LAC16 PHARMACY DEP DR.

LABEEB
‫اﻟﻌﻼج اﻟﻜﻴﻤﻴﺎﺋﻲ ﻟﻠﻌﺪوى‬

Chemotherapy of infections
COMBINATIONS
Treatment with a single antimicrobial is sufficient for most infections.
The indications for use of two or more antimicrobials are:
• To avoid the development of drug resistance,
• To broaden the spectrum of antibacterial activity:
• To obtain potentiation (or 'synergy'),
‫ﻣﺸﺎﻛﻞ ﻣﻊ اﻷدوﻳﺔ اﻟﻤﻀﺎدة ﻟﻠﻤﻴﻜﺮوﺑﺎت‬
Problems with antimicrobial drugs
1-RESISTANCE
Mechanisms of resistance act as follows:
• Naturally resistant strains.
‫اﻟﺪﻣﺞ‬
.‫ﻛﺎف ﻟﻤﻌﻈﻢ أﻧﻮاع اﻟﻌﺪوى‬ٍ ‫اﻟﻌﻼج ﺑﻤﻀﺎد ﺟﺮﺛﻮﻣﻲ واﺣﺪ‬
:‫ﻣﺆﺷﺮات اﺳﺘﺨﺪام اﺛﻨﻴﻦ أو أﻛﺜﺮ ﻣﻦ ﻣﻀﺎدات اﻟﻤﻴﻜﺮوﺑﺎت ﻫﻲ‬
، ‫• ﻟﺘﺠﻨﺐ ﺗﻄﻮر ﻣﻘﺎوﻣﺔ اﻷدوﻳﺔ‬
:‫• ﻟﺘﻮﺳﻴﻊ ﻧﻄﺎق اﻟﻨﺸﺎط اﻟﻤﻀﺎد ﻟﻠﺒﻜﺘﻴﺮﻳﺎ‬
، ("‫• ﻟﻠﺤﺼﻮل ﻋﻠﻰ اﻟﺘﻘﻮﻳﺔ )أو "اﻟﺘﺂزر‬
‫ اﻟﻤﻘﺎوﻣﺔ‬-1
:‫آﻟﻴﺎت اﻟﻤﻘﺎوﻣﺔ ﺗﻌﻤﻞ ﻋﻠﻰ اﻟﻨﺤﻮ اﻟﺘﺎﻟﻲ‬
.‫• ﺳﻼﻻت ﻣﻘﺎوﻣﺔ ﺑﺸﻜﻞ ﻃﺒﻴﻌﻲ‬
.‫• اﻟﻄﻔﺮة اﻟﺘﻠﻘﺎﺋﻴﺔ‬
‫• اﻧﺘﻘﺎل اﻟﺠﻴﻨﺎت ﻣﻦ اﻟﻜﺎﺋﻨﺎت اﻟﺤﻴﺔ اﻷﺧﺮى‬

