Antibacterial Drugs Today

1. Antibacterial Drugs.- 1.1 Mechanisms of Action.- 1.2 Side Effects and Toxicity.- 2. The Sulphonamides.- 2.1 Antibacterial Activity.- 2.2 Mode of Antibacterial Action.- 2.3 Pharmacology.- 2.4 Therapeutic Indications.- 2.5 Dosage.- 2.5.1 Short Acting Sulphonamides.- 2.5.2 Long Acting Sulphonamides.- 2.5.3 Non-absorbable Sulphonamides.- 2.6 Side Effects and Toxicity.- 2.6.1 Nephrotoxicity.- 2.6.2 Haematological Abnormalities.- 2.6.3 Pulmonary Disease.- 2.6.4 Hypersensitivity.- 2.7 Drug Interactions.- 3. The Natural Penicillins — Benzylpenicillin (Penicillin G) and Phenoxymethylpenicillin (Penicillin V).- 3.1 Physicochemical Properties.- 3.2 Mode of Antibacterial Action.- 3.3 Antibacterial Activity.- 3.3.1 Activity Against Streptococci.- 3.3.2 Activity Against Staphylococci.- 3.3.3 Activity Against Other Organisms.- 3.4 Pharmacology.- 3.4.1 Penicillin G.- 3.4.2 Benzathine and Procaine Salts of Penicillin G.- 3.4.3 Penicillin V.- 3.5 Therapeutic Indications.- 3.5.1 Streptococcal Infections.- 3.5.2 Meningococcal Infections.- 3.5.3 Gonorrhoea.- 3.5.4 Other Infections.- 3.6 Dosage.- 3.6.1 Penicillin G.- 3.6.2 Procaine and Benzathine Penicillin.- 3.6.3 Penicillin V.- 3.7 Side Effects and Toxicity.- 3.7.1 Neurotoxicity.- 3.7.2 Nephritis.- 3.7.3 Haemolysis.- 3.7.4 Hypersensitivity.- 3.7.5 Side Effects of Penicillin V.- 4. The Semi-synthetic Penicillins.- 4.1 Phenoxypenicillins.- 4.2 Penicillinase Resistant Penicillins.- 4.2.1 Methicillin.- 4.2.2 Isoxazolyl Penicillins.- 4.3 Other Penicillinase Resistant Penicillins.- 4.4 Broad Spectrum Penicillins.- 4.4.1 Ampicillin.- 4.4.2 Amoxycillin.- 4.4.3 Epicillin.- 4.4.4 Hetacillin, Pivampicillin and Talampicillin.- 4.4.5 Carbenicillin.- 4.4.6 Carindacillin (Indanyl Carbenicillin).- 5. Mecillinam and Pivmecillinam.- 5.1 Antibacterial Activity.- 5.2 Mode of Action.- 5.3 Pharmacology.- 5.4 Indications.- 5.5. Dosage.- 5.6 Side Effects.- 6. Co-trimoxazole (Trimethoprim-sulphamethoxazole).- 6.1 Antibacterial Activity.- 6.1.1 Gram-positive Bacteria.- 6.1.2 Gram-negative Bacteria.- 6.1.3 Miscellaneous.- 6.2 Mode of Action.- 6.3 Pharmacology.- 6.4 Indications.- 6.4.1 Urinary Tract Infections.- 6.4.2 Bacteraemic Syndromes.- 6.4.3 Gonorrhoea.- 6.4.4 Chest Infections.- 6.4.5 Enteric Fever.- 6.4.6 Brucellosis.- 6.4.7 Miscellaneous.- 6.5 Dosage.- 6.6 Contraindications.- 6.7 Side Effects and Toxicity.- 6.7.1 Haematological Abnormalities.- 6.7.2 Hypersensitivity.- 6.7.3 Nephrotoxicity.- 6.8 Drug Interactions.- 7. Chloramphenicol.- 7.1 Therapeutic Indications.- 7.1.1 Enteric Fever.- 7.1.2 Other Indications.- 8. The Tetracyclines.- 8.1 Antibacterial Activity.- 8.1.1 Spectrum of Activity.- 8.1.2 Development of Resistance.- 8.2 Pharmacology.- 8.3 Therapeutic Indications.- 8.4 Side Effects and Toxicity.- 8.4.1 Tooth Discoloration.- 8.4.2 Renal Toxicity.- 8.4.3 Liver Toxicity.- 9. The Macrolides.- 9.1 Erythromycin.- 9.1.1 Physicochemical Properties.- 9.1.2 Antibacterial Activity.- 9.1.3 Pharmacology.- 9.1.4 Therapeutic Indications.- 9.1.5 Dosage.- 9.1.6 Side Effects and Toxicity.- 9.2 Spiramycin and Triacetyloleandomycin.- 10. Lincomycin and Clindamycin.- 10.1 Mode of Action.- 10.2 Antibacterial Activity.