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Antibiotics

Antibiotics



In common usage, an antibiotic (from the Ancient Greek: ἀντί – anti, "against", and βίος – bios, "life") is a substance or compound that kills or inhibits the growth of bacteria. Antibiotics belong to the broader group of antimicrobial compounds, used to treat infections caused by microorganisms, including fungi and protozoa.

The term "antibiotic" was coined by Selman Waksman in 1942 to describe any substance produced by a microorganism that is antagonistic to the growth of other microorganisms in high dilution. This original definition excluded naturally occurring substances that kill bacteria but are not produced by microorganisms (such as gastric juice and hydrogen peroxide) and also excluded synthetic antibacterial compounds such as the sulfonamides. Many antibiotics are relatively small molecules with a molecular weight less than 2000 Da.

With advances in medicinal chemistry, most antibiotics are now semisynthetic — modified chemically from original compounds found in nature, as is the case with beta-lactams (which include the penicillins, produced by fungi in the genus Penicillium, the cephalosporins, and the carbapenems). Some antibiotics are still produced and isolated from living organisms, such as the aminoglycosides, and others have been created through purely synthetic means: the sulfonamides, the quinolones, and the oxazolidinones. In addition to this origin-based classification into natural, semisynthetic, and synthetic, antibiotics may be divided into two broad groups according to their effect on microorganisms: those that kill bacteria are bactericidal agents, while those that only impair bacterial growth are known as bacteriostatic agents.

Antibiotic resistance

The emergence of antibiotic resistance is an evolutionary process that is based on selection for organisms that have enhanced ability to survive doses of antibiotics that would have previously been lethal. Antibiotics like Penicillin and Erythromycin which used to be one-time miracle cures are now less effective because bacteria have become more resistant. Antibiotics themselves act as a selective pressure which allows the growth of resistant bacteria within a population and inhibits susceptible bacteria. Antibiotic selection of pre-existing antibiotic resistant mutants within bacterial populations was demonstrated in 1943 by the Luria-Delbrück experiment. Survival of bacteria often results from an inheritable resistance. Any antibiotic resistance may impose a biological cost and the spread of antibiotic resistant bacteria may be hampered by the reduced fitness associated with the resistance which proves disadvantageous for survival of the bacteria when antibiotic is not present. Additional mutations, however, may compensate for this fitness cost and aids the survival of these bacteria.

The underlying molecular mechanisms leading to antibiotic resistance can vary. Intrinsic resistance may naturally occur as a result of the bacteria's genetic makeup. The bacterial chromosome may fail to encode a protein which the antibiotic targets. Acquired resistance results from a mutation in the bacterial chromosome or the acquisition of extra-chromosomal DNA. Antibiotic-producing bacteria have evolved resistance mechanisms which have been shown to be similar to and may have been transferred to antibiotic resistant strains. The spread of antibiotic resistance mechanisms occurs through vertical transmission of inherited mutations from previous generations and genetic recombination of DNA by horizontal genetic exchange. Antibiotic resistance exchanged between different bacteria by plasmids that carry genes which encode antibiotic resistance which may result in co-resistance to multiple antibiotics. These plasmids can carry different genes with diverse resistance mechanisms to unrelated antibiotics but because they are located on the same plasmid multiple antibiotic resistance to more than one antibiotic is transferred. Alternatively, cross-resistance to other antibiotics within the bacteria results when the same resistance mechanism is responsible for resistance to more than one antibiotic is selected for.

