Topical Antibiotic Update. Brad Sutton, O.D., F.A.A.O. Indiana University School of Optometry Indianapolis Eye Care Center No financial disclosures

Size: px
Start display at page:

Download "Topical Antibiotic Update. Brad Sutton, O.D., F.A.A.O. Indiana University School of Optometry Indianapolis Eye Care Center No financial disclosures"

Transcription

1 Topical Antibiotic Update Brad Sutton, O.D., F.A.A.O. Indiana University School of Optometry Indianapolis Eye Care Center No financial disclosures

2 What do we have? We currently have many highly effective topical antibiotics in our arsenal Multiple categories including aminoglycosides, fluoroquinolones, and others Many are derived from successful oral drugs that were used first

3 What do we have? These various drugs as a whole are effective against a wide range of organisms and are well tolerated Many have very long track records of proven success Some have side effects that limit their usefulness and bacterial resistance is becoming an ever increasing problem

4 The ideal antibiotic would have the following characteristics It would have no side effects It would eradicate every infectious organism, every time It would work with a single, one-time dose It would be free (or maybe the manufacturer would pay the patient to use it!) The bottle would dispense winning Powerball tickets weekly

5 Since we ll never have that we ll have to accept A broad spectrum of antimicrobial activity Excellent effectivity with minimal dosing Affordability A mechanism of action which severely limits the potential for the development of resistant bugs An excellent side effect profile

6 Aminoglycosides Tobramycin Gentamycin Neomycin All work by inhibiting bacterial protein synthesis. Are bactericidal (actively kill bacteria, don t just inhibit growth) Highly effective against gram-negative bacteria, especially Pseudomonas Effective against gram-positive bacteria but less so with ever increasing resistance

7 Aminoglycosides Side effects common to the entire class include PEK (epithelial toxicity), potential allergic reactions, and eyelid edema / erythema Cost effective due to generic availability (4$ plans)

8 Tobramycin.3% Available generically in drop and ointment form More effective and less toxic than Gentamycin Less allergic potential than Neomycin Tobradex (Tobramycin & Dexamethasone) Tobradex ST: lower concentration of dexamthasone (.05%) ZyLet (Tobramycin & Loteprednol)

9 Gentamycin.3 % Available generically in drop and ointment form Overall, slightly less effective and slightly more toxic than Tobramycin Less allergic potential than Neomycin With the arrival of generic Tobramycin, Gentamycin s use dropped off considerably

10 Neomycin Not available as a stand alone drug Ointment or drops in combination with other medications. Highest potential for allergy Neosporin drops (Neomycin, Polymyxin, Gramacidin) Neosporin Ointment (Neomycin, Polymixin,Bacitracin) Maxitrol / Dexacidin (Neomycin / Polymixin/ Dexamethasone)

11 Others Polytrim Erythromycin Bacitracin Sulfacetamide 10%

12 Erythromycin.5% ointment only (Ilotycin) Bacteriostatic-inhibits protein synthesis Good gram-positive, marginal gram-negative Not good for active therapy, supportive only Prophylaxis for ophthalmia noenatorum

13 Bacitracin Ointment only Degrades cell walls works on gram positive only Great against Staph so good choice for blepharitis treatment Polysporin ointment (Bacitracin and Polymixin). Good gram pos. and good gram negative from polymyxin

14 Polytrim Polymyxin-B and Trimethoprim) Polymyxin great against gram negative, destroys cell membranes Trimethoprim inhibits folic acid synthesis and creates bacteriostasis. Effective against gram-positive and gram-negative except Pseudomonas

15 Polytrim Excellent choice in pediatric infections Very effective against Haemophilus (about 50% of pediatric conjunctivitis) and Streptococcus pneumonia which are the most common causes of childhood eye infections. Drop form only-generic available Good against MRSA

16 Sulfacetamide 10% What s old is new again. Many of today s bacterial strains have never been exposed Resistance is currently actually low High allergy rate Inactivated by puslike discharge

17 AzaSite 1% Azithromycin Approved for bacterial conjunctivitis: Used for MGD Bacteriostatic, not bactericidal Dosing is BID for two days, QD for five days so nine drops total for treatment course Very expensive, especially considering the fact that only nine drops are used May already be facing considerable resistance due to long time systemic use

18 Fluoroquinolones First Generation (Chibroxin-not marketed in US) Second Generation (Ocuflox, Ciloxan) Third Generation (IQuix) Fourth Generation (Zymaxid, Vigamox, Moxeza, Besivance) Minimal toxicity, minimal allergies

19 Fluoroquinolones (gen 1 & 2) Inhibit DNA gyrase (-) or topoisomerase 4 (+) Uncoil DNA causing death-bactericidal Very effective against gram-negative organisms Highly effective against gram-positive bugs but less so Ocuflox and Ciloxan available generically

20 Ciloxan.3% Ciprofloxacin (Alcon), generic available Second Generation Good gram-negative coverage, adequate pos. Weak against Strep, great against Pseudomonas White precipitate often seen in bed of ulcer with treatment. Occurs 15% of the time, increases dramatically with age (ph based) Has an available ointment

21 Ocuflox.3% Ofloxacin (Allergan) : generic Second generation Good gram-negative, better pos. Less effective against Pseudomonas Much better tissue penetration than Ciloxan present in therapeutic levels in the AC Very cost effective

22 Iquix 1.5% concentration of levofloxacin Only topical antibiotic ever to come to the market initially with FDA approval for treating bacterial keratitis (ulcers)

23 Fourth Generation Gatifloxacin.5% (Zymaxid) Zymar no longer made Moxifloxacin.5% (Vigamox) Moxeza, Besivance

24 Fourth generations Ciloxan and Ocuflox bind only to topoisomerase 4 or DNA gyrase, 4th generations bind to both. Therefore not one but two genetic mutations are required for resistance!

