1. Dr STSA

2. Antibiotics - chemical substances originally produced
by various species of micro-organisms (bacteria, fungi,
actinomycetes) that in high dilution suppress the
growth or cause death of other microorganisms
Objective of Rx- For curative - eradication by lethal
effect,inhibit growth & multiplication,phagocytosis
For preventive

3. Bacteria
Antimicrobial agents 3

4. Bacteriostatic
• inhibiting the growth or multiplication of bacteria
Bactericidal
• lethal effect on mature bacteria /kill the bacteria
Antibacterial spectrum
• list of bacteria which are normally susceptible to
antibacterial action of a particular agent (group or
particular organisms)

5. Antimicrobial agents 5

6. Antimicrobial agents 6

7. C
Antimicrobial agents 7

8. Classification
based on their Mechanism of Actions
1. Drugs that inhibit the synthesis of
bacterial cell walls
eg.Penicillins, Cephalosporins, Vancomycin
Clotrimazole
2. Agents that act directly on the cell
membrane
eg‘.Nystatin, Amphotericin
Antimicrobial agents 8

9. Cont-
3. Drugs inhibiting microbial protein synthesis by their
effect on bacterial ribosomes
(A) disrupt the function of 30S or 50S ribosomal subunits to reversibly inhibit
protein synthesis (mainly bacteriostatic)
eg – Chloramphenicol, Tetracyclines, Macrolides,
Clindamycin, Lincomycins
(B) agents that bind irreversibly to 30s ribosomal subunit (mainly
bactericidal)
– Aminoglycosides eg. Gentamicin
Antimicrobial agents 9

10. 4. Drugs that affect nucleic acid metabolism
eg.Rifampicin,Fluoroquinolones,Griseofulvin
Metronidazole
5. The antimetabolites - Drugs affecting the intermediary
metabolism which are essential to micro-organisms
Sulfonamides Competitive
antagonist of
Para-aminosalicylic acid PABA
(PAS)
Trimethoprim
inhibit DHFA-reductase enzyme
Pyrimethamine

11. • MOA
-inhibit the bact:cell wall syn by binding to protein,inhibit
crosslinking enz ∆ autolysis

12. Classification of Penicillins
1. Penicillin G - Benzyl penicillins
(a) Penicillin G- Crystalline I.V (Aqueous Pen G as K+ salt and Na+ salt)
(2,50000 to 10,00000 units IM, IV)
(b) Penicillin G -Procaine suspension
(3,00000 to 6,00000 units IM)
(c) Penicillin G -Benzathine suspension
(0.6 to 1.2 mega units IM)
2. Penicillins V (oral) Phenoxymethyl penicillin(250-500mg)
3. Penicillinase-resistant penicillins (Anti-staph)
Cloxacillin – orally,IM, IV
Flucloxacillin
Dicloxacillin, Oxacillin
Antimicrobial agents 12

13. • Methicillin - use as a laboratory tool for identification of
methicillin - resistant - Staphylococcus aureus (MRSA)
(MRSA = resistance to all the penicillinase-resistant penicillins and
cephalosporins) (Vancomycin is a drug of choice in MRSA)
4. Broad spectrum penicillins
Ampicillin
Amoxicillin
5. Antipseudomonal penicillins
Carboxypenicillins - Carbenicillin Indanyl (oral), Ticarcillin
Ureidopenicillins - Piperacillin
6. Penicillin β-lactamase inhibitor combination
Co-amoxiclav (Amoxicillin + clavulanic acid)

14. Pen G
Organisms Usage Dosage/Route
 gram(+)ve cocci Infections caused by Crystalline- IV
(except penicillanase -non-β-lactamase- 30 mg/kg6H
producing )staph producing staphylococci, (1mg=1667u)
-pneumococci -pneumococci Severe inf:50 mg/kg 6H
(max 2G)12 H/6H
-Streptococci -Streptococcal pneumo:
Procaine-IM
25-50 mg/kg 12H/OD
- Prophylatic Tx:* (Max 1.2-2.4G)
Benzathine –IM
gram (-) cocci - meningococci, 25mg/kg OD,3-4wkly
- meningococci, gonococci
gonococci
non-β-lactamase- non-β-lactamase-
producing anaerobes producing anaerobes

15. Organisms Usage Dosage/Route
gram (+) bacilli – Diphtheria C/pen 30-50mg/kg 6H
C. diphtheriae, Infection due to
B. anthracis, Bacillus anthracis
Clostridium, Clostridium species
Actinomyces -Actinomyces* and other
gram-positive rods
spirochetes Treponema pallidum C/pen “
(syphilis) and many other
spirochetes
Prophylatic Tx

