Overview of Antibiotics

Hussain A. Al Awami, B.Sc. Pharm., M.Sc., MBA

History

Chinese & Nubians used fermented bean and
corn respectively.

Detected through blue flouresence upon UV
light exposure.
Recent History

1928-29 By Alexender Fleming
(Microbiologist).

During expermental growth of S. Aureus

Agar plate contains fungus (Penicillium
Notatum).

He was able to produce Penicillins.
Continue, recent history

In 1941 Dubos noted that you cant find
Typhoid bacteria after certain period of death.

Soil should produce antibiotics!

He was able to produce Tyrothricin.

Between 40s and 60s, lot of natural
antibiotics like streptomycin, Bacitracin,
Erythromycin, chloramphenicol, tetracyclines.
Classification of Bacteria

Bacteria

Aerobic Anaerobic

G+ve G-ve G+ve G-ve

Cocci Cocci Cocci

Bacilli (rods) Bacilli Bacilli Bacilli

Antibiotics

Single largest subset of medication

Periodic formulary management

The most difficult group to deal with PT
committee.
Principles of Antibiotic Selection

Antimicrobial activity

Selective for particular organisms.

Companies present data about activity on
organisms clinically irrelevant.
Principles of Antibiotic Selection

MIC

In vitro

When isolated data is taken, will lead to
misconception.

Lower MIC does not mean higher efficacy nor
quicker action.

MIC should be interpreted in relation to the
achievable blood concentration.
Principles of Antibiotic Selection

Susceptibility testing

In vitro

Depends on methodology and micro-organism

Discrepancies between In vivo and In vitro
Principles of Antibiotic Selection

Bacteriostatic Vs Bactericidal

Advantage of one over the other?!

Exception:

Febrile neutropenia

Meningitis

Endocarditis
Principles of Antibiotic Selection

Pharmacokinetics

Absorption (IV, IM, Oral)

Route of Elimination (Renal Vs Hepatic and
Active Vs inactive metabolites)

Tissue penetration

Protein binding

Volume of distribution

Pharmacodynamics

PAE
Principles of Antibiotic Selection

Antibiotic resistance

Natural resistance

Acquired resistance

Absolute resistance

Relative resistance

Factors associated with resistance

Some antibiotics like ceftazidime induce resistance
organisms

Underdosing

Strategies to overcome resistance
Principles of Antibiotic Selection

Side effects

Drug fever

Drug rash

Diarrhea

Non infectious

Infectious

Cytopenias

Others
Principles of Antibiotic Selection

Pharmacoeconomics

Drug cost

Route of administration cost

Frequency of administration cost

Combination cost

Monitoring cost

Therapy failure