Get info. about the sulfonamides , fluroquinolones, Oxiquinolines, Nitrofurans, Quinoxalines, Oxazolidinones and Antifungal drugs.

1. SULFONAMIDES, FLUOROQUINOLONES,
OXIQUINOLINES, NITROFURANS,
QUINOXALINES, OXAZOLIDINONES and
ANTIFUNGAL DRUGS
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Sulfonamides – the synthetic antimicrobial agents,
containing a sulfonamido (–SO2–NH–) group.
This group is present in other compounds like antidiabetic
sulfonylureas, diuretics like thiazides, furosemide, and diacarb.
The structure of the sulfonamides is similar to
Para-Aminobenzoic Acid (PABA).
Sulfonamides tend to be much
more soluble at alkaline than at acid pH.
Solubility may be decreased
in acidic urine, resulting in
precipitation of the drug
or its acetylated metabolites.

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CLASSIFICATION of SULFONAMIDES
I. Oral, Absorbable (Systemic Action):
1. Short-acting (6-9 hours):
Sulfadimezine, Sulfazine, Ethazol, Urosulfane
2. Long-acting (24 hours) :
Sulfapyridazine, Sulfadimethoxine
3. Ultra-long acting (72 hours): Sulfalen
4. Combined preparations with:
- Trimethoprim: Co-trimoxazole [Biseptol]
- Aminosalicylic acid: Salazopyridazine, Sulfasalasine
Salazodimethoxine

4. II.II. Oral, NOral, Nonon-Absorbable-Absorbable
((acting the intestinal floraacting the intestinal flora):):
PhthalazolPhthalazol
SulginSulgin
III.III. For Topical UseFor Topical Use::
Sulfacil-natriumSulfacil-natrium (Albucid)(Albucid)––
Silver SulfadiazineSilver Sulfadiazine (1%(1% ccream)ream)
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6. CLINICAL USES of SULFONAMIDESCLINICAL USES of SULFONAMIDES ::
 Respiratory infectionsRespiratory infections
 Acute urinary tract infection:Acute urinary tract infection: UrosulfanUrosulfan
 Combined withCombined with PyromethaminePyromethamine ––
for drug-resistantfor drug-resistant MALARIAMALARIA, and for, and for TOXOPLASMOSISTOXOPLASMOSIS
 Inflammatory bowel disease, non-specific ulcerative colitis -Inflammatory bowel disease, non-specific ulcerative colitis -
SulfasalazineSulfasalazine ((SulfapyridineSulfapyridine ++ AminosalicylateAminosalicylate))
 Some sexually transmitted infections -Some sexually transmitted infections -
TRACHOMATRACHOMA,, CHLAMYDIACHLAMYDIA
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7. Co-trimoxazoleCo-trimoxazole: the combination of: the combination of
SulfamethoxazoleSulfamethoxazole andand TrimethoprimTrimethoprim::
is generally bactericidalis generally bactericidal
 acts by sequential blockade ofacts by sequential blockade of FOLIC ACIDFOLIC ACID enzymesenzymes
in the synthesis pathway:in the synthesis pathway:
SulfamethoxazoleSulfamethoxazole inhibits formation ofinhibits formation of
Dihydrofolic acidDihydrofolic acid fromfrom PABAPABA,,
TrimethoprimTrimethoprim inhibitsinhibits Dihydrofolate reductaseDihydrofolate reductase
responsible for formation ofresponsible for formation of Tetrahydrofolic acidTetrahydrofolic acid
fromfrom Dihydrofolic acidDihydrofolic acid
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8. Co-trimoxazoleCo-trimoxazole is effective against :is effective against :
Escherihia coliEscherihia coli
KlebsiellaKlebsiella
EnterobacterEnterobacter
Streptococcus pneumoniaeStreptococcus pneumoniae
Staphylococcus aureusStaphylococcus aureus
SalmonellaSalmonella
ShigellaShigella
Clinical useClinical use:: Chronic Bronchitis, Urinary tractChronic Bronchitis, Urinary tract
infections,infections,
Otitis media, Pneumocytis carini pneumonitis,Otitis media, Pneumocytis carini pneumonitis,
Traveller’s Diarrhea, Pertussis, Cholera.Traveller’s Diarrhea, Pertussis, Cholera.
