Lecturio: Study for Medical School, USMLE, MCAT & MBBS

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Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis complex bacteria. The bacteria usually attack the lungs, but can also damage other parts of the body. Approximately 30% of people around the world are infected with this pathogen, with the majority harboring a latent infection. Tuberculosis spreads through the air when a person with active pulmonary infection coughs or sneezes. M. tuberculosis are acid-fast, slowly growing bacteria that can survive in macrophages, allowing for a latent infection that can remain asymptomatic for decades, posing a challenge to diagnosis, therapy, and prevention. The diagnosis is established with tuberculin skin test, sputum culture, and lung imaging. The mainstay of management is anti-mycobacterial drugs.

Anthelmintic Drugs

Anthelmintic drugs are used to treat infections caused by parasitic helminths. Helminths include both flatworms (flukes and tapeworms) and roundworms. Anthelmintic medications are categorized on the basis of the class of helminths they are used for. Nematicidal agents include the benzimidazoles (albendazole, mebendazole, and triclabendazole), diethylcarbamazine, ivermectin, and pyrantel pamoate. Praziquantel is a trematocidal and cestodicidal agent. The mechanisms of action of the anthelmintic drugs vary, but many work by disrupting the normal function of the organism, inducing paralysis, and/or causing death. Most of these drugs are well absorbed, which can allow for treatment of systemic infections. Pyrantel pamoate, on the other hand, is poorly absorbed and is better suited to treating luminal nematodes. The benzimidazoles’ absorption is changed by the presence of food, which allows for some control in treating luminal or invasive infections (such as cysticercosis). Adverse effects of anthelmintics vary, but all classes of these drugs are associated with GI side effects.

Amebicides

Amebicides are drugs toxic to amoebas such as Entamoeba histolytica (the causative organism of amebiasis). Parasites enter the GI tract where trophozoites can penetrate the intestinal wall and cause an invasive infection. Amebicides are classified based on where the drug is most effective: intestinal lumen or tissues. Intestinal-lumen amebicides include iodoquinol and paromomycin. Tissue amebicides include the nitroimidazole drug class (e.g., metronidazole, tinidazole). Treatment of symptomatic disease usually requires a combination of both classes.

Antivirals for Herpes Virus

Antiviral agents against human herpesviruses (HHVs) include acyclovir, cidofovir, and foscarnet. Human herpesviruses are DNA viruses in the Herpesviridae family. Herpes simplex virus (HSV), varicella-zoster virus (VZV), cytomegalovirus (CMV), Epstein-Barr virus (EBV), and HHV-8 belong to the Herpesviridae family. Antivirals against the group generally act via inhibition of DNA polymerase. Acyclovir (the prototypical nucleoside analog) requires viral kinase for phosphorylation to become a triphosphate, which is incorporated in viral DNA. Cidofovir requires phosphorylation by host cellular kinase, which allows cidofovir to have activity against mutated viruses and become deficient in viral kinase. Foscarnet (a pyrophosphate analog) does not require phosphorylation. Nephrotoxicity is a shared adverse effect in the agents. Acyclovir can also cause obstructive crystalline nephropathy and foscarnet carries a risk of electrolyte abnormalities and seizures. The nephrotoxic effect of cidofovir can be reduced with IV saline and probenecid.

Antivirals for Hepatitis B

Antivirals for hepatitis B include the nucleoside/nucleotide analogs, also known as nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs). Because of their similar chemical structure to nucleosides and nucleotides, NRTIs are able to integrate into viral DNA during the replication process. This process inhibits the function of viral RNA-dependent DNA polymerase, resulting in chain termination. All of these medications are administered orally and are excreted by the kidneys. Indications include chronic hepatitis B infection, and some (such as lamivudine) are also used for HIV. Adverse effects include GI symptoms, evidence of mitochondrial toxicity (such as lactic acidosis), and rebound infection upon discontinuation.

