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Rationale for the use of antimicrobial combinations
Decreased emergence of resistance
Decrease dose related toxicity
Polymicrobial indections
Virulence suppression
Synergy
Synergy- Checkerboard assay
two or more antibiotics tested in combo in concentrations equal to, above, and below their MIC
<0.5 synergy
<1 additivity
>2 antagonism
Synergy- Agar solution
this technique involves incorporating antibiotics into agar plates at various concentrations and assessing bacterial growth inhibition.
Dynamic kill curve- synergy
Dynamic kill curve- indifference
Dynamic kill curve- antagoinsm
Serial Inhibition of metabolic pathway
Serial inhibition of folate synthesis
Both TMP and SMX are bacteriostatic as single agents but bactericcidal when used in combo
Inhibition of protective enzymes
Combination targets of cell wall or cell membrane antibiotics
Drug targets within cell wall or membrane function to synergize antibiotic effect
Phosphonic acid derivates + B-lactams/vanco
Daptomycin + B lactams
what vanco combo causes less nephrotoxicity ?
Vacno + Hydrophillic B lactams (ampicillin, most cephalosporins)
Use of cell wall agents to enhance uptake
Aminoglycosides + B lactams
Daptomycin + B lactams
Recognize mechanisms for and potential clinical implications of antagonistic combinations
Static agents used with cidal agents —> Induction of resistance, competitive binding
Note 
Flashcard (102)