16. Pen V
Organisms Usage Dosage/Route
•gram (+)ve cocci o minor infections oral
(except penicillinase (streptococcal pha- 15 mg/kg 6H (125-
producing ryngitis) 250mg)
staphylococci)
* narrow antibacterial o prophylaxis of 12.5 mg/kg 12 H
spectrum streptococcal infection
following rheumatic
fever and
pneumococcal
infection (following
splenectomy)
fusospirochetel
infection
(gingivostomatitis)

17. Pen resistent pen
Org Usage Dosage
more effective against staphylococcal Cloxacillin – orally,IM, IV
penicillinase producing infections-skin,LRIT 15 mg/kg 6H 12H,4-6H,
25- 50mg/kg
- staphylococci
Flucloxacillin
12.5-25 mg/kg 6H
25-50 mg/kg 8H,6H
less effective than pen. G
and pen. V against Gram
positive bacteria
Some strains of Gram H. influenzae, E. coli,
negative bacteria gonococci, Klebsiella

18. Aminopenicillins (Ampicillin, Amoxicillin)
Org Usage Dosage
gram (-)ve, (+)ve bacteria URTI (sinusitis, otitis Oral/I.M/I.V
(H. influenza, E.coli and Proteus media, acute 10-25 mg/kg 6H /8H
mirabilis)
exacerbations of severe -50mg/kg
chronic bronchitis &
epiglottitis)
Lower RTI,
UTI, Biliary tract
‴
Listeria monocytogen Meningitis,
Salmonella infection
(Enteric fever)
H. pylori
sensitive against Penicillin - β-lactamase
β-lactamase producing inhibitor combination
strains of G (+)ve & G (–)ve
bacteria*.Staph,Gono, (Clavulanic acid or
H. influenzae, E coli, Klebsiella, Sulbactam)
Proteus, 20-25 mg/kg IM,IV 6H
Bacteroides fragalis, Moraxella
catarrhalis

19. Vancomycin
Antimicrobial agents 19

20. Red man
syndrome
Antimicrobial agents 20

21. Mechanism of Action
• similar to penicillin , bactericidal, inhibit bacterial cell
wall synthesis
Classification of Cephalosporins
I. The first generation cephalosporins
Cefalexin
Cefadroxil
Cefazolin
II. The secondgeneration cephalosporins
Cefuroxime axetil ,Cefaclor (Oral)
Cefuroxime
Cefoxitin IV,IM
• Cefotetan

22. III. Third generation
Cefixime(oral)
Cefotaxime
Ceftriaxone IV,IM
Ceftazidime
IV. Fourth generation
Cefepime (I.V)

23. The First Gen:Cephalo
Drug Theraputic advantage Dosage
Gram- positive cocci upper and lower RTI Cefalexin- 7.5mg/kg 6h
(except MRSA) Cefadroxil 15-25mg/kg
12h
Cefazolin
Gram-negative bacteria urinary tract infection
Ecoli,Kleb,Proteus surgical prophylaxis
Oral cavity anaerobic
cocci
some β lactamase skin and soft tissue
producing strains infections owing to
(e.g, Staphylococcus) S. aureus and
S. pyogens

24. The second gen:cephalo
Gram + ve RTI (oral) Cefuroxime axetil 10-
15 mg/kg bd
Cefaclor 15mg/kg 8h
anaerobes (Bacteroids anaerobic infection Cefuroxime iv
fragilis) -pelvic inflammatory 25-50 mg/kg 8,12,6 hr
disease,
-Intra-abdominal inf,
- diabetic foot
Gram-ve bacteria G (-)ve bacterial
(< 3rdG)
(Neisseria,H.influenzae,
Enterobacter Proteus,
E.coli, Klebsiella)

25. The third gen:cephalo
less active against G + ve DOC for serious Cefotaxime iv
infn 25-50mg/kg-12 h
(Septicaemia,Pneu 8 h/6 h
monia,Meningitis) Ceftriaxone -iv,im
25-50mg/kg 12h,8h
Oral-Cefixime 5mg/kg od
Cefpodoxime ″ bd
more active against G -ve Enteric fever
Severe Lyme’s d/s
Gonococcal
much more active
enterobacteriaceae &
β-lactamase producing
strains
s/a (H. influenzae &
Neisseria)
some - active against P.aerug Ceftaxidime iv,im
15-25mg/kg 8h