Hepatitis C Virus

Hepatitis C is an infection of the liver caused by the hepatitis C virus (HCV). Hepatitis C virus is an RNA virus and a member of the genus Hepacivirus and the family Flaviviridae. The infection can be transmitted through infectious blood or body fluids and may be transmitted during childbirth or through IV drug use or sexual intercourse. Hepatitis C virus can cause both acute and chronic hepatitis, ranging from a mild to a serious, lifelong illness including liver cirrhosis and hepatocellular carcinoma (HCC). Hepatitis C infection is diagnosed by testing for the presence of HCV antibodies and HCV RNA. Management is supportive but includes direct antiviral agents (DAAs) if infection does not resolve spontaneously.

Anti-HIV Drugs

Antiretroviral therapy (ART) targets the replication cycle of the human immunodeficiency virus (HIV) and is classified based on the viral enzyme or mechanism that is inhibited. The goal of therapy is to suppress viral replication to reach the outcome of undetected viral load. Currently, reverse transcriptase, protease, integrase, and entry inhibitors are used in combined ART (cART) regimens. Combination therapy (3-drug regimen) is used to prevent drug resistance and cross-resistance, which develop through genetic mutations.

Leprosy

Leprosy, also known as Hansen's disease, is a chronic bacterial infection caused by Mycobacterium leprae complex bacteria. Symptoms primarily affect the skin and peripheral nerves, resulting in cutaneous manifestations (e.g., hypopigmented macules) and neurologic manifestations (e.g., loss of sensation). Leprosy is known for its historical stigma and psychosocial effects on infected persons, prompting the World Health Organization (WHO) to pursue a disease elimination plan that led to significant reduction in the prevalence of leprosy. The diagnosis of leprosy is established clinically and supported with skin biopsy. It is treated with long-term multidrug antibiotic combinations. Untreated leprosy leads to disability and permanent damage to the skin, nerves, limbs, and eyes.

Blastomyces/Blastomycosis

Blastomycosis is an infection caused by inhalation of the spores of the fungus, Blastomyces. Blastomyces species thrive in moist soil and decaying material and are common in the Ohio and Mississippi River valleys and the Great Lakes regions of the United States and Canada. Although most patients are asymptomatic, some can develop pneumonia. Extrapulmonary disease, such as skin lesions, osteomyelitis, genitourinary infections, and meningitis can occur. The diagnosis is made by identifying the organism in sputum or tissue samples using culture, PCR, or antigen testing. Antifungals are used for treatment.

Tetracyclines

Tetracyclines are a class of broad-spectrum antibiotics indicated for a wide variety of bacterial infections. These medications bind the 30S ribosomal subunit to inhibit protein synthesis of bacteria. Tetracyclines cover gram-positive and gram-negative organisms, as well as atypical bacteria such as chlamydia, mycoplasma, spirochetes, and even protozoa. The oral absorption of tetracyclines is decreased with the ingestion of some medications and supplements (e.g., milk of magnesia) or food (e.g., dairy products) that contain polyvalent cations, such as calcium and magnesium. Adverse effects include photosensitivity, GI upset, and skin pigmentation in the case of minocycline. Tetracyclines suppress bone growth and discolor teeth in children and are contraindicated in pregnancy and breastfeeding. Of importance, 3 new tetracyclines were approved by the FDA in 2018, which may have a role in treating certain infections due to drug-resistant organisms.

Hepatitis E Virus

The hepatitis E virus (HEV) is a small nonenveloped virus that contains linear, single-stranded, positive-sense RNA, making it similar to norovirus. Transmission of HEV is via the fecal–oral route and is clinically similar to that of hepatitis A. However, unlike hepatitis A, hepatitis E is quite severe, especially in pregnant women, and may cause fulminant hepatitis along with hepatic encephalopathy over a period of approximately 8 weeks. Management is mainly preventive and includes avoiding contaminated drinking water, good sanitation, and adequate personal hygiene.

Macrolides and Ketolides

Macrolides and ketolides are antibiotics that inhibit bacterial protein synthesis by binding to the 50S ribosomal subunit and blocking transpeptidation. These antibiotics have a broad spectrum of antimicrobial activity but are best known for their coverage of atypical microorganisms. Common macrolides are erythromycin, clarithromycin, and azithromycin. Side effects include GI upset, QT prolongation, and hepatotoxicity. Resistance mechanisms include ribosomal methylation or mutation, inactivation of the drug through enzyme production, or removal of the drug through efflux pumps.

