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20-September-2008 09:55:47 - Antibiotic This article may require cleanup to meet 's quality standards. Please improve this article if you can. July 2008 Testing the susceptibility of Staphylococcus aureus to antibiotics by the Kirby-Bauer disk diffusion method. Antibiotics diffuse out from antibiotic-containing disks and inhibit growth of S. aureus resulting in a zone of inhibition. Testing the susceptibility of Staphylococcus aureus to antibiotics by the Kirby-Bauer disk diffusion method. Antibiotics diffuse out from antibiotic-containing disks and inhibit growth of S. aureus resulting in a zone of inhibition. The term antibiotic from Greek αντί - anti, against + βιοτικός - biotikos, fit for life12 was coined by Selman Waksman in 1942 to describe any substance produced by a micro-organism that is antagonistic to the growth of other micro-organisms in high dilution. This definition therefore excludes naturally occurring substances, such as gastric juice and hydrogen peroxide, which may kill micro-organisms but are not produced by micro-organisms. The strict definition of antibiotic therefore excludes synthetic compounds such as the sulphonamides which are antimicrobial agents. In modern usage, the term antibiotic is more loosely used to refer to any chemotherapeutic agent or antimicrobial agent with activity against micro-organisms such as bacteria, fungi or protozoa.3 Many antibiotic compounds used in modern medicine are produced and isolated from living organisms, such as the penicillin class produced by fungi in the genus Penicillium, or streptomycin from bacteria of the genus Streptomyces. With advances in medicinal chemistry many antibiotics are now modified chemically from their original form found in nature. In addition, some modern antibiotics have been created through purely synthetic means. Many antibiotics are relatively small molecules with a molecular weight less than 2000 Da. Contents 1 Overview 2 History 3 Classes of antibiotics 4 Production 5 Usage 6 Side effects 7 Antibiotic misuse 7.1 Animals 7.2 Humans 8 Antibiotic resistance 8.1 Resistance modifying agents 9 Beyond antibiotics 10 References 11 External links 11.1 Resources Overview This section may contain original research or unverified claims. Please help by adding references. March 2008 Unlike previous treatments for infections, which often consisted of administering chemical compounds such as strychnine and arsenic, with high toxicity also against mammals, antibiotics from microbes had no or few side effects and high effective target activity. Most anti-bacterial antibiotics do not have activity against viruses, fungi, or other microbes. Anti-bacterial antibiotics can be categorized based on their target specificity: narrow-spectrum antibiotics target particular types of bacteria, such as Gram-negative or Gram-positive bacteria, while broad-spectrum antibiotics affect a wide range of bacteria. The environment of individual antibiotics varies with the location of the infection, the ability of the antibiotic to reach the site of infection, and the ability of the microbe to inactivate or excrete the antibiotic. Some anti-bacterial antibiotics destroy bacteria bactericidal, whereas others prevent bacteria from multiplying bacteriostatic. Oral antibiotics are simply ingested, while intravenous antibiotics are used in more serious cases, such as deep-seated systemic infections. Antibiotics may also sometimes be administered topically, as with eye drops or ointments. In the last few years three new classes of antibiotics have been brought into clinical use. This follows a 40-year hiatus in discovering new classes of antibiotic compounds. These new antibiotics are of the following three classes: cyclic lipopeptides daptomycin, glycylcyclines tigecycline, and oxazolidinones linezolid. Tigecycline is a broad-spectrum antibiotic, while the two others are used for