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What types of Micro-organisms cause infections?
- Bacteria
- Viruses
- Fungi
- Protozoa
- Parasitic worms
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What are the bodies natural barriers to infection?
- Host Defenses:
- Skin
- Mucous Membranes
- Gastric Acid
- Immune Factors
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What are some factors that put people at a greater risk for infection?
- Advanced age
- Diseases that suppress the immune system
- Impaired blood supply
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Explain in general how Antibacterials & Antimicrobials work.
They are substances that inhibit bacterial growth or kill bacteria & other microorganisms.
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What is the technical definition of "Antibiotic"?
refers to chemicals produced by one kind of microorganism that inhibits the growth of or kills another.
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How do Bacteriostatic drugs work?
By inhibiting the growth of bacteria.
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How do Bactericidal drugs work?
Kills the bacteria
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What are the 5 mechanisms of Antibacterial action that are responsible for the inhibition of growth or destruction of microorganisms?
- Inhibit cell wall synthesis
- Alter membrane permeability
- Inhibit protein synthesis
- Inhibit synthesis of RNA & DNA
- Interferes w/metabolism
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Antibacterial drugs must do two things in order to completely inhibit bacterial growth or kill bacteria, what are those two things?
- Penetrate cell wall in sufficient concentration.
- Must have an affinity to the binding sites on the bacterial cell.
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How does the MEC (minimum effective concentration) of the Antibacterial effect the inhibition/killing of the bacteria?
If the MEC is not maintained t/o the Antibacterial cycle it can leave room for another infection to get in or not completely kill the one it was meant to tx.
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The duration of time of an Antibacterial agent depends on what factors?
- Type of pathogen
- Site of infection
- Immunocompetence of the host
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The effect that Antibacterial drugs have on an infection depends not only on the drug but also on the host's defense mechanisms. What are these factors?
- Age
- Nutrition
- Immunoglobulins
- Circulation
- WBCs
- Organ fxn
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When a bacteria are sensitive to a drug what happens to the pathogen?
It is inhibited or destroyed.
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When a bacteria are resistant to an Antibacterial what happens to the pathogen?
It continues to grow, despite administration of that Antibacterial drug.
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How does bacterial resistance occur?
- Inherent resistance: bacteria is naturally resistant to the Antibacterial.
- Acquired resistance: prior exposure to antibacterial.
- Inappropriate use of Antibiotics
- Nosocomial infxns
- Cross-resistance: when a certain bacteria are resistant to certain Abx, but bacteria changes & is now resistant to many drugs.
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Typically one Antibiotic will successfully Tx a bacterial infection, but what is the next step if that doesn't work?
Antibiotic combinations.
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How do we know which Antibiotic will work best?
By doing a Culture & Sensitivity lab
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What are the 3 major A/R associated w/the administration of Antibacterial drugs?
- Allergic Rxns (hypersensitivity)
- Superinfection
- Organ Toxicity
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What are narrow-spectrum Abx primarily effective against?
one type of organism (b/c they're selective, they are more active against those single organisms than the broad-spectrum)
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What are broad-spectrum Abx effective against?
both gram-positive & gram-negative oraganisms.
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How often do bacteria reproduce?
about every 20 minutes by cell division
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When classifying bacteria by staining properties, gram staining is determined by the ability of the bacterial cell wall to retain a purple stain by basic dye. If the purple is retained what type of microorganisms are they?
Gram-positive microorganisms
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What are the s/s of an infection?
- Fever
- Chills
- Sweats
- Redness
- Pain & swelling
- Fatigue
- Weight loss (systemic infection)
- ^WBC
- purulent drainage
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What nursing assessments should be done before administration of an Abx?
- Weight
- Location of infection
- s/s
- Other current meds
- Vitals
- if IV Abx: compatibility w/other meds being hung
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What nursing assessments need to be done during Abx therapy?