26. The forth generation
• Cefepime (I.M ,IV)
25-50 mg/kg 12h

27. Antimicrobial agents 27

28. Untoward Effects
1. Hypersensitivity is most common
cross hypersensitivity & resistant < 10%
Caution – Penicillin allergic patient
2. Nephrotoxicity - ↑ with aminoglcosides
3. Renal tubular necrosis (Cephaloridine, Cephalothin)
4. Intolerance to alcohol (disulfiram –like reaction)
Antimicrobial agents 28

29. MACROLIDE
Antibacterial Activity Therapeutic Uses Dosage
G +ve (same as Pen G) alternative to penicillins in Erythromycin
strep pharyngitis, Oral 10-15mg/kg 6h
staph infections,
tetanus, syphilis, 25 mg/kg 6h
Bacterial endocarditis ,
Rheumatic fever
Diphtheria, Pertussis,
Chlamydia trachomatis, Chlamydial infections,
Mycoplasma, Mycoplasma p’nia,
Legionella, Legionnaires’ disease
Campylobacter infections
luminal amoebicide Intestinal amoebiasis

30. Mycobacterium Mycobacterial infection Azithromycin
15mg/kg D1
7.5mg/kg D2-5
more potent than Eradication of H.pylori Chlarithromycin
erythromycin in peptic ulcer
strept, staph,Chlamydia
Mycoplsma and
H.pylori

31. Untoward Effects
- not common
• cholestatic hepatitis is common with erythromycin
estolate (esp. in pregnancy)
• allergy, GI disturbances, arrhythmia*
• reversible hearing loss
Contraindication
• liver disease, pregnancy
Drug Interaction
Erythromycin and clarithromycin inhibit CYP3A4
potentiate the effects of digoxin, theophylline & valproate

32. LINCOSAMINES
(Lincomycin and Clindamycin)
Antibacterial Activity Therapeutic Uses Dosage
Anaerobic bacteria peritonitis, Lincomycin
(Bacteroides species, pelvic inflammation 10mg/kg 8h oral
Clostridium) IM or IV (over 1h)
10 -20mg/kg (over 2h)6h
Gram +ve bacteria – Bony infections Clindamycin
more effective - osteomyelitis, 6mg/kg 6h oral
(Staph. aureus) sinusitis, periosteitis, IV over 30min,IM 12h
periodontitis 10 -20mg/kg 8h
Aspiration pneumonia,
Lung abscess
Gram - ve bacteria
Less effective

33. Untoward Effects of Lincosamines
• Diarrhoea (superinfection)
• Pseudomembranous colitis due to Clostridium difficile
which produces enterotoxin(Tx –metronidazole)
• Hypersensitivity (rare);
• Granulocytopenia, thrombocytopenia,
• Stevens -Johnson Syndrome
(can occur, but not common)

34. Antibact Rx Dose& Route
a wide range of G(+)& (-) IV 1g every 6 hours for 4
Salmonella Enteric fever weeks in enteric fever
Shigella, Bacterial meningitis Chloramphenicol sodium
V . cholerae H.influenza, succinate (1g vial) I.M, I.V
H.influenza N.meningitidis
Bordetella pertussis Strep. Pneumoniae
Brucella, Rickettsia, Anaerobic infections Orally - Chloramphenicol
anaerobic bacteria Rickettsial infection 25mg/kg/D
(typhus fever, Q fever (250 - 500 mg) 6 - 8 hourly
Brucellosis
less effect on
Staphylococcus
Ophthalmic infection Eye drop- 2-6 H
Ear Ear drop- 6H

35. Untoward Effects
less selective toxicity; may inhibit protein synthesis of
mammalian tissues
1. Haematological toxicity - bone marrow depression
(a) true toxic reaction - dose related, common with prolong therapy
or large dose
- anaemia, leucopenia, thrombocytopenia
(b) Idiosyncratic manifestation - not dose related (occurs in
genetically susceptible patients)
- aplastic anaemia --- can be fatal

36. 2. Grey (gray) syndrome (Gray baby Syndrome)
• in premature and newborn infants
• due to ineffective conjugation & poor renal excretion
with dose above 50 mg/kg/day
• dose should be limited to 50 mg/kg/day in full term
infants and 25 mg/kg/day in premature infants
3. Superinfection (oral or vaginal candidiasis) due to
alteration of normal microbial flora
4. Haemolysis in G6PD deficient patients (dose-related)

