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Questions and Answers
Which adverse effect is most closely associated with cumulative aminoglycoside exposure rather than peak serum concentrations?
Which adverse effect is most closely associated with cumulative aminoglycoside exposure rather than peak serum concentrations?
What is an important consideration when administering aminoglycosides to different patients?
What is an important consideration when administering aminoglycosides to different patients?
Which of the following adverse effects is specifically associated with macrolide use but not aminoglycoside use?
Which of the following adverse effects is specifically associated with macrolide use but not aminoglycoside use?
What is the rationale behind monitoring both peak and trough serum levels of aminoglycosides?
What is the rationale behind monitoring both peak and trough serum levels of aminoglycosides?
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A patient is prescribed an antimicrobial medication that inhibits tetrahydrofolic acid production. Which of the following drug classes fits this description?
A patient is prescribed an antimicrobial medication that inhibits tetrahydrofolic acid production. Which of the following drug classes fits this description?
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Which mechanism of action is associated with selective toxicity in antimicrobial drugs?
Which mechanism of action is associated with selective toxicity in antimicrobial drugs?
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What is the most accurate definition of an antibiotic, according to the provided text?
What is the most accurate definition of an antibiotic, according to the provided text?
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An antimicrobial drug that inhibits the synthesis of nucleic acids would directly interfere with which bacterial process?
An antimicrobial drug that inhibits the synthesis of nucleic acids would directly interfere with which bacterial process?
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Which of the following best explains how bacteria develop acquired resistance to antimicrobial drugs?
Which of the following best explains how bacteria develop acquired resistance to antimicrobial drugs?
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How does classifying antimicrobial drugs by susceptible organism aid in treatment strategies?
How does classifying antimicrobial drugs by susceptible organism aid in treatment strategies?
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Which of the following is a noted mechanism of action for antibiotics?
Which of the following is a noted mechanism of action for antibiotics?
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Which of the following exemplifies selective toxicity?
Which of the following exemplifies selective toxicity?
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According to the classification of antimicrobial drugs, which of the following is NOT a typical target?
According to the classification of antimicrobial drugs, which of the following is NOT a typical target?
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What is the primary mechanism by which microbes develop resistance to drugs?
What is the primary mechanism by which microbes develop resistance to drugs?
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Which of the following is an example of a mechanism for acquired resistance in microbes?
Which of the following is an example of a mechanism for acquired resistance in microbes?
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Which strategy is LEAST likely to delay the emergence of drug resistance in a clinical setting?
Which strategy is LEAST likely to delay the emergence of drug resistance in a clinical setting?
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According to the guidelines for antibiotic selection, what information is most critical for a clinician to consider when choosing an appropriate antibiotic?
According to the guidelines for antibiotic selection, what information is most critical for a clinician to consider when choosing an appropriate antibiotic?
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Which host factor is least important to consider when selecting an antimicrobial drug?
Which host factor is least important to consider when selecting an antimicrobial drug?
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Why is it crucial for patients to complete the full course of an antibiotic prescription?
Why is it crucial for patients to complete the full course of an antibiotic prescription?
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Which of the following is generally considered an appropriate indication for prophylactic antibiotic use?
Which of the following is generally considered an appropriate indication for prophylactic antibiotic use?
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What distinguishes contamination from infection in the context of antimicrobial use?
What distinguishes contamination from infection in the context of antimicrobial use?
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Which of the following adverse effects is primarily associated with trough levels when administering aminoglycosides?
Which of the following adverse effects is primarily associated with trough levels when administering aminoglycosides?
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What is a significant consideration when administering aminoglycosides, based on the text?
What is a significant consideration when administering aminoglycosides, based on the text?
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Which of the following is a potential adverse effect associated with macrolide antibiotics such as erythromycin?
Which of the following is a potential adverse effect associated with macrolide antibiotics such as erythromycin?
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What is the primary mechanism of action for sulfonamides and trimethoprim?
What is the primary mechanism of action for sulfonamides and trimethoprim?
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Why are aminoglycosides typically administered in a single large dose each day, or in 2-3 smaller doses?
Why are aminoglycosides typically administered in a single large dose each day, or in 2-3 smaller doses?
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Which of the following mechanisms enables bacteria to become resistant to a drug by reducing the amount of drug that reaches its target site?
Which of the following mechanisms enables bacteria to become resistant to a drug by reducing the amount of drug that reaches its target site?
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What is the primary role of bacterial enzymes in drug resistance?
What is the primary role of bacterial enzymes in drug resistance?
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Which of the following modifications to a bacterial target site is a mechanism of antibiotic resistance?
Which of the following modifications to a bacterial target site is a mechanism of antibiotic resistance?