- s/e
- Hydration
- Nutrition
- Vitals
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What nursing assessment needs to be done after Abx therapy?
- Vitals
- s/s resolved?
- late s/e
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What is Empiric Therapy?
- The initiation of Abx Tx before determination of a firm diagnosis. Abx selected is one that can best kill the microorganism known to be the most common cause of that infection.
- (ie. UTI (ecoli) still do C&S but start on Abx early b/c probable common cause for UTI)
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What is prophylactic therapy?
Giving an Abx to prevent an infection or possibility of infection.
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How do we determine a therapeutic response?
Decrease in specific s/s of infection.
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How do we determine a sub-therapeutic response?
When s/s of infection do NOT improve.
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Why does a sub-therapeutic response occur?
- -Pt. not taking the Abx right
- -Not enough was given to get pt. to the MEC (Wrong dose)
- -Bacterial resistance
- -Course of therapy not long enough (dr. Rx short or pt. didn't take full course)
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What are the general a/r to Antibacterials?
Mild rxn: Rash, pruritus, hives
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What are the severe a/r to Antibacterials?
Anaphylactic shock: bronchospasms, laryngeal edema, vascular collapse, cardiac arrest.
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What are the treatments for Anaphylactic shock?
Epinephrine, Antihistamine, bronchodilator
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What is a Superinfection?
a secondary infection that occurs when the normal microbial flora of the body are disturbed during Abx therapy.
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Where can Superinfection's occur?
- Mouth
- Respiratory Tract
- Intestine
- GU tract (vagina; yeast infxn)
- Skin
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A superinfection typically occurs after how long on an Abx?
over 1 week
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Another A/R that can occur from Abx Tx affects the liver and kidneys, what is it?
Organ toxicity
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How do we test for organ damage?
- Labs: BUN, Creatinine (kidneys)
- Liver: AST, Bilirubin
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What are the classifications of Abx therapy?
- Penicillins
- Cephalosporins
- Macrolides
- Tetracyclines
- Aminoglycosides
- fluorquinolones
- Sulfonamides
- Miscellaneous
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Penicillins were first introduced to kill what type of bacteria?
Staphylococcus
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How do basic Penicillins work against bacteria?
- They inhibit bacterial cell wall synthesis.
- They are a Narrow-spectrum drug.
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Broad-spectrum Penicillins affect the bacteria how?
- They are Bactericidal
- (Amoxicillin, Ampicillin)
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When Broad-spectrum Abx (amoxicillin) is combined w/a beta-lactamase inhibitor (enzyme inhibitor) (ig. Clavulanic acid), the resulting Abx does what?
Inhibits the bacterial beta-lactamases, making the Abx effective & extending its antimicrobial effect.
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Name the 3 Beta-lactamase Inhibitors.
- Clavulanic Acid (Amoxicillin+Clav.Acid=Augmentin)
- Sulbactam (Ampicillin+Sulb. =Unasyn)
- Tazobactam (Piperacillin+Tazo.=Zosyn)
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What is the purpose of combining Beta-lactamase Inhibitors with Broad-spectrum Abx?
To potentiate the effectiveness of Penicillins
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What are the s/e of Penicillins?
- Common:N/V, Diarrhea
- A/R:
- *Hypersensitivity: Rash -->Could become-->Anaphylaxis
- Superinfection
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What are the drug interactions for Penicillins?
- Aspirin
- Oral Contraceptives: Broad-sprectrum Pencillins <the effectiveness of oral BCP, need to use alternate BC until end of cycle.
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What are the nursing interventions with Penicillins?
- check ALLERGIES before drugs given
- Monitor closely during 1st dose
- Take w/meals
- Assess for s/e
- Use alternate form of BC if taking BCP
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Where was cephalosporium acremonium discovered?
in seawater at a sewer outlet off the coast of Sardinia.
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Cephalosporium Acremonium was a fungus found to be effective against which bacterias?