gram-positive infections. These developments show promise as a means to counteract the growing bacterial resistance to existing antibiotics. History See also: Timeline of antibiotics Penicillin Penicillin Although potent antibiotic compounds for treatment of human diseases caused by bacteria such as tuberculosis, bubonic plague, or leprosy were not isolated and identified until the twentieth century, the first known use of antibiotics was by the ancient Chinese over 2,500 years ago.4 Many other ancient cultures, including the ancient Egyptians, ancient Greeks and medieval Arabs already used molds and plants to treat infections, owing to the production of antibiotic substances by these organisms, a phenomenon known as antibiosis5 Antibiosis was first described in 1877 in bacteria when Louis Pasteur and Robert Koch observed that an airborne bacillus could inhibit the growth of Bacillus anthracis.6 The antibiotic properties of Penicillium sp. were first described in France by Ernest Duchesne in 1897. However, his work went by without much notice from the scientific community until Alexander Fleming's discovery of Penicillin see below. Modern research on antibiotic therapy began in Germany with the development of the narrow-spectrum antibiotic Salvarsan by Paul Ehrlich in 1909, for the first time allowing an efficient treatment of the then-widespread problem of Syphilis. The drug, which was also effective against other spirochaetal infections, is no longer in use in modern medicine. Antibiotics were further developed in Britain following the discovery of Penicillin in 1928 by Alexander Fleming. More than ten years later, Ernst Chain and Howard Florey became interested in his work, and came up with the purified form of penicillin. The three shared the 1945 Nobel Prize in Medicine. In 1939, Rene Dubos isolated gramicidin, one of first antibiotics to be manufactured commercially used during World War II proving highly effective in the treatment of wounds and ulcers.7. Florey cred Dubos for reviving his research on penicillin7 Antibiotic was originally used to refer only to substances extracted from a fungus or other microorganism, but has come to also include the many synthetic and semi-synthetic drugs that have antibacterial effects. Antibiotics can help succeed in curing many illnesses. Classes of antibiotics Main article: Antibiotic classes At the highest level, antibiotics can be classified as either bactericidal or bacteriostatic. Bactericidals kill bacteria directly where bacteriostatics prevent them from dividing. However, these classifications are based on laboratory behavior; in practice, both of these are capable of ending a bacterial infection.8 Production Main article: Production of antibiotics Since the first pioneering efforts of Florey and Chain in 1939, the importance of antibiotics to medicine has led to much research into discovering and producing them. The process of production usually involves screening of wide ranges of microorganisms, testing and modification. Production is carried out using fermentation, usually in strongly aerobic fermentation. Usage Antibiotics are only intended to be used by a doctor's prescription. Doctors always specify dosage and duration of antibiotic treatment. It is very important to follow the prescription and complete the entire course see Antibiotic misuse further down. In general, alcohol should be avoided when taking antibiotics as it causes a variety of things to happen in the body, and some of them can impair the effectiveness of antibiotics9; It also competes with liver enzymes, which break down the antibiotics.10 Additionally, certain antibiotics including Metronidazole, Tinidazole, co-trimoxazole, cephamandole, ketoconazole chemically react with alcohol, leading to serious body reactions severe vomiting, nausea, etc.. Such antibiotics are explicitly prohibited to be used with alcohol.11 Side effects Possible side effects are varied, depending