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1/11/2015

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InfectiousDiseases
ClinicalConcepts1
TreatmentofInfectiousDiseasesinEnvironmentswithIncreasingNumbersofMultipledrugResistantBacteria

(BasedontheJapaneseoriginalbyDr.YoshikazuIto,
FirstDepartmentofInternalMedicine,TokyoMedicalUniversity)
Today,manyinfectiousdiseasesarebeingcausedbymultipledrugresistantbacteriasuchas
methicillinresistantStaphylococcusaureus(MRSA).Themainfactorbehindtheincreased
numberofmultipledrugresistantbacteriaisconsideredtobethefrequentdailyuseofbroad
spectrumantibiotics.Therehavethereforebeengrowingeffortstoadministerantibioticsina
carefulandappropriatemanneragainstinfectiousdiseases.
Infectiousdiseasesresultfrommicrobialinvasionofthehumanbody,whichaffectsthehost
tissuesandtheirfunctions.Basically,theapproachtothetreatmentofinfectiousdiseasesisthe
identificationoftheorganismcausingadisorderandtheselectionofasuitableantibiotic
againstit.However,thebacteriumdetectedinmicrobiologicalexaminationsisnotalwaysthe
actualcauseofinflammation.Wearesurroundedbylargenumbersofmicroorganisms,and
manyofthemhaveestablishedthemselveswithinourbodies.Thetypesoforganismsandthe
circumstancesoftheirpresenceinsidethebodyvarygreatlywiththehostdefenseagainst
infection.Inbacteriologicexaminations,thecharacteristicsofthespecimensanddetected
conditionsofthebacteriashouldbetakenintoaccount.Itisessentialtoidentifythecausative
agentbeforeanantibioticisadministered.However,onoccasion,treatmentwithantibiotics
maybeinitiatedbeforethepathogenisidentified,butitisnecessarytofullyunderstandthe
propertiesofeachantibioticwhenadrugisselectedfortreatment.
Itisimportanttorememberthatnoantibioticcanrenderapersonbacteriafree,however
effectiveitis.Thelongtermuseofanantibioticinevitablycausesmicrobialsubstitution,in
whichtheresidentfloraarereplacedwithmicroorganismsonwhichtheantibiotichasnoeffect.
Thehistoryofbacteriaismuchlongerthanthatofhumans,andduringit,bacteriahavegone
throughvariousenvironmentalchanges.Humanscannevergainfullcontrolovermicrobesand
thereisnopointintryingtodoso.Onereason,however,fortheincreasednumberofmultiple
drugresistantbacteriaisthatmanyhealthprofessionalsdidnotunderstandthisviewpoint.
Infectiousdiseasetreatmentwithantibioticstendstofocusoneliminationofthecausative
agents.However,forimmunocompromisedpeoplesuchastheelderly,cancerpatients,and
patientswhosebiologicalbarriershavebeenimpairedformedicalpurposes,theincreaseinthe
numberofmultipledrugresistantbacteriahasbecomeaproblemofincreasingseriousness.Itis
vitaltoconsiderhowinfectiousdiseasetreatmentshouldbeconducted,startingwiththe
coexistenceofhumansandmicrobesasabasicconcept.

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