- Gram-positive & Gram-negative
- & resistant to beta-lactamase
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How do Cephalosporins work?
They are bactericidal. They act by inhibiting the bacterial enzyme necessary for cell wall synthesis. Lysis to the other cells occurs, & the bacterial cell dies.
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What are Cephalosporins used to Tx?
- Respiratory infections
- UTIs
- Skin infections
- Bone infections
- Joint infections
- Genital infections
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For Cephalosporins to be effective against numerous organisms what had to be done to their molecules?
Had to be chemically altered.
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Four groups of Cephalosporins have been developed, identified as generations. What are these generations?
First, second, third, fourth generation
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What is the difference between the generations of Cephalosporins?
Each generation is effective against a broader spectrum of bacteria.
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Name the 1st Generation of Cephalosporins.
- Cefazolin
- Cefadroxil
- Cephalexin
- Cephradine
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Name the 2nd Generation of Cephalosporins.
- Cefaclor
- Cefuroxime
- Cefotetan
- Cefoxitin
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Name the 3rd Generation of Cephalosporins.
- Cefixime
- Ceftazdime
- Ceftriaxone
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Name the 4th Generation of Cephalosporins.
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Most of the 3rd & 4th Generation of Cephalosporins are effective in treating what?
Sepsis & many strains of gram-negative bacilli.
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If a patient is allergic to Penicillin but are taking a Cephalosporin, what should the nurse watch for?
An allergic rxn to the Cepholasporin
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What are the s/e of Cephalosporins?
- N/V, diarrhea, ^bleeding w/large doses
- *A/R= Nephrotoxicity
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What should the nurse assess for before giving a Cephalosporin?
- ALLERGIES
- C&S before therapy
- Take w/food or 1he before or 2hr after
- Assess renal & liver fxn (if exisiting impairment)
- Admin IV: over 30-45min
- Monitor for superinfection: if on abx of 1wk
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The Antimicrobial groups Macrolides & Tetracyclines act on bacteria in what way?
- Bacteriostatic: inhibit bacterial growth
- *may be bactericidal depending on drug dose or pathogen.
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The Antimicrobial groups Aminoglycosides & Fluoroquinolones act on bacteria in what way?
Bactericidal
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Name some of the Antimicrobials in the Macrolide group.
- Erythromycin (E-mycin)
- Azithromycin (Zithromax/Z-pack)
- Clarithromycin (Biaxin)
- Clindamycin
- Vancomycin
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Which Antimicrobials in the Microlides group are broad-spectrum antibiotics?
- Azithromycin (Zpack)
- Clarithromycin (Biaxin)
- Erythromycin (E-mycin)
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What are the Antimicrobials group, Macrolides used to treat?
- Mild-moderate infections of the:
- respiratory tract
- sinuses
- GI tract
- skin & soft tissue
- diphtheria
- impetigo contagiosa
- STDs
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Erythomycin (E-mycin) is the drug of choice to treat what two issues?
- Mycoplasmal Pneumonia
- Legionnaire's Disease
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What s/e or a/r could occur when taking the Macrolides; Erythromycin, Clarithromycin, & Azithromycin?
- GI distress- N/V, Diarrhea, abdominal cramping
- Superinfection
- Hepatotoxicity (when taken in high doses w/other hepatotoxic drugs. In pts w/pre-exisiting liver dx or on other liver impairing drugs.)
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Nurses need to be aware of what drug interactions with the Macrolides; Erythromycin, Clarithromycin, & Azithromycin?
- They ^ serum levels of Warfarin
- Theophylline (Bronchodilator)
- Carbamazepine (anticonvulsant)
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The Macrolide Erythromycin should NOT be given with what other drugs?
other Macrolides
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What other drugs will increase the Macrolide Erythromycin when taken with them?
- Fluconazole (Diflucan)
- Ketoconazole (Nizoral)
- Diltiazem (Cardizem)
- **risk of sudden cardiac death**
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The Macrolide Azithromycin levels may be reduced by what other drug?
