URINARY TRACT INFECTION & SEXUALLY TRANSMITTED DISEASE.pptx

IT INCLUDES INTRO TO UT MECHANISM OF MEDICATION FOR UTI AND STD...

1. QUICK RECAP OF URINARY TRACT

2. INTRODUCTION TO UTI (URINARY TRACT INFECTION) A urinary tract infection (UTI) is an infection in any part of the urinary system . The urinary system includes the kidneys, ureters, bladder and urethra. Most infections involve the lower urinary tract - the bladder and the urethra.

3. CLASSIFICATION OF URINARY TRACT INFECTION BACTERIOSTATIC AGENTS BACTERICIDAL AGENTS URINARY ANTISEPTICS SULPHONAMIDES TETRACYCLINES NITROFURANTOIN COTRIMOXAZOLE AMPICILLIN EXTENDED SPECTRUM PENICILLIN AMINOGLYCOSIDES FLUROQUINOLONES CEPHALOSPORINS NITROFURANTOIN METHENAMINE MANDELATE NALIDIXIC ACID

4. MECHANISM OF SULFONAMIDES Both human and microorganism requires the folic acid but we get through the diet where the microorganism synthesis folic acid from the PABA. Mechanism of sulfonamides as in the figure. It is the first antibiotic discovered by Domagk in 1935 later due to its toxicity it was used less in number like (presence of pus, blood and tissue break down products inactive to sulfonamides due these are rich in PABA.)

5. SULFONAMIDES RESISTANCE : Resistance due to mutation. Using alternative metabolic pathway. Low permeability to sulfonamides. PHARMACOKINETICS: Well absorbed in stomach and small intestine. Distributed even to the CSF. Metabolised in the liver and excreted through the kidney.

6. SULFONAMIDES EXAMPLES : Sulfisoxazole (1 gm QID), Sulfamethoxazole (1 gm TDS) GANTANOL 500 MG TAB. ADVERSE EFFECTS : Renal irritation, haematuria, albuminuria and crystalluria due to precipitation of drug in the acidic urine. This can be avoided by the intake of the alkaline fluids like sodium bicarbonate and etc. Nephrosis and nephritis.

7. MECHANISM OF TETRACYCLINES Tetracyclines is an antibiotic with four cyclic rings in their structure. Obtained from the Streptomyces aureofaciens in 1948 by Benjamin Duggar. Because of this unique structure it selectively bind to the microorganism and also lack of active site of mammalian cells it could not bind with the tetracyclines.(difference in the ribosomes structures of prokaryotes and eukaryotes).

8. MECHANISM OF TETRACYCLINES

9. TETRACYCLINES There are many types of derivatives in tetracycline n=but in case of UTI it is prescribed to use minocycline drugs and whose mechanism of action is same as the tetracyclines. Dose of minocycline is 100 mg OD - BD oral; CYANOMYCIN, CNN 50, 100 MG caps.

10. NITROFURANTOIN Nitrofurantoin is a synthetic nitrofuran but at higher concentration they act as bactericidal. It has broad spectrum activity , mechanism of activity is not known but damages the DNA of bacteria and affect the DNA and RNA synthesis. PHARMACOKINETICS : Well absorbed in the gut and taken by the plasma protein t1/2 is 0.3 - 1 hr; excreted through urine turns the urine into the dark brown color. ADR EFFECTS : Nausea, vomiting, diarrhoea, allergic reactions and sometimes hepatitis. Haemolytic anemia can occur G6PD enzyme especially in men. Pneumonitis and interstitial pulmonary fibrosis and neurological disorder which may occur due to the long term medication where the drugs toxic metabolites in the body. Examples are 50 - 100 mg 3 to 4 times a day oral FURADANTIN 50,100 MG, 25 MG/5ML susp., URINIF 100 MG TAB.

11. COTRIMOXAZOLE Cotrimoxazole is a combination of trimethoprim and sulfamethoxazole. It is a broad spectrum antibacterial drug like S.aureus, streptococci, meningococci, E.coli, and H.influenzae. RESISTANCE : compared to other drugs it is an better treatment and but may resist due to the mutation and another metabolic pathway and etc. PHARMACOKINETICS :it can be given in both I.V and oral, both well distributed to other target sites especially to the prostatic and vaginal fluids and due to its basic in nature it easily cures UTI and excreted by kidney.

12. MECHANISM OF COTRIMOXAZOLE

13. COTRIMOXAZOLE ADR EFFECTS : nausea, headache, stomatitis and allergic skin rashes and AIDS patients more prone to adverse effects of cotrimoxazole, uraemia. DOSES : for uncomplicated acute UTI treated for 7-10 days with cotrimoxazole twice a day Chronic and recurrent UTI small doses are given for prophylaxis. Bacterial prostatitis : cotrimoxazole twice a day.