25 Fourth generation A single genetic mutation can lead to resistance to the second generation fluoroquinolones and such a mutation occurs in one bacteria per ten million. The eyelids and large corneal ulcers can harbor around one million bacteria It takes two such mutations to confer resistance to fourth generation drugs and this can occur in one bacteria per ten trillion

26 Fourth generation A bacterial load of even two million is probably not possible in an ocular infection so resistance is statistically rare but certainly happens Remember.resistant bugs already have one mutation so they only have to come up with the other one, not both

27 Gatifloxacin Zymaxid.5% Excellent, broad spectrum agent TID for bacterial conjunctivitis Zymar has been discontinued

28 Moxifloxacin Vigamox.5% Excellent broad spectrum agent Preservative free TID dosing for conjunctivitis Penetrates AC better Moxeza.5% Different vehicle only Longer contact time, so BID conjunctivitis dosing

29 Besivance Besifloxacin.6% Suspension, so shake No oral version, so possibly less problems with resistance

30 Treatment tips Resistance develops when drugs are used at sub-lethal doses for extended periods of time (plasmids, mutations) Hit infections hard and stay the course for several days Biggest problem is sub-lethal dosing, not length of treatment alone Most resistance is from overuse of oral medications, not topicals. Oral Fluoroquinolones are misused extensively leading to strains resistant to topicals and orals

31 Resistance It has been estimated that more bacteria are exposed to an oral antibiotic given for a severe gastrointestinal infection in a single patient than in prophylaxis for every cataract surgery done in the US for an entire year!

32 ARMOR study Studied 592 ocular isolates 200 staph aureus, 144 coagulase negative staph, 75 strep pneumoniae, 73 haemophilus, and 100 pseudomonus All susceptibility studies were performed at the same lab

33 ARMOR study 39% of staph aureus was MRSA 80% of MRSA exhibited Fluoroquinolone resistance Besivance proved to show the least resistance across isolates Resistance was shown to be a significant problem with multiple drugs and multiple bugs

34 Treatment Use the expected type of pathogen to guide treatment choice (gram positive lid disease for example) Culture rarely, but when needed

35 Cost comparisons (smallest bottle size, generic if app.) Tobramycin and Ocuflox: $10.00 Gentamycin: $4.00 Ciloxan: $20.00 Polytrim: $15.00 (brand $60.00) Bacitracin ung: $42.00 Azasite: $ (brand $102.00) Ciloxan ung: $ Zymaxid: $ Vigamox / Moxeza: $120.00

36 Cost comparison Besivance: $ All cost comparisons of lowest available cost in pharmacies located in downtown Indianapolis

37 When good corneas go bad THE END

The Battle of Resistance: Treating Infections in the Age of Resistance

The Battle of Resistance: Treating Infections in the Age of Resistance The Age of Modern Medicine The Battle of Resistance: Treating Infections in the Age of Resistance Mark T. Dunbar, O.D., F.A.A.O. Bascom Palmer Eye Institute University of Miami, Miller School of Med Miami,

More information

Bacterial Resistance. The Battle of the Bugs: Treating Infections in the Age of Resistance. How Resistance Develops. The Age of Modern Medicine

Bacterial Resistance. The Battle of the Bugs: Treating Infections in the Age of Resistance. How Resistance Develops. The Age of Modern Medicine The Age of Modern Medicine The Battle of the Bugs: Treating Infections in the Age of Resistance Mark T. Dunbar, O.D., F.A.A.O. Bascom Palmer Eye Institute University of Miami, Miller School of Med Miami,

More information

Before we get started

Before we get started Pediatric Acute Bacterial Conjunctivitis: 2010 Update Before we get started Comment cards (90 day follow-up survey) Please hold questions until end of program Educational Objectives Educational Objectives

More information

Pathogens and Antibiotic Sensitivities in Post- Phacoemulsification Endophthalmitis, Kaiser Permanente, California,

Pathogens and Antibiotic Sensitivities in Post- Phacoemulsification Endophthalmitis, Kaiser Permanente, California, Pathogens and Antibiotic Sensitivities in Post- Phacoemulsification Endophthalmitis, Kaiser Permanente, California, 2007-2012 Geraldine R. Slean, MD, MS 1 ; Neal H. Shorstein, MD 2 ; Liyan Liu, MD, MS

More information

Burton's Microbiology for the Health Sciences. Chapter 9. Controlling Microbial Growth in Vivo Using Antimicrobial Agents

Burton's Microbiology for the Health Sciences. Chapter 9. Controlling Microbial Growth in Vivo Using Antimicrobial Agents Burton's Microbiology for the Health Sciences Chapter 9. Controlling Microbial Growth in Vivo Using Antimicrobial Agents Chapter 9 Outline Introduction Characteristics of an Ideal Antimicrobial Agent How

More information

Introduction to Chemotherapeutic Agents. Munir Gharaibeh MD, PhD, MHPE School of Medicine, The university of Jordan November 2018

Introduction to Chemotherapeutic Agents. Munir Gharaibeh MD, PhD, MHPE School of Medicine, The university of Jordan November 2018 Introduction to Chemotherapeutic Agents Munir Gharaibeh MD, PhD, MHPE School of Medicine, The university of Jordan November 2018 Antimicrobial Agents Substances that kill bacteria without harming the host.

More information

Bacterial Resistance. Battle of the Bugs: Treating Infections in the Age of Resistance. How Resistance Develops 10/16/2009. The Age of Modern Medicine

Bacterial Resistance. Battle of the Bugs: Treating Infections in the Age of Resistance. How Resistance Develops 10/16/2009. The Age of Modern Medicine The Age of Modern Medicine Battle of the Bugs: Treating Infections in the Age of Resistance Mark T. Dunbar, O.D., F.A.A.O. Bascom Palmer Eye Institute University of Miami, Miller School of Med Miami, FL

More information

Inhibiting Microbial Growth in vivo. CLS 212: Medical Microbiology Zeina Alkudmani

Inhibiting Microbial Growth in vivo. CLS 212: Medical Microbiology Zeina Alkudmani Inhibiting Microbial Growth in vivo CLS 212: Medical Microbiology Zeina Alkudmani Chemotherapy Definitions The use of any chemical (drug) to treat any disease or condition. Chemotherapeutic Agent Any drug

More information

Role of Moxifloxacin in Bacterial Keratitis

Role of Moxifloxacin in Bacterial Keratitis Original Article Role of Moxifloxacin in Bacterial Keratitis Aamna Jabran, Aurengzeb Sheikh, Syed Ali Haider, Zia-ud-din Shaikh Pak J Ophthalmol 29, Vol. 25 No. 2.................................................................................

