-(المضادة للميكروبات),Pharmacology-(1)Antimicrobial

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كلية تمريض جامعه عين شمش القاهره
كلية تمريض المنيا
كلية تمريض اسيوط
كلية تمريض المنصوره
كلية تمريض بني سويف
كلية تمريض الشرقيه
كلية تمريض الغربيه
كلية تمريض بور سعيد
كلية تمريض اسوان
كلية تمريض الاقصر
كلية تمريض قنا
كلية تمريض حلوان
Institute of Nursing, Ain Shamsh University, Cairo
Minya Nursing Institute
Assiut Nursing Institute
Mansoura Nursing Institute
Beni Suef Nursing Institute
Eastern Nursing Institute
Western Nursing Institute
Port Said Nursing Institute
Aswan Nursing Institute
Luxor Nursing Institute
Qena Nursing Institute
Helwan Nursing Institute
Faculty of Nursing, Ain Shamsh University, Cairo
Minya Faculty of Nursing
Assiut Faculty of Nursing
Mansoura College of Nursing
Beni Suef College of Nursing
Eastern Nursing College
Western College of Nursing
Port Said Nursing College
Aswan College of Nursing
Luxor Faculty of Nursing
Qena College of Nursing
Helwan College of Nursing
Antimicrobials
Classification of antibacterials

Mechanism of action
Drug
Inhibition of folic acid synthesis
(metabolic)
Sulfonamides, trimethoprim,
Inhibition of bacterial cell wall
synthesis
Penicillins, cephalosporins, vancomycin
Inhibition of bacterial protein
synthesis
Aminoglycosides, chloramphenicol,
macrolides, tetracyclines
Inhibition of nucleic acid
synthesis
Fluoroquinolones, rifampin
Sulfonamide
Adverse reactions:
1- GIT disturbance (nausea, vomiting, diarrhea, abdominal colics).
2- Urinary tract: Crystalluria and nephrotoxicity
3- Blood (hemolytic anemia, aplastic anemia, agranulocytosis, porphyria),

especially in G6PD deficiency people.
4- Hypersensitivity (may present as erythema multiforme of Stevens-Johnson
syndrome)
5- New-born: (hyperbilirubinemia and kernicterus)
6- CNS: headache, convulsions, depression, ataxia.
7- Liver: hepatitis and hepatocellular necrosis.
II- Inhibitors of cell wall synthesis
All inhibitors of cell wall synthesis are bactericidal. They are divided into:
1. Beta-Lactam group
2. Non Beta-Lactam group
Penicillins, cephalosporins
Vancomycin
Spectrum:
It is mainly active against gram positive bacteria.
Note: Penicillins are ineffective against organisms that lack a cell wall (e.g
mycobacteria).
- Penicillins kill bacterial cells only when they are actively growing and
synthesizing cell wall.
Types of penicillin:
1. Natural penicillin (Narrow spectrum) as penicillin G & penicillin V
2. Anti-staph penicillin (Very narrow spectrum) as oxacillin, Cloxacillin,
fluclocacillin, and nafcillin
3. Broad spectrum penicillin as ampicillin & amoxicillin
4. Extended Antipsudomonal penicillin as carbincillin & ticarcillin
Clinical uses of penicillin:

 Penicillin G is a drug of choice in streptococci, meningococci, enterococci
infection.
 Penicillin V, the oral form of penicillin, is indicated only in minor
infection because of relatively poor bioavailability.
 Benzathine penicillin (1.2 million units, im/3weeks), long acting form, is
effective in treatment and prophylaxis of pharyngitis caused by β-
hemolytic streptococci. It is used also in treatment of syphilis (2.4 million
units / week for 1-3 weeks).
 Broad spectrum penicillins (usually used with β-lactamase inhibitors;
Sulbactam & clavulanic acid) used in chest & urinary tract infections.
Adverse reactions:
A. Penicillin hypersensitivity: severe penicillin hypersensitivity with
anaphylactic shock is very rare and occurs mostly in connection with
parenteral administration (5 to 10 cases on 10000 treated subjects). The
emergency treatment is based primarily on adrenaline (and, in addition,
may be intravenous corticosteroids, antihistamine, and aminophylline).
However, hypersensitive skin reactions (skin rashes, urticaria) are
frequent (1 to 7% of the treated subjects).
Note: A simple skin allergy test can be performed to determine if you are allergic
to penicillin.
B. GIT disturbances (nausea, vomiting, diarrhea, with oral penicillins)
C. Hepatitis (oxacillin and some other anti-staph)
D. Non allergic skin rash (ampicillin & amoxicillin specially in patients with
viral infection)
E. Psudomembraneous colitis with ampicillin.
F. Neutropenia with nafcillin.
29
Flouroquinolones (Inhibitors of DNA)
Mechanism of action
 The quinolone antibiotics inhibit DNA synthesis
Note: Nucleic acid Inhibitors of RNA e.g.: rifampicin: see anti-TB drugs)
Spectrum of activity
Generally, flouroquinolons were developed because of their excellent activity
against gram-negative aerobic bacteria. They can be classified into:
 First group: (e.g. Norfloxacin).

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