Antibiotika T6 del 2

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    * Hur vanligt är det med allergiska reaktioner på penicillin? Jf med andra llm? 
    * Korssensitivitet förekommer med en annan typ av ab. Vilken? Hur vanligt är det?
    * Vilka typer av allergiska reaktioner ses?
    * Hur kan man testa aktuell risk? 
    * Hur handlägger man pt med en historia av penicillinallergi?
    Penicillins are the most common cause of drug allergy (1 - 10 % of the patients will experience an allergic response). There is no direct relationship between the size of the dose and the intensity of allergic response. 

    Cross-sensitivity: 5 - 10 % of patients allergic to penicillins are also allergic to cephalosporins

    • Types of allergic reactions:
    • 1) Immediate (occurring in 2 - 30 minutes after administration)
    • 2) Accelerated (occur within 1 - 72 hours)
    • 3) Late reactions (days or even weeks)
    • Anaphylaxis (laryngeal edema, bronchoconstriction, severe hypotension) in 0.2 % of patients. Treatment --> epinephrine +  respiratory support

    • Skin tests for penicillin allergy: skin tests are employed to assess the currents risk of a severe reaction.
    • A) BPO-PL (delayed hypersensitivity)
    • B) MDM ( anaphylaxis)  

    • * ASK patients for previous history of allergy to penicillin.
    • * If the patient refers to a positive history of allergy AVOID PENICILLINS entirely.
    • * If the allergy is mild a CEPHALOSPORINE is often appropriate as alternative.
    • * If the allergy is severe AVOID CEPHALOSPORINS.
    • * For many infections VANCOMYCIN AND ERYTHROMYCIN are effective and safe.
  2. Nämn viktiga pt-faktorer att beakta vid val av ab
    • 1) Host defenses
    • (immune system and phagocytic cells). 

    • 2) Site of infection
    • To be effective an antibiotic must be present in the site of infection in a concentration greater than MIC (endocarditis, meningitis, abscesses) 

    • 3) Age
    • (infants and elderly highly vulnerable to drug toxicity). 

    4) Pregnancy and lactation 

    5) Previous allergic reactions 

    • 6) Genetic factors
    • (eg hemolysis in patients with G-6PD deficiency if given sulfonamides). 

    IMPERATIVE: patients should be instructed to take their medication for the entire prescribed course even though symptoms may subside beforethe full course has been completed.
  3. Vilka ab är verksamma mot enterokocker?
    • Amoxicillin, Ampicillin (penicilliner)
    • Piperaxcillin-Tazobaktam (en penicillin)(Imipenem - en karbapenem)
    • Nitrofurantoin
    • Vancomycin (en glykopeptid)
  4. Vilka ab är inte verksamma på streptokocker?
    • Mecillinam (en penicillin)
    • Aminoglykosider (Gentamycin, Amikacin)
    • Ciprofloxacin (en kinolon)
    • Nitrofurantoin
    • Imidazolderivat (Metronidazol)
    * Vilken typ av ab är karbapenemer?
    * Beskriv imipenem o meropenem
    (aktivitet, indikationer, biverkningar).
    • WIKI:
    • Carbapenems are antibiotics used for the treatment of infections known or suspected to be caused by multidrug-resistant (MDR) bacteria. Their use is primarily in people who are hospitalized. Är betalaktam-ab. 

    • They exhibit a broader spectrum of activity compared to cephalosporins and penicillins. Their effectiveness is less affected by many common mechanisms of antibiotic resistance than other beta lactams.
    • Carbapenem antibiotics were originally developed at Merck & Co. from the carbapenem thienamycin, a naturally derived product of Streptomyces cattleya. Concern has arisen in recent years over increasing rates of resistance to carbapenems, as there are few therapeutic options for treating infections caused by carbapenem-resistant bacteria (such as the carbapenem-resistant Enterobacteriaceae).

