antibiotics. the problem drug companies have little interest in financing the testing of their newly...
TRANSCRIPT
![Page 1: ANTIBIOTICS. The problem drug companies have little interest in financing the testing of their newly discovered antibiotics, because they are more focused](https://reader033.vdocuments.site/reader033/viewer/2022060206/5a4d1bc67f8b9ab0599d4c34/html5/thumbnails/1.jpg)
ANTIBIOTICSANTIBIOTICS
![Page 2: ANTIBIOTICS. The problem drug companies have little interest in financing the testing of their newly discovered antibiotics, because they are more focused](https://reader033.vdocuments.site/reader033/viewer/2022060206/5a4d1bc67f8b9ab0599d4c34/html5/thumbnails/2.jpg)
The problemThe problem
drug companies have little interest in financing the testing of their newly discovered antibiotics, because they are more focused on drugs that people require daily for the rest of their lives
![Page 3: ANTIBIOTICS. The problem drug companies have little interest in financing the testing of their newly discovered antibiotics, because they are more focused](https://reader033.vdocuments.site/reader033/viewer/2022060206/5a4d1bc67f8b9ab0599d4c34/html5/thumbnails/3.jpg)
![Page 4: ANTIBIOTICS. The problem drug companies have little interest in financing the testing of their newly discovered antibiotics, because they are more focused](https://reader033.vdocuments.site/reader033/viewer/2022060206/5a4d1bc67f8b9ab0599d4c34/html5/thumbnails/4.jpg)
![Page 5: ANTIBIOTICS. The problem drug companies have little interest in financing the testing of their newly discovered antibiotics, because they are more focused](https://reader033.vdocuments.site/reader033/viewer/2022060206/5a4d1bc67f8b9ab0599d4c34/html5/thumbnails/5.jpg)
![Page 6: ANTIBIOTICS. The problem drug companies have little interest in financing the testing of their newly discovered antibiotics, because they are more focused](https://reader033.vdocuments.site/reader033/viewer/2022060206/5a4d1bc67f8b9ab0599d4c34/html5/thumbnails/6.jpg)
![Page 7: ANTIBIOTICS. The problem drug companies have little interest in financing the testing of their newly discovered antibiotics, because they are more focused](https://reader033.vdocuments.site/reader033/viewer/2022060206/5a4d1bc67f8b9ab0599d4c34/html5/thumbnails/7.jpg)
Principles of rational antibiotic therapy
Presence of substantiated indications for prescription of an Presence of substantiated indications for prescription of an antibioticantibiotic
Choosing of the most effective and the least toxic drug, intime Choosing of the most effective and the least toxic drug, intime administrationadministration
Introduction of optimal doses with optimal frequency, taking Introduction of optimal doses with optimal frequency, taking into consideration complexity of the diseaseinto consideration complexity of the disease
Choosing of the optimal way of introductionChoosing of the optimal way of introduction Estimation of treatment duration Estimation of treatment duration Control after treatmentControl after treatment
Monitoring and prophilactics of negative side effectsMonitoring and prophilactics of negative side effects Decision on expediency of combinated antibiotic therapyDecision on expediency of combinated antibiotic therapy
![Page 8: ANTIBIOTICS. The problem drug companies have little interest in financing the testing of their newly discovered antibiotics, because they are more focused](https://reader033.vdocuments.site/reader033/viewer/2022060206/5a4d1bc67f8b9ab0599d4c34/html5/thumbnails/8.jpg)
ANTIBIOTICS Beta-lactam antibiotics:Beta-lactam antibiotics: А. Penicillins, Б. Inhibitors of beta-lactamases and
combinated drugs, В. Cephalosporins Г. Monobactams Д. Tienamycin (carbapenems). Macrolides, azalides, streptogramins, prystinamycines. Linkozamides. Tetracyclines. Aminoglycosides. Chloramphenicols. Glycopeptides. Cyclic polipeptides (polimixins). Other antibiotics
