Antimicrobials:

An overview:i.
i. Antimicrobial
The term antimicrobial describes a medicine which destroys or inhibits the growth of
Microbes(Bcteria,fungi virus protozoa).
Most are naturally produced by bacteria and fungi, others are synthesized in LAB but have the same
effect.
Antibiotic is popularly used to describe this whole range of chemicals.
Strictly, it should only apply to the naturally derived chemical substances, with the term antimicrobial
describing the bigger group:
ii. Microbes:
Microbes are extremely small organisms that can only be seen with a microscope. They are smaller than a
human red blood cell. Millions of microbes can fit inside the eye of a needle. They are also very old. In
fact, they are the oldest form of life on Earth.
Type of microbes- Bacteria, Fungus/fungi, Virus and Protozoa
Type of anti-microbials accordingly are- Anti bacterials, Antifungals, Antivirals and Antiprotozoal
iii. Source of antimicrobials:
Anti-microbials may be Synthetic/semi synthetic chemicals or Antibiotics
Antibiotics are specific chemical substances derived from or produced by living organisms that are
capable of inhibiting the life processes of other organisms.
The first antibiotics were isolated from microorganisms but many are now synthesized chemically.
Over 3,000 antibiotics have been identified but only a few dozen are used in medicine.
Antibiotics are the most widely prescribed class of drugs comprising 12% of the prescriptions
iv. Definitions of some terms used :
Antibiotic substance produced by microbes or kills other microbes
Antibacterial antibiotics , semisynthetic or synthetic chemicals suppress growth of or kill bacteria
Bacteriostatic inhibits bacterial growth
Bactericidal kills bacteria
Disinfectants: the chemicals that can be used in killing many bac
teria on certain instruments, but cannot be used for internal consumption or on skin (e.g. phenol-based
products) -may be too toxic on skin
Antiseptics: These are the chemicals used only topically (e.g. on skin surfaces) to reduce bacterial load.
(e.g. iodine or 70% alcohol)
V. Common bacteria that infect humans.
Bacteria Bacteria Some Disease caused by the bacteria
category.
Gram Positive Staphylococcus Cellulitis, furuncle, carbuncle( skin infection0 lung
Cocci abscess
Streptococcus
URTI-pharyngitis, tonsillitis, sinusitis, pyoderma, acute
glomerulonephritis, otitis, pneumona, meningitis

Gram Positive Clostridium tetani Tetanus

Bacilli C. perfringens Gas gangrene
Bacillus anthrasis Anthrax
Corynebacterium
diphtheria Diphtheria
Listeria monocutogenus Meningitis, septicemia
 Actinomyces Actinomicosis (abscesses with sulfur granules)

Gram Negative Neisseria meningitidis Meningitis,

Cocci N.gonorrhea, Moraxella gonorrhea,
catarrhalis pneumonia

Gram Negative Esteretia coli Urinary tract infection(UTI)

Bacilli Haemophilus influenza URTI, Pneumonia, meningitis
Bordetella pertussis Whooping cough
Legionella pneumonia Pneumonia,
Pseudomonas Burns infection, UTI
Klebsiella Pneumonia,
Serratia Diarrhea
Proteus Diarrhea
Enterobacter Diarrhea
Yersinia Plague
Francisella Tularemia(septicemia)
Pastuerella Dog/cat bite (septicemia0
Salmonella Typhoid
Shigella Diarrhea

Anaerobes Bacteroides fragilis Peritonotis, dentalabscess

Fusobacterium Peritonitis
Peptostreptococcus Peritonitis
Clostrradia Tetanus, gas gangarene
Spirochetes Treponema palladum Syphilis
Borrelia Tic borne disease Cutaneous lesions(Borreliasis)
Mycobacteria Mycobacterium Tuberculosis
tuberculosis
Mycobacterium leprae Leprosy.

