Problem of Antibiotic Therapy

Selection of Antibiotics: Before selecting an antibiotic, the presence of infection must be establishment as also the indispensability of the use of an antibiotic. To employ an antibiotic in case of just any fever is not justified. Once it is certain that an antibiotic must be used, the choice of antibiotic becomes cirtical. The ideal method of selection is to carry out a bacterial test (it takes at least 24 hours) before starting the treatment. However, in cases where the infection is severe and the disease is likely to intensify before the sensitivity report is received, antibiotic therapy may be started on the basis of doctor's clinical judgement.

Failure of Response: The failure of response to antibiotics is frequent and the reasons many. It could be the wrong selection, the development of bacterial resistance in the patient or inadequate therapy. The mechanism of the development of drug resistance is quite complex. If a patient has been taking a particular antibiotic frequently, the bacteria in his system are likely to become resistant to it. The failure of response due to inadequate or inappropriate therapy involves several factors, some of which can be avoided by a vigilant doctor and some by the patients themselves.

The Patient's Role: In India, where most of the population is poor, people hesitate to purchase expensive drugs. When a doctor prescribes an antibiotic, the patient thinks twice before making up his mind to take it, and in the process, loses valuable time. The treatment thus gets postponed and the. infection becomes severe. Sometimes the patients stop the drug as soon as the symptoms are relieved, without completing a full course. This leads to the development of bacterial resistance, and the antibiotic becomes ineffective for future treatment of the disease.

In some cases, a patient takes either less than the prescribed dose, or decreases the frequency of the intake, advised by the physician. If, for example, a correct dose of an antibiotic is 250 mg four times a day (a total of 1 g), and the patient takes it only two or three times a day ( total of 500 or 750 mg), this inadequate dose leads to the development of bacterial resistance. Similarly, combinations of two antibiotics, each in a sub-therapeutic dose (smaller than the normal recommended dose), can also cause bacterial resistance and finally lead to a failure of the treatment.

Adverse Effects of Antibiotics: Except for a few, such as chloramphenicol which may depress the bone marrow, and neomycin which may damage the kidneys, almost all antibiotics have two important adverse effects: 1) allergic reactions, and 2) super-infections (added infections) due to other micro-organisms.

Allergic reactions to antibiotics are usually mild, in the form of skin rashes, fever, and joint pain. Serious allergic reactions, such as anaphylactic shock (hypersensitivity to an antigen), are quite rare. A person allergic to one antibiotic is likely to be allergic to

other antibiotics of the same group.

Super-infections occur because antibiotics kill one group of mlcro-orgainsms, while others keep growing uninhibited. This uninhibited growth of unaffected micro-organisms may occasionally lead to serious consequences, which are most difficult to treat.

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Autor: Alien

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