![Page 9: ANTIBIOTICS. The problem drug companies have little interest in financing the testing of their newly discovered antibiotics, because they are more focused](https://reader033.vdocuments.site/reader033/viewer/2022060206/5a4d1bc67f8b9ab0599d4c34/html5/thumbnails/9.jpg)
ANTIBIOTICS
Dose-dependent Time-dependent
Antibacterial effect directly depends on their concentrations in the source of inflammation (high doses 1-2 times/24h)
Aminoglycosides Aminoglycosides FFluluororoqoqinolonesinolones
MetronidazolMetronidazolAmphoterAmphoteriicin Bcin B
Effectiveness depends on a period of time, during which concentration in blood overwhelms MIC for a particular causative agent(constant infusion or 3-6 times/24h)
Beta-lactamesBeta-lactamesGlycopeptidesGlycopeptides
MacrolidesMacrolidesLinkozamidesLinkozamides
![Page 10: ANTIBIOTICS. The problem drug companies have little interest in financing the testing of their newly discovered antibiotics, because they are more focused](https://reader033.vdocuments.site/reader033/viewer/2022060206/5a4d1bc67f8b9ab0599d4c34/html5/thumbnails/10.jpg)
PENICILLINS PENICILLINS Natural (biosynthetic) penicillins:
benzylpenicillin (penicillin G), phenoxymethylpenicillin (penicillin V), novocain salt of benzylpenicillin (benzylpenicillin procain), bicillin-1 (benzatyn benzylpenicillin), bicillin-3, bicillin-5.
Semisynthetic penicillins: 1antistaphylococci penicillinase resistant penicillins – izoxazolil-
penicillins (oxacillin, dicloxacillin, methicillin); 2of a spread spectrum – aminopenicillins (ampicillin,
amoxicillin); 3antipseudomonade – carboxypenicillins (carbenicillin,
ticarcillin); ureidopenicillins (azlocillin, piperacillin, sulbenicillin); 56combined with inhibitors of beta-lactamases - “protected”
penicillins (amoxicillin/clavulanate, ampicillin/sulbactam, ticarcillin/clavulanate, piperacillin/tazobactam).
![Page 11: ANTIBIOTICS. The problem drug companies have little interest in financing the testing of their newly discovered antibiotics, because they are more focused](https://reader033.vdocuments.site/reader033/viewer/2022060206/5a4d1bc67f8b9ab0599d4c34/html5/thumbnails/11.jpg)
Nucleus of penicillin moleculeL – beta-lactame ring, T – thiazoline ring
N
TL
S
COOH
CH3
CH3
O
H2N
![Page 12: ANTIBIOTICS. The problem drug companies have little interest in financing the testing of their newly discovered antibiotics, because they are more focused](https://reader033.vdocuments.site/reader033/viewer/2022060206/5a4d1bc67f8b9ab0599d4c34/html5/thumbnails/12.jpg)
Mechanism of penicillins action
They form complexes with enzymes - trans- and carboxypeptidases (PCP), which control synthesis of peptidoglycan – component of cell-wall of microorganisms
![Page 13: ANTIBIOTICS. The problem drug companies have little interest in financing the testing of their newly discovered antibiotics, because they are more focused](https://reader033.vdocuments.site/reader033/viewer/2022060206/5a4d1bc67f8b9ab0599d4c34/html5/thumbnails/13.jpg)
Spectrum of action of biosynthetic penicllins
Gram-positive microorganisms
Gram-negative microorganisms
StreptococciBacillus anthracis Causative agents of tetanus, gas gangreneActinomycets Listeria
GonococciMeningococci MoraxellaCausative agent of syphilisLeptospiras
![Page 14: ANTIBIOTICS. The problem drug companies have little interest in financing the testing of their newly discovered antibiotics, because they are more focused](https://reader033.vdocuments.site/reader033/viewer/2022060206/5a4d1bc67f8b9ab0599d4c34/html5/thumbnails/14.jpg)
Directing schemes on introduction og biosynthetic penicillins
Antibiotic, way of introduciton
One time dose Frequency of introduction
Benzylpenicillini sodium salt, i.m., i.v.
0,5-2 mln OD (till 10 mln)
Every 4-6 hours (every6 hours)
Benzatyn benzylpenicillin (bicillin-1), i.m.
