LESSON 11. ANTIBIOTICS – SULFAMIDES.
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1. Describe the principles of using antibiotics and sulfonamides.
2. Describe the uses, uses, and dosages of antibiotics.
3. Describe the uses, dosages, and administration of sulfonamides.
CONTENT:
A. ANTIBIOTICS
I. GENERAL:
Antibiotics: are substances secreted by microorganisms (bacteria, fungi) that are synthetically or semi-synthetically extracted and have antibacterial effects.
Effects of antibiotics: Prevent the growth of bacteria, weaken bacteria and destroy them before the body's resistance or have antibacterial effects.
II. MECHANISM OF ACTION OF ANTIBIOTICS:
- Inhibits the synthesis of bacterial cell structures: penicillins, cephalosporins, vancomycin, foromycin, bacitracin.
- Altering bacterial cell membrane permeability: colistin, antifungal antibiotics.
- Disrupts the process of protein biosynthesis, inhibiting bacterial reproduction and development: aminosid group, macrolide group, lincomycin, fucidic acid.
- Change of genetic information due to impact on genes Bacterial inhibition: quinolones, rifampicin, novobiocin, co-trimoxazole.
III. PRINCIPLES OF USING ANTIBIOTICS (GENERAL PROCEDURES WHEN USING ANTIBIOTICS)
1. Only use antibiotics when definitely due to infection: Can be based on:
- Clinical: disease progression, medical examination process.
- Paraclinical: X-ray, white blood cell formula.
- Bacterial test: Find disease-causing bacteria.
- Do not use antibiotics for diseases caused by viruses: flu, measles, polio, allergies, anemia, physical weakness.
2. Choose the right antibiotic:
The choice of antibiotic to treat a patient with an infection is based on the following:
- Site of infection: is considered the most important factor in choosing antibiotics.
- Spectrum of activity: based on experience and antibiotic resistance.
- Pharmacokinetic properties of the drug: absorption, distribution, T1/2, MIC, Vd.
- Patient factors: disease status, age, liver and kidney function,
pregnancy, breastfeeding
3. Choose the appropriate form of use:
Depending on the patient's infection site, choose antibiotics in oral or injectable form. Topical antibiotics should be limited because they can easily cause allergies or drug resistance (except for eye infections). In cases of skin infections, antiseptics should be used.
4. Use antibiotics in the correct dosage.
- Use the treatment dose immediately, continuously, without interruption, without stopping suddenly, without gradually reducing the dose. All of the above to avoid drug resistance.
- For typhoid fever, the more severe the disease, the smaller the initial dose.
5. Use antibiotics at the prescribed time
- The duration of antibiotic use depends on many factors such as the severity of the patient's condition, the causative agent (fungal infection and long-term need), the site of infection (endocarditis, osteomyelitis, long-term need) and the patient's immune system status.
- The general principle is to use antibiotics until all bacteria in the body are gone (fever goes away and symptoms of the disease are reduced) + 2 - 3 days in normal people, 5 - 7 days in people with immunodeficiency
6. Use prophylactic antibiotics appropriately
- Prevention in patients exposed to pathogens
- Prophylaxis in patients at high risk of infection
- Prevention in surgery
7. Combine antibiotics when absolutely necessary.
- Antibiotic combination aims to expand the antibacterial spectrum, enhance bactericidal effect and reduce bacterial drug resistance.
- When combining antibiotics, the following principles must be followed:
+ Do not combine > 2 antibiotics (except for tuberculosis) because it can easily cause antagonism, complications and increase treatment costs.
+ Should combine 2 antibiotics from 2 different families.
+ Do not combine two antibiotics with the same toxicity.
IV. MAIN GROUPS OF ANTIBIOTICS:
- β lactam group (including penicillins and cephalosporins)
- Aminoglycoside group (also called aminoside): Streptomycin, Gentamycin, Kanamycin.
- Chloramphenicol group: Chloramphenicol, Thiamphenicol.
- Tetracycline group: Tetracycline, Docycylin, Minocylin.
- Macrolide group: Erythromycin, Troleadomycin, Spiramycin.
