principles of antimicrobial therapy. antimicrobial therapy takes advantage of biochemical...
TRANSCRIPT
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PRINCIPLES OF ANTIMICROBIAL THERAPY
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ANTIMICROBIAL THERAPY TAKES ADVANTAGE OF BIOCHEMICAL DIFFERENCES BETWEEN MICRO ORGANISMS AND HUMANS.
SELECTIVE TOXICITY RELATIVE RATHER THAN
ABSOLUTE.
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PRINCIPLES OF ANTIMICROBIAL THERAPY
SELECTION OF ANTIMICROBIAL AGENT
- Identity of organism & its sensitivity - Site of infection- Safety of agent- Patient factors- Cost of therapy
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Identity of organism Obtain sample prior to starting
therapy Microsopic examination Gram stain Culture media sensitivity
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Site of infection The blood brain barrier Choose drugs which are more lipid
soluble Low degree of protein binding Low molecular weight
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Safety of the agent Penicillins are among the least
toxic of the antibiotics Drugs such as chloramphenicol are
reserved for severe resistant cases
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Patient factors All conditions which can ,< immune
function have to be looked for Alcoholism, DM, malnutrition,
advanced age, HIV. Renal function– drugs which are
nephrotoxic are to be avoided Pregnancy Lactation Drugs like tetracyclines,
aminoglycosides are to be avoided. Age new born –avoid chloramphenicol ,
infants--tetracycline
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Emperic therapy prior to organism identification
Acutely ill patient Identification & sensitivity of organism
Selection of drug --Status of the patient- renal, hepatic.Pregnancy & lactation, age
-
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-Bacteriostatic-Bactericidal
SpectrumNarrow spectrum-- IsoniazidExtended spectrum-- ampicillinBroad spectrum– tetracycline,
chloramphenicol
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Minimum inhibitory concentration (MIC)
LOWEST concentration of the antibiotic which inhibits growth
To provide effective antimicrobial therapy the antibiotic concentration should be more than MIC
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Minimum bactericidal concentration Lowest concentration of
antimicrobial agent that results in a 99.999 percent decline in colony count.
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Combination of drugs used inMixed infectionsUnknown originResistant organisms Better to use bacteriostatic with
bacteriostatic, or bactericidal with bactericidal!
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Synergism between the actions of two or more drugs. Two bactericidal agents: Use a penicillin and an aminoglycoside. The increase in cell-wall permeability caused by the penicillin allows for easier access of the aminoglycoside.
To delay development of resistance. For the treatment of "mixed" infections.
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Drug resistance
Mainly byMutations of DNADNA transfer of drug resistanceModification of target sitesDecreased accumulationEnzymic inactivation
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Complications of antibiotic therapyHypersensitivity--- penicillin-urticaria, anaph
shokDirect toxicity---- aminoglycosideSuper infections SUPERINFECTIONS: Oral, GU, and GI
superinfections can occur with use of antibiotics. GI infections are most common. Intestinal Candidiasis: Fungal overgrowth
of the Candida secondary to giving an oral antibiotic and depleting intestinal flora. Add an antifungal drug to treat it.
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Staphylococcal Enterocolitis: Life-threatening infection with Staph Aureus as a result of antibiotics. To treat it: Stop the original antibiotic therapy. Start therapy with vancomycin or some other appropriate agent to fight Staph Aureus.
Pseudomembranous Colitis: Life-threatening infection of Clostridium Difficile secondary to antibiotic therapy. Stop the original antibiotic therapy.
Start therapy with vancomycin and/or metronidazole
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Prophylactic antibiotics
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prevention of streptococcal infections in patients with history of RHD
Prevention of TB in close relatives of patient
Prior to surgical procedures Prevent transmission of hiv from
mother to fetus.
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