Professional Documents
Culture Documents
a.) Specificity -
AM activity should match that of the
infecting organism. Indiscriminate
use of broad spectrum antibiotics
promote AM resistance & encourage
opportunistic inf.s
CHEMOTHERAPY
( in absence of precise identification of
responsible microbe, best guess chemoth. of
broad spectrum most often be given )
-Simplest , least expensive & useful of all rapid methods
of identification – Gram stain can be used to identify
the presence of bacteria & its morphological feature .
Spectrum of cover should be narrowed
once the causative organism have
been identified .But it should be changed only
after adequate trial ( usually 3 days ) .
CHEMOTHERAPY
Bacterial Resistance –
Recent emergence of ABT. resist. in
CHEMOTHERAPY
bact. pathogen mostly in nosocomial
& community acquired inf.s is a very
serious develop. that threatens the
end of the ABT. era .
- More than 70% bact.s associated with
hospital acquired inf.s are resist. to
one or more drugs e.g.-
CHEMOTHERAPY
Neisseria .
(Penicil. resist. pneumococ. produces altered
penicil. binding proteins( PBPs) that have low
affinity binding to penicil.)
Conjugation :
It is the gene transfer (R-factor ) by
direct cell-to-cell contact through a
CHEMOTHERAPY
sex pilus or bridge . This is important
because multiple resist. genes can be
transferred in a single event . The
transferable genetic material consists
of two different sets of plasmid-
encoded genes that may be on the
same or different plasmids .
CHEMOTHERAPY
(The first set codes for the actual resist. & is
termed the R-determinant plasmid. The second
plasmid termed as the resist. transfer factor
(RTF ) , contains the Genes necessary for bact.
conjugation. Each of these two plasmids can
exist independently or they can combine to form
a complete R-factor which can be disseminated
by bact. Conjugation ). e.g. in GI tracts of
human beings (Vancomycin resist. in
Enterococci by conj. Plasmid .)
CHEMOTHERAPY
Other org.s which dev. resist. by this
method are Shigella , Salmonella
,V. cholerae , Pseud. aerugenosa
(R-factor transfer is usually multiple & resistance can
occur to as many as seven drugs , occurs mainly in
intestinal tract e.g. Penicillin , Tetracyclines,
Chloramph., Erythromycin , Aminoglycos.,
Sulphonamides & Fusidic acid .)
CHEMOTHERAPY
CHEMOTHERAPY
SUPERINFECTIONS :
All individuals who receive
therapeutic doses of antib. undergo
alterations in the normal microbial
population of the intest. , upper
resp. & genitourinary tracts, as a
result some develop superinfection ,
CHEMOTHERAPY
which defined as the appearance of
bacteriological & clinical evidence
of new infection during the
chemotherapy of a primary one. It
is common & dangerous because the
micro- org. responsible for the new
infection can be resistant strains of
Enterobacteriace , Pseudomonas
CHEMOTHERAPY
& Candida or other fungi . It is due to
the removal of the inhibitory influence
of the normal flora which produces
antibacterial subst.s (Bacitracins) &
compete for essential nutrients.
CHEMOTHERAPY
The broader the spectrum & longer
the duration of Tt. greater is the
alteration in the normal flora. e.g.-
Tetracyclines & Chloramphenicol
(therefore the most specific &
narrowest spect. AM. ags. should
be chosen for Tt.).
more common in immunocompromised host
CHEMOTHERAPY
Misuses of Antibiotics:
i) Treatment of non-responsive
inf.s:
proved by experimental & clinical
observations e.g.- diseases caused
by viral inf.s are self limit.& do not
respond to any of the anti-infect.
agents (measles ,mumps , 90% of
CHEMOTHERAPY
URTIs & many GI inf.s ) therefore
useless to treat with antibiotics .
ii) Therapy of fever of unknown
origin :
fever of undetermined cause may
persist for only a few days to a wk. ,
in the absence of localizing signs
,mostly assos. with viral inf. & AM
CHEMOTHERAPY
therapy is unnecessary .
Fever for two or more wks commonly
referred as a fever of unknown origin
& has a variety of causes ( only one
fourth are infectious) .Some may req.
Tt. with uncomm. anti bact. agents
e.g.- T.B. or fungal inf.
CHEMOTHERAPY
Occult absc. may req. drainage or
prolong pathogen sp. therap. e.g. inf.
endocarditis .
Non infective causes are reg. enteritis
,lymphoma ,hepatitis ,collagen vas.
disorder & drug fever , which does not
respond to AM therapy at all .
CHEMOTHERAPY
iii) Improper dosage :
Use of either an excessive or a sub-
therapeutic dose is common. Excess
amounts can cause toxicities e.g.-
seizures (penicil.) ,vestibular
damage & renal failure ( Amgl. ).Sub -
therp. dose causes Tt. failure & resist.
CHEMOTHERAPY
iv) Inappropriate reliance on chemth.
Inf. complicated by absc. formation ,
presence of necrotic tissue or foreign
body often can not be cured by AM
therapy alone ( surgical intervention
is necessary ).
CHEMOTHERAPY
v) Lack of adequate bacteriological
information :
In hospitalized pts AM therapy is
oftenly started without microbiolog.
data .
Frequent use of drugs or drug comb.s
CHEMOTHERAPY
with the broadest spectra is a cover for
diagnostic error . So bacteriological
information is a correct practice for
use of AM agents until otherwise
required (e.g.- in emergency
conditions & in cond.s where specific
therapy is needed ) .
1.Goodman & Gilman’s ,The
Pharmacological Basis of
Therapeutics (12th Edition).
2.Clinical Pharmacology by Lawrence
(Latest edition)
THANK YOU