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The term "bacteriostatic antibiotics" is used to describe medications whose mechanism of action stalls bacterial cellular activity without directly causing bacterial death. The mechanisms of action of these antimicrobials are broad, and they generally require patients' to have functional immune systems to function optimally. This activity outlines the indications, mechanisms, and contraindications of bacteriostatic antimicrobials in treating bacterial infections and other key factors pertinent to members of the healthcare team treating patients with bacterial infections. Objectives: Identify the mechanism of action of various bacteriostatic antimicrobials. Describe the indications for different bacteriostatic antimicrobials. Review the toxicity of bacteriostatic antimicrobials. Outline interprofessional team strategies for improving care coordination and communication to advance the use of bacteriostatic antimicrobials. Access free multiple choice questions on this topic.

In general, due to the comparatively slower mechanism of action of bacteriostatic antimicrobials, the toxicity profiles of bacteriostatic agents are generally lesser than their comparable bacteriocidal analogs.[1][4] Tetracycline antimicrobials, while generally well tolerated, have the following toxicities: irritant gastritis, photosensitivity, hepatotoxicity, nephrotoxicity (except doxycycline), and hypersensitivity reactions (may not be allergic).[6][7] The most common toxicities of macrolide antimicrobials are allergic reactions, gastrointestinal distress and promotility, cardiac arrhythmias (erythromycin, QTc prolongation), and tinnitus (erythromycin).[8][9] These agents, however, are generally well tolerated. Trimethoprim/sulfamethoxazole has less than 10% gastrointestinal, dermatologic toxicities and a very rare risk of aplastic anemia. The toxicity regimen of linezolid is generally limited to low risks of gastrointestinal distress, headache, and rash.[14] The most significant toxicity reported in the literature for linezolid is myelosuppression and thrombocytopenia, with rates approaching 2.5%.[14]

There has been a traditional bias against bacteriostatic antimicrobials for a variety of indications, particularly in more acute settings, due to a misconception that they have clinically slower rates of activity and lose efficacy.[1][3] This perception, however, is untrue in several settings.[2][1][3] With appropriate stewardship and understanding of the risk and benefits of these agents, they can be used in a variety of clinical indications to help maintain the efficacy of many of the broad spectrum bactericidal agents commonly in use in hospitals and outpatient clinics.[2] The level of evidence for the composite studies in this article is I-II. The use of these bacteriostatic agents requires an interprofessional team approach to patient care. The prescribing/ordering clinician will decide which antimicrobial to use; this decision should be in tandem with a board-certified infectious disease pharmacist, in conjunction with the latest antibiogram data - especially in the inpatient setting. The pharmacist should also perform a complete medication reconciliation to rule out potential drug-drug interactions. Nursing will be responsible for administering these drugs in the inpatient setting, and for outpatients, they can still counsel the patient on proper administration. Nursing can also evaluate patient adherence and should be cognizant of potential adverse reactions so they can be reported to the prescriber immediately. This interprofessional team approach will optimize the therapeutic potential for bacteriostatic antimicrobials while limiting drug resistance and adverse events. [Level 5]