Oxazolidinones

The oxazolidinones (linezolid and tedizolid) are bacterial protein synthesis inhibitors. Their unique binding site on the 23S ribosomal RNA of the 50S ribosome gives them zero cross-resistance with other antibiotics. These medications are readily absorbed and widely distributed in the body, and they are indicated for gram-positive infections, including MRSA and vancomycin-resistant Enterococcus. Adverse effects include GI upset, myelosuppression, peripheral or optic neuropathy, and lactic acidosis. Linezolid is a weak monoamine oxidase inhibitor, which can increase the risk for serotonin syndrome when coadministered with other serotonergic medications.

Aminoglycosides

Aminoglycosides are a class of antibiotics including gentamicin, tobramycin, amikacin, neomycin, plazomicin, and streptomycin. The class binds the 30S ribosomal subunit to inhibit bacterial protein synthesis. Unlike other medications with a similar mechanism of action, aminoglycosides are bactericidal. Aminoglycosides provide coverage against aerobic gram-negative pathogens, including Pseudomonas. Aminoglycosides can also be used synergistically with inhibitors of bacterial cell wall synthesis (e.g., β lactams) for gram-positive pathogens. Use is limited by serious side effects, including nephrotoxicity and ototoxicity.

Chloramphenicol

Chloramphenicol, the only clinically relevant drug in the amphenicol class, is a potent inhibitor of bacterial protein synthesis by binding to the 50S ribosomal subunit and preventing peptide bond formation. Chloramphenicol is a broad-spectrum antibiotic with wide distribution; however, due to its toxicity, its use is limited to severe infections where another alternative antibiotic is not available (usually due to resistance issues). Adverse effects include optic neuritis, aplastic anemia, and gray baby syndrome.

Penicillins

Beta-lactam antibiotics contain a beta-lactam ring as a part of their chemical structure. Drugs in this class include penicillin G and V, penicillinase-sensitive and penicillinase-resistant penicillins, cephalosporins, carbapenems, and aztreonam. Beta-lactam antibiotics block bacterial transpeptidase (penicillin-binding protein) and, therefore, inactivate peptidoglycan crosslinking in the cell wall. All beta-lactam antibiotics are bactericidal. Common mechanisms of resistance include beta-lactamase production or mutation in the penicillin-binding protein gene. The common side effects include hypersensitivity reactions, GI upset, and hemolytic anemia.

Cephalosporins

Cephalosporins are a group of bactericidal beta-lactam antibiotics (similar to penicillins) that exert their effects by preventing bacteria from producing their cell walls, ultimately leading to cell death. Cephalosporins are categorized by generation and all drug names begin with “cef-” or “ceph-.” Cephalosporins have expanded antimicrobial activity compared with most penicillins, and are more effective against Enterobacteriaceae; some drugs are active against Pseudomonas and/or anaerobic species as well. Cephalosporins are often used to treat skin, soft tissue, bone, lung, urinary tract, intraabdominal, and pelvic infections caused by susceptible organisms.

Lipopeptides and Lipoglycopeptides

Lipopeptides and lipoglycopeptides are classes of antibiotics that have activity against gram-positive bacteria and that act on the bacterial cell wall. Lipopeptides (daptomycin) disrupt the cell membrane by creating an ion-conducting channel and causing potassium efflux and membrane depolarization. The subsequent processes lead to inhibited protein synthesis and eventual bacterial cell death. Lipoglycopeptides have a dual action of inhibiting bacterial cell-wall synthesis by binding peptidoglycan precursors and causing cell membrane depolarization. Telavancin, dalbavancin, and oritavancin belong to this group of drugs. All these medications are administered IV, as they have poor oral absorption. The lipopeptides and lipoglycopeptides are excreted unchanged in the urine. Dosage adjustments are generally needed in cases of reduced renal function. Both classes of antibiotics are used as alternative agents for gram-positive infections (bacteremia, skin and soft tissue infections). Telavancin is also effective against hospital-acquired and ventilator-associated pneumonia.

