemotherapeutic agents– Drugs that act against diseases
• Antimicrobial agents – Drugs that treat infections• Antibiotics
• Antimicrobial agents produced naturally by organisms
• Semisynthetics– Chemically altered antibiotics that are more effective than
naturally occurring ones• Synthetics
– Antimicrobials that are completely synthesized in a lab
• 1928 – Fleming discovered penicillin, produced by Penicillium.
• 1940 – Howard Florey and Ernst Chain performed first clinical trials of penicillin.
Features of Antimicrobial Drugs• Selective toxicity
– Antibiotics cause greater harm to microorganisms than to human host
– Toxicity of drug is expressed as therapeutic index• Lowest dose toxic to patient divided by dose typically
used for treatment– High therapeutic index = less toxic to patient– Narrow therapeutic index = more toxic, monitor closely
Features of Antimicrobial Drugs
• Antimicrobial action– Bacteriostatic drugs
• Inhibit bacterial growth• rely on host immunity
– Bacteriocidal drugs • Kill bacteria• Most useful in situations when host defenses cannot
control pathogen
Classification of antibacterial agents:
bactericidalβ-lactam agents Aminoglycosides Co-trimoxazoleVancomycin
bacteriostatic• Erythromycin• Tetracycline• Chloramphenicol• Sulfonamide• Trimethroprim
Features of Antimicrobial Drugs
• Spectrum of activity– Antimicrobials vary with respect to range of
organisms controlled• Narrow spectrum
– Work on narrow range of organisms» Gram-positive only OR Gram-negative only
– Advantage: effects pathogen only– Disadvantage: requires identification of pathogen
• Broad spectrum– Advantage: Work on broad range of organisms– Disadvantage : disruption of normal flora
Features of Antimicrobial Drugs
• Effects of combinations of antimicrobial drugs– Combination sometimes used to treat infections
• Synergistic: whole is > sum• Antagonistic: whole is < sum
Features of Antimicrobial Drugs
• Tissue distribution, metabolism and excretion– Drugs differ in how they are distributed,
metabolized and excreted– Half-life: Rate of elimination of drug from body
• Time it takes for the body to eliminate one half the original dose in serum
• Half-life dictates frequency of dosage– Patients with liver or kidney damage tend to
excrete drugs more slowly
Features of Antimicrobial Drugs
• Adverse effects– Allergic reactions– Toxic effects– Suppression of normal flora– Antimicrobial resistance
Figure 10.2 Mechanisms of action of microbial drugs
Humancell membrane
Inhibition of pathogen’sattachment to, orrecognition of, hostArildonePleconaril
Inhibition of cellwall synthesisPenicillinsCephalosporinsVancomycinBacitracinIsoniazidEthambutolEchinocandins(antifungal)
Inhibition of DNAor RNA synthesisActinomycinNucleotide analogsQuinolonesRifampin
Inhibition of generalmetabolic pathwaySulfonamidesTrimethoprimDapsone
Disruption ofcytoplasmic membranePolymyxinsPolyenes (antifungal)
Inhibition ofprotein synthesisAminoglycosidesTetracyclinesChloramphenicolMacrolides
Mechanisms of Antimicrobial Action
• Inhibition of Cell Wall Synthesis– Inhibition of bacterial wall synthesis
• Most common agents prevent cross-linkage of NAM subunits
• Beta-lactams are most prominent in this group– Functional groups are beta-lactam rings– Beta-lactams bind to enzymes that cross-link NAM
subunits• Bacteria have weakened cell walls and eventually lyse
© 2012 Pearson Education Inc.
Structural formulas of some beta-lactam drugs
Penicillin G (natural)
Methicillin (semisynthetic)
Penicillins Cephalosporin Monobactam
-lactam ring
Cephalothin (semisynthetic) Aztreonam (semisynthetic)
The effect of penicillin on peptidoglycan in preventing NAM-NAM cross-links
Penicillin interferes with the linking enzymes,and NAM subunits remain unattached to theirneighbors. However, the cell continues togrow as it adds more NAG and NAM subunits.
Growth
The cell bursts from osmoticpressure because the integrity ofpeptidoglycan is not maintained.
New NAM-NAMcross-linksinhibited bypenicillin
Previously formedcross-links remainunchanged
Mechanisms of Antimicrobial Action
• Inhibition of Cell Wall Synthesis– Inhibition of synthesis of bacterial walls
• Semisynthetic derivatives of beta-lactams – More stable in acidic environments– More readily absorbed– Less susceptible to deactivation– More active against more types of bacteria
• Simplest beta-lactams – effective only against aerobic Gram-negatives
Mechanisms of Antimicrobial Action
• Inhibition of Cell Wall Synthesis– Inhibition of synthesis of bacterial walls
• Vancomycin and cycloserine – Interfere with bridges that link NAM subunits in many
Gram-positives• Bacitracin
– Blocks secretion of NAG and NAM from cytoplasm• Isoniazid and ethambutol
– Disrupt mycolic acid formation in mycobacterial species
Mechanisms of Antimicrobial Action
• Inhibition of Cell Wall Synthesis– Inhibition of synthesis of bacterial walls
• Prevent bacteria from increasing amount of peptidoglycan
• Have no effect on existing peptidoglycan layer• Effective only for growing cells
Mechanisms of Antimicrobial Action
• Disruption of Cytoplasmic Membranes– Some drugs form channel through cytoplasmic
membrane and damage its integrity– Amphotericin B attaches to ergosterol in fungal
membranes
Mechanisms of Antimicrobial Action
• Disruption of Cytoplasmic Membranes– Azoles and allylamines inhibit ergosterol synthesis– Polymyxin disrupts cytoplasmic membranes of
Gram-negatives• Toxic to human kidneys
– Some parasitic drugs act against cytoplasmic membranes
Mechanisms of Antimicrobial Action
• Inhibition of Metabolic Pathways– Antimetabolic agents can be effective when
metabolic processes of pathogen and host differ– Quinolones interfere with the metabolism of
malaria parasites– Agents that disrupt tubulin polymerization and
glucose uptake by many protozoa and parasitic worms
– Drugs block activation of viruses– Metabolic antagonists
Mechanisms of Antimicrobial Action
• Inhibition of Nucleic Acid Synthesis– Quinolones and fluoroquinolones
• Act against prokaryotic DNA gyrase– Inhibitors of RNA polymerase during
transcription– Reverse transcriptase inhibitors
• Act against an enzyme HIV uses in its replication cycle• Do not harm people because humans lack reverse
transcriptase