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CH19 11/28/2012 13:31:2 Page 196 FFIRS 11/29/2012 9:57:41 Page 1 Essential Microbiology for Pharmacy and Pharmaceutical Science FFIRS 11/29/2012 9:57:41 Page 2 Companion website This book is accompanied by a companion website at: www.wiley.com/go/hanlon/essentialmicrobiology Visit the website for: • Figures and tables from the book • Interactive multiple choice questions • Links to more detailed reference sources, both printed and electronic FFIRS 11/29/2012 9:57:41 Page 3 Essential Microbiology for Pharmacy and Pharmaceutical Science Geoffrey Hanlon and Norman Hodges School of Pharmacy and Biomolecular Sciences, University of Brighton, UK FFIRS 11/29/2012 9:57:42 Page 4 This edition first published 2013 # 2013 by John Wiley & Sons, Ltd Wiley-Blackwell is an imprint of John Wiley & Sons, formed by the merger of Wiley’s global Scientific, Technical and Medical business with Blackwell Publishing. 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If professional advice or other expert assistance is required, the services of a competent professional should be sought. Library of Congress Cataloging-in-Publication Data Hanlon, Geoff. Essential Microbiology for Pharmacy and Pharmaceutical Science / Geoff Hanlon and Norman Hodges. p. ; cm. Includes bibliographical references and index. ISBN 978-0-470-66532-9 (cloth) – ISBN 978-0-470-66534-3 (pbk.) I. Hodges, Norman A. II. Title. [DNLM: 1. Microbiological Phenomena. 2. Anti-Infective Agents–pharmacology. 3. Infection–drug therapy. 4. Infection–microbiology. 5. Pharmaceutical Preparations. 6. Pharmacological Phenomena. QW 4] 0 615.7 92–dc23 2012027340 A catalogue record for this book is available from the British Library. Wiley also publishes its books in a variety of electronic formats. Some content that appears in print may not be available in electronic books. Set in 10/12pt Times by Thomson Digital, Noida, India First Impression 2013 FTOC 11/28/2012 14:18:2 Page 5 Contents Preface vii Part I Characteristics of microorganisms Chapter 1 The microbial world 3 Chapter 2 Handling and growing microorganisms 11 Chapter 3 Bacterial structure and function 21 Chapter 4 Mycology: the study of fungi 33 Chapter 5 Protozoa 43 Chapter 6 Viruses and viral infections 49 Chapter 7 Characteristics of other microorganisms and infectious agents 57 Part II Microorganisms and the treatment of infections Chapter 8 Infection and immunity 65 Chapter 9 The selection and use of antibiotics 79 Chapter 10 Antibacterial antibiotics 87 Chapter 11 Antifungal agents 95 Chapter 12 Antiviral agents 103 Chapter 13 Antibiotic resistance 117 Chapter 14 Antibiotic stewardship 127 Part III Microorganisms and the manufacture of medicines Chapter 15 Bioburdens: counting, detecting and identifying microorganisms 137 Chapter 16 Antiseptics, disinfectants and preservatives 149 Chapter 17 The manufacture of medicines: product contamination and preservation 161 Chapter 18 The design of sterilization processes 175 Chapter 19 Sterilization methods 183 Chapter 20 The use of microorganisms in the manufacture of medicines 197 Index 209 v FTOC 11/28/2012 14:18:2 Page 6 FPREF 11/28/2012 14:7:20 Page 7 Preface As a pharmaceutical scientist or practicing pharmacist, what do we need to know about microbiology? Whether you are studying for a degree in pharmacy or a related discipline such as pharmaceutical and chemical sciences, you are, first and foremost, pharmaceutical scientists and need to understand the main function of professionals working in this field. The pharmaceutical sciences are a very broad discipline encompassing The diagram above illustrates that pharmaceutical everything from the basic sciences to the social sci- microbiology touches on a number of major aspects in ences; however, the bottom line is that pharma- the production and use of medicines and we will briefly ceutical scientists are the only professionals with an deal with each of these in turn. intimate knowledge of the production and use of medicines. They are involved at every stage in the production of medicines – from drug discovery, prod- Production of medicines uct formulation and manufacture to regulatory control and quality assurance, while pharmacists are specifi- A large number of medicines and medical devices are cally involved in overseeing the safe and effective use of manufactured as sterile products – for example, injec- medicines in the community and in hospital. However, tions and infusions, eye drops and eye ointments, some regardless of where your specific expertise resides, it is dressings, catheters and cannulas. Going back in time, important to have a good knowledge of all stages in there were a number of horrific incidents where products the process. that had not been properly sterilized were given to With this in mind we now need to understand where patients, some of whom subsequently died. It is our pharmaceutical microbiology fits into