Antibiotics for acute maxillary sinusitis in adults.

Antibiotics for acute maxillary sinusitis in adults.

Sinusitis is one of the most common diagnoses among adults in ambulatory care, accounting for 15% to 21% of
all adult outpatient antibiotic prescriptions. However, the role of antibiotics for sinusitis is controversial.
OBJECTIVES:
To assess the effects of antibiotics in adults with acute maxillary sinusitis by
comparing antibiotics with placebo, antibiotics from different classes and the side effects of different treatments.
We included 63 studies in this updated review; nine placebo-controlled studies involving 1915 participants (seven
of the studies clearly conducted in primary care settings) and 54 studies comparing different classes
of antibiotics (10 different comparisons). Five studies at low risk of bias comparing penicillin or amoxicillin
to placebo provided information on the main outcome: clinical failure rate at 7 to 15 days follow-up, defined as a
lack of full recovery or improvement, for participants with symptoms lasting at least seven days. In these
studies antibioticsdecreased the risk of clinical failure (pooled RR of 0.66, 95% CI 0.47 to 0.94, 1084 participants
randomised, 1058 evaluated, moderate quality evidence). However, the clinical benefit was small. Cure or
improvement rates were high in both the placebo group (86%) and the antibiotic group (91%) in these five
studies. When clinical failure was defined as a lack of full recovery (n = five studies), results were
similar: antibiotics decreased the risk of failure (pooled RR of 0.73, 95% CI 0.63 to 0.85, high quality evidence)
at 7 to 15 days follow-up.Adverse effects in seven of the nine placebo-controlled studies (comparing penicillin,
amoxicillin, azithromycin or moxicillin to placebo) were more common in antibiotic than in placebo groups
(median of difference between groups 10.5%, range 2% to 23%). However, drop-outs due to adverse effects were
rare in both groups: 1.5% in antibiotic groups and 1% in control groups.In the 10 head-to-head comparisons, none
of the antibiotic preparations were superior to another. However, amoxicillin-clavulanate had significantly more
drop-outs due to adverse effects than cephalosporins and macrolides.
AUTHORS' CONCLUSIONS:
There is moderate evidence that antibiotics provide a small benefit for clinical outcomes in immunocompetent
primary care patients with uncomplicated acute sinusitis. However, about 80% of participants treated
without antibiotics improved within two weeks. Clinicians need to weigh the small benefits of
antibiotic treatment against the potential for adverse effects at both the individual and general population levels.
 Histrico dos antibiticos

1905 - Paul Erhlich (1854 - 1915) - Salvarsan

1935 - Gerard Domagk (1895 - 1964) - Sulfa

1929 - Alexander Fleming (1881 - 1955) Penicilina

 Histrico dos antibiticos

1905 - Paul Erhlich (1854 - 1915) - Salvarsan

1935 - Gerard Domagk (1895 - 1964) - Sulfa

1929 - Alexander Fleming (1881 - 1955) Penicilina

Histrico dos antibiticos

Derivado imidazlico com amplo

espectro de atividade antimictica.

Age contra fungos por meio da inibio

da sntese do ergosterol, ocasionando
dano estrutural e funcional da
membrana citoplasmtica.
 Antimicrobianos

Bactericidas / Bacteriostticos

Antibiticos / Quimioterpicos

Resistente x Sensvel
Antimicrobianaos
 antimicrobianaos

aa
 antimicrobianaos

aa
 Teste de Sensibilidade

Teste de sensibilidade aos

aa antimicrobianos de uma amostra
de S. aureus pela tcnica de disco-
difuso, incubado por 24 horas.

O mecanismo de resistncia oxacilina

mais comum em amostra
de Staphylococcus spp.

Amostras de Staphylococcus spp.,

resistentes oxacilina, so resistentes a
todos os -lactmicos
independentemente dos resultados in
vitro
Teste de Sensibilidade

Amostra de S.
pneumoniae com halo de
oxacilina 20 mmreportar
como sensveis penicilina e
aos -lactmicos que no
foram testados por esta
tcnica devido falta de
padronizao.
Effects of bacteriostatic versus bactericidal antibiotics on
logarithmically growing bacterial culture.
Log Number of Viable Bacteria

Drug Control
Addition

+ Bacteriostatic Agent

+ Bactericidal Agent

Time
 Evolution of resistance to antibiotics
Antibiotic Year deployed Resistance observed
Sulfonamides 1930s 1940s
Penicilin 1943 1946
Streptomycin 1943 1959
Chloramphenicol 1947 1959
Tetracycline 1948 1953
Erythromycin 1952 1988
Vancomycin 1956 1988
Methicillin 1960 1961
Ampicillin 1961 1973
Cephalosporins 1960s late 1960s
 Progression of antibiotics required for efficacy in
staphylococcal infections

H
HOOC N S
Penicillin 1946
NH2 O N
O
COOH
Progression of antibiotics required for efficacy in
staphylococcal infections

O
H
N
Methicillin 1961 S
O O N
O
COO
H
 Progression of antibiotics required for efficacy in
staphylococcal infections

Sugar
O
Cl
O O

HO Cl OH
O O H
H
Vancomycin 1986 O
N
N
N
N
NH H
H H O N
HN O O O
HO
NH2
OH
O OH
HO
Progression of antibiotics required for efficacy in
staphylococcal infections

O
Zyvox 1999 O
O
O N N
N
F
 Antibiotic sales in 1997
DRUG $ MILLIONS
Cephalosporins
Recephin (Roche) 933
Ceftin (GlaxoWellcome) 640
Ceclor (Lilly) 542
Fortaz (GlaxoWellcome) 449
Claforan (Hofmann LaRoche) 335
Macrolides
Bixin (Abbott) 1,150
Zithromax (Pfizer) 619
-Lactamase inhibitors
Augmentin (GlaxoSmithKline) 1,354
Primaxin (Merck) 555
Unasyn (Pfizer) 619
Penicillins
Amoxil (GlaxoSmithKline) 406
Quinolones
Ciprofloxacin (Bayer) 1,290
 Antibiotic market in 1995
Class Wordwide sales Representative Infections that have
($ millions) drugs developed resistance
Cephalosporins 8,446 Cefalor, cefuroxime Bronchitis,
pneumonia meningitis
Penicillins 4,413 Amoxicilin, Ampicillin Pneumonia,
septicemia, bronchitis
Fluoroquinolones 3,309 Ciprofloxacin, ofloxacin
Meningitis
Macrolides 2,927 Clarithromycin, erythromycin
Meningitis
Tetracyclines 744 Minocycline Urinary tract
infections, pelvic
inflammatory disease
Aminoglycosides 729 Gentamicin Intestinal infections,
septicemia
Glycopeptides 462 Vancomycin Intestinal infections
All other 1,873 Imipenem, rifampin Bronchitis,
systemic antibiotic tuberculosis
 Bacteria that are common causes of infections
Infections Gram-negative pathogens Gram-positive pathogens

