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Könyvajánlók

Homeopátia és a várandós nő

Fáradékonyság és vérszegénység a daganatos betegségekben

Urológiai betegségek

Parkinson-kór

Szerzők:

• Gillespie, Stephen H.
• Tillotson, Glenn S.

Kiadás:

Kiadó: The Royal Society of Medicine Press
2002
Round Table Series 76
ISBN 1-85315-530-6
ISSN 0268-3091

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Fülszöveg

The evaluation of antimicrobial efficacy is unique in that it is the only process in which the target of medication is not the actual human host, but an invading microorganism. Thus, what is generally measured is the physiological consequence of this application, le cure and eradication. Our understanding of how antimicrobials work on bacteria has expanded significantly since Fleming's notable observations. We now appreciate the interactions of P lactams and specific cell wall proteins, and how fluoroquinolones attack at least two sites involved in DNA replication. We also understand that different modes of microbial death can lead to different release of cell components. Even within the same antimicrobial class there are differences in extent and type of cell component released. Carbapenems, such as imipenem, cause a significantly lower release of both lipopolysaccharides and lipoteichoic acid compared with penicillin or cephalosporins. These cellular components are 'toxic', ie they elicit a marked host response, which may lead directly to cell wall associated inflammation. It is therefore preferable to cause a rapid bacterial cell death with minimal release of these cell wall antigens.
Studies have shown that sub optimal concentrations of antimicrobials can both diminish and enhance microbial virulence mechanisms, such as specific enzyme activity or adherence factors. It is preferable for sub optima concentrations to weaken microbial virulence mechanisms.
Antimicrobials may also have a direct effect on the host defences because of their chemical structure. Macrolicle agents, specifically erythromycin, have other'non antibiotic' uses such as immunomodulators in a chronic lung condition, diffuse panbronchiolitis. Recently, the direct effects of fluoroquinolones on various parts of the immune and host defence have been reported [ I ]. These effects vary from agent to agent some increase white blood cell production and others increase anti inflammatory factors. Each of these individual actions can contribute to inhibition or death and removal of the pathogen; however, these processes may be inter woven in such a way that collectively they can exert a more rapid and comprehensive effect.
This symposium was convened to discuss many of these antimicrobial features (especially of the fluoroquinolones, including the new 'respiratory' fluoroquinolone, moxifloxacin) and to review how, holistically, they may contribute to a quicker resolution of the signs and symptoms of infection.