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B qHB  `DԔ??  t rH T  ?"~v0___PPT106___PPT9 q)nonfunctional or toxic protein synthesis ,*0($+ F pF sH <7\ tH  G0e0e    B8CDEdF,  5% 8c8c     ?1 d0u0@Ty2 NP'p<'pA)BCD|EH00P0`XPHxxP(80(P0@        S"r uH  F;0e0e    BC`DEF<ff ff 5% 8c8c     ?1 d0u0@Ty2 NP'p<'pA)BCD|E%%8`$D(pH 8X P`pxpPhH@ 88@H0`p8 0@            S"F2 vH 3 r(f8c?#" `}c :  wH Z ?"ft =P 'f32 xH  `38c?#" `k yH Zx ?#" `t =A 'f3 zH Tf?"pi {H Z?"i |H Z?"iF }H Z?"<i ~H Z?"i H Z?"iI H Z?"DiT @+& HC# dP' H Zf?"& H  `?"# H  `?"T H  `?"\T  ' H# 3 H 3 hB C<DEFDb ++vP.1)6Glkpgd^^6 *I'PQ^gs<"+H<Q6[2c*j"lt  @              "` ' H 3 BCPDEFb  /P@ "` 2 H c  @?#"  `@+T @+& HC# tX$ H Zf?"& H  `?"# H  `?"T H  `?"\T  ' H# 3 H 3 hB C<DEFDb ++vP.1)6Glkpgd^^6 *I'PQ^gs<"+H<Q6[2c*j"lt  @              "` ' H 3 BCPDEFb  /P@ "` 2 H c  @?#"  `@+ H  f_~+$ ??,pD BDecoding  & H H& ?"s =y ~v0___PPT106___PPT9 2breakup of polysomes into nonfunctional monosomes  303$+,   H  fL) ??"Iw~v0___PPT106___PPT9 f*0Mechanism of action0 & 3H H 0޽h ? H TTrff___PPT10i.4K\+D=' = @B +0  jL(  L L Tx4 ??+4___PPT10 B___PPT9$ "Tetracyclines and Chloramphenicol ,#!&$` $  L  f 5? ??"! ~v0___PPT106___PPT9 Section 1 Tetracyclines 0&$`&$f3 H L 0޽h ? 3333y___PPT10Y+D=' = @B +H0 _W`P(  P P  `F ??" <   P ZDI? ??"<)  \"0Adverse effect 0&$f3 P TL ??"[ x0___PPT108___PPT9 Gastric discomfort: Nausea, vomiting, and diarrhea Bony structures and Teeth :discoloration and hypoplasia of the teeth and a temporary stunting of growth Fatal hepatotoxicity: in pregnant women Phototoxicity: severe sunburn b5&ff&3v&ff"!&ff>b 7  @`H P 0޽h ? TTrff___PPT10i.0J+D=' = @B +: 0 PTE(  T T Zt> ??"&, ~v0___PPT106___PPT9 4. Vestibular problems: dizziness, nausea, vomiting 5. Pseudotumor cerebri: Benign intracranial hypertension , headache , blurred vision 6. Superinfections: pseudomembranous enterocolitisB&ff&3 &ffb8 K  @`D T  `vGDH̙??#" `c @  ,$D 0 l Vancomycin: *  &3" H T 0޽h ?T TTrff ___PPT10.iOv+qZD' y= @B DD' = @BA?%,( < +O%,( < +D{' =%(D#' =%(D' =A@BBBB0B%(D' =1:Bvisible*o3>+B#style.visibility<*T%(D' =+4 8?\CB#ppt_xBCB#ppt_xB*Y3>B ppt_x<*TD' =+4 8?dCB1+#ppt_h/2BCB#ppt_yB*Y3>B ppt_y<*T+8+0+T0 +T0 {sX (  X X  fp? ??".t uSection 2 Chloramphenicol&$`  X  f? ??"  j00 Antibacterial action0 & f3 X T ??"P x0___PPT108___PPT9 Chloramphenicol is either bacteriostatic or bactericidal It is active against both aerobic and anaerobic gram-positive and gram-negative organisms It has effective against rickettsiae, helicoids, Chlamydia and mycoplasma.  &ffH    @`H X 0޽h ? 