1. Copyright © 2010 Pearson Education, Inc. Lectures prepared by Christine L. Case Chapter 20 Antimicrobial Drugs

2. Copyright © 2010 Pearson Education, Inc. Q&A  This bacterium is lysing because an antibiotic disrupted its cell wall. Why doesn’t the antibiotic lyse human cells?

3. Copyright © 2010 Pearson Education, Inc. The History of Chemotherapy 20-1Identify the contributions of Paul Ehrlich and Alexander Fleming to chemotherapy. 20-2Name the microbes that produce most antibiotics. Learning Objectives

4. Copyright © 2010 Pearson Education, Inc. Antimicrobial Drugs  Chemotherapy: The use of drugs to treat a disease  Antimicrobial drugs: Interfere with the growth of microbes within a host  Antibiotic: A substance produced by a microbe that, in small amounts, inhibits another microbe  Selective toxicity: A drug that kills harmful microbes without damaging the host

5. Copyright © 2010 Pearson Education, Inc.  1928: Fleming discovered penicillin, produced by Penicillium  1940: Howard Florey and Ernst Chain performed first clinical trials of penicillin Antimicrobial Drugs Figure 1.5

6. Copyright © 2010 Pearson Education, Inc. Drug Discovery Figure 20.1

7. Copyright © 2010 Pearson Education, Inc.

8. Check Your Understanding Who coined the term magic bullet? 20-1 More than half our antibiotics are produced by a certain species of bacteria. What is it? 20-2

9. Copyright © 2010 Pearson Education, Inc. The Spectrum of Antimicrobial Activity 20-3Describe the problems of chemotherapy for viral, fungal, protozoan, and helminthic infections. 20-4Define the following terms: spectrum of activity, broad-spectrum antibiotic, superinfection. Learning Objectives

10. Copyright © 2010 Pearson Education, Inc.

11. The Spectrum of Antimicrobial Activity  Broad spectrum  Narrow spectrum  Superinfection ANIMATION Chemotherapeutic Agents: Modes of Action

12. Copyright © 2010 Pearson Education, Inc. Check Your Understanding Identify at least one reason why it is so difficult to target a pathogenic virus without damaging the host’s cells. 20-3 Why are antibiotics with a very broad spectrum of activity not as useful as one might first think? 20-4

13. Copyright © 2010 Pearson Education, Inc. The Action of Antimicrobial Drugs Figure 20.5

14. Copyright © 2010 Pearson Education, Inc. The Action of Antimicrobial Drugs 20-5Identify five modes of action of antimicrobial drugs. Learning Objective

15. Copyright © 2010 Pearson Education, Inc.  Bactericidal  Kill microbes directly  Bacteriostatic  Prevent microbes from growing The Action of Antimicrobial Drugs

16. Copyright © 2010 Pearson Education, Inc. The Action of Antimicrobial Drugs Figure 20.2

17. Copyright © 2010 Pearson Education, Inc. The Inhibition of Protein Synthesis by Antibiotics Figure 20.4

18. Copyright © 2010 Pearson Education, Inc. Q&A  This bacterium is lysing because an antibiotic disrupted its cell wall. Why doesn’t the antibiotic lyse human cells?

19. Copyright © 2010 Pearson Education, Inc. Check Your Understanding What cellular function is inhibited by tetracyclines? 20-5

20. Copyright © 2010 Pearson Education, Inc. Commonly Used Antimicrobial Drugs 20-6Explain why the drugs described in this section are specific for bacteria. 20-7List the advantages of each of the following over penicillin: semisynthetic penicillins, cephalosporins, and vancomycin. 20-8Explain why isoniazid (INH) and ethambutal are antimycobacterial agents. Learning Objectives

21. Copyright © 2010 Pearson Education, Inc. 20-9Describe how each of the following inhibits protein synthesis: aminoglycosides, tetracyclines, chloramphenicol, macrolides. 20-10Compare the mode of action of polymyxin B, bacitracin, and neomycin. 20-11Describe how rifamycins and quinolones kill bacteria. 20-12Describe how sulfa drugs inhibit microbial growth. Commonly Used Antimicrobial Drugs Learning Objectives

22. Copyright © 2010 Pearson Education, Inc. Inhibitors of Cell Wall Synthesis  Penicillin  Natural penicillins  Semisynthetic penicillins  Extended-spectrum penicillins

