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BACTERIA & ANTIBIOTICS Introduction Lele (199

Lele (1991) reports that non-response to drugs is a problem that all clinicians face. The cause may be due to resistance of the invading micro-organism or the drug used, drug dose, frequency, duration, and administration, or inadequate patient compliance.

Antibiotics have been found to reduce mortality from infectious diseases, however, the prevalence of these diseases remains. It is hypothesized that use and misuse of antimicrobial agents facilitates the evolution of bacterial resistance which results in therapeutic failure. This trend is due to new resistance mechanisms and the spreading of well-characterized resistance mechanisms to the majority of bacterial species. Intrinsic resistance, or insensitivity, is described as species or genus specific; it delineates the spectrum of activity of the antibiotic. Acquired resistance is found only in certain strains of a species or genus; this results from "mutation in a gene located in the host chromosome or a plasmid or from acquisition of new genetic information by a bacterium, mainly by conjugation or transformation" (Courvalin, 1996, p. 855).

Intrinsic resistance refers to a trait present in all of the members of a bacterial genus or species. However, this is a relative notion, since insensitivity can be overcome. For example, gram-negative bacteria, Enterobacteriaceae in particular, are considered naturally resistant to macrolides. However, higher local antibiotic concentrations obtained in the lumen of the intestinal tract after administration of recommended oral doses, render these bacteria susceptible to selective decontamination of the gut (prevention of travellers' diarrhoea). Other bacteria such as streptococci and enterococci have a natural resistance to low levels of aminoglycosides, however, systemic infections due to these microorganisms are successfully treated with combinations of aminoglycosides and beta-lactams. Intrinsic resistance can be due to trait...

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