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Antimicrobial Drug Resistance (AMDR)

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APPENDICES



APPENDICES 

Appendix A: Antibiotics and Anti-infective Agents by Category and Mechanism of Action

CATEGORIES

SUBCATEGORIES

MODE of ACTION

COMMENTS

Antibacterial

Sulfonamides

Bacteriostatic

Broad-spectrum activity against both gram-negative and gram-positive bacteria

Penicillins

Bactericidal

Active against many gram-negative and some gram-positive bacteria

Cephalosporins

Bactericidal

Grouped in four broad classes:

A. First generation: More gram-positive than gram-negative activity

B. Second generation: Enhanced gram-negative activity vs first-generation

C. Third generation: more gram-negative than gram-positive activity

D. Fourth generation: gram-positive and gram-negative activity

Tetracyclines

Bacteriostatic

Broad-spectrum drugs effective against intracellular bacteria

Aminoglycosides

Bacteriostatic

Active against aerobic gram-negative and select aerobic gram-positive bacteria

Quinolones

Bactericidal

Active against both gram-positive and gram-negative bacteria

Macrolides

Bacteriostatic

Also called “erythromycins”; mostly active against gram-positive bacteria

Antiviral

Interferes with life cycles

Prereceptor

Neutralizes virus before reaching receptor

Receptor

Inhibits viral attachment to target cell receptors. Primarily used for HIV infections

Transcription/reverse transcription

Divided in 2 groups: nucleoside and non-nucleoside analogs

Integrase

Inhibits integrase, a vital enzyme that integrates viral genome into host genome. Mainly used against retroviruses

Protease

Inhibits protease. Used in HIV infection

Assembly

Principally used as anti-influenza drug

Release

Principally used as anti-influenza drug

Antifungal

Amphotericin B

Damages fungal cell membrane

Changes the fluidity of fungal cell membrane

Azoles

Impair fungal cell membrane

Inhibit enzyme cytochrome P450 14α-demethylase

Echinocandins

Inhibit cell wall synthesis

Their target has no mammalian counterpart

Flucytosine

Nucleic acid analog

Administered in combination with amphotericin B

 



Appendix A (cont)

CATEGORIES

SUBCATEGORIES

MODE of ACTION

COMMENTS

Antiparasite

Aminoquinoline (Chloroquine)

Suppression or chemoprophylaxis of malaria

Treatment of uncomplicated or mild-to-moderate malaria

Aminoquinoline (Primaquine)

Generates reactive oxygen species or interferes with the electron transport chain in the parasite.

Treatment and prevention of malaria

Aminoquinoline (Melfoquine)

Form toxic complexes with free heme that damage membranes and interact with other plasmodia components

Treatment of acute malarial infections and prevention of malaria

Abamectin

Stunning or killing worms

Nematocide

Benzimidazole (Albendazole)

Stunning or killing worms

Effective against threadworms,  roundworms,  whipworms, tapeworms, hookworms

Meglumine antimoniate

Disrupts energy production/metabolism of microorganism

 

 



Appendix B

Top 8 Most Prescribed Antibiotics (2008)

 

Antibiotic Name (generic)

Select Target

Pathogen(s)

Indications

Manufacturer

2008 Global Sales

(USD Billion)

(estimated)

 2008

USD Billion

Azithromycin

(erythromycin derivative)

Haemophilus influenzae, Moraxella catarrhalis, Streptococcus pneumoniae, Chlamydia pneumoniae, Mycoplasma pneumoniae

Upper and lower respiratory, urinary tract, middle ear, and soft tissue infections

Pfizer

Piva

 

1,280

0,7

Linezolid

S pneumoniae, Streptococcus pyogenes, or Streptococcus agalactiae, Staphyloccocus aureus, vancomycin-resistant enterococci, methicillin-resistant S aureus

Pneumonia (hospital acquired), soft tissue infections resistant to antibiotics

Pfizer

1,100

NA

Amoxicillin-clavulinate

H influenzae, M (Branhamella) catarrhalis,

Bacterial infections of the middle ear and upper respiratory tract

GlaxoSmithKline

Pfizer (veterinary)