on the antibiotics used and the microbial organisms targeted. Adverse effects can range from fever and nausea to major allergic reactions including photodermatitis.citation needed One of the more common side effects is diarrhea, sometimes caused by the anaerobic bacterium Clostridium difficile, which results from the antibiotic disrupting the normal balance of the intestinal flora,12 Such overgrowth of pathogenic bacteria may be alleviated by ingesting probiotics during a course of antibiotics.citation needed. An antibiotic-induced disruption of the population of the bacteria normally present as constituents of the normal vaginal flora may also occur, and may lead to overgrowth of yeast species of the genus Candida in the vulvo-vaginal area. 13 Other side effects can result from interaction with other drugs, such as elevated risk of tendon damage from administration of a quinolone antibiotic with a systemic corticosteroid. Hypothetically, some antibiotics might interfere with the efficiency of birth control pills. However there have been no conclusive studies that proved that; on the contrary, the majority of the studies indicate that antibiotics do not interfere with contraception14, even though there is a possibility that a small percentage of women may experience decreased effectiveness of birth control pills while taking an antibiotic.15 Antibiotic misuse Common forms of antibiotic misuse include failure to take the entire prescribed course of the antibiotic, or failure to rest for sufficient recovery to allow clearance of the infecting organism. These practices may facilitate the development of bacterial populations with antibiotic resistance. Inappropriate antibiotic treatment is another common form of antibiotic misuse. A common example is the prescription and use of antibiotics to treat viral infections such as the common cold that have no effect. Animals It is estimated that greater than 70% of the antibiotics used in U.S. are given to feed animals e.g. chickens, pigs and cattle in the absence of disease.16 Antibiotic use in food animal production has been associated with the emergence of antibiotic-resistant strains of bacteria including Salmonella spp., Campylobacter spp., Escherichia coli, and Enterococcus spp. Evidence from some US and European studies suggest that these resistant bacteria cause infections in humans that do not respond to commonly prescribed antibiotics. In response to these practices and attendant problems, several organizations e.g. The American Society for Microbiology ASM, American Public Health Association APHA and the American Medical Association AMA have called for restrictions on antibiotic use in food animal production and an end to all non-therapeutic uses.citation needed However, delays in regulatory and legislative actions to limit the use of antibiotics are common, and may include resistance to these changes by industries using or selling antibiotics, as well as time spent on research to establish causal links between antibiotic use and emergence of untreatable bacterial diseases. Today, there are two federal bills S.742 and H.R. 2562 aimed at phasing out non-therapeutic antibiotics in US food animal production. These bills are endorsed by public health and medical organizations including the American Nurses Association ANA, the American Academy of Pediatrics AAP, and the American Public Health Association APHA.citation needed Humans One study on respiratory tract infections found physicians were more likely to prescribe antibiotics to patients who they believed expected them, although they correctly identified only about 1 in 4 of those patients.17 Multifactorial interventions aimed at both physicians and patients can reduce inappropriate prescribing of antibiotics. 