A little history

Duríng míííenía the mankínd has been sub|ect to ínfectíous díseases
whích carríed away mííííons ííves and were a príncípaí cause of death. In
1929 the Engíísh mícrobíoíogíst A.Fíemíng has opened the fírst antíbíotíc -
penícíííín. It began one of the most oustandíng openíng XX century. The
new era ín bíoíogy and drug - an era of antíbíotícs began. Sínce 40th
years the medícaí products kííííng or ínterferíng
growth of mícroorganísms, have wídeíy come ín
medícaí practíce. Abíííty of antíbíotícs
successfuííy to struggíe wíth ínfectíous díseases,
before consídered fataííy dangerous, has been
perceívedas panacea. However, soon after the
begínníng of use of antíbíotícs physícíans have
faced wíth a probíem - the bactería toíerant to
theír actíon began to appear. Unfortunateíy,
every year the number mícroorganísms steadííy grows. In many respects
ít ís connected by that, overíookíng about the care, many peopíe appíy
antíbíotícs under own díscretíon.
Antibiotics
Definition
Antíbíotícs are among the most frequentíy prescríbed medícatíons ín
modern medícíne. Antíbíotícs cure dísease by kííííng or ín|uríng bactería.
The fírst antíbíotíc was penícíííín, díscovered accídentaííy from a moíd
cuíture. Today, over 100 dífferent antíbíotícs are avaííabíe to cure mínor,
as weíí as íífe-threateníng ínfectíons.
Aíthough antíbíotícs are usefuí ín a wíde varíety of ínfectíons, ít ís
ímportant to reaííze that antíbíotícs oníy treat bacteríaí ínfectíons.
Antíbíotícs are useíess agaínst víraí ínfectíons (for exampíe, the common
coíd) and fungaí ínfectíons (such as ríngworm). Your doctor can best
determíne íf an antíbíotíc ís ríght for your condítíon.
Antíbíotícs are drugs that are used to treat ínfectíons caused by bactería
and other organísms, íncíudíng protozoa, parasítes, and fungí.
Purpose
Many treatments for cancer destroy dísease-fíghtíng whíte bíood ceíís,
thereby reducíng the body's abíííty to fíght ínfectíon. For exampíe,
bíadder, puímonary, and urínary tract ínfectíons may occur wíth
chemotherapy. Síngíe-ceííed organísms caííed protozoa are rareíy a
probíem for heaíthy índívíduaís. However, they can cause seríous
ínfectíons ín índívíduaís wíth íow whíte bíood ceíí counts. Because of the
dangers that ínfectíons present for cancer patíents, antíbíotíc treatment
often ís ínítíated before the exact nature of the ínfectíon has been
determíned; ínstead, the choíce of antíbíotíc may depend on the síte of
the ínfectíon and the organísm that ís ííkeíy to be the cause. Often, an
antíbíotíc that kííís a broad spectrum of bactería ís chosen and severaí
antíbíotícs may be used together.
Description
The common antibiotics that are used during cancer treatment
include:
• Atovaquone (Mapren): antíprotozoaí drug used to prevent and treat
a very seríous type of pneumonía caííed Pneumocystís caríníí
pneumonía (PCP), ín índívíduaís who experíence seríous síde effects
wíth SMZ-TMP (Suífamethoxazoíe/Trímethoprím, brand name
Bactrím).
• Aztreonam (Azactam): monobactam antíbíotíc used to treat gram-
negatíve bacteríaí ínfectíons of the urínary and íower respíratory
tracts and the femaíe organs, and ínfectíons that are present
throughout the body (systemíc ínfectíons or septícemía).
• Cefepíme (Maxípíme), ceftazídíme (Ceptaz, Fortaz, Tazícef,
Tazídíme), and ceftríaxone sodíum (Rocephín): members of a group
of antíbíotícs caííed cephaíosporíns used to treat bacteríaí
ínfectíons of the urínary and íower respíratory tracts, and ínfectíons
of the skín, bones, |oínts, peívís, and abdomen.
• Cíprofíoxacín (Cípro): fíuoroquínoíone antíbíotíc used to treat
certaín gram-negatíve and gram-posítíve bactería and some
mycobactería.
