Combining Antibiotics

Should or not? In many cases, using an antibiotic that is unable to fight off the disease and having to use a combination of two or three different types is thought to be better than one. However, this is not always the case.
The benefits of coordination
In fact, many cases of using an antibiotic do not cure the disease but resort to a combination of two or three different drugs.
In terms of therapeutic effects, there are cases where two drugs are better than one. Because there are so many bacteria around us, many different types, so there are many different pathogens that can cause disease in the same organ

. But the fact that no drug is versatile can kill the bacteria at the same time. Each type has only a certain mechanism of action, works well with certain types of pathogens. The combined use of drugs will increase the spectrum of action with harmful bacteria
For example, pneumonia and respiratory infections are generally caused by a group of staphylococcal bacteria, streptococcal bacteria, but sometimes due to the presence of E.



coli or Klebsiella. If we use beta lactam antibiotics, they often have a strong effect on staphylococcal bacteria, streptococci. But if we combine it with aminoglycosides, we can cover the effect on the intestinal bacteria when we have no conditions to determine which bacteria are causing the disease.
The effectiveness of antibiotic combination is that the two drugs sometimes increase the effectiveness of each other. A good example of this is the combination of sulfamid antibiotics and trimethoprim antibiotics. Both antibiotics are newly discovered antibiotics compared to "elder" antibiotics like penicillin. Sulfamides inhibit competition with PABA so it reduces the synthesis of dihydrofolat, an important stage in DNA synthesis Trimethoprim, on the other hand, inhibits dihydrofolat reductase, an enzyme that breaks down dihydrofolate.



If the two drugs are used together, the effect is found to be increased by 100 times.
... and unwanted side effects
The downside of using multiple antibiotics in treatment is that multiple therapies are also harmful. The use of a drug has also caused the user harm, if used concurrently many drugs, of course the harm will be resonant.
For example, aminoglycoside antibiotics are drugs that cause flatulence, nausea, and vomiting. If metronidazole is used, a drug that causes fatigue will cause patients to endure twice the unwanted effects.



Clearly, the combination of drugs in this case is not good and it is difficult for patients to come to the same treatment.
More complex is the case of combination of drugs, but the mechanism of action is not reciprocal. For example, a combination of penicillin and tetracycline to treat meningitis.
Tetracycline is a drug that inhibits ribSome 30S subunit during protein synthesis, but it is hindered by penicillin. Therefore, we must avoid combining these two antibiotics.
Coordinate when?
Usually, the use of multi-treatment regimens is only applied when patients are at risk of serious or widespread bacterial infections and we cannot immediately identify which bacteria are causing the disease. While in doubt, one can make many judgments about the type of bacteria that cause illness.
Therefore, when a serious lung infection is present, the combination of a ß-lactam antibiotic such as co-amoxiclav, cefuroxime, cefotaxime or ceftriaxone with a macrolide antibiotic such as clarithromycin is recommended because it strengthens the effect.



of each other.
This combination is effective both on "normal" bacteria in the respiratory tract and at the same time on the less typical bacteria like legionella pneumophila, mycoplasma pneumoniae.
For abdominal infections, most of it is due to the co-infection of anaerobic and anaerobic bacteria. Therefore, it is often recommended that metronidazole antibiotics be used in combination with a broad-spectrum antibiotic such as cefotaxime, gentamicin, ciprofloxacin to cover the pathogen that may be causing the disease.
It should be noted that abdominal infection (or more accurately peritonitis) is a serious infection which, if not managed well, can lead to death. For important infections such as endocarditis, multiple drug use is often indicated at the outset. For example, a combination of penicillin and gentamicin to treat endocarditis caused by intestinal coccidiosis. This combination is better than when used alone with penicillin.



This regimen is also valid when we treat staph endocarditis.
An extremely powerful effect of drug combination is resistance to resistance, with TB treatment being the most vivid example. When using isoniazid, the rate of drug-resistant TB was 1/106 and for rifampicin the resistance rate was 1/108 pathogens.
But when we combine it, the resistance rate is lowered to a gap. To lower the rate of drug-resistant bacteria caused by tuberculosis and c treatment.

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