18 Delaying antibiotics for 48 hours while observing for spontaneous resolution of respiratory tract infections may reduce antibiotic usage; however, this strategy may reduce patient satisfaction.19 Excessive use of prophylactic antibiotics in travelers may also be classified as misuse. Antibiotic resistance Main article: Antibiotic resistance SEM depicting methicillin-resistant Staphylococcus aureus bacteria. SEM depicting methicillin-resistant Staphylococcus aureus bacteria. Use or misuse of antibiotics may result in the development of antibiotic resistance by the infecting organisms, similar to the development of pesticide resistance in insects. Evolutionary theory of genetic selection requires that as close as possible to 100% of the infecting organisms be killed off to avoid selection of resistance; if a small subset of the population survives the treatment and is allowed to multiply, the average susceptibility of this new population to the compound will be much less than that of the original population, since they have descended from those few organisms that survived the original treatment. This survival often results from an inheritable resistance to the compound that was infrequent in the original population, but became more frequent in the descendants. Antibiotic resistance has become a serious problem in both developed and underdeveloped nations. By 1984 half of those with active tuberculosis in the United States had a strain that resisted at least one antibiotic.citation needed In certain settings, such as hospitals and some childcare locations, the rate of antibiotic resistance is so high that the usual, low-cost antibiotics are virtually useless for treatment of frequently seen infections. This leads to more frequent use of newer and more expensive compounds, which in turn leads to the rise of resistance to those drugs. A struggle to develop new antibiotics ensues to prevent losing future battles against infection. To date, tuberculosis and pneumococcus are prominent examples of once easily treated infections where drug-resistance has become a problem. Points of attack on bacteria by antibiotics Points of attack on bacteria by antibiotics Another example of selection is Staphylococcus aureus 'golden staph', which could be treated successfully with penicillin in the 1940s and 1950s. At present, nearly all strains are resistant to penicillin, and many are resistant to nafcillin, leaving only a narrow selection of drugs such as vancomycin useful for treatment. The situation is complicated by the fact that genes coding for antibiotic resistance can be transferred between bacteria via plasmids, making it possible for bacteria never exposed to an antibiotic to acquire resistance from those which have. The problem of antibiotic resistance is made more widespread when antibiotics are used to treat disorders in which they have no efficacy, such as the common cold or other viral complaints, and when they are used broadly as prophylaxis rather than treatment as in, for example, animal feeds, because this exposes more bacteria to selection for resistance. Resistance modifying agents One solution to combat resistance currently being researched is the development of pharmaceutical compounds that would revert multiple antibiotic resistance. These so called resistance modifying agents may target and inhibit MDR mechanisms, rendering the bacteria susceptible to antibiotics to which they were previously resistant. These compounds targets include among others Efflux inhibitionPhe-Arg-β-naphthylamide20 Beta Lactamase inhibitors - Including Clavulanic acid and Sulbactam Beyond antibiotics The comparative ease of identifying compounds which safely cured bacterial infections was more difficult to duplicate in treatments of fungal and viral infections. Antibiotic research led to great strides in the knowledge of biochemistry, establishing large differences between the cellular and molecular physiology of the bacterial cell and that of the mammalian cell. This explained the observation that many compounds that are toxic to bacteria are non-toxic to human