23. Copyright © 2010 Pearson Education, Inc. The Structure of Penicillins Figure 20.6

24. Copyright © 2010 Pearson Education, Inc. The Structure of Penicillins Figure 20.6

25. Copyright © 2010 Pearson Education, Inc. Retention of Penicillin G Figure 20.7

26. Copyright © 2010 Pearson Education, Inc. The Effect of Penicillinase on Penicillins Figure 20.8

27. Copyright © 2010 Pearson Education, Inc.  Lactam Antibiotics  Penicillin  Penicilinase-resistant penicillins  Penicillins +  -lactamase inhibitors  Carbapenems  Substitute a C for a S, add a double bond  Monobactam  Single ring Figure 20.6a

28. Copyright © 2010 Pearson Education, Inc. Inhibitors of Cell Wall Synthesis  Cephalosporins  First-generation: Narrow spectrum, gram-positive  Second-generation: Extended spectrum includes gram-negative  Third-generation: Includes pseudomonads; injected  Fourth-generation: Oral

29. Copyright © 2010 Pearson Education, Inc. Comparison of Cephalosporin and Penicillin Figure 20.9

30. Copyright © 2010 Pearson Education, Inc. Inhibitors of Cell Wall Synthesis  Polypeptide antibiotics  Bacitracin  Topical application  Against gram-positives  Vancomycin  Glycopeptide  Important "last line" against antibiotic-resistant S. aureus

31. Copyright © 2010 Pearson Education, Inc. Inhibitors of Cell Wall Synthesis  Antimycobacterial antibiotics  Isoniazid (INH)  Inhibits mycolic acid synthesis  Ethambutol  Inhibits incorporation of mycolic acid

32. Copyright © 2010 Pearson Education, Inc. Check Your Understanding One of the most successful groups of antibiotics targets the synthesis of bacterial cell walls; why does the antibiotic not affect the mammalian cell? 20-6 What phenomenon prompted the development of the first semisynthetic antibiotics, such as methicillin? 20-7 In what genus of bacteria do we find mycolic acids in the cell wall? 20-8

33. Copyright © 2010 Pearson Education, Inc. Inhibitors of Protein Synthesis  Chloramphenicol  Broad spectrum  Binds 50S subunit; inhibits peptide bond formation Figure 20.10

34. Copyright © 2010 Pearson Education, Inc. Inhibitors of Protein Synthesis  Aminoglycosides  Streptomycin, neomycin, gentamycin  Broad spectrum  Changes shape of 30S subunit

35. Copyright © 2010 Pearson Education, Inc. Inhibitors of Protein Synthesis  Tetracyclines  Broad spectrum  Interferes with tRNA attachment Figure 20.11

36. Copyright © 2010 Pearson Education, Inc. Inhibitors of Protein Synthesis  Streptogramins  Gram-positives  Binds 50S subunit; inhibits translation

37. Copyright © 2010 Pearson Education, Inc.  Macrolides  Gram-positives  Binds 50S; prevents translocation Inhibitors of Protein Synthesis Figure 20.12

38. Copyright © 2010 Pearson Education, Inc. Inhibitors of Protein Synthesis  Oxazolidinones  Linezolid  Gram-positives  Binds 50S subunit; prevents formation of 70S ribosome

39. Copyright © 2010 Pearson Education, Inc. Injury to the Plasma Membrane  Polymyxin B  Topical  Combined with bacitracin and neomycin in over-the-counter preparation

40. Copyright © 2010 Pearson Education, Inc. Check Your Understanding Why does erythromycin, a macrolide antibiotic, have a spectrum of activity limited largely to gram-positive bacteria even though its mode of action is similar to that of the broad-spectrum tetracyclines? 20-9 Of the three drugs often found in over-the- counter antiseptic creams—polymyxin B, bacitracin, and neomycin—which has a mode of action most similar to that of penicillin? 20-10

41. Copyright © 2010 Pearson Education, Inc. Inhibitors of Nucleic Acid Synthesis  Rifamycin  Inhibits RNA synthesis  Antituberculosis  Quinolones and fluoroquinolones  Nalidixic acid: Urinary infections  Ciprofloxacin  Inhibits DNA gyrase  Urinary tract infections

