LECTURES IN MICROBIOLOGY Antimicrobial Agents LESSON 8 Sofronio Agustin Professor Lesson 8 Topics Antimicrobial Therapy Selective Toxicity Survey of Antimicrobial Agents Microbial Drug Resistance Drug-Host Interaction 2 The Ideal Antimicrobial Drug 3 Selective Toxicity An ideal in chemotherapy that an antimicrobial drug kills only pathogenic microbes without harming the host. Historically, reminiscent of the “magic bullet” of Paul Ehrlich. 4 Terms in Chemotherapy Chemotherapy - use of drugs to treat diseases. Antimicrobials - any drug used in treating infectious diseases. Antibiotics - substances produced by some microbes that inhibit or kill other microbes. Synthetic drugs - antimicrobial compounds synthesized in the laboratory. 5 Historical Note in Chemotherapy 1928 – Alexander Fleming discovered penicillin from Penicillium notatum. 1940 – Howard Florey and Ernst Chain performed first clinical trials of penicillin. 6 Antibiotics Naturally occurring Metabolic products of bacteria and fungi Reduce competition for nutrients and space Examples: Bacteria- Streptomyces, Bacillus Molds -Penicillium, Cephalosporium 7 Antimicrobial Activity Narrow-spectrum Broad-spectrum Bactericidal Bacteriostatic 8 Antimicrobial Activity 9 Modes of Action Primary target sites of antimicrobial drugs in bacterial cells. 10 Cell Wall Active Agents Bactericidal Penicillin and Cephalosporins – binds and blocks peptidases involved in cross-linking the glycan molecules. Vancomycin – prevents peptidoglycan elongation Cycloserine – inhibits the formation of the basic peptidoglycan subunits 11 Cell Wall Active Agents Antibiotics weaken the cell wall and cause the cell to lyse. 12 Cell Wall Active Agents Penicillins and cephalosporins destroy the peptidoglycan layer by disrupting the peptide cross bridges. 13 Cell Wall Active Agents Penicillin Natural penicillins Semi-synthetic penicillins Molecular Structure Thiazolidine ring Beta-lactam ring Variable side chain (R group) 14 Penicillins 15 Penicillinase 16 Penicillins Penicillinase-resistant penicillins Extended-spectrum penicillins Penicillins + -lactamase inhibitors Carbapenems Monobactam 17 Penicillins Bactericidal Narrow spectrum. Used to treat: Streptococcal Staphylococcal Meningococcal, and Spirochaete infections. 18 Cephalosporins Derived from Cephalosporium acremonium Beta lactam antibiotic like penicillin Main ring different from penicillin 2 sites for R groups 19 Cephalosporins Inhibit cell wall synthesis Broad-spectrum or extended spectrum antibiotic 2nd, 3rd, 4th generations more effective against Gram-negatives 20 Cephalosporins Different R groups allow for versatility and improved effectiveness of cephalosporins. 21 Polypeptide Antibiotics Bacitracin Topical application Effective against Gram-positives Vancomycin Glycopeptide Important "last line" against antibiotic resistant S. aureus Hinders peptidoglycan elongation 22 Mycolic Acid Inhibitors Antimycobacterial antibiotics Isoniazid (INH) - inhibits mycolic acid synthesis Ethambutol - inhibits incorporation of mycolic acid into cell wall 23 Inhibition of Protein Synthesis Various antibiotics and their sites of protein synthesis inhibition on the prokaryotic ribosome. 24 Inhibitors of Protein Synthesis Aminoglycosides Broad-spectrum antibiotics Changes shape of 30S subunit Treatment of bubonic plague,STD, and Gram-negative infections Examples: Streptomycin, neomycin, gentamycin 25 Aminoglycoside Structure Amino sugars and a six-carbon ring (aminocyclitol) in Streptomycin. 26 Streptomyces Streptomyces sp. synthesizes many antibiotics such as: aminoglycosides, tetracycline, chloramphenicol, and erythromycin. 27 Tetracycline Broad spectrum Interferes with tRNA attachment Treat intracellular infections Chemical Structure of Tetracycline Risk to pregnant women 28 Chloramphenicol Broad-spectrum Binds 50S subunit, inhibits peptide bond formation Cheap synthetic Nitrobenzene ring of chloramphenicol Treat typhoid fever Side effects: Aplastic anemia 29 Erythromycin A macrolide Bactericidal Binds 50s, prevents translocation Gram positives Lactone ring of erythromycin Side effects: GI disturbance 30 Streptogramins A combination drug of quinopristin and dalfopristin Bactericidal Binds 50s, inhibits translation Affect Gram-positives Example: Synercid 31 Oxazolidinones Bactericidal Binds 50S, prevents formation of 70S ribosome Affect Gram-positives Example: Linezolid 32 Injury to Cell Membrane Polymyxins Interact with membrane phospholipids Topical Combined with Bacitracin and Neomycin as over-the counter antibiotic Amphotericin B Anit-fungal agent Forms complexes with sterols in the membrane Causes cytoplasmic leakage Can affect human cell membranes (toxicity) 33 Nucleic Acid Synthesis Inhibitors Rifamycin Inhibits RNA synthesis Anti-tuberculosis drug Quinolones and fluoroquinolones inhibits DNA unwinding enzymes (gyrases) Urinary tract infections Ciprofloxacin 34 Nucleic Acid Synthesis Inhibitors Chloroquine binds and cross-links the double helix anti-malarial Quinolones - e.g. Cirpofloxacin inhibits DNA unwinding enzymes (gyrases) Azidothymidine (AZT) Antiviral Analogs of purines and pyrimidines 35 Sulfa Drugs Analogs of important metabolites (folic acid) Competitive enzyme inhibition Prevents the metabolism of DNA, RNA, and amino acid Examples: Sulfonamides, and trimethoprim 36 Sulfa Drugs Sulfonamides compete with PABA for the active site on the enzyme. 