Burton's Microbiology for the Health Sciences, Enhanced Eleventh Edition

Chapter 9
Inhibiting the Growth of Pathogens In Vivo Using
Antimicrobial Agents
Learning Objectives
Chapter 9 serves as an introduction to antimicrobial agents—the drugs used to treat infectious
diseases. This chapter is considered to be a key chapter in the education of students of the health
care professions. Important topics discussed in Chapter 9 include how antimicrobial agents work,
bacterial drug resistance, “superbugs,” the role of physicians and patients in the war against drug
resistance, empiric therapy, and undesirable effects of antimicrobial agents.

Terms Introduced in This Chapter

After reading Chapter 9, you should be familiar with the following terms. These terms are
defined in Chapter 9 and in the Glossary.

Acquired resistance
Antagonism
Antibacterial agents
Antifungal agents
Antimicrobial agents
Antiprotozoal agents
Antiviral agents
-Lactam ring
-Lactamases
Broad-spectrum antibiotics
Cephalosporinase
Chemotherapeutic agent
Chemotherapy
Drug-binding site
Empiric therapy
Intrinsic resistance
Narrow-spectrum antibiotics
Penicillinase
Semisynthetic antibiotic
“Superbugs”
Superinfection
Synergism

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Review of Key Points

 A chemotherapeutic agent is any drug used to treat any condition or disease.

 The chemotherapeutic agents used to treat infectious diseases are collectively called
antimicrobial agents, some of which are antibiotics. Antimicrobial agents are often
referred to simply as “drugs.”
 Some antimicrobial agents are “-cidal” agents, meaning that they kill pathogens, whereas
others are “static” agents, meaning that they stop pathogens from growing and
multiplying.
 An antibiotic is a substance produced by a microorganism (usually a soil organism) that
is effective in killing or inhibiting the growth of other microorganisms.
 Some antibiotics (e.g., penicillins and cephalosporins) are produced by moulds, whereas
others (e.g., tetracycline, erythromycin, and chloramphenicol) are produced by bacteria.
 The first antibiotic to be discovered (penicillin) was accidentally discovered by
Alexander Fleming in 1928.
 Antibiotics are primarily antibacterial agents and are thus used to treat bacterial diseases.
 Narrow-spectrum antibiotics kill either Gram-positive or Gram-negative bacteria,
whereas broad-spectrum antibiotics kill both Gram-positives and Gram-negatives.
 When the use of two antimicrobial agents to treat an infectious disease produces a degree
of killing that is far greater than that achieved by either drug alone, the phenomenon is
known as synergism.
 When the use of two drugs produces an extent of pathogen killing that is less than that
achieved by either drug alone, the pnenomenon is known as antagonism.
 Antifungal and antiprotozoal drugs tend to be more toxic to the patient because, like the
infected human, fungi and protozoa are eukaryotic organisms.
 Although the term “superbug” most often refers to multidrug-resistant bacteria, other
types of microbes (e.g., viruses, fungi, and protozoa) have also become multidrug-
resistant.
 Bacteria can acquire resistance to antimicrobial agents as a result of chromosomal
mutation or the acquisition of new genes by transduction, by transformation, and, most
commonly, by conjugation.
 The most frequent ways by which bacteria become resistant to antimicrobial agents
include altering drug-binding sites, altering cell membrane permeability, developing the
ability to produce an enzyme that destroys or inactivates a drug, and developing
multidrug-resistance (MDR) pumps.
 MDR pumps are also known as MDR transporters or efflux pumps.
 A -lactam antibiotic is an antibiotic that contains a -lactam ring in its molecular
structure.
 -Lactamases are bacterial enzymes that destroy the -lactam ring in -lactam
antibiotics.
 Examples of -lactamases are penicillinases, cephalosporinases, and carbapenemases,
which destroy the -lactam ring in penicillins, cephalosporins, and carbapenems,
respectively. When the -lactam ring is destroyed, the drug no longer works.
 Bacteria that produce penicillinases are resistant to penicillins, those that produce

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cephalosporinases are resistant to cephalosporins and those that produce carbapenemases

are resistant to carbapenems. It is possible for an organism to produce all three resistance
factors.
 Empiric therapy is therapy that is initiated by a clinician before laboratory results are
available (i.e., before the clinician is informed of the specific pathogen that is causing the
patient’s infectious disease and before any antibiotic susceptibility test results are
available). Based on the patient’s signs, symptoms, and history, the clinician must
“guess” the most likely pathogen and the drug most likely to be effective. This is, of
course, an “educated guess,” based on the clinician’s prior experiences with similar
diseases.
 Adverse side effects of antimicrobial agents include selective pressure on microbial
populations (i.e., selecting for drug-resistant organisms); patients becoming allergic to the
agent; toxicity and damage to humans; and destruction of human indigenous microbiota
of the mouth, vagina, and intestine, leading to superinfections or increased susceptibility
to infectious diseases.

