Basics of

Antibiotics
Bugs and Drugs in Practice.
Mohamed Fahmy
Clin.Dip ,CLSSWB.

● Head of Clinical Pharmacy Dep., CSH.

● Clinical Pharmacist, CSH.
● Former Clinical Pharmacist, SOH.
● Former Hospital Pharmacist, SOH.

CME Trainer, L&D Passionate.

 Microbiome

The microbes that are both helpful and potentially harmful.

Most are symbiotic (where both the human body and microbiota benefit) and
some, in smaller numbers, are pathogenic (promoting disease).
 Antibiotic Pressure

A term reflects the fact that antibiotic-resistant strains may emerge when
antibiotic susceptible strains are killed.

But excessive pressure placed on the microorganisms in the patient can be

limited by how we use antibiotics.
 Collateral Damage
a term describes the impact of antibiotic use on bugs in the body
beyond The targeted bug.

Every dose of antibiotics affects bug causing infection, plus billions of

other commensal bacteria in and on the body.

Bacteria that are just minding their business and often helping us out by
preventing colonization by more aggressive bacteria.

Collateral damage will occur with any antibiotic, but can be minimized
by using less-broad-spectrum antibiotics and, perhaps most importantly,
minimizing the duration of use of all antibiotics.
Hans Christian Gram
The inventor of the Gram stain, which still a
standard technique to classify bacteria and
make them more visible under a microscope.
 Spectrum
The range of microorganisms an antibiotic is usually
effective against.
 Types of Therapy
When to use Examples

Cefazolin given before

Prevent an infection that has surgery to prevent a
Prophylactic
not yet developed. staphylococcal skin infection
of the surgical site.

For proven or suspected Levofloxacin initiated for a

infection, but the patient with presumed
Empiric
responsible bug(s) has or community-acquired
have not yet been identified. Pneumonia.

Discontinuing ceftriaxone,
Bugs known after culture initiating ciprofloxacin for
Definitive
result.
UTI caused by K.pneumonia.
 Definition of concepts
MIC
the lowest concentration
of an antibiotic required to
inhibit the growth of an
organism.
Bacteriostatic
Drugs only inhibit the growth
or multiplication of bugs giving
the immune system of the host
time to clear them from the
system.
Breakpoint
A chosen concentration of an
antibiotic defines whether a
species of bacteria is susceptible
or resistant to the antibiotic.
Bactericidal
kill bugs, with or without a
competent immune system of
the host, the bacteria will be
dead in most instances
 Cidal vs Static

Remember But
For most infections, Bactericidal antibiotics have
bacteriostatic and an advantage in certain
bactericidal antibiotics infections, such
inhibit/kill organisms at the endocarditis, meningitis,
same rate, and should not and febrile leukopenia, but
be a factor in antibiotic there are exceptions even
selection. in these cases
Monotherapy vs Combination
● Monotherapy is preferred to combination therapy for nearly all infections.
because of cost savings, less chance of medication error and fewer missed
doses/drug interactions.

● Combination therapy may be useful for drug synergy or for extending

spectrum beyond what can be obtained with a single drug. Antibiotics should
be combined for synergy if synergy is based on actual testing.

● Combination therapy is not effective in preventing antibiotic resistance, except

in very few situations.

● eg. Anti-pseudomonal penicillin + aminoglycoside.

 Renal Insufficiency
01 03
Antibiotics Patients
For antibiotics receiving nephrotoxic
eliminated by kidneys medications.

02 04
Antibiotics Patients
narrow toxic-to- have pre-existing renal
therapeutic ratios. disease.
 Aminoglycosides
enterococcal
endocarditis
gentamicin
extended- dosing every 8 hr
interval dosing Gram-negatives
single daily Escher coli,
dosing Klebsiella,Pseudomonas,
Acinetobacter.
narrow
therapeutic
window Synergizing
nephrotoxic, beta-lactams,
ototoxic drugs. glycopeptides
 Anti MRSA

Clindamycin Vancomycin Linezolid

Diarrhea, C. difficile– Needs TDM, Red man Serotonin Syndrome,
associated diarrhea. syndrome. Bone Marrow Suppression.

Tigecycline Teicoplanin TMP/SMX

Eliminated hepatically, Nephrotoxicity. Uncomplicated
not be used for UTIs. lower UTIs.
 Anti Pseudomonals

Pip/Tazo Ceftazidime Cefepime

Nosocomial C.D. Diarrhea Renal Adjustment is a
pneumonia must for avoiding
neurotoxicity

Mer/Imi/Dori Genta/Tobra Levo/Cipro

Watch for seizures and As previously Watch for bioavailbility
nephrotoxicity mentioned of Ciprofloxacin
 Anti Anaerobes

Metro/Clind Pip/Tazo Amp/Sulb

Tigecycline Irta/Mer/Imi Moxifloxacin

 01
Myth
Stopping antibiotic courses early leads to resistance
 Fact 01
Antibiotic use leads to antibiotic resistance.
More use causes more resistance.

Reference: article in BMJ that details the topic

 02
Myth
People can become resistant to antibiotics
 Fact 02
Bacteria become resistant to antibiotics, not
humans. People can become colonized with
drug resistant bacteria, but they themselves
cannot become antibiotic resistant.
 03
Myth
Antibiotics are non-toxic
 Fact 03
Use antibiotics with caution and only when indicated.
Highlight that antibiotic use does not come without risk.

Examples of Antibiotic Toxicites:

Arrhythmia × Azithromycin
CDAD × Levofloxacin/Ciprofloxacin
RMS × Vancomycin
kernicterus in neonates × Ceftriaxone
 04
Myth
IV antibiotics are more effective than oral antibiotics
 Fact 04
Once the bacteria are dead, it does not matter if the antibiotic was given oral or IV.

Giving IV antibiotics does not make it more effective for treating infections.

In fact, it may actually be risker due to potential for line infections.

If the gut works, use it!

 05
Myth
The antibiotic with the lowest MIC is the best
 Fact 05

These drugs and bugs are not all measured on the same scale, do not all have the same
penetration to infection sites, and may not offer the same safety profile.

MICs should not even be reviewed beyond

S for susceptible, I for intermediate, or R for resistant.
 06
Myth
Broader is better
 Fact 06
Taking antibiotics not only pressures bacteria to become drug-resistant, it also
negatively impacts the host’s microbiome.

The most important skill herr is not knowing when to give antibiotics,
rather it is knowing when not to give antibiotics.
 Remember
1 Colistin For Gram negative only

2 Vancomycin For Gram positive only

3 Cephalosporins Not for anaerobes

4 Vancomycin PO For C. Difficile only

5 Tigecycline Not for Pseudomonas

6 TMP/SMX For Stenotrophomonas maltophilia

7 Ertapenem Not for APE

“If we use antibiotics when not
needed, We may not have them
when they are most needed.”

—Tom Frieden
 3/4
body bacteria live in our intestines

500
species have been found in oral flora

1M
of germs hide in a bath sponge
Awesome
words
 Homework

What Is The
Difference between
XDR, MDR, PDR ?
 References

● https://www.idstewardship.com

● Antibiotics Essentials Text Book

● Antibiotics Simplified Text Book

● https://www.Learnantibiotics.com

Contact me on LinkedIn “mohamedfahmyph94” for more references.