Glycopeptides

The glycopeptide antibiotics (GPAs) vancomycin and teicoplanin are inhibitors of bacterial cell wall synthesis and considered the last resort treatment of severe infections due to gram-positive bacteria such as Staphylococcus aureus, Enterococcus spp., and Clostridiodes difficile. Vancomycin is the only GPA available in the United States. The medication has poor absorption in the GI tract; therefore, oral vancomycin is used for infections of the intestinal lumen including C. difficile. Intravenous vancomycin is indicated for severe gram-positive infections including endocarditis, pneumonia, and bacteremia. Significant adverse effects include anaphylaxis, hypersensitivity reactions, red man syndrome (related to rapid infusion), nephrotoxicity, and ototoxicity.

Sulfonamides and Trimethoprim

The sulfonamides are a class of antimicrobial drugs inhibiting folic acid synthesize in pathogens. The prototypical drug in the class is sulfamethoxazole. Although not technically sulfonamides, trimethoprim, dapsone, and pyrimethamine are also important antimicrobial agents inhibiting folic acid synthesis. The agents are often combined with sulfonamides, resulting in a synergistic effect. The primary indication for use is treatment of urinary tract infection (although significant resistance has emerged). In addition, the drugs are used to treat and prevent opportunistic infections such as toxoplasmosis encephalitis and pneumocystis pneumonia in immunosuppressed individuals. The most common adverse events are hypersensitivity reactions, fever, rash, GI upset, and hematologic reactions. The drugs are generally contraindicated in pregnancy, young/ill infants, and individuals with megaloblastic anemia or severe renal impairment.

Fluoroquinolones

Fluoroquinolones are a group of broad-spectrum, bactericidal antibiotics inhibiting bacterial DNA replication. Fluoroquinolones cover gram-negative, anaerobic, and atypical organisms, as well as some gram-positive and multidrug-resistant (MDR) organisms. A new fluoroquinolone, delafloxacin, covers both Pseudomonas aeruginosa and MRSA. Although fluoroquinolones have a wide spectrum of activity, the use is limited secondary to a number of risks associated with the fluoroquinolone class (i.e. permanent peripheral neuropathy and tendon rupture in children). Fluoroquinolones are indicated in complicated urinary, respiratory, intra-abdominal, bone, joint, and skin infections. Fluoroquinolones are 2nd-line agents used to treat tuberculosis and 1st-line agents in a number of less common infections (e.g., anthrax, plague, and tularemia).

Carbapenems and Aztreonam

The carbapenems and aztreonam are both members of the bactericidal beta-lactam family of antibiotics (similar to penicillins). They work by preventing bacteria from producing their cell wall, ultimately leading to bacterial cell death. There are 4 available carbapenems, all ending in “-penem,” and 1 available monobactam, which is aztreonam. The carbapenems are all broad-spectrum antibiotics used for a variety of serious, often MDR and/or hospital-acquired infections (HAIs) that can occur throughout the body. Aztreonam has a narrower spectrum and is typically used for aerobic gram-negative bacilli infections in patients who have a serious beta-lactam allergy but require beta-lactam therapy, as there is no significant cross-allergenicity between aztreonam and the other beta-lactams.

Hepatitis A Virus

The hepatitis A virus (HAV) is a nonenveloped virus of the Picornaviridae family with single-stranded RNA. The virus replicates in the liver, is excreted in the bile, and is found in high concentrations in the stool of acutely infected individuals. The 2 main routes of infection are consumption of contaminated food or water and direct contact with an infected person. HAV causes an acute, highly contagious hepatitis with unspecific prodromal symptoms such as fever and malaise followed by jaundice and elevated liver transaminases. Most individuals recover fully within a few months, and the immunity resulting from HAV infection is lifelong. Unlike hepatitis B and C, HAV infection does not result in chronic infection or chronic liver disease. Preventive vaccination is available for HAV and is recommended for individuals with increased risk of exposure and, in some countries such as the United States, for all children > 12 months of age.

Azoles

Azoles are a widely used class of antifungal medications inhibiting the production of ergosterol, a critical component in the fungal cell membrane. The 2 primary subclasses of azoles are the imidazoles, older agents typically only used for topical applications, and the triazoles, newer agents with a wide spectrum of uses. Various members of the class are indicated in the treatment and prophylaxis of candidiasis, aspergillosis, cryptococcus meningitis, dimorphic fungal infections (e.g., blastomycosis), and mucormycosis. Significant adverse effects are possible and include hepatotoxicity, GI distress, cardiac issues, and neurotoxicity. Azoles interact with the CYP450 system causing significant drug-to-drug interactions with many other medications, potentially limiting the usefulness in medically complex individuals.

