July 7, 2009 | In: GENERAL TOPICS
ANTIBIOTICS
11. Are antibiotics the classic wonder drugs?
Show answer
Only because you wonder if they are going to work, if they are going to cause more harm than good, and if the next generation will be unaffordable or toxic.
Skepticism is healthy with regard to any procedure or agent in heath care but especially with regard to antibiotics, which are embraced almost universally as agents that both prevent and cure infections. The primacy of the host defense in this vital process and the potential interference by the very drugs given credit for infection control are overlooked. We must look critically at the limited role that antibiotics should play in health care and restrain their overuse, which generates even more harm than unnecessary expense.
12. What is meant by generations of antibiotics, as in third-generation cephalosporins?
Show answer
The earliest antibiotics were bacteriostatic, largely through interference in protein synthesis, so that they might keep a microorganism from reproducing even if they did not kill it. The difference between infestation (presence of living microbes in the host) and infection (replication and spread of microorganisms in the host) may be useful in understanding how earlier drugs possibly controlled infection but were less capable of eliminating organisms in any brief period of therapy.
Penicillin changed all that. It may be the first antibiotic with a legitimate claim to the title “wonder drug” because it has the microbicidal capability of eradicating sensitive organisms. Penicillin was the first generation of the beta-lactam antibiotics, joined by the congener first-generation cephalosporins (e.g., cefazolin). They shared beta-lactam structure and had good gram-positive coverage with less range in any effect over gram-negative microbes.
The second-generation beta-lactam antibiotics (e.g., cefoxitin) covered new classes of microbes beyond gram-positive aerobes, such as many of the Bacteroides species, but had little effect on gram-negative aerobic microbes. Because the third-generation cephalosporins covered some of the latter microbes, they were touted as single-agent therapy for all principal-risk flora.
As with penicillin, the original wonder drug, the wonderment waned with failures of the new agents because of rapidly induced antimicrobial resistance. The most easily measured and calculated difference in the generations is cost: wholesale values are about $2.00/g for the first generation, $5.00/g for the second, and $30.00/g for the third. Despite this bracket creep in cost, the higher generations lose some of their potency against the original gram-positive organisms for which the first-generation agents were truly wonderful. Therefore, it takes 2 g of moxalactam to be half as good as 1 g of cefazolin for gram-positive coverage. It does not take a pharmacoeconomist to ask, “What have I got in return for this 60-fold surcharge?”
13. What is the role of third-generation cephalosporins in surgical prophylaxis?
Show answer
None (no more wondering here!). If the principal-risk flora are gram-positive, the first generation is better; if the anaerobic risk is sizable, the second generation is better. And either class is cheaper by far and seems to have generated less resistance than the third-generation cephalosporins, which are unconscionably expensive for use in prophylaxis and rarely as effective as other single-agent therapy for established surgical infection. Specific indications, such as pediatric meningitis, hospital-acquired pneumonia, or other specific infections outside the indications of surgical predominance, might use or exclude these agents.
> Show answer
14. How do enzyme inhibitors combined with antibiotics enhance their antimicrobial spectrum?
Microorganisms have defense mechanisms of their own, and the strains that have the capacity to make antibiotic-degrading enzymes achieve an unnatural selection advantage with the widespread use of antibiotics. This is what happened to penicillin: penicillinases emerged. But clever pharmaceutical manufacturers closed that loophole for bacterial ingenuity in degrading penicillin by strategic placement of a methyl group to ruin the survival fitness of penicillinase producers. Methicillin was the result, but the persistence of the microbes means that we now have a plague of methicillin-resistant Staphylococcus aureus (MRSA). Besides, microbes outnumber pharmaceutical manufacturers and have a shorter turnaround time than the approval process of the Food and Drug Administration (FDA). Microbes will always be ahead of us in ingenuity if only because of their numbers.
Newer strategies by the bacteria included the production of beta-lactamases. The response of the pharmaceutical industry was a group of inhibitors of beta-lactamase, such as clavulanic acid or sulbactam. The combination of a beta-lactamase inhibitor with a modified penicillin such as ampicillin should have enhanced activity against bacteria that produce beta-lactamase, provided that they were ampicillin-sensitive in the first place. Higher doses of the original agent for a shorter time may accomplish the same effect, often at lower cost, because the combined drugs were developed much more recently and are under patent protection.
