PRINCIPLES OF ANTIBIOTIC

THERAPY

INDRATI
Antimicrobial drugs are effective in treatment of
infections
Source of infection are : bacteria, fungi, virus
Antibiotic is a substance to inhibit or kill bacterial
Antisepsis is the use of chemicals to destroy most
pathogenic organism on animate surface --
antiseptics
Disinfection is the application of chemicals to
destroy most pathogenic organism on inanimate
surfaces disinfectants
Antifungal is a substance to inhibit fungal
Antivirus is a substance to inhibit viral
Mechanisms of action antibiotic :
1. Inhibition of cell wall synthesis : penicillin,
cephalosporin, vancomycin
2. Alteration of cell membranes integrity :
amphotericin B, azoles, nystatin
3. Inhibition of ribosomal protein synthesis :
clindamycin, macrolides, tetracyclines
4. Suppression of DNA : metronidazole
5. Inhibition of folic acid synthesis :
sulfonamides
Antibiotic drugs are classified as either
bacteriostatic or bactericidal. Bacteriostatic
arrest the growth and replication. Bactericidal
kill bacteria
Antibiotic drugs spectra :
- Narrow spectrum : acting only on a
single/limited group of microorganism
- Broad spectrum : affect a wide variety of
microbial
Clinical indication of AB combination
- Mixed infection
- Synergism effect
- Risk of developing resistent organisms
- Increase antimirobial coverage
- Infection of unknown origin
Some clinical situation for prophylactic AB
- pre-dental extraction who have implanted
prosthetic devices
- Pre-operative treatment (e.g bowel
- Protect fetus in HIV infection pregnant woman

Side effect of AB therapy :

Hypersensitivity : if an allergic reaction occurs, the
drug must be discontinued immediately
Drug interaction : antibiotics may interact with
other drugs. These interaction can either increase
or decrease serum levels of the antibiotic
 Superinfections : occur when a broad
spectrum antibiotic used. This reduction of
normal bacterial allows for growth of other
organisms such as fungi
Gastrointestinalis problem : nausea, vomiting,
diarrhea, antibiotic associated
pseudomembranous colitis
Antibiotic resistance : mutation is a genetic
transformation. Adaptation is a nongenetic
transformation but there is a genetic
capability ex penicillinase is produced by S.
aureus
Antibiotic failure :
- Incorrect diagnosis
- Antibiotic antagonism
- Delay in diagnosis
- Inability of the antibiotic to penetrate to the site
of infection
- To low a blood antibiotic concentration
- Failure to surgically eradicate the source of the
infection
- Inadequate host defenses
- Inappropriate choice of antibiotic
- Emergence of antibiotic resistance
 Antibiotics resistance mechanisms
1) enzymatic inactivation : lactam by
lactamases
2) modification of target site : ribosomal point
mutations
3) overproduction of target site : sulfonamides
:over production PABA