Antacids
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What should a nurse include in nursing interventions for Erythromycin, Clarithromycin, & Azithromycin?
- C&S before therapy
- Monitor liver enzymes during therapy
- Advise clients to complete Abx course
- & report any s/e or a/r
- Administer antacids 2hrs before or 2hrs after meals
- Give Zpack 1hr before or 2hrs after meals w/full glass of water
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What is the action of the Macrolide Clindamycin?
- Inhibit bacterial protein synthesis
- *Depending on dosage could be: Bacteriostatic & Bactericidal
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Define Bactericidal
kills bacteria
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Define Bacteriostatic
Inhibits bacteria growth
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What are the s/e or a/r of the Macrolide Clindamycin?
- GI distress
- Rash
- Colitis
- Anaphylactic Shock
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What are the drug interaction problems with the Macrolide Clindamycin?
- Aminophylline
- Phenytoin (Dilantin)
- Barbiturates
- Ampicillin
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What is the action of the Macrolide Vancomycin?
- Bacteriostatic: Inhibits cell wall synthesis
- Bactericidal
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What are the indications for use of the Macrolide Antibiotic, Vancomycin?
- Serious infections of:
- Bone
- Skin
- LRI (Lower respiratory infection)
- MRSA
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What are the contraindications of the Macrolide Abx, Vancomycin?
Use cautiously w/kidney dysfunction or hearing loss.
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What are the s/e or a/r of the Macrolide Abx, Vancomycin?
- Rash
- N/V
- Ototoxicity & Nephrotoxicity
- Pseudomembranous Colitis
- Red Neck syndrome
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What are the nursing interventions for the Macrolide Abx, Vancomycin?
- C&S prior to therapy
- Monitor Vanco levels
- *
- *
- Monitor BP, renal fxn, superinfection, hearing, IV site
- Infuse over 60min or greater
- ^fluids to <nephrotoxicity
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What is the action of Aminoglycoside Antibiotics?
Inhibit bacterial protein synthesis (Bactericidal)
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Name some Aminoglycoside Antibiotics.
- Gentamicin
- Tobramycin
- Neomycin
- Amikacin
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What are the possible routes for Aminoglycoside Abx?
- IM, IV
- *Neomycin; PO or IM
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What types of infections are the Aminoglycoside Abx used for?
Gram-negative bacteria (ie. E. coli)
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The Aminoglycoside Abx, Neomycin is used pre-op what?
bowel antiseptic
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What are the s/e or a/r of the Aminoglycoside Abxs?
- GI disturbances, HA, parethesias, skin rash, fever
- photosensitivity
- superinfection
- ototoxicity
- nephrotoxicity (Amikacin & Gentamicin)
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The Aminoglycosides increase the effects of what medication, thereby causing what problem?
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What are the drug interaction problems for Aminoglycosides and other nephrotoxic drugs?
^^^toxic effects
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What nursing interventions need to be done with Aminoglycoside Abx?
- C&S
- Monitor: renal fxn
- Hearing loss
- Superinfection
- peak & trough levels
- *Warn to use sunblock & protective clothing
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What types of bacteria are Tetracycline Abx effective against?
Gram-positive & Gram-negative bacteria & many other organisms.
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How do Tetracyclines effect the bacteria?
Bacteriostatic & Inhibit protein synthesis of bacteria
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What are Tetracylines used for?
- fights Helicobacter pylori
- Treats acne (oral, topical)
- Treats chlamydia, mycoplasma & lyme disease
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Tetracyclines are given via what routes?
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Tetracyclines can be _____ acting, ______ acting, or _____ acting.
- Short - Tetracyline (Achromycin)
- Intermediate - Demeclocycline (Declomycin)
- Long - Minocycline (Minocin)
- Doxycycline (Vibramycin)
- *May be taken w/_____ _____ & food
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What are the s/e & a/r of Tetracycline Abx?