More information

number Done by Corrected by Doctor Dr Hamed Al-Zoubi

number Done by Corrected by Doctor Dr Hamed Al-Zoubi number 8 Done by Corrected by Doctor Dr Hamed Al-Zoubi 25 10/10/2017 Antibacterial therapy 2 د. حامد الزعبي Dr Hamed Al-Zoubi Antibacterial therapy Figure 2/ Antibiotics target Inhibition of microbial

More information

Approach to pediatric Antibiotics

Approach to pediatric Antibiotics Approach to pediatric Antibiotics Gassem Gohal FAAP FRCPC Assistant professor of Pediatrics objectives To be familiar with common pediatric antibiotics o Classification o Action o Adverse effect To discus

More information

Aminoglycosides. Spectrum includes many aerobic Gram-negative and some Gram-positive bacteria.

Aminoglycosides. Spectrum includes many aerobic Gram-negative and some Gram-positive bacteria. Aminoglycosides The only bactericidal protein synthesis inhibitors. They bind to the ribosomal 30S subunit. Inhibit initiation of peptide synthesis and cause misreading of the genetic code. Streptomycin

More information

Microbiology : antimicrobial drugs. Sheet 11. Ali abualhija

Microbiology : antimicrobial drugs. Sheet 11. Ali abualhija Microbiology : antimicrobial drugs Sheet 11 Ali abualhija return to our topic antimicrobial drugs, we have finished major group of antimicrobial drugs which associated with inhibition of protein synthesis

More information

Principles of Antimicrobial therapy

Principles of Antimicrobial therapy Principles of Antimicrobial therapy Laith Mohammed Abbas Al-Huseini M.B.Ch.B., M.Sc, M.Res, Ph.D Department of Pharmacology and Therapeutics Antimicrobial agents are chemical substances that can kill or

More information

DNA Gyrase Inhibitors, Sulfa drugs and VRE

DNA Gyrase Inhibitors, Sulfa drugs and VRE Quick Review: Side Effects Tetracyclines: Phototoxicity and it may precipite in bones and joints. This is why I don t give tetracycline to children. Macrolides: Safe drugs; Virtually no side effects. This

More information

Antibiotics in vitro : Which properties do we need to consider for optimizing our therapeutic choice?

Antibiotics in vitro : Which properties do we need to consider for optimizing our therapeutic choice? Antibiotics in vitro : Which properties do we need to consider for optimizing our therapeutic choice? With the support of Wallonie-Bruxelles-International 1-1 In vitro evaluation of antibiotics : the antibiogram

More information

Antimicrobials. Antimicrobials

Antimicrobials. Antimicrobials Antimicrobials For more than 50 years, antibiotics have come to the rescue by routinely producing rapid and long-lasting miracle cures. However, from the beginning antibiotics have selected for resistance

More information

Ophthalmologic Drug Guide

Ophthalmologic Drug Guide Ophthalmologic Drug Guide Ophthalmologic Drug Guide Douglas J. Rhee, MD Assistant Professor, Harvard Medical School, Massachusetts Eye & Ear Infirmary, Boston, Massachusetts, USA Kathryn A. Colby, MD,

More information

number Done by Corrected by Doctor

number Done by Corrected by Doctor number 32 Done by Nazek Hyasat Corrected by Doctor مالك الزحلف In this sheet we will talk about two cute drugs and a group of drugs, wish you a pleasant study... First of all, we will talk about clindamycin,which

More information

Microbiology ( Bacteriology) sheet # 7

Microbiology ( Bacteriology) sheet # 7 Microbiology ( Bacteriology) sheet # 7 Revision of last lecture : Each type of antimicrobial drug normally targets a specific structure or component of the bacterial cell eg:( cell wall, cell membrane,

More information

Bacterial Resistance of Respiratory Pathogens. John C. Rotschafer, Pharm.D. University of Minnesota

Bacterial Resistance of Respiratory Pathogens. John C. Rotschafer, Pharm.D. University of Minnesota Bacterial Resistance of Respiratory Pathogens John C. Rotschafer, Pharm.D. University of Minnesota Antibiotic Misuse ~150 million courses of antibiotic prescribed by office based prescribers Estimated

More information

Antibiotics: mode of action and mechanisms of resistance. Slides made by Special consultant Henrik Hasman Statens Serum Institut

Antibiotics: mode of action and mechanisms of resistance. Slides made by Special consultant Henrik Hasman Statens Serum Institut Antibiotics: mode of action and mechanisms of resistance. Slides made by Special consultant Henrik Hasman Statens Serum Institut This presentation Definitions needed to discuss antimicrobial resistance

More information

Treatment of Respiratory Tract Infections Prof. Mohammad Alhumayyd Dr. Aliah Alshanwani

Treatment of Respiratory Tract Infections Prof. Mohammad Alhumayyd Dr. Aliah Alshanwani Treatment of Respiratory Tract Infections Prof. Mohammad Alhumayyd Dr. Aliah Alshanwani 30-1-2018 1 Objectives of the lecture At the end of lecture, the students should be able to understand the following:

More information

Antibiotics (2): - Before you start: this lecture has a lot of names and things get entangled together, but I

Antibiotics (2): - Before you start: this lecture has a lot of names and things get entangled together, but I Antibiotics (2): - Before you start: this lecture has a lot of names and things get entangled together, but I have nothing to do but to write everything the Doctor mentioned. I hope it will be clear. -

More information

مادة االدوية المرحلة الثالثة م. غدير حاتم محمد

مادة االدوية المرحلة الثالثة م. غدير حاتم محمد م. مادة االدوية المرحلة الثالثة م. غدير حاتم محمد 2017-2016 ANTIMICROBIAL DRUGS Antimicrobial drugs Lecture 1 Antimicrobial Drugs Chemotherapy: The use of drugs to treat a disease. Antimicrobial drugs:

More information

Simplifying Systemic Antibiotics

Simplifying Systemic Antibiotics 1 Simplifying Systemic Antibiotics Blair Lonsberry, MS, OD, MEd., FAAO Diplomate, American Board of Optometry Professor of Optometry Pacific University College of Optometry blonsberry@pacificu.edu 2 3

More information

For the use only of Registered Medical Practitioners or a Hospital or a Laboratory NEOSPORIN SKIN / ANTIBIOTIC OINTMENT

For the use only of Registered Medical Practitioners or a Hospital or a Laboratory NEOSPORIN SKIN / ANTIBIOTIC OINTMENT For the use only of Registered Medical Practitioners or a Hospital or a Laboratory NEOSPORIN SKIN / ANTIBIOTIC OINTMENT Neomycin and Polymyxin B Sulfates and Bacitracin Zinc Ointment / Ophthalmic Ointment

More information

Antimicrobials & Resistance

Antimicrobials & Resistance Antimicrobials & Resistance History 1908, Paul Ehrlich - Arsenic compound Arsphenamine 1929, Alexander Fleming - Discovery of Penicillin 1935, Gerhard Domag - Discovery of the red dye Prontosil (sulfonamide)

More information

Other Beta - lactam Antibiotics

Other Beta - lactam Antibiotics Other Beta - lactam Antibiotics Assistant Professor Dr. Naza M. Ali Lec 5 8 Nov 2017 Lecture outlines Other beta lactam antibiotics Other inhibitors of cell wall synthesis Other beta-lactam Antibiotics

More information

Proceedings of the 13th International Congress of the World Equine Veterinary Association WEVA

Proceedings of the 13th International Congress of the World Equine Veterinary Association WEVA www.ivis.org Proceedings of the 13th International Congress of the World Equine Veterinary Association WEVA October 3-5, 2013 Budapest, Hungary Reprinted in IVIS with the Permission of the WEVA Organizers

More information

Selective toxicity. Antimicrobial Drugs. Alexander Fleming 10/17/2016

Selective toxicity. Antimicrobial Drugs. Alexander Fleming 10/17/2016 Selective toxicity Antimicrobial Drugs Chapter 20 BIO 220 Drugs must work inside the host and harm the infective pathogens, but not the host Antibiotics are compounds produced by fungi or bacteria that

More information

Public Assessment Report Paediatric data. EXOCIN (OCUFLOX) Ofloxacin. Marketing Autorisation Holder: Allergan

Public Assessment Report Paediatric data. EXOCIN (OCUFLOX) Ofloxacin. Marketing Autorisation Holder: Allergan Public Assessment Report Paediatric data EXOCIN (OCUFLOX) Ofloxacin Marketing Autorisation Holder: Allergan Rapporteur: Co-Rapporteur: Currently approved indication(s): Pharmaceutical form(s) and strengths

More information

11/10/2016. Skin and Soft Tissue Infections. Disclosures. Educational Need/Practice Gap. Objectives. Case #1

11/10/2016. Skin and Soft Tissue Infections. Disclosures. Educational Need/Practice Gap. Objectives. Case #1 Disclosures Selecting Antimicrobials for Common Infections in Children FMR-Contemporary Pediatrics 11/2016 Sean McTigue, MD Assistant Professor of Pediatrics, Pediatric Infectious Diseases Medical Director

More information

** the doctor start the lecture with revising some information from the last one:

** the doctor start the lecture with revising some information from the last one: Page 1 of 7 ** the doctor start the lecture with revising some information from the last one: #penicillin G has a good susceptibility against gram(+ve), Neisseria (-ve) #mostly active against strep. (don

More information

Challenges Emerging resistance Fewer new drugs MRSA and other resistant pathogens are major problems

Challenges Emerging resistance Fewer new drugs MRSA and other resistant pathogens are major problems Micro 301 Antimicrobial Drugs 11/7/12 Significance of antimicrobial drugs Challenges Emerging resistance Fewer new drugs MRSA and other resistant pathogens are major problems Definitions Antibiotic Selective

More information

Is Tobramycin Ophthalmic Solution Usp 0.3 Used For Pink Eye

Is Tobramycin Ophthalmic Solution Usp 0.3 Used For Pink Eye Is Tobramycin Ophthalmic Solution Usp 0.3 Used For Pink Eye Tobramycin ophthalmic is applied as a liquid solution or as an eye ointment, according to MedlinePlus. It is an antibiotic that treats bacterial

More information

Clinical Features, Antibiotic Susceptibility Profile, and Outcomes of Infectious Keratitis Caused by Stenotrophomonas maltophilia

Clinical Features, Antibiotic Susceptibility Profile, and Outcomes of Infectious Keratitis Caused by Stenotrophomonas maltophilia Clinical Features, Antibiotic Susceptibility Profile, and Outcomes of Infectious Keratitis Caused by Stenotrophomonas maltophilia Sotiria Palioura, MD, MSc, PhD Cornea & External Disease Specialist Athens

More information

Pharmacology Week 6 ANTIMICROBIAL AGENTS

Pharmacology Week 6 ANTIMICROBIAL AGENTS Pharmacology Week 6 ANTIMICROBIAL AGENTS Mechanisms of antimicrobial action Mechanisms of antimicrobial action Bacteriostatic - Slow or stop bacterial growth, needs an immune system to finish off the microbe

More information

Slide 1. Slide 2. Slide 3. Current Trends in Medical Management. Financial Disclosure. Antibiotics - Systemic

Slide 1. Slide 2. Slide 3. Current Trends in Medical Management. Financial Disclosure. Antibiotics - Systemic Slide 1 Current Trends in Medical Management Ron Melton, OD, FAAO Randall Thomas, OD, MPH, FAAO www.eyeupdate.com Slide 2 Financial Disclosure Dr. Ron Melton and Dr. Randall Thomas are consultants to,