cells. In contrast, the basic biochemistries of the fungal cell and the mammalian cell are much more similar. This restricts the development and use of therapeutic compounds that attack a fungal cell, while not harming mammalian cells. Similar problems exist in antibiotic treatments of viral diseases. Human viral metabolic biochemistry is very closely similar to human biochemistry, and the possible targets of antiviral compounds are restricted to very few components unique to a mammalian virus. Research into bacteriophages for use as antibiotics is presently ongoing. Several types of bacteriophage appear to exist that are specific for each bacterial taxonomic group or species.citation needed Research into bacteriophages for medicinal use is just beginning, but has led to advances in microscopic imaging.21 While bacteriophages provide a possible solution to the problem of antibiotic resistance, there is no clinical evidence yet that they can be deployed as therapeutic agents to cure disease.citation needed Phage therapy has been used in the past on humans in the US and Europe during the 1920s and 1930s, but these treatments had mixed results. With the discovery of penicillin in the 1940s, Europe and the US changed therapeutic strategies to using antibiotics. However, in the former Soviet Union phage therapies continued to be studied. In the Republic of Georgia, the Eliava Institute of Bacteriophage, Microbiology Virology continues to research the use of phage therapy. Various companies and foundations in North America and Europe are currently researching phage therapies.citation needed However, phage are living and reproducing; concerns about genetic engineering in freely released viruses currently limit certain aspects of phage therapy. Bacteriocins are also a growing alternative to the classic small-molecule antibiotics 22. Different classes of bacteriocins have different potential as therapeutic agents. Small molecule bacteriocins microcins, for example, and lantibiotics may be similar to the classic antibiotics; colicin-like bacteriocins are more likely to be narrow-spectrum, demanding new molecular diagnostics prior to therapy but also not raising the spectre of resistance to the same degree. One drawback to the large molecule antibiotics is that they will have relative difficulty crossing membranes and travelling systemically throughout the body. For this reason, they are most often proposed for application topically or gastrointestinally23. Because bacteriocins are peptides, they are more readily engineered than small molecules24. This may permit the generation of cocktails and dynamically improved antibiotics that are modified to overcome resistance. Probiotics are another alternative that goes beyond traditional antibiotics by employing a live culture which may establish itself as a symbiont, competing, inhibiting, or simply interfering with colonization by pathogens. It may produce antibiotics or bacteriocins, essentially providing the drug in vivo and in situ, potentially avoiding the side effects of systemic administration. References ^ %3A1999.04.0057%3Aentry%3D%239779 Anti, Henry George Liddell, Robert Scott, A Greek-English Lexicon, at Perseus ^ Biotikos, Henry George Liddell, Robert Scott, A Greek-English Lexicon, at Perseus ^ Davey PG 2000. Antimicrobial chemotherapy, in Ledingham JGG, Warrell DA: Concise Oxford Textbook of Medicine. Oxford: Oxford University Press, 1475. ISBN 0192628704. ^ How Products Are Made: Antibiotics ^ http://en.wiktionary.org/wiki/antibiosis ^ H. Landsberg 1949. Prelude to the discovery of penicillin. Isis 40 3: 225-227.. doi:10.1086/349043. ^ a b Van Epps HL 2006. René Dubos: unearthing antibiotics. J. Exp. Med. 203 2: 259. PMID 16528813. ^ Pelczar, M.J., Chan, E.C.S. and Krieg, N.R. 1999 Host-Parasite Interaction; Nonspecific Host Resistance, In: Microbiology Conceptsand Applications, 6th ed., McGraw-Hill Inc., New York, U.S.A. pp. 478-479. ^ Exploding the urban myth: alcohol and antibiotics. Yahoo answers. Retrieved on 2008-02-17. ^ Antibiotics FAQ. McGill University, Canada. Retrieved on 2008-02-17. ^ Can I drink alcohol while taking antibiotics?. NHS Direct UK electronic health service. Retrieved on 2008-02-17. ^ University of Michigan Health System: Antibiotic-Associated Diarrhea, November 26, 2006 ^ Pirotta MV, Garland SM 2006. Genital Candida species detected in samples from women in Melbourne, Australia, before and after treatment with antibiotics. J Clin Microbiol. 