3333y___PPT10Y+D=' = @B +B0 AAKK\~A(  \F  y@  \  \ \  G0e0e    B8CDEdF,  5% 8c8c     ?1 d0u0@Ty2 NP'p<'pA)BCD|EH00P0`XPHxxP(80(P0@        S" X{  \  F;0e0e    BC`DEF<ff ff 5% 8c8c     ?1 d0u0@Ty2 NP'p<'pA)BCD|E%%8`$D(pH 8X P`pxpPhH@ 88@H0`p8 0@            S" @ 2 \ 3 r@f8c?#" `6]  :  \ Z ?"J f  =P 'f32 \  `38c?#" `K)e  \ Zdh ?#" `j f  =A 'f3  \ Tf?" c y   \ Z?"*c    \ Z?"c    \ Z?"c /   \ Z?"/c   \ Z?"c   \ Z?"c 7 T @+& \C# 9^!  \ Zf?"& \  `?"# \  `?"T \  `?"\T  ' \# 3 \ 3 hB C<DEFDb ++vP.1)6Glkpgd^^6 *I'PQ^gs<"+H<Q6[2c*j"lt  @              "` ' \ 3 BCPDEFb  /P@ "` 2 \ c  @?#"  `@+T @+& \C#  R  \ Zf?"& \  `?"# \  `?"T \  `?"\T  ' \# 3 \ 3 hB C<DEFDb ++vP.1)6Glkpgd^^6 *I'PQ^gs<"+H<Q6[2c*j"lt  @              "` '  \ 3 BCPDEFb  /P@ "` 2 !\ c  @?#"  `@+$z  @ "\ 0x ,$D 0\ #\  G0e0e    B8CDEdF,  5% 8c8c     ?1 d0u0@Ty2 NP'p<'pA)BCD|EH00P0`XPHxxP(80(P0@        S"   $\  F;0e0e    BC`DEF<ff ff 5% 8c8c     ?1 d0u0@Ty2 NP'p<'pA)BCD|E%%8`$D(pH 8X P`pxpPhH@ 88@H0`p8 0@            S"^ z2 %\ 3 rf8c?#" `9  :  &\ Z ?"  =P 'f32 '\  `38c?#" `A  (\ Z ?#" `5  =A 'f3 )\ Tf?" @6 *\ Z?" K6 +\ Z?"K 6 ,\ Z?" 6 -\ Z?" Q6 .\ Z?"O 6 /\ Z?" 6T  @  0\#  , N @+& 1\  @@  2\ Zf?"& 3\  `?"# 4\  `?"T 5\  `?"\T  ' 6\# 3 7\ 3 hB C<DEFDb ++vP.1)6Glkpgd^^6 *I'PQ^gs<"+H<Q6[2c*j"lt  @              "` ' 8\ 3 BCPDEFb  /P@ "` 2 9\ c  @?#"  `@+2 :\B c  @?#"  ` ` N @ h X #  ;\    <\B Zf?"@ X !  =\B  `?"C  >\B  `?" !  ?\B  `?" Q # T  ' @\C# } h P  A\ 3 hB C<DEFDb ++vP.1)6Glkpgd^^6 *I'PQ^gs<"+H<Q6[2c*j"lt  @              "` ' B\ 3 BCPDEFb  /P@ "`  C\  `$ ??"w :  J D\ # lM,??   ,$D 0 zPeptidyl transferaseF$$  E\  ` ??"},  :   F\  f ??"m NChloramphenicol(50S,A)&`  G\  fH? ??"  f,0Mechanism of action0 &$f3B H\  fdD)?"v ,$D 0L  t I\A# < P B J\B  `DԔ??   B K\B  `DԔ??  tH \ 0޽h ? TTrff___PPT10i.iJ+D=' = @B +0 `(  ` `  f ? ??"  8___PPT10N___PPT90( &0pharmacokinetics0 B&$f3&$f3&$f3 ` T ??&f x0___PPT108___PPT9 uChloramphenicol may be administered either intravenously or orally It penetrate blood-brain barrier, placental barrier, blood-ocular barrier It is inactivated by conjugation with glucuronic acid in liver, secreted by the renal tubule.&ff"$ - @`H ` 0޽h ? 3333y___PPT10Y+D=' = @B +60 ]Ud(  d d Z(? ??"< $  Z 0Clinical uses0 &$f3 d T ??"lx0___PPT108___PPT9  Bacterial meningitis: meningococcal meningitis Rickettsial infections: typhus or Rocky Mountain spotted fever Eye infection: outer eye infection, intraocular infection, eyeball infection Anaerobic infection: peritoneal abscess, pelvic inflammation and peritonitis @.&ff"&ff0  @`H d 0޽h ? 3333y___PPT10Y+D=' = @B +0 h(  h h Z? ??" 