Polyenes

Polyenes are a class of fungicidal agents that consist of 2 primary drugs in current use, namely, nystatin and amphotericin B. Both these drugs exert their effects by binding to ergosterol (a critical component of fungal cell membranes) and creating pores in the membrane, leading to the leakage of intracellular components and ultimately cell lysis. Both nystatin and amphotericin B have a broad spectrum of antifungal activity, little to no oral absorption, and significant toxicity (especially nephrotoxicity) when used parenterally. Nystatin is too toxic to be administered intravenously; thus, it is only used to treat fungal infections of the skin, mucous membranes, and GI lumen. Amphotericin B is administered via IV, intrathecal, or intraperitoneal routes, or using aerosols to treat serious, life-threatening fungal infections. Secondary resistance to nystatin and amphotericin B is rare but emerging.

Flucytosine, Griseofulvin, and Terbinafine

In addition to the 3 other major classes of antifungal agents (azoles, polyenes, and echinocandins), several other clinically important antifungal agents are used, including flucytosine, griseofulvin, and terbinafine. Each drug has a distinct mechanism of action and unique characteristics and indications. Flucytosine is a pyrimidine analog that disrupts fungal DNA and RNA synthesis. Flucytosine is always used in combination with other antifungal agents and is primarily used to treat cryptococcal meningitis. Both griseofulvin and terbinafine act within the stratum corneum of the skin and are used to treat dermatophyte infections of the skin, hair, and nails.

Echinocandins

Echinocandins are a group of fungicidal agents that target the fungal cell wall. Echinocandins inhibit β-glucan synthase, which in turn inhibits the production of β-glucan, a key structural component of fungal cell walls. The 3 primary drugs in this class include caspofungin, micafungin, and anidulafungin. Echinocandins are mainly used to treat Candida and Aspergillus infections in individuals who are critically ill or have neutropenia. Although echinocandins have a narrower spectrum of activity than some other antifungal classes, they are clinically useful because of their relatively low toxicity profiles and significantly fewer drug interactions than the azoles and amphotericin B. Resistance to echinocandins is generally uncommon, but is emerging in some strains of C. glabrata, usually through mutations that reduce the affinity of this drug to β-glucan synthase.

Hepatitis D Virus

Hepatitis D virus (HDV) is a small enveloped, single-stranded RNA virus. Hepatitis D virus is considered a satellite virus, as it requires the presence of hepatitis B virus (HBV) for assembly and secretion. Therefore, in order for an individual to contract hepatitis D, coinfection or superinfection with HBV is required. Like HBV, HDV is transmitted parenterally, through unprotected sexual intercourse, or perinatally. Clinical presentation is that of a classical viral hepatitis, including coinfection of HDV and HBV, which is considered the most serious form of hepatitis because of the high mortality rate. For acute cases, management is supportive, whereas for chronic cases, pegylated interferon alfa (PEG-IFN-α) is needed.

Antivirals for Hepatitis C

Antivirals against hepatitis C include a wide range of drug classes. The previous treatment regimen included interferon alfa (IFN-α) and ribavirin, which target viral entry, immune modulation, and viral replication. New, direct-acting antiviral (DAV) agents target specific nonstructural (NS) proteins of hepatitis C virus (HCV), which are important for viral replication. These agents include NS3A/4A protease inhibitors, NS5A inhibitors, and NS5B polymerase inhibitors. DAVs are often given in combination therapy and are the preferred management of hepatitis C due to their high success rate and milder side effect profile.

Antimycobacterial Agents

Antimycobacterial agents represent a diverse group of compounds that have activity against mycobacterial infections, including tuberculosis, leprosy and Mycobacterium avium complex (MAC) disease. The 1st-line agents for tuberculosis are rifampin, isoniazid, pyrazinamide, and ethambutol. The drugs vary in their mechanisms of action: rifampin inhibits RNA synthesis, isoniazid inhibits mycolic acid synthesis, pyrazinamide acts on membrane transport and protein synthesis, and ethambutol prevents cell wall synthesis. Monotherapy is not recommended because of the increased risk of drug resistance. Multidrug treatment takes several months and requires sputum monitoring. As for leprosy, an infection due to Mycobacterium leprae, rifampin is also used, with dapsone. The lepromatous form requires a 3rd agent (clofazimine). Pulmonary infections with MAC are managed with macrolides (azithromycin), rifampin, and ethambutol.