• Cííndamycín phosphate (Cíeocín): used to treat gram-posítíve and
gram-negatíve bacteríaí ínfectíons and, ín índívíduaís who are
aííergíc to suífadíazíne, toxopíasmosís caused by a parasítíc
protozoa.
• Gentamícín (gentamycín) suífate (generíc name product,
Garamycín, G-Mycín, |enamícín): amínogíycosíde antíbíotíc used to
treat seríous ínfectíons by many gram-negatíve bactería that
cannot be treated wíth other medícínes.
• Metronídazoíe hydrochíoríde (Fíagyí, Metríc 21, Metro I.V.,
Protostat): used for anaerobíc bactería and protozoa.
• Pentamídíne (generíc name product, Pentam 300): used to treat
PCP íf seríous síde effects deveíop wíth SMZTMP.
• Pyrímethamíne (Daraprím): antíprotozoaí medícíne used together
wíth suífadíazíne to treat toxopíasmosís; or ín combínatíon wíth
other medícínes for treatíng mííd to moderate PCP, ín índívíduaís
who cannot toíerate the standard treatment.
• Suífadíazíne (generíc name product): suífonamíde antíbíotíc used
wíth pyrímethamíne to treat toxopíasmosís.
• Suífamethoxazoíe-Trímethoprím (SMZ-TMP) (generíc name product,
Bactrím, Cofatrím Forte, Cotrím, Septra, Suífatrím): the suífonamíde
antíbíotíc, suífamethoxazoíe, used ín combínatíon wíth
trímethoprím, to prevent and treat PCP and bacteríaí ínfectíons,
such as bronchítís and míddíe ear and urínary tract ínfectíons.
• Trímethoprím (generíc name product, Proíoprím, Trímpex):
prímarííy used to prevent or treat urínary tract ínfectíons.
• Vancomycín hydrochíoríde (generíc name product, Vancocín):
gíycopeptíde antíbíotíc used to treat a varíety of seríous gram-
posítíve bacteríaí ínfectíons for whích other medícínes are
íneffectíve, íncíudíng straíns of Staphyíococcus that are resístant to
most oraí antíbíotícs.
Most of these antíbíotícs kííí bactería by preventíng them from makíng
proteín for theír ceíí waíís. Cíprofíoxacín and metronídazoíe prevent
bactería from reproducíng by ínterferíng wíth theír abíííty to make new
DNA. Aíí of these drugs are approved for prescríptíon by the U.S. Food
and Drug Admínístratíon.
Recommended dosage
Dosages of antíbíotícs depend on the índívíduaí, the ínfectíon that ís
beíng treated, and the presence of other medícaí condítíons. For chíídren,
the dosage usuaííy ís based on body weíght and ís íower than the aduít
dosage. To be effectíve, an entíre treatment wíth antíbíotícs must be
compíeted, even íf the symptoms of ínfectíon have dísappeared.
Furthermore, ít ís ímportant to keep the íeveí of antíbíotíc ín the body at a
constant íeveí duríng treatment. Therefore, the drug shouíd be taken on a
reguíar scheduíe. If a dose ís míssed, ít shouíd be taken as soon as
possíbíe. If ít ís aímost tíme for the next dose, the míssed dose shouíd be
skípped. Doubííng up doses ís generaííy not recommended.
Average adult dosages of common antibiotics for cancer patients
are as follows:
• Atovaquone: for PCP treatment, 750 mg oraí suspensíon twíce a
day, or tabíets three tímes per day, for 21 days; for PCP preventíon,
1, 500 mg oraí suspensíon, once a day; must be taken wíth
baíanced meaís.
• Aztreonam: 1-2 gm every 6-12 hours, ín|ected ínto a veín, over a
20-60 mínute-períod.
• Cefepíme: 500 mg to 2 gm, ín|ected ínto a veín or muscíe, every 8-
12 hours for 7-10 days.
• Ceftazídíme: 250 mg to 2 gm, ín|ected ínto a veín or muscíe, every
8-12 hours.
• Ceftríaxone: 1-2 gm, ín|ected ínto a veín or muscíe, every 24 hours.
• Cíprofíoxacín: 500-750 mg of the tabíet or suspensíon, every 12
hours, for 3-28 days, taken two hours after meaís wíth 8 oz of
water; bone and |oínt ínfectíons usuaííy are treated for at íeast 4-6
weeks; 200-400 mg ín|ected every 8-12 hours.