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9. ADVERSE EFFECTS of SULFONMIDESADVERSE EFFECTS of SULFONMIDES::
 Hypersensitivity Reactions:Hypersensitivity Reactions: rashes, angioedema.rashes, angioedema.
All sulfonamides and their derivatives, includingAll sulfonamides and their derivatives, including
Diacarb, Thiazides, Furosemide, Butamide,Diacarb, Thiazides, Furosemide, Butamide,
Glibenclamide, DiazoxideGlibenclamide, Diazoxide areare CROSS-ALLERGICCROSS-ALLERGIC
 Nephrotoxicity, Urinary tract disturbances:Nephrotoxicity, Urinary tract disturbances:
SulfonamidesSulfonamides precipitate in urine, esp. at neutral orprecipitate in urine, esp. at neutral or
acid pH, producingacid pH, producing CRYSTALLURIACRYSTALLURIA,, HAEMATURIAHAEMATURIA,,
or evenor even OBSTRUCTIONOBSTRUCTION..
Adequate HYDRATION and ALKALINIZATION of urineAdequate HYDRATION and ALKALINIZATION of urine
prevent the problemprevent the problem
 Haemopoietic disturbancesHaemopoietic disturbances:: hemolytic anemia,hemolytic anemia,
agranulocytosis, leukopenia, thrombocytopeniaagranulocytosis, leukopenia, thrombocytopenia
 Depression, aseptic meningitis, seizuresDepression, aseptic meningitis, seizures 99

10. Acute Poisoning/OverdoseAcute Poisoning/Overdose
SULFONAMIDESSULFONAMIDES are able to formare able to form METHEMOGLOBINMETHEMOGLOBIN andand
SULF-METHEMOGLOBINESULF-METHEMOGLOBINE, block the haemopoiesis and, block the haemopoiesis and
produce hepato- and nephrotoxicity.produce hepato- and nephrotoxicity.
ManifestationManifestation:: dizziness, drowsiness, unconsciousness, anorexia,dizziness, drowsiness, unconsciousness, anorexia,
abdominal pain, nausea, vomiting, haemolytic anemia, acidosis,abdominal pain, nausea, vomiting, haemolytic anemia, acidosis,
agranulocytosis, sensitivity reactions, jaundice, hepatomegaliaagranulocytosis, sensitivity reactions, jaundice, hepatomegalia
TreatmentTreatment:: gastric lavage, forced diuresisgastric lavage, forced diuresis
ANTIDOTESANTIDOTES::
 Nicotinic acidNicotinic acid IV 1% solution 2–5 mlIV 1% solution 2–5 ml oror NicotinamidNicotinamidee
 ChromosmonChromosmon (1%(1% Methylene BlueMethylene Blue solution in 25% glucose)solution in 25% glucose)
IV 0.1 ml/kgIV 0.1 ml/kg
 Lipoic acidLipoic acid IV 0.5% solution 60-80 mlIV 0.5% solution 60-80 ml
 Folic acidFolic acid PO 1 mg tidPO 1 mg tid
 Transfusion of appropriate BLOOD PRODUCT:Transfusion of appropriate BLOOD PRODUCT:
Fresh blood, Dry Plasma, Polyglucin , RheopolyglucinFresh blood, Dry Plasma, Polyglucin , Rheopolyglucin
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11. SulfasalazineSulfasalazine - Tab 0.5 g:- Tab 0.5 g:
SulfapyridineSulfapyridine ++ Aminosalicylic AcidAminosalicylic Acid ––
is split into its component parts by bacteria in the colon.is split into its component parts by bacteria in the colon.
Clinical UsesClinical Uses::
 Ulcerative Colitis, Enteritis, Inflammatory Bowel DiseasesUlcerative Colitis, Enteritis, Inflammatory Bowel Diseases
 Rheumatoid diseases: acts by scavenging the toxicRheumatoid diseases: acts by scavenging the toxic oxygenoxygen
metabolitesmetabolites produced by neutrophilsproduced by neutrophils
 IgAIgA andand IgMIgM Rheumatoid FactorRheumatoid Factor productionproduction
 Suppression ofSuppression of T cellT cell responsesresponses
 Inhibition ofInhibition of B cellB cell proliferationproliferation
 The absorption ofThe absorption of folic acidfolic acid is impaired –is impaired –
this can be counteredthis can be countered
by givingby giving Folic AcidFolic Acid supplementssupplements 1111

12. Sulfacyl-sodiumSulfacyl-sodium ((AlbucidAlbucid) –) –
10%, 15%, 30% ophthalmic solution or10%, 15%, 30% ophthalmic solution or
ointment - effective for:ointment - effective for:
 Bacterial ConjunctivitisBacterial Conjunctivitis and as adjunctive therapy forand as adjunctive therapy for
TrachomaTrachoma..