0,3-0,6 mln OD1,2 mln OD
1 time/week 1 time/2 weeks
Bicillin-3, i.m. 0,6 mln OD 1 time/weekBicillin-5, i.m. 1,5 mln OD 1 time/week
![Page 15: ANTIBIOTICS. The problem drug companies have little interest in financing the testing of their newly discovered antibiotics, because they are more focused](https://reader033.vdocuments.site/reader033/viewer/2022060206/5a4d1bc67f8b9ab0599d4c34/html5/thumbnails/15.jpg)
Complications of biosynthetic Complications of biosynthetic penicillinspenicillins
Allergic reactionsAllergic reactions (10 (10 %)%) Endotoxic shockEndotoxic shock Disorders of electrolyte balanceDisorders of electrolyte balance Neurotoxic reactionsNeurotoxic reactions ( (in using of big dosesin using of big doses) – ) –
encephalopathyencephalopathy ( (hyperreflexiahyperreflexia, , seizuresseizures, , hallucinationshallucinations, , comacoma))
Daily dose of BPDaily dose of BP during intratecal during intratecal introductionintroduction should not overcomeshould not overcome 10 10 000 000 UU (5 (5 000 000 UU – – for childrenfor children))
Interstitial nephritisInterstitial nephritis
![Page 16: ANTIBIOTICS. The problem drug companies have little interest in financing the testing of their newly discovered antibiotics, because they are more focused](https://reader033.vdocuments.site/reader033/viewer/2022060206/5a4d1bc67f8b9ab0599d4c34/html5/thumbnails/16.jpg)
OxacillinOxacillin
Antistaphylococci penicillinase-resistant halfsynthetic penicillin, acid stable
Administration: intramuscular, intravenously, oraly
3-6-8 g/24 hours (4-6 times of injections)
![Page 17: ANTIBIOTICS. The problem drug companies have little interest in financing the testing of their newly discovered antibiotics, because they are more focused](https://reader033.vdocuments.site/reader033/viewer/2022060206/5a4d1bc67f8b9ab0599d4c34/html5/thumbnails/17.jpg)
.
Spectrum of action of aminopecillins (ampicillin, amoxicillin)
wide spectrum, destructed by beta-lactamases
Influence on: streptococci, Haemophilus influenzae, causative agent of wooping cough, gonococci, meningococci, proteus,
Escherichia coli, salmonella, shigella
![Page 18: ANTIBIOTICS. The problem drug companies have little interest in financing the testing of their newly discovered antibiotics, because they are more focused](https://reader033.vdocuments.site/reader033/viewer/2022060206/5a4d1bc67f8b9ab0599d4c34/html5/thumbnails/18.jpg)
Ampicillin
![Page 19: ANTIBIOTICS. The problem drug companies have little interest in financing the testing of their newly discovered antibiotics, because they are more focused](https://reader033.vdocuments.site/reader033/viewer/2022060206/5a4d1bc67f8b9ab0599d4c34/html5/thumbnails/19.jpg)
Amoxicillin
![Page 20: ANTIBIOTICS. The problem drug companies have little interest in financing the testing of their newly discovered antibiotics, because they are more focused](https://reader033.vdocuments.site/reader033/viewer/2022060206/5a4d1bc67f8b9ab0599d4c34/html5/thumbnails/20.jpg)
Differences between ampicillin and amoxicillin Parameters
Ampicillin Amoxycillin
Activity towdards- pneumococci- H. pylori- salmonella- shigellaBioavailability after oral administrationInfluence of food on bioavailability
Level in sputum
Level in urine
Appearance of diarrhea
+++
++/++++++
40 %
dicreases in 2 timeslowhigh
frequently
+++++++++
+
90 %
no influencehigh
very high
rarely
![Page 21: ANTIBIOTICS. The problem drug companies have little interest in financing the testing of their newly discovered antibiotics, because they are more focused](https://reader033.vdocuments.site/reader033/viewer/2022060206/5a4d1bc67f8b9ab0599d4c34/html5/thumbnails/21.jpg)
Indications for administration of amoxicillin Localisation of ifection Drug of choice Alternative drug