- 10.3 Pharmacology.- 10.4 Therapeutic Indications.- 10.5 Dosage.- 10.6 Side Effects and Toxicity.- 11. Fusidic Acid (Sodium Fusidate).- 11.1 Mode of Action.- 11.2 Antibacterial Activity.- 11.3 Pharmacology.- 11.4 Therapeutic Indications.- 11.5 Dosage.- 11.6 Side Effects and Toxicity.- 12. The Urinary Antiseptics.- 12.1 Nitrofurantoin.- 12.1.1 Physicochemical Properties.- 12.1.2 Antibacterial Activity.- 12.1.3 Pharmacology.- 12.1.4 Therapeutic Indications.- 12.1.5 Dosage.- 12.1.6 Side Effects and Toxicity.- 12.2 Nalidixic Acid.- 12.2.1 Antibacterial Activity.- 12.2.2 Pharmacology.- 12.2.3 Therapeutic Indications and Dosage.- 12.2.4 Side Effects and Toxicity.- 12.3 Oxolinic Acid.- 13. Cephalosporins.- 13.1 Cephaloridine.- 13.1.1 Antibacterial Activity.- 13.1.2 Pharmacology.- 13.1.3 Indications.- 13.1.4 Dosage.- 13.1.5 Side Effects and Toxicity.- 13.2 Cephalothin.- 13.2.1 Dosage.- 13.3 Cephalexin.- 13.4 Cephradine.- 13.5 The Cephamycins.- 13.5.1 Cefoxitin.- 13.6 Newer Cephalosporin Derivatives.- 14. Peptide Antibiotics (Polymyxin B and Polymyxin E).- 14.1 Antibacterial Activity.- 14.2 Pharmacology.- 14.3 Therapeutic Indications and Dosage.- 14.3.1 Topical Therapy.- 14.3.2 Parenteral Therapy.- 14.3.3 Intrathecal Therapy.- 14.3.4 Oral Therapy.- 14.4 Side Effects and Toxicity.- 14.4.1 Neurotoxicity.- 14.4.2 Nephrotoxicity.- 15. The Aminoglycosides.- 15.1 Streptomycin.- 15.1.1 Antibacterial Activity.- 15.1.2 Pharmacology.- 15.1.3 Indications.- 15.1.4 Dosage.- 15.1.5 Side Effects and Toxicity.- 15.2 Kanamycin.- 15.2.1 Antibacterial Activity.- 15.2.2 Pharmacology.- 15.2.3 Indications.- 15.2.4 Dosage.- 15.2.5 Side Effects and Toxicity.- 15.3 Gentamicin.- 15.3.1 Antibacterial Activity.- 15.3.2 Pharmacology.- 15.3.3 Indications.- 15.3.4 Dosage.- 15.3.5 Side Effects and Toxicity.- 15.4 Tobramycin.- 15.4.1 Antibacterial Activity.- 15.4.2 Pharmacology.- 15.4.3 Indications.- 15.4.4 Dosage.- 15.4.5 Side Effects and Toxicity.- 15.5 Neomycin, Framycetin and Paromomycin.- 15.5.1 Antibacterial Activity.- 15.5.2 Pharmacology.- 15.5.3 Indications.- 15.5.4 Side Effects and Toxicity.- 15.6 Newer Aminoglycosides.- 15.6.1 Sissomicin.- 15.6.2 Amikacin.- 15.6.3 Netilmicin.- 16. Metronidazole.- 16.1 Antibacterial Activity.- 16.2 Mode of Action.- 16.3 Pharmacology.- 16.4 Therapeutic Indications $.- 16.4.1 Intra-abdominal Sepsis and Wound Infections.- 16.4.2 Gynaecological Surgery.- 16.4.3 General Anaerobic Sepsis.- 16.4.4 Protozoal Infection.- 16.5 Dosage.- 16.6 Toxicity and Interactions.- 17. Antituberculosis Drugs.- 17.1 Isoniazid.- 17.1.1 Toxicity.- 17.2 Rifampicin.- 17.3 Ethambutol.- 17.4 Streptomycin.- 17.4.1 Pharmacology.- 17.4.2 Dosage.- 17.4.3 Toxicity.- 17.5 Para-aminosalicylic Acid (PAS).- 17.5.1 Toxicity.- 17.6 Capreomycin.- 17.7 Other Drugs.- 18. Chemotherapy of Gram-negative Bacillary Infections.- 18.1 General Considerations.- 18.2 Organisms.- 18.3 Choice of Antibacterial Agents.- 18.4 Routes of Administration and Duration of Therapy.- 18.5 Precautions.- 18.6 Specific Infections.- 18.6.1 Urinary Tract Infections.- 18.6.2 Gastrointestinal Infections.- 18.6.3 Biliary Tract Infections.- 18.6.4 Respiratory Tract Infections.- 18.6.5 Endocarditis.- 18.6.6 Meningitis.