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 :
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