44: 3213-3217. doi:10.1128/JCM.00218-06. PMID 16954250. ^ Drugs Affecting Birth Control Pills. Retrieved on 2008-02-17. ^ Antibiotic and birth control. Yahoo answers. Retrieved on 2008-02-17. ^ Mellon, M et al. 2001 Hogging It!: Estimates of Antimicrobial Abuse in Livestock, 1st ed. Cambridge, MA: Union of Concerned Scientists. ^ Ong S, Nakase J, Moran GJ, Karras DJ, Kuehnert MJ, Talan DA 2007. Antibiotic use for emergency department patients with upper respiratory infections: prescribing practices, patient expectations, and patient satisfaction. Annals of emergency medicine 50 3: 213-20. doi:10.1016/j.annemergmed.2007.03.026. PMID 17467120. ^ Metlay JP, Camargo CA, MacKenzie T, et al 2007. Cluster-randomized trial to improve antibiotic use for adults with acute respiratory infections treated in emergency departments. Annals of emergency medicine 50 3: 221-30. doi:10.1016/j.annemergmed.2007.03.022. PMID 17509729. ^ Spurling G, Del Mar C, Dooley L, Foxlee R 2007. Delayed antibiotics for respiratory infections. Cochrane database of systematic reviews Online 3: CD004417. doi:10.1002/14651858.CD004417.pub3. PMID 17636757. ^ B. Marquez. 2005. Bacterial efflux systems and efflux pumps inhibitors. Biochimie87 1137-1147 ^ Purdue University Biologists build better software, beat path to viral knowledge, see Imaging of Epsilon 15, a virus that infects the bacterium Salmonella News report ^ Gillor O, Kirkup BC, Riley MA 2004. Colicins and microcins: the next generation antimicrobials. Adv. Appl. Microbiol. 54: 129-46. doi:10.1016/S0065-21640454005-4. PMID 15251279. ^ Kirkup BC 2006. Bacteriocins as oral and gastrointestinal antibiotics: theoretical considerations, applied research, and practical applications. Curr. Med. Chem. 13 27: 3335-50. PMID 17168847. ^ Gillor O, Nigro LM, Riley MA 2005. Genetically engineered bacteriocins and their potential as the next generation of antimicrobials. Curr. Pharm. Des. 11 8: 1067-75. PMID 15777256. External links Wikimedia Commons has media related to: Antibiotics Antibiotic News from Genome News Network GNN JAAPA: New antibiotics useful in primary care A new method for controlling bacterial activity without antibiotics - Research conducted at the Hebrew University BURDEN of Resistance and Disease in European Nations Antibiogram technique video European Surveillance of Antimicrobial Consumption ESAC Resources Bacteria Tower Defense - Antibiotic Coverage Resource and Game Alliance for the Prudent Use of Antibiotics v d e Antibacterials for systemic use: protein synthesis inhibitors 30S - tetracycline antibiotics J01A Tetracyclines Chlortetracycline Clomocycline Demeclocycline Doxycycline Lymecycline Meclocycline Metacycline Minocycline Oxytetracycline Penimepicycline Rolitetracycline Tetracycline Glycylcyclines Tigecycline v d e Antibacterials for systemic use: protein synthesis inhibitors 50S - amphenicols J01B Chloramphenicol - Thiamphenicol - Florfenicol v d e Antibacterials for systemic use: cell wall disruption - beta-lactam antibiotics J01C-J01D Penicillins Amoxicillin · Ampicillin · Azlocillin · Bacampicillin · Carbenicillin · Carindacillin · Cloxacillin · Dicloxacillin · Epicillin · Flucloxacillin · Metampicillin · Mezlocillin · Nafcillin · Piperacillin · Pivampicillin · Sulbenicillin · Ticarcillin Cephalosporins 1st generation PeCK Cefacetrile · Cefadroxil · Cefalexin · Cefaloglycin · Cefalonium · Cefaloridine · Cefalotin · Cefapirin · Cefatrizine · Cefazedone · Cefazaflur · Cefazolin · Cefradine · Cefroxadine · Ceftezole 2nd generation HEN Cefaclor · Cefamandole · Cefmetazole · Cefminox · Cefonicid · Ceforanide · Cefotiam · Cefprozil · Cefbuperazone · Cefuroxime · Cefuzonam 3rd generation Cefcapene · Cefdaloxime · Cefdinir · Cefditoren · Cefetamet · Cefixime · Cefmenoxime · Cefodizime · Cefoperazone · Cefotaxime · Cefpimizole · Cefpiramide · Cefpodoxime · Cefsulodin · Ceftazidime · Cefteram · Ceftibuten · Ceftiolene · Ceftizoxime · Ceftriaxone · Flomoxef · Latamoxef 4th generation Cefepime · Cefozopran · Cefpirome · Cefquinome 5th generation Ceftobiprole Monobactams Aztreonam Carbapenems Parenteral: Biapenem · Doripenem · Ertapenem · Imipenem · Meropenem · Panipenem Oral: Faropenem Beta-lactamase inhibitors Sulbactam · Tazobactam · Clavulanic acid Combinations Ampicillin/sulbactam Sultamicillin · Co-amoxiclav v d e Antibacterials for systemic use: cell wall disruption - beta-lactam antibiotics J01C-J01D Penicillins Amoxicillin · Ampicillin · Azlocillin · Bacampicillin · Carbenicillin · Carindacillin · Cloxacillin · Dicloxacillin · Epicillin · Flucloxacillin · Metampicillin · Mezlocillin · Nafcillin · Piperacillin · Pivampicillin · Sulbenicillin · Ticarcillin Cephalosporins 1st generation PeCK Cefacetrile · Cefadroxil · Cefalexin · Cefaloglycin · Cefalonium · Cefaloridine · Cefalotin · Cefapirin · Cefatrizine · Cefazedone · Cefazaflur · Cefazolin · Cefradine · Cefroxadine · Ceftezole 2nd generation HEN Cefaclor · Cefamandole · Cefmetazole · Cefminox · Cefonicid · Ceforanide · Cefotiam · Cefprozil · Cefbuperazone · Cefuroxime · Cefuzonam 3rd generation Cefcapene · Cefdaloxime · Cefdinir · Cefditoren · Cefetamet · Cefixime · Cefmenoxime · Cefodizime · Cefoperazone · Cefotaxime · Cefpimizole · Cefpiramide · Cefpodoxime · Cefsulodin · Ceftazidime · Cefteram · Ceftibuten · Ceftiolene · Ceftizoxime · Ceftriaxone · Flomoxef · Latamoxef 4th generation Cefepime · Cefozopran · Cefpirome · Cefquinome 5th generation Ceftobiprole Monobactams Aztreonam Carbapenems Parenteral: Biapenem · Doripenem · Ertapenem · Imipenem · Meropenem · Panipenem Oral: Faropenem Beta-lactamase inhibitors Sulbactam · Tazobactam · Clavulanic acid Combinations Ampicillin/sulbactam Sultamicillin · Co-amoxiclav v d e Antibacterials for systemic use: antifolates - sulfonamides sulfa drugs and trimethoprim J01E Trimethoprim and derivatives Trimethoprim Brodimoprim Sulfonamides Short-acting Sulfaisodimidine Sulfamethizole Sulfadimidine Sulfapyridine Sulfafurazole Sulfanilamide Sulfathiazole Sulfathiourea Intermediate-acting Sulfamethoxazole Sulfadiazine Sulfamoxole Long-acting Sulfadimethoxine Sulfalene Sulfametomidine Sulfametoxydiazine Sulfamethoxypyridazine Sulfaperin Sulfamerazine Sulfaphenazole Sulfamazon Combinations Sulfamethoxazole and trimethoprim Other Mafenide Prontosil Sulfacetamide Sulfasalazine Sulfisoxazole v d e Antibacterials for systemic use: protein synthesis inhibitors 50S - macrolides, lincosamides and streptogramins J01F Macrolides Erythromycin - Spiramycin - Midecamycin - Oleandomycin - Roxithromycin - Josamycin - Troleandomycin - Clarithromycin - Azithromycin - Miocamycin - Rokitamycin - Dirithromycin - Flurithromycin - Telithromycin - Cethromycin Lincosamides Clindamycin - Lincomycin Streptogramins Pristinamycin - Quinupristin/dalfopristin v d e Antibacterials for systemic use: protein synthesis inhibitor 30S - aminoglycosides J01G -mycin Streptomyces Streptomycin Neomycin Framycetin, Paromomycin, Ribostamycin Kanamycin Amikacin, Dibekacin, Tobramycin Hygromycin B Spectinomycin -micin Micromonospora Gentamicin Netilmicin, Sisomicin, Isepamicin Verdamicin v d e Antibacterials for systemic use: topoisomerase inhibitors - quinolones J01M 1st generation Cinoxacin Flumequine§ Nalidixic acid Oxolinic acid Pipemidic acid Piromidic acid Rosoxacin Fluoroquinolones 2nd generation Ciprofloxacin Enoxacin Fleroxacin‡ Lomefloxacin