Burns Pseudomonas aeruginosa Staphylococcus aureus

Skin infections S. aureus
Throat Streptococcus pygeneses
Otitis media Haemophilus influenzae Streptococcus pneumoniae
Pneumonia H. influenzae S. pneumoniase
Endocarditis S. aureus, Enterococcus
faecalis
Septicemia Escherichia Coli S. aureus, S. pyogenes
Gastrointestinal tract Salmonella enterica serovar
Typhimurium
Helicobacter pylori, E. coli
Shigela dysenteriae
Urinary tract E. coli Enterococcus sp.
 Summary of typical first-line approach for antibiotic treatment
Infections Likely Reasonable first-choice therapy
Community- Streptococcus For hospitalized patients: broad-
acquired pneumonia pneumoniae spectrum or fourth-generation
cephalosporin; for ambulatory
patients: an orally available macrolide
or fluoroquinolone
Hospital-acquired Gram-negative For Pseudomonas aeruginosa: broad-
pneumonia bacterium or spectrum or fourth-generation
Staphylococcus cephalosporin, imipenem, and
aminoglycoside; for MRSA:
vancomycin
Broad-spectrum cephalosporin +
Meningitis S. Pneumoniae or
vancomycin + rifampin
Neisseria menigitidis
Sepsis syndrome Gram-negative baicillin Cephalosporin + aminoglycosides;
but also gram-positive vancomycin
cocci such as MRSA
Urinary tract Gram-negative Sulfamethoxazole + trimethoprim;
infections bacterium such as E. coli fluoroquinolones; fosfomycin
Tuberculosis Mycobacterium Isoniazid + rifampin +
tuberculosis pyrizinamide + ethambutol
Parede Bacteriana

Membrana Plasmtica

Ribossomos

cidos Nuclicos

Metabolismo Intermedirio

Principles of Pharmacology - The Pathophysiologic Basis of Drug Therapy Table 32.1

Mechanisms of Selective Targeting by Chemotherapeutic Agents

Principles of Pharmacology - The Pathophysiologic Basis of Drug Therapy Table 32.1

IC50 Values for three Dihydrofolate Reductase Inhibitors

Principles of Pharmacology - The Pathophysiologic Basis of Drug Therapy Table 32.3

 antimicrobianaos

aa
 antimicrobianaos

aa
Sites of action of antibacterial drug classes

Principles of Pharmacology - The Pathophysiologic Basis of Drug Therapy Fig 32.1

Stages of the viral life cycle targeted by antiviral drug classes

Principles of Pharmacology - The Pathophysiologic Basis of Drug Therapy Fig 32.2

Antineoplastic drug classes

Principles of Pharmacology - The Pathophysiologic Basis of Drug Therapy Fig 32.3

Log cell kill model of tumor growth and regression

Principles of Pharmacology - The Pathophysiologic Basis of Drug Therapy Fig 32.5

The Bacterial 70S ribosome

Principles of Pharmacology - The Pathophysiologic Basis of Drug Therapy Fig 33.6

Bacterial translation

Principles of Pharmacology - The Pathophysiologic Basis of Drug Therapy Fig 33.7

Structure of antimicrobial drugs targeting the 30S ribosomal subunit

Principles of Pharmacology - The Pathophysiologic Basis of Drug Therapy Fig 33.9

 Structure of antimicrobial
drugs targeting the 50S
ribosomal subunit

Principles of Pharmacology - The Pathophysiologic Basis of Drug Therapy Fig 33.11

Mechanism of action of erythromycin, clindamycin, and chloramphenicol revealed by
crystallographic analysis of drug binding to the 50S ribosomal subunit

Principles of Pharmacology - The Pathophysiologic Basis of Drug Therapy Fig 33.12

Structure of some sulfonamides
and p-aminobenzoic acid

Basic and Clinical Pharmacology 11th Edition Fig 46.1

Impedem sntese do cido Flicopela Bactria
Actions of sulfonamides and trimethoprim

Basic and Clinical Pharmacology 11th Edition Fig 46.2

Pharmacokinetic properties of some sulfonamides and trimethoprim

Basic and Clinical Pharmacology 11th Edition Table 46.1

Basic and Clinical Pharmacology 11th Edition pag. 818
 ANTIBITICOS BETA-LACTMICOS

uma classe ampla de antibiticos, que inclui a penicilina e seus

derivados, que possuem agente antibitico, o ncleo -lactmico em
sua estrutura molecular.
 Sub-classes de beta-lactmicos
penicilnicos, derivados semi-sintticos da penicilina, como
penicilina V, penicilina G, amoxicilina e ampicilina.

cefalospornicos de 1, 2, 3, 4 e 5 geraes

carbapenmicos (Imipenem, Meropenem, Ertapenem e Panipenem).

clavulanato: inativador de betalactamase, enzima produzida por

bactrias para resistirem a ao dos antibiticos betalactmicos.
Bacterial cell wall architecture

Principles of Pharmacology - The Pathophysiologic Basis of Drug Therapy Fig 34.1

Bacterial cell wall biosynthesis and its inhibition by pharmacologic agents

Principles of Pharmacology - The Pathophysiologic Basis of Drug Therapy Fig 34.2

 Transpeptidase
action and its
inhibition by
penicilin

Principles of Pharmacology - The Pathophysiologic Basis of Drug Therapy Fig 34.3

Structure features of -lactam
antibiotics and -lactamase
inhibitors

Principles of Pharmacology - The Pathophysiologic Basis of Drug Therapy Fig 34.6

Core structure of four -lactam antibiotic families

Basic and Clinical Pharmacology 11th Edition Fig 43.1

Side chains of some penicillins
(R groups of Figure 43-1)

Basic and Clinical Pharmacology 11th Edition Fig 43.2

A highly simplified diagram of the cell envelope of a gram-negative bacterium

Basic and Clinical Pharmacology 11th Edition Fig 43.3

The transpeptidation reaction
in Staphylococcus aureus that
is inhibited by lactam
antibiotics

Basic and Clinical Pharmacology 11th Edition Fig 43.4

The biosynthesis of cell wall peptidoglycan, showing the sites of action of five antibiotics
(shaded bars; 1 = fosfomycin, 2 = cycloserine, 3 = bacitracin, 4 = vancomycin, 5 = -lactam antibiotics)

Basic and Clinical Pharmacology 11th Edition Fig 43.5

Basic structures of four groups of -lactam antibiotics and
clavulanic acid.

Book Rang & Dales Pharmacology Eighth Edition Fig 51.3

 SUMMARY Beta-Lactam & Other Cell Wall- &
Membrane-Active Antibiotics

Basic and Clinical Pharmacology 11th Edition Pag 790

 SUMMARY Beta-Lactam & Other Cell Wall- &
Membrane-Active Antibiotics

Basic and Clinical Pharmacology 11th Edition Pag 791

Guidelines for dosing of some commonly used penicillins

Basic and Clinical Pharmacology 11th Edition Table 43-1

 Penicilina G (Bezentacil)

inibio da biossntese do mucopeptdeo da parede celular

dos microorganismos;

IM de 1.200.000 unidades, os nveis sricos adequados (

0,02 g/ml penicilina) durante os 28 dias;

est contra-indicado para pacientes com

hipersensibilidade s penicilinas.
 Penicilina G (Bezentacil)
INDICAO: infeces causadas por germes sensveis penicilina G, que
sejam suscetveis aos nveis sricos baixos, porm muito prolongados.

