ANTI-INFECTIVE AGENTS Anti-infective agents are drugs that are designed to act selectively on foreign organisms that have

invaded and infected the body B. Anti-infective Activity: Spectrum range of effectiveness of an antibiotic. Narrow Spectrum Anti-infectives affect only a few bacterial types. Ex. Early penicillins

Ideally, anti-infectives would be toxic to the infecting organisms only and would have no effect on the host cell. This is known as Selective Toxixity.

Broad Spectrum Anti-infectives affect many bacteria Selective Toxicity the ability to affect certain proteins or enzyme systems that are used by the infecting organisms but not by the human cell. Ex. Meropenem

Anti-infective range from antibiotics, antifungals, antiprotozoals, antihelmintics, antivirals and antimycobacterial.

Bacteriostatic Anti-infectives that interfere with the ability of the cell to reproduce without killing them. Ex. Tetracycline

A. General Mechanisms of Action of Anti-infective:

Bactericidal Antibiotics that can aggressively cause bacterial death. Ex. Penicillin

Some interfere with the biosynthesis of bacterial cell wall. Ex. Penicillins C. Some anti-infectives prevent the cells of the invading organisms from using substances essential to their growth and development Ex. Sulfonamides Anti-infective Therapy

The goal of anti-infective therapy is the reduction of the invading organisms to a point at which the human immune response can take care of the infection. If the drug would eliminate all forms of the organisms by itself it might be toxic to the to the host itself.

Some anti-infectives interfere with the steps involved in protein synthesis. Ex. Aminoglycosides

Some anti-infectives interfere with DNA synthesis. Ex. Fluoroquinolones

Immuno-compromised patients have difficulty in using anti-infectives. Malnutrition Age AIDS

Other anti-infectives alter the permeability of the cell memebrane to allow the components to leak out.

Anti-infective drugs cannot totally eliminate the pathogen without causing severe toxicity in the host. These patients do not have the immune response on place to deal with even a few invading organisms.

Accumulates in the retina and optic nerves causing blindness

Hypersensitivity Most antibiotics can induce the bodys immune response to produce allergic responses. D. Common Adverse Reactions to Anti-infective Therapy Allergic reactions

Nephrotoxicity Anti-infectives that are metabolized and excreted in the kidney most frequently cause kidney damage. My lead to renal damage and renal failure Keep the patient well hydrated Ex. Aminoglycosides

Super-infections Broad spectrum anti-infecties can destroy the normal flora which can cause oppurtunustic microorganisms to be active.

E.

Resistance

Indiscriminate use of anti-infectives drugs has serious consequences. Gastro-intestinal toxicity Direct toxic effect to the cells of the GI tract Some anti-infectives are toxic on the mucosal lining of the GIT and can cause nausea, vomiting, stomach pain or diarrhea Some drugs are toxic to liver cells and can cause hepatitis or liver failure Unnecessary exposure of organisms to these drugs lead to the development of resistant strain. Acquiring Resistance Producing an enzyme that deactivates the anti-infective drugs. Ex. Penicillinase 1. Changing cellular permeability to prevent the drug from entering the cell. 2. Altering binding sites on the membrane which no longer accept the drug. Producing a chemical that act as an antagonist

Neurotoxicity When drugs can pass through the brain barrier and accumulate in the nervous tissues, they can interfere with neural function. Ex. Aminogycosides

Accumulates in the 8th cranial nerve causing dizziness, vertigo and loss of hearing Ex. Chloroquine