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Antibiotics halt bacterial growth and cure infection through two main mechanisms. Antibiotics
are either bactericidal or bacteriostatic. Bactericidal antibiotics kill the bacteria causing the
infection through direct action, usually by causing the cells to split open, or lyse. Bacteriostatic
antibiotics act on the internal workings of the bacterial cell to stop it dividing and so slow down
the advance of the infection. A bacterial population that divides more slowly, or that cannot
divide at all is much more easily dealt with by the bodys immune system.
Bactericidal Antibiotics
Many bactericidal antibiotics work by altering the biochemical pathway through
which bacteria make the cell wall. As the antibiotic is taken into the cell, it stops the
biochemical machinery of the cell producing or attaching one the major components
of cell wall structure.
The cell wall produced is thinner than usual. As the cell divides, the two daughter cells then also
have weaker cell walls and they cannot strengthen them because they are also prevented from
making all of the necessary components. As they try to divide subsequently, the cell walls of
these daughter bacteria fail. Lysis of the cell follows and the bacterium dies. Penicillin antibiotics
work in this way, as do the cephalosporins.
Other antibiotics in the aminoglycoside class are also bactericidal in some infections (they are
bacteriostatic in others). They bind to part of an intracellular structure - the ribosome. This
usually assembles amino acids together to form complete proteins. When the antibiotic is bound
to the ribosome, it cannot make proteins efficiently, and fewer proteins, or proteins that contain
mistakes, are made. Vital proteins that are required by the bacterium are therefore in short supply
and the cell dies.
The quinolones disable bacterial enzymes that normally replicate bacterial DNA making it
impossible for the bacterium to divide. This happens quickly, and the affected bacteria die within
a few hours. Quinolone antibiotics enter human cells very easily, so are useful for treating
bacteria that penetrate and invade cells. The antibiotic has no toxic effects on the human cell
itself because its own enzymes for copying DNA are completely different.
Bacteriostatic Antibiotics
Bacteriostatic antibiotics do not kill bacteria directly, but slow their growth so that
antibodies and white blood cells of the immune system destroy them more quickly.
Antibiotics that are predominantly bacteriostatic include the tetracyclins, the
macrolides, chloramphenicol and trimethoprim. These antibiotics all tend to work in
a similar way, by binding to part of the ribosome structure that controls the
synthesis of proteins in the bacterial cell. Most tend to act more slowly than the
quinolones, which have a similar mechanism of action, but that can be bactericidal
at some doses.
Narrow Spectrum And Broad Spectrum
Antibiotics are classed as bactericidal or bacteriostatic according whether they kill
bacterial cells directly or indirectly. They are also divided into classes such as
cephalosporins or macrolides depending in their chemical structure and action. All
antibiotics can also be described as either narrow spectrum or broad spectrum.
Those with a narrow spectrum of action can kill only a small number of species of
bacteria, maybe even just one. Broad spectrum antibiotics are active against a wide
range of bacterial species.
Narrow spectrum antibiotics tend to be very specific and act on a molecule in the metabolism of
one particular type of bacteria that is special to that species. Broad spectrum antibiotics act on
structures or processes that are common to many different bacteria, such as the components of
the cell wall.
Choosing Which Antibiotic
Doctors are sometimes faced with difficult choices. So many different bacteria cause
infections, and there are many different antibiotics to choose from. The problem of
antibiotic resistance is always an important consideration. Widespread use of broad
spectrum antibiotics is one factor that is thought to have helped the spread of
antibiotic resistance and doctors aim to prescribe antibiotics sensibly so that
antibiotic resistance does not increase further.
The ideal treatment involves an antibiotic that is effective against the organism causing the
infection and few others. Unfortunately, although taking samples of infected material from each
patient and culturing the bacteria to make a positive identification would make this possible, this
would not be a cost-effective practice because of the huge numbers of patients who go to their
GP with an infection.
For most doctors, the choice ultimately depends on the seriousness of the infection, the
antibiotics that are readily available, the most cost effective treatment, and the drug that will
cause the fewest side effects.