Chapter 8:

Anti-infective Agents

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Development of Anti-Infective Therapy
❖ 1920s
o Paul Ehrlich worked on developing a synthetic
chemical effective only against infection-causing cells
o Scientists discovered penicillin in a mold sample
❖ 1935
o The sulfonamides were introduced

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Therapeutic Action #1
❖ Interfere with biosynthesis of the bacterial cell wall
❖ Prevent the cells of the invading organism from using
substances essential to their growth and development
❖ Interfere with steps involved in protein synthesis

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Therapeutic Action #2
❖ Interfere with DNA synthesis
❖ Alter the permeability of the cell membrane to allow
essential cellular components to leak out

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Drug Therapy Across the Lifespan

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Anti-Infective Activity
❖ Anti-infectives vary in their effectiveness against invading
organisms.
❖ Some are selective – only effective for a few number of
organisms
❖ Bactericidal – kill the cell
❖ Bacteriostatic – prevent reproduction of the cell

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Narrow Spectrum vs. Broad Spectrum
❖ Narrow Spectrum of Activity
o Effective against only a few microorganisms with a
very specific metabolic pathway or enzyme
❖ Broad Spectrum of Activity
o Useful in treating a wide variety of infections

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Therapeutic action of Anti-Infective
Agents

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Human Immune Response
❖ Goal of anti-infective therapy is reduction of the
population of the invading organism.
❖ Drugs that would eliminate all traces of any invading
pathogen might be toxic to the host as well.
❖ Immune response is a complex process involving
chemical mediators, leukocytes, lymphocytes, antibodies,
and locally released enzymes and chemicals.

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Resistance
❖ Natural or acquired: Ability over time to adapt to an
anti-infective drug and produce cells that are no longer
affected by a particular drug.
❖ Anti- infectives act on specific enzyme system or
biological process, many microorganisms that do not act
on this system are not affected by this particular drug

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Acquired Resistance
❖ Microorganisms that were once sensitive to the particular
drug have begun to develop acquired resistance.
❖ This results in serious clinical problems.

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Ways Anti-Infective Agents Resistance
Develops
❖ Producing an enzyme that deactivates the antimicrobial
drug
❖ Changing cellular permeability to prevent the drug from
entering the cell
❖ Altering transport systems to exclude the drug from
active transport into the cell
❖ Altering binding sites on the membranes or ribosomes,
which then no longer accept the drug
❖ Producing a chemical that acts as an antagonist to the
drug

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Question #1
Which of the following has been found to be as important
as drug therapy when treating infections in the
immunosuppressed?
A. Maintaining standard precautions
B. Proper nutrition
C. Good hand washing
D. Exercise

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Answer to Question #1

B. Proper nutrition

Rationale: In helping these people (the

immunosuppressed) cope with infections, prevention of
infection and proper nutrition are often as important as
drug therapy.

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Preventing Resistance
❖ Limit the use of antimicrobial agents to the treatment of
specific pathogens sensitive to the drug being used
❖ Make sure doses are high enough, and the duration of
drug therapy long enough
❖ Be cautious about the indiscriminate use of
anti-infectives

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Factors Affecting Prescribing
Anti-Infective Agents
❖ Identification of the correct pathogen
❖ Selection of the right drug
o One that causes the least complications for that
particular patient
o One that is most effective against the pathogen
involved

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Problems With Treating Infections in
Immunosuppressed Patients

❖ Anti-infective drugs cannot totally eliminate the pathogen

without causing severe toxicity in the host.
❖ These patients do not have the immune response in place
to deal with even a few invading organisms.

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Identification of the Pathogen
❖ Identification of the infecting pathogen is done by culture
❖ A culture of a tissue sample from the infected area is
done
o A swab of infected tissue is allowed to grow on an
agar plate
o Staining techniques and microscopic examination
identify the bacterium
❖ Stool can be examined for ova and parasites

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Sensitivity of Pathogen
❖ Shows which drugs are capable of controlling the
particular microorganism
❖ Is important with microorganisms that have known
resistant strains
❖ Along with a culture, identifies the pathogen and
appropriate drug for treatment

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Combination Therapy
❖ Use of a smaller dosage of each drug
❖ Some drugs are synergistic
❖ In infections caused by more than one organism, each
pathogen may react to a different anti-infective agent
❖ Sometimes, the combined effects of the different drugs
delay the emergence of resistant strains

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Prophylaxis of Anti-Infective Agents
❖ People traveling to an area where malaria is endemic
❖ Patients who are undergoing GI or genitourinary surgery
❖ Patients with known cardiac valve disease, valve
replacements, and other conditions requiring invasive
procedures

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Adverse Reactions to Anti-Infective
Therapy

❖ Kidney Damage
❖ Gastrointestinal (GI) Tract Toxicity
❖ Neurotoxicity
❖ Hypersensitivity Reactions
❖ Superinfections

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Question #2
You are caring for a patient who has just been
diagnosed with a pseudomonas infection. You know that
in deciding what medication to order for this patient the
physician will take what into account?
A. The patient’s age
B. The patient’s gender
C. The drug that causes the least complication
D. The drug that has the longest half-life

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Answer to Question #2
C. The drug that causes the least complication

Rationale: Identification of the correct pathogen

Selection of the right drug
One that causes the least complications for that
particular patient
One that is most effective against the pathogen
involved

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