• Spontaneous mutation
• Transmission of genes from other organisms
Limitation of resistance to antimicrobials may be achieved by:
• ensuring that the indication, dose and duration of treatment are
appropriate
• Using antimicrobial combinations in appropriate circumstances,
• Constant monitoring of resistance patterns in ahospital or
community
• Restricting the use of the newest member of a group of
antimicrobials so long as the currently-used drugs are effective;
restricting use of a drug may become necessary where it promotes
theproliferation of resistant strains.
:‫ﻳﻤﻜﻦ اﻟﺤﺪ ﻣﻦ ﻣﻘﺎوﻣﺔ ﻣﻀﺎدات اﻟﻤﻴﻜﺮوﺑﺎت ﻣﻦ ﺧﻼل‬
‫• اﻟﺘﺄﻛﺪ ﻣﻦ أن اﻟﺒﻴﺎن واﻟﺠﺮﻋﺔ وﻣﺪة اﻟﻌﻼج ﻣﻨﺎﺳﺒﺔ‬
، ‫• اﺳﺘﺨﺪام ﻣﺠﻤﻮﻋﺎت ﻣﻀﺎدات اﻟﻤﻴﻜﺮوﺑﺎت ﻓﻲ اﻟﻈﺮوف اﻟﻤﻨﺎﺳﺒﺔ‬
‫• اﻟﻤﺮاﻗﺒﺔ اﻟﻤﺴﺘﻤﺮة ﻷﻧﻤﺎط اﻟﻤﻘﺎوﻣﺔ ﻓﻲ اﻟﻤﺴﺘﺸﻔﻰ أو اﻟﻤﺠﺘﻤﻊ‬
.‫ اﻷدوﻳﺔ اﻟﻤﺴﺘﺨﺪﻣﺔ ﻓﻌﺎﻟﺔ‬- ‫• ﺗﻘﻴﻴﺪ اﺳﺘﺨﺪام أﺣﺪث ﻋﻀﻮ ﻓﻲ ﻣﺠﻤﻮﻋﺔ ﻣﻀﺎدات اﻟﻤﻴﻜﺮوﺑﺎت ﻃﺎﻟﻤﺎ‬
.‫ﻗﺪ ﻳﺼﺒﺢ ﺗﻘﻴﻴﺪ اﺳﺘﺨﺪام اﻟﺪواء ﺿﺮورﻳً ﺎ ﺣﻴﺚ ﻳﻌﺰز اﻧﺘﺸﺎر اﻟﺴﻼﻻت اﻟﻤﻘﺎوﻣﺔ‬

1
 LAC16 PHARMACY DEP DR. LABEEB
‫اﻟﻔﺎﺋﻖ‬-2
‫ ﻋﺎدة ﻣﺎ ﻳﻜﻮن ﻫﻨﺎك ﻗﻤﻊ ﻟﺠﺰء ﻣﻦ اﻟﻔﻠﻮرا اﻟﺒﻜﺘﻴﺮﻳﺔ‬، ‫ﻋﻨﺪ اﺳﺘﺨﺪام أي دواء ﻣﻀﺎد ﻟﻠﻤﻴﻜﺮوﺑﺎت‬
‫ وﻟﻜﻦ ﻓﻲ‬، ‫ ﻻ ﻳﺴﺒﺐ ﻫﺬا أي آﺛﺎر ﺿﺎرة‬، ‫ ﻓﻲ ﻛﺜﻴﺮ ﻣﻦ اﻷﺣﻴﺎن‬.‫اﻟﻄﺒﻴﻌﻴﺔ ﻟﻠﻤﺮﻳﺾ اﻟﻤﻌﺮﺿﺔ ﻟﻠﺪواء‬
2-SUPERINFECTION .‫ إﻟﻰ ﺣﺪ ﻳﺴﻤﺢ ﺑﺎﻟﻌﺪوى‬، ‫ اﻟﻤﺘﺤﺮر ﻣﻦ اﻟﻤﻨﺎﻓﺴﺔ‬، ‫ﺑﻌﺾ اﻷﺣﻴﺎن ﻳﺘﻜﺎﺛﺮ اﻟﻜﺎﺋﻦ اﻟﻤﻘﺎوم ﻟﻸدوﻳﺔ‬