15. What are the most expensive kinds of antibiotic therapy?
Show answer
* Drugs that are given when they are not needed.
* Drugs that are badly needed but do not work.
* Drugs that cause more harm than good because of host toxicity, whatever their antibiotic potential.
16. Can oral antibiotics be given in place of intravenous antibiotics in seriously ill surgical patients?
Show answer
Yes, if only they could take them! These patients almost invariably can take nothing by mouth (NPO), are often unconscious, and are as likely as not to be on a ventilator. In addition, the gut has been put out of commission by nasogastric suction tubes, laparotomy, and ileus, and primary intraabdominal problems often associated with the need for the antibiotics, such as intraabdominal sepsis and pancreatitis. Usually such patients are on complete gut rest and are likely to be on parenteral nutrition as well.
The attempt to use some form of gut-delivered antibiotic is based on the favorable pharmacokinetics and spectrum of quinolones, which can be started intravenously and switched as soon as possible to the oral form when feeding has resumed. Nearly all such patients begin on some form of intravenous (IV) antibiotic program and the start-up of the antibiotic regimen is more important than the form to which patients are tapered before treatment is discontinued.
118 Responses to Surgical Infectious Disease. Antibiotics
Habez
January 21st, 2012 at 4:44 am
Great website…
[...]we like to honor many other internet sites on the web, even if they aren’t linked to us, by linking to them. Under are some webpages worth checking out[...]……
Dallas Marketing
January 25th, 2012 at 3:39 pm
Awesome website…
[...]the time to read or visit the content or sites we have linked to below the[...]……
Dallas Video Production
January 25th, 2012 at 3:58 pm
Check this out…
[...] that is the end of this article. Here you’ll find some sites that we think you’ll appreciate, just click the links over[...]……
All New Kia Picanto
January 25th, 2012 at 5:04 pm
Recommeneded websites…
[...]Here are some of the sites we recommend for our visitors[...]……
auto body shop NJ
January 25th, 2012 at 5:12 pm
Cool sites…
[...]we came across a cool site that you might enjoy. Take a look if you want[...]……
Dallas Boudoir Photographer
January 25th, 2012 at 6:16 pm
You should check this out…
[...] Wonderful story, reckoned we could combine a few unrelated data, nevertheless really worth taking a look, whoa did one learn about Mid East has got more problerms as well [...]……
best seo blog
January 25th, 2012 at 6:38 pm
Websites we think you should visit…
[...]although websites we backlink to below are considerably not related to ours, we feel they are actually worth a go through, so have a look[...]……
pre workout supplements
January 25th, 2012 at 11:56 pm
Cool sites…
[...]we came across a cool site that you might enjoy. Take a look if you want[...]……
Peak Oil
January 26th, 2012 at 12:46 am
Wikipedia…
Wikipedia linked to this place…
bodybuilding supplement
January 26th, 2012 at 7:54 am
Blogs ou should be reading…
[...]Here is a Great Blog You Might Find Interesting that we Encourage You[...]……
webcam chat
January 26th, 2012 at 6:32 pm
Check this out…
[...] that is the end of this article. Here you’ll find some sites that we think you’ll appreciate, just click the links over[...]……
scary
January 26th, 2012 at 8:12 pm
Gems form the internet…
[...]very few websites that happen to be detailed below, from our point of view are undoubtedly well worth checking out[...]……
Phil Cannella
January 26th, 2012 at 9:12 pm
Related……
[...]just beneath, are numerous totally not related sites to ours, however, they are surely worth going over[...]……
Phil Cannella
January 26th, 2012 at 9:24 pm
Sources…
[...]check below, are some totally unrelated websites to ours, however, they are most trustworthy sources that we use[...]……
flights to pakistan
January 26th, 2012 at 11:36 pm
Check this out…
[...] that is the end of this article. Here you’ll find some sites that we think you’ll appreciate, just click the links over[...]……