Antivirals for Influenza

Antiviral agents against influenza are important in preventing and treating influenza infection. Influenza is often self-limited, but high-risk populations suffer significant morbidity and mortality from the illness. Different classes of drugs act on the influenza virus. Neuraminidase inhibitors include oseltamivir (oral), zanamivir (inhalation) and peramivir (IV); these drugs act by inhibiting neuraminidase, the enzyme that cleaves off the new virus particle. By blocking the enzymatic effect, further release of progeny virus to nearby respiratory cells is reduced. Baloxavir, a selective inhibitor of influenza cap-dependent endonuclease, inhibits viral mRNA synthesis. Both neuraminidase inhibitors and baloxavir have activity against influenzas A and B. Adamantanes, or M2 inhibitors, include amantadine and rimantadine, which are active against influenza A but are not often used owing to resistance.

Malaria

Malaria is an infectious parasitic disease affecting humans and other animals. Most commonly transmitted via the bite of an infected female Anopheles mosquito, malaria is caused by single-celled microorganisms of the Plasmodium genus. Patients present with fever, chills, myalgia, headache, and diaphoresis after a history of exposure in an area endemic to malaria, which is often cyclical. Prophylaxis is of utmost importance. Treatment with oral medications is available, but malaria can be severe and fatal without a timely diagnosis, especially in young children.

Influenza Viruses/Influenza

Influenza viruses are members of the Orthomyxoviridae family and the causative organisms of influenza, a highly contagious febrile respiratory disease. There are 3 primary influenza viruses (A, B, and C) and various subtypes, which are classified based on their virulent surface antigens, hemagglutinin (HA) and neuraminidase (NA). Influenza typically presents with a fever, myalgia, headache, and symptoms of an upper respiratory infection. Symptoms of gastroenteritis may also commonly occur in children. Influenza is usually a self-limiting condition, though viral or secondary bacterial pneumonia may complicate the disease. Management is generally supportive, although NA inhibitors can be helpful if initiated within 48 hours of infection. Prevention relies on the annual vaccination of the public and practicing good hygiene.

HIV Infection and AIDS

Human immunodeficiency virus (HIV), a single-stranded RNA virus belonging to the Retroviridae family, is the etiologic agent of acquired immunodeficiency syndrome (AIDS). The human immunodeficiency virus is a sexually transmitted or blood-borne infection that attacks CD4+ T lymphocyte cells, macrophages, and dendritic cells, leading to eventual immunodeficiency. The presentation is marked by constitutional symptoms such as lymphadenopathy and fever. Further progression predisposes to opportunistic infections and malignancies. Diagnosis is by enzyme immunoassay for HIV-1 and -2. Additional tests include HIV viral load, genotyping, and CD4+ T lymphocyte count to determine therapy and evaluate treatment response and disease progression. Immediate treatment with combination antiretroviral therapy is recommended.

Tuberculosis

Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis complex bacteria. The bacteria usually attack the lungs but can also damage other parts of the body. Approximately 30% of people around the world are infected with this pathogen, with the majority harboring a latent infection. Tuberculosis spreads through the air when a person with active pulmonary infection coughs or sneezes. M. tuberculosis are acid-fast, slowly growing bacteria that can survive in macrophages, allowing for a latent infection that can remain asymptomatic for decades, posing a challenge to diagnosis, therapy, and prevention. The diagnosis is established with tuberculin skin test, sputum culture, and lung imaging. The mainstay of management is anti-mycobacterial drugs.

Antimalarial Drugs

Malaria, a vector-borne parasitic disease caused by Plasmodium spp., is transmitted via injection of sporozoites or immature forms of the parasite into a person's bloodstream. Sporozoites then infect the hepatocytes and differentiate into schizonts, which subsequently rupture, and merozoites invade red blood cells. As such, pharmacotherapy for malaria targets exoerythrocytic and erythrocytic forms of schizonts. Collectively, these agents are classified as schizonticides.