37. Antimicrobial spectrum Theraputic advantage Dosage
Mainly active against Genta IV,IM
Gram - ve bacteria UTI 7-8 mg/kg/D1,then
(Pseudomonas, Shigella, G -ve bacillary infect: 5mg/kg 12H
E.coli, Proteus, H.influ, Gonorrhoea Neonate5-7.5mg/kg/d
Brucella, Klebsiella) Bowel sterilization 24H
active against some Topical – Streptomycin IM 20-
Gram +ve wounds,burns,dermatitis 30mg/kg (max:1G)OD
Intestinal amoebiasis Amikacin IV,IM
Mycobacteria TB Prem -15mg/kg/D
(Streptomycin, Amikacin, D17.5mg/kg OD
Netilmicin, Kanamycin) Term-15mg/kg/D OD
Anaerobic bacteria are 1 wk to 10yr -15 mg/kg
resistant to Netilmicin IV,IM
aminoglycosides 1wk-10yr= 8mg/kg/D1
then 6mg/kgOD ,>10yr =
7 in D1 then 5mg/kg
Neonate5 mg/kg/D
OD

38. Unwanted effects
1. Ototoxicity
• irreversible results from progressive destruction of vestibular or
cochlear sensory cells
(a) Vestibular dysfunction
(Gentamicin, Streptomycin, Netilmicin)
(b) Auditory dysfunction – Kanamycin , Amikacin
(potent diuretics potentiate ototoxicity)
2. Nephrotoxicity
• due to accumulation of aminoglycosides in the proximal tubular
cells
3. Neuromuscular blockade (reversible)due to inhibition of prejunctional release
of ACh(Aminoglycosides potentiate d-tubocurarine)
4. Others
• rare - hypersensitive reactions
• vague feelings of paraesthesia of the lips or circumoral region
• prolong use -- superinfection, diarrhoea, malabsorption
can occur with neomycin

39. I. First Generation Quinolones
• Nalidixic acid
II. Second Generation Quinolones
• Norfloxacin
• Ciprofloxacin
III. New fluoroquinolones
• Gatifloxacin
• Moxifloxacin

40. • MOA
• Bactericidal
• Block bact synthesis by inhibiting bact DNA gyrase and
topoisomerase
• Antibact spectrum--
E.coli,Salmonella,Shigella,Enterobacter,Campylo-
bacter,Neisseria
Pseudomonas(Ciprofloxacin)
Staph( not MRSA)
Strep,Chlamydia,Mycoplasma,Legionella,Mycobact

41. Clinical Uses of Fluoroquinolones
1. Urinary tract infections (Norfloxacin)
2. Prostatitis (Norfloxacin, Ciprofloxacin, Ofloxacin)
3. Sexually transmitted diseases
(Not for Treponema pallidum )
4. Gastrointestinal & abdominal infections
– Traveller’s diarrhoea
– Shigellosis (Norfloxacin, Ciprofloxacin, Ofloxacin)
– Enteric fever (Ciprofloxacin, Ofloxacin)
5. Bone, Joint & soft tissue infections
( osteomyelitis caused by Staph &G-ve rods)
6.Others
M.avium complex (in AIDS)
MDR TB
7. Meningococcal Prophylaxis

42. • Dosage
Ciprofloxacin- oral= 5-10 mg/kg 12H
IV = 4-7 mg/kg 12 H
Norflox = 10 mg/kg 12H
Prophylaxis
15 mg/kg oral single

43. Side effects
Generally well tolerated
• nausea, abdominal discomfort, diarrhoea, headache,
dizziness, allergy, photosensitivity
• cartilaginous erosion in foetus and children (arthropathy)
and tendonitis --- limited used in children age <14 years and
pregnancy
• Increse BUSE
• Transient ↑ in Liver enzymes,Bilirubin
• Disturbance in vision,taste and smell
• Risk of haemolysis in G6PD def;

44. • Drug interaction
- Cipro,Ofloxa ,Peflox inhibit the metabolism of Theophylline

45. • Bacteriostatic
• Competitive inhibitor of dihydropteroate
synthase which is responsible for the
incorporation of PABA (para-aminobenzoic
acid) which is essential for the formation of
folic acid (pteroylglutamic acid)

46. Antibact spectrum Theraputic application
G+ve and –ve except 1.Urinary tract infection
pseudo,proteus
2.Other Gram-positive and
Gram-negative infections (in
penicillin allergic patients)
Chlamydia trachomatis
Trachoma & conjunctivitis
Toxoplasma
(Sulfacetamide)
Ulcerative colitis -
Sulfasalazine
Local infections: Dermatitis –
Sulfapyridine
Burns - Sulfamylon, Silver
Sulfadiazine
Pneumocystis carinni Prophylaxis for HIV associated
opportunistic infection
Malaria parasites Chloroquine resistant malaria
(Pyrexine = Sulfadoxine +
Pyrimethamine)