As seguintes indicaes usualmente iro responder a doses adequadas de

Benzetacil :

Infeces estreptoccicas
Infeces leves e moderadas do trato respiratrio superior e da pele. Infeces
venreas: sfilis, bejel (sfilis endmica).
Profilaxia da glomerulonefrite aguda e doena reumtica.
Profilaxia de recorrncias da febre reumtica (doena reumtica de origem auto-
imune, em resposta do organismo a infeces pelo estreptococo).
 Penicilina G (Bezentacil)
POSOLOGIA

injeo nica de 300.000 a 600.000 unidades de Benzetacil (benzilpenicilina

benzatina) para crianas at 27 kg.

injeo nica de 900.000 unidades para crianas maiores.

injeo nica de 1.200.000 unidades para adultos.

Amoxicilina
 Amoxicilina
aminopenicilina semi-sinttica do grupo beta-lactmico

amplo espectro de atividade contra microrganismos gram-

positivos e gram-negativos.

age atravs da inibio da biossntese do mucopeptdeo

das paredes das clulas
 Amoxicilina
Indicaes: infeces bacterianas causadas por germes
sensveis ao da amoxicilina.

Tambm pode ser usado para prevenir infeces.

Contra indicaes: hipersensibilidade a antibiticos beta-

lactmicos.
 Amoxicilina

Posologia profiltica: 4 (quatro) cpsulas de 500 mg antes

(1 hora) antes do procedimento.

Posologia dose ataque: 2 (duas) cpsulas de 500 mg antes

(1 hora) antes do procedimento.

Posologia usual: 1 (uma) cpsulas de 500 mg a cada 8

(oito) horas por 7 dias.
Ampicilina
 Ampicilina
bactericida, semi-sinttico, derivado do ncleo das
penicilinas, o cido 6-aminopenicilnico.

amplo espectro contra microrganismos gram-positivos e

gram-negativos.

age inibindo a biossntese do mucopeptdeo das paredes

das clulas
 Ampicilina
Indicaes: infeces bacterianas causadas por germes
sensveis ao da ampicilina.

Tambm pode ser usado para prevenir infeces.

Contra indicaes: pacientes com histria de reaes de

hipersensibilidade (alergia) s penicilinas e cefalosporinas,
devido a ocorrncia de reao alrgica cruzada.
 Ampicilina

Posologia profiltica: 4 (quatro) comprimidos de 500 mg

antes (1 hora) antes do procedimento.

Posologia usual: 1 (uma) comprimidos de 500 mg a cada 8

(oito) horas por 7 dias.
 Ampicilina
MEAN CONCENTRATION
Ampicillin

Amplacilina Standacillin
7.5 Mean SD Mean SD
AUClast([ng*h]/mL) 15.43Amplacilina
9.56 14.72 8.66
AUC inf ([ng * h]/mL) 16.03 9.84 15.20 8.81
AUC all (0-8h) ([ng * h]/mL) Standacillin
Concentration

14.76 9.63 14.68 8.69

Cmax(ng/mL) 4.98 3.60 5.15 3.48
5.0
(ng/mL)

Median (Range) Median (Range)

Tmax(h) median 1.80 1.00 3.30 2.00 1.00 4.00
T 1/2 (h) median 1.27 0.86 3.10 1.24 0.72 4.12

2.5

0.0
0 1 2 3 4 5 6 7 8
Time (h)
 Cefalosporinas

grupo de antibiticos beta-lactmicos relacionados com as

penicilinas, usados no tratamento de infeces bacterianas.
Basic and Clinical Pharmacology 11th Edition Table 43.2
 Structure of some
cephalosporins
R1 and R2 structures are substituents on the 7-
aminocephalosporanic acid nucleus pictured at the top

Basic and Clinical Pharmacology 11th Edition Fig 43.6

 Cefalexina

O
H H
S
N
H N
NH 2 CH 3
O
COOH

interferncia sobre a sntese da parede celular bacteriana.

 Cefalexina
Indicaes:
1. Infeces do trato respiratrio
2. Otite mdia aguda
3. Infeces da pele e tecidos moles
4. Infeces genitourinrias
5. Infeces odontolgicas
6. Infeces sseas e de articulaes

Contra indicaes: A cefalexina contra-indicada nos casos

de hipersensibilidade s penicilinas e cefalosporinas.
 Cefalexina

Cefalexina administrada por via oral.

Adultos: 1 a 4 g dirios, em doses fracionadas. A dose usual

para adultos de 250 mg a cada 6 horas.

Crianas: dose diria de 25 a 50 mg/kg em doses fracionadas.

Cefalexina
 Clavunalato

H
O OH

N
O
O
H
OH
 Clavunalato
O cido clavulnico um beta-lactmico, estruturalmente
relacionado s penicilinas, que possui a capacidade de
inativar uma grande variedade de enzimas beta-
lactamases, comumente produzidas por microrganismos
resistentes s penicilinas e s cefalosporinas.

Associado a outros antibiticos: amoxicilina

-Lactamase inhibitors

Basic and Clinical Pharmacology 11th Edition Fig 43.7

 Clavunalato+Amoxicilina
Indicaes: um agente antibitico com um espectro de
ao notavelmente amplo contra os patgenos bacterianos,
A ao inibitria da -lactamase do clavulanato estende o
espectro da amoxicilina, abrangendo uma variedade maior
de microrganismos, incluindo muitos resistentes a outros
antibiticos - lactmicos

Contra indicaes: pacientes com hipersensibilidade

penicilina e com histrico prvio de ictercia / disfuno
heptica associadas ao Clavulin BD ou penicilina.
 Clavulanato

Adulto: Um comprimido de CLAVULIN BD 875 mg/120mg,

2 vezes ao dia.

Crianas acima de 2 anos:

2 - 6 anos (13 - 21 kg): 5mL de Clavulin BD Suspenso
200mg+28,5mg/5mL 2x dia

7 - 12 anos (22 - 40 kg): 10mL de Clavulin BD Suspenso

200mg+28,5mg/5mL 2x dia
Clavunalato Amoxicilina
Carbapenmicos: Imipenem, Meropenem,
Ertapenem, Panipenem
Possuem atividade bactericida de amplo espectro e melhor estabilidade
diante das b lactamases.

Ligam-se s protenas fixadoras de penicilina presentes na parede

bacteriana, provocando a lise osmtica da bactria e so mais resistentes
hidrlise pela maioria das b -lactamases.
Carbapenmicos: Imipenem, Meropenem,
Ertapenem, Panipenem

Efeitos Colaterais: prurido, febre, reao anafiltica e reao cruzada

penicilina podem ocorrer como com qualquer outro b lactmico.

