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Introduction to Antimicrobials

Introduction to Antimicrobials. General Terms. Chemotherapy Antibiotic – substance produced by a microbe that may harm another microbes Antimicrobial – any agent that harms a Microbe Anti-infective – any agent that reduces or eliminates infection. Selective Toxicity.

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Introduction to Antimicrobials

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  1. Introduction to Antimicrobials

  2. General Terms • Chemotherapy • Antibiotic – substance produced by a microbe that may harm another microbes • Antimicrobial – any agent that harms a Microbe • Anti-infective – any agent that reduces or eliminates infection

  3. Selective Toxicity • Ability of an antibiotic to destroy target cells without damaging host cells • Differences between microbes and host • Prokaryotic vs Eukaryotic • Cell wall • Inhibition of microbial enzymes • Disruption of bacterial protein synthesis

  4. Antibiotic classifications • Narrow vs. Broad Spectrum • Susceptible organisms • Antibacterials • Antifungal • Antiviral • Classification by mechanism • Distinction: Bacteriocidal vs. Bacteriostatic

  5. Resistance • Relative resistance vs. True Resistance • MIC: Minimum inhibitory concentration • Mechanisms • Drug enzymes • Cease uptake of drug • Change in bacterial receptors • Synthesize drug antagonists • Acquisition • Spontaneuos mutation – single resistance • Conjugation –multiple drug resistance

  6. Factors that Influence Resistance • Use of broad vs. narrow spectrum • Suprainfection • CDC Twelve step program highlights • Immunize • IV’s out • ID consult • Contamination vs. infection • Colonization vs infection • Say no to vanco • Stop when infection is gone • Isolate the pathogen • Break the chain – wash your freaking hands

  7. Selection of Antibiotics • Considerations • Identification of microbe • Drug sensitivity of microbe • Host factors • Site of infection • Immune status • Empiric therapy

  8. Host Factors • Host defense (immune system, skin) • Site of infection • BBB, vascularity, heart valves, abcess • Age • Pregnancy & Lactation • Previous Allergic Reaction • Genetic

  9. Therapy • Dosage 4-8 x higher than MIC • Duration of therapy – relapse & resistance • Combinations • Additive • Potentiative (synergistic) • Antagonistic: bateriocidal + bacteriostatic

  10. Prophylaxis • Surgery • Bacterial endocarditis • Neutropenia • Other

  11. Attempted Tx of untreatable infection • “Concerned mother syndrome” • “Physician wants to appear to be doing something syndrome” • Tx of fever of unknown origin • Dosage too low • Tx in absence of adequate bacteriologic information • Omission of surgical drainage

  12. Monitoring Antibiotic Therapy • Fever • Resolution of S/S • Serum drug levels • Cultures

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