Unformatted text preview: Antibacterial Drugs
Anti-Infective Drugs
Chapter 35 Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Identifying the Appropriate
Antibacterial Drug Culture and sensitivity test Used to determine if a specific type of bacteria is
sensitive to a particular antibacterial drug Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Actions of Sulfonamides
• First antibiotic drugs developed that effectively
treated infections
• Use has declined, but they are still used
• Bacteriostatic – slow or retard the multiplication of
bacteria Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Uses of Sulfonamides Urinary tract infections Sulfadiazine: malaria, meningococcal meningitis,
rheumatic fever Trimethoprim/sulfamethoxazole and erythromycin
ethylsuccinate/sulfisoxazole: otitis media Mafenide and silver sulfadiazine: topical for
treatment of partial-thickness and full-thickness
burns Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Adverse Reactions of Sulfonamides Hematologic changes: Agranulocytosis Thrombocytopenia Aplastic anemia Leukopenia Others: Anorexia Hypersensitivity, including Stevens-Johnson syndrome Also, nausea, vomiting, diarrhea, abdominal pain, chills, fever, stomatitis,
crystalluria Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Adverse Reactions of Sulfonamides Mafenide Burning sensation or pain Rash, itching, edema, urticaria Silver sulfadiazine Burning, rash, itching Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Contraindications, Precautions, and
Interactions of Sulfonamides Contraindications: Known hypersensitivity, lactation, children younger
than 2 years old, near the end of pregnancy, infections
caused by group A beta-hemolytic streptococci Precautions: Kidney or liver impairment, bronchial asthma, allergies Interactions: Oral anticoagulants, methotrexate, hydantoins, oral
hypoglycemic drugs Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Patient Management Issues with
Sulfonamide Temperature, pulse, respiratory rate, and blood pressure
should be assessed regularly. If fever is present and suddenly increases or was normal
and suddenly increases, notify health care provider. Burns: Inspect burn area every 1–2 hours Keep the area covered with ointment at all times Report any adverse reactions Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Patient Management Issues with
Sulfonamide Should drink at least 2 liters of fluid per day Should be taken on an empty stomach Take with a full glass of water Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Educating the Patient and Family
About Sulfonamides Patients have tendency to discontinue drug when
symptoms are relieved Importance of completing therapy must be emphasized Infection may recur if patient does not complete the full
course of therapy Notify health care provider if: fever, skin rash or other
skin problems, nausea, vomiting, unusual bleeding or
bruising, sore throat, extreme fatigue Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Educating the Patient and Family
About Sulfonamides Take as prescribed Take on an empty stomach Take with a full glass of water Complete full course Drink 8-10 glasses (8 oz.) of water daily Prolonged exposure to sunlight may result in
photosensitivity Keep all appointments
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Penicillin Four groups: Natural penicillins: penicillin G, penicillin, V Penicillinase-resistant penicillin: dicloxacillin,
nafcillin, oxacillin Aminopenicillins: ampicillin, amoxicillin Extended-spectrum penicillins: piperacillin,
ticarcillin Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Drug Resistance
• Bacterial resistance: ability of bacteria to produce
substances that inactivate or destroy an anti-infective
drug
• Natural penicillin – fairly narrow spectrum of activity
• Newer penicillins – designed with a broader spectrum Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Actions of Penicillins Bactericidal or bacteriostatic Bactericidal against sensitive microorganisms if there is
an adequate concentration If there is an inadequate concentration, they are
bacteriostatic Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Uses of Penicillins Infectious disease Urinary tract infections, septicemia, meningitis, intraabdominal infection, gonorrhea, syphilis, pneumonia,
other respiratory infections Prophylaxis Against a potential secondary bacterial infection that
can occur in a patient with a viral infection Patients at high risk for developing an infection, such
as a history of rheumatic fever