Indicaes Clnicas: infeces hospitalares graves, com falncia

teraputica a outras drogas decorrente de resistncia bacteriana.
MACROLDEOS
Macrolides

Basic and Clinical Pharmacology 11th Edition Pag 799

 MACROLDEOS
MECANISMOS DE AO

So drogas bacteriostticas* que bloqueiam aminocidos

essenciais para a sntese protica bacteriana.

Em concentrao elevada ou contra microorganismos

extremamente sensveis, podem ser bactericidas.

*Bacteriosttico: impede o crescimento de bactrias. Bactericidas: destroe a parede

bacteriana, eliminando a bactria
 ESPECTRO DE AO

Os macroldeos apresentam amplo

espectro de ao!
 Bactrias aerbicas
Gram-Positivas: Gram-Negativas:
Bacillus sp; B. pertussis;
Corynebacterium diphtheriae; C. Jejuni
Erysipelothrix rhusiopathiae. Gardnerella vaginalis;
Listeria monocytogenes; H. influenzae;
S. agalactiae; H. Pylori
S. aureus meticilino - sensvel; L. pneumophila;
S. epidermidis meticilino-sensvel; Leptospira sp;
S. pyogenes; M. catarrhalis;
S. viridans; N. asteroides;
N. meningitidis;
S. pneumoniae;
T. pallidum;

N. gonorrhoeae;
 Outros
Chlamydia trachomatis; Mycobacterium scrofulaceum;
Cryptosporiduim Mycoplasma hominis
E. Coli Salmonella sp
Shigella sp
Entamoeba hystolitica
T. pallidum;
Mycobacterium avium - intacellulare Toxoplasma gondii
Mycobacterium kansasii; Ureaplasma urealyticum;
Mycobacterium leprae Yersina sp
Mycoplasma pneumoniae; Babesia microti
N. gonorrhoeae;
 MACROLDEOS
Eritromicina Claritromicina
Clorafenicol Espiramicina
Azitromicina Miocamicina
Diritromicina Roxitromicina
 Azitromicina
Nome comercial: Zitromax

Nome genrico: azitromicina diidratada

Formas farmacuticas: comprimidos revestidos, p para

suspenso oral

Via de administrao: ORAL

 Azitromicina
INDICAES DO MEDICAMENTO:
infeces causadas por bactrias sensveis azitromicina;

infeces do trato respiratrio inferior e superior, incluindo

sinusite (infeco nos seios da face), faringite ou amigdalite;

infeces da pele e tecidos moles; em otite mdia aguda e nas

doenas sexualmente transmissveis no complicadas no
homem e na mulher
 Azitromicina

Contra-indicaes:

hipersensibilidade (reaes alrgicas) azitromicina,

eritromicina, a qualquer antibitico macroldeo (classe de
antibiticos a qual pertence a azitromicina) ou a qualquer
componente da frmula.
 Azitromicina
Apresentaes comercializadas:

500 mg - 2 ou 3 comprimidos revestidos.

900 e 600 mg em embalagem com 1 frasco contendo p para

suspenso oral, acompanhado de 1 flaconete com 9 mL de
diluente, 1 seringa para uso oral graduada at 5 mL, 1 tampa
interna para fixao boca do frasco.
 Azitromicina
Posologia: deve ser administrado em dose nica e diria.

Uso em adultos

formulao oral, uma dose total de 1500 mg deve ser administrada em

doses dirias de 500 mg, durante 3 dias.

Como alternativa, a mesma dose total pode ser administrada durante 5

dias, em dose nica de 500 mg no 1 dia e 250 mg, 1 vez ao dia, do 2
ao 5 dia.
 Azitromicina
Crianas:
A dose mxima total recomendada para qualquer tratamento em
crianas de 1500 mg.

Em geral, a dose total em crianas de 30 mg/kg. No tratamento da

faringite estreptoccica peditrica deve ser administrada sob
diferentes esquemas posolgicos.

A dose total de 30 mg/kg deve ser administrada em dose nica diria de

10 mg/kg, durante 3 dias, ou a mesma dose total pode ser
administrada durante 5 dias, em dose nica de 10 mg/kg no 1 dia e 5
mg/kg, 1 vez ao dia, do 2 ao 5 dia.
 Azitromicina

REAES ADVERSAS

Azitromicina diidratada bem tolerada, apresentando baixa

incidncia de efeitos colaterais.

diarria, vmito e dor abdominal

 ERITROMICINA
NOME GENRICO: eritromicina

FORMA FARMACUTICA: Comprimidos

APRESENTAES

Caixa com 10 e 120 comprimidos revestidos de 250mg

Caixa com 6, 60 e 120 comprimidos revestidos de 500mg
 ERITROMICINA
INDICAES :
- Streptococcus pyogenes: vias respiratrias superiores e
inferiores e infeces da pele e tecido celular subcutneo de
pequena a moderada gravidade.

- Estreptococos alfa hemolticos (Grupo Viridansi: profilaxia

a curto prazo, contra endocardite bacteriana, antes de
intervenes cirrgicas ou dentrias em pacientes com
histria de febre reumtica ou cardiopatia congnita
 ERITROMICINA
INDICAES :

- Diplococcus pneumoniae: infeces das vias respiratrias

superiores e inferiores (pneumonia).

-Neisseria gonorrhoeae (Gonorreia) e Treponema

pallidummeses agente (Sfilis)

-Corynebacterium diphtheriae (Difteria)

 ERITROMICINA
Contra-indicaes:

Pacientes com conhecida hipersensibilidade eritromicina

 ERITROMICINA
Posologia:

Adultos: A dose usual 250mg a cada 6 horas, porm, de acordo com a

gravidade da infeco, esta poder ser aumentada at 4g ou mais por
dia.

Crianas: Idade, peso e gravidade da infeco so fatores importantes

na determinao da posologia adequada. O esquema usual de 30 a
50mg/kg por dia, dividido em 3 ou 4 doses a intervalos iguais.
 ERITROMICINA
REAES ADVERSAS

Nuseas, vmitos, diarria ocorrem pouco freqentemente

com as doses usuais.

Urticria e erupes cutneas

 CLARITROMICINA

Nome genrico: claritromicina

Formas farmacuticas: comprimidos 250 mg ou 500 mg:

embalagens contendo 10 e 14 comprimidos.