colorado unemployment office
January 27th, 2012 at 12:22 am
Websites we think you should visit…
[...]although websites we backlink to below are considerably not related to ours, we feel they are actually worth a go through, so have a look[...]……
womens sandals
January 27th, 2012 at 1:19 am
Gems form the internet…
[...]very few websites that happen to be detailed below, from our point of view are undoubtedly well worth checking out[...]……
SATNAV
January 27th, 2012 at 3:33 am
Check this out…
[...] that is the end of this article. Here you’ll find some sites that we think you’ll appreciate, just click the links over[...]……
Great logos
January 27th, 2012 at 7:12 am
Websites we think you should visit…
[...]although websites we backlink to below are considerably not related to ours, we feel they are actually worth a go through, so have a look[...]……
fast weight loss
January 27th, 2012 at 10:50 am
Recommeneded websites…
[...]Here are some of the sites we recommend for our visitors[...]……
inkjet cartridges
January 27th, 2012 at 5:52 pm
Websites worth visiting…
[...]here are some links to sites that we link to because we think they are worth visiting[...]……
uzaktan egitim
January 27th, 2012 at 9:30 pm
Websites worth visiting…
[...]here are some links to sites that we link to because we think they are worth visiting[...]……
free apple ipad 3
January 27th, 2012 at 9:57 pm
Links…
[...]Sites of interest we have a link to[...]……
tracking
January 27th, 2012 at 10:34 pm
Related……
[...]just beneath, are numerous totally not related sites to ours, however, they are surely worth going over[...]……
Atlanta Limousine Service
January 27th, 2012 at 11:34 pm
Sites we Like……
[...] Every once in a while we choose blogs that we read. Listed below are the latest sites that we choose [...]……
best over the counter sleep aid
January 27th, 2012 at 11:44 pm
Superb website…
[...]always a big fan of linking to bloggers that I love but don’t get a lot of link love from[...]……
best shampoo
January 28th, 2012 at 8:42 am
Websites we think you should visit…
[...]although websites we backlink to below are considerably not related to ours, we feel they are actually worth a go through, so have a look[...]……
Sullair Air Compressor
January 28th, 2012 at 9:15 am
Check this out…
[...] that is the end of this article. Here you’ll find some sites that we think you’ll appreciate, just click the links over[...]……
facebook
January 28th, 2012 at 1:39 pm
Sites we Like……
[...] Every once in a while we choose blogs that we read. Listed below are the latest sites that we choose [...]……
Omega 3
January 28th, 2012 at 2:01 pm
Read was interesting, stay in touch……
[...]please visit the sites we follow, including this one, as it represents our picks from the web[...]……
Free Dell XPS M1530
January 28th, 2012 at 2:10 pm
Recommeneded websites…
[...]Here are some of the sites we recommend for our visitors[...]……
article
January 28th, 2012 at 4:14 pm
Recommeneded websites…
[...]Here are some of the sites we recommend for our visitors[...]……
wedding rings
January 28th, 2012 at 5:41 pm
Links…
[...]Sites of interest we have a link to[...]……
Cary Leung Sun Life
January 28th, 2012 at 9:21 pm
Superb website…
[...]always a big fan of linking to bloggers that I love but don’t get a lot of link love from[...]……
black hairstyles
January 28th, 2012 at 9:31 pm
Sites we Like……
[...] Every once in a while we choose blogs that we read. Listed below are the latest sites that we choose [...]……
wedding photography Oxfordshire
January 28th, 2012 at 10:34 pm
Recommeneded websites…
[...]Here are some of the sites we recommend for our visitors[...]……
geocaching gps
January 29th, 2012 at 2:08 pm
Visitor recommendations…
[...]one of our visitors recently recommended the following website[...]……
investment property
January 29th, 2012 at 3:14 pm
Online Article……
[...]The information mentioned in the article are some of the best available [...]……
suplimente nutritive
January 29th, 2012 at 3:35 pm
Superb website…
[...]always a big fan of linking to bloggers that I love but don’t get a lot of link love from[...]……
Jesse V.
