Chapter 8:
Anti-infective Agents
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Development of Anti-Infective Therapy
1920s
o Paul Ehrlich worked on developing a synthetic
chemical effective only against infection-causing cells
o Scientists discovered penicillin in a mold sample
1935
o The sulfonamides were introduced
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Therapeutic Action #1
Interfere with biosynthesis of the bacterial cell wall
Prevent the cells of the invading organism from using
substances essential to their growth and development
Interfere with steps involved in protein synthesis
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Therapeutic Action #2
Interfere with DNA synthesis
Alter the permeability of the cell membrane to allow
essential cellular components to leak out
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Drug Therapy Across the Lifespan
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Anti-Infective Activity
Anti-infectives vary in their effectiveness against invading
organisms.
Some are selective – only effective for a few number of
organisms
Bactericidal – kill the cell
Bacteriostatic – prevent reproduction of the cell
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Narrow Spectrum vs. Broad Spectrum
Narrow Spectrum of Activity
o Effective against only a few microorganisms with a
very specific metabolic pathway or enzyme
Broad Spectrum of Activity
o Useful in treating a wide variety of infections
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Therapeutic action of Anti-Infective
Agents
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Human Immune Response
Goal of anti-infective therapy is reduction of the
population of the invading organism.
Drugs that would eliminate all traces of any invading
pathogen might be toxic to the host as well.
Immune response is a complex process involving
chemical mediators, leukocytes, lymphocytes, antibodies,
and locally released enzymes and chemicals.
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Resistance
Natural or acquired: Ability over time to adapt to an anti-
infective drug and produce cells that are no longer
affected by a particular drug.
Anti- infectives act on specific enzyme system or
biological process, many microorganisms that do not act
on this system are not affected by this particular drug
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Acquired Resistance
Microorganisms that were once sensitive to the particular
drug have begun to develop acquired resistance.
This results in serious clinical problems.
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Ways Anti-Infective Agents Resistance
Develops
Producing an enzyme that deactivates the antimicrobial
drug
Changing cellular permeability to prevent the drug from
entering the cell
Altering transport systems to exclude the drug from
active transport into the cell
Altering binding sites on the membranes or ribosomes,
which then no longer accept the drug
Producing a chemical that acts as an antagonist to the
drug
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Question #1
Which of the following has been found to be as important
as drug therapy when treating infections in the
immunosuppressed?
A. Maintaining standard precautions
B. Proper nutrition
C. Good hand washing
D. Exercise
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Answer to Question #1
B. Proper nutrition
Rationale: In helping these people (the
immunosuppressed) cope with infections, prevention of
infection and proper nutrition are often as important as
drug therapy.
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Preventing Resistance
Limit the use of antimicrobial agents to the treatment of
specific pathogens sensitive to the drug being used
Make sure doses are high enough, and the duration of
drug therapy long enough
Be cautious about the indiscriminate use of anti-infectives
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Factors Affecting Prescribing
Anti-Infective Agents
Identification of the correct pathogen
Selection of the right drug
– One that causes the least complications for that
particular patient
– One that is most effective against the pathogen
involved
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Problems With Treating Infections in
Immunosuppressed Patients
Anti-infective drugs cannot totally eliminate the pathogen
without causing severe toxicity in the host.
These patients do not have the immune response in
place to deal with even a few invading organisms.
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Identification of the Pathogen
Identification of the infecting pathogen is done by culture
A culture of a tissue sample from the infected area is
done
o A swab of infected tissue is allowed to grow on an
agar plate
o Staining techniques and microscopic examination
identify the bacterium
Stool can be examined for ova and parasites
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Sensitivity of Pathogen
Shows which drugs are capable of controlling the
particular microorganism
Is important with microorganisms that have known
resistant strains
Along with a culture, identifies the pathogen and
appropriate drug for treatment
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Combination Therapy
Use of a smaller dosage of each drug
Some drugs are synergistic
In infections caused by more than one organism, each
pathogen may react to a different anti-infective agent
Sometimes, the combined effects of the different drugs
delay the emergence of resistant strains
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Prophylaxis of Anti-Infective Agents
People traveling to an area where malaria is endemic
Patients who are undergoing GI or genitourinary surgery
Patients with known cardiac valve disease, valve
replacements, and other conditions requiring invasive
procedures
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Adverse Reactions to Anti-Infective
Therapy
Kidney Damage
Gastrointestinal (GI) Tract Toxicity
Neurotoxicity
Hypersensitivity Reactions
Superinfections
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Question #2
You are caring for a patient who has just been diagnosed
with a pseudomonas infection. You know that in deciding
what medication to order for this patient the physician
will take what into account?
A. The patient’s age
B. The patient’s gender
C. The drug that causes the least complication
D. The drug that has the longest half-life
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Answer to Question #2
C. The drug that causes the least complication
Rationale: Identification of the correct pathogen
Selection of the right drug
One that causes the least complications for that
particular patient
One that is most effective against the pathogen
involved
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