Via de administrao: ORAL

 CLARITROMICINA
INDICAES:
infeces de vias areas superiores e inferiores
infeces de pele e tecidos moles
faringite, amigdalite
sinusite maxilar aguda
bronquite crnica
infeces cutneas
pneumonia
 CLARITROMICINA
Contra-indicaes:

A claritromicina est contra-indicada para pacientes com

conhecida hipersensibilidade claritromicina, eritromicina
e a outros antibiticos macroldeos.

ainda contra-indicada em pacientes tratados com

terfenadina (antihistaminico), que tenham anormalidades
cardacas preexistentes (arritmias, bradicardia,
insuficincia cardaca congestiva, etc.), ou distrbios
hidroeletrolticos.
 CLARITROMICINA

Posologia adulto: 01 comprimido de 250 mg, por via oral, a

cada 12 horas de 7 a 14 dias.

infeces graves: 02 comprimidos de 250 mg, por via oral, a

cada 12 horas de 7 a 14 dias.
 CLARITROMICINA

Uso em crianas e lactentes: no se recomenda a utilizao de

claritromicina, na forma farmacutica de comprimidos, em
crianas com idade inferior a 12 anos.
 CLARITROMICINA
REAES ADVERSAS

nusea, dispepsia (indigesto ou indisposio estomacal),

dor abdominal, vmito e diarria.

cefalia, paladar alterado e elevao transitria de enzimas

hepticas (Como ocorre com outros macroldeos). Esta
disfuno heptica pode ser severa, sendo usualmente
reversvel.
 ROXITROMICINA
Nome genrico: roxitromicina

Formas farmacuticas: comprimidos revestidos de 150 ou 300

mg

Via de administrao: ORAL

 ROXITROMICINA
INDICAES PARA INFECES DE:

Otorrinolaringologia
Pneumologia
Dermatologia
Odontoestomatologia
Infeces genitais
Profilaxia da meningite meningoccica.
 ROXITROMICINA
Contra-indicaes:

Hipersensibilidade eritromicina, lincomicina,

cloranfenicol, clindamicina e demais antibiticos
macroldeos.
 ROXITROMICINA
Adultos e crianas acima de 10 anos:
01 comprimido de 150mg pela manh e outro noite (a cada
12 horas), ou um nico comprimido de 300mg ao dia,
preferencialmente em jejum, antes das refeies. O perodo
de tratamento de 5 a 10 dias ou a critrio mdico.
Crianas de 06 a 10 anos:

01 comprimido de 150mg, em uma nica tomada ao dia, de

preferncia em jejum, antes das refeies.
 CONCLUSO
Quando a administrao de rifampicina inevitvel,
back-up ou outro tipo de contracepo adicional
deve ser usado.
Montelucaste de sdio um antagonista do receptor de leucotrienos
que bloqueia as substncias chamadas leucotrienos. Os leucotrienos
causam estreitamento e inchao das vias areas dos seus pulmes. Os
leucotrienos tambm causam sintomas alrgicos. O bloqueio da ao
dos leucotrienos melhora os sintomas de asma e rinite alrgica e
ajuda a evitar as crises de asma.
 Em concluso, nossos resultados indicam que a
administrao concomitante de claritromicina
aumentou significativamente a biodisponibilidade
montelucaste
 TETRACICLINAS
MECANISMOS DE AO
Tetraciclinas so agentes bacteriostticos de largo espectro, que
agem inibindo a sntese protica de bactrias sensveis,
bloqueando a ligao do RNA-t (RNA transportador) ao
RNA-m (RNA mensageiro) dos microorganismos.

O espectro de ao abrange microorganismos Gram-positivos

(aerbicos e anaerbicos), Gram-negativos, protozorios,
micoplasma, clamdias, riquetsias e espiroquetas.
Tetracyclines

Basic and Clinical Pharmacology 11th Edition Pag. 796

Tetracyclines

Basic and Clinical Pharmacology 11th Edition Pag. 796

TETRACICLINAS

Tetraciclina
Doxiciclina
Doziciclina
Minociclina
 TETRACICLINAS
- Acne vulgaris: como adjuvante de tratamento.
- Actinomicoses causadas por Actinomyces israelii.
- Infeco geniturinria causada por N. gonorrhoeae e por
Chlamydia trachomatis.
- Gengivoestomatite causada por Fusobacterium
fusiformisans.
- Granuloma inguinal causada por Calymmatobacterium
granulomatis.
- Linfogranuloma venreo por Chlamydia sp.
 TETRACICLINAS
- Otite mdia, faringite, pneumonia e sinusite causadas por H.
influenzae e Klebsiella sp.
- Tifo causada por Rickettsias.
- Sfilis causada por Treponema pallidum.
- Infeco bacteriana do aparelho urinrio causada por
Escherichia coli e Klebsiella sp.
- Infeco retal menor causada por Chlamydia trachomatis.
- Enterocolites causadas por Shigella sp.
 TETRACICLINAS
Contra-indicaes:

No deve ser administrado a pessoas com hipersensibilidade

s Tetraciclinas. tambm contra-indicado durante a
gravidez e amamentao.
 TETRACICLINAS
PRECAUES:

As tetraciclinas se depositam nos dentes em formao,

causando descolorao do dente e hipoplasia do esmalte. Elas
tambm so depositadas nos ossos e unhas onde formam um
complexo estvel com o on clcio. Portanto, no devem ser
administradas a crianas menores de 8 anos de idade, porque
afeta o seu crescimento sseo.
 TETRACICLINAS
PRECAUES:

Uso na gravidez: As Tetraciclinas atravessam a barreira

placentria; portanto, o seu uso no recomendado durante a
segunda metade da gestao. As tetraciclinas podem causar
descolorao e hipoplasia do esmalte do dente e inibio do
crescimento linear do esqueleto do feto.
 TETRACICLINAS
PRECAUES:

Uso na amamentao: As Tetraciclinas so encontradas no leite

materno; portanto, seu uso no recomendado durante a
lactao pela possibilidade de causarem descolorao do dente,
hipoplasia do esmalte, inibio do crescimento linear do
esqueleto, reaes fotossensitivas e afta oral e vaginal em
bebs.
 TETRACICLINA
Posologia:

500 mg a cada 6 horas ou 500 mg a 1 g a cada 12 horas.

De 5 a 15 dias

Limite mximo de ingesto diria: 4 gramas.

 TETRACICLINA
REAES ADVERSAS

As reaes alrgicas s Tetraciclinas so comumente cruzadas e

se manifestam como alteraes da pele, descolorao do dente
e hipoplasia do esmalte.
Efeitos gastrointestinais: nuseas, vmitos, diarrias,
acompanhados ou no de dor e queimao epigstrica.
Pode ainda ocorrer: candidase oral, vulvovaginite e prurido anal,
escurecimento ou descolorao da lngua; colite
pseudomembranosa, fotossensibilidade da pele e pigmentao
da pele e membrana mucosa.
 MINOCICLINA

Nome genrico: minociclina

Forma farmacutica: comprimido 100 mg

Via de administrao: ORAL

 MINOCICLINA
INDICAES:

Indicado no tratamento de vrias infeces causadas por

microorganismos Gram-positivos e Gram-negativos

febre maculosa, tifo murino, febre, infeces do trato

respiratrio, pneumoniae, linfogranuloma venreo,
psitacose, tracoma e conjutivite de incluso.
 MINOCICLINA
Contra-indicaes: contra-indicado nos casos de
hipersensibilidade reconhecida s tetraciclinas.
 MINOCICLINA

POSOLOGIA

Adulto: 200 mg como dose inicial, seguida de 100 mg a cada 12

horas.

