GUIDELINES FOR RATIONAL

USE OF ANTIBIOTICS
Definitions

 Anti-infective agents treat infection by suppressing

or destroying the causative microorganisms.
 Anti-infective agents derived from natural substances
are called antibiotics.
 Synthetic substances are called antimicrobials.
 An “empiric” antimicrobial regimen is begun before
the offending organism is identified and sometimes
before the documentation of the presence of
infection.
 “Definitive” regimen is instituted when the causative
organism is known.
Host Factors
 Allergy or h/o of ADR
 Age of patients
 Pregnancy
 Metabolic or genetic variation
 Renal and hepatic function
 Concomitant drug therapy
 Concomitant disease state
Drug factors
 Pharmacokinetic And Pharmacodynamic
considerations
 Tissue Penetration
 Drug Toxicity
 Cost
COMBINATION ANTIMICROBIAL
THERAPY
 Broaden the spectrum of coverage for empiric therapy,
achieve synergistic activity against the infecting
organism, and prevent the emergence of resistance.
 Broaden the spectrum

- Generally necessary in mixed infections in which multiple

organisms are likely to be present(intraabdominal and
female pelvic infections in which a variety of aerobic
and anaerobic bacteria may produce disease)
- Nosocomial infection.
 Synergism

- advantageous for infections caused by gram-negative

bacilli in immunosuppressed patients.
- Traditionally, combinations of aminoglycosides and β-
lactams have been used because these drugs together
generally act synergistically against a wide variety of
bacteria.
- Synergistic combinations may produce better results in
infections caused by Pseudomonas aeruginosa, as well as
in certain infections caused by Enterococcus spp.
 Prevention of resistance:

- To prevent the emergence of resistance (tuberculosis)

FAILURE OF ANTIMICROBIAL THERAPY

 Drug Selection
- inappropriate selection of drug, dosage, or route of
administration.
- Accelerated drug elimination
- poor penetration into the site of infection.
 Host Factors
- Immunosuppressed
- surgical drainage
 Micro-organism:
- Primary resistance
- Acquisition of resistance during therapy
- Overuse of antibiotics