Microbial Resistance Medical Presentation

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Published on : Mar 10, 2018 | Views : 1934 | Downloads : 0

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Under supervision of :Dr. Microbial Resistance
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ANTIMICROBIAL DRUGS USED IN COMBINATION Name : Alia Elneanaey ID : 669
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Indications To give prompt treatment in desperately ill patients suspected of having serious microbial infections. To delay the emergence of microbial mutants resistant to one drug in chronic infections. To treat mixed infections. Each drug is aimed at an important pathogenic microorganism. To achieve bactericidal synergism or to provide bactericidal action.
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Disadvantages physician may believe that because several drugs are already being given, everything possible has been done for the patient, leading to relaxation of the effort to establish a specific diagnosis. The more drugs that are administered, the greater the chance for drug reactions to occur or for the patient to become sensitized to drugs. The cost is unnecessarily high. Antimicrobial combinations usually accomplish no more than an effective single drug. Very rarely, one drug may antagonize a second drug given simultaneously.
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Mechanisms Indifference. Addition. Synergism. Antagonism. The effects that can be achieved with combinations of antimicrobial drugs vary with different combinations and are specific for each strain of microorganism. Thus, no combination is uniformly synergistic.
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Antimicrobial synergism Two drugs may sequentially block a microbial metabolic pathway. eg : Sulfonamides and Trimethoprim. A drug such as a cell wall inhibitor (a penicillin or cephalosporin) may enhance the entry of an aminoglycoside into bacteria and thus produce synergistic effects. One drug may prevent the inactivation of a second drug by microbial enzymes. eg : inhibitors of β-lactamase and amoxicillin.
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Antimicrobial antagonism Antagonism resulting in higher morbidity and mortality rates has been most clearly demonstrated in bacterial meningitis. It occurred when a bacteriostatic drug (which inhibited protein synthesis in bacteria) such as chloramphenicol or tetracycline was given with a bactericidal drug such as a penicillin or an aminoglycoside. Antagonism occurred mainly if the bacteriostatic drug reached the site of infection before the bactericidal drug, if the killing of bacteria was essential for cure, and if only minimal effective doses of either drug in the pair were present.