Infectious Disease

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Infectious diseases regarding various systems in human body and prefered antibiotics to treate such disease

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INFECTIOUS DISEASES Presented by Guided by Miss. Parbhane Saranga B. Prof. Dr. Kasture S.B. F.Y.M. Pharm ( sem -II ) Sanjivani College Of Pharmaceutical Education And Research, Kopargaon

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CONTENTS Introduction to infection Antibiotics General guidelines for rational use of antibiotics Resistance to antibiotics

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INFECTION It is an ability of organism to enter, survive and multiply in host to initiate certain symptoms. TYPES OF INFECTION Bacterial Infection Viral Infection Fungal Infection Parasitic Infestation

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Bacterial infection Viral infection BACTERIA VIRUS

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INFECTIOUS DISEASE In medicine Infectious disease or Communicable disease is a disease caused by biological agents such as bacteria, virus or parasite. Infectious disease also known as Contagious disease or Trasmissible disease and also includes Communicable disease comprise clinically evident illness.

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PATHOGENS (patho:disease,gen:produce) An agent of disease,a disease producer. A term pathogen most commonly used to refer to infectious organism. It basically includes: Bacteria (eg.staph) Virus (eg.yeast) Protozoa (eg.trophozoites) Multicellular parasites Aberrant proteins known as Prions

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CLASSIFICATION Primary pathogens: Cause disease as a result of their presence or activity within the normal, healthy host, and their intrinsic virulence is, in part, a necessary consequence of their need to reproduce and spread. Opportunistic pathogens: Opportunistic disease may be caused by microbes that are ordinarily in contact with the host, such as pathogenic bacteria or fungi in GI tract and upper respiratory tract. They may also result from microbes acquired from other host or environment.

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ANTIBIOTICS These are the substances that are produced by micro-organisms which selectively supress the growth or kill the micro-organisms at very low concentration. An antibiotic is given for treatment of an infection caused by bacteria.

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MAJOR CLASSES Aminoglycosides Beta lactams Lincosamides -Penicillins Macrolides -Cephalosporins Oxazolidinones -Carbapenams Streptogramins -Monobactams Sulphonamides Fluoroquinolones Tetracyclines Glycopeptides Ketolides Polymixins Miscellaneous

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MODE OF ACTION SITE OF ANTIMICROBIAL ACTION

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HOW ANTIBIOTIC WORKS

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Antibiotics work by being either bactericidal where they kill micro-organisms or by being bacteristatic where they inhibit the growth of micro-organisms. Eg.Penicillin (bactericidal antibiotic) Tetracycline (bacteriostatic antibiotic)

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SIDE EFFECTS Most common : Diarrohea Feeling and being seek Rare: Formation of kidney stones (when taking Sulphonamides) Abnormal blood clotting(when taking some cephalosporins) Sensitivity to sun (when taking Tetracycline )

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WHY ANTIBIOTICS ARE NOT EFFECTIVE AGAINST VIRUSES Antibiotics means it is against live things and viruses are not living. Antibiotics work to alter cellwall of bacteria. By breaking down cellwall it destroy the bacteria. A virus has different makeup. The wall covering a virus is not easily attacked by antibiotics. Antibiotics are totally ineffective for treatment of flu or other viral diseases because viruses hide inside cells, this make it difficult for antibiotic to reach them.

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GENERAL GUIDELINES FOR RATIONAL USE OF ANTIBIOTICS Introduction Guidelines

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INTRODUCTION Antibiotics are one of the most commonly prescribed drugs today.Rational use of antibiotics is extremely important as injudicious use, can adversly affect the patient, cause emergence of antibiotic resistance and increase cost of health care. Prescribing an antibiotic comprises several phases- Perception of need -Is an antibiotic necessary ? Choice of antibiotic - What is most appropriate antibiotic ? Choice of regimen - What dose,route , frequency and duration are needed ? Monitoring efficacy -Is the treatment effective?

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Is an antibiotic necessary? Choice of an antibiotic - Aetiological agent - The patient - The antibiotic Choice of regimen -Parenteral or oral -Duration of treatment Monitoring efficacy -Early review of response -Inconsistant microbiology reports -Causes of non-response to antibiotics -Changing from intravenous to oral

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ANTIBIOTIC GUIDELINES 1996 Respiratory Infections Urinary Tract Infections Skin And Soft Tissue Infections Musculoskeletal Infections GI Infections Genitourinary Infections CNS Infections CVS Infections Bacteraemia And Septicaemia Infections Associated With Pregnancy

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Respiratory Infections Conditions 1 st choice antibiotic 2 nd choice antibiotic Acute pharyngitis / tonsilitis , scarlet fever Penicillin V Erythromycin Diphtheria Benzyl penicillin - Acute epiglottitis Chloramphenicol Ampicillin or 30 Cephalosporin Pertussis Erythromycin - Cont’d…

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Pneumonia: Community acquired pnumonia - Mild to moderate Benzyl penicillin or Ampicillin or Erythromycin - Community acquired pnemonia - severe Benzylpenicillin and Gentamicin or 20 or 30 Cephalosporin Betalactam or Betalactamase inhibitor combination Atypical pnemonia Erythromycin or Doxycyclin (for adults) -

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Urinary Tract Infections Conditions 1 st choice antibiotic 2 nd choice antibiotic Acute urinary tract infection Cotrimazole or Trimethoprim or Ampicillin or Nitrofurantoin 10/20 Cephalosporin Pyelonephritis and complicated urinary tract infection 20 Cephalosporin and Gentamicin or Quinolone - Recurrent UTI Cotrimazole 1 tab nightly or Nitrofurantoin 50mg nightly Ampicillin 500mg nightly or Cephalexin 250mg nightly or Nalidixic acid 500mg nightly

