N3365 AntiInfectives Fall 2015(final) - Anti-infective...

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Anti-infective AgentsAnti-infective AgentsN3365 PharmacologyFall 2015Sandy Laird, R.N., DNP, ACNP-BC, AOCNP
AntimicrobialsAntibioticsFor Bacterial InfectionsAnti-FungalsFor Fungal InfectionsAnti- ViralsFor viral infectionsInfluenza A &BHIVANTIBIOTICS DO NOT WORK FOR VIRAL INFECTIONS
How we differ US THEMNucleiCell membranesRibosomesDietary folic acidDNA protoplasmCell wallRibosomesFolic acid synthesized
Antibiotic Therapy: Mechanism of ActionInterference with cell wall synthesisInterference with protein synthesisInterference with DNA replicationActing as an anti- metabolite to disrupt critical metabolic reactions inside the bacterial cell
TB
Mechanisms of ActionMechanisms of ActionBactericidal Drugsdirectly kill bacteriaBacteriostatic DrugsArrest infectious agentGives body time TimeNO DRUGcidal - kill
Spectrum of activitySpectrum of activityBroadTreats multiple organismsSuperinfection more likelyClostridium difficile (c-diff)Causes »AAPC (antibiotic associated Pseudomembranous colitis) »AAD (antibiotic-associated diarrhea)Candida albicansNarrowTreat limited number of organismsUsed when organism identified by culture Super-infection less likely
Classification of Antibiotic TherapyEmpiric therapy: treatment of an infection before specific culture information has been reported or obtainedDefinitive therapy: antibiotic therapy tailored to treat organism identified with cultures Prophylactic therapy: treatment with antibiotics to prevent an infection, as in intraabdominal surgery or after trauma
Bacterial Resistance To AntibioticsCausesOver useAntibacterial soaps and household cleanersPatient Non complianceInappropriate useFarmersPrescribers
Examples of Inappropriate Antibiotic prescriptionsType of InfectionPrescriptions per yearPercent inappropriateCommentCommon cold18 million100Antibiotics are ineffective against the common coldBronchitis16 million80Antibiotics are ineffective against bronchitis. In patients with severe lung disease they are likely colonized with bacteriaSore throat13 million50Antibiotics should be used only in patients with confirmed streptococcal infectionSinusitis13 millionTotal = 60 million50Most cases viral not bacterial*
Host Factors affecting Antibiotic TherapyAge very young / very old Medical history Current medicationsAllergiesNoncomplianceKidney or liver dysfunctionPregnancy statusSite of infectionImmune statusGenetic factorsG6PD Slow acetylators
Signs of InfectionRedness, Heat, Pain, Swelling, Fever /Chills Elevated WBC ↑Neutrophils (immuno-competent patient)Low WBC ↓Neutrophils (immuno-compromised patient)Presence of Pus or other abnormal drainage
Red Warm Swollen TenderBoil
Tonsillitis+3+4
How Do We Know if Abx is Working?

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