More information

ANTIBIOTICS USED FOR RESISTACE BACTERIA. 1. Vancomicin

ANTIBIOTICS USED FOR RESISTACE BACTERIA. 1. Vancomicin ANTIBIOTICS USED FOR RESISTACE BACTERIA 1. Vancomicin Vancomycin is used to treat infections caused by bacteria. It belongs to the family of medicines called antibiotics. Vancomycin works by killing bacteria

More information

Is erythromycin bactericidal

Is erythromycin bactericidal Is erythromycin bactericidal Search Comparison of erythromycin, clarithromycin, azithromycin, telithromycin, roxithromycin: mechanism of action, spectrum of activity, side effects, drug interactions. Erythromycin

More information

Advanced Practice Education Associates. Antibiotics

Advanced Practice Education Associates. Antibiotics Advanced Practice Education Associates Antibiotics Overview Difference between Gram Positive(+), Gram Negative(-) organisms Beta lactam ring, allergies Antimicrobial Spectra of Antibiotic Classes 78 Copyright

More information

Antibiotic Updates: Part I

Antibiotic Updates: Part I Antibiotic Updates: Part I Fredrick M. Abrahamian, DO, FACEP, FIDSA Health Sciences Clinical Professor of Emergency Medicine David Geffen School of Medicine at UCLA Los Angeles, California Financial Disclosures

More information

Necrotizing Soft Tissue Infections: Emerging Bacterial Resistance

Necrotizing Soft Tissue Infections: Emerging Bacterial Resistance Necrotizing Soft Tissue Infections: Emerging Bacterial Resistance Eileen M. Bulger, MD Professor of Surgery Harborview Medical Center University of Washington Objectives Review definition & diagnostic

More information

Antibiotic Stewardship Program (ASP) CHRISTUS SETX

Antibiotic Stewardship Program (ASP) CHRISTUS SETX Antibiotic Stewardship Program (ASP) CHRISTUS SETX Program Goals I. Judicious use of antibiotics Decrease use of broad spectrum antibiotics and deescalate use based on clinical symptoms Therapeutic duplication:

More information

Antibiotics. Antimicrobial Drugs. Alexander Fleming 10/18/2017

Antibiotics. Antimicrobial Drugs. Alexander Fleming 10/18/2017 Antibiotics Antimicrobial Drugs Chapter 20 BIO 220 Antibiotics are compounds produced by fungi or bacteria that inhibit or kill competing microbial species Antimicrobial drugs must display selective toxicity,

More information

WHY IS THIS IMPORTANT?

WHY IS THIS IMPORTANT? CHAPTER 20 ANTIBIOTIC RESISTANCE WHY IS THIS IMPORTANT? The most important problem associated with infectious disease today is the rapid development of resistance to antibiotics It will force us to change

More information

Class Update with New Drug Evaluation: Ototopical Antibiotics

Class Update with New Drug Evaluation: Ototopical Antibiotics Copyright 2012 Oregon State University. All Rights Reserved Drug Use Research & Management Program Oregon State University, 500 Summer Street NE, E35 Salem, Oregon 97301-1079 Phone 503-947-5220 Fax 503-947-1119

More information

Antimicrobial Therapy

Antimicrobial Therapy Chapter 12 The Elements of Chemotherapy Topics - Antimicrobial Therapy - Selective Toxicity - Survey of Antimicrobial Drug - Microbial Drug Resistance - Drug and Host Interaction Antimicrobial Therapy

More information

Community Acquired Pneumonia: An Update on Guidelines

Community Acquired Pneumonia: An Update on Guidelines Community Acquired Pneumonia: An Update on Guidelines Claudia Summa, BScPhm Pharmacy Resident September 12, 2006 Objectives To give a brief description of the pathophysiology of community acquired pneumonia

More information

CLINICAL DECISION MAKING IN MICROBIAL KERATITIS. Gregory M. Schultz, O.D.,F.A.A.O. Eye Center of Virginia Williamsburg and Gloucester Virginia

CLINICAL DECISION MAKING IN MICROBIAL KERATITIS. Gregory M. Schultz, O.D.,F.A.A.O. Eye Center of Virginia Williamsburg and Gloucester Virginia CLINICAL DECISION MAKING IN MICROBIAL KERATITIS Gregory M. Schultz, O.D.,F.A.A.O. Eye Center of Virginia Williamsburg and Gloucester Virginia : GOALS OF THIS COURSE: QUESTIONS WE WILL ANSWER Do I have

More information

An#bio#cs and challenges in the wake of superbugs

An#bio#cs and challenges in the wake of superbugs An#bio#cs and challenges in the wake of superbugs www.biochemj.org/bj/330/0581/bj3300581.htm ciss.blog.olemiss.edu Dr. Vassie Ware Bioscience in the 21 st Century November 14, 2014 Who said this and what

More information

ONTARIO REGULATION 112/11 made under the OPTOMETRY ACT, 1991 Made: December 8, 2010 Approved: March 23, 2011 Filed: April 5, 2011 Published on

ONTARIO REGULATION 112/11 made under the OPTOMETRY ACT, 1991 Made: December 8, 2010 Approved: March 23, 2011 Filed: April 5, 2011 Published on ONTARIO REGULATION 112/11 made under the OPTOMETRY ACT, 1991 Made: December 8, 2010 Approved: March 23, 2011 Filed: April 5, 2011 Published on e-laws: April 6, 2011 Printed in The Ontario Gazette: April

More information

CONTAGIOUS COMMENTS Department of Epidemiology

CONTAGIOUS COMMENTS Department of Epidemiology VOLUME XXIII NUMBER 1 July 2008 CONTAGIOUS COMMENTS Department of Epidemiology Bugs and Drugs Elaine Dowell, SM (ASCP), Marti Roe SM (ASCP), Ann-Christine Nyquist MD, MSPH Are the bugs winning? The 2007

More information

Controlling Microbial Growth in the Body: Antimicrobial Drugs

Controlling Microbial Growth in the Body: Antimicrobial Drugs Controlling Microbial Growth in the Body: Antimicrobial Drugs Chapter 12 Topics - Antimicrobial Therapy - Selective Toxicity - Survey of Antimicrobial Drug - Microbial Drug Resistance - Drug and Host Interaction

