Benign Prostatic Hyperplasia – Prostate Cancer – Prostatitis

Archive for the ‘Treatment’ Category

Chemotherapy: Drug-Resistance and Superinfection

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In the Individual Patient The use of two drugs in combination to delay the emergence of a drug-resistant strain is now a well established principle and is almost universally used in the treatment of tuberculosis. A change in the drug sensitivity of an infecting bacterium during a single short course of treatment does not in fact occur very frequently. On the bacterial side the only organisms likely to show such a change are staphylococci and conform bacilli. When antibiotics have to be given for long periods the danger is increased, and is particularly great in the case of tuberculosis, since tubercle bacilli are nearly as adaptable to antibacterial drugs as are staphylococci and coliform bacilli. Although staphylococci appear to be able to develop resistance to almost any antibiotic, this usually only follows continued use of the antibiotic in a hospital where strains are spreading from patient to patient. With streptomycin, erythromycin, novobiocin and Fucidin, however, resistance develops so rapidly that a gross change in sensitivity of an infecting strain is not infrequent after antibiotic Read more [...]

Chemotherapy: Bactericidal Synergy And Antagonism

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Jawetz & Gunnison (1953) in one of their now classic papers on 'Antibiotic Synergism and Antagonism' defined 'synergism' as 'the ability of two antimicrobial drugs acting together to increase markedly the rate of early bactericidal [my italics] action, as compared to the rate with either drug alone, and to kill greater numbers of bacteria or to cure experimental or clinical infections more effectively than could be expected from simple algebraic summation of single drug effects'. Simple summation was termed 'addition' and any combined effect less than the sum was called 'antagonism'. It will be seen from this definition that Jawetz & Gunnison were concerned with the bactericidal, not the bacteristatic, effect of drugs and it has been found in practice that it is synergy of this type which operates in vivo. In special cases a combination of drugs may be qualitatively as well as quantitatively different from the action of either drug alone. Thus the combination of penicillin and streptomycin acting together against enterococci is more effective than any concentration of either drug separately. Read more [...]

Chemotherapy: Introduction

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The use of antibiotic combinations for the treatment of bacterial infections has been the subject of many reviews (Garrod 1953, 1964, Chabbert 1953, Dowling 1957, Jawetz 1958, Lacey 1960). All the authors take the view that double chemotherapy is only justified for certain specific reasons, and condemn factory-made mixtures of antibiotics, on the grounds that it is important to prescribe the two antibiotics in appropriately chosen doses. Moreover, the trade name of a mixture often gives no indication of the drugs it contains and may suggest to the uninitiated that it is a new antibiotic, rather than a mixture of two well known ones. The reasons suggested for double chemotherapy are: (1) To achieve a synergic effect. (2) To delay the emergence of resistant strains. (3) To prevent super infection. (4) To treat relatively inaccessible bacteria. (5) To treat mixed infections. (6) To treat undiagnosed infections. In addition some people have recommended the use of two drugs in order to achieve good therapeutic results with small doses of drugs which would be too toxic to use in larger doses, Read more [...]