NRS 112 Antimicrobials

• Kills organisms
• Used only on non living objects.

Inhibits growth of microorganisms but does not neccessarily kill them.

Applied exclusively to living tissue.

Kills or destroys microorganisms

Retards growth of microorganisms

used by bacteria to destroy PCN

breaks down structure of the ABX and inactivates the drug

Severe hypersensitivity reaction

Inflammation of skin and mucous membranes progressing to necrosis. Can progress to lining of organs.

Secondary infections during ABX tx.

Located in groin, axilla, mouth, unber breast tissue, ANY WARM MOIST AREA.

Caused by yeast/bacteria.

Effective against Gram neg and Gram pos.

Includes carbapenems, extended spectrum cephalosporins, beta-lactam/beta-lactamase inhibitors, fluoroquinolones.

Effective against limited number of microorganisms.

PCN G, Macrolides, Nitrofurantoin, Metronidazole, Aztreonam, Nalidixic Acid.

Sulfadiazine, Sulfamethoxazole, Sulfisolxazole

Often combined w/ other ABX - combined with trimethoprim = Bactrim or Septra

• Effective against Gram pos and neg
• Used to tx UTI's and URI's.

Prevents synthesis of Folic Acid

Does not effect human cells or certain bacteria, only organisms that synthesize their own folic acid

Hemolytic or aplastic anemia, thrombocytopenia, agranulocytosis, photosensitivity, exfoliative SJS, epidermal necrosis, n/v/d, pancreatitis, convulsions, crystalluria, toxic neprhosis, h/a, peripheral neuritis, urticaria.

• PCNs
• Cephalosporins
• Carbapenems
• Monobactams

• Bacteriocidal: inhibit cell wall synthesis
• Effective against wide variety of bacteria.

PCN G, PCN V K+.

Cloxacillin, dicloxacillin, nafcillin, oxacillin.

Amoxicillin, ampicillin

Piperacillin, ticarcillin, barbenicillin

Usually used with other drugs, rarely used alone.

Unasyn - Ampicillin + sulbactam

Augmentin - Amoxicillin + clavulanic acid

Timentin - Ticarcillin + clavulanic acid

Zosyn - Piperacillin + tazobactam

Enter via cell wall, disrupt normal bacterial cell synthesis.

Does not kill other cells in body

Prevention and tx of Gram pos, streptococcus, Enterococcus, Staphylococcus bacteria.

Allergic reactions in .7 - 4% of cases.

Allergic to PCN = four to sixfold higher risk of allergy to other beta-lactam ABX

NSAIDs, oral contraceptives, Warfarin (enhances anticoagulant effect r/t decrease in intestinal flora)

Producing vitamin K

Take with full glass of water

Don't skp doese

Take all as prescribed

Notify MD of adverse reactions

Structurally/pharmacologically r/t PCN

Bacteriocidal

Broad spectrum

Good gram pos coverage/poor gram neg coverage.

Cefadroxil, cephradien, cefazolin, cephalexin (Keflex)

Surgical prophylaxis and for susceptible staph infections.

Good gram pos/better gram neg than 1st gen.

Cefaclor, cefprozil, cefoxitin, cefuroxime, loracarbef, cefotetan.

Cefoxitin IV and IM used prophylactically for ABD or colorectal surgeries. Kills anaerobes.

Cefuroxime - Zinacef parenteral, Ceftin PO- surgical prophylaxis, does not kill anaerobes

Most potent agains gram neg/less active agains gram pos.

Ceftibuten, cefotaxime, ceftazidime, cefdinir, ceftizoxime, ceftriaxone, ceftazidime

IV and IM, long half life, QD dosing

Hepatic elimination

Tx CSF and CNS infections

• IV and IM
• Excellent gram neg coverage
• Used for difficult to tx organisms such as pseudomonas
• Renal eliminations

Broader spectrum, especially against gram pos.

Used for UTI's- cefepime (Maxipime)

Ceftobipriole (not available)

Broader spectrum- effective against MRSA, pseudomonas.

Similar to PCN

Potential cross sensitivity with PCNs

Broad spectrum.

Used for complicated body cavity and CT infections.

May cause seizures

Given parenterally

Primaxin, Meropenem (Merrem), Ertapenem (Invanz), Doripenem (Doribax)

Used for tx of bone, joint, skin and soft-tissue infections.