- GI distress, photosensitivity, stomatitis
- Discolors permanent teeth in 3rd trimester of pregnancy & children under 8yrs old
- Blood dyscrasias
- *Thrombocytopenia & Hemolytic anemia
- Superinfection
- *Pseudomembranous colitis
- CNS toxicity
- Hepatotoxicity
- Nephrotoxicity
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What are the food & drug interactions with Tetracycline Abx?
- Antacids, Milk products (not Doxy), Iron preparations
- <effects of oral BC
- Digoxin absorption is ^, leading to toxicity
- ^effect of Aminoglycosides ????
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What are the contraindications for the Tetracycline group of Abx?
Avoid during pregnancy & in children <8yrs old
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What are the nursing interventions with Tetracycline Abx?
- Obtain C&S prior to drug
- Admin 1hr before or 2hr after meals
- Monitor: Kidney & liver fxn
- Store out of light & extreme heat
- Avise client to report superinfection
- Warn client to avoid milk*, Iron, antacids
- Tell client to use effective oral hydiene
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Fluoroquinolones (Quinolones) Abx are a ______ spectrum abx.
Broad specturm
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How do Flouroquinolone Abx effect bacteria?
Bactericidal: interfere w/the enxyme DNA gyrase
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What types of bacteria do Fluoroquinolone Abx work against?
- Streptococcus
- Pneumoniae
- Pseudomonas
- Salmonella
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What types of infections are Fluoroquinolone Abx used for?
- UTI
- Bone & joint infxns
- Bronchitis
- Pneumonia
- Gonorrhea
- Gastroenteritis
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What routes are Fluoroquinolones given?
-
Name some Fluoroquinolone Abx.
- Ciprofloxacin
- Levofloxaxin (Levaquin)
- Norflaxacin (Noroxin)
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What are the s/e & a/r of Fluoroquinolone Abx?
- GI upset, rash, urticaria, tinnitius, photosensitivity
- Superinfection
- Hematuria, crystalluria
- Pseudomembranous colitis
- ^^AST & ALT levels
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What are the drug interaction problems with Fluoroquinolone Abx?
- Antacids <absorption rate
- Levoflaxacin ^ effect of oral hypoglycemics, theophylline & caffeine
- ^bleeding with Coumadin
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What are the nursing interventions with Fluoroquinolones?
- C&S
- Infuse IV over 60-90min
- ^fluid intake to >2000ml/d to avoid Crystalluria
- Check for superinfection
- photosensitivity
- monitor labs
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What is the action of Sulfonamides?
- Inhibit bacterial synthesis of folic acid
- Bacteriostatic
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What are Sulfonamides used in the TX of?
- UTIs
- Prostatitis
- Gonorrhea
- Otitis media
- Respiratory Infections
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What routes can Sulfonamides be given?
-
What is the short-acting Sulfonamides?
Sulfadiazine (Microsulfon)
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What are the intermediate-acting Sulfonamides?
- Sulfasalazine (Azulfidine)
- Sulfamethaxazole (Gantanol)
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Explain how Trimethoprim works & what is it used for?
- An antibacterial agent that interferes w/bacterial folic acid synthesis just as sulfonamides do.
- Urinary tract anti-infective
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When Trimethoprim & Sulfamethoxazole (sulfonamide) are combined, what occurs?
(TMP-SMZ, bactrim-septra)
Synergistic effect; ^the desired drug response against gram-negative bacteria Proteus & E. coli.
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Trimethoprim/sulfamethoxazole (TMP/SMZ) do what to the bacteria & what type of infections are they used for?
- Blocks bacterial protein synthesis
- Bactericidal effect
- TX: UTI, Otitis media, Intestinal infxns, Lower resp.tract ifxns, Prostatitis, Gohorrhea
- Routes: Oral, IV
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