    • Image Upload 1
    • Fig: Core structure of the carbapenem molecules
    • In terms of structure, the carbapenems are very similar to the penicillins (penams), but the sulfur atom in position 1 of the structure has been replaced with a carbon atom, and an unsaturation has been introduced—hence the name of the group, the carbapenems.

    • Imipenem + cilastatin
    • • Bredspektrumantibiotika med effekt mot gramnegativa och grampositiva
    • bakterier samt anaerober inklusive pseudomonas och Stenotrophomonas
    • maltophilia. Effekt mot Enterococcus faecalis men inte E. faecium. Effekt även
    • mot ESBL-bildande Enterobacteriaceae (resistens förekommer dock).

    • Meropenem
    • * Spektrum som imipenem frånsett att det har dålig effekt mot enterokocker.
    • Något bredare gramnegativt spektrum än imipenem.
    • * Lättare att styra vid nedsatt njurfunktion än imipenem.

    • Praktiskt (imipenem och meropenem)
    • * Används vid allvarliga nosokomiala infektioner, som empirisk behandling vid
    • misstanke om ESBL-relaterad allvarlig infektion
    • * Alternativpreparat vid feber hos neutronerna
    • * Allvarliga intraabdominella infektioner
    • * Meropenem: alternativ vid empirisk behandling av bakteriell meningit

    • Ska användas med eftertanke och sparas till patienter som är i behov av preparatet
    • då ökande karbapenemresistens hos Enterobacteriaceae är ett allvarligt hot mot
    • framtida möjlig användning av karbapenemer.

    • Ertapenem
    • * Lång halveringstid möjliggör dosering 1 gång/dygn
    • * Något smalare gramnegativt spektrum än imipenem och meropenem, ingen effekt mot Pseudomonas aeruginosa, enterokocker eller Acinetobacter spp. Även vanligare med nedsatt känslighet (på grund av annan resistensmekanism än karbapenemasproduktion) hos ESBL-bildande tarmbakterier

    • Praktiskt
    • • Vid behandling i hemsjukvård av infektioner orsakade av ESBL-bildande tarmbakterier
  6. VANKOMYCIN (Glykopeptid)
    * Varför används den endast vid allvarliga infektioner?
    * Indikationer?
    * Biverkningar?
    It is used only for serious infections due to toxicity. Ges iv.  

    • Principal indications: MRSA
    • * antibiotic-associated pseudomembranous colitis (Clostridium difficile)
    • * infection with methicillin-resistant Staphylococcus aureus (MRSA

    Adverse effects: ototoxicity, thrombophlebitis.

    Image Upload 2
  7. DEF: Vad är kemoterapi, ett kemoterapeutiskt lkm, ett antibiotikum, ett antimikrobiellt ämne

    Antibiotika: vad finns det för naturligt förekommande antimikrobiella ämnen?
    Chemotherapy is the use of any chemical agent in the treatment of disease. 

    A chemotherapeutic agent or drug is any chemical agent used in medical practice. 

    An antibiotic agent is usually considered to be a chemical substance made by a microorganism that can inhibit the growth or kill microorganisms. 

    An antimicrobic or antimicrobial agent is a chemical substance similar to an antibiotic, but may be synthetic.  

    • * Naturally occurring antimicrobials
    • – Metabolic products of bacteria and fungi
    • – Reduce competition for nutrients and space
    • * Bacteria
    • Streptomyces, Bacillus
    • * Molds
    • Penicillium, Cephalosporium

    * Mekanismer? 

    * Mekanismer? 
    * Vanlig tillämpning?
    * Biverkningar? Vilka grupper ska inte ges sulfonamid? 

    * Mekanism?
    * Indikationer?
    * Biverkningar?  

    * Indikationer?
    * Biverkningar? 

    * Mekanism?
    * Indikationer? 

    IMIDAZOLDERIVAT: Metronidazol

    * Vad är handelsnamnet?
    * Mekanism?
    * Indikationer?
    * Biverkningar?

