Choice of antibiotics for prophylaxis

Benzylpenicillin should be used if Clostridium infection is a possibility Patients with heart valve disease or a prosthesis should be protected from bacteraemia caused by dental work, urethral instrumentation or viscus surgery

Principles in the use of antibiotics

Given in the ‘decisive period’, they are useful for prophylaxis Only spreading infection or signs of systemic infection justify the use of antibiotics Whenever possible, the organism and sensitivity should be determined

Treatment of commensals that have become opportunist pathogens

They are likely to have multiple antibiotic resistance It may be necessary to rotate antibiotics

Antibiotics & surgery

Pseudomonas infection is indicative criteria reflecting the hygiene of the hospital. Don’t use antibiotics in surgical infections unless it is spreading. In Abscesses after aspiration of the pus, and returning of G stain and C&S give the antibiotics accordingly ,when indicated.

 2.

2 Types of antibiotic regime Narrow spectrum (single ) for known microorganism .i.e. vancomycine for MRSA Combination for unknown microorganism For synergistic infection…..triple therapy

5.  

Natural like penicillin Synthetics …most

1. 2.

Bactericidal …. Penicillin. Cell wall Aminoglycoside.. Ribosome  Bacteriostatic…. Tetracycline, Erythromycine … Cell Division

G+ Strept. Clostridia Staph. (Non B_lactamase) Actinomyce Spp.

  

Orally Enterobacteriace D Strept.

Amoxicillin + Clavulanic Acid
  

Klebsiella E.coli Amoxicillin alone must be used for animal & human bites.





first-generation cephalosporins have excellent activity against methicillin-susceptible staphylococci and all streptococcal species, but not against enterococci.

three generations

The only important difference between members of the first generation is in half-life. Cefazolin, with its longer half-life, can be given every 8 hours rather than every 4 to 6 hours and maintains more reliable serum and tissue levels when used for prophylaxis than do the other members of this class.

2nd Generation
The second-generation cephalosporins have expanded gram-negative activity when compared with the first generation but still lack activity against many gram-negative rods.

The most important distinction within the second generation is between those antibiotics with good activity against anaerobes (cefoxitin, cefotetan, and cefmetazole) and those without important anaerobic activity (cefamandole, ceforanide, and cefonicid). Within each of these groups are antibiotics with relatively short half-lives (cefamandole and cefoxitin) and with relatively long half-lives (cefotetan, cefmetazole, ceforanide, and cefonicid).

The third-generation cephalosporins have greatly expanded activity against gram-negative rods, including many resistant strains, and rival the aminoglycosides in their coverage while having a much more favorable safety profile. In exchange for this gram-negative coverage, most members of this group have significantly less activity against staphylococci and streptococcal species than firstand second-generation cephalosporins. Anaerobic coverage is, generally, rather poor as well.

The third-generation cephalosporins

The important distinction in the third-generation cephalosporins is between those with significant activity against Pseudomonas species (cefoperazone and ceftazidime) and those without (cefotaxime, ceftizoxime, and ceftriaxone).


Monobactams. Aztreonam is the only currently available member of the class of monobactams. It has gram-negative coverage, including most Pseudomonas species, similar to the aminoglycosides, and like the aminoglycosides lacks significant activity against gram-positive cocci and anaerobes. It also lacks activity against most Acinetobacter species. It has the safety profile of other beta-lactam antibiotics but does not cross react in patients who are allergic to penicillins or cephalosporins.


Carbapenems. Imipenem is the first representative of the class of carbapenems. It has probably the broadest spectrum of antibacterial activity of any antibiotic currently available. It has excellent activity against all gram-positive cocci except for methicillin-resistant staphylococci and only modest activity against enterococci. It is very active against all anaerobic bacteria


The second carbapenem,, which is given without a renal enzyme inhibitor, has been released in Europe but not in the United States. Its spectrum of activity is similar to that of imipenem.


the fluoroquinolonesLIKE CIPRODAR ,CIP[ROFLOXACINE are marked by extremely broad activity against gram-negative rods, including Pseudomonas species. Most also have relatively broad activity against gram-positive cocci, including some methicillin-resistant staphylococci


aminoglycosides have very broad activity against aerobic and facultative gramnegative rods. They have relatively indifferent activity against gram-positive cocci but are an important component of synergistic therapy against enterococci when combined with a penicillin or vancomycin. Aminoglycosides have no activity against anaerobes or against facultative bacteria in an anaerobic environment.


Clinically, aminoglycosides are difficult to use because the ratio of therapeutic levels to toxic levels is low, approximately 2:3. The primary toxicities are nephro and eighth nerve damage, both auditory and vestibular


More recent data suggest that oncedaily administration of aminoglycosides is as effective as the more traditional twice or three times per day administration and is less toxic

Metronidazole currently possesses the most complete activity against all anaerobic pathogens. However, it has no activity against any aerobic or facultative pathogens, either gram negative or gram positive, so it must always be combined with another antibiotic for complete coverage.


. Because it has no activity against the gram-positive cocci, as clindamycin does, its combination with aztreonam in the treatment of mixed aerobic and anaerobic infections leaves this potentially important group of pathogens uncovered. For this

reason, metronidazole is theoretically better combined with a thirdgeneration cephalosporin or a fluoroquinolone. Metronidazole is active against Clostridium difficile


Macrolides. Erythromycin is a macrolide antibiotic with only modest antianaerobic activity in the concentrations that can be achieved systemically. It has found widespread use, however, as an oral agent (erythromycin base) used in combination with an aminoglycoside to reduce numbers of bacteria in the lumen of the bowel before operations on the colon

Erythromycin is also active against most gram-positive cocci and Neisseria species sometimes used as an alternate agent for patients allergic to penicillins. In addition, it has significant activity against mycoplasmas, Chlamydia, Legionella species, and Rickettsia.


Clarithromycin and azithromycin are two more recent macrolides with expanded antimicrobial spectra that are available only in oral formulation


. Tetracyclines have been an important class of antibiotics with significant antianaerobic activity. In addition to activity against anaerobes, tetracyclines possess modest activity against easy gramnegative rods and many grampositive cocci


Glycopeptides. Vancomycin is the only glycopeptide antibiotic available. It is active against essentially all gram-positive cocci, especially the methicillin-resistant staphylococci, for which it is the only reliable antibiotic. It also has moderate activity against enterococci.


Vancomycin is active against most Clostridium species, especially C. difficile, the primary pathogen responsible for antibiotic-associated diarrhea. However, it should not be used as a first-line agent against C. difficile diarrhea, owing to the risk that this will increase the incidence of vancomycin-resistant enterococci

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