More information

CLINICAL USE OF AMINOGLYCOSIDES AND FLUOROQUINOLONES THE AMINOGLYCOSIDES:

CLINICAL USE OF AMINOGLYCOSIDES AND FLUOROQUINOLONES THE AMINOGLYCOSIDES: CLINICAL USE OF AMINOGLYCOSIDES AND FLUOROQUINOLONES Douglas Black, Pharm.D. Associate Professor School of Pharmacy University of Washington dblack@u.washington.edu THE AMINOGLYCOSIDES: 1944-1975 Drug

More information

Protein Synthesis Inhibitors

Protein Synthesis Inhibitors Protein Synthesis Inhibitors Assistant Professor Dr. Naza M. Ali 11 Nov 2018 Lec 7 Aminoglycosides Are structurally related two amino sugars attached by glycosidic linkages. They are bactericidal Inhibitors

More information

Antimicrobial susceptibility

Antimicrobial susceptibility Antimicrobial susceptibility PATTERNS Microbiology Department Canterbury ealth Laboratories and Clinical Pharmacology Department Canterbury District ealth Board March 2011 Contents Preface... Page 1 ANTIMICROBIAL

More information

folate-derived cofactors purines pyrimidines Sulfonamides sulfa drugs Trimethoprim infecting bacterium to perform DNA synthesis cotrimoxazole

folate-derived cofactors purines pyrimidines Sulfonamides sulfa drugs Trimethoprim infecting bacterium to perform DNA synthesis cotrimoxazole Folate Antagonists Enzymes requiring folate-derived cofactors are essential for the synthesis of purines and pyrimidines (precursors of RNA and DNA) and other compounds necessary for cellular growth and

More information

Antibiotics & Resistance

Antibiotics & Resistance What are antibiotics? Antibiotics & esistance Antibiotics are molecules that stop bacteria from growing or kill them Antibiotics, agents against life - either natural or synthetic chemicals - designed

More information

Antimicrobial Susceptibility Testing: Advanced Course

Antimicrobial Susceptibility Testing: Advanced Course Antimicrobial Susceptibility Testing: Advanced Course Cascade Reporting Cascade Reporting I. Selecting Antimicrobial Agents for Testing and Reporting Selection of the most appropriate antimicrobials to

More information

Antimicrobial Therapy

Antimicrobial Therapy Antimicrobial Therapy David H. Spach, MD Professor of Medicine Division of Infectious Diseases University of Washington, Seattle Disclosure: Dr. Spach has no significant financial interest in any of the

More information

Perichondritis: Source: UpToDate Ciprofloxacin 10 mg/kg/dose PO (max 500 mg/dose) BID Inpatient: Ceftazidime 50 mg/kg/dose q8 hours IV

Perichondritis: Source: UpToDate Ciprofloxacin 10 mg/kg/dose PO (max 500 mg/dose) BID Inpatient: Ceftazidime 50 mg/kg/dose q8 hours IV Empiric Antibiotics for Pediatric Infections Seen in ED NOTE: Choice of empiric antibiotic therapy must take into account local pathogen frequency and resistance patterns, individual patient characteristics,

More information

SUMMARY OF PRODUCT CHARACTERISTICS. Lincomycin (as Lincomycin hydrochloride) Neomycin (as Neomycin sulphate) Excipients Disodium edetate

SUMMARY OF PRODUCT CHARACTERISTICS. Lincomycin (as Lincomycin hydrochloride) Neomycin (as Neomycin sulphate) Excipients Disodium edetate SUMMARY OF PRODUCT CHARACTERISTICS AN: 00221/2013 1. NAME OF THE VETERINARY MEDICINAL PRODUCT Lincocin Forte S Intramammary Solution 2. QUALITATIVE AND QUANTITATIVE COMPOSITION Active substances Lincomycin

More information

Einheit für pädiatrische Infektiologie Antibiotics - what, why, when and how?

Einheit für pädiatrische Infektiologie Antibiotics - what, why, when and how? Einheit für pädiatrische Infektiologie Antibiotics - what, why, when and how? Andrea Duppenthaler andrea.duppenthaler@insel.ch Limping patient local pain swelling tenderness warmth fever acute Osteomyelitis

More information

number Done by Corrected by Doctor

number Done by Corrected by Doctor number 28 Done by Dina Yaseen Corrected by حسام أبو عوض Doctor مالك الزحلف Cephalosporins -Cephalosporins are β-lactam antibiotics isolated from a strain of Streptomyces. -They are bactericidal and work

More information

Lab Exercise: Antibiotics- Evaluation using Kirby Bauer method.

Lab Exercise: Antibiotics- Evaluation using Kirby Bauer method. Lab Exercise: Antibiotics- Evaluation using Kirby Bauer method. OBJECTIVES 1. Compare the antimicrobial capabilities of different antibiotics. 2. Compare effectiveness of with different types of bacteria.

More information

4/29/12. Dr. Taravella does not have any financial interest in the material, methods or techniques presented.

4/29/12. Dr. Taravella does not have any financial interest in the material, methods or techniques presented. Dr. Taravella does not have any financial interest in the material, methods or techniques presented. Michael J. Taravella Professor of Ophthalmology Rocky Mountain Lions Eye Institute University of Colorado

More information

Pharm 262: Antibiotics. 1 Pharmaceutical Microbiology II DR. C. AGYARE

Pharm 262: Antibiotics. 1 Pharmaceutical Microbiology II DR. C. AGYARE Pharm 262: 1 Pharmaceutical Microbiology II Antibiotics DR. C. AGYARE Reference Books 2 HUGO, W.B., RUSSELL, A.D. Pharmaceutical Microbiology. 6 th Ed. Malden, MA: Blackwell Science, 1998. WALSH, G. Biopharmaceuticals:

More information

Mechanism of antibiotic resistance

Mechanism of antibiotic resistance Mechanism of antibiotic resistance Dr.Siriwoot Sookkhee Ph.D (Biopharmaceutics) Department of Microbiology Faculty of Medicine, Chiang Mai University Antibiotic resistance Cross-resistance : resistance

More information

Introduction to Antimicrobials. Lecture Aim: To provide a brief introduction to antibiotics. Future lectures will go into more detail.