 Ocular Gonorrheal infectionOcular Gonorrheal infection inin newbornsnewborns and adults.and adults.
It acts byIt acts by inhibiting the uptake of PABAinhibiting the uptake of PABA, which is required in, which is required in
the synthesis ofthe synthesis of Folic AcidFolic Acid needed for bacterial growth.needed for bacterial growth.

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15. CiprofloxacinCiprofloxacin ((TaTabb.. 0.0.5 g5 g; amp; amp.. 1%-10 ml)1%-10 ml) ––
a synthetic, broad-spectrum, bactericidal antibiotic,a synthetic, broad-spectrum, bactericidal antibiotic,
effective against both Gr(+) and Gr(-) bacteria.effective against both Gr(+) and Gr(-) bacteria.
It has excellent activity against:It has excellent activity against:
 EnterobacteriaceaeEnterobacteriaceae
 Enteric coliform bacilliEnteric coliform bacilli, including resistant to, including resistant to Penicillins,Penicillins,
CephalosporinsCephalosporins andand AminoglycosidesAminoglycosides
 Haemophilus influenzae,Haemophilus influenzae,
 Penicillinase-producingPenicillinase-producing Neisseria gonorrhoeae,Neisseria gonorrhoeae,
CampylobacterCampylobacter andand PseudomonadsPseudomonads..
 Gr(+) organisms,Gr(+) organisms, streptococcistreptococci andand pneumococcipneumococci are only weaklyare only weakly
inhibited and there is high incidence ofinhibited and there is high incidence of staphylococcal resistancestaphylococcal resistance..
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16. Clinical usesClinical uses of the Fluoroquinolonesof the Fluoroquinolones
 Urinary tract infections:Urinary tract infections: Norfloxacin, OfloxacinNorfloxacin, Ofloxacin
 Complicated respiratory tract infections -Complicated respiratory tract infections -
Gr(-) floraGr(-) flora
 Pseudomonas aeruginosaPseudomonas aeruginosa respiratoryrespiratory infectioninfection
 External otitis caused byExternal otitis caused by PP.. aeruginosaaeruginosa
 Chronic Gr(-) bacillaryChronic Gr(-) bacillary OSTEOMYELITISOSTEOMYELITIS
 Eradication ofEradication of Salmonella typhiSalmonella typhi in carriersin carriers
 Gonorrhoea:Gonorrhoea: Norfloxacin, OfloxacinNorfloxacin, Ofloxacin
 AnthraxAnthrax
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17. Chinoxydin
(Quinoxydin – tab. 0.25 g)
Dioxydin (amp. 1%-10 ml for topical use;
amp. 0.5%-10 ml IV).
They have broad-spectrum antibacterial effect including
Proteus vulgaris, blue pus bacillus (Pseudomonas aeruginosa),
pathogen anaerobes and others.
These drugs are used in severe pyoinflammatory processes.
They are toxic and adverse effects
are not infrequent and include
GIT upsets, headache,
chill, seizures, allergic reactions.1717

18. NitroxolineNitroxoline ((5-NOK, Nitrox)5-NOK, Nitrox) –– Tab. 0.05 gTab. 0.05 g
a urinary antiseptic -a urinary antiseptic -
a broad-spectrum, bacteriostatic agent.
 blocks replication of nucleonic acids,
forming chelate complexes with microelements (Fe, Cu) of
microbes => enzyme systems inhibition.
 is quickly absorbed from GIT, eliminates in unmodified
mode with urine, where it is accumulated in bacteriostatic
concentrations.
Clinical uses: urinary tract infections (Cystitis, Pyelonephritis,
Urethritis, Prostatitis), prophylaxis of infections after kidney
and urinary tract surgery.
Unwanted effects: GIT upsets.
Urine is discolored brightly yellow during
administration of drug.