8___PPT10N___PPT90( "0Adverse effect0 T&$3&$3&$3&$f3 h ZT? ??" I1 8___PPT10H___PPT9*" HBone marrow depression Aplastic anemia Gray baby syndrome: poor feeding, depressed breathing, cardiovascular collapse, cyanosis and death \=\;&ff""V&ffz @`H h 0޽h ? TTrff___PPT10i.ӎ;+D=' = @B +E0 \TPml(  l l  f? ??"& 8___PPT10N___PPT90( &0Drug resistance 0 X'$f3&$f3&$f3'$f3 l Z%? ??"m x0___PPT108___PPT9 Produce inactivator acetyl coenzyme A transferase Membrane permeability is decreased, chloramphenicol penetrate the organism less"&ffH  % @`H l 0޽h ? TTrff___PPT10i.ӎ?+D=' = @B +0 ` (     Z0+? ??"B~v0___PPT106___PPT9 @Artificial Synthetic antibacterial drugs AA&$` 7   `4 ?? 0! ~v0___PPT106___PPT9 Section I Quinolones : &$`  &$` H  0޽h ? fffy___PPT10Y+D=' = @B +0  (  k  T; ??"9%~v0___PPT106___PPT9 SThe first generation : nalidixic acid, pipemidic acid The second generation: norfloxacin, ofloxacin, ciprofloxacin The third generation: sparfloxacin, levofloxacin, grepafloxacin The fourth generation: clinafloxacin, gatifloxacin. x& `&f3& `&&f3& `*&f3& `&f3    &     H  0޽h ? TTrff80___PPT10.tQ|0 (  U   fJ ??"Y  SFluorequionlones: The second generation The third generation The fourth generation TT& `CH  0޽h ? TTrff80___PPT10.pw90 PH (     TD ?"0~v0___PPT106___PPT9 l.0antibacterial action0 "0&$3  H$a ?"M%x0___PPT108___PPT9 ^All of the quinolones are bactericidal First generation only has active against some gram-negative bacteria Second generation expend gram-negative bacteria spectrum Third generation have active against gram-positive organisms, chlamydia, mycoplasma, Legionella and Bacillus tuberculosis The fourth generation have active against anaerobic bacterium &_1x_&ffP    [ @`H  0޽h ? fff___PPT10i.ɹ+D=' = @B +|0  3(     THs ??}TZ ~v0___PPT106___PPT9 x interfering with the action of DNA gyrase: gram-negative bacteria interfering with the action of topoisomerase IV: gram-positive bacteria ,vv2vv&f3 '$ff6#? !   `g ?? V @     `| ??"8]~v0___PPT106___PPT9 c)Inhibit the replication of bacterial DNA **&ff    fT? ??"< f,0Mechanism of action0 &$3H  0޽h ? 3333y___PPT10Y+D=' = @B +n0  %(      `T ??  @    Z<? ??"  Z 0Clinical uses0 &$f3   ` ??"~v0___PPT106___PPT9 +1. Genitourinary tract infections : Urinary tract infections, prostatitis, cervicitis 2. Intestinal infection: gastroenteritis, bacillary dysentery, diarrhea 3. Respiratory infection: bronchitis, nasosinusitis ,pneumonia 4. Skeletal system infection: medullitis and arthrosis 0,&f3)&ffbC  z 1   @`H  0޽h ? fffy___PPT10Y+D=' = @B +,0 SKy (   z  Z? ??"Z ~v0___PPT106___PPT9 \"0adverse effect0 &$f3|  T ??"M f 