1.Direct inhibition:
- Quinolones
- Azoles { DNA inhibitor }
- Rifampicin { RNA inhibitor }
2. Indirect inhibition:
- Sulphonamides & trimethoprim.
1- Medical preparations containing Al, Ca Mg, Zn salts & iron preparations all can
decrease the absorption of ciprofloxacin.
2- Sucralfate.
3- Opioid analgesics increase cipro.. metabolism.
4- Ciprofloxacin inhibit hepatic drug metabolism (theophyllin, warfarin,
glibenclamide and zolmitriptan) .
Precautions
Treatment should be stopped if the patient experience tendon pain.
Adequate fluid intake should be maintained because of the risk of crystal urea
.
Doses should be reduced in patient with renal impairment .
Ciprofloxacin should not be used in children.
4. Should be used with caution in pts with active disease of CNS because of its
potential neurotoxicity.
• Drug interactions of Metronidazole :
1. Metronidazole can inhibit the metabolisim of : -Warfarin.
- lithium.
2. While phenytoin , phenobarbiton can increase the clearance of metro..
3. Plasma levels of metro..can be elevated by cimetidine.
• Inhibition of bacterial nucleic acid:
1.Direct inhibitors include:
a.Inhibitors of DNA synthesis: quinolones & azoles.
b. Inhibitors of RNA synthesis: Rifampicin.
2.Indirect inhibitors of bacterial nucleic acid synthesis:
- Sulphonamides & trimethoprim.
• Direct Inhibitors of RNA synthesis: Rifampicin
It is particularly effective against mycobacteria ,so it is used in combination with
other antituberculous drugs for T.B..rifampin can
inhibit the growth of gr+ve & gr-ve bacteria .
Rifampin is effective for chemoprophylaxis of meningeococcal infections and
meningitis due to H.influenzae.
• Adverse effects of Rifampicin
1.Allergic reactions.
2.thrombocytopenia.
3.hepatitis.
4.Red discoloration of urin , tears, and sputum.
5. Influenza like syndrome.
purine
DNA
• trimethoprim & sulphonamides
Both are bacteriostatic.
*resistance to sulphonamides is increasingly a problem.
*trimethoprim can exert a synergistic effect with sulfonamides.
1- N, , V. & dia..
2- allergic reactions.
3- mental depression.
4- acute haemolytic anaemia.
Inhibition of cytoplasmic membrane of bacteria
e.g. : Polymixin B. ,Nystatin, Amphotericin.
Polymixin B. : is an antibiotic primarily used for resistant gram negative infections.
Polymyxins bind to the cell membrane and alters its structure making it more
permeable. The resulting water uptake leads to cell death. Side effects include
neurotoxicity and acute renal tubular necrosis.
• NYSTATINS
it is antifungal drug,this agents will bind to ergosterol that is found in the sensitive
fungi & increasing its permeability allowing the leakage of a variety of small
molecules.
It is used for prophylaxis & treatment of superficial candidiasis.
*nystatin is too toxic for systemic use, so not available for parantral use.
• Amphotericin
It has same mechanism of action of nystatin.
It is the d. of choice for fungal systemic infections but renal impairment limits its use.
• Resistance to Antibiotics
Intrinsic resistance
Some bacteria are intrinsically resistant to certain of the antibiotics. Example: Gram-
positive bacteria are much less susceptible to polymixins than Gram-negative
bacteria.
Acquired resistance
Many bacteria acquire resistance to one or more of the antibiotics to which they were
formerly susceptible.
Clinical Diagnosis
Microbiologic Diagnosis
Culture and Susceptibility Testing
Appropriate Selection of Antimicrobial Agents
Correct Dosage and Route of Administration