Crianas (maiores de 8 anos): 4 mg/kg, inicialmente, seguida de 2 mg/kg a

cada 12 horas.
 MINICICLINA
REAES ADVERSAS

Gastrintestinais: anorexia, nusea, vmitos, diarria,

glossite, leses inflamatrias da regio anogenital, aumento
das enzimas hepticas e raramente hepatite.
Sistema Nervoso Central: abaulamento de fontanela foi
relatado em crianas pequenas, hipertenso intracraniana
benigna.
Sangue: anemia hemoltica, trombocitopenia, neutropenia e
eosinofilia foram relatadas.
Clindamycin

Basic and Clinical Pharmacology 11th Edition Pag 801

 CLINDAMICINA
Nome comercial: Dalacin C

Nome genrico: cloridrato de clindamicina

Forma farmacutica: cpsula

Via de administrao: ORAL

um antibitico inibidor da sntese protica bacteriana.

 CLINDAMICINA
INDICAES:
infeces do trato respiratrio superior (traquia, seios da
face, amgdalas, faringe, laringe, ouvido) e inferior
(brnquios, pulmes), infeces da pele e partes moles
(tecido subcutneo, msculos, tendes, etc.), infeces da
pelve e trato genital feminino (tero, trompas, ovrio e
vagina). tambm indicado no tratamento de infeces
sseas e articulares. Infeces dentrias, incluindo
abscessos periodontais, periodontite, gengivite e abscessos
periapicais.
 CLINDAMICINA
Contra-indicaes: contra-indicado em caso de
hipersensibilidade (reao alrgica) clindamicina ou
lincomicina ou a qualquer componente da frmula.
 Clindamicina
Cada cpsula contm 300 mg de clindamicina.

Uso em Adultos

A dose diria recomendada de 600 - 1800 mg, dividida em 2,

3 ou 4 doses iguais. (7-10 dias)

A dose mxima recomendada de 1800 mg por via oral

(divididos em 2, 3 ou 4 doses dirias).
 Clindamicina
Infeces dentrias:

A clindamicina (150 mg, a cada 6 horas) tem eficcia

comparvel a da ampicilina (250 mg, a cada 6 horas) no
tratamento de abscessos odontognico.
 Clindamicina
REAES ADVERSAS

foram observados poucos casos de reaes anafilactides.

dor abdominal, nusea, vmito, diarria, esofagite e lcera
esofgica
foram observadas anormalidades em testes de funo
heptica
rash, urticria, erupes, prurido
 METRONIDAZOL
Nome comercial: Flagyl

Nome genrico: metronidazol

Forma farmacutica: comprimido, injetvel, creme vaginal

 METRONIDAZOL
INDICAES DO MEDICAMENTO:
- tricomonase;
- vaginites por Gardnerella vaginalis;
- giardase;
- amebase e
- tratamento de infeces causadas por bactrias anaerbias
como Bacteroides fragilis e outros bacterides,
Fusobacterium sp, Clostridium sp, Eubacterium sp e cocos
anaerbios.
 METRONIDAZOL
Contra-indicaes: contra-indicado em pacientes com
hipersensibilidade anterior ao metronidazol ou outro
derivado imidazlico e aos demais componentes do
produto.
 METRONIDAZOL
- Infeces por bactrias anaerbias

Adultos e crianas maiores de 12 anos:

1 comprimido de metronidazol 400 mg trs vezes ao dia,
durante 7 dias ou critrio mdico. Tomar aps as
refeies.

Crianas menores de 12 anos

Administrar a dose de 7,5 mg/Kg, 3 vezes ao dia (22,5
mg/Kg/dia), durante 7 dias, ou critrio mdico.
 METRONIDAZOL
REAES ADVERSAS

dor epigstrica, nusea, vmito, diarria;

mucosite oral, alteraes no paladar, incluindo gosto
metlico, anorexia;
casos excepcionais e reversveis de pancreatite;
rash, prurido, rubor, urticria;
febre, excepcionalmente choque anafiltico;
muito raramente erupes pustulosas.
cefalia, convulses, tontura;
Structure of nalidixic acid and
some fluoroquinolones

Basic and Clinical Pharmacology 11th Edition Fig 46.3

Pharmacokinetic properties of fluoroquinolones

Basic and Clinical Pharmacology 11th Edition Table 46.2

 CIPROFLOXACINO
Nome comercial: CIPRO

Nome genrico: CIPROFLOXACINO

Forma farmacutica: COMPRIMIDO, POMADA,

SOLUO INJETVEL
 CIPROFLOXACINO
O ciprofloxacino um agente antibacteriano quinolnico
sinttico, de amplo espectro.

O ciprofloxacino tem atividade in vitro contra uma ampla gama

de microorganismos gram-negativos e gram-positivos.

A ao bactericida do ciprofloxacino resulta da inibio da

topoisomerase bacteriana do tipo II e topoisomerase IV,
necessrias para a replicao, transcrio, reparo e
recombinao do DNA bacteriano.
 CIPROFLOXACINO
INDICAES NAS INFECES:

Pneumonias, ouvido mdio (otite mdia) e seios paranasais

(sinusite), olhos, rins e/ou trato urinrio eferente,
gonorria e prostatite, infeces bacterianas do trato
gastrintestinal ou do trato biliar e peritonite, pele e tecidos
moles, ossos e articulaes e sepse.
 CIPROFLOXACINO
Contra-indicaes: no deve ser usado em casos de
hipersensibilidade ao ciprofloxacino, ou s outras
quinolonas ou a qualquer um dos excipientes.

contra-indicada a administrao concomitante de

ciprofloxacino e tizanidina (relaxamente muscular), pois
pode ocorrer um aumento indesejvel nas concentraes
sricas de tizanidina associado aos efeitos colaterais
clinicamente importantes induzidos por esta (hipotenso,
sonolncia)
 CIPROFLOXACINO

Uso em Adultos

A dose diria recomendada de 250 - 500 mg, dividida em 2,

doses iguais. (7-14 dias)
 CIPROFLOXACINO
REAES ADVERSAS

eosinofilia

anorexia

hiperatividade psicomotora/agitao

cefalia, tontura, distrbios do sono e alterao do paladar.

