random information on antibiotics usage

All cephalosporins have no activity against Enterococcus

Generally the higher the cephalosporin generation, the less Gram positive activity and the more Gram negative activity

Cephalosporins used to be spelt with “ph” but got changed to “f” → 1st generation cephalosporins are spelt with “ph” while the rest are spelt with “f”

Important oral cephalosporins are cephalexin, cefuroxime & cefaclor

Piperacillin, Ticarcillin, etc. (extended spectrum penicillins) are the only penicillins to have activity against Pseudomonas

Clavulanic acid, sulbactam & tazobactam are β-lactamase inhibitors that are combine with some penicillins to make them more effective

Amoxicillin + clavulanate = co-amoxiclav (Augmentin)

Ampicillin + sulbactam = Unasyn

Ticarcillin + clavulanate = Timentin

Piperacillin + tazobactam = Tazocin

Only oral penicillins are penicillin V, diclox/fluclox & amoxicillin

Common resistant bacteria

MRSA → methicillin resistant S. aureus (can be just methicillin resistant or multi-drug resistant)

MRSE → methicillin resistant S. epidermidis

Penicillin resistant Strep. pneumoniae & H. influenzae

VRE → vancomycin resistant Enterococcus

MRAB → multi-resistant Acinetobacter

ESBL bacteria → extended spectrum β-lactamase producing bacteria

GISA/VISA → glycopeptide/vancomycin intermediate S. aureus

Most resistance is acquired or inherent, not developed via mutation

Obviously you wouldn’t choose an antibiotic a bacteria is inherently resistant to

When an infection is exposed to the external environment, it is best to use multiple drugs to treat it so that resistance can’t be acquired from other bacteria

However, when the infection is “sterile”/closed off e.g. joint infections, abscesses, osteomyelitis, cellulitis, etc. there is less chance of acquiring resistance → a single antibiotic can be used e.g. only diclox/fluclox against osteomyelitis (unless MRSA)

Although most antibiotics have a short half life compared to other drugs, there is a post-antibiotic effect that is still inhibitory towards bacteria even when plasma levels of the antibiotic are sub-therapeutic → hence dosing is not needed as often as you may think




Antibiotic general uses
β-lactams → won’t go into here ‘cause it’s too much (see diagram)

Glycopeptides for MRSA

Aminoglycosides → used with β-lactams against Pseudomonas, used against Gram negatives

Tetracyclines → intracellular organisms, PID, CAP (especially atypical)

Macrolides → CAP (especially atypical including mycobacteria), chlamydia, some parasites, for people who are penicillin hypersensitive

Lincosamides → mixed anaerobic infections, some parasites, penicillin hypersensitivity

Streptogrammins → IV, glycopeptide resistant MRSA, VRE

Oxazolidinones → oral, VRE/MRSA/GISA

Fusidic acid + rifampicin → MRSA

Quinolones → Gram negatives, esp. Pseudomonas, intracellular organisms

Rifamycins → mycobacteria, MRSA, prophylaxis, good for all over skin action

Sulphamethoxazole + trimethoprim/ trimethoprim alone → UTIs

Nitroimidazoles → anaerobes, parasites

In general

Gram positives → penicillins

Staph skin/cone infections (without resistance) → di/fluclox, augmentin

Pseudomonas → extended spectrum penicillins, ceftazidime, cefepime, gentamicin, cipro

Anaerobes → metronidazole

Gram negatives → gentamicin, quinolones

Not much works against enterococcus

dr sunil kumar sharma biography

dr sunil kumar sharma is the head of department of surgery of kathmandu

medical college.he also works in the famous om hospital of chavel of

kathmandu,nepal.
his biography as far as my memory of his interview taken by my

colleagues of kathmandu medical college is able to recall is presented

below
his childhood
he was born to dr anjani kumar sharma ,the first surgeon of nepal and

widely respected figure in nepal as a surgeon and as very humble man by

his nature and his mother whose name i dont recall.
his childhood went well .he studied in st xaviers college ,which is

also one of the respected institutions of nepal.he was a good student

and almost always came among the top three students of the school.his

colleage dr shishir lakhe of school is also a respected figure in

orthopaedic surgery. he passed his school leaving certificate from st

xaviers school.
his 20s
he studied in ascol ,i s c..........but didnt complete it here and was

sent to india for higher studies by his father.
then he joined the madras university for medical science....like his

father did.........although he claims himself not to be influenced by

his father but by one of the surgeons who worked at the university.
he did his first surgery of hernia in the same university.......in fact

he was selected for it for his confidence and dedication to studies

among all his friends,who were ofcourse jealous of him.
his career
he then went to edinburg to do FRCS.he did it by so many attempts....6

attempts.infact it is a very difficult exam to pass.he did it on

minimally invasive surgery.then he took many trainings and he completed

his training on oncosurgery.he did go to places like japan,phillipines

and many others for his further studies.
his present status
he is one of the most respected surgerons in nepal in the present

context.i am one of his students in kmc.here ,he is handling the all of

general surgery.he is a talented young but big figure.his classes are

very influencial.i am one of his fans.his voice is a bit high and

scary....so all of the students are scared of him.he is famous for his

intellect,his catchy mind{you wouldnt wanna mess around him,coz he will

remember it till exams-say seniors}i like him till date for what he

is.lets see if he makes me fail or pass,then i dont know whether i ll

continue liking him or not..hehe.but i ll always respect him.i bet he

will grow very much in the coming future.he is still a very young man.
thanx

movies i have found really very interesting

well,i have watched plenty of movies because it seems to be my favourite time pass when people arent around ..........i have listed a list of movies u guys should watch if u find them
schinders list
back to the future
braveheart
alive
daisy(korean)
my sassy gal(korean)
an american crime
basic instinct
1408
the amitsville horror

i dont remember all those movies i ve watched ..........as i remember or watch more quality picture,i will write them out.please post ur comments on which movies i should watch

what do you think about the famous crop circles?

well i know not much information about the famous crop circles......but i know that they exist and that they are quite mysterious about how they may have been formed.imagine this story
u are a farmer and you own a big farm in a village in england.you are happy to own the field and have grown rich by the maize it yields.next month the crops are grown fully and u r harvesting them.all your family are ready for that.today,like a routine you visited your crop field to see if the irrigation is right.u ve eaten ur dinner after working in the field...watching the irrigation and managing everything.tomorrow morning also u wake up ,have ur lunch and go to the field to see it,to see the irrigation,to manage the birds,insects harming you.......alas suddenly you see a path formed ........its a big one .......its somewhat curved.......u inform the police.......a police helicopter comes..........and as they come to u ....u see their surprised faces....they force u to get in the heli..........as u go up you find that its not a mere path its a whole circle and its beautiful one .......looks like someone very big has made a drawing in your field and the guy is an artist......
now u imagine how this monsterous art can be formed in a single day by a human.....
was it god?or an alien?or some ghost or some secret aircraft of the us army that has landed and made an impression.