Increase Your Knowledge

1. Learn more about Alexander Fleming at:

https://www.nobelprize.org/nobel_prizes/medicine/laureates/1945/fleming-bio.html

2. Read about the history of antimicrobial agents at

https://en.wikipedia.org/wiki/Antibiotic

3. Learn more about how antibiotics work at:

ezinearticles.com/?Antibiotics-And-The-Mode-Of-Action&id=1193644

4. Read more about drug-resistant bacteria at

https://en.wikipedia.org/wiki/Antimicrobial_resistance

5. View the animation on antimicrobial resistance at the Food and Drug Administration’s
Web site (for slow connections, you can also view individual sections of the complete
animation):
www.fda.gov/AnimalVeterinary/SafetyHealth/AntimicrobialResistance/ucm134359.htm

6. See what the CDC has to say about antibiotic resistance at:
www.cdc.gov/getsmart/antibiotic-use/antibiotic-resistance-faqs.html

7. Learn more about drug resistance at

www.cdc.gov/drugresistance/

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Critical Thinking
1. Louis Pasteur once stated that “chance favors the prepared mind.” What did he mean by
that? What discovery, mentioned in this chapter, clearly illustrates Pasteur’s statement?

2. It has been stated that “when science builds a better mousetrap, nature builds a better
mouse.” How does that statement relate to drug-resistant bacteria?

3. A friend of yours is planning a trip to a country where diarrhea is commonly experienced

by visitors to that country. She asked her physician to prescribe an antibiotic to prevent
traveler’s diarrhea, and the physician complied. She has already started taking the drug,
and plans to take it throughout her trip. How would you explain to your friend that taking
the drug in this manner (i.e., prophylactically) is not a good idea?

4. A good friend of yours is a dairy farmer. He routinely uses antibiotic-containing cattle

feed to keep his cows from getting sick. How would you tactfully explain to him how this
practice is contributing to the problem of multidrug-resistant bacteria?

Additional Chapter 9 Self-Assessment Exercises

(Note: Do not peek at the answers before you attempt to solve these self-assessment exercises.)

Matching Questions
A. Bactrim and septra _____ 1. _______________ are examples of
B. Chloramphenicol, antibiotics that are produced by fungi.
erythromycin, and
tetracycline _____ 2. _______________ are in a class of drugs
C. Isoniazid, rifampin, known as penicillinase-resistant
pyrazinamide, ethambutol, penicillins.
and streptomycin
D. Methicillin, nafcillin, _____ 3. _______________ are examples of
oxacillin, and cloxacillin drugs that are used to treat tuberculosis.
E. Penicillin and cephalosporin
_____ 4. _______________ are examples of
drugs that inhibit protein synthesis.

_____ 5.
_______________ are examples of
drugs that could be destroyed by -
lactamases.
__________________________________________________________________________
A. a chemotherapeutic agent D. an antiviral agent
B. an antibiotic E. an antimicrobial agent
C. an antifungal agent

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_____ 1. Acyclovir is a substance produced by a

specifically used as
_______________.
_____ 2. _______________ is
any chemical or drug
that is used to treat
any disease or
medical condition.
_____ 3. _______________ is
microorganism that is effective in killing
or inhibiting the growth of another
species of microorganism.
_____ 4. Any drug used to treat an infectious
disease is called _______________.
_____ 5. Amphotericin B is specifically used as
_______________.

True/False Questions

_____ 1. Strains of Staphylococcus aureus known as MRSA are resistant to methicillin but
are susceptible to most other antibacterial agents.

_____ 2. Bacteria can develop resistance to a particular antimicrobial agent as a result of a

chromosomal mutation or the acquisition of a new gene.

_____ 3. A bacterial cell that receives an R-factor becomes multidrug resistant.

_____ 4. A “superinfection” is an infection that cannot be cured.

_____ 5. Using two different antimicrobial agents to treat a patient’s infection is referred to
as antagonism if the result that is achieved is much better than that which could
have been achieved using only one of the drugs.

_____ 6. Because he discovered penicillin, Alexander Fleming is often referred to as the

“Father of Chemotherapy.”

_____ 7. Bacteria can become drug resistant as a result of transduction, transformation, or

conjugation.

_____ 8. All antimicrobial agents are antibiotics.

_____ 9. Administering an antibiotic to a patient to treat one type of infectious disease

could actually cause other types of infectious diseases in that patient.

_____ 10. Bacteria that acquire the genes that code for an MDR pump become multidrug
resistant.

Answers to the Additional Chapter 9 Self-Assessment Exercises

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Matching Questions

1. E
2. D
3. C
4. B
5. E

1. D
2. A
3. B
4. E
5. C

True/False Questions

1. False (MRSA strains are resistant to most antimicrobial agents.)

2. True
3. True
4. False (A superinfection is not a disease; it is an overgrowth of organisms that are usually
present only in small numbers.)
5. False (This is known as synergism, not antagonism.)
6. False (Paul Ehrlich is often referred to as the “Father of Chemotherapy.”)
7. True
8. False (Some antimicrobial agents are antibiotics, but not all of them.)
9. True
10. True

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