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Skin and Soft Tissue Infections Conditions 1 st choice antibiotic 2 nd choice antibiotic Impetigo Penicillin Erythromycin or Cloxacillin and Penicillin or Cephalexin Cellulitis / Lymphangitis Severe Benzylpenicillin or Procaine penicillin - Mild to moderate Penicillin V or Erythromycin - Facial and orbital cellulitis in children 20/30 Cephalosporin - Diabetic foot infection s 20/30 cephalosporin and Metronidazole betalactamase inhibitor combination Cloxacillin , Gentamicin and Metronidazole

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Musculoskeletal Infections Condition 1 st choice antibiotic 2 nd choice antibiotic Acute osteomyelitis Cloxacilin Fusidic acid Chronic osteomyelitis Cloxacilin Fusidic acid and Refampicin Septic arthritis Cloxacillin

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Gastrointestinal Infections Conditions 1 st choice antibiotic 2 nd choice antibiotic Gingivitis Penicillin V and Metronidazole - Acute peritonitis Primary (children) Penicillin and Gentamicin 30 Cephalosporin Primary with cirrhosis 30 Cephalosporin Gentamicin Secondary ( polymicrobial infection) 20/30 Cephalosporin and Metronidazole Gentamicin and Metronidazole Acute cholecystitis 20/30 Cephalosporin with or without Metronidazole Gentamicin with or without Metronidazole Cont’d….

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Conditions 1 st choice antibiotic 2 nd choice antibiotic Acute cholangitis Ampicillin or 20/30 Cephalosporin Gentamicin Enteric fever Chloramphenicol or Cotrimazole or Ceftriaxone Ampicillin or Quinolone Cholera Doxycycline for 4 days - Bacterial dysentry Cotrimazole - Amoebic dysentry Metronidazole Tinidazole

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Genitourinary Infections(Including sexually transmitted disease) Conditions 1 st choice antibiotic 2 nd choice antibiotic Gonorrhoea Uncomplicated urethritis,rectal and pharyngeal gonorrhoea Ceftriaxone or Ceprofloxacin - Syphilis Early Procaine penicillin (10 days) or Benzathine penicillin(2 weekly doses) - Late Procaine penicillin(21days) or Benzathine penicillin(3weekly doses) -

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Central Nervous System Infections Conditions 1 st choice antibiotic 2 nd choice antibiotic Meningitis Adult Benzyl penicillin and Chloramphenicol or 30 Cephalosporin - Children Ampicillin and Choramphenicol or 30 Cephalosporin - Neonetal meningitis Ampicillin and Gentamicin or 30 Cephalosporin -

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Cardiovascular Infections Conditions 1 st choice antibiotic 2 nd choice antibiotic Endocarditis Non-intravenous drug user Benzylpenicillin and Gentamicin - Intravenous drug user Cloxacillin and Gentamicin - Post-surgical endocarditis Cloxacillin and Gentamicin -

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Bacteraemia and Septisaemia Conditions 1 st choice antibiotic 2 nd choice antibiotic Urinary (community acquired) Ampicillin and Gentamicin - Urinary (hospital acquired) 20/30 Generation Cephalosporin and Gentamicin - Gall bladder/bowel 30 generation Cephalosporin and Metronidazole Gentamicin and Metronidazole or Betalactamase inhibitor combination and Gentamicin Skin ( cellulitis ) Benzyl penicillin - Skin (abscess) Cloxacillin -

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Infections Associated With Pregnancy Conditions 1 st choice antibiotics 2 nd choice antibiotics Asymptomatic bacteriuria / Cystitis Ampicillin or Cephalexin - Acute pyelonephritis 20/30 Cephalosporin Ampicillin

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Resistance To Antibiotics Antibiotic resistance is the ability of micro-organisms to withstand the effect of an antibiotic. Today many patients are being infected with organisms once controlled by antibiotics, including pneumonia, tuberculosis and meningitis. New infections are surfacing because many existing drugs no longer work. Cont’d…

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Resistance to antibiotic is developing largly because of overuse and misuse. Since bacteria reproduce rapidly, resistance can arise quickly. Those antibiotics resistant will remain after treatment and can continue to divide. Eg. Penicillin Some bacteria can produce an enzyme called Penicillnase which breaks down penicillin before it can take effect.

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Resistance to Antibiotics

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Mechanism Of Resistance Naturally resistant strains Spontaneous mutation Transmission of genes from other organisms Enzymatic destruction of drug Preventation of penetration of drug Alteration of drug’s target site Rapid ejection of drug

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Limitation of resistance to antimicrobials Using antimicrobial combinations in appropriate circumstances eg. Tuberculosis. Constant monitoring of resistance pattern in hospital or community and good infection control in hospitals to prevent spread of resistant bacteria.

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References Lippincott’s Illustrated Reviews, 2009, Pharmacology, South Asian Edition, 4th edition, Page no. 357 Don A. Ballington, Mary A. Laughlin, Pharmacology, 3rd edition, Page no. 67 P.N.Bennett, M.J.Brown, 2005, Ethical Pharmacology, 9th edition, Page no. 208 Rang and Dale’s Pharmacology, International edition, 7th Edition, Page no. 622-636 Cont’d…

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http://scienceaid.co.uk/biology/micro/bacteria.html http://scienceaid.co.uk/biology/micro/viral.html http://www.sciencedaily.com/articles/i/infectious_ disease.htm