Antimicrobials and Resistance Flashcards
What are the characteristics of bacterial disease?
- Associated with bacterial growth: physical/mechanical effects and intracellular multiplication, leading to cell lysis.
- Immunopathology: inflammatory response to bacterial products and bacterial endotoxins
- Associated with bacterial secretions, such as bacterial exotoxins
- Hosts inappropriate response to bacteria
Describe the structure and properties of bacterial endotoxins.
- Structural components is released with organism dies
- Heat stable, intrinsically poorly antigenic
Describe the action of bacterial endotoxins.
Over activates complement cascade, causing:
- High fever
- Severe fluid loss from blood system, leading to vascular collapse
- IV coagulation then organ haemorrhaging
- Septicaemia/endotoxic shock and death
Why are antimicrobials used?
To prevent bacteria multiplying and shedding components. Bacteriostatic to prevent growing.
What are the properties of bacterial exotoxins?
- Actively secreted proteins
- Specific activity
- Heat labile
- Antigenic
What are the factors that facilitate entry, invasion and survival?
Mucinase
Collagenase
Urease
Leukocidins
What is the function and structure of bactericidal drugs?
Bactericidal to prevent bacteria producing toxins.
AB subunit structure (A=activity / B=binding):
- Decreased protein synthesis
- Decreased nerve synapse function
- Membranes damaged, physically or functionally
Such as neurotoxins, cytotoxins and enterotoxins.
What are the uses of antimicrobial agents?
Antimicrobial agents inhibit/kill microorganisms.
99% unsuitable for treatment of infectious diseases as they are too toxic for the host, such as disinfectants and antiseptics.
1% suitable for treatment, such as chemotherapeutic agents.
Distinguish natural and synthetic chemotherapeutic agents.
Naturally produced CTAs are antibiotics, metabolic biproducts of certain bacteria/fungi.
Synthetic CTAs are either totally man made or modified from antibiotics to improve activity and pharmacological properties, such as penicillin, ampicillin and carbenicillin.
What makes a successful chemotherapeutic agent?
Its selective toxicity, such as toxicity to prokaryotes being greater than toxicity to eukaryotes.
Define therapeutic dose.
The level of CTA needed for clinical treatment of an infection in a specific host.
Define toxic dose.
Level of the same CTA which is too toxic for use in that host.
What is the therapeutic index?
Therapeutic index = toxic dose / therapeutic dose
High index = selectively toxic, useful
Low index = tox to host, side effects
Distinguish bacteriostatic and bactericidal chemotherapeutic agents.
Bacteriostatic - inhibit bacterial growth and multiplication but rely on the host’s immune system to remove the bugs.
Bactericidal - rapidly lethal to the bacterial in their own right.
How are bacteriostatic chemotherapeutic agents given?
It is therefore essential to give the full course of such agents to allow sufficient time for the immune system to complete its job whilst preventing regrowth of the bacterial population.
It is contraindicated to use these CTAs in immunosuppressed patients.
What are 3 examples of agents that may be bacteriostatic and bactericidal, dependent on condition?
- Chloramphenicol kills H.influenza but only inhibits E.coli
- Erythromycin is bacteriostatic at normal concentrations but bactericidal at higher levels
- Penicillin is bactericidal against rapidly growing organisms but ineffective against those in stationary phase
Distinguish broad and narrow range chemotherapeutic agents.
Broad range CTAs – effective against many different bacterial types.
Narrow range CTAs – affect limited groups, such as gram negatives or certain genera only.
Start broad and get narrower once we have a better identification of the bacteria present and the conditions.
What are the mechanisms of CTAs?
- Inhibiting peptidoglycan cell wall
- Inhibiting protein synthesis
- Inhibiting nucleic acid synthesis
- Impairing membrane functions
What are the stages of inhibiting the peptidoglycan cell wall?
- Precursors
- Subunits
- Lipid carrier
- Growing peptidoglycan molecule
Affects only actively growing bacteria, bactericidal and selectively toxic.
What are the CTAs that inhibit protein synthesis?
Some are bactericidal and some are bacteriostatic, but are all selectively toxic.
What are the CTAs that inhibit nucleic acid synthesis?
Bactericidal and bacteriostatic, some are selectively toxic.
What are the CTAs that impair membrane function?
Eukaryotic and prokaryotic share features so few are selectively toxic, but are bactericidal.
What is metabolic antagonism of CTAs?
- CTAs are structural but not functional analogues of bacterial growth factors
- Bactericidal
- Selectively toxic
What are the mechanisms of bacterial resistance?
- Production of enzymes – attack CTA prevent activity or degrade CTA
- Modify CTAs target – as produced or after production. Must be a sublethal change
- Alter CTA uptake/retention – no entry to cell, upregulate removal more than uptake
- Upregulate target production – dilute out effect of CTA
- Modify metabolic pathways – alternative pathway to the same end point
- Cross resistance
What is cross resistance by ESBLs?