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20. FuracilinFuracilin ((NitrofurazoneNitrofurazone,, Furacin)Furacin)
0.02% solution, Tab. 0.02 and 0.1 g -0.02% solution, Tab. 0.02 and 0.1 g -
is a synthetic, broad-spectrum antibacterialis a synthetic, broad-spectrum antibacterial NITROFURANNITROFURAN
derivative used mainly for topic application as ANTISEPTIC:derivative used mainly for topic application as ANTISEPTIC:
 Externally for the treatment and prevention ofExternally for the treatment and prevention of
pyoinflammatory processes, major burnspyoinflammatory processes, major burns
(esp. when resistance to other antibacterial agents occurs)(esp. when resistance to other antibacterial agents occurs);;
 PreventionPrevention of skin graft infections.of skin graft infections.
0.02%0.02% FuracilinFuracilin SolutionSolution is applied directly to lesion or tois applied directly to lesion or to
dressing used to cover the affected area daily ordressing used to cover the affected area daily or
as indicated,as indicated,
depending on severity ofdepending on severity of
burn or injury.burn or injury.
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21. FurazolidoneFurazolidone (Tab 0.05 g) is a(Tab 0.05 g) is a NITROFURANNITROFURAN
compound active against manycompound active against many Gr(–) bacilliGr(–) bacilli
includingincluding Salmonella, ShigellaSalmonella, Shigella,, Giardia lambliaGiardia lamblia
andand TrichomonasTrichomonas..
Clinical Uses:Clinical Uses:
 ForFor GIARDIASISGIARDIASIS 100 mg tid for 5–7 days is inferior to100 mg tid for 5–7 days is inferior to metronidazolemetronidazole
oror tinidazoletinidazole..
 Intestinal infections: Bacterial EnteritisIntestinal infections: Bacterial Enteritis
 Food poisoning diarrhoeas, Bacillary DysenteryFood poisoning diarrhoeas, Bacillary Dysentery
 Trichomonad colpitisTrichomonad colpitis
FurazolidoneFurazolidone is partly absorbed from intestines and excreted in urineis partly absorbed from intestines and excreted in urine
which turns orange – patients should be told about it.which turns orange – patients should be told about it.
It is used orally, intravaginally and rectally.It is used orally, intravaginally and rectally.
Adverse effectsAdverse effects are mild and infrequent – nausea, headache, dizziness.are mild and infrequent – nausea, headache, dizziness.2121

22. FuradoninFuradonin (Nitrofurantoin(Nitrofurantoin – Tab. 0.05 g, Caps. 0.1 g) is– Tab. 0.05 g, Caps. 0.1 g) is
an effectivean effective urinary antisepticurinary antiseptic..
 Is a bacteriostatic compound, but may be cidal at higherIs a bacteriostatic compound, but may be cidal at higher
concentrations and inconcentrations and in acidic urineacidic urine: its activity: its activity
is enhanced at loweris enhanced at lower pH 5.5pH 5.5 or below.or below.
 Ihibits many Gr(+) and Gr(–) bacteria.Ihibits many Gr(+) and Gr(–) bacteria.
 It antagonizes the action ofIt antagonizes the action of Nalidixic acidNalidixic acid..
 Mechanism of actionMechanism of action. Susceptible bacteria appear to enzymetically. Susceptible bacteria appear to enzymetically
reducereduce furadoninfuradonin to generate the active form:to generate the active form:
it is highly reactive and damages DNA.it is highly reactive and damages DNA.
Clinical usesClinical uses:: urinary tract infection.urinary tract infection.
Adverse reactionsAdverse reactions:: Interstitial changes in the lung, bronchoobstructiveInterstitial changes in the lung, bronchoobstructive
syndrome, cough; neuropathies and hemolytic anaemia occur insyndrome, cough; neuropathies and hemolytic anaemia occur in
glucose-6-phosphate dehydrogenase deficiency.glucose-6-phosphate dehydrogenase deficiency.
Rashes, pulmonary infiltration and other hypersensitivity reactionsRashes, pulmonary infiltration and other hypersensitivity reactions
(chills, fever, anaphylaxis); nausea, epigastric pain, diarrhoea.(chills, fever, anaphylaxis); nausea, epigastric pain, diarrhoea. 2222

23. OXAZOLIDINONES
Linezolid (Zyvox) – tab. 0.6 g, amp. 15% - 2 ml
● a synthetic antibiotic for the treatment of resistant
Gr(+) coccal (aerobic and anaerobic) and bacillary infections.