    • Mekanismer:
    • 1. competitive inhibition eller
    • 2. erroneous incorporation - molecular mimicry 

    • SULFONAMIDER (= sulfa-preparat)
    • Blockerar syntes av folsyra --> blockerad syntes av nukleinsyror.
    • Syntetisk drog baserad på sulfanilamider. Används i kombination m andra syntetiska lkm som trimetoprim.Commonly used to treat pneumonia in AIDS patients.  
    • Bredspektrum-ab. Indikation: UVI.  

    • 1) Hypersensitivity reactions. Mild reactions are common (rash,drug fever, photosensitivity). Stevens-Johnson syndrome.
    • 2) Hematologic effects (hemolytic anemia inpatients with G-6PD deficiency).
    • 3) Kernicterus (a disorder in newborns caused by deposition of bilirubin in the brain). The drugs should NOT be given to infants under the age of 2 months, pregnant women near term or breast-feeding mothers.
    • 4) Renal damage from crystalluria. 

    Image Upload 3

    Image Upload 4

    • Mechanism of action: inhibitor of dihydrofolatereductase (--> suppresses bacterial synthesis of DNA,RNA and proteins) 

    Therapeutic uses: it is approved only for initialtreatment of acute uncomplicated urinary tractinfections due to susceptible organisms(E.Coli, Proteus Mirabilis etc) 

    • Generally the drug is well tolerated.
    • Most common adverse effects include itching and rash. GI reactions occur occasionally. Caution when administering the drug to patients with suspected folate deficiency --> danger of bone marrow suppression (thrombocytopenia, neutropenia, anemia). 


    • Aktivitet mot Strep, S aureus, HI, E coli. Indikation: UVI.
    • Therapeutic uses: urinary tract infections, otitis media, bronchitis, shingellosis, pneumonia, Pneumocystis Carinii pneumonia

    • The combination is generally well-tolerated.
    • Most common adverse effects: nausea, vomiting, rash. Infrequent but serious toxicities: hypersensivity reactions (including Stevens-Johnson Syndrome), blood dycrasias, renal damage
    • Image Upload 5

    • Antimetabolit för två vitaminer.
    • Therapeutic uses: prophylaxis and treatment of tuberculosis

    • 1) Peripheral Neuropathy (dose-related): peripheral paresthesias of hands and feet, clumsiness, unsteadiness, muscle aches (--> administer pyridoxine).
    • 2) Hepatotoxicity (incidence increases with age)  

    • IMIDAZOLDERIVAT: Metronidazol (Flagyl)
    • Aktivitet mot anaerober.
    • Indikationer: Clostridier, bukabscess
    • Mechanism of action :inhibition of nucleic acidssynthesis.
    • Therapeutic uses: The drug is active against obligate anaerobes only. It is used in CNS infections, abdominal organs, bones, joints, skin, soft tissues and genitourinary tract. It is used in combination against Helicobacter Pylori.
    • Är antiprotozoa - används mot Giardia o amöbor. 
    • Tämligen toxisk. Ger "black hairy tongue". 

    • Image Upload 6

    * Mekanism? Indikation? Bieffekter?
    * Nämn två ab
    • Polyenes
    • • Antifungal
    • * Commonly used for skin infections
    • * Targets the membrane - loss of selective
    • permeability
    • Polyenes – Amp B and Nystatin
    • * Amphotericin B - binds to ergosterol found in fungi and protozoa, but not in human cells - increases membrane permeability
    • * Side effects are numerous due to toxicity
    • of the drug
  10. Antiviraler
    • • Limited drugs available
    • • Difficult to maintain selective toxicity
    • • Effective drugs – target viral replication
    • cycle
    • – Entry
    • – Nucleic acid synthesis
    • – Assembly/release

    Interferon – artificial antiviral drug

    • Acyclovir

    • Amantadine -
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Antibiotika T6 del 2
2016-02-24 19:54:15
antibiotika infektion

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