42. Copyright © 2010 Pearson Education, Inc.  Sulfonamides (sulfa drugs)  Inhibit folic acid synthesis  Broad spectrum Competitive Inhibitors Figure 5.7b

43. Copyright © 2010 Pearson Education, Inc. Figure 20.13

44. Copyright © 2010 Pearson Education, Inc. Check Your Understanding What group of antibiotics interferes with the DNA-replicating enzyme DNA gyrase? 20-11 Both humans and bacteria need the essential nutrient para-aminobenzoic acid; why, then, are only bacteria affected by sulfa drugs? 20-12

45. Copyright © 2010 Pearson Education, Inc. Commonly Used Antimicrobial Drugs 20-13Explain the modes of action of currently used antifungal drugs. 20-14Explain the modes of action of currently used antiviral drugs. 20-15 Explain the modes of action of currently used antiprotozoan and antihelminthic drugs. Learning Objectives

46. Copyright © 2010 Pearson Education, Inc. Antifungal Drugs  Inhibition of ergosterol synthesis  Polyenes  Amphotericin B Figure 20.14

47. Copyright © 2010 Pearson Education, Inc. Antifungal Drugs  Inhibition of cell wall synthesis  Echinocandins  Inhibit synthesis of  -glucan  Cancidas is used against Candida and Pneumocystis

48. Copyright © 2010 Pearson Education, Inc. Antifungal Drugs  Azoles  Miconazole  Triazoles  Allylamines  For azole-resistant infections Figure 20.15

49. Copyright © 2010 Pearson Education, Inc. Inhibition of Nucleic Acids  Flucytocine  Cytosine analog interferes with RNA synthesis  Pentamidine isethionate  Anti-Pneumocystis; may bind DNA

50. Copyright © 2010 Pearson Education, Inc. Other Antifungal Drugs  Griseofulvin  Inhibits microtubule formation  Superficial dermatophytes  Tolnaftate  Action unknown

51. Copyright © 2010 Pearson Education, Inc. Check Your Understanding What sterol in the cell membrane of fungi is the most common target for antifungal action? 20-13

52. Copyright © 2010 Pearson Education, Inc. Antiviral Drugs  Nucleoside and nucleotide analogs Figure 20.16a

53. Copyright © 2010 Pearson Education, Inc. Nucleoside and Nucleotide Analogs Figure 20.16b,c

54. Copyright © 2010 Pearson Education, Inc. Antiviral Drugs  Protease inhibitors  Indinavir: HIV  Integrase inhibitors  HIV  Inhibit attachment  Zanamivir: Influenza  Block CCR5: HIV  Inhibit uncoating  Amantadine: Influenza

55. Copyright © 2010 Pearson Education, Inc. Enzyme Inhibitors  Fusion inhibitors  Enfuvirtide: HIV  Inhibit attachment  Zanamivir: Influenza  Inhibit uncoating  Amantadine: Influenza

56. Copyright © 2010 Pearson Education, Inc. Interferons  Prevent spread of viruses to new cells  Alpha interferon: Viral hepatitis  Imiquimod  Promotes interferon production

57. Copyright © 2010 Pearson Education, Inc. Antiprotozoan Drugs  Chloroquine  Inhibits DNA synthesis  Malaria  Diiodohydroxyquin  Unknown mode of action  Amoebic diseases

58. Copyright © 2010 Pearson Education, Inc.  Metronidazole  Damages DNA –Entamoeba, Trichomonas  Nitazoxanide  Interferes with metabolism of anaerobes Antiprotozoan Drugs

59. Copyright © 2010 Pearson Education, Inc. Antihelminthic Drugs  Niclosamide  Prevents ATP generation  Tapeworms  Praziquantel  Alters membrane permeability  Flatworms Figure 12.26

60. Copyright © 2010 Pearson Education, Inc. Antihelminthic Drugs Figure 12.28a  Mebendazole  Inhibits nutrient absorption  Intestinal roundworms  Ivermectin  Paralyzes worm  Intestinal roundworms

61. Copyright © 2010 Pearson Education, Inc. Check Your Understanding One of the most widely used antivirals, acyclovir, inhibits the synthesis of DNA. Humans also synthesize DNA, so why is the drug still useful in treating viral infections? 20-14 What was the first drug available for use against parasitic infections? 20-15