Introduction to Antimicrobials. Lecture Aim: To provide a brief introduction to antibiotics. Future lectures will go into more detail. Introduction to Antimicrobials Rachel J. Gordon, MD, MPH Lecture Aim: To provide a brief introduction to antibiotics. Future lectures will go into more detail. Major Learning Objectives: 1) Learn the different

More information

Chapter concepts: What are antibiotics, the different types, and how do they work? Antibiotics

Chapter concepts: What are antibiotics, the different types, and how do they work? Antibiotics Chapter concepts: Antibiotics What are antibiotics, the different types, and how do they work? How do we decided on the most appropriate antibiotic treatment? What are some of the ways that bacteria are

More information

CLINICAL USE OF AMINOGLYCOSIDES AND FLUOROQUINOLONES

CLINICAL USE OF AMINOGLYCOSIDES AND FLUOROQUINOLONES CLINICAL USE OF AMINOGLYCOSIDES AND FLUOROQUINOLONES Douglas Black, Pharm.D. Associate Professor School of Pharmacy University of Washington dblack@u.washington.edu THE AMINOGLYCOSIDES: 1944-1975 Drug

More information

CME/CE QUIZ CME/CE QUESTIONS. a) 20% b) 22% c) 34% d) 35% b) Susceptible and resistant strains of typical respiratory

CME/CE QUIZ CME/CE QUESTIONS. a) 20% b) 22% c) 34% d) 35% b) Susceptible and resistant strains of typical respiratory CME/CE QUIZ CME/CE QUESTIONS Continuing Medical Education Accreditation This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for

More information

PRESCRIBING INFORMATION

PRESCRIBING INFORMATION PRESCRIBING INFORMATION Pr PENTAMYCETIN Chloramphenicol Ophthalmic Solution USP 0.25%, 0.5% Chloramphenicol Ophthalmic Ointment USP 1% Antibiotic Pr PENTAMYCETIN/HC Chloramphenicol and Hydrocortisone Eye

More information

Principles of Antimicrobial Therapy

Principles of Antimicrobial Therapy Principles of Antimicrobial Therapy Key Points Early and rapid diagnosis of infection and prompt initiation of appropriate antimicrobial therapy, if warranted, are fundamental to reducing the mortality

More information

Antibiotic Updates: Part II

Antibiotic Updates: Part II Antibiotic Updates: Part II Fredrick M. Abrahamian, DO, FACEP, FIDSA Health Sciences Clinical Professor of Emergency Medicine David Geffen School of Medicine at UCLA Los Angeles, California Financial Disclosures

More information

Standing Orders for the Treatment of Outpatient Peritonitis

Standing Orders for the Treatment of Outpatient Peritonitis Standing Orders for the Treatment of Outpatient Peritonitis 1. Definition of Peritonitis: a. Cloudy effluent. b. WBC > 100 cells/mm3 with >50% polymorphonuclear (PMN) cells with minimum 2 hour dwell. c.

More information

EUCAST recommended strains for internal quality control

EUCAST recommended strains for internal quality control EUCAST recommended strains for internal quality control Escherichia coli Pseudomonas aeruginosa Staphylococcus aureus Enterococcus faecalis Streptococcus pneumoniae Haemophilus influenzae ATCC 59 ATCC

More information

Antibacterial susceptibility testing

Antibacterial susceptibility testing Antibiotics: Antil susceptibility testing are natural chemical substances produced by certain groups of microorganisms (fungi, ) that inhibit the growth of or kill the other that cause infection. Several

More information

Optometry Act, 1991 Loi de 1991 sur les optométristes

Optometry Act, 1991 Loi de 1991 sur les optométristes Optometry Act, 1991 Loi de 1991 sur les optométristes ONTARIO REGULATION 112/11 DESIGNATED DRUGS AND STANDARDS OF PRACTICE Consolidation Period: From February 6, 2017 to the e-laws currency date. Last

More information

Can levaquin treat group b strep

Can levaquin treat group b strep Can levaquin treat group b strep The Borg System is 100 % Can levaquin treat group b strep IBS - Symptoms, Diet and Treatment. IBS, is the common slang term or abbreviation for Irritable Bowel Syndrome

More information

Fundamentals of Pharmacology for Veterinary Technicians Chapter 18

Fundamentals of Pharmacology for Veterinary Technicians Chapter 18 Figure 18-1 Anterior chamber Cornea Vitreous chamber Sclera Choroid coat Retina Iris Fovea Lens Blind spot Posterior chamber Optic nerve Figure 18-2 Lateral canthus Cilia (eyelashes) Nictitating membrane

More information

Antimicrobial use in poultry: Emerging public health problem

Antimicrobial use in poultry: Emerging public health problem Antimicrobial use in poultry: Emerging public health problem Eric S. Mitema, BVM, MS, PhD CPD- Diagnosis and Treatment of Poultry Diseases FVM, CAVS, 6 th. August, 2014 AMR cont Antibiotics - Natural or

More information

UPDATES ON ANTIBIOTIC THERAPY. Jennifer L. Davis, DVM, PhD, DACVIM (LA), DACVCP VA-MD College of Veterinary Medicine VA Tech, Blacksburg, VA

UPDATES ON ANTIBIOTIC THERAPY. Jennifer L. Davis, DVM, PhD, DACVIM (LA), DACVCP VA-MD College of Veterinary Medicine VA Tech, Blacksburg, VA UPDATES ON ANTIBIOTIC THERAPY Jennifer L. Davis, DVM, PhD, DACVIM (LA), DACVCP VA-MD College of Veterinary Medicine VA Tech, Blacksburg, VA ANTIBIOTICS Fluoroquinolones The fluoroquinolone class of antibiotics

