LEARNING OBJECTIVES CH 20 ANTIMICROBIAL MEDICATIONS 12-29-2021

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MICROBIOLO

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Biology

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Jan 9, 2024

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INTRODUCTION TO MICROBIOLOGY LEARNING OBJECTIVES CHAPTER 20: ANTIMICROBIAL MEDICATIONS (NESTER) 1.Describe how Paul Ehrlich and Alexander Fleming contributed to the development of antimicrobial chemotherapy (this is also a review of some Chapter 1 material). 2.Describe Gerhard Domagk’s invention of the sulfa drugs; explain why sulfa drugs are not considered antibiotics in the strictest sense. 3.Define an antibiotic as a microbe-made antimicrobial molecule. 4.Name several microorganisms that produce medically-useful antibiotics (a very partial listing follows): a. Bacillus (soil bacterium): bacitracin b. Streptomyces (soil bacterium): streptomycin c. Penicillium (mold/fungus): penicillin 5.Explain the principle of selective toxicity, and discuss why it is easier to find selectively toxic antibacterial agents than it is to find selectively toxic agents against other forms of microorganisms (e.g. viruses, fungi, protists, helminths). 6.Discuss advantages and disadvantages of using both broad- and narrow-spectrum antibiotics. 7.Define superinfection as an infection acquired as a consequence of antimicrobial (usually broad-spectrum) drug use. Discuss how each of these common superinfections occur:  Oral or vulvovaginal candidiasis (a.k.a. yeast infections)  C. difficile colitis 8.We will describe the general mechanisms (i.e. “mechanism of action”) through which antibiotics affect microorganisms; the drug in parentheses will be discussed as an example of each mechanism; mechanisms of selective toxicity of each class of drug will also be discussed: (see blank table, next page) a.Inhibition of cell wall synthesis b.Inhibition of protein synthesis c.Inhibitors of nucleic acid synthesis d.Competitive inhibition of folic acid synthesis 9.Define a drug resistant bacterial strain as one that cannot be killed with an achievable in vivo drug dose (but may be susceptible to higher doses) 10. Differentiate between:  innate (“inborn”) drug resistance: e.g. Gram-negative bacteria are considered innately resistant to penicillin  acquired (“picked up”) resistance: e.g. MRSA, VRE 11. Describe 4 common mechanisms of acquired drug resistance in bacteria: a. enzymatic destruction or inactivation of the drug (ex: β-lactamase production in penicillin-resistant bacteria) b. prevention of penetration to the target site within the microbe (ex: especially small porins in mutant Pseudomonas strains) c. mutations leading to alteration of the drug’s target (ex. mutant ribosomes) d. rapid efflux (ejection) of the antibiotic e. note also that often, drug resistant strains have longer doubling times than comparable nonresistant strains 12. Describe human practices that have caused populations of antibiotic-resistant bacteria to increase. (mutation creates drug-resistant bacteria; human activity makes drug-resistant bacteria common) a. unnecessary prescription of antibiotics (e.g. for viral infections) b. failure to take full course of antibiotics c. use of low dosages of antibiotics in animal (pig, chicken, etc.) feed 11. Describe several strategies for slowing the spread of drug resistance in bacterial populations. The following is a copy/paste from: http://www.cdc.gov/features/antibioticresistance/ 1

Patients can:  Ask if tests will be done to make sure the right antibiotic is prescribed.  Take antibiotics exactly as the doctor prescribes. Do not skip doses. Complete the pre- scribed course of treatment, even when you start feeling better.  Only take antibiotics prescribed for you; do not share or use leftover antibiotics. Antibi- otics treat specific types of infections. Taking the wrong medicine may delay correct treatment and allow bacteria to multiply.  Do not save antibiotics for the next illness. Discard any leftover medication once the pre- scribed course of treatment is completed.  Do not ask for antibiotics when your doctor thinks you do not need them. Remember an- tibiotics have side effects.  Prevent infections by practicing good hand hygiene and getting recommended vaccines. View Larger Graphic Healthcare providers can:  Prescribe antibiotics correctly – get cultures, start the right drug promptly at the right dose for the right duration. Reassess the prescription within 48 hours based on tests and patient exam.  Document the dose, duration and indication for every antibiotic prescription.  Stay aware of antibiotic resistance patterns in your facility.  Participate in and lead efforts within your hospital to improve prescribing practices.  Follow hand hygiene and other infection control measures with every patient. World Health Organization press release 2-28-17 WHO priority pathogens list for R&D of new antibiotics (fyi only; no test questions on this pathogens list) Priority 1: CRITICAL  Acinetobacter baumannii , carbapenem-resistant 2

 Pseudomonas aeruginosa , carbapenem-resistant  Enterobacteriaceae , carbapenem-resistant, ESBL-producing Priority 2: HIGH  Enterococcus faecium , vancomycin-resistant  Staphylococcus aureus , methicillin-resistant, vancomycin-intermediate and resistant  Helicobacter pylori , clarithromycin-resistant  Campylobacter spp., fluoroquinolone-resistant  Salmonellae , fluoroquinolone-resistant  Neisseria gonorrhoeae , cephalosporin-resistant, fluoroquinolone-resistant Priority 3: MEDIUM  Streptococcus pneumoniae , penicillin-non-susceptible  Haemophilus influenzae , ampicillin-resistant  Shigella spp., fluoroquinolone-resistant DRUG CLASS MECHANISM OF ACTION MECHANISM OF SELECTIVE TOXICITY EXAMPLE MECHANISM OF ACQUIRED RESISTANCE β–Lactams NOTE: YOU’LL FIND THIS TABLE, COMPLETELY FILLED-IN, AS A 3

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SEPARATE DOCUMENT IN THE CH 20 ANTIMICROBIAL MEDICATIONS MODULE Tetracyclines Fluoro- quinolones Trimethoprim and Sulfa drugs 4

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