NeoMedD

Mascot

 

1,100

0.8

Amoxicillin

H influenzae, Neisseria gonorrhoeae, Escherichia coli, pneumococci, streptococci, and certain strains of staphylococci

Upper and lower respiratory tract infections, middle ear infections in children, urinary tract and skin (cystic acne) infections, and gonorrhea

Multiple international manufacturers for nonproprietary preparations

1,100 (estimated)

0.5

Oseltamivir phosphate

Seasonal and pandemic influenza A virus

Uncomplicated influenza infections and prophylaxis in children <1 year

Hoffman-La Roche/Gilead

Chugai Pharma. Co

>1.8

0.3

Cephalexin

S pneumoniae, H influenzae, S aureus, S pyogenes, M catarrhalis

Urinary tract, skin, and soft tissue infections

Eli Lilly

Ranbaxy

1.6

0.3

Trimethoprim

E coli, Proteus mirabilis, Klebsiella pneumoniae, Enterobacter species, coagulase-negative Staphylococcus species

Urinary tract, upper and lower respiratory tract infections

Multiple international pharmaceutical companies

0.5 (estimated)

0.2

 



Appendix C

Pathogens Suspected in the Genesis of Chronic Disorders2-5

 

1. Chronic Disorders and Cancers

 

Hepatitis viruses (B and C)

Hepatocellular carcinoma

Epstein-Barr Virus

Lymphomas, nasopharyngeal carcinoma

Human papilloma virus 16, 18, 33, 39

Cervical, anal, vulvar carcinoma; laryngeal papillomatosis

Human herpetic virus-8

Kaposi's sarcoma, Castleman's disease

Human T-cell leukemia/lymphoma virus-I

Adult T-cell leukemia

Helicobacter pylori

Mycobacterium paratuberculosis

Tropherima whippelii

Enterovirus

Gastric carcinoma, lymphoma

Crohn’s disease

Whipple’s disease

Type 1 diabetes

 

2. Neurologic Disorders

 

Treponema pallidum

Tertiary syphilis (neurosyphilis)

Borellia burgdorferi

Lyme disease complications

Prions

Creutzfeldt-Jakob disease variants

HHV-6

Multiple sclerosis

HTLV-I

Myelopathy, tropical spastic paraparesis

Chlamydophila pneumoniae

Alzheimer's disease, multiple sclerosis

Bornavirus

Autism

JC virus

Progressive multifocal leukoencephalopathy

Herpes simplex virus, cytomegalovirus

Mental impairment

Rubella

Mental impairment

Toxoplasmosis

Mental impairment, retinal lesions

Campylobacter jejuni

Guillain-Barré syndrome

 




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Table of Contents

ACTIVITY OVERVIEW
INTRODUCTION
SECTION ONE: The global threat of AMDR
SECTION TWO: Understanding AMDR
    1. Etiology and Epidemiology
    2. Incidence and Prevalence of Microbial Resistance
    3. Major AMDR Pathogens
       a. Acinetobacter baumanii
       b. Clostridium difficile
       c. Escherichia coli
       d. HIV/AIDS and Sexually Transmitted Infection
       e. Influenza virus
       f. Malaria (Plasmodium)
       g. Methicillin-resistant Staphylococcus aureus (MRSA)
       h. Streptococcus pneumoniae
       i. Tuberculosis and MDR-TB
       j. Vancomycin-Resistant Enterococcus (VRE)
SECTION THREE: Control and Prevention of AMDR
    1. Implications of Microbial Resistance
    2. Infections and Chronic Diseases
    3. Policies and Best Practices
       a. Antimicrobial Drug Stewardship
       b. Surveillance
       c. Environmental Decontamination
       d. Infection Control
       e. Patient Education
    4. Antibiotic Development Pipeline
SECTION FOUR: Conclusions
REFERENCES
APPENDICES
GLOSSARY
Test Questions
Program Evaluation
Self Assessment


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