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Antimicrobial general considerations, Superinfection, Post antibiotic…
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Superinfection
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Broad spectrum antibiotics AACCT aminoglycosides, ampicillin, chloramphenicol,clindamycin and tetracyclines may kill the normal flora and result in the development of new infections.
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Oropharynx, intestine, respiratory and genitourinary tract are common sites for the development of new infection.
Organisms frequently involved are candida albicans, clostridium difficle, staphylococci, proteus and pseudomonas.
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MBC and MIC
Minimum bactericidal concentration MBC of an antibiotic is the concentration which kills 99.9% of the bacteria
whereas minimum inhibitory concentrations MIC of the antibiotic is the concentration which prevents visible growth of bacteria in culture plates using serial dilutions.
A small difference between MIC and MBC indicates
that the antibiotic is primarily bactericidal whereas
large difference indicates bacteriostatic action.
Antibiotics
are the substances produced by microorganisms,
which suppresses the growth of or kill other
microorganisms at very low concentrations.
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Transduction
Transduction is the transfer of resistance gene
through bacteriophage e.g. PEC penicillin, erythromycin and chloramphenicol.
Conjugation
Conjugation is due to physical contact between bacteria and is responsible for multidrug resistance.
Important mechanism for the development of resistance against SC streptomycin and chloramphenicol
Transformation
Transformation is the transfer of resistance gene through environment and is not significant clinically e.g. penicillin G
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MIC
The MIC, or minimum inhibitory concentration, is
the lowest concentration (in μg/mL) of an antibiotic that inhibits the growth of a given strain of bacteria.
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Time dependent killing
TDK means antimicrobial action depends on the length of time the concentration remains above the MIC. E.g. BV B-lactams and vancomycin.
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Macrolides and clindamycin also possess time dependent activity. However these are static drugs not TDK but Time dependent inhibitory activity drugs. Remember most common.
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Two bactericidal agents
Two bactericidal agents are additive if the organism is sensitive to both e.g. isoniazid and rifampicin in tuberculosis.
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In immunocompromised patients, patients with HIV, on steroid therapy, neutropenic etc,
In immunocompromised patients, patients with HIV, on steroid therapy, neutropenic etc, only the bactericidal drugs should be used.
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