8___PPT10H___PPT9*" J|Gastrointestinal discomfort: poor appetite, nausea, vomiting, diarrhea 2. CNS problems: dizziness, headache, insomnia, convulsion 3. Allergies angioneurotic edema skin rash J/qN&ffq&ffJ     @`  Z ??" w'~v0___PPT106___PPT9 ;Contraindications: pregnancy, nursing mothers and children0<&f3(&ffH  0޽h ? fffy___PPT10Y+D=' = @B +0  R(     Z? ??"7W _8___PPT10N___PPT90( &0drug resistance 0 F'$f3&$f3'$f3L  T< ??"v ~v0___PPT106___PPT9 41. Altered target: modifications in the bacterial DNA gyrase 2. Decreased accumulation: decreased number of porin proteins increased energy-dependent efflux system 0&f3&ff,;69H  0޽h ? fffy___PPT10Y+D=' = @B +0 ` e(      ` ??j  _ norfloxacin  &$` 6  T ??"m ~v0___PPT106___PPT9  This agent is effective against both gram-negative and gram-positive organisms in treating urinary tract infections and prostatitis, but not in systemic infections 0&f3&ff"x "H  0޽h ? fffy___PPT10Y+D=' = @B + 0 2* (     Z$? ??"w; v G ciprofloxacin&$`   ` ??"/? ~v0___PPT106___PPT9  Ciprofloxacin is the most potent, used to treat many systemic infections with the exception of serious infections caused by MRSA, the enterococci and pneumococci. It is particularly useful in treating infections caused by gram-negative bacilli. 0&f3&ff4  UH  0޽h ? fffy___PPT10Y+D=' = @B +0 ! (      f? ??"j  ] Ofloxacin  &$` p  T ??"I ~v0___PPT106___PPT9 X Ofloxacin is primarily used in the treatment of prostatitis. It may be used as alternative therapy in patients with gonorrhea. It has some benefit in the treatment of skin and lower respiratory tract infections. 0&f3&ff, ' H  0޽h ? fffy___PPT10Y+D=' = @B +0 D<(    Z? ??"<~v0___PPT106___PPT9 pSection II Sulfonamides : &$` &$`   ` ??Q ~v0___PPT106___PPT9 ,oral, absorbable oral, nonabsorbable topical --&$f3  ^   ` ?? ~v0___PPT106___PPT9 Hclassification&$f3H  0޽h ? 33330 E=e(     `  ??8 @     fx ? ??"p8___PPT10N___PPT90( .0Antibacterial action0 B&$f3&$f3&$f3  T! ??"x0___PPT108___PPT9 The sulfonamides are bacteriostatic; These drugs inhibit both gram-positive and gram negative bacteria; They have active against nocardia, Chlamydia trachomatis, and some protozoa; They have no effective against mycoplasma, Rickett's organism, helicoid  &fft_ 4    @`H  0޽h ? 3333O0 'p(  p p <)9< >"  p <-`  lPABA + Pteridine&f  p <  gDihydropteroic acid&f p <l1  }Dihydropteroate synthase$$ p <6pm  a Dihydrofolate&f   p B;? ?" 4  Dihydrofolate reductase(DHFR)$$   p <?   dTetrahydrofolate&f  p 0D >% C precursor  &f  p <\HP   :Purine0 pyrimidine nucleotide&f.    p  l1"0e0e    B8CPDEF @    8c8c     ?1 d0u0@Ty2 NP'p<'p@A)BCD|E?8tXX(P@  #"   p <N L C Glutamate  &f p # lA ? ?? 