37 Sulfonamides Attachment of different R groups to the main structural nucleus affords versatility of sulfonamides. 38 Sulfonamides Synthetic drug derived from dyes (Prontosil of Domagk) Synergistic combination as Trimethoprim/Sulfamethoxazole Treatment of pneumonia in AIDS patients 39 Antifungal Drugs (a) Polyenes (b) Azoles (c) Fluorocytosine 40 Antifungal Drugs Amphotericin B Polyene derivative Affects sterols in fungal membrane Causes cytoplasmic leakage Can affect human cell membranes (nephrotoxicity) For systemic fungal infections 41 Antifungal Drugs Azoles- Miconazole, Triazoles Inhibit ergosterol synthesis For cutaneous fungal infections 42 Antifungal Drugs Echinocandins Inhibit synthesis of -glucan, cell wall component in yeasts Used against Candida and Pneumocystis infections 43 Antifungal Drugs Fluorocytosine (5-FC) Cytosine analog, interferes with RNA synthesis Used in serious systemic fungal infections For Amphotericin B resistant fungi 44 Antifungal Drugs Pentamidine isothionate May bind DNA For Pneumocystis infections Griseofulvin Inhibition of microtubules (mitosis) For superficial mycoses Tolnaftate Action unknown For Athlete’s foot 45 Antiprotozoal Drugs Chloroquine Inhibits DNA synthesis For Malaria Metronidazole Damages DNA For Entamoeba, Trichomonas infections 46 Antihelminthic Drugs Niclosamide Prevents ATP generation For Tapeworms Praziquantel Alters membrane permeability For Flatworms Pyrantel pamoate Neuromuscular block Intestinal roundworms 47 Antihelminthic Drugs Mebendazole Inhibits nutrient absorption For intestinal roundworms Ivermectin Paralyzes worm For intestinal roundworms 48 Antiviral Drugs Few antiviral drugs available Selective toxicity difficult - viruses are intracellular in host cells Targets in viral replication cycle: -Entry -Nucleic acid synthesis -Assembly and release Interferons – natural or artificial 49 Antiviral Drugs 50 Antiviral Drugs 51 Antiviral Drugs 52 Antiviral Drugs 53 Antimicrobial Agents 54 Antimicrobial Agents 55 Antimicrobial Agents 56 Antimicrobial Therapy Identify infectious agent Susceptibility testing Minimum Inhibitory Concentration (MIC) Minimum Bactericidal Concentration (MBC) 57 Kirby-Bauer Test 58 Kirby-Bauer Test The Kirby-Bauer Test is used to determine the effectiveness of a drug by measuring the zone of inhibition. 59 E-Test The E-test as an alternative method to the Kirby-Bauer test 60 Dilution Methods The dilution test determines actual MIC values. Correlated with in vivo reactions More accurate and standardized Modern micro-dilution techniques are used in automated methods. 61 MIC Comparative MIC values for sample bacterial isolates 62 Combination Therapy Synergism occurs when the effect of two drugs together is greater than the effect of either alone. Antagonism occurs when the effect of two drugs together is less than the effect of either alone. 63 Synergism 64 Drug-Host Interaction Toxicity to organs Allergic reactions Suppression or alteration of microbiota Effective drugs 65 Drug-Induced Side Effects Tetracycline treatments can cause teeth discoloration 66 Disruption of Microbiota Disrupting the microbiota in the intestine can result in superinfections 67 Drug Toxicity 68 Antimicrobial Resistance A variety of mutations can lead to antibiotic resistance. Mechanisms of antibiotic resistance 1. Enzymatic destruction of drug 2. Prevention of penetration of drug 3. Alteration of drug's target site 4. Rapid ejection of the drug Resistance genes are often on plasmids or transposons that can be transferred between bacteria. 69 Antimicrobial Resistance 70 Antimicrobial Resistance Intermicrobial transfer of plasmids bearing resistance genes R factors) by conjugation, transformation, and transduction. 71 Natural Selection 72 Antimicrobial Resistance Misuse of antibiotics selects for resistance mutants. Misuse includes: Using outdated, weakened antibiotics Using antibiotics for the common cold and other inappropriate conditions Use of antibiotics in animal feed Failure to complete the prescribed regimen Using someone else's leftover prescription 73 New Approaches To counter emergence of drug resistance requires new approaches to drug development. Prevent iron –scavenging capabilities of microbes Inhibit genetic controls (riboswitches) Probiotics and prebiotics 74 Future Approaches Antimicrobial peptides- broad spectrum antibiotics from plants and animals Squalamine (sharks) Protegrin (pigs) Magainin (frogs) Antisense agents -complementary DNA or peptide nucleic acids that binds to a pathogen's virulence gene(s) and prevents transcription 75