Antibiotics by class

Generic name Brand names Common uses Possible side effects Mechanism of action
Aminoglycosides
Amikacin Amikin Infections caused by Gram-negative bacteria, such as Escherichia coli and Klebsiella particularly Pseudomonas aeruginosa. Effective against Aerobic bacteria (not obligate/facultative anaerobes) and tularemia.
  • Hearing loss
  • Vertigo
  • Kidney damage
Binding to the bacterial ribosomal subunit (some work by binding to the 50S subunit), inhibiting the translocation of the peptidyl-tRNA from the A-site to the P-site and also causing misreading of mRNA, leaving the bacterium unable to synthesize proteins vital to its growth.
Gentamicin Garamycin
Kanamycin Kantrex
Neomycin Mycifradin
Netilmicin Netromycin
Streptomycin
Tobramycin Nebcin
Paromomycin Humatin
Ansamycins
Geldanamycin Experimental, as antitumor antibiotics
Herbimycin
Carbacephem
Loracarbef Lorabid prevents bacterial cell division by inhibiting cell wall synthesis.
Carbapenems
Ertapenem Invanz Bactericidal for both Gram-positive and Gram-negative organisms and therefore useful for empiric broad-spectrum antibacterial coverage. (Note MRSA resistance to this class.)
  • Gastrointestinal upset and diarrhea
  • Nausea
  • Seizures
  • Headache
  • Rash and allergic reactions
Inhibition of cell wall synthesis
Doripenem Finibax
Imipenem/Cilastatin Primaxin
Meropenem Merrem
Cephalosporins (First generation)
Cefadroxil Duricef
  • Gastrointestinal upset and diarrhea
  • Nausea (if alcohol taken concurrently)
  • Allergic reactions
Same mode of action as other beta-lactam antibiotics: disrupt the synthesis of the peptidoglycan layer of bacterial cell walls.
Cefazolin Ancef
Cefalotin or Cefalothin Keflin
Cefalexin Keflex
Cephalosporins (Second generation)
Cefaclor Ceclor
  • Gastrointestinal upset and diarrhea
  • Nausea (if alcohol taken concurrently)
  • Allergic reactions
Same mode of action as other beta-lactam antibiotics: disrupt the synthesis of the peptidoglycan layer of bacterial cell walls.
Cefamandole Mandole
Cefoxitin Mefoxin
Cefprozil Cefzil
Cefuroxime Ceftin, Zinnat
Cephalosporins (Third generation)
Cefixime Suprax
  • Gastrointestinal upset and diarrhea
  • Nausea (if alcohol taken concurrently)
  • Allergic reactions
Same mode of action as other beta-lactam antibiotics: disrupt the synthesis of the peptidoglycan layer of bacterial cell walls.
Cefdinir Omnicef, Cefdiel
Cefditoren Spectracef
Cefoperazone Cefobid
Cefotaxime Claforan
Cefpodoxime Vantin
Ceftazidime Fortaz
Ceftibuten Cedax
Ceftizoxime
Ceftriaxone Rocephin
Cephalosporins (Fourth generation)
Cefepime Maxipime
  • Gastrointestinal upset and diarrhea
  • Nausea (if alcohol taken concurrently)
  • Allergic reactions
Same mode of action as other beta-lactam antibiotics: disrupt the synthesis of the peptidoglycan layer of bacterial cell walls.
Cephalosporins (Fifth generation)
Ceftobiprole Used to treat MRSA
  • Gastrointestinal upset and diarrhea
  • Nausea (if alcohol taken concurrently)
  • Allergic reactions
Same mode of action as other beta-lactam antibiotics: disrupt the synthesis of the peptidoglycan layer of bacterial cell walls.
Glycopeptides
Teicoplanin inhibiting peptidoglycan synthesis
Vancomycin Vancocin
Macrolides
Azithromycin Zithromax, Sumamed, Zitrocin Streptococcal infections, syphilis, respiratory infections, mycoplasmal infections, Lyme disease
  • Nausea, vomiting, and diarrhea (especially at higher doses)
  • Jaundice
inhibition of bacterial protein biosynthesis by binding irreversibly to the subunit 50S of the bacterial ribosome, thereby inhibiting translocation of peptidyl tRNA.
Clarithromycin Biaxin
Dirithromycin Dynabac
Erythromycin Erythocin, Erythroped
Roxithromycin
Troleandomycin TAO
Telithromycin Ketek Pneumonia Visual Disturbance, Liver Toxicity.
Spectinomycin Antimetabolite, Anticancer
Monobactams
Aztreonam Azactam Same mode of action as other beta-lactam antibiotics: disrupt the synthesis of the peptidoglycan layer of bacterial cell walls.
Penicillins
Amoxicillin Novamox, Amoxil Wide range of infections; penicillin used for streptococcal infections, syphilis, and Lyme disease
  • Gastrointestinal upset and diarrhea
  • Allergy with serious anaphylactic reactions
  • Brain and kidney damage (rare)