More information

Principles of Anti-Microbial Therapy Assistant Professor Naza M. Ali. Lec 1

Principles of Anti-Microbial Therapy Assistant Professor Naza M. Ali. Lec 1 Principles of Anti-Microbial Therapy Assistant Professor Naza M. Ali Lec 1 28 Oct 2018 References Lippincott s IIIustrated Reviews / Pharmacology 6 th Edition Katzung and Trevor s Pharmacology / Examination

More information

The β- Lactam Antibiotics. Munir Gharaibeh MD, PhD, MHPE School of Medicine, The University of Jordan November 2018

The β- Lactam Antibiotics. Munir Gharaibeh MD, PhD, MHPE School of Medicine, The University of Jordan November 2018 The β- Lactam Antibiotics Munir Gharaibeh MD, PhD, MHPE School of Medicine, The University of Jordan November 2018 Penicillins. Cephalosporins. Carbapenems. Monobactams. The β- Lactam Antibiotics 2 3 How

More information

GENERAL NOTES: 2016 site of infection type of organism location of the patient

GENERAL NOTES: 2016 site of infection type of organism location of the patient GENERAL NOTES: This is a summary of the antibiotic sensitivity profile of clinical isolates recovered at AIIMS Bhopal Hospital during the year 2016. However, for organisms in which < 30 isolates were recovered

More information

Antimicrobial agents

Antimicrobial agents Bacteriology Antimicrobial agents Learning Outcomes: At the end of this lecture, the students should be able to: Identify mechanisms of action of antimicrobial Drugs Know and understand key concepts about

More information

Study of Bacteriological Profile of Corneal Ulcers in Patients Attending VIMS, Ballari, India

Study of Bacteriological Profile of Corneal Ulcers in Patients Attending VIMS, Ballari, India International Journal of Current Microbiology and Applied Sciences ISSN: 2319-7706 Volume 5 Number 7 (2016) pp. 200-205 Journal homepage: http://www.ijcmas.com Original Research Article http://dx.doi.org/10.20546/ijcmas.2016.507.020

More information

Standing Orders for the Treatment of Outpatient Peritonitis

Standing Orders for the Treatment of Outpatient Peritonitis Standing Orders for the Treatment of Outpatient Peritonitis 1. Definition of Peritonitis: a. Cloudy effluent. b. WBC > 100 cells/mm3 with >50% polymorphonuclear (PMN) cells with minimum 2 hour dwell. c.

More information

Appropriate Antimicrobial Therapy for Treatment of

Appropriate Antimicrobial Therapy for Treatment of Appropriate Antimicrobial Therapy for Treatment of Staphylococcus aureus infections ( MRSA ) By : A. Bojdi MD Assistant Professor Inf. Dis. Dep. Imam Reza Hosp. MUMS Antibiotics Still Miracle Drugs Paul

More information

For some reason the skin on the inside of both my nostrils continually splits, heals, and splits again. I do have allergies frequently

For some reason the skin on the inside of both my nostrils continually splits, heals, and splits again. I do have allergies frequently 12-3-2018 For some reason the skin on the inside of both my nostrils continually splits, heals, and splits again. I do have allergies frequently which may contribute. What is Folliculitis? Folliculitis

More information

DOSAGE FORMS AND STRENGTHS Otic Suspension: Each OTIPRIO vial contains 1 ml of 6% (60 mg/ml) ciprofloxacin otic suspension. (3)

DOSAGE FORMS AND STRENGTHS Otic Suspension: Each OTIPRIO vial contains 1 ml of 6% (60 mg/ml) ciprofloxacin otic suspension. (3) HIGHLIGHTS OF PRESCRIBING INFORMATION These highlights do not include all the information needed to use OTIPRIO safely and effectively. See full prescribing information for OTIPRIO. OTIPRIO (ciprofloxacin

More information

Oral Antibiotics in Eye Care

Oral Antibiotics in Eye Care Disclosures- Greg Caldwell, OD, FAAO Oral Antibiotics in Eye Care Disclosure Statement (next slide) Greg Caldwell, OD, FAAO 2018 TOA Annual Convention February 24, 2018 $ Will mention many products, instruments

More information

Antibacterial therapy 1. د. حامد الزعبي Dr Hamed Al-Zoubi

Antibacterial therapy 1. د. حامد الزعبي Dr Hamed Al-Zoubi Antibacterial therapy 1 د. حامد الزعبي Dr Hamed Al-Zoubi ILOs Principles and terms Different categories of antibiotics Spectrum of activity and mechanism of action Resistancs Antibacterial therapy What

More information

number Done by Corrected by Doctor Dr.Malik

number Done by Corrected by Doctor Dr.Malik number 27 Done by Fatimah Farhan Corrected by Basil Al-Bakri Doctor Dr.Malik Note: anything in red is just extra info and you will not be asked about it in the exam. In this sheet we will continue talking

More information

Medicinal Chemistry 561P. 2 st hour Examination. May 6, 2013 NAME: KEY. Good Luck!

Medicinal Chemistry 561P. 2 st hour Examination. May 6, 2013 NAME: KEY. Good Luck! Medicinal Chemistry 561P 2 st hour Examination May 6, 2013 NAME: KEY Good Luck! 2 MDCH 561P Exam 2 May 6, 2013 Name: KEY Grade: Fill in your scantron with the best choice for the questions below: 1. Which

More information

Antibiotic. Antibiotic Classes, Spectrum of Activity & Antibiotic Reporting

Antibiotic. Antibiotic Classes, Spectrum of Activity & Antibiotic Reporting Antibiotic Antibiotic Classes, Spectrum of Activity & Antibiotic Reporting Any substance of natural, synthetic or semisynthetic origin which at low concentrations kills or inhibits the growth of bacteria

More information

What s next in the antibiotic pipeline?

What s next in the antibiotic pipeline? What s next in the antibiotic pipeline? Jennifer Tieu, Pharm.D., BCPS Clinical Pearls OSHP Spring Meeting Mercy Hospital April 13, 2018 Objective 2 Describe the drug class and mechanism of action of antibiotics

More information