January 29th, 2012 at 4:49 pm
Blog PR and Resources…
[...]!Important! I really like your website, it’s very well built and the material is very good so I’d like to ask you a quick question: As a website owner, have you ever wanted to make money off of your website? Not just a few bucks a month, but hundr…
how to link wheel
January 29th, 2012 at 4:57 pm
Online Article……
[...]The information mentioned in the article are some of the best available [...]……
Make Money Online
January 29th, 2012 at 5:31 pm
Websites you should visit…
[...]below you’ll find the link to some sites that we think you should visit[...]……
Best Treatment For Eczema
January 29th, 2012 at 6:21 pm
Sites we Like……
[...] Every once in a while we choose blogs that we read. Listed below are the latest sites that we choose [...]……
Escort girl Paris
January 29th, 2012 at 6:51 pm
Websites you should visit…
[...]beneath you will see the link to few websites that we think you could visit[...]……
Merchant Services
January 29th, 2012 at 7:42 pm
Websites you should visit…
[...]below you’ll find the link to some sites that we think you should visit[...]……
bingo game template
January 29th, 2012 at 10:24 pm
Recent Blogroll Additions……
[...]usually posts some very interesting stuff like this. If you’re new to this site[...]……
touch phone
January 29th, 2012 at 10:43 pm
Websites we think you should visit…
[...]although websites we backlink to below are considerably not related to ours, we feel they are actually worth a go through, so have a look[...]……
hypnosis for weight loss
January 29th, 2012 at 11:55 pm
Great website…
[...]we like to honor many other internet sites on the web, even if they aren’t linked to us, by linking to them. Under are some webpages worth checking out[...]……
shutter graphics
January 30th, 2012 at 7:48 am
Cool sites…
[...]we came across a cool site that you might enjoy. Take a look if you want[...]……
Minnesota SEO
January 30th, 2012 at 7:59 am
Recommeneded websites…
[...]Here are some of the sites we recommend for our visitors[...]……
Meet and Greet Parking
January 30th, 2012 at 12:08 pm
Gems form the internet…
[...]very few websites that happen to be detailed below, from our point of view are undoubtedly well worth checking out[...]……
tanie noclegi zakopane
January 30th, 2012 at 12:51 pm
Check this out…
[...] that is the end of this article. Here you’ll find some sites that we think you’ll appreciate, just click the links over[...]……
Wholesale Clothing
January 30th, 2012 at 2:07 pm
Recent Blogroll Additions……
[...]usually posts some very interesting stuff like this. If you’re new to this site[...]……
chest coach system
January 30th, 2012 at 9:35 pm
You should check this out…
[...] Wonderful story, reckoned we could combine a few unrelated data, nevertheless really worth taking a look, whoa did one learn about Mid East has got more problerms as well [...]……
marijuana addiction
January 31st, 2012 at 12:45 am
Websites worth visiting…
[...]here are some links to sites that we link to because we think they are worth visiting[...]……
income at home
January 31st, 2012 at 10:42 am
Cool sites…
[...]we came across a cool site that you might enjoy. Take a look if you want[...]……
passive income
January 31st, 2012 at 11:20 am
Websites worth visiting…
[...]here are some links to sites that we link to because we think they are worth visiting[...]……
mma workouts
January 31st, 2012 at 12:29 pm
Websites you should visit…
[...]below you’ll find the link to some sites that we think you should visit[...]……
icf bracing system
January 31st, 2012 at 1:51 pm
Superb website…
[...]always a big fan of linking to bloggers that I love but don’t get a lot of link love from[...]……
coleman roadtrip grill light
January 31st, 2012 at 2:55 pm
Read was interesting, stay in touch……
[...]please visit the sites we follow, including this one, as it represents our picks from the web[...]……
how to scrunch hair without frizz
January 31st, 2012 at 8:03 pm
Online Article……
[...]The information mentioned in the article are some of the best available [...]……
sharp pain during intercourse
January 31st, 2012 at 8:39 pm
Online Article……
[...]The information mentioned in the article are some of the best available [...]……
Scleritis treatment
January 31st, 2012 at 10:19 pm
Links…
[...]Sites of interest we have a link to[...]……
fire pit screens
January 31st, 2012 at 11:25 pm
Great website…
[...]we like to honor many other internet sites on the web, even if they aren’t linked to us, by linking to them. Under are some webpages worth checking out[...]……