Respiratory tracts Acute midlle otitisBacterial sinusititAcute bronchititsExtrahospital pneumonia of light or medium-severe complexity
Acute pharingitisChronical bronchitis
Kidneys and urinary tracts
Acute pielonephritisAcute cystitisBacteriouria in children and pregnant women
Chronical pielonephritisAcute prostatitisGonorrhea
Digestive tract Cholangitis, cholecystitisTyphoid fever
Other pathology Borreliosis Leptospirosis
![Page 22: ANTIBIOTICS. The problem drug companies have little interest in financing the testing of their newly discovered antibiotics, because they are more focused](https://reader033.vdocuments.site/reader033/viewer/2022060206/5a4d1bc67f8b9ab0599d4c34/html5/thumbnails/22.jpg)
Ampiox (ampicillin+oxacillin)
![Page 23: ANTIBIOTICS. The problem drug companies have little interest in financing the testing of their newly discovered antibiotics, because they are more focused](https://reader033.vdocuments.site/reader033/viewer/2022060206/5a4d1bc67f8b9ab0599d4c34/html5/thumbnails/23.jpg)
SSide effects of ide effects of semisemisynthetic synthetic penicillinspenicillins
Irritation of mucous membrane of digestive tract (diarrhea)
Disbacteriosis Superinfection (colonizing of gut with Candida fungi,
enterococci, Pseudomonas aeruginosa, clostridia) Pain in injection area, aseptical inflammation,
phlebitis Allergic reactions Granulocytopenia (oxacillin) Reduction of platelets agregation (ampicillin) Disorders of liver function Encephalopathy (in introduction of high doses)
![Page 24: ANTIBIOTICS. The problem drug companies have little interest in financing the testing of their newly discovered antibiotics, because they are more focused](https://reader033.vdocuments.site/reader033/viewer/2022060206/5a4d1bc67f8b9ab0599d4c34/html5/thumbnails/24.jpg)
Inhibitors of beta-lactamases
Clavulanic acid Sulbactam
Tazobactam
![Page 25: ANTIBIOTICS. The problem drug companies have little interest in financing the testing of their newly discovered antibiotics, because they are more focused](https://reader033.vdocuments.site/reader033/viewer/2022060206/5a4d1bc67f8b9ab0599d4c34/html5/thumbnails/25.jpg)
Unasyn (ampicillin/sulbactam)
![Page 26: ANTIBIOTICS. The problem drug companies have little interest in financing the testing of their newly discovered antibiotics, because they are more focused](https://reader033.vdocuments.site/reader033/viewer/2022060206/5a4d1bc67f8b9ab0599d4c34/html5/thumbnails/26.jpg)
Inhibitor-protected (“screened”, “protected”) Inhibitor-protected (“screened”, “protected”) penicillinspenicillins
Amoxicillin/clavulanateAmoxicillin/clavulanate (amoxyclav, augmentin, enha(amoxyclav, augmentin, enhattsin)sin)
AmpicillinAmpicillin/sulbactam/sulbactam (sultamycillin, unasin)(sultamycillin, unasin) TicarcillinTicarcillin/clavulanate/clavulanate
(timentin)(timentin) PiperacillinPiperacillin/tazobactam/tazobactam
![Page 27: ANTIBIOTICS. The problem drug companies have little interest in financing the testing of their newly discovered antibiotics, because they are more focused](https://reader033.vdocuments.site/reader033/viewer/2022060206/5a4d1bc67f8b9ab0599d4c34/html5/thumbnails/27.jpg)
Structure of cephalosporinsL – beta-lactame ring, D – dihydrothiazine ring
CH2 O CO CH3
C
O
H2N
O
OH
S
L D
N
![Page 28: ANTIBIOTICS. The problem drug companies have little interest in financing the testing of their newly discovered antibiotics, because they are more focused](https://reader033.vdocuments.site/reader033/viewer/2022060206/5a4d1bc67f8b9ab0599d4c34/html5/thumbnails/28.jpg)
Classification of cephalosporinsClassification of cephalosporins
Way of introduction
Generation of cephalosporin antibioticsGeneration of cephalosporin antibiotics
ffirstirst I I secondsecond II II thirdthird III III fourthfourth IV IV
Injection CefaloridinCefadroxil*Cefazolin*Cefalexin*Cephradin*
Cefamandole* Cefoxytyn*Cefuroxime*