Gr(–) bacteria ARE NOT INHIBITED!
It is active against methicillin resistant and vancomycin resistant
Staph. Aureus (VRSA), vancomycin resistant enterococci (VRE),
penicillin resistant Strep. pyogenes, Str. viridans and Str. pneumoniae,
Corynebacterium, Listeria, Clostridia and Bact. fragilis.
Linezolid is primarily bacteriostatic, but cidal against some streptococci,
pneumococci and Bact. Fragilis.
MOA: It binds to the 23S fraction of the 50S ribosomes and
interferes with formation of the ternary tRNA–ribosome–mRNA
complex and stops protein synthesis before it starts.
There is no cross resistance with any other class of antibiotics.
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24. ANTIFUNGAL DRUGSANTIFUNGAL DRUGS
I. For the treatment of mycoses causedI. For the treatment of mycoses caused
byby PATHOGENICPATHOGENIC FUNGIFUNGI::
1.1. ForFor subcutaneoussubcutaneous andand systemicsystemic mycosesmycoses::
AntibioticsAntibiotics::
Amphotericin BAmphotericin B
MycoheptinMycoheptin
Azole derivatives:Azole derivatives:
•• ImidazolesImidazoles:: Ketoconazole,Ketoconazole, MiconazoleMiconazole
•• TriazolesTriazoles:: Itraconazole, FluconazoleItraconazole, Fluconazole
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25. 2.Drugs for2.Drugs for Superficial FungalSuperficial Fungal InfectionsInfections::
AntibioticsAntibiotics:: GriseofulvinGriseofulvin
Methylnaftaline derivativeMethylnaftaline derivative::
TerbinafineTerbinafine ((LamizylLamizyl – Tab 0.25 g– Tab 0.25 g;; 1% cream)1% cream)
Imidazole derivativesImidazole derivatives::
MiconazoleMiconazole
ClotrimazoleClotrimazole
(1% cream, lotion(1% cream, lotion;; Tab. vaginal 0.1 g)Tab. vaginal 0.1 g)
Nitrophenol derivativesNitrophenol derivatives::
NitrofunginNitrofungin
Iodine preparationsIodine preparations::
Iodide alcohol solutionIodide alcohol solution
Potassium iodide solutionPotassium iodide solution
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26. II. Drugs for the treatment of mycoses caused byII. Drugs for the treatment of mycoses caused by
Conditional Pathogenic FungiConditional Pathogenic Fungi::
AntibioticsAntibiotics::
NystatinNystatin
Amphotericin BAmphotericin B
LevorinLevorin
Imidazole derivativesImidazole derivatives::
MiconazoleMiconazole
ClotrimazoleClotrimazole
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27. Amphotericin BAmphotericin B is a macrolide antibiotic, producedis a macrolide antibiotic, produced
byby Streptomyces nodosumStreptomyces nodosum..
the drug of choice in the treatment of thethe drug of choice in the treatment of the Systemic MycosesSystemic Mycoses..
MOAMOA: Several polyene molecules bind to: Several polyene molecules bind to ERGOSTEROLERGOSTEROL in cellin cell
membrane of fungal cells to form pores disrupting membranemembrane of fungal cells to form pores disrupting membrane
permeabilitypermeability andand transport functions,transport functions, allowing electrolytesallowing electrolytes
(esp.(esp. K+K+) and small molecules to leak from the cell, leading to cell death.) and small molecules to leak from the cell, leading to cell death.
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28. Synthetic Antifungal AgentsSynthetic Antifungal Agents ––
AAzoleszoles:: Miconazole, KetoconazoleMiconazole, Ketoconazole
TTriazolesriazoles:: Fluconazole, ItraconazoleFluconazole, Itraconazole
MOAMOA: produce: produce inhibitinhibition ofion of the fungalthe fungal CYCYPP--450 enzyme450 enzyme,,
LLanosine 14anosine 14αα-demethylase-demethylase which is responswhich is responsiible forble for
convertingconverting LLANOSTEROLANOSTEROL toto EERGOSTEROLRGOSTEROL,,
the main sterol in the fungal cell membrane.the main sterol in the fungal cell membrane.