Structure of folic acid, PABA analogues (sulfonamides), and folate analogues
(dihydrofolate reductase inhibitors)

Principles of Pharmacology - The Pathophysiologic Basis of Drug Therapy Fig 32.6 (cont.)
Structure of folic acid, PABA analogues (sulfonamides), and folate analogues
(dihydrofolate reductase inhibitors)

Principles of Pharmacology - The Pathophysiologic Basis of Drug Therapy Fig 32.6 (cont.)
 Folate synthesis and
function

Principles of Pharmacology - The Pathophysiologic Basis of Drug Therapy Fig 32.7

Principles of Pharmacology - The Pathophysiologic Basis of Drug Therapy Table Chapter 33 pag 596
Principles of Pharmacology - The Pathophysiologic Basis of Drug Therapy Table Chapter 33 pag 596
Principles of Pharmacology - The Pathophysiologic Basis of Drug Therapy Table Chapter 33 pag 597
Principles of Pharmacology - The Pathophysiologic Basis of Drug Therapy Table Chapter 33 pag 597
Principles of Pharmacology - The Pathophysiologic Basis of Drug Therapy Table Chapter 33 pag 598
The Bacterial 70S ribosome

Principles of Pharmacology - The Pathophysiologic Basis of Drug Therapy Fig 33.6

Bacterial translation

Principles of Pharmacology - The Pathophysiologic Basis of Drug Therapy Fig 33.7

Structure of antimicrobial drugs targeting bacterialtopoisomerases and
transcription

Principles of Pharmacology - The Pathophysiologic Basis of Drug Therapy Fig 33.8

Structure of antimicrobial drugs targeting the 30S ribosomal subunit

Principles of Pharmacology - The Pathophysiologic Basis of Drug Therapy Fig 33.9

 Together, disruption of the decoding function of the 30S ribosomal subunit and the Davis model for
concentration-dependent effects of aminoglycosides can explain the bactericidal activity of these drugs

Principles of Pharmacology - The Pathophysiologic Basis of Drug Therapy Fig 33.10 (cont.)
 Structure of antimicrobial
drugs targeting the 50S
ribosomal subunit

Principles of Pharmacology - The Pathophysiologic Basis of Drug Therapy Fig 33.11

Mechanism of action of erythromycin, clindamycin, and chloramphenicol revealed by
crystallographic analysis of drug binding to the 50S ribosomal subunit

Principles of Pharmacology - The Pathophysiologic Basis of Drug Therapy Fig 33.12

Bacterial cell wall architecture

Principles of Pharmacology - The Pathophysiologic Basis of Drug Therapy Fig 34.1

Bacterial cell wall biosynthesis and its inhibition by pharmacologic agents

Principles of Pharmacology - The Pathophysiologic Basis of Drug Therapy Fig 34.2

 Transpeptidase
action and its
inhibition by
penicilin

Principles of Pharmacology - The Pathophysiologic Basis of Drug Therapy Fig 34.3

 Mycolic acid synthesis and
antimycobacterial drug
action

Principles of Pharmacology - The Pathophysiologic Basis of Drug Therapy Fig 34.4

Structure of cycloserine

Principles of Pharmacology - The Pathophysiologic Basis of Drug Therapy Fig 34.5

Structure features of -lactam
antibiotics and -lactamase
inhibitors

Principles of Pharmacology - The Pathophysiologic Basis of Drug Therapy Fig 34.6

Core structure of four -lactam antibiotic families

Basic and Clinical Pharmacology 11th Edition Fig 43.1

Side chains of some penicillins
(R groups of Figure 43-1)

Basic and Clinical Pharmacology 11th Edition Fig 43.2

A highly simplified diagram of the cell envelope of a gram-negative bacterium

Basic and Clinical Pharmacology 11th Edition Fig 43.3

The transpeptidation reaction
in Staphylococcus aureus that
is inhibited by lactam
antibiotics

Basic and Clinical Pharmacology 11th Edition Fig 43.4

The biosynthesis of cell wall peptidoglycan, showing the sites of action of five antibiotics
(shaded bars; 1 = fosfomycin, 2 = cycloserine, 3 = bacitracin, 4 = vancomycin, 5 = -lactam antibiotics)

Basic and Clinical Pharmacology 11th Edition Fig 43.5

Guidelines for dosing of some commonly used penicillins

Basic and Clinical Pharmacology 11th Edition Table 43-1

 Structure of some
cephalosporins
R1 and R2 structures are substituents on the 7-
aminocephalosporanic acid nucleus pictured at the top

Basic and Clinical Pharmacology 11th Edition Fig 43.6

 Guidelines for dosing
of some commonly used
cephalosporins and
other cell-wall

Basic and Clinical Pharmacology 11th Edition Table 43.2

-Lactamase inhibitors

Basic and Clinical Pharmacology 11th Edition Fig 43.7

Structure of daptomycin (Kyn, deaminated tryptophan)

Basic and Clinical Pharmacology 11th Edition Fig 43.8

Proposed mechanism of action of daptomycin

Basic and Clinical Pharmacology 11th Edition Fig 43.9

 SUMMARY Beta-Lactam & Other Cell Wall- &
Membrane-Active Antibiotics

Basic and Clinical Pharmacology 11th Edition Pag 790

 SUMMARY Beta-Lactam & Other Cell Wall- &
Membrane-Active Antibiotics

Basic and Clinical Pharmacology 11th Edition Pag 791

Tetracyclines

Basic and Clinical Pharmacology 11th Edition Pag. 796

Tetracyclines

Basic and Clinical Pharmacology 11th Edition Pag. 796

Steps in bacterial protein synthesis and targets of several antibiotics

Basic and Clinical Pharmacology 11th Edition Fig 44.1

Macrolides

Basic and Clinical Pharmacology 11th Edition Pag 799

Clindamycin

Basic and Clinical Pharmacology 11th Edition Pag 801

Chloramphenicol

Basic and Clinical Pharmacology 11th Edition Pag 802

 SUMMARY Tetracyclines, Macrolides, Clindamycin,
Chloramphenicol, Streptogramins, & Oxazolidinones

Basic and Clinical Pharmacology 11th Edition Pag 805

Structure of several important aminoglycoside antibiotics

Basic and Clinical Pharmacology 11th Edition Fig 45.2

Structure of streptomycin

Basic and Clinical Pharmacology 11th Edition Fig 45.1

Putative mechanisms of action of the aminoglycosides in bacteria

Basic and Clinical Pharmacology 11th Edition Fig 45.3

Spectinomycin

Basic and Clinical Pharmacology 11th Edition Pag. 813

 SUMMARY Aminoglycosides

Basic and Clinical Pharmacology 11th Edition Pag 814

Structure of some sulfonamides
and p-aminobenzoic acid

Basic and Clinical Pharmacology 11th Edition Fig 46.1

Impedem sntese do cido Flicopela Bactria
Actions of sulfonamides and trimethoprim

Basic and Clinical Pharmacology 11th Edition Fig 46.2

Pharmacokinetic properties of some sulfonamides and trimethoprim

Basic and Clinical Pharmacology 11th Edition Table 46.1

Basic and Clinical Pharmacology 11th Edition pag. 818
 SUMMARY Sulfonamides, Trimethoprim, and
Fluoroquinolones

Basic and Clinical Pharmacology 11th Edition Pag 821

Chloramphenicol

Basic and Clinical Pharmacology 11th Edition Pag 802

 SUMMARY Tetracyclines, Macrolides, Clindamycin,
Chloramphenicol, Streptogramins, & Oxazolidinones

Basic and Clinical Pharmacology 11th Edition Pag 805

Structure of several important aminoglycoside antibiotics

Basic and Clinical Pharmacology 11th Edition Fig 45.2

Structure of streptomycin

Basic and Clinical Pharmacology 11th Edition Fig 45.1

Putative mechanisms of action of the aminoglycosides in bacteria

Basic and Clinical Pharmacology 11th Edition Fig 45.3

Spectinomycin

Basic and Clinical Pharmacology 11th Edition Pag. 813

 SUMMARY Aminoglycosides

Basic and Clinical Pharmacology 11th Edition Pag 814

Diagram of the structure and metabolism of a typical bacterial cell.