47. Untoward Effects
1. Renal toxicity
• a local reaction with short-acting sulfonamides
(high doses)
• may precipitate in the urine(obstruction,haematuria)
2. Haemopoietic reactions
Anaemia-haemolytic/aplastic,granulocytopenia
H’lysis in G6PD def:
Neonatal jaundice in new-born babies(especially in last
trimester—Haemolytic jaundice)
antimicrobial agents III 47

48. Untoward Effects
3. Allergic reactions --- skin rashes, exfoliative
dermatitis, photosensitivity --- more severe with long
acting sulfonamides
• Stevens-Johnson Syndrome
- mucosal, dermal, genital and occular lesions; joint pain,
high fever, oedema, ulcerations of the lips and tongue
- erythema multiforme on skin of hands and thighs
- severe urethritis and balanitis in males
antimicrobial agents III 48

49. • Synergists of Sulfonamides
1. Trimethoprim 80mg
+ 
Sulfamethoxazole 400 mg

50. MOA of Cotrimoxazole
• Sulfonamides are the competitive antagonist of PABA. They
inhibit the incorporation of paraaminobenzoic acid(PABA) to
folic acid.
• Trimethoprim is a dihydrofolic acid reductase inhibitor. It
prevents the reduction of dihydrofolate to tetrahydrofolate.
• Inhibition of two consequent steps in the synthesis of DNA
and RNA of bacteria when a sulfonamide and trimethoprim
are used together.(Sequential Blockade)
• Two bacteriostatic compounds act synergistically and become
bactericidal

51. antimicrobial agents III 51

52. Antibacterial spectrum Rx uses Dosage
Streptococci, (1)Urinary tract TMP 1.5-3mg/kg 12H
Staphylococci, infections IV ,Oral
Neisseria (2) Respiratory tract PCP Tx 250mg/m2 stat
E. coli, infections 150mg/m 2 8H
(3) Gonococcal Prophylaxis
Salmonella, Shigella, infections for UTI- 5 mg/kg oral
Enterobacter Proteus, (4) Enteric fever PCP- 5mg/kg 3days/wk
Klebsiella, Brucella, (5) Malaria
Chlamydia (CQ resistant falciparum
except Pseudomonas malaria)
aeruginosa (6) Brucellosis
Pneumocystis carinii (7) Pneumocystis carinii
infection in AIDS Patient
Untoward effects
-Same as S’.Megaloblastic A with prolonged Rx

53. Cont - Synergists of S’
2. Pyrimethamine
also an inhibitor of DHFA reductase enzyme of malarial parasites and
toxoplasma
Pyrexine (or)
Fansidar = Sulfadoxine 500 mg + Pyrimethamine 25 mg
Therapeutic Uses --- Malaria, Toxoplasmosis

54. 3. Tetracycline
• in combination with sulfonamides produce
synergistic effects because both are
bacteriostatic drugs
4. Penicillin:
• although bactericidal, it produces a
synergistic effect when used in combination
with sulfonamides.

55. Drug Interactions with Sulfonamides
• warfarin, sulphonylureas,diphenylhydantoin
(1) potentiation of action of other drugs due to
competition at plasma protein binding site
(drug displacement interaction)
(2) inhibition of metabolism
antimicrobial agents III 55

56. Metronidazole
(Nitroimidazole-antiprotozoal)
• MOA
- Effect on nucleic acid metabolism
Potent antibacterial ,anaerobes , Bacteroides and Clostridium sp
• Theraputic advantage
• Anaerobic or mixed intraabdominal infection
- Extraluminal amoebiasis - 30-50mg/kg/d oral
- Amoebic liver abscess - 7.5to 30mg/kg iv 12H/8H x7-10 days
- Trachomonal vaginitis
- Clostridium defficile colitis
- Brain abscess

57. • Side-effects
- GI disturbance,metallic taste,peripheral neuropathy,
seizures
Interacting drugs
- Alcohol
- Warfarin  increase anticoagulant effect
(enzyme inhibition)

