General principles of antimicrobial therapy

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General principles of antimicrobial therapy

Selective toxicity:
• the ability of a drug to act against a target cell or organism without injuring other cells or organisms (ie the ability to act against infecting microbes without injury to the host)
• without selective toxicity, there can be no therapeutic effect
• selective toxicity is achieved by making use of differences in the cellular chemistry between microbe and humans

Principles of use:
1. Culture  make diagnosis
2. Remove barrier to cure (eg lack of free drainage; nail corner in infected onychocryptosis)
3. Decide if antibiotic is really needed
4. Select best drug
5. Use drug until apparent cure

Classification of antimicrobials by mechanism of action:
1. Drugs that inhibit synthesis of the cell wall or activate enzymes that disrupt the cell wall (eg penicillins, cephalosporins)
2. Drugs that increase permeability of the cell membrane (eg amphotericin B)
3. Drugs that inhibit protein synthesis (eg gentamicin, tetracyclines)
4. Drugs that inhibit nucleic acid synthesis (eg ciprofloxacin)
5. Drugs that disrupt specific biochemical reactions (eg sulfonamides)
6. Drugs that inhibit viral enzymes

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