Book Rang & Dales Pharmacology Eighth Edition Fig 50.1

Schematic diagram of a single layer of peptidoglycan from a
bacterial cell (e.g. Staphylococcus aureus), showing the site of
action of the -lactam antibiotics

Book Rang & Dales Pharmacology Eighth Edition Fig 50.2

Schematic diagram of the biosynthesis of peptidoglycan in a
bacterial cell (e.g. Staphylococcus aureus), with the sites of
action of various antibiotics.

Book Rang & Dales Pharmacology Eighth Edition Fig 50.3

Schematic diagram of bacterial protein synthesis, indicating the points
at which antibiotics inhibit the process.

Book Rang & Dales Pharmacology Eighth Edition Fig 50.4

Schematic diagram of bacterial protein synthesis, indicating the points
at which antibiotics inhibit the process.

Book Rang & Dales Pharmacology Eighth Edition Fig 50.4

Schematic diagram of bacterial protein synthesis, indicating the points
at which antibiotics inhibit the process.

Book Rang & Dales Pharmacology Eighth Edition Fig 50.4

Schematic diagram of bacterial protein synthesis, indicating the points
at which antibiotics inhibit the process.

Book Rang & Dales Pharmacology Eighth Edition Fig 50.4

Schematic diagram of DNA replication, showing some antibiotics that
inhibit it by acting on DNA polymerase.

Book Rang & Dales Pharmacology Eighth Edition Fig 50.5

Schematic diagram of the action of DNA gyrase: the site of action for
quinolone antibacterials

Book Rang & Dales Pharmacology Eighth Edition Fig 50.6

An example of the transfer and replication of a transposon (which may
carry genes coding for resistance to antibiotics)

Book Rang & Dales Pharmacology Eighth Edition Fig 50.7

Book Rang & Dales Pharmacology Eighth Edition Pag 616
?????????

Book Rang & Dales Pharmacology Eighth Edition Pag 620

Book Rang & Dales Pharmacology Eighth Edition Pag 621
Specificity of inhibitors of dihydrofolate reductase

Book Rang & Dales Pharmacology Eighth Edition Table 50.1

Structures of two representative sulfonamides and trimethoprim.

Book Rang & Dales Pharmacology Eighth Edition Fig 51.1

The action of sulfonamides and trimethoprim on bacterial
folate synthesis

Book Rang & Dales Pharmacology Eighth Edition Fig 51.2

Basic structures of four groups of -lactam antibiotics and
clavulanic acid.

Book Rang & Dales Pharmacology Eighth Edition Fig 51.3

A simplified diagram of the mechanism of action of the
fluoroquinolones

Book Rang & Dales Pharmacology Eighth Edition Fig 51.4

Schematic diagram of the components of a virus particle or virion.

Book Rang & Dales Pharmacology Eighth Edition Fig 52.1

How a CD8+ T cell kills a virus-infected host cell.

Book Rang & Dales Pharmacology Eighth Edition Fig 52.2

Schematic diagram of infection of a CD4+ T cell by an HIV virion, with
the sites of action of the two main classes of anti-HIV drugs.

Book Rang & Dales Pharmacology Eighth Edition Fig 52.3

Schematic outline of the course of HIV infection.

Book Rang & Dales Pharmacology Eighth Edition Fig 52.4

Some host cell structures that can function as receptors for viruses

Book Rang & Dales Pharmacology Eighth Edition Table 52.1

Diagram of the structure and metabolism of a typical bacterial cell.

Book Rang & Dales Pharmacology Eighth Edition Fig 50.1

Schematic diagram of a single layer of peptidoglycan from a
bacterial cell (e.g. Staphylococcus aureus), showing the site of
action of the -lactam antibiotics

Book Rang & Dales Pharmacology Eighth Edition Fig 50.2

Schematic diagram of the biosynthesis of peptidoglycan in a
bacterial cell (e.g. Staphylococcus aureus), with the sites of
action of various antibiotics.

Book Rang & Dales Pharmacology Eighth Edition Fig 50.3

Schematic diagram of bacterial protein synthesis, indicating the points
at which antibiotics inhibit the process.

Book Rang & Dales Pharmacology Eighth Edition Fig 50.4

Schematic diagram of bacterial protein synthesis, indicating the points
at which antibiotics inhibit the process.

Book Rang & Dales Pharmacology Eighth Edition Fig 50.4

Schematic diagram of bacterial protein synthesis, indicating the points
at which antibiotics inhibit the process.

Book Rang & Dales Pharmacology Eighth Edition Fig 50.4

Schematic diagram of bacterial protein synthesis, indicating the points
at which antibiotics inhibit the process.

Book Rang & Dales Pharmacology Eighth Edition Fig 50.4

Schematic diagram of DNA replication, showing some antibiotics that
inhibit it by acting on DNA polymerase.

Book Rang & Dales Pharmacology Eighth Edition Fig 50.5

Schematic diagram of the action of DNA gyrase: the site of action for
quinolone antibacterials

Book Rang & Dales Pharmacology Eighth Edition Fig 50.6

An example of the transfer and replication of a transposon (which may
carry genes coding for resistance to antibiotics)

Book Rang & Dales Pharmacology Eighth Edition Fig 50.7

Book Rang & Dales Pharmacology Eighth Edition Pag 616
?????????

Book Rang & Dales Pharmacology Eighth Edition Pag 620

 SUMMARY Sulfonamides, Trimethoprim, and
Fluoroquinolones

Basic and Clinical Pharmacology 11th Edition Pag 821

Book Rang & Dales Pharmacology Eighth Edition Pag 621
Specificity of inhibitors of dihydrofolate reductase

Book Rang & Dales Pharmacology Eighth Edition Table 50.1

Structures of two representative sulfonamides and trimethoprim.

Book Rang & Dales Pharmacology Eighth Edition Fig 51.1

The action of sulfonamides and trimethoprim on bacterial
folate synthesis

Book Rang & Dales Pharmacology Eighth Edition Fig 51.2

A simplified diagram of the mechanism of action of the
fluoroquinolones

Book Rang & Dales Pharmacology Eighth Edition Fig 51.4

Schematic diagram of the components of a virus particle or virion.

Book Rang & Dales Pharmacology Eighth Edition Fig 52.1

How a CD8+ T cell kills a virus-infected host cell.

Book Rang & Dales Pharmacology Eighth Edition Fig 52.2

Schematic diagram of infection of a CD4+ T cell by an HIV virion, with
the sites of action of the two main classes of anti-HIV drugs.

Book Rang & Dales Pharmacology Eighth Edition Fig 52.3

Schematic outline of the course of HIV infection.

Book Rang & Dales Pharmacology Eighth Edition Fig 52.4

Some host cell structures that can function as receptors for viruses

Book Rang & Dales Pharmacology Eighth Edition Table 52.1