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DRUGS USED FOR THE TREATMENT OF SYPHILIS & GONORRHEA

DRUGS USED FOR THE TREATMENT OF SYPHILIS & GONORRHEA. Prof. Mohammad Alhumayyd. OBJECTIVES. At the end of lecture , the students should understand: The drugs used in the treatment of syphilis & gonorrhea. The mechanism of action, adverse effects of each drug.

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DRUGS USED FOR THE TREATMENT OF SYPHILIS & GONORRHEA

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  1. DRUGS USED FOR THE TREATMENT OF SYPHILIS & GONORRHEA

  2. Prof. Mohammad Alhumayyd

  3. OBJECTIVES • At the end of lecture , the students should understand: • The drugs used in the treatment of syphilis & gonorrhea. • The mechanism of action, adverse effects of each drug

  4. OBJECTIVES ( continue) • The contraindications of drugs used • The recommended regimens used for treatment of syphilis & gonorrhaea • The alternative treatments in allergic patients

  5. SYPHILIS What is Syphilis? • Sexually transmitted disease caused by bacterium TreponemaPallidum

  6. Stages Of Syphilis • A primary stage ( a single sore ( a chancre ) )

  7. Secondary Stage • Skin rash & mucous membranes lesions

  8. Latent stage 70% may have NO SYMPTOMS

  9. Drugs used in the treatment of Syphilis • Penicillins*** Penicillin G BenzathinP. ; Procaine P. • Tetracyclines Doxycycline • Macrolides Clarithromycin • Cephalosporins Ceftriaxone

  10. PENICILLINS • Mechanism of action • Inhibit the synthesis of bacterial cell wall . These drugs are bactericidal

  11. Preparations of penicillins used for the treatment of syphilis • Penicillin G, i.v(Short duration of action) • Procaine P,i.m(Long acting(24-48hrs) • BenzathineP,i.m(Long acting(every 3-4 weeks) All are: Acid unstable Penicillinasesensitive

  12. Adverse effects of penicillins • Hypersensitivity • Convulsions with high doses or in renal failure • Super infections

  13. Drugs used in Allergic Patients To Penicillins • Tetracyclines such as: Doxycycline • Macrolidessuch as: Clarithromycin • Cephalosprins such as : Ceftriaxone cefixime

  14. TETRACYCLINES e.g, Doxycycline • Well absorbed orally • Long-acting

  15. Mechanism of action • Inhibit bacterial protein synthesis by reversibly binding to 30 S bacterial ribosomal subunits .

  16. Side effects 1. nausea, vomiting ,diarrhea & epigastric pain(give with food) 2. Hepatic toxicity ( prolonged therapy with high dose ) 3. Brown discolouration of teeth – children 4. Deformity or growth inhibition of bones – children 5. Vertigo 6. Superinfections.

  17. Contraindications • Pregnancy • Breast feeding • Children(below 10 yrs)

  18. MACROLIDES e.g., clarithromycin Mechanism of action • Inhibits bacterial protein synthesis by binding to bacterial 50S ribosomal subunits

  19. Side Effects Nausea, vomiting, abdominal pain & diarrhea. Allergic reactions- urticaria, mild skin rashes Irregular heart beats(recent)

  20. Cephalosporins Mechanism of action Inhibits bacterial cell wall synthesis Bactericidal β-lactam antibiotics 3rd Generation cephalosporins e.g. Ceftriaxone cefixime

  21. Adverse effects • Allergic manifestations • Thrombophilibitis • Superinfection • Diarrhea

  22. GONORRHEA Caused by Neisseria gonorrhea, a pus producing bacteria Up to 1 MILLION people affected each year Teenagers (15-19) have the highest rate if infection

  23. Drugs used in the treatment of Gonorrhea • 3rd generation Cephalosporins*** Ceftriaxone,I.M, Cefixime,P.O • Fluoroquinolones Ciprofloxacin • Spectinomycin

  24. :Recommended regimens ( 1st line treatment) Uncomplicated gonorrheal infections 3rd generation cephalosporins 500mg ceftriaxone,IM or 400 mg of cefixime,po Typically given with a single dose of azithromycin(1gm,po) or doxycycline(100mg,b.i.d,po) for 7 days.

  25. FLUOROQUINOLONES Single oral dose of : Ciprofloxacin(500 mg) Ofloxacin(400 mg)

  26. MECHANISM OF ACTION of fluoroquinolones • All are bactericidal • Inhibit DNA synthesis by inhibiting DNA gyrase enzyme

  27. Side effects Nausea , vomiting & diarrhoea Headache& dizziness May damage growing cartilage &cause arthropathy. Phototoxicity – avoid excessive sunlight

  28. CONTRAINDICATIONS • Pregnancy • Nursing mothers • Children under 18 years

  29. Alternative treatment in pts cannot tolerate or be treated with 1st line treatment Spectinomycin • 2g ,IM

  30. Mechanism of action • Inhibits protein synthesis by binding to 30 S ribosomal subunits

  31. Adverse Effects 2. Fever Nausea • Pain at the site of injection Nephrotoxicity (not common)

  32. CONTINUE Complicated gonorrheal infections Spread through blood stream • EYE • Joints • Heart valves • Brain

  33. Harmful effects of gonorrhea Newborn eye infections, may lead to blindness

  34. Treatment of Complicated infections • With conjunctivitis in new born Silver nitrate Germicidal effects are due to precipitation of bacterial proteins by liberated silver ions

  35. Silver nitrate ( continue) • Put into conjunctival sac once immediately after birth (no later than 1 h after birth )

  36. ERYTHROMYCIN • 0.5% ointement for teatment & prevention of corneal & conjunctival infections. • Put into conjunctival sac immediately after birth (no later than 1 hr after delivery )

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