Antibiotics (Properties, Application, Interaction) - Posokhova K.A., Viktorov O.P. 2005

Preface

Antibiotics ... For a long time, doctors and their patients associated this word with the hope of a rapid and effective recovery from most diseases caused by microorganisms. This optimistic attitude toward antibiotics was grounded in years of their successful application across all fields of medical practice. Ever since Scottish microbiologist Alexander Fleming discovered penicillin, the first antibiotic, in 1928, and its clinical use began in the 1940s, a truly new era in medical history had begun. Numerous bacterial infections that previously caused epidemics with high mortality rates began to be treated effectively. It has even been suggested that the rapid growth of the global population in the 20th century is linked to a sharp decline in mortality resulting from The Use of antibiotics. Most of humanity remained unalarmed by reports of decreased microbial sensitivity to antibacterial drugs and The Emergence of multi-resistant strains. This was especially true given that year after year, new agents in this drug Class emerged, continually proving the superiority of human intellect over the natural, lightning-fast, and relentless—though blind—ability of microorganisms to alter their properties in order to survive.

By the end of the 20th century, it became clear that humanity had not only failed to win the battle against pathogenic microorganisms, but in many cases had catastrophically lost ground. Every year, up to 17 million people worldwide die from infectious diseases, including 9 million children. Over the past 30 years, 38 new infectious diseases have been discovered, 9 of them of bacterial origin and 6 caused by Protozoa. Perspectives on the Etiology of several long-known diseases have also shifted. In particular, The Role of Microorganisms in the development of gastric and duodenal ulcers, atherosclerosis, Crohn's disease, and certain mental disorders has been proven. The phenomenon of multiple drug resistance in microorganisms has assumed life-threatening proportions. Today, annual expenditures for the Treatment of diseases caused by antibiotic-resistant Bacteria amount to $4 billion in the United States alone.

Regarding the consequences and ways to overcome this problem, various views exist. Some scientists argue that antibacterial therapy in its current form has no future. After all, the newest antibiotics—whose creation and clinical Structure/175.html">Implementation take 8–10 years and tens of millions of dollars—progressively lose their activity after just a few years of use. Other researchers are more optimistic; while agreeing that The Development of Antibiotic Resistance is an extremely adverse factor for the human population as a whole, they nevertheless propose seeking adequate ways to counteract this phenomenon. Specifically, they emphasize the need at the state level to recognize The Importance of this issue, establish the collection of high-quality data on the spread of resistance, and develop and implement programs aimed at combating it. Educational outreach is also crucial, including popularizing the latest information among the broader medical community regarding the rational use of antibiotics, preventing patients from using these potent agents for self-medication, and so on.

Today it is already clear that only a comprehensive approach to solving all problems related to the development and use of antibiotics will make it possible, if not to improve the situation, then at least to postpone as long as possible the moment when, in the fight against infectious agents, we will have to rely solely on the natural resistance of the macroorganism—which, unfortunately, year after year due to a combination of factors, is progressively declining.

The clinical use of antibiotics has long required a profound knowledge of their spectra of activity—taking into account current trends in the development of microbial resistance, pharmacokinetic features, adverse side effects and complications, and the rules for selecting the necessary drugs in a specific clinical situation. Rational antibiotic prescribing nowadays is impossible without a physician's ongoing and persistent familiarization with all new developments appearing in this field. Moreover, the regular publication of literature summarizing such information from the perspective of evidence-based medicine is an urgent necessity of our time.

Authors

Abbreviations

ABT - antibacterial therapy

AG - Aminoglycosides

BD - bioavailability

BP - benzylpenicillin

VAP - ventilator-associated Pneumonia

IV - intravenous

IM - intramuscular

HIV - HUMAN IMMUNODEFICIENCY VIRUS

ICU - intensive care unit

GABA - gamma-aminobutyric acid

G (+) - Gram-positive

G (-) - Gram-negative

BBB - Blood-Brain barrier

ARVI - acute respiratory viral infections

MIC - minimum inhibitory concentration

HAP - hospital-acquired pneumonia

IU - international units

PAE - post-antibiotic effect

PBP - penicillin-binding Proteins

CAP - community-acquired pneumonia

SSI - surgical site infections

p.o. - per os (orally)

HF - Heart Failure

AIDS - Acquired Immunodeficiency Syndrome

T 1/₂ - half-life

FQ - fluoroquinolones

CRF - chronic renal failure

C - Cephalosporins

C I-IV - generations I-IV cephalosporins

DM - Diabetes Mellitus

CNS - Central Nervous system

IMV - intermitted mechanical ventilation

BSS - broad-spectrum activity

FDA - Food and Drug Administration

MRS - methicillin-resistant staphylococcal strains

MRCNS - methicillin-resistant coagulase-negative staphylococci

spp. - species

MTC - mean therapeutic concentration

drugs - Pharmaceuticals

ACE - angiotensin-converting enzyme

NSAIDs - nonsteroidal anti-inflammatory drugs

PABA - Para-aminobenzoic Acid

Antibiotics (from Greek anti meaning 'against' and bios meaning 'life') are chemotherapeutic agents produced by microorganisms or derived from other natural sources, as well as their derivatives and synthetic analogues, capable of selectively inhibiting pathogens of infectious diseases and tumor Cells in the patient's body.

Certain requirements are placed on medications used in clinical practice. They must exhibit a high selectivity of antimicrobial effect at doses non-toxic to the Organism, and ensure effective antibacterial concentrations in Body Fluids and Tissues over an extended period. Pathogens must be susceptible to these antibacterial agents, and the use of such drugs should not rapidly induce microbial resistance. Finally, the formulations should be convenient to administer.