April 3, 2007

 Announcement
o Case 4 is due in a week’s time
o Not the same extent as most of the other cases
Antimicrobials
 Reviewing the whole pathophysicological basis of antimicrobials
 Terms and Definitions
o Chemotherapy
 Any drug that’s going to get rid of the organism
o Antibiotic
 Anything that will inhibit the growth or kill the microorganisms
 Antimicrobial Spectrum
o Narrow spectrum – eg. Penicillin
o Broad spectrum – most freq. used b/c kills off so many species
 Most likely to cause superinfection
 Concentration and Time-Dependent Effects
o MIC
 Test that determines the in dose that will kill off the species
 Used to determine which species are susceptible to the drug and
which are not
o CDKR
 If give more will kill more species
 True with a great majority of antibiotics but NOT with penicillin
o PAE
 Drug has an effect against the organism even after drug removed
 Prolonged effect
o Ideal drug is one that has CDKR and PAE – b/c this is drug that only have
to give once a day and give in large dose and is safe
 Microbial Sensitivity
o All are basically similar
o Take a pool of bacteria
o Add different antibiotics
o Can gather a faint circle around it
o Determines which Ab has the strongest effect for that species
o Etest – taking an agar plate and instead of the plate with different drug,
trying to find the MIC of one drug
 Uses different concentrations
 Will see
o Peak conc. Has to be 2-4x – to get right conc.
 Microbial Resistance
o (1 in 1012) should be (1 in 1012)
o Mutations occur as they are dividing
o If give drug at point where already developed
o Mutations occur if:
 If don’t have strong enough dose of Ab - don’t stop Ab if your
child is feeling better
 On a course of Ab for a very long time
• Longer the Ab is around the longer the microbe has a
chance to mutate
o Transferable resistance
 One microbe can bass on resistance to another
 Bacteria can serve has reservoir for this resistance factor
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