Overview – Cell Wall Synthesis Inhibitors (Antibiotics) 08:03 min

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Penicillins – Cell Wall Synthesis Inhibitors (Antibiotics) 09:14 min

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Cephalosporins – Cell Wall Synthesis Inhibitors (Antibiotics) 05:49 min

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Penems – Cell Wall Synthesis Inhibitors (Antibiotics) 02:39 min

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Monobactams, Cyclic Lipopeptide and Polypeptide – Cell Wall Synthesis Inhibitors (Antibiotics) 04:13 min

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Glycopeptide and Intracellular Agents – Cell Wall Synthesis Inhibitors (Antibiotics) 04:38 min

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Overview – Bacterial Protein Synthesis Inhibitors (Antibiotics) 04:42 min

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Linezolid, Streptogramins and Chloramphenicol – Bacterial Protein Synthesis Inhibitors (Antibiotics) 04:14 min

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Macrolides and Ketolides – Bacterial Protein Synthesis Inhibitors (Antibiotics) 03:02 min

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Tetracyclines – Bacterial Protein Synthesis Inhibitors (Antibiotics) 02:30 min

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Aminoglycosides – Bacterial Protein Synthesis Inhibitors (Antibiotics) 05:26 min

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Quiz Questions and Case Studies – Antibacterial Agents (Antibiotics) 07:33 min

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Overview – Antimetabolites 00:49 min

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Sulfonamides, Trimethoprim and Fluoroquinolones – Antimetabolites 07:48 min

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Case Studies – Antimetabolites 03:39 min

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Overview – Antimycobacterial Agents 02:24 min

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First-line Agents to Treat Tuberculosis – Antimycobacterial Agents 13:39 min

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Other Agents to Treat Tuberculosis – Antimycobacterial Agents 05:02 min

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New Agents to Treat Tuberculosis – Antimycobacterial Agents 04:57 min

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Treatment Regimens for Mycobacterium Tuberculosis – Antimycobacterial Agents 03:30 min

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Treatment Regimens for Leprosy and Other Infections – Antimycobacterial Agents 03:36 min

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Case Studies – Antimycobacterial Agents 06:16 min

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Overview – Antifungals 00:42 min

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Azoles – Antifungals 04:20 min

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Polyenes – Antifungals 04:25 min

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Flucytosine (5-Fluorocytosine/5-FC) – Antifungals 01:29 min

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Griseofulvin and Squalene Epoxidase Inhibitor (Terbinafine) – Antifungals 02:01 min

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Echinocandins – Antifungals 06:09 min

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Questions – Antifungals 03:00 min

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Overview of Antiviral Activity – Antiviral Drugs 02:22 min

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Anti-HIV Agents – Antiviral Drugs 03:50 min

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CCR5 – Antiviral Drugs 02:16 min

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Anti-HIV Agents: Entry Inhibitors – Antiviral Drugs 07:16 min

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Anti-HIV Agents: Nucleoside Reverse Transcriptase Inhibitors (NsRTIs) – Antiviral Drugs 06:54 min

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Anti-HIV Agents: Nucleotide Reverse Transcriptase Inhibitors (NtRTIs) – Antiviral Drugs 03:46 min

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Anti-HIV Agents: Nucleotide Reverse Transcriptase Inhibitors (NtRTIs) – Antiviral Drugs 2 Concept Pages
Anti-HIV Agents: Non-nucleoside Reverse Transcriptase Inhibitors (NNRTIs) – Antiviral Drugs 04:46 min

Anti-HIV Agents: Non-nucleoside Reverse Transcriptase Inhibitors (NNRTIs) – Antiviral Drugs 3 quiz questions

Anti-HIV Agents: Non-nucleoside Reverse Transcriptase Inhibitors (NNRTIs) – Antiviral Drugs 2 Concept Pages
Anti-HIV Agents: Integrase Strand Transfer Inhibitors – Antiviral Drugs 01:55 min

Anti-HIV Agents: Integrase Strand Transfer Inhibitors – Antiviral Drugs 1 quiz question

