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Introduction to Antimicrobials: Classification, Resistance, and Treatment Considerations

This comprehensive guide covers the general terms related to antimicrobials, including the classifications of antibiotics, factors influencing resistance, and selection of appropriate antibiotics based on host factors and site of infection. It discusses selective toxicity, antibiotic classifications, resistance mechanisms, prophylaxis, and monitoring of antibiotic therapy.

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Introduction to Antimicrobials: Classification, Resistance, and Treatment Considerations

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  1. Introduction to Antimicrobials

  2. General Terms • Chemotherapy • Antibiotic – substance produced by a microbe that may harm another microbes • Antimicrobial – any agent that harms a Microbe • Anti-infective – any agent that reduces or eliminates infection

  3. Selective Toxicity • Ability of an antibiotic to destroy target cells without damaging host cells • Differences between microbes and host • Prokaryotic vs Eukaryotic • Cell wall • Inhibition of microbial enzymes • Disruption of bacterial protein synthesis

  4. Antibiotic classifications • Narrow vs. Broad Spectrum • Susceptible organisms • Antibacterials • Antifungal • Antiviral • Classification by mechanism • Distinction: Bacteriocidal vs. Bacteriostatic

  5. Resistance • Relative resistance vs. True Resistance • MIC: Minimum inhibitory concentration • Mechanisms • Drug enzymes • Cease uptake of drug • Change in bacterial receptors • Synthesize drug antagonists • Acquisition • Spontaneuos mutation – single resistance • Conjugation –multiple drug resistance

  6. Factors that Influence Resistance • Use of broad vs. narrow spectrum • Suprainfection • CDC Twelve step program highlights • Immunize • IV’s out • ID consult • Contamination vs. infection • Colonization vs infection • Say no to vanco • Stop when infection is gone • Isolate the pathogen • Break the chain – wash your freaking hands

  7. Selection of Antibiotics • Considerations • Identification of microbe • Drug sensitivity of microbe • Host factors • Site of infection • Immune status • Empiric therapy

  8. Host Factors • Host defense (immune system, skin) • Site of infection • BBB, vascularity, heart valves, abcess • Age • Pregnancy & Lactation • Previous Allergic Reaction • Genetic

  9. Therapy • Dosage 4-8 x higher than MIC • Duration of therapy – relapse & resistance • Combinations • Additive • Potentiative (synergistic) • Antagonistic: bateriocidal + bacteriostatic

  10. Prophylaxis • Surgery • Bacterial endocarditis • Neutropenia • Other

  11. Attempted Tx of untreatable infection • “Concerned mother syndrome” • “Physician wants to appear to be doing something syndrome” • Tx of fever of unknown origin • Dosage too low • Tx in absence of adequate bacteriologic information • Omission of surgical drainage

  12. Monitoring Antibiotic Therapy • Fever • Resolution of S/S • Serum drug levels • Cultures

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