VI. Classification of Antimicrobials Based on the Sites of Action

A. Drugs which interfere with the cell wall: penicillins, cephalosporins, vancomycin,
bacitracin,, aztreonam, imipenem.
B. Drugs which interfere with the cell membrane: polymyxins, colistin, nystatin,
amphotericin B.
C. Drugs which interfere with protein synthesis: aminoglycosidesspectinomycin, tetracyclines,
chloramphenicol, clindamycin, erythromycin
D. Drugs which interfere with nucleic acid synthesis: sulfonamides, trimethoprim,sulfones, ,
ciprofloxacin, nalidixic acid, rifampin
VII. Antimicrobial resistance:
The increased improper use of an antibiotic may lead to the emergence of resistant strains of bacteria.
There are geographic variations in antibiotic resistance depending on local prescribing trends.
For safe empirical therapy, it is important to know the local patterns of resistance and help should be
sought from a microbiologist.
Some bacteria are naturally resistant & some acquire resistance.
These traits may arise as new mutations or may be transferred from organism to organism
by plasmids (DNA packages) either by conjugation or transduction, or
by bacteriophage viruses.
Mechanisms of resistance:
1. The production of an enzyme that breaks down the antibiotic, e.g. -lactamase and many
penicillins
2. The cell membrane becomes impermeable to a drug, e.g. tetracyclines
3. Structural or biochemical alteration within the organism makes it less susceptible, e.g. alteration
of ribosomal structure may lead to erythromycin resistance
4. Development of a pathway that bypasses the reaction inhibited by the antibiotic, e.g. a
dihydrofolate reductase that is insensitive to trimethoprim
VIII. Antibacterial treatment:
Choice of drug should be guided
1. by a local formulary, as sensitivities and local policies may vary.
2.by culture and sensitivity results.

IX. Principles for prescribing antibiotics:

1. Make a diagnosis of bacterial infection (fever alone does not always imply bacterial infection) and its
site and consider the likely organisms, e.g. in lobar pneumonia, the likely organism is Streptococcus
pneumoniae.
2. Wherever possible, and particularly in all serious infections, take appropriate specimens (blood,
sputum, pus, urine, swabs) for culture and antibiotic sensitivity testing,

3. Consider the need for antibiotic therapy at all, e.g.antibiotics are usually inappropriate in
gastroenteritis or many skin infections.
4. Empirical antibiotic therapy may be necessary in seriously ill patients but may prevent the
confirmation of the diagnosis of infection later or the identification of the infecting organism. This
may be particularly important when there is a subsequent failure to respond or only partial response
to the chosen antibiotic.
5. Select the most appropriate drug, its dose and route of administration. Consider the following factors.
a. The organism:
b. The patient: age,allergy,renal or hepatic function, conditions that diminish resistance to
infection (malnutrition,malignant disease, immunosuppression,drugs),pregnancy or genetic
factors,response to antibiotics).
c. The severity of the infection:
d. The site of infection:
e. The presence of foreign bodies: such as a piece of glass in a skin wound,

6. Monitor success of therapy clinically, or microbiologically by repeated cultures as appropriate. Some

antibiotics with serious concentration-related toxicity also require monitoring of plasma
concentrations (e.g. gentamicin).
7. Combinations of antibiotics are occasionally used:
a. where there is a mixed infection, e.g. in peritonitis
b. for(synergism), e.g. penicillinand gentamicin in treating infective endocarditis
c. organism is not known and broad-spectrum cover is required urgently, e.g. septicaemia
d. to prevent the development of resistance to one antibiotic, e.g. in tuberculosis.

8. Antibiotics may also be used occasionally for prophylaxis, i.e. to prevent the development of
infection rather than to treat established infection. Examples are in some abdominal or orthopaedic
surgery, in dental procedures for patients at risk of infective endocarditis, or in the close contacts of
patients who have meningococcal meningitis. The duration of prophylactic use is brief (usually 24
hours or less), and the choice of drug is based on previous experience of what organisms are likely.
THE END.