When any antimicrobial drug is used, there is usually suppression of

part of the normal bacterial flora of the patient which is susceptible to
the drug. Often, this causes no ill effects, but sometimes a drug-
resistant organism, freed from competition, proliferates to an extent
which allows an infection to be established.
Antibiotic-associated (or Clostridium difficileassociated)colitis
is an example of a superinfection. It is caused by alteration of the
normal bowel flora, which allows multiplication of Clostridium
difficile which releases several toxins which damage the mucosa of
the bowel and promote excretion of fluid Mild cases usually respond
to discontinuation of the offending antimicrobial allowing
re-establishment of the patient's normal bowel flora. More severe
(‫اﻟﺘﻬﺎب اﻟﻘﻮﻟﻮن اﻟﻤﺮﺗﺒﻂ ﺑﺎﻟﻤﻀﺎدات اﻟﺤﻴﻮﻳﺔ )أو اﻟﻤﻄﺜﻴﺔ اﻟﻌﺴﻴﺮة‬
cases treatment with oral metronidazole. ‫ واﻟﺘﻲ ﺗﺴﻤﺢ ﺑﺘﻜﺎﺛﺮ‬، ‫ ﻛﺎن ﺳﺒﺒﻪ ﺗﻐﻴﻴﺮ ﻓﻠﻮرا اﻷﻣﻌﺎء اﻟﻄﺒﻴﻌﻴﺔ‬.‫ﻣﺜﺎل ﻋﻠﻰ اﻟﻌﺪوى‬
‫اﻟﻤﻄﺜﻴﺔ اﻟﻌﺴﻴﺮة اﻟﺘﻲ ﺗﻄﻠﻖ اﻟﻌﺪﻳﺪ ﻣﻦ اﻟﺴﻤﻮم اﻟﺘﻲ ﺗﻠﺤﻖ اﻟﻀﺮر ﺑﺎﻟﻐﺸﺎء اﻟﻤﺨﺎﻃﻲ‬
.‫ ﻋﻼج اﻟﺤﺎﻻت اﻷﻛﺜﺮ ﺷﺪة ﺑﺎﻟﻤﻴﺘﺮوﻧﻴﺪازول ﻋﻦ ﻃﺮﻳﻖ اﻟﻔﻢ‬.‫ﻟﻸﻣﻌﺎء وﺗﻌﺰز إﻓﺮاز اﻟﺴﻮاﺋﻞ‬

3-Opportunistic infection arises in patients whose immune systems

are compromised Such infections involve organisms that rarely or
‫اﻟﻌﺪوى اﻻﻧﺘﻬﺎزﻳﺔ ﻳﻨﺸﺄ ﻓﻲ اﻟﻤﺮﺿﻰ اﻟﺬﻳﻦ ﺗﻜﻮن أﺟﻬﺰﺗﻬﻢ اﻟﻤﻨﺎﻋﻴﺔ‬-3
never cause clinical disease in normal hosts ً
‫ﻧﺎدرا ﻣﺎ‬ ‫ﻣﻌﺮﺿﺔ ﻟﻠﺨﻄﺮ ﻣﺜﻞ ﻫﺬه اﻟﻌﺪوى ﺗﺸﻤﻞ اﻟﻜﺎﺋﻨﺎت اﻟﺤﻴﺔ اﻟﺘﻲ‬
‫ﺗﺴﺒﺐ أو ﻻ ﺗﺴﺒﺐ اﻟﻤﺮض اﻟﺴﺮﻳﺮي ﻓﻲ اﻟﻌﻮاﺋﻞ اﻟﻌﺎدﻳﺔ‬
.
4- Masking of infection
Masking of infections by chemotherapy is an important possibility.
For example, a course of penicillin adequate to cure gonorrhoea may
preventsimultaneously contracted syphilis from showing primary and
secondary stages without effecting a cure.
‫ اﺧﻔﺎء اﻟﻌﺪوى‬-4
ً
‫ ﻋﻠﻰ ﺳﺒﻴﻞ‬.‫اﺣﺘﻤﺎﻻ ﻣﻬﻤً ﺎ‬ ‫ﻳﻌﺪ إﺧﻔﺎء اﻻﻟﺘﻬﺎﺑﺎت ﻋﻦ ﻃﺮﻳﻖ اﻟﻌﻼج اﻟﻜﻴﻤﻴﺎﺋﻲ‬
‫ ﻗﺪ ﻳﻤﻨﻊ ﺗﻨﺎول اﻟﺒﻨﺴﻠﻴﻦ اﻟﻜﺎﻓﻲ ﻟﻌﻼج اﻟﺴﻴﻼن ﻣﺮض اﻟﺰﻫﺮي اﻟﻤﺘﻌﺎﻗﺪ‬، ‫اﻟﻤﺜﺎل‬
.‫ﻋﻠﻴﻪ ﻓﻲ وﻗﺖ واﺣﺪ ﻣﻦ إﻇﻬﺎر اﻟﻤﺮاﺣﻞ اﻷوﻟﻴﺔ واﻟﺜﺎﻧﻮﻳﺔ دون إﺣﺪاث ﻋﻼج‬