HOW TO TREAT USING ANTIOBIC AGENTS

1. TREATMENT OF UNTREATABLE INFECTION:

The majority of viral diseases are self-limiting and don’t respond to presently available anti microbial. Thus anti microbial therapy of measles, mumps, at least 90% of infection of upper respiratory tract is ineffective and useless and rather harmful.

2. THERAPY OF PYREXIA OF UNKNOWN ORIGIN:

Fever of undetermined cause may be of two types:

Short duration fever.

Prolonged or extended duration fever.

Both of these condition are frequently treated with anti microbial. In the absence of localizing signs, fever of short duration is, in majority of cases due to undefined viral infection and does not respond to antibiotic. In vast majority of such cases (period of reduction of fever) occurs spontaneously with in a week or less.

The causes of prolong period are:

Tuberculosis (T.B.)

Hidden pyrogenic intra-abdominal abscesses.

Endocarditis.

Hepatitis.

Neoplasm.

Atypical rheumatoid Arthritis and many other non-infection disorders.

Antibiotics are not the antipyretic and the patient should not be expressed unnecessary to chemotherapy with a hope that if one antibiotic is ineffective that the other or the combination of antibiotics may work. Instead cause of fever must be probed (investigated) and treatment should be done accordingly.

3. IMPROPER DOSAGE:

Erroneous dosage of antimicrobial agents may be of two types.

Excessive quantity of drug

Suboptimal quantity of the drug

Over dose of anti microbial might cause severe toxicity in patients with renal and hepatic dysfunction. Thus it becomes mandatory to use the proper dose of a drug by taking into account all the factors that might influence the effectiveness of therapy. However using the drug dosage at sub-therapeutic levels, b/c of fear of toxicity, may result into clinical failure and emergence of resistant microorganisms.

4. INAPPROPRIATE RELIANCE ON CHEMOTHERAPY ALONE:

In some cases, cure of the infection is not possible with anti-infective agent alone. The condition in which such problems arises are that which considerably quantity of product exudates, or necrotic or avascular infected tissue e.g. the patient with Pneumonia and Empyema (accumulation of pus in the cavities of body) can’t be cured with the use of large dose of effective drug unless the drainage of the involved area is established.

Secondly a patient with renal lithiasis can’t be cured even with effective antimicrobial for a number of time without removal of stones. Thus as a general rule, when an appreciable amount of pus or foreign body is present, the most effective therapy is a combination of the antimicrobial and proper surgical procedure.

5. LACK OF ADEQUATE BACTERIOLOGICAL INFORAMATION:

In Pakistan, 90% of the hospitalized patients receive anti microbial therapy with out support from microbiological labs. This is purely based on so called clinical judgment only. Another major contributor to the misuse of antibiotic is chemoprophylaxis. Bacterial cultures and Gram stains of infected materials are obtained after trying single or combined anti-microbial therapy.

If a bacteriological diagnosis is available, it is often disregarded in the selection of anti-microbial therapy. Frequent use of anti-microbial combination with broader spectra is a cover for diagnostic inspection. The anti-microbial agents are selected and prescribed by the prescriber depending upon the un-ethical convincing by sale promoters of the pharmaceutical manufacturers.

This irrational use of drugs is not only hazardous to patient’s health, it also adds to the suffering of the patient’s b/c of the high cost of drug therapy. The anti-microbial must be individualized on the basis of clinical situations, microbiological information’s, and pharmacological consideration available.