Justine Mae R.

Gonzales, RMT
2
Interaction Between Drug and Host

SIDE EFFECTS
 treatment goes beyond the desired
effect

 problems that occur in addition to the

desired therapeutic effect
 Interaction Between Drug and Host

MAJOR SIDE EFFECTS OF DRUGS:

A. Toxicity to organs

B. Allergic responses to drugs

C. Suppression and alteration of the

microflora by antimicrobials
 A. Toxicity to organs
HEPATOTOXICITY
 chemical-driven liver damage
 responsible for 5% of all hospital
admissions and 50% of all
acute liver failures.

KIDNEY TOXICITY
 reduced energy output
 damage to the surface of cells
 Dehydration
 death of the tubes used by the kidney to eject wastes
or reabsorb nutrients
B. Allergic responses to drugs
DRUG ALLERGY
 are a group of symptoms caused by allergic reaction to a drug
(medication).
 Involves antibodies and memory lymphocyte
 more likely to develop with large doses and extended
exposure

DRUG INTOLERANCE/ SENSITIVITY

 milder, non-immune-mediated reaction
 Ex. TINNITUS after a normal dose of aspirin
 MOST COMMON DRUG ALLERGIES
Painkillers
 (called analgesics) such as codeine, morphine,
nonsteroidal anti-inflammatory drugs (NSAIDs, such as ibuprofen or
indomethacin), and aspirin

Antibiotics
 such as penicillin, sulfa drugs, and tetracycline

Antiseizure medications
 such as phenytoin (Dilantin) or carbamazepine (Tegretol)
8
 C. SUPPRESSION AND ALTERATION OF
THE MICROFLORA BY ANTIMICROBIALS
SUPERINFECTION
appearance of bacteriological and clinical evidence of new
infection during the chemotherapy of a primary one
Some causative organism of Superinfection:
1. Candida or fungal infection
2. Enterobacteriaceae (Shigella, Salmonella, Escherichia, Klebsiella)
3. Pseudomonas
4. Staphylococcus
10
 Considerations in
Selecting an
Antimicrobial Drug
Considerations in Selecting an Antimicrobial Drug

1. Identify the microorganism causing the

infection.
2. Test the microorganism’s susceptibility
(sensitivity) to various drugs in vitro
when indicated.
3. The overall medical condition of the
patient
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 Identifying the Agent
Identification of infectious agent
should be attempted as soon as
possible.
Specimens should be taken before
antimicrobials are initiated.

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 Testing for Drug Susceptibility
Minimum inhibitory concentration (MIC)

E-test diffusion

Kirby-Bauer disk diffusion test

14
Minimum inhibitory concentration
(MIC)
smallest concentration of drug that
visibly inhibits growth

a quantitative test to determine the LOWEST

CONCENTRATION of a specific antimicrobial
drug needed to prevent the growth of a given
organism in vitro.
16
Minimum bactericidal concentration
(MBC)

Is the lowest concentration of a

specific antimicrobial drug that kills
99.9% of cells of a given strain of
bacteria
E-test diffusion
KIRBY-BAUER DISK DIFFUSION
TEST
 KIRBY-BAUER METHOD
•known as the disk-diffusion method

•determines what treatment of antibiotics

should be used when treating an infection

•relies on the inhibition of bacterial growth

measured under standard conditions

•Mueller-Hinton agar is used

 STANDARDIZATION OF THE KIRBY-
BAUER METHOD:

1.Mueller-Hinton agar
 must also only be 4mm deep

2.The size of the inoculated organism

 using barium sulfate standards, McFarland standards
 McFarland standards are used as a reference
to adjust the turbidity of bacterial suspensions so
that the number of bacteria will be within a given
range.
PROCEDURE IN KIRBY-BAUER DIFFUSION TEST

1.Using a aseptic technique, place a sterile swab into the broth

culture of a specific organism and then gently remove excess
liquid by gently pressing the swab against the inside of the tube.
2.Using the swab, streak the Mueller-Hinton agar plate.  To obtain
uniform growth, streak the plate with the swab in one direction and
then rotate the plate 90° and streak the plate again in that
direction.  Repeat the rotation 3 times.  Allow the plate to dry for
approximately 5 minutes.
3. Antibiotic discs can be dispensed onto the agar using an
Antibiotic Disc Dispenser
4.Using flame-sterilized forceps, gently press each disc to the
agar to ensure that the disc is attached to the agar. 
5.Plates should be incubated overnight at an incubation
temperature of 37°.
 
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 The Therapeutic Index
MARGIN OF SAFETY
Best to chose a drug with HIGHEST LEVEL OF
SELECTIVITY BUT LOWEST LEVEL TOXICITY
 measured by therapeutic index – the ratio of the dose of the
drug that is toxic to humans as compared to its minimum
effective dose

High index is desirable.

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