Antibiotics--all-purpose agents.

One of the greatest discoveries in medicine was the observation by Dr. Alexander Fleming that the fungus, Penicillium notatum, excreted a substance, subsequently named penicillin, that inhibited growth of bacteria. This discovery was particularly fortuitous because of penicillin's low toxicity to human cells. Penicillin is an exemplary antibiotic because its primary mechanism of action is to interfere with or inhibit the synthesis of the bacterial cell wall. The human cell does not possess a cell wall and therefore is not subject to action of penicillin. However, penicillin should not be misconstrued as being totally without potential harm for humans; e.g., anaphylaxis. Since Fleming's discovery, many antibiotics have been developed that do not have a highly specialized mechanism of action that is unique to the bacterial cell. Many of these newer agents have the potential to interact with human cellular function. Unfortunately, these interactions are not uncovered until after millions of doses of the antibiotic have been administered. Administering antibiotics in the absence of true bacterial infection has the potential for doing more harm than good. It is important to understand that antibiotics may result in harm to the patient and may select for resistant bacterial strains. These two facts are extremely important for the physician to bear in mind when considering the administration of antibiotics to patients. Antibiotics are not antipyretic agents and should not be given to patients only because their body temperature is increased. This is commonly done in patients with fever and symptoms of pharyngitis. Often the patient is requesting antibiotics , and the physician agrees because he or she does not want to anger the patient. In addition, the physician often feels that the antibiotic is innocuous and cannot cause harm to the patient. Another instance when antibiotics are prescribed indiscriminately is in postoperative fever. The typical response to a patient who has had a hysterectomy or cesarean section and develops a fever is to give antibiotics without a thorough evaluation. When the patient responds, e.g., becomes afebrile in 24 hours, the physician feels justified in having administered antibiotics. Antibiotics are not tocolytic agents. However, it is common practice to administer antibiotics to pregnant women in preterm labor in the belief that antibiotics can increase the latent phase and therefore allow the administration of steroids. The selection of resistant bacterial strains is beginning to surface in our specialty This has been demonstrated by the selection of …