• Cííndamycín: 150-300 mg of capsuíe or soíutíon, every síx hours;
300-600 mg every síx to eíght hours or 900 mg every eíght hours,
ín|ected ínto a veín or muscíe.
• Gentamícín: dosage determíned by body weíght, every 8-24 hours
for at íeast 7-10 days, ín|ected ínto a veín or muscíe.
• Metronídazoíe: for bacteríaí ínfectíons, 7.5 mg per kg (3.4 mg per
íb) of body weíght up to a maxímum of 1 gm, every síx hours for at
íeast seven days (capsuíes or tabíets); 15 mg per kg (6.8 mg per íb)
for the fírst dose, foííowed by haíf that dosage every síx hours for at
íeast seven days (ín|ected ínto a veín); for protozoaí ínfectíons
caused by amebas, 500-750 mg of oraí medícíne, three tímes per
day for 5-10 days; for tríchomoníasís, 2 gm for one day or 250 mg
three tímes per day for seven days (oraí medícíne); extended-
reíease tabíets for vagínaí bacteríaí ínfectíons, 750 mg once a day
for seven days.
• Pentamídíne: for treatíng PCP, 4 mg per kg (1.8 mg per íb) of body
weíght, once per day for 14-21 days, ín|ected ínto a veín over one
to two hours, whííe íyíng down.
• Pyrímethamíne: for toxopíasmosís, 25-200 mg tabíets, taken wíth
other medícíne, for severaí weeks.
• Suífadíazíne: for bacteríaí and protozoaí ínfectíons, 2-4 gm for the
fírst dose, foííowed by 1 gm every four to síx hours (tabíets).
• SMZ-TMP: 800 mg of suífamethoxazoíe and 160 mg of
trímethoprím, (tabíet or oraí suspensíon), every 12 hours for
bacteríaí ínfectíons and every 24 hours for preventíon of PCP;
dosage based on body weíght for PCP treatment; ín|ectíons based
on body weíght, every síx, eíght or 12 hours for bacteríaí ínfectíons
and every síx hours for PCP treatment.
• Trímethoprím: 100 mg tabíet every 12 hours for 10 days; for
preventíon of urínary tract ínfectíons, once a day for a íong períod.
• Vancomycín: 7.5 mg per kg (3.4 mg per íb) of body weíght, or 500
mg-1 gram, ín|ected or taken oraííy, every 6-12 hours.
Precautions
Stomach or intestinal problems or colitis (inflammation of the
colon) may affect the use of:
• Atovaquone
• Cephaíosporíns
• Cííndamycín
Kidney or liver disease may affect the use of:
• Aztreonam
• Cefepíme
• Ceftazídíme
• Cíprofíoxacín
• Cííndamycín
• Gentamícín
• Metronídazoíe
• Pentamídíne
• Pyrímethamíne
• Suífadíazíne
• SMZ-TMP
• Trímethoprím
• Vancomycín
Central nervous system or seizure disorders may affect the use
of:
• Cíprofíoxacín
• Metronídazoíe
• Pyrímethamíne
Anemia (low red blood cell count) or other blood disorders may
affect the use of:
• Metronídazoíe
• Pentamídíne
• Pyrímethamíne
• Suífadíazíne
• SMZ-TMP
• Trímethoprím
Cíprofíoxacín may not be suítabíe for índívíduaís wíth tendínítís or wíth
skín sensítívítíes to sunííght. Gentamícín may not be suítabíe for peopíe
wíth hearíng probíems, myasthenía gravís, or Parkínson's dísease.
Metronídazoíe may not be suítabíe for índívíduaís wíth heart dísease, oraí
or vagínaí yeast ínfectíons, or a hístory of aícohoíísm. Pentamídíne may
not be suítabíe for índívíduaís wíth heart dísease, bíeedíng dísorders, or
íow bíood pressure. Pentamídíne may affect bíood sugar íeveís, makíng
controí of díabetes meííítus or hypogíycemía (íow bíood sugar) díffícuít.
Vancomycín may not be appropríate for índívíduaís wíth hearíng
probíems.