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How does the production of a drug antagonist contribute to microbial resistance?
How does the production of a drug antagonist contribute to microbial resistance?
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Which mechanism is responsible for the transfer of resistance genes between bacteria?
Which mechanism is responsible for the transfer of resistance genes between bacteria?
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In what way does proper catheter management help delay the emergence of drug resistance?
In what way does proper catheter management help delay the emergence of drug resistance?
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Why is it important to target the pathogen with a narrow-spectrum antibiotic whenever possible?
Why is it important to target the pathogen with a narrow-spectrum antibiotic whenever possible?
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What is the most significant reason to avoid unnecessary vancomycin use in hospitals?
What is the most significant reason to avoid unnecessary vancomycin use in hospitals?
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What is the most accurate definition of an antimicrobial agent?
What is the most accurate definition of an antimicrobial agent?
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According to the information, antimicrobial drugs can be classified based on:
According to the information, antimicrobial drugs can be classified based on:
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An antimicrobial drug that inhibits cell wall synthesis would directly interfere with which bacterial process?
An antimicrobial drug that inhibits cell wall synthesis would directly interfere with which bacterial process?
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Which of the following is an accurate description of how some organisms develop resistance to antimicrobial drugs?
Which of the following is an accurate description of how some organisms develop resistance to antimicrobial drugs?
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Which bacterial structure or function is LEAST likely to be a target for antimicrobial drugs, based on the information?
Which bacterial structure or function is LEAST likely to be a target for antimicrobial drugs, based on the information?
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For an antimicrobial drug to exhibit selective toxicity, it should:
For an antimicrobial drug to exhibit selective toxicity, it should:
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Which of the following organisms is identified as having microbial drug resistance?
Which of the following organisms is identified as having microbial drug resistance?
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Flashcards
Chemotherapy
Chemotherapy
Use of chemicals against invading organisms.
Antibiotic
Antibiotic
A chemical produced by one microbe that harms other microbes.
Antimicrobial agent
Antimicrobial agent
Any substance that kills or suppresses microorganisms.
Selective Toxicity
Selective Toxicity
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Classification by Mechanism of Action
Classification by Mechanism of Action
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Acquired Resistance
Acquired Resistance
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Examples of Drug-Resistant Organisms
Examples of Drug-Resistant Organisms
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Mechanisms of Antibiotics
Mechanisms of Antibiotics
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Macrolides
Macrolides
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Aminoglycosides
Aminoglycosides
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Nephrotoxicity
Nephrotoxicity
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Serum Levels Monitoring
Serum Levels Monitoring
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Sulfonamides
Sulfonamides
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Drug Resistance Actions
Drug Resistance Actions
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Conjugation
Conjugation
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Delaying Drug Resistance
Delaying Drug Resistance
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Treating Infections Correctly
Treating Infections Correctly
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Identifying Organisms
Identifying Organisms
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Host Factors
Host Factors
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Prophylactic Antimicrobials
Prophylactic Antimicrobials
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Classification by Susceptible Organism
Classification by Susceptible Organism
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Disruption of Bacterial Cell Wall
Disruption of Bacterial Cell Wall
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Inhibition of Protein Synthesis
Inhibition of Protein Synthesis
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Nucleic Acids Synthesis Inhibitors
Nucleic Acids Synthesis Inhibitors
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Antimetabolites
Antimetabolites
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Viral Enzyme Inhibitors
Viral Enzyme Inhibitors
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Acquired Resistance Development
Acquired Resistance Development
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Selective Toxicity Mechanism
Selective Toxicity Mechanism
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Therapeutic uses of Macrolides
Therapeutic uses of Macrolides
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Adverse effects of Aminoglycosides
Adverse effects of Aminoglycosides
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Monitoring Serum Levels
Monitoring Serum Levels
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Sulfonamides and Trimethoprim
Sulfonamides and Trimethoprim
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Decrease drug concentration
Decrease drug concentration
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Inactivate a drug
Inactivate a drug
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Alter drug target molecules
Alter drug target molecules
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Produce a drug antagonist
Produce a drug antagonist
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Spontaneous mutation
Spontaneous mutation
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Vaccination to delay resistance
Vaccination to delay resistance
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Complete prescription
Complete prescription
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Study Notes
Basic Principles of Antimicrobial Therapy
- Chemotherapy is the use of chemicals to target invading organisms.
- An antibiotic is a chemical produced by one microbe that harms other microbes.
- An antimicrobial agent is any substance that kills or suppresses microorganisms.
Selective Toxicity
- Antimicrobials are toxic to microbes but harmless to the host.
- Mechanisms include disrupting bacterial cell walls, inhibiting unique bacterial enzymes, or disrupting bacterial protein synthesis.
