2009, Vol. I, No. 1, . 1-6 / UDK 615.33.

032

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RATIONAL USE OF ANTIBIOTICS IN CLINICAL PRACTICE

Slobodan Jankovic
Clinical Pharmacology Department,
Clinical Center Kragujevac
/Received: 10.12.2008.

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ABSTRACT
Antibiotics are compounds produced by microorganisms, which inhibit growth of concurrent
microbes. There are several mechanisms of antibiotic action: inhibition of cell wall growth, inhibition of protein synthesis, blockade of DNA
functioning or metabolic pathways blockade.
Antibiotics should be administered only with
clear indications, in appropriate doses and for
long enough. Beneficial clinical effect of antibiotics becomes apparent after 2-3 days, and it is
indispensable prerequisite for continuation of the
same therapy. The effect of some antibiotics
(aminoglycosides, quinolones, ketolides, metronidazole and amphotericin B) depends on peak
serum concentrations, suggesting dose regimens
with longer dose intervals; the other antibiotics (lactams, macrolides, clindamycin, glycopeptides,
tetracyclines, trimethoprim, linezolid and flucytosine) have higher efficiency if serum concentrations are stabile, suggesting short dose
intervals or administration by intravenous infusion. Choice of an antibiotic should be influenced by its pharmacokinetics, spectrum of action,
and adverse effects profile; if all of these
requirements are met, a drug with the lowest
costs should be chosen.
Key Words: antibiotics, rational drug use,
mechanism of action, adverse effects

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e-mail: slobodan.jankovic@medf.kg.ac.yu

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. 2 , , 2007.
Katzung BG. Basic & Clinical Pharmacology. 10th
edition, McGrawHill Lange, Boston, 2007.
Tierney LM, McPhee SJ, Papadakis MA. 2006 Current
Medical Diagnosis and Treatment. 45th edition, Lange,
2006.
Hsu LY, Kwa AL, Lye DC, Chlebicki MP, Tan TY,
Ling ML, Wong SY, Goh LG. Reducing antimicrobial
resistance through appropriate antibiotic usage in Singapore. Singapore Med J 2008; 49: 749-55.
Strlin K, Goscinski G, Hedlund J, Lidman C, Spindler
C, Ortqvist A, Holmberg H. Management of adult patients with community-acquired pneumonia. Evidencebased guidelines from the Swedish Infectious Diseases
Association. Lakartidningen 2008; 105: 2582-7.

6.

Bogner JR, Angstwurm M. Antibiotic therapy in the

family doctor's office. MMW Fortschr Med 2008; 150:
35-9.
7. Grau S, Rubio-Terrs C. Pharmacoeconomics of
linezolid. Expert Opin Pharmacother 2008; 9: 9871000.
8. Cunha BA. Antibiotics Essentials. 2nd ed., Physicians
Press, Royal Oak, USA, 2003.
9. Falagas ME, Vouloumanou EK, Matthaiou DK, Kapaskelis AM, Karageorgopoulos DE. Effectiveness and
safety of short-course vs long-course antibiotic therapy
for group a beta hemolytic streptococcal
tonsillopharyngitis: a meta-analysis of randomized trials. Mayo Clin Proc 2008; 83: 880-9.
10. Carroll DN, Carroll DG. Interactions between warfarin
and three commonly prescribed fluoroquinolones. Ann
Pharmacother 2008; 42: 680-5.
11. Ranji SR, Steinman MA, Shojania KG, Gonzales R.
Interventions to reduce unnecessary antibiotic prescribing: a systematic review and quantitative analysis.
Med Care 2008; 46: 847-62.