Antimicrobial agents/drugs toxicity

For most antimicrobial agents, the relation between dose and therapeutic outcome is well established, and serum concentration monitoring is unnecessary for these drugs. To justify routine serum concentration monitoring, it should be established (1) that a direct relationship exists between drug concentrations and efficacy or toxicity (2) that substantial interpatient variability exists in serum concentrations on standard doses (3) that a small difference exists between therapeutic and toxic serum concentrations (4) that the clinical efficacy or toxicity of the drug is delayed or difficult to measure and (5) that an accurate assay is available. 

Most infections should be treated with a single antimicrobial agent. Although indications for combination therapy exist, antimicrobial combinations are often overused in clinical practice. The unnecessary use of antimicrobial combinations increases toxicity and costs and may occasionally result in reduced efficacy due to antagonism of one drug by another. Antimicrobial combinations should be selected for one or more of the following reasons ... 

Drug Discovery Today 7 25-27 Li AP (2004) In vitro approaches to evaluate ADMET drug properties. Curr Top Med Chem 4 701-706 Li W, Escarpe PA, Eisenberg EJ et al. (1998) Identification of GS 4104 as an orally bioavailable prodrug of the influenza virus neuraminidase inhibitor GS 4071. Antimicrobial Agents and Chemotherapy 42 647-653 Los LE, Welsh DA, Herold EG et al. (1996) Gender differences in toxicokinetics, liver metabolism, and plasma esterase activity observations from a chronic (27-week) toxicity study of enalapril/diltiazem combinations in rats. Drug Metab Dispos 24 28-33... 

Also, gel microemulsions have been recently reported as safe and devoid of mucosal toxicity drug delivery systems, presenting intrinsic spermicide activity and the possibility of improving vaginal bioavailability of poorly soluble antimicrobial agents [100],... 

The sulfonamides are a group of organic compounds with chemotherapeutic activity they are antimicrobial agents and not antibiotics. They have a common chemical nucleus that is closely related to PABA, an essential component in the folic acid pathway of nucleic acid synthesis. The sulfonamides are synergistic with the diaminopyrim-idines, which inhibit an essential step further along the folate pathway. The combination of a sulfonamide and a diaminopyrimidine is advantageous because it is relatively non-toxic to mammalian cells (less sulfonamide is administered) and is less likely to select for resistant bacteria. Only these so-called potentiated sulfonamides are used in equine medicine. These drugs are formulated in a ratio of one part diaminopyrimidine to five parts sulfonamide, but the optimal antimicrobial ratio at the tissue level is 1 20, which is achieved because the diaminopyrimidines are excreted more rapidly than the sulfonamides. 

Apart from a very occasional anaphylactic reaction, antimicrobial agents do not produce clinically observable pharmacological effects unless (acute reaction) or until toxicity is manifested. The latter is generally associated with multiple dosing that leads to drug accumulation and can be precipitated by the presence of a concurrent disease state, such as renal function impairment or hepatic dysfunction. Inherent dangers associated with the indiscriminate use of antimicrobials are the widespread development of bacterial resistance and the production of toxicity without premonitory signs. 

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