Same mode of action as other beta-lactam antibiotics: disrupt the synthesis of the peptidoglycan layer of bacterial cell walls.
Ampicillin Principen
Azlocillin
Carbenicillin
Cloxacillin Tegopen
Dicloxacillin Dynapen
Flucloxacillin Floxapen
Mezlocillin
Meticillin
Nafcillin
Oxacillin
Penicillin
Piperacillin
Ticarcillin
Polypeptides
Bacitracin Eye, ear or bladder infections; usually applied directly to the eye or inhaled into the lungs; rarely given by injection Kidney and nerve damage (when given by injection) Inhibits isoprenyl pyrophosphate, a molecule which carries the building blocks of the peptidoglycan bacterial cell wall outside of the inner membrane
Colistin Interact with the bacterial cytoplasmic membrane, changing its permeability.
Polymyxin B
Quinolones
Ciprofloxacin Cipro, Ciproxin, Ciprobay Urinary tract infections, bacterial prostatitis, community-acquired pneumonia, bacterial diarrhea, mycoplasmal infections, gonorrhea Nausea (rare), irreversible damage to central nervous system (uncommon), tendinosis (rare) inhibit the bacterial DNA gyrase or the topoisomerase IV enzyme, thereby inhibiting DNA replication and transcription.
Enoxacin Penetrex
Gatifloxacin Tequin
Levofloxacin Levaquin
Lomefloxacin Maxaquin
Moxifloxacin Avelox
Norfloxacin Noroxin
Ofloxacin Floxin, Ocuflox
Trovafloxacin Trovan Withdrawn
Grepafloxacin Raxar Withdrawn
Sparfloxacin Zagam Withdrawn
Temafloxacin Omniflox Withdrawn
Sulfonamides
Mafenide Urinary tract infections (except sulfacetamide and mafenide); mafenide is used topically for burns
  • Nausea, vomiting, and diarrhea
  • Allergy (including skin rashes)
  • Crystals in urine
  • Kidney failure
  • Decrease in white blood cell count
  • Sensitivity to sunlight
Folate synthesis inhibition. They are competitive inhibitors of the enzyme dihydropteroate synthetase, DHPS. DHPS catalyses the conversion of PABA (para-aminobenzoate) to dihydropteroate, a key step in folate synthesis. Folate is necessary for the cell to synthesize nucleic acids (nucleic acids are essential building blocks of DNA and RNA), and in its absence cells will be unable to divide.
Sulfonamidochrysoidine (archaic) Prontosil
Sulfacetamide
Sulfadiazine Micro-Sulfon
Sulfamethizole
Sulfanilimide (archaic)
Sulfasalazine Azulfidine
Sulfisoxazole
Trimethoprim Trimpex
Trimethoprim-Sulfamethoxazole (Co-trimoxazole) (TMP-SMX) Bactrim, Septra
Tetracyclines
Demeclocycline Declomycin Syphilis, chlamydial infections, Lyme disease, mycoplasmal infections, acne rickettsial infections, malaria. Note: Malaria is caused by a protist and not a bacterium.
  • Potentially Permanent
  • Gastrointestinal upset
  • Sensitivity to sunlight
  • Potential toxicity to mother and fetus during pregnancy
  • Enamel hypoplasia (staining of teeth)
  • transient depression of bone growth
inhibiting the binding of aminoacyl-tRNA to the mRNA-ribosome complex. They do so mainly by binding to the 30S ribosomal subunit in the mRNA translation complex.
Doxycycline Vibramycin
Minocycline Minocin
Oxytetracycline Terramycin
Tetracycline Sumycin, Achromycin V, Steclin
Others
Arsphenamine Salvarsan Spirochaetal infections (obsolete)
Chloramphenicol Chloromycetin meningitis, Rarely: aplastic anemia. Inhibits bacterial protein synthesis by binding to the 50S subunit of the ribosome
Clindamycin Cleocin acne infections, prophylaxis before surgery
Lincomycin Lincocin acne infections, prophylaxis before surgery
Ethambutol Myambutol Antituberculosis
Fosfomycin Monurol
Fusidic acid Fucidin
Furazolidone
Isoniazid I.N.H. Antituberculosis
Linezolid Zyvox VRSA
Metronidazole Flagyl Giardia
Mupirocin Bactroban
Nitrofurantoin Macrodantin, Macrobid
Platensimycin
Pyrazinamide Antituberculosis
Quinupristin/Dalfopristin Syncercid
Rifampicin (Rifampin in US) mostly Gram-positive and mycobacteria Reddish-orange sweat, tears, and urine Binds to the β subunit of RNA polymerase to inhibit transcription
Thiamphenicol Gram-negative, Gram-positive, anaerobes. Widely used in veterinary medicine. Lacks known anemic side-effects. A chloramphenicol analog. May inhibit bacterial protein synthesis by binding to the 50S subunit of the ribosome
Tinidazole
Dapsone Avlosulfon Antileprotic
Lamprene Antileprotic
Generic Name Brand Names Common Uses Possible Side Effects Mechanism of action

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