PRINCIPLES OF

ANTIMICROBIAL
THERAPY
INDRATI

Antimicrobial drugs are effective in treatment

of infections because of their selective
toxicity
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

Selection of AM agent
Required knowledge of :
1. Identification & sensitivity of the
organism
2. Site of action : adequate level of AM
in SOI
3. Safety the agent
4. Patient factors : age, pregnancy,
renal & hepar dysfunction, immune
system
5. Cost of therapy

Mechanisms of action :
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 :

Drug resistance
- Microbial growth is not halted by the
maximal level of AM that is tolerated
by the host
- Some organisms inherently resisten
to an AM
e.g Gram resistent to eritromycin
- Microbial species normally
responsive to particularly drug, may
developed resistent strains

Mechanism of drug resistance

- Genetic alteration : spontaneus
mutations of DNA
- Enzymatic inactivation

Antimicrobial drugs are classified as

either bacteriostatic or bactericidal.
Bacteriostatic arrest the growth and
replication. Bactericidal, organism
are killed byAM
Antimicrobial drugs spectra :
- Narrow spectrum : acting only on a
single/limited group of
microorganism
- Broad spectrum : affect a wide
variety of microbial

Clinical indication of AM combination

- Mixed infection
- Synergism effect
- Risk of developing resistent
organisms
- Increase antimirobial coverage
- Infection of unknown origin

Some clinical situation for prophylactic

AM
- pre-dental extraction who have
implanted prosthetic devices
- Pre-operative treatment (e.g bowel
- Protect fetus in HIV infection
pregnant woman
Side effect of AM therapy :
Hypersensitivity: allergic &
idiosyncracy
Direct toxicity: ototoxic

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

THANK YOU