Cefotaxime*Ceftriaxone*Cefoperazone*Ceftazidime*
Cefpirome*Cefepime*
Oral Cephalexin *Cefadroxil*
Cefuroxime axetyl* Cefaclor *
Cefixime *Ceftibuten * -
![Page 29: ANTIBIOTICS. The problem drug companies have little interest in financing the testing of their newly discovered antibiotics, because they are more focused](https://reader033.vdocuments.site/reader033/viewer/2022060206/5a4d1bc67f8b9ab0599d4c34/html5/thumbnails/29.jpg)
Cefazolin-sodium (C I)
![Page 30: ANTIBIOTICS. The problem drug companies have little interest in financing the testing of their newly discovered antibiotics, because they are more focused](https://reader033.vdocuments.site/reader033/viewer/2022060206/5a4d1bc67f8b9ab0599d4c34/html5/thumbnails/30.jpg)
Cezolin (Cefazolin, C I)
![Page 31: ANTIBIOTICS. The problem drug companies have little interest in financing the testing of their newly discovered antibiotics, because they are more focused](https://reader033.vdocuments.site/reader033/viewer/2022060206/5a4d1bc67f8b9ab0599d4c34/html5/thumbnails/31.jpg)
Cefalexin ( C I)
![Page 32: ANTIBIOTICS. The problem drug companies have little interest in financing the testing of their newly discovered antibiotics, because they are more focused](https://reader033.vdocuments.site/reader033/viewer/2022060206/5a4d1bc67f8b9ab0599d4c34/html5/thumbnails/32.jpg)
Zinnat (Cefuroxime, C II)
![Page 33: ANTIBIOTICS. The problem drug companies have little interest in financing the testing of their newly discovered antibiotics, because they are more focused](https://reader033.vdocuments.site/reader033/viewer/2022060206/5a4d1bc67f8b9ab0599d4c34/html5/thumbnails/33.jpg)
Cefotaxime (C III)
![Page 34: ANTIBIOTICS. The problem drug companies have little interest in financing the testing of their newly discovered antibiotics, because they are more focused](https://reader033.vdocuments.site/reader033/viewer/2022060206/5a4d1bc67f8b9ab0599d4c34/html5/thumbnails/34.jpg)
Claphoran (cefotaxime, C III)
![Page 35: ANTIBIOTICS. The problem drug companies have little interest in financing the testing of their newly discovered antibiotics, because they are more focused](https://reader033.vdocuments.site/reader033/viewer/2022060206/5a4d1bc67f8b9ab0599d4c34/html5/thumbnails/35.jpg)
Cefobid (Cefoperazone, C III)
![Page 36: ANTIBIOTICS. The problem drug companies have little interest in financing the testing of their newly discovered antibiotics, because they are more focused](https://reader033.vdocuments.site/reader033/viewer/2022060206/5a4d1bc67f8b9ab0599d4c34/html5/thumbnails/36.jpg)
Antimicrobial spectrum of cephalosporins Generation of cephalosporins
Active towards Stability towards beta-lactamase
Gram-positive bacteria
Gram-negative bacteria
Staphylo cocci
Gram-negative bacteria
ІІ ++++++ +/-+/- ++++ --
ІІІІ ++++ ++ ++++ +/-+/-
ІІІІІІ ++ ++++++ ++ ++
ІІVV ++++ ++++++ ++++ ++++
![Page 37: ANTIBIOTICS. The problem drug companies have little interest in financing the testing of their newly discovered antibiotics, because they are more focused](https://reader033.vdocuments.site/reader033/viewer/2022060206/5a4d1bc67f8b9ab0599d4c34/html5/thumbnails/37.jpg)
Complications, caused by cephalosporins
Irritation of mucous membrane of digestive tract, infiltrates after intromuscular introduction , phlebitis after inrtavenous introduction
Disbacteriosis, superinfection Allergic reactions, including cross allergy with
penicillins Granulocytopenia (in case of treatment during more
than 2 weeks) Hemorrhages (inhibition of synthesis of factors of
blood coagulation in liver) – cephalosporins ІІІ Nephrotoxicity (accumulation in epithilial cells of
kidney canalicules) Encephalopathy (hyperreflexia, судоми, coma)