- Lincosamide group: Lincomycin, Clindamycin.
- Quinolone group: Nalidicid acid, pefloxacin, ofloxacin.
- 5-nitro-imidazole group
- Polypeptide group: Colistin, bacitracin, Tyrothricin.
- Sulfamide group: co-trimmxazole (Sulfamethazole + Trimethazole)
- Antifungal group.
- Other Antibiotics Group. β- LACTAMIN GROUP
1. GENERAL INFORMATION ABOUT β-LACTAMIN GROUP 1. Mechanism of action:
This group inhibits bacterial cell wall synthesis, causing the wall to change so that bacteria cannot survive and grow.
2. Classification : 2 types
- Penicillin.
- Cephalosporin.
3. Side effects:
- Allergy: hives, fever, itching, anaphylactic shock (very rare 0.05%).
- Gastrointestinal disorders: nausea, diarrhea.
- High doses in people with kidney failure: dizziness, convulsions, blood disorders.
II. PENICILIN SUBSTRATE.
1. Peniciin G group:
- Properties: Preparation of Penicillinum notatum fungus , white powder, odorless, bitter taste, easily soluble in water, easily decomposed with acid, penicillinase.
- Effect: Has bactericidal effect: Gram (+), Gram (-) cocci; Gram () bacilli.
+ ).Works well with anaerobic bacteria.
- Side effects.
+ Easily causes anaphylactic shock, need to test reaction before injection.
- Indications:
+ Pneumonia, arthritis.
+ Endocarditis.
+ Anthrax, gonorrhea, syphilis.
- Contraindications.
+ Sensitive.
+ Bacteria are resistant to penicillin.
- Penicillin G form (sodium benzylpenicillin):
+ Drug form: bottle of 500,000 - 1,000,000 IU
+ Intramuscular injection: 200,000 - 1,000,000 units/24 hours: 3-4 times, can use 2 - 3 million units/24 hours.
+ If endocarditis can use 20 - 30 million units/24 hours.
+ Can also be mixed with 0.9% NaCl solution for intravenous injection.
+ Note: Must test for intradermal reaction before injection.
- Long-acting penicillin G: combines poorly soluble and slowly absorbed salts such as:
* Bipenicillin (sodium benzylpenicillinate + procaine benzylpenicillinate) injected once daily
, not for children
* Extencilin (Benzathine penicillin) intramuscular injection once, effect lasts 3 - 4 weeks, used to prevent Rheumatism.
2. Penicillin V :
Phenoxymethylpenicillin, Ospen, Oracillin.
- Properties : Product of Peniclinum notaum fungus. White powder, odorless, bitter taste, slightly soluble in water, stable in acidic environment, drinkable.
- Effect : similar to penicillin G, but weaker against Gram (-) and anaerobic bacteria
- Side effects:
+ Allergy: hives, fever, itching.
+ Digestive disorders: nausea, diarrhea.
+ High doses in people with kidney failure: dizziness, convulsions, blood disorders.
- Indications:
+ Infections of the ear, nose, throat, skin and mucous membranes.
+ Mild respiratory infections in children.
+ Further indications after using PNC-G
- Contraindications.
+ Sensitive.
+ Bacteria are resistant to penicillin.
- How to use : take 1 hour before meals.
+ Drug form: tablets: 400,000 units - 500,000 units
+ Oral: adults: 1 million - 2 million units / day x 3 - 4 times / day. Children: 50,000 units - 400,000 units / kg / day x 3 times / day.
3. Penicillin A group: (broad spectrum)
* Ampicillin (also destroyed by penicillinase)
- Properties: Semi-synthetic Penicillin, has broad effects: both Gram bacteria
(-) and (+), well absorbed orally, food affects drug absorption. Should be taken on an empty stomach.
- Side effects:
+ Allergy.
+ Digestive disorders.
+ Candida infection .
- Indications:
+ Ear, nose, throat and oral infections.
+ Mild respiratory infections.
+ Kidney, urinary and genital infections.
- Contraindications.
+ Sensitive.
+ Bacteria are resistant to penicillin.