playhouses
January 31st, 2012 at 11:51 pm
Gems form the internet…
[...]very few websites that happen to be detailed below, from our point of view are undoubtedly well worth checking out[...]……
Online Calculators
February 1st, 2012 at 7:55 am
Websites we think you should visit…
[...]although websites we backlink to below are considerably not related to ours, we feel they are actually worth a go through, so have a look[...]……
commercial inspections
February 1st, 2012 at 9:20 am
Visitor recommendations…
[...]one of our visitors recently recommended the following website[...]……
Visit
February 1st, 2012 at 10:41 am
Sources…
[...]check below, are some totally unrelated websites to ours, however, they are most trustworthy sources that we use[...]……
normal cholesterol levels
February 1st, 2012 at 11:27 am
Awesome website…
[...]the time to read or visit the content or sites we have linked to below the[...]……
jobs hair
February 1st, 2012 at 12:58 pm
Great website…
[...]we like to honor many other internet sites on the web, even if they aren’t linked to us, by linking to them. Under are some webpages worth checking out[...]……
long hair model
February 1st, 2012 at 1:50 pm
Sites we Like……
[...] Every once in a while we choose blogs that we read. Listed below are the latest sites that we choose [...]……
Scott Tucker Payday Loans
February 1st, 2012 at 3:10 pm
Links…
[...]Sites of interest we have a link to[...]……
Scott Tucker Payday Loans
February 1st, 2012 at 3:15 pm
Recommeneded websites…
[...]Here are some of the sites we recommend for our visitors[...]……
Scott Tucker Payday Loans
February 1st, 2012 at 7:40 pm
Read was interesting, stay in touch……
[...]please visit the sites we follow, including this one, as it represents our picks from the web[...]……
iphone 4 cases
February 1st, 2012 at 10:25 pm
Online Article……
[...]The information mentioned in the article are some of the best available [...]……
Scott Tucker Racing
February 2nd, 2012 at 7:22 am
Links…
[...]Sites of interest we have a link to[...]……
Scott Tucker Racing
February 2nd, 2012 at 10:24 am
Visitor recommendations…
[...]one of our visitors recently recommended the following website[...]……
REO Real Estate Owned
February 3rd, 2012 at 7:53 am
Online Resource…
[...]The information mentioned in the article are some of the best available [...]……
Brazzers Password
February 3rd, 2012 at 12:15 pm
Visitor recommendations…
[...]one of our visitors recently recommended the following website[...]……
WP Optin Pro
February 3rd, 2012 at 12:17 pm
Websites worth visiting…
[...]here are some links to sites that we link to because we think they are worth visiting[...]……
Insurance news
February 3rd, 2012 at 3:07 pm
Gems form the internet…
[...]very few websites that happen to be detailed below, from our point of view are undoubtedly well worth checking out[...]……
Medical Tourism Houston
February 3rd, 2012 at 7:54 pm
Websites worth visiting…
[...]here are some links to sites that we link to because we think they are worth visiting[...]……
lipo 6 side effects
February 4th, 2012 at 10:31 am
Related……
[...]just beneath, are numerous totally not related sites to ours, however, they are surely worth going over[...]……
best electronic cigarette
February 4th, 2012 at 12:00 pm
You should check this out…
[...] Wonderful story, reckoned we could combine a few unrelated data, nevertheless really worth taking a look, whoa did one learn about Mid East has got more problerms as well [...]……
steven cymbrowitz
February 4th, 2012 at 1:07 pm
Online Article……
[...]The information mentioned in the article are some of the best available [...]……
Waxing
February 4th, 2012 at 10:41 pm
You should check this out…
[...] Wonderful story, reckoned we could combine a few unrelated data, nevertheless really worth taking a look, whoa did one learn about Mid East has got more problerms as well [...]……
fitness boot camp
February 5th, 2012 at 12:22 am
Recommeneded websites…
[...]Here are some of the sites we recommend for our visitors[...]……
ecommerce seo
February 5th, 2012 at 2:36 am
Blogs ou should be reading…
[...]Here is a Great Blog You Might Find Interesting that we Encourage You[...]……
Fully Managed Shared Hosting
February 5th, 2012 at 2:45 am
Awesome website…
[...]the time to read or visit the content or sites we have linked to below the[...]……
spinach health benefits
February 5th, 2012 at 4:10 am
Gems form the internet…
[...]very few websites that happen to be detailed below, from our point of view are undoubtedly well worth checking out[...]……
bedding sets