![Page 38: ANTIBIOTICS. The problem drug companies have little interest in financing the testing of their newly discovered antibiotics, because they are more focused](https://reader033.vdocuments.site/reader033/viewer/2022060206/5a4d1bc67f8b9ab0599d4c34/html5/thumbnails/38.jpg)
Cephalosporines Cephalosporines
NNot recommendedot recommended to combine with other nephrotoxic drugs
(aminoglycosides)
ContraindicatedContraindicated to combine with loop diuretics (furocemid,
etacrinic acid)
![Page 39: ANTIBIOTICS. The problem drug companies have little interest in financing the testing of their newly discovered antibiotics, because they are more focused](https://reader033.vdocuments.site/reader033/viewer/2022060206/5a4d1bc67f8b9ab0599d4c34/html5/thumbnails/39.jpg)
MonobactamsMonobactamsAetreonam
Action spectrum - Gram (-) bacteria, including Escherichia colli, Clebsiellas, Proteum, Haemophilus influenzae (activity is equal to the activity of cephaloporins of third generation)
Ways of introduction: oral (20% are being absorbed), intramuscular, intravenous
Clinical uses: sepsis, infection of urinary tracts, soft tissues, meningitis and others (often combined with aminoglycosides , clindamycin, metronidazole, vankomycin).
![Page 40: ANTIBIOTICS. The problem drug companies have little interest in financing the testing of their newly discovered antibiotics, because they are more focused](https://reader033.vdocuments.site/reader033/viewer/2022060206/5a4d1bc67f8b9ab0599d4c34/html5/thumbnails/40.jpg)
Carbapenems (tienamytsin)Carbapenems (tienamytsin)
Tienam (imipenem + cylastatin) Tienam (imipenem + cylastatin) Meropenem Meropenem
The widest spectrum of antibacterial action - most of aerobe and anaerobe Gram(+) and Gran (-) bacteria, including those which produse beta-lactamase
![Page 41: ANTIBIOTICS. The problem drug companies have little interest in financing the testing of their newly discovered antibiotics, because they are more focused](https://reader033.vdocuments.site/reader033/viewer/2022060206/5a4d1bc67f8b9ab0599d4c34/html5/thumbnails/41.jpg)
Classificaion of Classificaion of macrolidesmacrolides
І. Natural substances: erythromycin, oleandomycin,spiramycin, jozamycin, midecamycin.
ІІ. Half-synthetic substances: rozythromycin, clarithromycin, flurythromycin, dyrythromycin, miokamycin, rokitamycin.
III. Azalides (neutrogen atom is introduced in lacton ring): azithromycin.
![Page 42: ANTIBIOTICS. The problem drug companies have little interest in financing the testing of their newly discovered antibiotics, because they are more focused](https://reader033.vdocuments.site/reader033/viewer/2022060206/5a4d1bc67f8b9ab0599d4c34/html5/thumbnails/42.jpg)
ErythromycinErythromycin
![Page 43: ANTIBIOTICS. The problem drug companies have little interest in financing the testing of their newly discovered antibiotics, because they are more focused](https://reader033.vdocuments.site/reader033/viewer/2022060206/5a4d1bc67f8b9ab0599d4c34/html5/thumbnails/43.jpg)
Macropen (midecamycin)Macropen (midecamycin)
![Page 44: ANTIBIOTICS. The problem drug companies have little interest in financing the testing of their newly discovered antibiotics, because they are more focused](https://reader033.vdocuments.site/reader033/viewer/2022060206/5a4d1bc67f8b9ab0599d4c34/html5/thumbnails/44.jpg)
Sumamed (azithromycin)Sumamed (azithromycin)
![Page 45: ANTIBIOTICS. The problem drug companies have little interest in financing the testing of their newly discovered antibiotics, because they are more focused](https://reader033.vdocuments.site/reader033/viewer/2022060206/5a4d1bc67f8b9ab0599d4c34/html5/thumbnails/45.jpg)
Action spectrum of maclrolides Action spectrum of maclrolides and azalidesand azalides
staphylo-, strepto-, hono-, anaerobe cocci, enterobacteria
H.influenzae (clarythromycin, azithromycin) intracellular situated microorganisms (stamps
of Helicobacter, Chlamydia, Legionellа, M. pneumoniae, U. urealyticum etc.)
