ANTIMICROBIAL THERAPY

Pharmacists are deputized to be the advocates of antimicrobials.

OBJECTIVES
 Review the classification of antimicrobials.
 Define pharmacokinetic and pharmacodynamics principles and their relationship to
effective antimicrobial therapy.
 Review relevant microbiologic information as it relates to choosing an antimicrobial.
 Discuss patient and drug related factors that influence the selection of the appropriate
antimicrobial agent.
 Identify monitoring parameters to evaluate antimicrobial therapy.

ANTIMICROBIALS - are drugs that destroy microbes (such as bacteria, fungi, protozoa,
etc.), prevent their multiplication or growth, or prevent their
pathogenic action
- differ in physical, chemical and pharmacological properties
- differ in antibacterial spectrum of activity
- differ in their mechanism of action

CLASSIFICATION OF ANTIMICROBIALS
Inhibit cell wall synthesis Inhibit protein synthesis
- Cell wall is first defense followed by cell 1. Chloramphenicol
membrane 2. Tetracyclines
- Gram positive: cell wall + beta lactamase 3. Macrolides
- Gram negative: cell wall + beta lactamase 4. Clindamycin
1. Penicillins 5. Streptogramins (Quinupristin/Falfopristin)
2. Cephalosporins 6. Oxadolidones
3. Carbapenems 7. Aminoglycosides
4. Monobactams (Aztreonam)
5. Vancomycin Inhibit folate metabolism
1. Sulfamethozaxole
] synergism
Alter nucleic acid metabolism 2. Trimethoprim
1. Rifampicin
2. Quinolone

Miscellaneous
1. Metronidazole
2. Daptomycin

MORON, R. 1
SELECTING AN ANTIMICROBIAL

1. Confirm presence of infection

- most common presentation of infection: fever
- History and physical
- Signs and symptoms
 colds: caused by viral infections so give fluids
 infant ear pain: breastmilk goes to infant’s ears
 cough: if non-productive, it maybe because of allergy or heartburn
- Predisposing factors
 patient with HIV suddenly develops UTI and has clinical data of 10 pus cells per
urine: give antibiotics since patient has poor immunity

* Auxiliary temperature is not a reliable method of assessing body temperature.

Measuring the core temperature is the most accurate (rectal and tympanic temperature.

2. Identification of pathogen
- Collection of infected material
 stool with parasite: anthelminthic
 vaginal swab with Trichomonas: antiprotozoal
 skin smear with hyphae: antifungal
- Stains
 gram positive
 gram negative
- Serologies
 blood tests such as:
 RPR: blood test for syphilis (caused by vertical transmission; sexual
contact – spirochetes such as Treponema, Vibrio, and Leptospiro)
- Culture and sensitivity
 best method because it tells you what antibiotic is effective (through zones of
inhibition)

3. Selection of presumptive therapy

- Drug factors
 infected burn wounds on neck, face, and shoulder: give topical such as Mupirocin
instead of Silversulfadiazine (Flammazine) because it causes hyperpigmentation
of skins
- Host factors
 one patient has NSAID allergy: do not give penicillin

MORON, R. 2
 * Every medicine you dispense must be coupled with advice.

4. Monitor therapeutic response

- Clinical assessment
 Tell patients to take medications until you finish the prescribed regimen.
- Lab tests
- Assessment of therapeutic failure

* In antimicrobial stewardship, partial filling of antibiotic is not allowed. You have to dispense
all medications because the patient may not come back.
* Prescription is a property of the pharmacist. How would the patient know how to take the
medication if you got the prescription? Through patient counselling.
* If patient is deaf, put instructions on label.

MORON, R. 3