- 19. Anaerobic Infections.- 19.1 Clostridial Infections.- 19.2 Non-clostridial Anaerobic Infections.- 19.2.1 Pulmonary Infection.- 19.2.2 Cerebral Abscess.- 19.2.3 Intra-abdominal Sepsis.- 19.2.4 Female Genital Tract Infection.- 19.2.5 Other Infections.- 20. Antibacterial Therapy in Renal and Hepatic Disease.- 20.1 Renal Disease.- 20.1.1 Sulphonamides.- 20.1.2 Penicillins.- 20.1.3 Co-trimoxazole.- 20.1.4 Chloramphenicol.- 20.1.5 Tetracyclines.- 20.1.6 Macrolides.- 20.1.7 Lincomycin and Clindamycin.- 20.1.8 Fusidic Acid.- 20.1.9 Nitrofurantoin.- 20.1.10 Nalidixic Acid.- 20.1.11 Cephalosporins.- 20.1.12 Peptide Antibiotics.- 20.1.13 Aminoglycosides.- 20.1.14 Cycloserine.- 20.1.15 Antituberculosis Drugs.- 20.2 Hepatic Disease.- 20.2.1 Drugs Causing Hepatocellular Damage.- 20.2.2 Drugs Causing Hepatitis-like Reactions.- 20.2.3 Drugs Causing Cholestasis.- 20.2.4 Drugs Mainly Metabolised or Detoxicated in the Liver.- 21. Antibacterial Therapy in Infants and Children.- 21.1 General Considerations.- 21.2 Dosage.- 21.3 Clinical Pharmacology in Premature Infants and the Newborn.- 21.3.1 Protein Binding.- 21.3.2 Metabolism and Detoxication.- 21.3.3 Renal Excretion.- 21.3.4 Genetic Factors.- 21.4 Special Considerations with Individual Drugs.- 21.4.1 Sulphonamides.- 21.4.2 The Penicillins.- 21.4.3 Co-trimoxazole.- 21.4.4 Chloramphenicol.- 21.4.5 Tetracyclines.- 21.4.6 Macrolides 1.- 21.4.7 Novobiocin.- 21.4.8 Lincomycin and Clindamycin.- 21.4.9 Fusidic Acid.- 21.4.10 Nitrofurantoin 1.- 21.4.11 Nalidixic Acid.- 21.4.12 Cephalosporins.- 21.4.13 Polypeptide Antibiotics.- 21.4.14 Aminoglycosides.- 21.4.15 Hexachlorophane.- 21.5 Specific Infections in Infants.- 21.5.1 Congenital Syphilis.- 21.5.2 Gonococcal Ophthalmia.- 21.5.3 Staphylococcal Infections.- 21.5.4 Gram-negative Bacillary Septicaemia.- 21.5.5 Meningitis in Children.- 21.5.6 Urinary Infections.- 21.5.7 Gastroenteritis.- 21.5.8 Cystic Fibrosis.- 21.5.9 Whooping Cough.- 22. Antibacterial Therapy in the Elderly.- 22.1 General Principles.- 22.2 Urinary Tract Infection.- 22.2.1 Indications for Treatment.- 22.2.2 Drugs of Choice.- 22.3 Chest Infection.- 22.4 Skin and Soft Tissue Infection.- 22.4.1 Impetigo.- 22.4.2 Erysipelas.- 22.4.3 Cellulitis.- 22.4.4 Lymphangitis.- 22.4.5 Bedsores.- 23. Antibacterial Drugs in Obstetrics and Gynaecology.- 23.1 Obstetrics.- 23.1.1 Bacteriuria of Pregnancy.- 23.2 Gynaecology.- 23.2.1 Venereal Disease.- 23.2.2 Salpingitis.- 23.2.3 Puerperal Sepsis.- 23.2.4 Tuberculous Salpingitis.- 23.2.5 Acute Pelvic Peritonitis.- 24. Surgical Infections.- 24.1 Prophylaxis of Surgical Infection.- 24.2 Pyrexia Following Surgery.- 25. Opportunistic Infection.- 25.1 Exogenous Opportunistic Infection.- 25.1.1 Intravenous Cannulae.- 25.1.2 Urinary Catheters.- 25.1.3 Infections of Prostheses.- 25.1.4 Infections Associated with Injections.- 25.2 Endogenous Opportunistic Infection.- 25.2.1 Pre-disposing Conditions.- 25.2.2 Predisposing Conditions: Neutropenia.- 25.3 Bacteraemia.- 25.3.1 Incidence.- 25.3.2 Underlying Conditions.- 25.3.3 Treatment.- 25.3.4 Outcome of Treatment.- 25.3.5 Interpretation of Results.- 25.4 Management of Opportunistic Infection.- 26. The Management of Tuberculosis.- References.