58. TETRACYCLINES
Broad spectrum bacterostatic
Antimicrobial spectrum Tx - Infections with Dosage
Gram+ ve and –ve
Bacteria
Rickettsiae,Mycoplasma, Rickettsia oral –
Chlamydia Mycoplasma pneumonia 250-500 mg/ 6H
Spirochetes Non-specific urethritis ( >8yrs)
(Treponema, Leptospira, Trachoma,Syphilis,STD Eye ointment-
Borrelia), Leptospirosis, Lymes apply 8H
Vibrio cholerae Cholera
H.pylori Combination Tx GU/DU
E.histolytica Amoebiasis
Malaria parasites CQ resistant P.f
less effect on Strep,
Staph, Pneunococci
Not effective against –
Pseudomonas,Proteus,
Salmonella

60. Anti-TB
Adverse effects
1st line
Peripheral neuro
IN(A)H 10mg/kgoral od
( recommended-B6 20-
30mg/D )
TBM 15 -20mg/kg
Hepatotoxicity,Rash
Rifampincin* 10-15 mg/kg
Hepatitis.nephritis,ITP
20-30mg/kg oral
PZA
Hepatitis,Interstitial nephritis
Ethambutol 25mg/kg oral
Retrobulbar neuritis,yellow-
Streptomycin 20-30 mg/kg IM green colour vision defect
Ototoxic,Nephrotoxic
2nd line
Capreomycin 20mg/kg oral Ototoxicity
Cycloserine 5-10mg/kg oral CNS toxicity
Ethionamide 15mg/kg oral Hepatotoxic
Azitho/clarithromycin

62. Bactericidal drugs
- Penicillins
- Cephalosporins
-Other -lactam antibiotics
- Aminoglycosides
- Rifampicin
- Fluoroquinolones
- Cotrimoxazole
- Metronidazole

63. Bacteriostatic drugs
- Chloramphenicol
- Tetracycline
- Erythromycin
- Clindamycin
- Lincomycin
- Sulphonamides

64. Broad-spectrum Antibiotics
- Broad-spectrum penicillins
(Aminopenicillins and Antipseudomonal penicillins)
- Coamoxiclav
- the second, third and fourth generation
Cephalosporins
- Tetracyclines
- Chloramphenicol
- Rifampicin
- Cotrimoxazole

65. Antipseudomonal Agents
- Carbenicillin, Carbenicillin indanyl
- Ticarcillin
- Piperacillin
- The third generation cephalosporins
- The fourth generation cephalosporins
- Amikacin, Netilmycin
- Fluoroquinolones
- Polymyxin - topical application for wounds

66. Anti-infective agents which can be used
for Staphylococcus
- Penicillinase resistant penicillins(Cloxa,Flucloxacillin)
- AUGMENTIN (Coamoxiclav) (Amoxicillin + Clavulanic acid)
- TIMENTIN (Ticarcillin + Clavulanic acid)
- UNASYN (Ampicillin + Sulbactam)
- ZOSYN (Piperacillin + Tazobactam)
- Some first & second generation Cephalosporins
- third & fourth generation Cephalosporins
- Erythromycin
- Vancomycin
- Rifampicin
- some fluoroquinolones

67. Anti-infective agents for anaerobic bacteria
- Metronidazole
- Lincomycin, Clindamycin
- Chloramphenicol
- Fluoroquinolones
- the third & fourth generation cephalosporins

68. Empiric antimicrobial Rx
(based on site of Infection)
SOI Pathogens DOC Alternative
Meningitis Ampi+3rd Cepha Ampi(Cotri)+3rd Ce
-Neonate (+Aminogly)
-Child C/Pen C.Pen+
+Cefotaxime or Chloram
Ceftraxone
Pneumonia
-Neonate Ampi+3rd Cepha
-Younger child C/Pen Ampi -sulbactam
Cefotaxime or
Ceftraxone
-Older child Macrolides Quinolines

69. SOI Pathogens DOC Alternative
IE Vancomy+Genta Pen-resistant
acute pen+Genta
SBE Pen G+ Genta Vanco+ Genta
Septic arthritis Ceftriaxone Ampi+Sulbactam
Acute OM,Sinusitis Amoxil Amoxil+Sulbact
Cefuroxime
TMP-SMZ
Cellulitis Pen-resistant pen Vancomycin
Clindamycin
Peritonitis 3rd cephalo+Metro Carbapenem
Septicemia 3rd cephalo+Vanco
Antipseudo+Amino
(Granulocytopenia) 3rd cepha/ceftazidime
Sepsis d/t UTI 3rd cephalo±Genta
Sepsis d/t GIT 3rd cephalo +Metro
Neo sepsis Early -- Ampi+Genta
Late - Ampi+Genta+Clox/Van
rd