ESBLs, extended spectrum beta lactamases – produced by enterobacteria, but are secreted so will target penicillins/cephalosporins which are used to target MRSA for example. Resistance occurs and is effective in non-target organisms.
How can cross resistance be treated?
Can be treated by using agents such as clavulanic acid (a suicide inhibitor) which inhibits beta lactamases in combination (such as coamoxiclav).
What are metallo beta lactamases?
Resistant to inhibitors such as clavulanic acid.
How can bacterial resistance arise to a CTAs?
Intrinsically resistant, or being intrinsically sensitive but still developing resistance via spontaneous mutation or recombination.
How does spontaneous mutation cause CTA resistance?
- Under normal conditions there is no advantage. CTA resistance lost by overgrowth by sensitive bacteria.
- During treatment there is clear advantage. Resistance clone selected.
How does recombination lead to CTA resistance?
- Transformation
- Transduction
- Conjugation
What is the importance of recombination causing CTA resistance?
- Negates therapy – individuals/outbreaks
- Resistance arising in commensals may lead to pathogens
- Zoonoses pass resistance from animals to humans
What are the veterinary aims regarding CTAs?
- CTA development
- Restrict CTA use in therapy and in growth promotion
- Test pathogen sensitivity
- Use correct dose, avoiding toxicity in the rest of the body
- Use dual therapy, attacking different sites on the bacteria at once to prevent resistance
What is the structure of a virus?
- Lipoprotein envelope
- Nucleic acid core and capsid make up the nucleocapsid
- Capsomere - the morphological protein units of the coat
Give a brief description of the process of viral replication.
- Attachment to plasma membrane
- Entry into cytoplasm and nucleus
- Uncoating of virus particle
- Synthesis of mRNA and protein
- Assembly of virus particles
- Exit from cell
Give the process of the lifecycle of a retrovirus.
- Retrovirus will bind to cell surface, often involving interacting with specific proteins.
- Fusion of the virus with the cell membrane and virus can then gain entry into the cytoplasm.
- Uncoating of the virus and reverse transcription. This leads to the production of DNA.
- DNA can then be integrated into the host cell DNA.
- Transcription of mRNA.
- mRNA converted to protein.
- New genetic material along with protein can be assembled into a new viral particle.
- New viral particle released into the extracellular space.
- Viral particles mature and repeat process at a new host cell.
What are the potential drug targets in viruses?
Attachment
Penetration
Uncoating
Multiplication of genetic material
Protein synthesis
Assembly
Release
Why are there few antiviral drugs available in both human and veterinary medicine?
- Viruses replicate genome I different ways, therefore not all antivirals will work for every drug
- Viral latency
- Viruses do not produce protein making machinery and instead use host cell machinery. Drugs that interfere with such pathways are likely to have effects on the host cells.
- Viruses may not encode many surface proteins for drugs to attach to (as they have a small genome).
- Viruses replicate by hijacking host cells and using their machinery to replicate (they are very small). So if a drug is going to kill a virus, it will also be killing host cells which they have hijacked.
- Some viruses are host specific, thus targeting specific receptors which might be unique to the species. Drugs that interfere with such interaction have to account for this.
- A lot of viral replication phases are intracellular, meaning it may be hard o target these phases without also damaging the host cell.
How are viruses targeted via viral attachment?
- Most effective preventative step, which stops virus attaching to host cells
- Is done by immunisation – antibodies against viral proteins to prevent attachment
- Interferons are sometime useful
Describe the action of amantadine.
- Inhibits penetration and uncoating of influenza A virus in humans.
- Has been used to prophylactically in humans when facing epidemic to control spread.
- Experimentally used in control of influenza in horses and turkeys
- Some drug also has analgesic actions via inhibiting NMDA glutamate receptor – sometimes used in animals unresponsive to other analgesics, such as opioids.
What are the 3 sets of drugs used to inhibit viral multiplication? How do they work?
- Idoxuridine and related and compounds
- Acyclovir and related compounds
- Zidovudine/azidothymidine
These are all nucleoside analogues, resemble the structures of specific nucelosides so they can interfere with the formation of double stranded DNA and the base pairing between them.
Which drugs have very similar structures to deoxyuridine?
Trifluridine and idoxuridine have very similar structures to deoxyuridine but with halogens groups attached, which changes the shape and charge of the molecule.
How do trifluridine and idoxuridine work?
- Trifluridine and idoxuridine can be incorporated into viral DNA
- Trifluridine iodine groups prevent base pairing
- This therefore inhibits DNA replication – mainly affective against herpes virus
- Inhibits mammalian DNA replication, therefore not given systematically. Only be used topically
- Not licensed for vet use
- Used only topically – herpetic keratitis