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Adverse Reactions of Penicillins Mild nausea Vomiting Diarrhea Sore tongue or mouth Fever Pain at injection site Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Adverse Reactions of Penicillins Hypersensitivity Skin rash Urticaria Sneezing Wheezing Pruritus Bronchospasm Laryngospasm Angioedema Hypotension Signs and symptoms
resembling serum
sickness Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Adverse Reactions to Penicillins Those allergic to penicillins may have a crosssensitivity to cephalosporins Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Adverse Reactions to Penicillins Superinfection Antibiotics disrupt normal flora A new infection can occur that is superimposed on
the original infection Pseudomembranous colitis Fungal superinfections can occur in the vagina,
mouth, and anal and genital areas Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Contraindications, Precautions,
and Interactions of Penicillins Contraindications: Known hypersensitivity Precautions: Renal disease, lactation, history of allergies, asthma,
renal disease, bleeding disorders, GI disease,
cephalosporin allergy Interactions: Oral contraceptives, tetracyclines, anticoagulants, betaadrenergic blockers, food Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Patient Management Issues with
Penicillins General health history must be reviewed, especially any
allergies Infection must be assessed, usually by culture and
sensitivity, but also for: Signs and symptoms Color and type of drainage Pain, redness, and inflammation Patient monitored daily for response Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Educating the Patient and Family
About Penicillins Drug regimen must be completely understood by patient
and family Importance of completing the full course must be
stressed Prophylaxis: Take as prescribed Infection: Complete full course at prescribed times of day Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Educating the Patient and Family
About Penicillins Oral Take on an empty stomach Take with a full glass of water To reduce the risk of superinfection, eat yogurt,
drink buttermilk, or take acidophilus Notify health care provider if: skin rash; hives;
severe diarrhea; vaginal or anal itching; sore
mouth; black, furry tongue; sores in the mouth;
swelling around mouth or eyes; breathing
difficulty; GI disturbances
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Educating the Patient and Family
About Penicillins
• Oral suspensions
– Note storage requirements
– Shake well before use
– Complete full course of therapy
– Discard any remaining drug at end of therapy
– If take oral contraceptives, use alternate form of
birth control – ampicillin, penicillin V
– Do not share with others
– Notify health care provider if not improving
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Cephalosporins Structurally and chemically related to penicillins Five generations: First: cefadroxil, cefazolin, cephalexin Second: cefaclor, cefotetan, cefoxitin, cefprozil,
cefuroxime Third: cefdinir, cefditoren, cefixime, cefotaxime,
cefpodoxime, ceftazidime, ceftibuten, ceftizoxime,
ceftriaxone Fourth: cefepime Fifth: ceftaroline
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Cephalosporins Progression from first- to second-generation and
then to third-generation drugs shows an increase in
sensitivity of gram-negative microorganisms and a
decrease in the sensitivity of gram-positive
microorganisms. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Actions of Cephalosporins Bactericidal Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Uses of Cephalosporins Pharyngitis tonsillitis, otitis media, lower respiratory
tract infections, UTIs, septicemia, gonorrhea Before, during, or after surgery to prevent infection
in patients having surgery on a contaminated or
potentially contaminated area Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Adverse Reactions of Cephalosporins Gastrointestinal effects most common Nausea, vomiting, diarrhea Hypersensitivity Similar effect as penicillin allergies Cross-sensitivity Superinfection Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Contraindications, Precautions, and
Interactions of Cephalosporins Contraindications: History of allergies to cephalosporins Precautions: Renal or hepatic impairment, bleeding history,
lactation Interactions: Aminoglycosides, oral anticoagulants, alcohol Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Patient Management Issues with
Cephalosporins Inform health care provider if allergy to penicillin or possible
allergy to cephalosporins Liver and kidney function tests may be ordered prior to
therapy Monitor for improvement in infection symptoms Notify health care provider if symptoms of infection worsen Check skin for rash Monitor for loose stools or diarrhea Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Patient Management Issues with