The depletion ofThe depletion of ERGOSTEROLERGOSTEROL alters the fluidity of thealters the fluidity of the
membrane and interferes with the action of themembrane and interferes with the action of the
Membrane-Membrane-AAssociated Enzymesssociated Enzymes..
=>=> InhibitionInhibition oof Replicationf Replication..
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29. KetoconazoleKetoconazole ((NizoralNizoral) –) –
Tab. 0.2 g, 2% cream, 1% Shampoo -Tab. 0.2 g, 2% cream, 1% Shampoo -
is distinguished fromis distinguished from FluconazoleFluconazole andand ItraconazoleItraconazole
by its greater propensity toby its greater propensity to inhibitinhibit humanhuman CYP-450CYP-450 enzymesenzymes
Inhibition of human CYP-450 enzymes:Inhibition of human CYP-450 enzymes:
◊◊ Interferes with biosynthesis ofInterferes with biosynthesis of ADRENALADRENAL andand GONADAL STEROIDGONADAL STEROID
HORMONESHORMONES, producing significant endocrine effects such as, producing significant endocrine effects such as
GYNECOMASTIA, INFERTILITYGYNECOMASTIA, INFERTILITY, and, and MENSTRUAL IRREGULARITIES.MENSTRUAL IRREGULARITIES.
◊◊ CYCYPP 450 enzymes450 enzymes inhibition =>inhibition => MMetabolismetabolism of other drugs,of other drugs,
leadingleading toto enhancedenhanced toxicitytoxicity
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30. CLOTRIMAZOLECLOTRIMAZOLE – only for local administration– only for local administration
1% cream, lotion1% cream, lotion;; Tab. vaginal 0.1 g –Tab. vaginal 0.1 g –
a synthetic imidazole derivative for dermatophytic infections,a synthetic imidazole derivative for dermatophytic infections,
IncludingIncluding Tinea corporis, Tinea pedis, Tinea crurisTinea corporis, Tinea pedis, Tinea cruris;;
VVulvovaginalulvovaginal andand Oropharyngeal CandidiasisOropharyngeal Candidiasis,, KKeratitiseratitis..
MOAMOA: by binding with: by binding with PHOSPHOLIPIDSPHOSPHOLIPIDS in the fungal cell membrane,in the fungal cell membrane,
alters cellalters cell MEMBRANE PERMEABILITYMEMBRANE PERMEABILITY
It inhibits or kills many fungi, including yeast and dermatophytes, andIt inhibits or kills many fungi, including yeast and dermatophytes, and
also is acting against some Gr(+) bacteria.also is acting against some Gr(+) bacteria.
Pharmacokinetics:Pharmacokinetics: Absorption is negligible and adverse effects are rare.Absorption is negligible and adverse effects are rare.
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31. TerbinafineTerbinafine ((LamizilLamizil – Tab 0.25 g– Tab 0.25 g;; 1% cream) -1% cream) -
Methylnaftaline derivative forMethylnaftaline derivative for
Superficial FungalSuperficial Fungal Infections –Infections –
a highly lipophilic keratophilic fungicidal compounda highly lipophilic keratophilic fungicidal compound
 Inhibits the enzymeInhibits the enzyme Squalene EpoxidaseSqualene Epoxidase, which is involved in the, which is involved in the
synthesis ofsynthesis of ERGOSTEROLERGOSTEROL fromfrom SQUALENESQUALENE in the fungal cell wall.in the fungal cell wall.
The accumulation of squalene within the cell is toxic to the organism.The accumulation of squalene within the cell is toxic to the organism.
 Given orally, it is rapidly absorbed and is taken up by skin, nails andGiven orally, it is rapidly absorbed and is taken up by skin, nails and
adipose tissue.adipose tissue.
 Given topically, it penetrates skin and mucous membranes.Given topically, it penetrates skin and mucous membranes.
 1 tab. PO for 12 weeks achieves a cure rate of up to1 tab. PO for 12 weeks achieves a cure rate of up to 90%90% forfor
onychomycosisonychomycosis (ringworm of nails)(ringworm of nails)
Unwanted effectsUnwanted effects ::
GGIT upsets, rashes, pruritus, joint and muscle pains, hepatitis.IT upsets, rashes, pruritus, joint and muscle pains, hepatitis.
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