Professional Documents
Culture Documents
PENICILLINS
Drugs used to treat infectious diseases constitute one of our most widely used families
of medicines.
- despite impressive advances, continued progress is needed = there are
organisms that respond poorly to
available drugs; there are effective drugs whose use is limited by toxicity;
there is the constant threat
that currently effective antibiotics will be rendered useless
Drug Clarification: chemotherapy – use of drugs to kill or suppress cancer cells; use of
chemicals against invading
organisms
antimicrobial drug – any agent, natural or synthetic, with the ability to kill
or suppress microorganisms
b. antifungal drugs
c. antiviral drugs
2. Classification of Mechanism of Action
• Inhibition of cell wall synthesis or activate enzymes that disrupt the
cell wall (penicillin, cephalosporin)
• Drugs that increase cell membrane permeability
• Drugs that cause lethal inhibition of bacterial protein synthesis
(aminoglycosides)
• drugs that cause non-lethal inhibition of protein synthesis
(tetracyclines)
• drugs that inhibit bacterial synthesis of nucleic acids
(fluroquinolones)
• Antimetabolites (sulpha)
• Inhibitors of viral enzymes (antivirals)
b. Get the Catheters Out – catheters and other invasive devises are the
leading exogenous cause
of nosocomial infections
- can occur in association with IV catheters, arterial catheters,
urinary tract catheters,
endotracheal tubes, and other devices
- catheters should be used only when essential for patient
care, and should be removed
as soon as they are no longer needed
f. Use Local Data – drug susceptibility of microbes varies over time and
according to locale,
patient population, and hospital unit
- compile data on drug susceptibility into an “antibiogram”,
providing an overview of
common local pathogens and their current pattern of
drug sensitivity
Prevent Transmission
k. Isolate the Pathogen – proper containment and disposal of
contagious body fluids
- reduces the risk of transferring resistant organisms from one
patient to another
- usually one drug of first choice may be preferred for several reasons, such as
greater efficacy, lower toxicity, or
more narrow spectrum
- conditions might rule out a first-choice agent, such as allergy to the drug of
choice, inability of the drug of
choice to penetrate to the site of infection, and unusual susceptibility of
the patient to toxicity of the first-
choice drug
A. EMPIRIC THERAPY PRIOR TO COMPLETION OF LABORATORY TESTS
- drug selection must be based on clinical evaluation and knowledge of
which microbes are most likely
to cause infection at a particular site
- broad-spectrum agent can be used for initial treatment; however, once
the identity and drug sensitivity
of the infecting organism have been determined, switch to a more
selective antibiotic
- essential that samples of exudates and body fluids be obtained for
culture prior to initiation of
treatment
- if antibiotics are present, these agents can suppress microbial
growth in culture and confound
identification
A. HOST DEFENSES
- consist primarily of the immune system and phagocytic cells
- drugs used to treat infections do not produce cure on their own
- they work in concert with host defense system to subdue infection
- objective of antibiotic treatment is not outright kill of infecting
organisms, rather to suppress
microbial growth to the point at which the balance is tipped in
favor of the host
- people whose defenses are impaired, such as those with AIDS and those
undergoing cancer
chemotherapy, frequently die from infections that drugs alone are
unable to control
B. SITE INFECTION
OF
- an antibiotic must be present at the site of infection in a concentration
greater than the MIC
- drug penetration may be hampered, making it difficult to achieve the MIC
- when pus and other fluids hinder drug access, surgical drainage is
indicated
- foreign materials (cardiac pacemakers, prosthetic joints) present a
special local problem
- when attempts are made to treat these infections, relapse and
failure are common
4. Decreased Toxicity
A. SURGERY
- antibiotics can decrease the incident of infection in certain kinds of
surgery, such as cardiac surgery,
peripheral vascular surgery, orthopedic surgery, and surgery on the
GI tract
- beneficial for women undergoing a hysterectomy or an emergency
cesarean section
- in “dirty” surgery (operations performed on perforated abdominal organs,
compound fractures, or
lacerations from animal bites), use of antibiotics is considered
treatment
- when given for prophylaxis, antibiotics should be administered before
surgery has begun and may
need to be readministered if the procedure is unusually long
B. BACTERIAL ENDOCARDITIS
- individuals with congenital or valvular heart disease and those with
prosthetic heart valves are
unusually susceptible to bacterial endocarditis
- endocarditis can develop following surgery, dental procedures, and other
procedures that may
dislodge bacteria into the bloodstream
C. IMPROPER DOSAGE
- if dosage is too low, the patient will be exposed to a risk of adverse
effects without benefit of
antibacterial effects
- if dosage is too high, the risks of suprainfection and adverse effects
become unnecessarily high
- lack of identification of the organism is the most common reason for
misdosing