Classification of Antimicrobial Drugs
- Classifying antimicrobials is done in various ways.
- The textbook uses classification by susceptible organism and mechanism of action.
Classification of Antibiotics
- Antibiotics work on various cellular processes.
- These processes include cell wall synthesis, cell membrane permeability, protein synthesis (lethal and non-lethal inhibition), nucleic acid synthesis, antimetabolites, and viral enzyme inhibitors.
Antibiotic Mechanisms of Action (Diagram)
- The diagram displays the various mechanisms of antibiotic action.
- These include inhibition of bacterial protein synthesis, inhibition of cell membrane synthesis, and inhibition of nucleic acid synthesis.
- Specific examples of antibiotics that target each mechanism are shown in the diagram.
Acquired Resistance to Antimicrobial Drugs
- Over time, organisms develop resistance.
- Resistance can occur even if the organism was highly susceptible previously.
Organisms with Microbial Drug Resistance
- Specific examples include Enterococcus faecium, Staphylococcus aureus, Enterobacter species, Klebsiella species, Pseudomonas aeruginosa, Acinetobacter baumannii, and Clostridium difficile.
Microbial Mechanisms of Drug Resistance
- Microbes can resist drugs by decreasing the drug's concentration, inactivating the drug, modifying drug targets, or producing drug antagonists.
Mechanisms for Acquired Resistance
- Resistance occurs through spontaneous mutation and conjugation.
Delaying Emergence of Drug Resistance
- Strategies to prevent drug resistance include vaccination, removing catheters, targeting the pathogen, preventing nosocomial infections, and preventing superinfections.
Delaying Emergence of Drug Resistance
- Effective strategies include treating the infection, not just the contamination, recognizing when to stop using a drug, isolating the pathogen, and breaking the chain of contagion.
Selection of Antibiotics
- Selecting antibiotics involves identifying the organism, evaluating drug sensitivity, and considering clinical factors and the likely infectious agent.
Host Factors
- Factors affecting antibiotic selection include host defenses, site of infection, patient age, pregnancy/lactation, and any previous allergic reactions.
Dosage Size and Duration
- Antibiotics must be present at the site of infection for a sufficient duration.
- Complete the full prescription.
Prophylactic Use of Antimicrobials
- Antibiotics are used to prevent infections, not treat them.
- Prophylactic use can occur in surgeries, bacterial endocarditis, and neutropenia.
Penicillins
- Active against many bacteria.
- Low direct toxicity.
- Principal adverse effect is an allergic reaction.
- Beta-lactam ring structural component.
- Other beta-lactam drugs include cephalosporins, aztreonam, imipenem, meropenem, and ertapenem.
Penicillins: Mechanism of Action and Resistance
- Weaken bacteria cell walls to allow water uptake, leading to rupture.
- Primarily active against growing and dividing bacteria.
- Bacterial resistance due to inability of penicillins to reach targets, bacterial enzymes inactivating penicillins, and production of low affinity penicillin-binding proteins.
Mechanisms of Bacterial Resistance- Additional Factors
- Bacteria resist penicillins by preventing their entry, inactivating them via bacterial enzymes, or creating low-affinity penicillin-binding proteins.
Staphylococcus Aureus
- S. aureus became resistant to penicillin during the 1960s.
- MRSA (methicillin resistant Staphylococcus aureus) has a unique mechanism of resistance; producing penicillin-binding proteins with low affinity.
- Mechanisms develop by acquiring genes that code for low-affinity PBPs from other bacteria.
Penicillinases
- Beta-lactamases are enzymes that inactivate penicillins.
- Bacteria produce a variety of these enzymes that target penicillins and other beta-lactam antibiotics.
Classification of Penicillins
- Narrow-spectrum vs broad-spectrum penicillin, sensitive or resistant to penicillinase, and extended-spectrum.
Gram-Negative vs Gram-Positive Cell Envelopes
- Gram-negative bacteria have a thin cell wall, and an additional outer membrane. This outer membrane makes gram-negative bacteria harder to penetrate with antibiotics.
- Gram-positive bacteria have only two layers, and usually a thicker cell wall. The thicker cell wall in gram-positive bacteria makes them more permeable and easier to treat with some antibiotics.
Penicillinase-Resistant Penicillins
- Nafcillin, oxacillin, and dicloxacillin are examples, available in the United States.
- Used to treat infections by methicillin-resistant Staphylococcus aureus.
Broad-Spectrum Penicillins
- Aminopenicillins, such as ampicillin and amoxicillin (Amoxil, DisperMox), are broad-spectrum, meaning they can combat many bacteria.
- Possible adverse effects include rashes or diarrhea.