62. Copyright © 2010 Pearson Education, Inc. Tests to Guide Chemotherapy 20-16Describe two tests for microbial susceptibility to chemotherapeutic agents. Learning Objective

63. Copyright © 2010 Pearson Education, Inc. The Disk-Diffusion Method Figure 20.17

64. Copyright © 2010 Pearson Education, Inc. The E Test Figure 20.18

65. Copyright © 2010 Pearson Education, Inc. Tests to Guide Chemotherapy  MIC: Minimal inhibitory concentration  MBC: Minimal bactericidal concentration  Antibiogram

66. Copyright © 2010 Pearson Education, Inc. Broth Dilution Test Figure 20.19

67. Copyright © 2010 Pearson Education, Inc. Check Your Understanding In the disk-diffusion (Kirby-Bauer) test, the zone of inhibition indicating sensitivity around the disk varies with the antibiotic. Why? 20-16

68. Copyright © 2010 Pearson Education, Inc. Resistance to Antimicrobial Drugs 20-17Describe the mechanisms of drug resistance. Learning Objective

69. Copyright © 2010 Pearson Education, Inc. Resistance to Antibiotics Figure 20.20

70. Copyright © 2010 Pearson Education, Inc. Antibiotic Resistance Figure 20.21

71. Copyright © 2010 Pearson Education, Inc. Antibiotic Resistance  A variety of mutations can lead to antibiotic resistance  Mechanisms of antibiotic resistance 1.Enzymatic destruction of drug 2.Prevention of penetration of drug 3.Alteration of drug's target site 4.Rapid ejection of the drug  Resistance genes are often on plasmids or transposons that can be transferred between bacteria

72. Copyright © 2010 Pearson Education, Inc. Antibiotic Resistance  Misuse of antibiotics selects for resistance mutants. Misuse includes  Using outdated or weakened antibiotics  Using antibiotics for the common cold and other inappropriate conditions  Using antibiotics in animal feed  Failing complete the prescribed regimen  Using someone else's leftover prescription ANIMATION Antibiotic Resistance: Forms of Resistance ANIMATION Antibiotic Resistance: Origins of Resistance

73. Copyright © 2010 Pearson Education, Inc. Clinical Focus, p. 577 Antibiotic Resistance ANIMATION Antibiotic Resistance: Origins of Resistance

74. Copyright © 2010 Pearson Education, Inc. Antibiotics and Animal Feed Clinical Focus, p. 577

75. Copyright © 2010 Pearson Education, Inc. Check Your Understanding What is the most common mechanism that a bacterium uses to resist the effects of penicillin? 20-17

76. Copyright © 2010 Pearson Education, Inc. Effects of Combinations of Drugs 20-18Compare and contrast synergism and antagonism. Learning Objective

77. Copyright © 2010 Pearson Education, Inc. Effects of Combinations of Drugs  Synergism occurs when the effect of two drugs together is greater than the effect of either alone  Antagonism occurs when the effect of two drugs together is less than the effect of either alone

78. Copyright © 2010 Pearson Education, Inc. Synergism between Two Different Antibiotics Figure 20.23

79. Copyright © 2010 Pearson Education, Inc. Antibiotic Safety  Therapeutic index: risk vs. benefit

80. Copyright © 2010 Pearson Education, Inc. Check Your Understanding Tetracycline sometimes interferes with the activity of penicillin. How? 20-18

81. Copyright © 2010 Pearson Education, Inc. Future of Chemotherapeutic Agents 20-19Identify three areas of research on new chemotherapeutic agents. Learning Objective

82. Copyright © 2010 Pearson Education, Inc.  Antimicrobial peptides  Broad-spectrum antibiotics  Nisin (lactic acid bacteria)  Magainin (frogs)  Cecropin (moths) Future of Chemotherapeutic Agents

83. Copyright © 2010 Pearson Education, Inc. Future of Chemotherapeutic Agents  Antisense agents  Complementary DNA that binds to a pathogen's virulence gene(s) and prevents transcription  Fomivirsen to treat CMV retinitis

84. Copyright © 2010 Pearson Education, Inc. Future of Chemotherapeutic Agents  siRNA  Complementary RNA that binds mRNA to inhibit translation Figure 9.14

85. Copyright © 2010 Pearson Education, Inc. Check Your Understanding Why is the positive electric charge on antimicrobial peptides such a probable factor in the mode of action? 20-19