0   p # lA ? ??9P  z b  p  @,$D 0 p 0Qb  G Sulfonamides &1' p  fA ? ?? 0 r  p  fU? ??"{8___PPT10N___PPT90( ,0Mechanism of action0 F'$f3&$f3'$f3 p # lA ? ?? ]    p # lA ? ??0   p # lA ? ??0  H p 0޽h ? TTrff___PPT10.@֖+ځD|' = @B D7' = @BA?%,( < +O%,( < +Dn' =%(D' =%(D' =4@BBBB%(D' =1:Bvisible*o3>+B#style.visibility<*p%(D' =+4 8?dCB0-#ppt_w/2BCB#ppt_xB*Y3>B ppt_x<*pD' =+4 8?\CB#ppt_yBCB#ppt_yB*Y3>B ppt_y<*p+`0 t`(  t t  fY? ??"jd <___PPT10Z___PPT9<4 "0Clinical uses 0 R'$f3 &$f3  ' $f3 t Tg ?" Zj  L&0g ff P t  `Lv ??"I"x0___PPT108___PPT9 *Systemic infections: oral and absorbable sulfonamides 2. Intestinal infection: oral and nonabsorbable sulfonamides 3. Wound infection: topical sulfonamides,&ffb < @`H t 0޽h ? TTrff80___PPT10.0 5-x(  x x  fq? ??"+ 8<___PPT10Z___PPT9<4 "0adverse effect 0V'$3&$3$3 ' $3 x Td ??"<&W~v0___PPT106___PPT9 O1. Crystalluria: crystallura, hematuria, obstruction adequate hydration and alkalinization of urine 2. Kernicterus: sulfonamides displace bilirubin from binding sites on serum albumin 3. Hypersensitivity: rashes, angioedema 4. Hemopoietic disturbances: Hemolytic anemia, Granulocytopenia thrombocytopenia LPx&f3l&ff &ff   *  H  & @`H x 0޽h ? TTrff80___PPT10. U0 e])|(  | | T ??"I/ ~v0___PPT106___PPT9 YContraindications: newborns and infants less than 2 months old as well as pregnant women0Z&f3F&ffH | 0޽h ? TTrff80___PPT10.ܼ0 XP(     fT? ??"l H<___PPT10Z___PPT9<4 &0drug resistance 0 R'$f3&$f3  ' $f3  T ??"08___PPT10H___PPT9*" Increased PABA synthesis: overcome the inhibition of the dihydropteroate synthetase by the sulfas 2. Altered enzyme: decreased affinity for the sulfonamides 3. Decreased uptake: decreased permeability of membrane>&ff&ff,>  @`H  0޽h ? 3333n0 n(  v   ` ??"WX~v0___PPT106___PPT9 ROral, absorbable agents &$`   ` ??" ~v0___PPT106___PPT9 .Sulfisoxazole Sulfamethoxazole Sulfadiazine //& `$ H  0޽h ? TTrff80___PPT10.00 TL(    Z ??"& 4___PPT10 B___PPT9$ ~ Sulfisoxazole and sulfamethoxazole are used almost exclusively to treat urinary tract infections. Sulfadiazine achieves high concentrations in cerebrospinal fluid, therefore it has preventative and therapeutic effective against Epidemic meningitis( &ff. H  0޽h ? TTrff80___PPT10. 0 91(     `P ??"GX~v0___PPT106___PPT9 vOral nonabsorbable agents &$`    Tt ??"d ~v0___PPT106___PPT9 i Sulfasalazine is widely used in ulcerative colitis, enteritis, and other inflammatory bowel disease. 