Inhibits enzyme that breaks down imipenem (Primaxin)

Erythromycin, azithromycin (zythromax), clarithromycin (biaxin), dirithromycin

Preven protein synthesis in bacteria

Bacteriostatic but in high concentrations bacteriocidal

Strep infections

Mild to moderate URI and LRI

Spitochetal infection -syphillis and Lyme disease

Gonorrhea, Chlamydia, Mycoplasma

approved for mycobaterium avium intracellular complex infection


Clarithromycin used with omeprazole for ulcers assoc with H pylori

GI effects primarily with erythromycin

n/v/d, hepatotoxicity, flatulenc, jaundice, anorexia

Azithromycin and clirithromycin - fewer side effects, better efficacy, longer duration

Demeclocycline (Declomycin), Oxytetracylcin, tetracyline, doxycicline (doryix, vibramycin), minocycline, tigecycline (tygacil)

Natural and semisynthetic

Obtained from strep cx

Bacteriostatic, stop many essential functions of bacteria

Broad spectrum- gram neg and pos, protozoa, mycoplasma, rickettsia, chlamydia, syphilis, Lyme disease, acne.

Used for SIADH by inhibiting ADH

Dairy, antacids and iron salts redude oral absorption

Don't use in children under 8 or in pregnant/lactating women due to teeth discoloration

Teeth discoloration, retardation of fetal growth

Alteration in intestinal flora - may result in superinfection, diarrhea, pseudomembranous colitis

Vaginal candidiasis, gastris upset, maculopapular rash

Temporary or permanent hearing loss, balance problems

• Reduced renal function
• Rising serum Cretinine

Monitor levels every 5-7 days

Monitor creatinine every 3 days

Gentamicin, neomycin, tobramyicn, amikacin, kanamycin, streptomycin

Natural and semisynthetic, from streptomyces, poor oral absorption, very potent, bacteriocidal, mostly gram neg

gram neg - pseudomonas, E coli, Proetus, Klebsiella, Serratia

Often used with other ABS for synergistic effects

Used for resistant gram pos infections

Only aminoglycoside given orally, used to decontaminate GI tract before surgery, also used as enema.

Nephro and oto-toxicity ( most significant)

h/a, paresthesia, fever, superinfetions, vertigo, skin rash, dizziness

Ciproflaxin, norfloxacin, levofloxacin, moxifloxacin

Excellent oral absorptoin

Absorptoin reduced by antacids

Gram neg and some gram pos

Bacteriocidal, alters DNA of bacteria, does not affect human DNA

• Gram neg - pseudomonas
• Respiratory infections
• Bone and joint infections
• GI infections
• Skin infections
• STD
• ANTHRAX

h/a, dizziness, fatigue, depression, restlessness, insomnia, n/v/d, constipation, thrush, increased liver functions studies, prolonged QT interval, rash, pruritus, urticaria, flushing, photsensitivity, fever, chills, blurred vision, tinnitus.

BLACK BOX WARNING: INCREASED RISK OF TENDONITIS AND TENDON RUPTURE

Chornic bone infections, GU infections, intra abdominal infections.

May cause pseudomembranous coliits

• New class: oxazolidinones
• Tx vancomycin resistant enterococcus faecium (VREF, VRE), hospital acquired infections, MRSA

May cause HYPOtension, serotoniin syndrome if taken with SSRI's and reactions if taken with tyramine containing foods.

Anaerobic organisms, intra abdominal and gynecologic infections, protozoal infections.

Several drug interactions

• UTI's
• use carefully if renal function impaired
• Concentrates in urine
• May cause fatal hepatotoxicity
• Tolerated well if pt is hydrated

30:70 combo

• Used for bacteremia and infections caused by VRE and skin infections
• May cause arthralgias, myalgias

New class: lipopeptide

Tx complicated skin and soft tissue infections

• Natural
• Tx of choice for MRSA and gram pos
• Monitor blood for therapuetic levels
• INFUSED OVER 60 MINUTES-rapid infusion may cause hypotension
• Red man syndrome may occur
• Ensure adquate hydration

• Allergies, hepatic, renal and cardiac function.
• s/sx of superinfections, fever, itching, cough, lethargy or unusual discharge.