Cephalosporins Take around the clock Most are taken with food Cefuroxime and cefpodoxime should be taken on an
empty stomach unless GI upset occurs Oral suspensions should be shaken well before use Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Educating the Patient and Family About
Cephalosporins
• Complete the full course of therapy
• Take at prescribed times of day
• Take with food or milk or on an empty stomach depending on
product
• No alcohol
• Notify health care provider if: vomiting, skin rash, hives, severe
diarrhea, vaginal or anal itching, sores in the mouth, swelling around
mouth or eye, breathing difficulty, stomach disturbances, nausea,
vomiting, diarrhea, symptoms of infection do not improve or worsen
• Do not share with others Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Educating the Patient and Family About
Cephalosporins Oral suspensions Note storage requirements Shake well before using Discard any medication left at end of therapy Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Tetracyclines, Macrolides, and
Lincosamides Broad-spectrum antibiotics Tetracyclines: demeclocycline, doxycycline,
minocycline, tetracycline Macrolides: azithromycin, clarithromycin, erythromycin Lincosamides: clindamycin, lincomycin Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Actions of Tetracyclines, Macrolides,
and Lincosamides Tetracyclines Bacteriostatic Macrolides Bacteriostatic or bactericidal Lincosamides Bacteriostatic or bactericidal Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Uses of Tetracyclines, Macrolides, and
Lincosamides Tetracyclines Cholera, Rocky Mountain spotted fever, typhus Situations when penicillin is contraindicated Treatment of intestinal amebiasis Some skin and soft tissue infections Oral: treatment of uncomplicated urethral,
endocervical, or rectal infections caused by
Chlamydia trachomatis; and for severe acne In combination with metronidazole and bismuth
subsalicylate: H. pylori
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Uses of Tetracyclines, Macrolides, and
Lincosamides Macrolides Gram-negative and gram-positive bacteria Acne vulgaris and skin infections With sulfonamide to treat upper respiratory
infections Prophylaxis before dental or other procedures
in patients allergic to penicillin Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Uses of Tetracyclines, Macrolides, and
Lincosamides Lincosamides Treatment of serious infection in which
penicillin or erythromycin is not effective More serious infections May be used in conjunction with other
antibiotics Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Adverse Reactions of Tetracyclines,
Macrolides, and Lincosamides Tetracyclines GI reactions: nausea, vomiting, diarrhea, epigastric
distress, stomatitis, sore throat Skin rashes Photosensitivity Demeclocycline most serious, minocycline least likely Yellow-gray-brown discoloration of teeth Superinfection
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Adverse Reactions of Tetracyclines,
Macrolides, and Lincosamides Macrolides Azithromycin and clarithromycin: nausea, vomiting,
diarrhea, abdominal pain Erythromycin: abdominal cramping, nausea,
vomiting, diarrhea, allergic reaction Pseudomembranous colitis Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Adverse Reactions of Tetracyclines,
Macrolides, and Lincosamides Lincosamides Abdominal pain Esophagitis Nausea Vomiting Diarrhea Skin rash Blood dyscrasias Pseudomembranous colitis Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Contraindications, Precautions, and
Interactions of Tetracyclines, Macrolides,
and Lincosamides Tetracycline Contraindications: Hypersensitivity, pregnancy, lactation, children
younger than 9 years old Precautions: Renal function impairment Interactions: Antacids containing aluminum, zinc, magnesium,
bismuth salts; foods high in calcium; dairy products;
oral contraceptives; digoxin; insulin
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Contraindications, Precautions, and
Interactions of Tetracyclines, Macrolides,
and Lincosamides Macrolides Contraindications: Hypersensitivity, preexisting liver disease Precautions: Lactation Azithromycin and clarithromycin: liver dysfunction Interactions: Kaolin, aluminum salts, magaldrate, digoxin,
anticoagulants, clindamycin, lincomycin,
chloramphenicol, theophylline
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Contraindications, Precautions, and
Interactions of Tetracyclines, Macrolides,
and Lincosamides Lincosamides Contraindications: Hypersensitivity, minor bacterial or viral infections,
lactation, infancy Precautions: History of GI disorders, renal disease, liver impairment Interactions: Neuromuscular blocking agents, kaolin, aluminum Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Patient Management Issues with