0j&f3f&ff YH  0޽h ? TTrff80___PPT10.iX0 pX(  l   ` ??" X~v0___PPT106___PPT9 HTopical Agents&$`  T ??"" ~v0___PPT106___PPT9 (Sodium sulfacetamide Mafenide acetate ))& `,  H  0޽h ? TTrff80___PPT10.g00 E=`(    T ??"| ~v0___PPT106___PPT9  Sodium sulfacetamide ophthalmic solution or ointment is effective treatment for bacterial conjunctivitis and as adjunctive therapy for trachoma. Mafenide acetate is used topically to prevent bacterial colonization and infection of burn wounds. 0&f3&ff4 \H  0޽h ? TTrff80___PPT10.м0 P (       `  ??"Z ~v0___PPT106___PPT9 a Trimethoprim &$`    T ??"z8___PPT10L___PPT9.& V1. The antibacterial spectrum is similar to that of sulfamethoxazole It inhibited dihydrofolate reductase It is used alone in acute urinary tract infections and in the treatment of bacterial prostatitis It induce megaloblastic anemia, leukopenia, and granulocytopenia It altered dihydrofolate reductase, resulting in drug resistancePNx x&f3K&ff &ff<  W      @`H   0޽h ? TTrff80___PPT10.Pm0 ,$@(    T< ??"ZJ.~v0___PPT106___PPT9 jCo-trimoxazole&$3   T| ??"M\] 8___PPT10N___PPT90( Co-trimoxazole is combination of trimethoprim- sulfamethoxazole It shows greater antimicrobial activity than equivalent quantities of either drug used alone It inhibits two sequential steps in the synthesis of tetrahydrofolic acidL/F&ff&ffP   @`H  0޽h ? TTrff80___PPT10.0 /N0 @(    <%9Y >"   <(il lPABA + Pteridine& f   <H-/ gDihydropteroic acid& f  <0O U }Dihydropteroate synthase$$   <x6m ?  a Dihydrofolate& f    B:? ?" 4  Dihydrofolate reductase(DHFR)$$    <p?S   dTetrahydrofolate& f   0D0> C precursor  & f   <\HA  :Purine0 pyrimidine nucleotide& f.     l1"0e0e    B8CPDEF @    8c8c     ?1 d0u0@Ty2 NP'p<'p@A)BCD|E?8tXX(P@  #"   W  <NO  C Glutamate  &f  # lA #? ?? 0   #  # lA $? ??D  $  # lA %? ??e7 U %  # lA &? ??r?  &  # lA '? ??P [ 'z b    ,$D 0S  0Tb ~v0___PPT106___PPT9 esulfamethoxazole &1'   fA (? ?? 0 r (z  P l    P ,$D 0  0PZ ` l  Trimethoprim (TMP)D &1'& 1'&1' 6   A o P  H  0޽h ? TTrffF > ___PPT10 .y`9+^YID ' = @B D ' = @BA?%,( < +O%,( < +Dn' =%(D' =%(D' =4@BBBB%(D' =1:Bvisible*o3>+B#style.visibility<*%(D' =+4 8?dCB0-#ppt_w/2BCB#ppt_xB*Y3>B ppt_x<*D' =+4 8?\CB#ppt_yBCB#ppt_yB*Y3>B ppt_y<*Dn' =%(D' =%(D' =4@BBBB%(D' =1:Bvisible*o3>+B#style.visibility<*%(D' =+4 8?dCB0-#ppt_w/2BCB#ppt_xB*Y3>B ppt_x<*D' =+4 8?\CB#ppt_yBCB#ppt_yB*Y3>B ppt_y<*+0 0(  t  T b ??",K ~v0___PPT106___PPT9 \4. Co-trimoxazole is used to treat upper respiratory infection, urinary tract infection intestinal infection typhoid fever 5. It is less frequently encountered than resistance to either of the drugs alone :&f3&ffH Fb @`H  0޽h ? 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