Monitor peak and trough blood levels

Monitor for therapuetic and adverse effects

dizziness, tinniuts, hearing loss

urinary casts, proteinuria, increased BUN and creatinine

Toxoplasmosis of the brain

Candidiasis of the lungs, esophagus and trachea

CMV disease, HSV infections

Various mycobacterial infecitons

Extrapulmonary TB

Karposi's sarcoma

Instruce pt to wear gloves when aplying ointment to affected areas

Treat all forms of myobacterium

• Lung - primary
• Brain
• Bone
• Liver
• Kidney

• Aerobic bacillus
• Passed from infected humans, cows, birds

• INH
• Rifapetine
• Ethambutol
• Rifabutin
• Pyrazinamide (PZA)
• Rifampin
• Steptomycin

• Caperomycin
• Amikacin
• Cycloserine
• Levofloxacin
• Ethionamide
• Ofloxacin
• Kanamyicn
• Para-aminosalicylic acid (PAS)

Protein wall synthesis inhibitiors-streptomycin, kanamycin, capreomycin, rifampin, rifabutin

Cell wall synthesis inhibitors-cycloserine, ethionamide, INH

• Drug of choice for TB
• Metabolized in liver -watch for slow acetylators
• Contraindicated with liver disease

• Peripheral neuropathy
• hepatotoxicity

• Retrobulbar neuritis
• blindness

• Hepatitis
• discoloration of urine, stools and body fluids
• interferes with oral b/c

• perform liver function studies on pt rx'd INH and rifampin
• -especially older/high alcohol use pt's
• -Therapy may last up to 2 years
• -Pt's are contagious during initial phase of illness
• -do not consume alcohol while taking ATB's
• -take meds one hour before or two hours after meals
• -Pyridoxine may be used to combat neurologic effects

fatigue, n/v, numbness and tingling of extremities, fever, loss of appetite, depression, jaundice

• Isolation-
• negative airflow room
• micron filter masks

Systemic and topical fungal infections

Amphotericin B is druge of choice

Drug choice depens on type and location of infection

• Main concern is renal toxicity and neurotoxicity - seizures and paresthesias
• Fever
• chills
• dysrhythmias
• nausea, gi upset
• renal toxicity
• h/a
• malaise
• hypotension
• tingling and numbness in hands and feet
• Lowered K+ and Mg levels

Antipyretic and corticosteriods may be given to reduce effects of infusion reaction

use IV infusion pumps and most distal veins possible

To provide prophylactic therapy.

Pt should use sunscreen or avoid exposure to sunlight because tetracycline may cause photosensitivity.

Call prescriber to clarify the order because of the pt's allergy.

The pt may take the drug with a small snack to reduce GI irritation.

A superinfection has developed

• Antiseptics are appropriate for use on living tissue
• The pt's allergies should be assessed before using the antiseptic
• Antiseptics are used to inhibit the growth of microorganisms

a superinfection

SSRI

Renal function

Stop the infusion immediately and notify the prescriber

Oran anticoagulants

• Monitor serum creatinine levels
• Instruct the pt to report dizziness or a feeling of fullness in the ears.

Reddish brown urine

The helps to preven neurologic side effects

If you are taking bc pills, you will need to switch to another form of bc.

during the initial period of the illness and its diagnosis

There is a decrease in sx, along with improved CXR and sputum cx results.

• Darkened urine
• Fatigue
• Jaundice

Hepatic disease

Fever and chills

cytochrome P-450 enzyme system

Infusing the medication over a longer period of time

Dissolve the lozenge slowly and completely in your mouth

• Blood dyscrasias
• Hypotension
• Hepatotoxicity

Rheumatoid arthritis

These medications may cause anorexia and ABD distress

Warfarin

Hemoglobin level

Plasmodium spp.

• Giveing oral forms with food
• Infusing IV doses over 30 to 60 minutes
• Obtaining ordered specimens before starting the medication

Oral contraceptives, NSAIDs, warfarin

8 oz of water

Vancomycin

• Ringing in ears
• Dizziness
• Hearing loss
• Fullness in ears

Numbness, Vertigo, Dizziness

Liver enzyme levels

Yeast

Polyenes

Fungi

Azoles

Thrush

Griseofulvin

Amphotericin B

Nystatin

Mycosis

Molds

Malaise, fever, chills

Underlying renal, cardiac, thyroid or liver disease and pregnancy.

Urine with an asparagus-like odor

Pentamidine or Atovaquone