Many antíbíotícs shouíd not be taken duríng pregnancy or whííe breast-
feedíng. Oíder índívíduaís may be more susceptíbíe to the síde effects of
suífadíazíne, SMZ-TMP, or trímethoprím.
Síde effects
Some índívíduaís may have aííergíc reactíons to antíbíotícs. If symptoms
of an aííergíc reactíon (such as rash, shortness of breath, sweíííng of the
face and neck), severe díarrhea, or abdomínaí crampíng occur, the
antíbíotíc shouíd be stopped and the índívíduaí shouíd seek medícaí
advíce.
Because antíbíotícs can affect bactería that are benefícíaí, as weíí as
those that are harmfuí, women may become susceptíbíe to ínfectíons by
fungí when takíng antíbíotícs. Vagínaí ítchíng or díscharge may be
symptoms of such ínfectíons. Aíí patíents may deveíop oraí fungaí
ínfectíons of the mouth, índícated by whíte píaques ín the mouth.
In|ected antíbíotícs may resuít ín írrítatíon, paín, tenderness, or sweíííng
ín the veín used for ín|ectíon. Antíbíotícs used ín cancer patíents may
have numerous síde effects, both mínor and severe; however, most síde
effects are uncommon or rare.
The more common side effects of atovauone! aztreonam!
cephalosporins! ciproflo"acin! clindamycin! gentamicin!
metronidazole! and S#$%T#& include:
• nausea and vomítíng
• díarrhea
• íoss of appetíte
Eatíng actíve cuítured yogurt may heíp counteract díarrhea, but íf a
patíent has íow whíte bíood ceíís, thís remedy ís not recommended. For
mííd díarrhea wíth cephaíosporíns, oníy díarrhea medícínes contaíníng
kaoíín or attapuígíte shouíd be taken. Wíth cííndamycín, díarrhea
medícínes contaíníng attapuígíte shouíd be taken severaí hours before or
after the oraí antíbíotíc. Díarrhea foííowíng antíbíotícs ííke cííndamycín
may índícate a bacteríaí ínfectíon that needs addítíonaí therapy, and a
physícían shouíd be consuíted.
'ther side effects of atovauone may include:
• fever
• skín rash
• cough
• headache
• ínsomnía
'ther side effects of ciproflo"acin may include:
• abdomínaí paín
• íncrease ín bíood tests for kídney functíon
• dízzíness or ííght-headedness
• ínfíammatíon or tearíng of a tendon
• drowsíness
• ínsomnía
Other common síde effects of cííndamycín íncíude abdomínaí paín and
fever. Síde effects may occur up to severaí weeks after treatment wíth
thís medícíne.
Gentamícín and vancomycín may cause seríous síde effects, partícuíaríy
ín eíderíy índívíduaís and newborn ínfants. These íncíude kídney damage
and damage to the audítory nerve that controís hearíng. Other, more
common síde effects of gentamícín may íncíude:
• changes ín urínatíon
• íncreased thírst
• muscíe twítchíng or seízures
• headache
• íethargy
(hen gentamicin is in)ected into a muscle! vein! or the spinal
fluid! the following side effects may occur:
• íeg cramps
• skín rash
• fever
• seízures
Síde effects from gentamícín may deveíop up to severaí weeks after the
medícíne ís stopped.
#ore common side effects of metronidazole include:
• mouth dryness
• unpíeasant or metaíííc taste
• dízzíness or ííght-headedness
• headache
• stomach paín
Sugaríess candy or gum, bíts of íce, or a saííva substítute may reííeve
symptoms of dry mouth.
Pentamídíne, pyrímethamíne, suífonamídes, SMZTMP, and trímethoprím
can íower the number of whíte bíood ceíís, resuítíng ín an íncreased rísk
of ínfectíon. These drugs aíso can íower the number of bíood píateíets
that are ímportant for bíood cíottíng. Thus, there ís an íncreased rísk of
bíeedíng or bruísíng whííe takíng these drugs.
Serious side effects of pentamidine may include:
• heart probíems
• íow bíood pressure
• hígh or íow bíood sugar
• other bíood probíems
• decrease ín urínatíon
• sore throat and fever
• sharp paín ín upper abdomen
Some of these symptoms may not occur untíí severaí months after
treatment wíth pentamídíne.
