ANTIMICROBIAL

AGENTS
• A person is normally able
to remain healthy and
resistant to infectious
microorganisms because
of the existence of certain
host defenses.

• These defenses take

various forms.
 • Microorganisms are
everywhere in both the
external environment
and many parts of the
internal environment of
our bodies.
• Every known major class
of microbes has member
organisms that can infect
humans.
This includes
bacteria,
viruses, fungi
and protozoa.
 ANTIMICROBIAL
AGENTS

- Are chemicals that eliminate

living microorganisms that
are pathogenic to the
patient.

- Is a substance which kills or

inhibits the growth of
microorganisms.
 GENERAL
PRINCIPLES
OF
ANTIBIOTIC
THERAPY
 ANTIBIOTIC drug
therapy should begin
with a clinical
assessment of the
patient to determine
whether he or she has
the common signs and
symptoms of infection.
• The antibiotic selected
is one that can best kill
the microorganisms
known to be the most
common causes of
infection.

• This is called empiric

therapy.
• Antibiotics are also given for
prophylaxis.

• For example, when patients are

scheduled to undergo a
procedure in which the
likelihood of dangerous microbial
contamination is high during or
after the procedure.

• Called as Prophylactic antibiotic

therapy.
 Selective toxicity

• The ability to affect

certain proteins or
enzyme systems that are
used by bacteria but not
by human cell.
• May act on the cells of
the invading organism in
several ways.
Spectrum of Activity

1. Narrow spectrum drugs

• Effective against only a

few microorganisms with
a very specific metabolic
enzyme.
 Spectrum of Activity
2. Broad spectrum drugs

• - Interfere with biochemical

reactions in many different
kinds of microorganisms,
making them useful in the
treatment of a wide variety
of infections.
Antimicrobial activity
(mode of action)

1. Bactericidal drug
• Cause the death of the
cells they affect (Kills)
Antimicrobial activity
2. Bacteriostatic drug
• They interfere with the
ability of the cells to
reproduce or divide but
does not kill them

* Several drugs are both

bactericidal & bacteriostatic.
 Resistance
• Many microorganisms that do
not use that system or process
are not affected by a particular
anti-infective drug.

• These organisms are said to

have a natural or intrinsic
RESISTANCE to that drug
Preventing Resistance
• Limit the use of antimicrobial
agents to the treatment of
specific pathogens known to be
sensitive to the drug being used.

• Drug dosage is important in

preventing the development of
resistance.
• *doses- High enough
• *duration- long enough
 Culture
• Identification of the infecting
pathogen through culture of a
tissue sample from the infected
area.

• Bacterial cultures are performed

in a laboratory, where a swab of
infected tissue is allowed to
grow on an agar plate.
 Sensitivity testing

• Experience influences
selection of the drug, based on
the presenting signs &
symptoms.

• Shows which drugs are capable

of controlling the particular
microorganism
Sensitivity testing

• Identify the causal

pathogen & the most
appropriate drug for
treating the infection.
Mechanism of Action
of Antibacterial drugs

1. Disrupts bacterial cell wall

synthesis.
2. Affect bacterial protein
synthesis
3. Inhibit bacterial DNA and RNA
synthesis.
4. Disrupts folic acid synthesis.
Side effects and Clinical
Implications

• Most common encountered

adverse effects are direct toxic
effects on the kidneys,
gastrointestinal tract(GI)tract,
& nervous system.
Hypersensitivity reactions &
superinfections also can occur.
 1. Kidney damage

Most frequently with To prevent any

drugs that are accumulation of the drug in
metabolized by the the kidney, patients should
kidneys & eliminated in also be well hydrated
the urine. throughout the course of
the drug therapy.
 2. Gastrointestinal toxicity
• Is very common with
many of the anti-
infectives.

• Direct toxic effects on

the cell lining of the GI
tract causing Nausea &
vomiting, stomach
upset or diarrhea.
 3. Neurotoxicity
• It damage or interfere
with the function of
nerve tissue, usually in
areas where drugs tend
to accumulate in high
concentrations.
• Dizziness, vertigo, loss
of hearing, blindness,
lethargy, changes in
reflexes.
 4. Hypersensitivity

• Allergic or
hypersensitivity
reactions occur in
many antimicrobial
agents
 5. Superinfections
• The use of anti-infectives
esp. broad spectrum anti-
infectives is destruction of
normal flora
• Once normal flora is
destroyed, opportunistic
pathogens have the
opportunity to invade
tissues & cause infections • Eg: vaginal or GI
yeast infections
 Nursing Implications
• Check the IM site for evidence of local abscess
& the IV site for phlebitis, rotate sites
• Teach the patient to continue the full course
of treatment
• Instruct to take the medication with a small
meal or snack to decrease GI effects.
• Frequent oral care & sucking ice chips or
sugar-less candy may relieve stomatitis
discomfort
 Nursing Implications
• Dose will be reduced with renal impairment
and decreased liver function
• Monitor renal, liver function studies and I&O
• Advise the patient to report difficulty
breathing, severe headache, severe diarrhea,
dizziness, weakness & superinfections