February 5th, 2012 at 5:13 am
Superb website…
[...]always a big fan of linking to bloggers that I love but don’t get a lot of link love from[...]……
athletes acceleration sports training
February 5th, 2012 at 12:01 pm
Related……
[...]just beneath, are numerous totally not related sites to ours, however, they are surely worth going over[...]……
football speed
February 5th, 2012 at 1:13 pm
Awesome website…
[...]the time to read or visit the content or sites we have linked to below the[...]……
future technology predictions
February 5th, 2012 at 2:38 pm
Awesome website…
[...]the time to read or visit the content or sites we have linked to below the[...]…
track and field training
February 5th, 2012 at 4:21 pm
Gems form the internet…
[...]very few websites that happen to be detailed below, from our point of view are undoubtedly well worth checking out[...]……
san diego seo management
February 5th, 2012 at 6:05 pm
Awesome website…
[...]the time to read or visit the content or sites we have linked to below the[...]……
boise seo
February 5th, 2012 at 7:22 pm
Awesome website…
[...]the time to read or visit the content or sites we have linked to below the[...]……
DUI defense Indianapolis
February 5th, 2012 at 11:20 pm
Check this out…
[...] that is the end of this article. Here you’ll find some sites that we think you’ll appreciate, just click the links over[...]……
money
February 6th, 2012 at 2:50 am
Read was interesting, stay in touch……
[...]please visit the sites we follow, including this one, as it represents our picks from the web[...]……
stevia pulver kaufen
February 6th, 2012 at 12:29 pm
Sites we Like……
[...] Every once in a while we choose blogs that we read. Listed below are the latest sites that we choose [...]……
Fetisch Sex
February 6th, 2012 at 1:28 pm
Blogs ou should be reading…
[...]Here is a Great Blog You Might Find Interesting that we Encourage You[...]……
tarot gratis
February 6th, 2012 at 4:00 pm
Superb website…
[...]always a big fan of linking to bloggers that I love but don’t get a lot of link love from[...]……
soul eater streaming ita
February 6th, 2012 at 5:08 pm
Awesome website…
[...]the time to read or visit the content or sites we have linked to below the[...]…
genital warts treatment
February 6th, 2012 at 11:04 pm
Visitor recommendations…
[...]one of our visitors recently recommended the following website[...]……
best treatment for psoriasis
February 7th, 2012 at 12:29 am
Online Article……
[...]The information mentioned in the article are some of the best available [...]……
Air Conditioning Repairs
February 7th, 2012 at 2:39 am
Awesome website…
[...]the time to read or visit the content or sites we have linked to below the[...]……
Three Second Rule
February 7th, 2012 at 8:06 am
Websites you should visit…
[...]below you’ll find the link to some sites that we think you should visit[...]……
escorts in london
February 7th, 2012 at 8:08 am
Recommeneded websites…
[...]Here are some of the sites we recommend for our visitors[...]……
chris murray
February 7th, 2012 at 9:37 am
Websites you should visit…
[...]below you’ll find the link to some sites that we think you should visit[...]……
resume
February 7th, 2012 at 8:54 pm
Visitor recommendations…
[...]one of our visitors recently recommended the following website[...]……
tanie noclegi zakopane
February 7th, 2012 at 10:31 pm
Websites you should visit…
[...]below you’ll find the link to some sites that we think you should visit[...]……
teeth whitening beverly hills
February 7th, 2012 at 10:46 pm
Superb website…
[...]always a big fan of linking to bloggers that I love but don’t get a lot of link love from[...]……
know more about seo
February 8th, 2012 at 2:18 am
Recent Blogroll Additions……
[...]usually posts some very interesting stuff like this. If you’re new to this site[...]……
goal rush
February 8th, 2012 at 3:26 am
Awesome website…
[...]the time to read or visit the content or sites we have linked to below the[...]……
pinoy channel
February 8th, 2012 at 11:56 am
Websites you should visit…
[...]below you’ll find the link to some sites that we think you should visit[...]……
dance music
February 8th, 2012 at 12:43 pm
Visitor recommendations…
[...]one of our visitors recently recommended the following website[...]……
Scott tucker
February 8th, 2012 at 2:45 pm
Related……
[...]just beneath, are numerous totally not related sites to ours, however, they are surely worth going over[...]……
Scott Tucker Racing
February 8th, 2012 at 3:26 pm
Cool sites…
[...]we came across a cool site that you might enjoy. Take a look if you want[...]……