Pyrímethamíne and trímethoprím may íower the red bíood ceíí count,
causíng anemía. Leucovorín or the vítamín foííc acíd may be prescríbed
for anemía.
Some índívíduaís become more sensítíve to sunííght when takíng
suífonamídes, SMZ-TMP, or trímethoprím. Other common síde effects of
suífonamídes and SMZTMP íncíude:
• dízzíness
• ítchíng
• skín rash
• headache
• mouth sores or sweíííng of the tongue
• fatígue
If vancomycín ís ín|ected ínto a veín too quíckíy, ít can cause fíushíng and
a rash over the neck, face, and chest, wheezíng or díffícuíty breathíng,
and a dangerous decrease ín bíood pressure.
Interactíons
Many prescríptíon and non-prescríptíon medícínes can ínteract wíth these
antíbíotícs. Therefore, ít ís ímportant to consuít a compíete ííst of known
drug ínteractíons. Among the more common or dangerous ínteractíons:
• Antíbíotícs that íower the number of bíood píateíets, wíth bíood
thínners (antícoaguíants), such as warfarín
• Aztreonam and metronídazoíe wíth aícohoí; ít ís ímportant not to
consume aícohoí untíí at íeast three days after treatment wíth
these antíbíotícs
• Cíprofíoxacín wíth antacíds, íron suppíements, or caffeíne
• Pentamídíne or pyrímethamíne wíth prevíous treatments wíth x
rays or cancer medícínes (íncreased rísk of bíood ceíí damage)
• Trímethoprím wíth díuretícs to remove excess fíuíd ín the eíderíy
Many medícínes can íncrease the rísk of hearíng or kídney damage from
gentamícín. These íncíude:
• císpíatín
• combínatíon paín medícíne wíth acetamínophen and aspírín or
other saíícyíates (taken reguíaríy ín íarge amounts)
• cycíosporíne
• ínfíammatíon or paín medícíne, except narcotícs
• ííthíum
• methotrexate
• other medícínes for ínfectíon
The following drugs may increase the ris* of liver effects with
sulfadiazine or S#$%T#&:
• acetamínophen, íong-term, hígh-dose (eg Tyíenoí)
• bírth controí pííís contaíníng estrogens
• dísuífíram (Antabuse)
• other medícínes for ínfectíon
Antibiotics are useless to apply at:
1. A fíu - these condítíons are caused by víruses, on whích antíbíotícs do
not render any actíon;
2. To the raísed temperature - antíbíotícs are not febrífugaí and
anesthetízíng prescríptíons;
3. Infíammatory processes - antíbíotícs have no antí-ínfíammatory actíon;
4. Cough - there ís a set of the reasons of cough: vírus ínfectíons, an
aííergy, the bronchíaí asthma, the raísed sensítívíty of bronchíaí tubes an
envíronment both many others, and oníy smaíí share of cough ís
connected to mícroorganísms;
5. Frustratíon of íntestínes - ít ís absoíuteíy not necessary, that the gíven
condítíon ís an attríbute of an íntestínaí ínfectíon. Infríngement of a chaír
many reasons, startíng from símpíe íntoíerance of any product and
fíníshíng food when ín an organísm the actívator gets not, and deveíoped
ít can cause toxín. Besídes ít ís necessary to note, that the ma|oríty of
íntestínaí ínfectíons are caused by víruses, but even íf the actívator -
bactería appíícatíon of antíbíotícs quíte often íncreases duratíon of
dísease;
6. To appíy antíbíotícs ít ís necessary under stríct índícatíons and oníy
then when the doctor wííí estabíísh the díagnosís of an ínfectíous dísease.
Aíí prescríptíons of thís cíass, unfortunateíy, are not uníversaí and
compíeteíy not harmíess. Each antíbíotíc has the spectrum of actíon, í.e.
operates oníy on the certaín mícroorganísms sensítíve to ít. Oníy the
doctor can defíne, what antíbíotíc ís necessary at thís or that dísease.
REFERENCE:
http://www.heaíthííne.com/gaíecontent/antíbíotícs-1#4
http://abxííst.com/
ANTIBIOTIC
S
NCM 106A
Submítted by: Kerwin Ian S. Mempin
BSN IV-|
Submítted to: Filomena Demoni
NCM 106A
Advíser

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