Professional Documents
Culture Documents
USE OF
ANTIMICROBIAL DRUGS
Johnmartin M. De Los Reyes, RMT MSc
Host Factors
In vitro susceptibility testing does not always predict clinical outcome
Host factor plays an important role in determining outcome and this
applies particularly to circulating and tissue phagocytic activity
Pharmacological Factors
Satisfactory drug concentration
Absorption, distribution, metabolism and excretion
Presence of food, drug interactions
Drug Resistance
Natural or acquired characteristic of microorganism
Acquired mutation, adaptation, gene transfer
Multidrug resistance
Epidemics and worldwide
MRSA, Enterococcus (Van), Extended spectrum B-lactamase (ESBL)
Drug combinations
Synergism
Indifference
Antagonism
Adverse reactions
Side effects hypersensitivity
Toxicity lethal dose
Superinfection
Anti-infective drugs may also affect the normal bacterial flora of skin
and mucous membrane and this may result in microbial overgrowth
of resistant organisms with subsequent superinfection
Chemoprophylaxis
Antimicrobial agents used to prevent infection in surgery
Perioperative period first dose 1 hour before surgery
Clinical Uses
Focus on the drugs used for specific infection
See tables
Antibiotic policies
Rationale
Number of antimicrobial drugs
Excessive use of antimicrobial agents
Susceptibility of microorganisms must be monitored
Free prescribing
Greater the number of agents in use the less likely it is that drug
resistance will emerge
Restricted reporting
Tests only a limited range of agents against bacterial isolates
Allows the clinician to use such agents with greater confidence
Restricted dispensing
Unrestricted vs Restricted drugs
Pending expert approval
ANTIBIOTIC PRESCRIBING
AND ANTIBIOTIC
STEWARDSHIP