Nadifloxacin Ofloxacin Norfloxacin Pefloxacin Rufloxacin 3rd generation Balofloxacin Grepafloxacin‡ Levofloxacin Pazufloxacin Sparfloxacin Temafloxacin‡ Tosufloxacin 4th generation Clinafloxacin†Garenoxacin Gemifloxacin Moxifloxacin Gatifloxacin Sitafloxacin Trovafloxacin‡/Alatrofloxacin‡ Prulifloxacin Veterinary Danofloxacin§ Difloxacin§ Enrofloxacin§ Ibafloxacin§ Marbofloxacin§ Orbifloxacin§ Pradofloxacin§ Sarafloxacin§ †Undergoing clinical trials. ‡ Withdrawn from market. § Veterinary use medications. v d e Antibacterials for systemic use: others J01X Cell wall disruption Glycopeptide Vancomycin Oritavancin, Telavancin - Teicoplanin Dalbavancin - Ramoplanin Polymyxins Colistin - Polymyxin B -mycin Fosfomycin - Daptomycin - Hitachimycin Protein synthesis inhibitors Steroid antibacterials Fusidic acid Other Linezolid Nucleic acid inhibitors Imidazole derivatives Metronidazole - Tinidazole - Ornidazole Nitrofuran derivatives Nitrofurantoin - Nifurtoinol Other/ungrouped Other Xibornol - Clofoctol - Methenamine - Iclaprim - Mandelic acid - Nitroxoline - Spectinomycin - Mupirocin v d e Major drug groups Gastrointestinal tract/metabolism A stomach acid Antacids, H2 antagonists, Proton pump inhibitors Antiemetics Laxatives Antidiarrhoeals/Antipropulsives Anti-obesity drugs Anti-diabetics Vitamins Dietary minerals Blood and blood forming organs B Antithrombotics Anticoagulants, Antiplatelets, Thrombolytics Antihemorrhagics Cardiovascular system C cardiac therapy/antianginals Cardiac glycosides, Antiarrhythmics, Cardiac stimulant Antihypertensives Diuretics Vasodilators Beta blockers renin-angiotensin system ACE inhibitors, Angiotensin II receptor antagonists, Renin inhibitors Antihyperlipidemics Skin D Emollients Cicatrizant Antipruritics Reproductive system G Hormonal contraception Fertility agents SERMs Sex hormones Endocrine system H Corticosteroids Sex hormones Thyroid hormones Antithyroid agent Infections and infestations J, P Antibiotics Antivirals Vaccines Antifungals Antiparasitic Antiprotozoals, Anthelmintics Malignant and immune disease L Anticancer agents Immunostimulators Immunosuppressants Muscles, bones, and joints M Anabolic steroids Anti-inflammatories NSAID Antirheumatics Corticosteroids Muscle relaxants Brain and nervous system N Anesthetics General, Local Analgesics Anticonvulsants Mood stabilizers Psycholeptic Anxiolytics, Antipsychotics, Hypnotics/Sedatives Psychoanaleptic Antidepressants, Stimulants/Psychostimulants Respiratory system R Bronchodilators Decongestants H1 antagonists Other ATC V Antidotes Contrast media Radiopharmaceuticals Dressing Retrieved from http://en..org/wiki/Antibiotic Categories: Antibiotics | Greek loanwordsHidden categories: Cleanup from July 2008 | All pages needing cleanup | Articles that may contain original research since March 2008 | All articles with statements | Articles with statements since April 2007 | Articles with statements since May 2007 | Articles with statements since January 2008 | Articles with statements since March 2008 Views Article Discussion this page History Personal tools Log in / create account Navigation Main page Contents Featured content Current events Random article Search Go Search Interaction Community portal Recent changes Contact Donate to Help Toolbox What links here Related changes Upload file Special pages Printable version Permanent link Cite this page Languages Afrikaans العربية বাংলা Bosanski БългарÑ?ки Català Česky Dansk Deutsch Ελληνικά Español Esperanto Ù?ارسی Føroyskt Français Galego í•œêµì–´ Hrvatski Ido Bahasa Indonesia Ã?slenska Italiano עברית Lietuvių Magyar Bahasa Melayu Nederlands 日本語 ‪Norsk bokmÃ¥l‬ ‪Norsk nynorsk‬ Polski Português Română Runa Simi РуÑ?Ñ?кий Simple English SlovenÄ?ina SlovenÅ¡Ä?ina СрпÑ?ки / Srpski Suomi Svenska ไทย Tiếng Việt Türkçe УкраїнÑ?ька اردو ייִדיש ä¸æ–‡ This page was last modified on 20 August 2008, at 14:21
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