70. STSA

71. Antiviral drugs
1.Nucleoside Acyclovir* HSV1,2 Herpes-oral,genital
Analogues* 20mg/kg iv VZV HS-Encephalitis
(synthesis of DNA 100mgodx 5 d CMV Varicella(immu ↓)
&RNA) Ginclovir EB CMV retinitis,
Cidofovir HHV6 Pneumonitis
Hepa C
2.Amantadine 100mg OD Influenza A,B Influenza A-H1N1
Rimantadine 200mg OD H1N1,H1N2,
(penetration of cell) H1N3
3.Foscanet CMV,VZV CMV retinitis in HIV p/t
(DNA &RNAsyn:) HSV(Aciclovir
20mg/kg iv over 30’ resist)

72. 4.Immunomodulator Hepatitis B &C Chronic hepatitis B
Interferon α HPV &C
(inhibit the transcription) CGD
Plavizumab RSV RSV Bronchiolitis
5.Ribavarin RSV RSV Bronchiolitis
(aerosol-20mg/ml 12- Pn’ia
18hrly)
(oral5-50mg)
6.Neuraminidase Influenza A & B Influenza A & B
Inhibitors
(release of virus)
Zanamivir/Oseltamivir

73. 7.Antiretroviral HIV Side effects
NRTI-competative inhibit:
activated i/c by A,neutropenia,myopathy
phosphorylation
Zidovudine(2mg/kg) Pancreatitis,Periph neuro,D
Didanosine(ddI ) Peri neuro,pancreatitis,rash
Dideoxycytidine(ddC) Peri neuro,A,Lipoatrophy
Stavudine(d4T) Headche,N,abdo pain
Lamivudine(3TC) Hepa B
Adefovir
NNRTI-inhibit viral HIV
replication by direct binding
to RT
Nevaripine Rash,Steven syn,Hepatitis
120mg/m2 daily oral

74. Protease Inhibitors
-Interfere with post-
translational
processing of HIV Asymptomatic hyper bili-
precursor proteins rubinemia,GI disturbance
Eg.Ritonavir Skin,hair changes
Indinavir
Dose-500mg/m2 8H
oral

75. Major adverse effects
1. Nephrotoxicity
eg. Foscarnet, Amantadine
2. Neurotoxicity - seizures
eg. Nucleoside analogues, Amantadine(high dose),INFs
3. E imbalance- hypo K,hypo &hyper Ca
eg.Foscarnet
4. Hypo & hypertension
eg. INFs
5.Bone marrow supression- neutropenia
eg. INFs,Aciclovir
6.GI disturbance
eg.INFs

76. 7. Flu like syndrome- F,fatigue, myalgia
• eg. INFs
8. Teratogenic
eg.Aciclovir,Ginciclovir
9.Hepatic steatosis
eg. NRTI

78. How Does These Drugs Works…

81. Management in babies born to infected
mothers
Scenarios Therapy
- HIV mother on HAART Zidovudine
- HIV mother started on zidovudine at 14-28 2mg/kg/dose QIDx 6wks
weeks gestation OR
4mg/kg/does BDx6 wks
-HIV mother at delivery with inadequate Single dose
prophylaxis (<4 weeks) Nevirapine
+
-Infant born to HIV mother without prophylxis
Zidovudine
2mg/kg/dose QID
6 weeks
OR
4mg/kg/does BD 6 weeks

82. Antifungal agents
based on route of administration
1.Systemic
For deep fungal infection Amphotericin B (I.V)
(oral/parenteral) Flucytosine (oral)
Imidazoles and Triazoles
-Ketoconazole, Itraconazole
-Fluconazole
For superficial fungal infections Griseofulvin (Oral)
2.Topical antifungal agents Clotrimazole (CANESTEN)
- Miconazole
-Econazole
-Ketoconazole
-Nystatin (MYCOSTATIN)
Miscellaneous MYCODERM

83. Drug Dose & Rx Side effects
Preparation
Ampho.B IV 1.5 mg/kg/d Local &systemic- Hypersensitivity
(fungistatic/fungicid Intrathecal Meningitis,Endocardit Nephrotoxic
al) Oral 100mg 6h is due to Liver impairment
Cream,ointment Cryptococcus Anaemia,Hypo-k
Local installation Coccidioides
Histoplasma
Candida,
Blastomyces
Aspergillus
Griseofulvin 5-7mg/kg oral Broad spectrum Photosensitivity
(fungiststic) Topical Microsporum,Epider Porphyria
mophyton,
Trichophyton Headache
(Dermatophytosis) Hepatitis
Superficial
ringworm
infestation
(Tineacaptis,Tinea
corporis,Tinea pedis)