Anti-HIV Agents: Integrase Strand Transfer Inhibitors – Antiviral Drugs 2 Concept Pages
Anti-HIV Agents: Maturation Inhibitors – Antiviral Drugs 02:16 min

Anti-HIV Agents: Maturation Inhibitors – Antiviral Drugs 1 quiz question

Anti-HIV Agents: Maturation Inhibitors – Antiviral Drugs 2 Concept Pages
Anti-HIV Agents: Protease Inhibitors – Antiviral Drugs 06:30 min

Anti-HIV Agents: Protease Inhibitors – Antiviral Drugs 4 quiz questions

Anti-HIV Agents: Protease Inhibitors – Antiviral Drugs 2 Concept Pages
Anti-HIV Agents: Other Inhibitors – Antiviral Drugs 01:45 min

Anti-HIV Agents: Other Inhibitors – Antiviral Drugs 1 quiz question

Anti-HIV Agents: Other Inhibitors – Antiviral Drugs 2 Concept Pages
Case Studies about Anti-HIV Agents – Antiviral Drugs 03:21 min

Case Studies about Anti-HIV Agents – Antiviral Drugs 2 quiz questions

Case Studies about Anti-HIV Agents – Antiviral Drugs 2 Concept Pages
Anti-Herpes Agents: Thymidine Kinase Agents – Antiviral Drugs 05:21 min

Anti-Herpes Agents: Thymidine Kinase Agents – Antiviral Drugs 4 quiz questions

Anti-Herpes Agents: Thymidine Kinase Agents – Antiviral Drugs 1 concept page
Anti-Herpes Agents: RNA Polymerase Inhibitors and Other Drugs – Antiviral Drugs 01:59 min

Anti-Herpes Agents: RNA Polymerase Inhibitors and Other Drugs – Antiviral Drugs 1 quiz question

Anti-Herpes Agents: RNA Polymerase Inhibitors and Other Drugs – Antiviral Drugs 1 concept page
Influenza Treatment – Antiviral Drugs 01:08 min

Influenza Treatment – Antiviral Drugs 2 quiz questions

Influenza Treatment – Antiviral Drugs 2 Concept Pages
Hepatitis Treatment – Antiviral Drugs 06:45 min

Hepatitis Treatment – Antiviral Drugs 4 quiz questions

Hepatitis Treatment – Antiviral Drugs 7 Concept Pages
Overview – Antiviral Agents and Treatment of CMV Retinitis – Antiviral Drugs 02:03 min

Overview – Antiviral Agents and Treatment of CMV Retinitis – Antiviral Drugs 0 quiz questions

Overview – Antiviral Agents and Treatment of CMV Retinitis – Antiviral Drugs 2 Concept Pages
Case Study – Antiviral Drugs 05:16 min

Case Study – Antiviral Drugs 3 quiz questions

Case Study – Antiviral Drugs 5 Concept Pages
Antimalarial Drugs – Antiprotozoal Agents 12:41 min

Antimalarial Drugs – Antiprotozoal Agents 7 quiz questions

Antimalarial Drugs – Antiprotozoal Agents 2 Concept Pages
Amebicides – Antiprotozoal Agents 08:25 min

Amebicides – Antiprotozoal Agents 5 quiz questions

Amebicides – Antiprotozoal Agents 1 concept page
Nematicides – Anthelmintic Drugs 05:11 min

Nematicides – Anthelmintic Drugs 4 quiz questions

Nematicides – Anthelmintic Drugs 1 concept page
Trematocides (Praziquantel) and Cestodicides (Niclosamide) – Anthelmintic Drugs 02:29 min

Trematocides (Praziquantel) and Cestodicides (Niclosamide) – Anthelmintic Drugs 2 quiz questions

Trematocides (Praziquantel) and Cestodicides (Niclosamide) – Anthelmintic Drugs 1 concept page
Questions – Antiprotozoal and Anthelmintic Drugs 03:18 min

Questions – Antiprotozoal and Anthelmintic Drugs 2 quiz questions

Questions – Antiprotozoal and Anthelmintic Drugs 1 concept page

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Antimicrobial Pharmacology

Course Details

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Your Educators of course Antimicrobial Pharmacology

Pravin Shukle, MD

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