Tetracyclines, Macrolides, and
Lincosamides Identify and record signs and symptoms of infection Allergy history obtained Vital signs before first dose Culture and sensitivity tests Other lab tests may be performed Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Patient Management Issues with
Tetracyclines, Macrolides, and
Lincosamides Tetracycline oral use Take on an empty stomach Except doxycycline and minocycline Do not take with dairy products Except doxycycline and minocycline Take with a full glass of water Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Patient Management Issues with
Tetracyclines, Macrolides, and
Lincosamides
• Macrolides oral use
– Clarithromycin
• Without regard to meals
• May be taken with food – Azithromycin
• Tablets – without regard to meals
• Suspension – on an empty stomach – Erythromycin
• On an empty stomach
• May take with food if GI upset
• With a full glass of water Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Patient Management Issues with
Tetracyclines, Macrolides, and
Lincosamides Lincosamides oral use Food impairs absorption of lincomycin Do not eat for 1–2 hours before or after taking Clindamycin may be taken without regard to food Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Educating the Patient and Family About
Tetracyclines, Macrolides, and
Lincosamides Educate about the therapeutic regimen Educate about adverse reactions Take at prescribed intervals Do not increase, skip, or stop Complete entire course of therapy Take with a full glass of water Do not drink alcohol Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Educating the Patient and Family About
Tetracyclines, Macrolides, and
Lincosamides Notify health care provider if: symptoms of infection
worsen or no improvement in 5 days Tetracycline: avoid exposure to sun Educate on whether medication should be taken with or
without food Educate regarding foods that should be avoided Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Fluoroquinolones and Aminoglycosides More powerful drugs that are effective against
resistant pathogens Fluoroquinolones Ciprofloxacin, gemifloxacin, levofloxacin,
moxifloxacin, norfloxacin, ofloxacin Aminoglycosides Amikacin, gentamicin, kanamycin, neomycin,
paromomycin, streptomycin, tobramycin Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Actions of Fluoroquinolones and
Aminoglycosides Fluoroquinolones Bactericidal Aminoglycosides Bactericidal Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Uses of Fluoroquinolones and
Aminoglycosides
• Fluoroquinolones
– Lower respiratory infections, infections of the
skin, UTIs, sexually transmitted diseases
– Some available in ophthalmic forms
• Aminoglycosides
– Suppress GI bacteria
– Preoperatively to reduce the number of
bacteria normally present in the intestine
– Hepatic coma – neomycin and paromomycin
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Adverse Reactions of
Fluoroquinolones and
Aminoglycosides Fluoroquinolones Superinfection Pseudomembranous colitis Hypersensitivity Nausea, diarrhea, headache, abdominal pain or
discomfort, dizziness Photosensitivity Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Adverse Reactions of
Fluoroquinolones and
Aminoglycosides Aminoglycosides Nephrotoxicity Ototoxicity Neurotoxicity Nausea, vomiting, anorexia, rash, urticaria Superinfection Pseudomembranous colitis Hypersensitivity
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Contraindications, Precautions, and
Interactions of Fluoroquinolones and
Aminoglycosides Fluoroquinolones Contraindications: Hypersensitivity, children younger than 18, lifestyles
that do not allow adherence Precautions: Renal impairment, history of seizures, geriatric
patients, dialysis patients Interactions: Theophylline, cimetidine, oral anticoagulants, antacids,
iron salts, zinc, NSAIDs, Risk of severe cardiac arrhythmias with drugs that
increase the QT interval
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Contraindications, Precautions, and
Interactions of Fluoroquinolones and
Aminoglycosides Aminoglycosides Contraindications: Hypersensitivity, patients that require long-term
treatment (except streptomycin for tuberculosis),
preexisting hearing loss, myasthenia gravis,
parkinsonism, lactation, pregnancy Precautions: Renal failure, elderly, neuromuscular disorders Interactions: Cephalosporins, loop diuretics, neuromuscular blockers
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Patient Management Issues with
Fluoroquinolones and Aminoglycosides Culture and sensitivity tests Fluoroquinolones Increase fluid intake. Norfloxacin sh...
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