84. Imidazole 5mg/kg oral,cream Supercial & Deep N,V,Pruritus,Rash,
Ketoconazole 7.5-15mg/kg iv 8H Candida Hepatitis
Miconazole Topical,vg cream Dermatophytes Fluid & H2O
(broadspectrum) (Teniasis,Pityriasis retension
versicolar) Gynaecomastia
Seborric dermatitis
Fluconazole (penetrate readily to Dermatophytosis Itchiness,burning,
CSF) 3-6mg/kg oral Candidasis Rash
/iv Cryptococcus
Itraconazole 2-4mg/kg oral Aspergillosis
Clotrimazole Vaginal tab Candidasis No serious
(fungistatic) 1%cream,oral Dermatophytosis systemic side
effect
Nystatin Cream,ointment Candidasis(oral No systemic side
(fungistatic/cid Vg tab thrush,GI,vaginal, effect
al) Oral Skin)

85. Summary
• Ampho B –drug of choice except candida
• Griseofulvin –drug of choice for dermatophytes except
aspergillus
• Fluconazole ,Miconazole _ for candida/dermatophytes
• Nystatin _ for candida

86. Anti-protozoal drugs
• Antmalarial drugs
1. 4 Aminoquinolones
CQ
2. 8- Aminoquinolones
Primaquine
3. Arylamino alcohols
Quinine, Mefloquine
4. Anti-folates
Sulphadoxine,Pyrimethamine
5. Quinghaosu
Artemisin

87. Blood schizontocides Alleviate symptoms-a/c attack Photosensitivity,n,v,reti-
CQ Oral 10mg/kg x 3d nal damage
Quinine Oral 8.3mg/kg x7-10 d Tinnitus,Hglycemia
Iv 20mg/kgx4h,8.3mg/kg 8H Hypotension
Mefloquine 15mg/kg stat,10mg/kg a/f 6-8hr (cinchonism)
(Prophylaxis- 5mg/kg wkly) Postural Hypotension
Cardiac conduct defect
Artesunate Oral 5mg/kg D1,2.5mg/kg D2- Relatively safe
D3
IV,IM 2mg/kg then 1 mg/kg 6H
Artemether IM 3.2mg/kg stat 1.6 mg/kg
daily
Sporontocides
Pyrimethamine
Prophylaxis
Primaguine
Proguanil

88. Tissue schizointocides To prevent parasites
becoming established in the
Liver
Pyrimethamine 25mg tab*
0.3mg/kg daily X14 d CI –Pregnancy
Primaquine
3.5mg/kg oral H’lysis in G6PDdef,BM˅,
Proguanil
alopecia
Hypnozoiticides To prevent relaspe
Primaquine
Gametocides
Primaquine
0.7mg/kg od

89. Mgt of Pl.falciparum(Paed:protocol)
• Uncomplicated • Complicated
1st line- 1st line
Artesunate odx3D IV Artesunate bdod
Mefloquine od 2nd line
Alternate: IV Quinine oral
Artemether/lumefantrine Doxycycline/Clindamycin
2nd line
Qunine
Clindamycin

90. Antihelminthics
Drugs Rx advantage Mode of Action Adverse Effects
Mebendazole Trichuriasis Broad spectrum, inhibit Worm migration
50-100mg BDx Enterobiasis microtubules, glucose (rare)
3D Ascariasis absorption 
immobilization death
Albendazole Trichuriasis
200-400mg single Enterebiasis
Ascariasis
Hookworm
Pyrantel pamoate Trichuriasis Depolarization of the Mild abdominal pain
10-11mg/kg OD Ascariasis neuromuscular
Repeat in D14 Enterobiasis (Neuromuscular blocking
agent)
Levamizole Ascariasis Immunostimulants Abdominal pain
3mg/kg Enterobiasis Paralysis of the muscle of
the worm – expelled by
Repeat in 1 wk Hookworm peristalsis
Ivermectin Hookworm, filariasis, Membrane Abdominal
0.15-0.4mg/kg strongyloides hyperpolarization ; distension ,
paralysis wheeze, TOC
Thiabendazole Hookworm
200-400mg OD

91. • References:
- Paed:Protocol (2nd edition)
- Nelson Text Book (19th edition)
- Basic and Clinical Pharmacology(11th edition)
- Basic Medical Science(Easterbrook-3rd edition)