Toxicology: Therapeutic

Drugs: ANTIBIOTICS
Presented by:
Flores, Lanie Grace P.
Gongora, Erica Mae S.

What are antibiotics?

Antimicrobial agents that kill or inhibit the
growth of bacteria
Produced naturally by a bacterium or fungus

How do antibiotics work?

W
I
S

Weakening the bacterias cell wall until it bursts

Interfering with the bacterias ability to repair its
damaged DNA
Stopping the bacterias ability to make what it
needs to grow

AMINOGLYCOSIDES
Group of chemically related antibiotics
Treatment of infections with Gram () bacteria that are
resistant to less toxic antibiotics
Act synergistically against certain Gram (+) organisms
Used in treatment of:
Severe infections of abdomen and UT
Bacteremia
Endocarditis

Require trough and peak measurements

ROUTES OF
ADMINISTRATION
Not well absorbed from the GI tract,
it is limited to:
Intravenous (IV)
Intramuscular (IM)

Not used in an outpatient setting

GENTAMICIN
Most commonly used
Low cost
Reliable activity against Gram (-)
aerobes

Isolated from Micromonospora

Breakthrough in the treatment of
bacillary infections ( Pseudomonas
aeruginosa)

TOBRAMYCIN
Has greater in vitro activity against
Pseudomonas aeruginosa

AMIKACIN
Effective against resistant organisms
Its chemical structure makes it less
susceptible to inactivating enzymes

Preferred agent for serious

nosocomial infections caused by
Gram (-) bacilli

KANAMYCIN
Used to treat serious bacterial
infections in many different parts of
the body
Short-term use only
Toxic effects more likely to occur in
elderly patients and newborn infants

STREPTOMYCIN
The first aminoglycoside
Isolated from Streptomyces griseus

Used for:
Tuberculosis
Infections caused by certain bacteria

NEOMYCIN
Had better activity than
Streptomycin against aerobic Gram
(-) bacilli
Could not safely be used systemically
due to its formidable toxicity
Isolated from Streptomyces fradiae

TOXIC EFFECTS
Ototoxic effect
Disrupts inner ear cochlear and vestibular
membrane
o Hearing and balance impairment
o Irreversible

Nephrotoxic effect
Increase in serum creatinine and BUN
Impairs the function of the PCT
o Electrolyte imbalance
o Possibly proteinuria

TOXIC EFFECTS
Neuromuscular blockade
Administration of neuromuscular blocking
drugs and anesthetics
Hypocalcemia
Myasthenia gravis

Hypersensitivity reactions
Superinfections
CNS effects
GI disturbances

ELIMINATION
Renal filtration
Patients with compromised renal
function, adjustments must be made
based on serum concentration

METHODS
Chromatography
Immunoassay

VANCOMYCIN
Glycopeptide antibiotic
Effective against Gram (+) cocci and bacilli
Skipping doses may increase risk of further
infection that is resistant to antibiotics
Used against resistant strains of
Streptococcus and Staphylococcus
Only trough levels are monitored to ensure
the serum drug concentration is within the
therapeutic range

ROUTE OF ADMINISTRATION
Because of poor oral absorption, it is
administered by:
IV infusion

TOXIC EFFECTS
Red-man syndrome
Erythemic flushing of the extremities

Ototoxic and Nephrotoxic effects are

similar to aminoglycosides

ELIMINATION
Renal filtration
Excretion

METHODS
Chromatography
Immunoassay

CHLORAMPHENICOL

Distributes to all tissues

Concentrates in the CSF
Isolated from Streptomyces venezuelae
50% protein bound; rapidly absorbed in the GIT
No longer drug of choice due to BM toxicity
Used against:
Gram (+) and Gram (-) cocci and bacilli (including
anaerobes)
Ricketssia, Mycoplasma, Chlamydia, and
Chlamydophila spp.

ROUTES OF
ADMINISTRATION
Well absorbed orally
Intravenous (IV)

TOXIC EFFECTS
Blood dyscrasia
Gray baby syndrome
Condition that occurs in newborns
(especially premature babies) who are
given the drug chloramphenicol

Cytoplasmic vacuolation
Erythroid cells
Myeloid cells

ELIMINATION
68%-99%
Excreted in the urine

8% - 12%
Excreted as free chloramphenicol

Remainder is excreted as inactive

metabolites

REFERENCES:
Bishop, Michael (2010). Clinical Chemistry 6th Edition: Techniques, Principles,
Correlations.
Rodriguez, M.T. (2014). Clinical Chemistry Review Handbook for Medical
Technologists.
Tortora et al. (1998). Microbiology: An Introduction 6th Edition.
http://www.aafp.org/afp/1998/1115/p1811.html
http://www.drugs.com/cdi/streptomycin.html
http://campus.usal.es/~galenica/clinpkin/Aminoglycosides.htm
http://www.nlm.nih.gov/medlineplus/druginfo/meds/a604038.html
https://www.merckmanuals.com/professional/infectious-diseases/bacteria-and-antib
acterial-drugs/chloramphenicol
http://www.medicinenet.com/chloramphenicol-oral/article.htm