Professional Documents
Culture Documents
Jagir R. Patel
Assistant Professor
Dept. Pharmacology
Correlation between AMAs, Host
and Microbes
What influences the choice of AMAs
Activity of agent against proven or suspected organism
Site of infection
Mode of administration
Metabolism and excretion
Duration of treatment
frequency of dose
Toxicity
cost
Local rates of resistance
Empiric Therapy
Empiric therapy is when drug therapy is initiated before
laboratory results are available (i.e., before the pathogen is
identified and/or before susceptibility test results are
available).
Empiric therapy is sometimes necessary to save a
patient’s life.
Clinicians make an “educated guess” based on past
experience with the type of infectious disease and the most
effective drugs.
•Clinicians must take a number of factors into
consideration before prescribing antimicrobial agents.
Selection of Appropriate AMA
Patient related factors
Cont.…
Organism related considerations
Drug factors
Cont..
Combined use
of
Antimicrobials
Chemotherapeutic spectrum
Narrow spectrum antibiotics:
Chemotherapeutic agents acting only on
limited group of microorganisms are said to
have narrow spectrum.E.g.,isoniazid is active
only against mycobacteria.
organisms
Tetracycline and chloramphenicol
those with HIV infection, those who are undergoing chemotherapy for
cancer, or those who are receiving immunosuppressive therapy after organ
transplant
Cont.…
Antimicrobial prophylaxis to prevent transmission of communicable
Why?
Due to development of resistance
Or more complex disease conditions
Combined Drugs targets
To achieve synergism, additive or antagonistic effect
Antagonism(A+B)<A+B
Concept of synergism
It may manifest in terms of decrease in the MIC of one AMA in presence of other or
This may also manifest as more rapid lethal action of combination then either of
individual
Cont.…
synergistic interaction, then the addition
of Drug B to Drug A results in a
significantly lower MIC for Drug A (i.e.,
there is an increase in the potency of
Drug A)
Additive interaction, addition of
increasing amounts of Drug B to Drug A
results in a linear decrease in the MIC of
Drug A; in this case, each of the two
drugs can be thought of as
interchangeable
Antagonistic interaction, addition of
Drug B to Drug A does not significantly
lower the MIC of Drug A;
Cont.…
Each combination is unique: the same drugs be synergistic for one organism
Rifampicin+ isoniazid
Combination of bacteriostatic + bactericidal = synergistic or antagonistic
This is needed for AMA with low dose safety margin which when alone
diagnosis is not known drugs covering gram –ve and +ve may be given
together e.g. penicillins + streptomycin
Topically : AMA which are not used systemically are poorly absorbed from
local site so broad range for grm +ve and –ve should be used e.e neomycin,
bacitracin
Disadvantages of antimicrobial
combinations
They foster a casual rather than rational outlooks in diagnosis of
infection and choice of AMA
Chances of superinfection