the picture. responsibility as pharmaceutical scientists to understand vii FPREF 11/28/2012 14:7:20 Page 8 viii Preface the processes of sterilization and aseptic manufacture so the environment. From a patient perspective probably the that patients’ lives are not put at risk. most important role of the pharmacist is to understand the Even if a medicine is not a sterile product, there are still use of antibiotics – what they can do and what they can’t. requirements for it to be manufactured in such a way as to For instance, an antibiotic such as amoxicillin would be of restrict microbial contamination, and quality control pro- no use in treating a patient with a viral sore throat or a cedures including bioburden determination and environ- fungal lung infection. Indeed we need to go further and mental monitoring are pivotal to achieve this. Many understand why an antibacterial antibiotic such as ben- products, such as creams, lotions and liquid oral products, zylpenicillin would be ineffective in treating a patient with are opened and used on a number of separate occasions. In a Gram-negative bacteraemia. An increasingly important order to protect the product and the patient we need to issue and one that will play amajor part in the career of any incorporateantimicrobialpreservatives intothesemedicines pharmacist or pharmaceutical scientist is that of antibiotic and understand what influences their efficacy. resistance. Many of the antibiotics that we have come to While we spend a lot of time trying to eliminate rely upon are losing their usefulness as certain pathogens microorganisms from our environment and the products develop mechanisms to resist their effects. Some clinical we make, it should not be forgotten that they are also isolates of Pseudomonas aeruginosa, Acinetobacter bau- responsible for the production of a number of very useful mannii and Mycobacterium tuberculosis have been found materials. These include antibiotics, steroids, insulin and which are resistant to virtually all of the standard antibiotic other recombinant proteins, amino acids, organic acids, therapies. How these infections can be managed in the enzymes and polysaccharides. future requires a clear understanding of the basics of microbiology. Controlling microorganisms in the environment by Understanding infection the use of disinfectants and antiseptics has become increasingly crucial as we understand more about the It is not the role of a pharmaceutical scientist to diagnose role of microbes in infection. The use of alcohol gels in infections; that is the job of the clinician, but it is hospitals has become the norm and the public has important that we have a clear understanding of viral, become more aware of the importance of disinfection fungal and bacterial diseases. The reason this is important around the home. Disinfectants are the main tool in deep is because it critically influences the choice of medication cleaning procedures applied following outbreaks of infec- to be used in themanagement of the disease. Knowing the tions such as MRSA and Clostridium difficile in hospitals. characteristics of different pathogens, the diseases they Pharmacists will play a role in implementing these strat- cause and the most suitable management protocols is egies and will need to be in a position to provide advice critical for our role in the infection control team. Part of on all of these scenarios. our daily professional routine may be to discuss treatment options with clinical colleagues and we have to be able to speak their language. The scope of this book We also need to understand how the body reacts to infectious agents so that we can advise patients on how to This book covers the microbiology content of the Royal deal with their symptoms. Many patients will present with Pharmaceutical Society’s syllabus for Pharmacy degrees minor conditions such as coughs and colds, skin infections, in the UK which is equally relevant to those studying the gastro-intestinal problems such as diarrhoea and vomiting pharmaceutical and chemical sciences. It is not intended andwe need to understandwhat is going on in order to give to give a comprehensive coverage of the whole subject but them the best advice. Moreover, we are seeing increasing instead to be an easily digestible outline of the most numbers of patients with compromised immune systems important features. If the reader requires further infor- and so it is necessary to understand why these are more mation on any of the subjects, the website associated with susceptible to infection and how this might be managed. this book gives examples of where this may be found, and in addition it contains a range of multiple choice ques- Control of microbes tions to allow a reader to check their understanding of the material. An understanding of the control of microbes is relevant in terms of patient treatment and also control of microbes in Geoffrey Hanlon and Norman Hodges