14. AMPICILLIN AND CEPHALOSPORINS Ampicillin is an broad spectrum activity containing antibiotic comes under the beta lactam antibiotics and very effective against the UTI . PHARMACOKINETICS : well absorbed orally and given IM injections excreted through the kidneys and prolonged use leads to nephritis or renal failure. ADR effect : diarrhoea with irritation due to unabsorbed drugs and skin rashes. DOSES : 0.5-2 G 6 HRS - ORALLY OR IM/IV AND ETC.given as a choice of earlier.

15. CEPHALOSPORINS Cephalosporin belongs to the beta lactam antibiotic drug and more potent than the penicillin. Obtained from the fungus Cephalosporium acremonium discovered by Giuseppe in 1945 which act as a bactericidal and broad spectrum activity. Mechanism of cephalosporin is similar to that of penicillin and classified from first to fourth generation based on the selectivity of microorganism and potent of drugs. ADR EFFECTS : pain after injection through i.m, diarrhoea, rashes, angioedema, asthma, urticaria, nephrotoxicity and etc.

16. CEPHALOSPORINS Examples of cephalosporins are cefamandole, cefonicid, ceftibuten (PROCADOX 400 MG cap), cefepime (1-2 g i.v, 8-12 hours KEFAGE) and etc. belongs to second, third and fourth generation drugs. PHARMACOKINETICS : most are taken orally and are not metabolised by liver and excreted through the kidney in the form of urine. Effective against the E.coli, Proteus and Klebsiella infections.Fourth generation drugs are effective against the Enterobacter bacteria and Pseudomonas.

17. AMINOGLYCOSIDES Streptomycin belongs to aminoglycosides discovered by the Waksman in 1944 and it was effective against the tubercle bacilli . Classified into the systemic and topical aminoglycosides obtained from the soil actinomycetes. They have bactericidal property and broad spectrum activity similar mechanism of action as tetracycline. Examples are Gentamicin (3-5 MG/KG/DAY) and Amikacin(7.5-15 MG/KG/DAY) are effective against the E.coli, proteus and Pseudomonas and these can be given only parenterally. ADR EFFECTS : ototoxicity, nephrotoxicity and neuromuscular blockade risk for pregnant women due to cause of ototoxicity of fetal.

18. FLUOROQUINOLONES Fluoroquinolones have advantage than quinolone like broad spectrum activity, fewer side effects and classified into two generations namely first generation and second generation. MECHANISM OF ACTION OF FLUOROQUINOLONES NOTE : Similarly there is presence of topoisomerase ll which will be used for the separation of supercoiled DNA of human but cannot be affected by the FQ because they require in 500-1000 times concentration of FQs.

19. FLUOROQUINOLONES ADR EFFECTS : nausea, vomiting, abdominal discomfort, diarrhoea, skin rashes, tendonitis, headache, dizziness, epileptogenic drugs taking patients can lead to seizures sometimes cardiac arrhythmias hepatotoxicity and etc. Medicines like norfloxacin is taken at dose of 400 mg BD for 5-10 days. Lomefloxacin is taken at dose of 400 mg BD for 7-14 days LOMADAY, LOMEDON. Effective against the complicated UTI and renal failure and etc.

20. METHENAMINE MANDELATE It is salt of mandelic acid and methenamine and functions combinely. Absorbed at GIT and excreted through kidney and effective against the Candida albicans by r eleasing formaldehyde at pH< 5.5 methenamine liberates formaldehyde which active against the gram-ve bacteria and also helps lower urine pH. It is not effective against the upper UTI it is taken at dose of 1 gm four times a day and large doses may cause the inflammation of UTI . It should not taken along with the sulfonamide because it form insoluble precipitate with the formaldehyde.

21. MECHANISM OF METHENAMINE MANDELATE

22. NALIDIXIC ACID It is an non fluorinated quinolones and show narrow spectrum activity and bactericidal. Mechanism of action is similar to that of FQs it is absorbed orally and metabolised by liver and excreted through urine. It belongs to the 1st generation of quinolone. Its main purpose is used for UTI treatment. Its dose is 4 mg/day and in four divided doses for 7-10 days.

23. SEXUALLLY TRANSMITTED DISEASES

24. SEXUALLLY TRANSMITTED DISEASES

25. SEXUALLLY TRANSMITTED DISEASES

26. THNAK YOU G.K.SARANVIJAY B.PHARMACY VMCP