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Related Experiment Videos

Bowel microorganisms--a target for selective antimicrobial control.

H K van Saene1, A Percival

  • 1Department of Medical Microbiology, University of Liverpool.

The Journal of Hospital Infection
|September 1, 1991
PubMed
Summary
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Selective antimicrobial control (SAC) effectively clears gut bacteria using specific factors. A potent fluoroquinolone with oral polymyxin/tobramycin offers the best strategy against enterobacteria and pseudomonads, minimizing resistance.

Area of Science:

  • Microbiology
  • Pharmacology
  • Clinical Medicine

Background:

  • Selective antimicrobial control (SAC) aims to eliminate intestinal Gram-negative bacillary carriage.
  • Understanding the eight key factors influencing SAC outcomes is crucial for effective application.

Purpose of the Study:

  • To review the determinants of selective antimicrobial control (SAC) efficacy.
  • To compare different SAC regimens in various clinical scenarios.
  • To discuss current challenges including resistance, selectivity, and tissue effects.

Main Methods:

  • Review of eight factors influencing SAC: carrier state, compliance, prophylaxis vs. treatment, minimum bactericidal concentration (MBC), dosage, pharmacokinetics, fecal inactivation, and target microorganisms.
  • Comparison of non-absorbable SAC regimens with absorbable trimethoprim/sulfamethoxazole (TMP/SMZ) and fluoroquinolones.

Related Experiment Videos

  • Analysis of clinical settings: neutropenia, intensive care, hepatic encephalopathy, liver transplantation, and Salmonella carrier state.

    • Main Results:

    • Newer fluoroquinolones are effective SAC agents against enterobacteria, but have limitations against Pseudomonads.
    • Trimethoprim/sulfamethoxazole (TMP/SMZ) shows limited value as a SAC agent.
    • A combination of polymyxin/tobramycin demonstrates potent SAC activity, including against Pseudomonads.

    Conclusions:

    • A combination of a potent fluoroquinolone with oral polymyxin/tobramycin represents the most effective SAC program currently available.
    • This combined approach effectively controls enterobacteria and pseudomonads, particularly in patients at risk of bacterial translocation.
    • This strategy offers minimal risk of emerging antimicrobial resistance.