Extended-Spectrum Penicillins
- Piperacillin is an example; it's broad-spectrum but sensitive to penicillinase.
Drugs That Weaken Bacterial Cell Walls
- Cephalosporins, carbapenems, and others, combat bacteria by weakening their cell walls.
Cephalosporins
- Widely used beta-lactam antibiotics.
- Similar to penicillin in structure.
- Usually given intravenously.
- Low toxicity
- Mechanisms include binding to penicillin-binding proteins, disrupting cell wall synthesis, and causing cell lysis.
- Beta-lactamases destroy first-generation but affect later generations less.
Classification of Cephalosporins
- Categorized into generations (first, second, third, fourth, and fifth), each with varying levels of resistance to beta-lactamases and spectrum of activity.
Cephalosporins: Therapeutic Uses
- First generation often used prophylactically in surgical procedures.
- Second generation is rarely used for active infections.
- Third generation are often the first choice when active infections are occurring.
- Fourth generation are most often used to treat healthcare and hospital-associated pneumonia.
- Fifth generation are most often used to treat infections associated with MRSA.
Carbapenems
- Broad-spectrum beta-lactam antibiotics with low toxicity.
- Not active against MRSA.
- Examples include imipenem, meropenem, ertapenem, and doripenem.
Carbapenems [Imipenem]
- Active against many pathogens, including those resistant to other antibiotics.
- Effective against gram-positive cocci, gram-negative cocci/bacilli, and anaerobic bacteria.
- Administered intravenously.
- Potential adverse effects and interactions.
Vancomycin
- Inhibits bacterial cell wall synthesis.
- Primarily used for severe infections caused by MRSA, Staphylococcus epidermidis, and Clostridium difficile.
- Intravenous administration necessary.
- Potential adverse effects, including ototoxicity (reversible or permanent), "red man" syndrome, thrombophlebitis, rare cases of thrombocytopenia, allergic reactions.
- Vancomycin is a last resort antibiotic due to rare toxicity.
Tetracyclines
- Broad-spectrum antibiotics that inhibit protein synthesis.
- Resistance is rising.
- Commonly used for rickettsial diseases, chlamydia, brucellosis, cholera, and other conditions.
Tetracyclines: Specific Drugs
- Tetracycline, demeclocycline, doxycycline, and minocycline are available systemically.
- Treatment for various infections and conditions, including mycoplasma pneumonia, Lyme disease, anthrax, Helicobacter pylori infections, acne, peptic ulcers, and periodontal disease.
Macrolides (Erythromycin)
- Broad-spectrum antibiotics that inhibit protein synthesis (often bacteriostatic, but potentially bactericidal in some circumstances).
- Usually used when patients are allergic to penicillin.
- Effective against most gram-positive and some gram-negative bacteria.
- Treats whooping cough, diphtheria, chlamydia, M. pneumoniae, and group A strep.
Macrolides (Erythromycin): Uses and Adverse Effects
- Treating whooping cough, acute diphtheria, chlamydial infections, certain bacterial infections, and potentially helpful when penicillin is contraindicated.
- Potential adverse effects including gastrointestinal problems, QT prolongation, and potentially rare life-threatening side effects.
Aminoglycosides
- Narrow-spectrum antibiotics, typically bactericidal.
- Commonly used to treat infections from aerobic gram-negative bacilli, including gentamicin, tobramycin, and amikacin.
- Can cause significant damage to the inner ear and kidneys.
- Not well-absorbed from the gastrointestinal tract and usually administered intravenously.
Aminoglycosides: Adverse Effects and Interactions
- Potential adverse effects include ototoxicity (hearing damage), nephrotoxicity (kidney damage), hypersensitivity reactions, neuromuscular blockade, and blood dyscrasias..
- Interactions with other medications possible.
Serum Levels of Aminoglycosides
- Monitoring serum levels is crucial for effective aminoglycoside use.
- Dosage is typically adjusted according to these levels.
- Peaks need to be high enough to appropriately treat bacterial infections, but troughs must be low enough to prevent toxic effects.
Sulfonamides and Trimethoprim
- Broad-spectrum antibiotics that inhibit tetrahydrofolic acid synthesis.
- Frequently used to combat bacterial infections, especially urinary tract infections (UTIs).
Sulfonamides: Primary Uses and Microbial Resistance
- Historically among the first drugs used, they primarily treat urinary tract infections.
- Resistance has been developed by many bacteria, and can be more significant in certain types.
General antibiotic principles
- Understanding the different classes of antibiotics and their mechanisms of action.
- Knowing the conditions for which antibiotics are appropriate and when they are contraindicated.
- Understanding how to choose or optimize the antibiotic protocol to minimize patient risk.
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