![Page 46: ANTIBIOTICS. The problem drug companies have little interest in financing the testing of their newly discovered antibiotics, because they are more focused](https://reader033.vdocuments.site/reader033/viewer/2022060206/5a4d1bc67f8b9ab0599d4c34/html5/thumbnails/46.jpg)
Pharmacokinetics of Pharmacokinetics of macrolidesmacrolides
Quiclkly and fully distributed through the Quiclkly and fully distributed through the tissues (do not pass through HEB)tissues (do not pass through HEB)
Correlation tissues/blood:Correlation tissues/blood:Erythromycin – (5-10) : 1Erythromycin – (5-10) : 1Azithromycin – (100-500) : 1Azithromycin – (100-500) : 1Their concentration in phagocyting cells Their concentration in phagocyting cells
prevails concentration in blood pasma in prevails concentration in blood pasma in 12-20 times, they get accumulated in source 12-20 times, they get accumulated in source of inflammation - macrolides paradoxisof inflammation - macrolides paradoxis
![Page 47: ANTIBIOTICS. The problem drug companies have little interest in financing the testing of their newly discovered antibiotics, because they are more focused](https://reader033.vdocuments.site/reader033/viewer/2022060206/5a4d1bc67f8b9ab0599d4c34/html5/thumbnails/47.jpg)
Indications for usage of macrolides and Indications for usage of macrolides and azalidesazalides
LOR- infections, infections of upper respiratory tracts, hynecological infection, skin and soft tissues infections; ulcer disease; dyphteria; whooping-cough; honorrhea; syphilis; typhoid fever (azithromycin).
Drugs of choice for: mycoplasma, chlamidial, legionela pneumonia
![Page 48: ANTIBIOTICS. The problem drug companies have little interest in financing the testing of their newly discovered antibiotics, because they are more focused](https://reader033.vdocuments.site/reader033/viewer/2022060206/5a4d1bc67f8b9ab0599d4c34/html5/thumbnails/48.jpg)
Side affects of microlidesSide affects of microlides Dispeptic disorders, disbacteriosis, superinfectionDispeptic disorders, disbacteriosis, superinfection Cholestasis, cholestatic jaundice (erythromycin)Cholestasis, cholestatic jaundice (erythromycin) Depression of liver microsome enzyme activity Depression of liver microsome enzyme activity
(erythromycin, oleandomycin can not be combined (erythromycin, oleandomycin can not be combined with theophylline, ergot alkaloids, carbamazepine)with theophylline, ergot alkaloids, carbamazepine)
Development of resistance in process of treatmentDevelopment of resistance in process of treatment
![Page 49: ANTIBIOTICS. The problem drug companies have little interest in financing the testing of their newly discovered antibiotics, because they are more focused](https://reader033.vdocuments.site/reader033/viewer/2022060206/5a4d1bc67f8b9ab0599d4c34/html5/thumbnails/49.jpg)
Linkosamides Linkosamides Linkomycin Linkomycin ClindamycinClindamycin
Action spectrum: Gram positive aerobe cocci, grampositive and gramnegatvie anaerobes
Penetrate all the tissues (don’t pass through HEB) including intracellurally
Usage: usually in heavy infections, caused by anaerobe microorganisms
Complicated side affects
![Page 50: ANTIBIOTICS. The problem drug companies have little interest in financing the testing of their newly discovered antibiotics, because they are more focused](https://reader033.vdocuments.site/reader033/viewer/2022060206/5a4d1bc67f8b9ab0599d4c34/html5/thumbnails/50.jpg)
Linkomycini Linkomycini hydrochloridumhydrochloridum