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Antiinfectives

Key Points

N203
ATI (Unit 2)
Antiinfectives -

Broad-spectrum vs. narrow-spectrum antibiotics

Antimicrobials treat bacterial, viral, and fungal infections

Culture and sensitivity specimens should be collected prior to


initiation of therapy.

Adverse reactions include:

Hypersensitivity & anaphylaxis

Superinfection

Organ toxicity (ototoxic,


nephrotoxic)

warfarin activity

efficacy of oral contraceptives

Penicillins

N203
ATI (Unit 2)
Antiinfectives -

Expected Action:

-lactam destroys bacteria by weakening cell wall

Therapeutic Uses:

Med of choice for G+ cocci (Strep pneumoniae, S. viridans, S. pyogenes)


Med of choice for

First choice for meningitis


syphilis
Prophylaxis against bacterial endocarditis

Extended spectrum against Pseudomonas, Proteus, Klebsiella

Adverse Effects:

Anaphylaxis / Renal Impairment / Hyperkalemia (w doses)

Contraindications:

Allergies to Penicillin, Cephalosporin, or Imipenem / Kidney Dysfunction

Interactions:

Aminoglycosides / Oral Contraceptives

Education:

Take orals H2O, food (some may be taken food)

Cephalosporins

N203
ATI (Unit 2)
Antiinfectives -

Expected Action:

-lactam destroy bacteria by destroying cell wall


Four generations, each is: against G- and anaerobes more resistant to
lactamase more able to reach CSF

Therapeutic Uses:

Broad spectrum with TI for postop infections, meningitis, pelvic infections

Adverse Effects:

Anaphylaxis / Bleeding / Thrombophlebitis / Pain IM / cross allergies to


penicillins / AA-pseudomembranous colitis

Contraindications:

Allergies to Penicillin / Kidney Dysfunction


Caution with anticoagulants, antiplatelets, and thrombolytics

Interactions:

EtOH intolerance (disulfiram reaction) / Probenecid renal excretion

Education:

Take food

Carbapenems

N203
ATI (Unit 2)
Antiinfectives -

Expected Action:

-lactam destroy bacteria by destroying cell wall

Therapeutic Uses:

Broad spectrum effective for serious infections such as pneumonia, peritonitis,


and UTIs. P. aeruginosa develops resistance (use combo) [broadest spectrum
available]

Adverse Effects:

Allergy / GI symptoms / Superinfection

Contraindications:

Caution with renal impairment

Interactions:

Education:

Monobactams

N203
ATI (Unit 2)
Antiinfectives -

Expected Action:

-lactam destroy bacteria by destroying cell wall

Therapeutic Uses:

MRSA / Antibiotic-associated pseudomembranous colitis by C. difficile

Adverse Effects:

Ototoxicity / Infusion Rxn (red man syndrome) / Thrombophlebitis

Contraindications/Precautions:

Caution with renal impairment


Infuse over 60 minutes
Very low therapeutic index

Interactions:

Education:

Tetracyclines

N203
ATI (Unit 2)
Antiinfectives -

Expected Action:

Bacteriostatic by preventing protein synthesis

Therapeutic Uses:

Acne / rickettsia / Chlamydia / Helicobacter pylori / periodontal disease / typhus


fever / Rocky Mountain spotted fever / Lyme disease / UTI & VI

Adverse Effects:

GI symptoms / tooth discoloration / hepatotoxicity / photosensitivity /


superinfection of bowel

Contraindications/Precautions:

Renal disease (except doxycycline) / Use during pregnancy will stain deciduous
teeth but not permanent teeth

Interactions:

Milk / Ca2+, Fe3+ supplements / Mg2+ laxatives / antacids (chelates to )


of oral contraceptives

Education:

Give with water on an empty stomach (except doxycycline & minocycline)

Bacteriostatic Inhibitors
(Macrolides / Ketolides)

N203
ATI (Unit 2)
Antiinfectives -

Expected Action:

Bacteriostatic by inhibiting protein synthesis Bactericidal at high doses

Therapeutic Uses:

Use for pts with penicillin allergies / pertussis / diphtheria / Legionnaires


Chlamydia, Mycoplasma pneumoniae, Streptococcus pyogenes

Adverse Effects:

GI discomfort / thrombophlebitis

Contraindications/Precautions:

Pre-existing liver disease

Interactions:

Toxic with: antihistamines, theophylline (asthma med), carbamazepine


(anticonvulsant), warfarin

Education:

Administer on empty stomach with water IV is rarely used

Aminoglycosides
(Medication List)

N203
ATI (Unit 2)
Antiinfectives -

gentamicin

amikacin

kanamycin

tobramycin sulfate

neomycin

paromomycin

streptomycin

Aminoglycosides

N203
ATI (Unit 2)
Antiinfectives -

Expected Action:

Kill bacteria by disrupting protein synthesis

Therapeutic Uses:

Med of choice against aerobic G- bacilli (E. coli, K. pneumoniae, P. mirabilis, P.


aeruginosa)
Oral paromomycin use for amebiasis and tapeworm

Adverse Effects:

Ototoxicity ()/ nephrotoxicity / neuromuscular blockade / hypersensitivity


Streptomycin: Neurologic disorders

Contraindications/Precautions:

Renal impairment reduced doses

Interactions:

Ethacrynic acid (oto-tox) / amphotericin, cephalosporins, vanco (neph-tox) /


tubocurarine / penicillins ( AG)

Education:

Penicillins
(Medication List)

N203
ATI (Unit 2)
Antiinfectives -

Penicillin G

Augmentin (amoxicillin-clavulanate) - Broad spectrum

Nafcillin Antistaphylococcal

Carbenicillin Antipseudomonas

Cephalosporins
(Medication List)

N203
ATI (Unit 2)
Antiinfectives -

Cephalexin (Keflex)

Cephapirin (Cefadyl)

Cefaclor (Ceclor)

Cefotetan (Cefotan)

Cefatriaxone (Rocephin)

Cefotaxime (Claforan)

Cefepime (Maxipime)

Carbapenems
(Medication List)

N203
ATI (Unit 2)
Antiinfectives -

Imipenem (Primaxin)

Meropenem (Merrem IV)

Monobactams
(Medication List)

N203
ATI (Unit 2)
Antiinfectives -

Vancomycin (Vancocin)

Aztreonam (Azactam)

Fosfomycin (Monurol)

Tetracyclines
(Medication List)

N203
ATI (Unit 2)
Antiinfectives -

Tetracycline hydrochloride (Sumycin)

Doxycycline (Vibramycin)

Minocycline

Macrolides / Ketolides
(Medication List)

N203
ATI (Unit 2)
Antiinfectives -

Azithromycin (Zithromax)

Clarithromycin (Biaxin)

Dirithromycin

Erythromycin

Clindamycin (Cleocin)

Sulfonamides & Trimethoprim


(Medication List)

N203
ATI (Unit 2)
Antiinfectives -

SulfamethoxazoleTrimethoprim (TMP-SMZ, Bactrim)

Cotrim

Septra

Sulfadiazine

Sulfamethoxazole

Sulfisoxazole

Sulfonadmides-Trimethoprim

N203
ATI (Unit 2)
Antiinfectives -

Expected Action:

Bacteriostatic by inhibiting folate synthesis

Therapeutic Uses:

Med of choice for UTI by E. coli and Pneumocystis carinii.

Adverse Effects:

Hypersensitivity (sulfonamides, thiazide diuretics, tolbutamide, loop diuretics)


Blood dyscrasias / crystalluria / kernicterus ( bilirubin) / photosensitivity

Contraindications/Precautions:

Avoid in: folate deficiency / pregnancy / creatinine clearance < 15 mL/min


Reduce dosages with renal dysfunction

Interactions:

Warfarin / phenytoin / tolbutamide ( effects of these)

Education:

Empty stomach with full glass of water

Urinary Tract Aseptics

N203
ATI (Unit 2)
Antiinfectives -

Expected Action:

Damages DNA

Prototype: Nitrofurantoin

Static a@ doses, Cidal @ doses

Therapeutic Uses:

Acute UTIs / Prophylaxis for recurrent lower UTI

Adverse Effects:

GI / hypersensitivity / blood dyscrasias / peripheral neuropathy

Contraindications/Precautions:

Renal dysfunction creatinine clearance < 40

Interactions:

Education:

Urine will be brown

Antimycobacterial

N203
ATI (Unit 2)
Antiinfectives -

Expected Action:

Prototypes: isoniazid (INH), streptomycin, ethambutol,


pyrazinamide

Prevents synthesis of mycolic acid

Therapeutic Uses:

Active and latent tuberculosis

Adverse Effects:

Peripheral neuropathy (administer 50-200 mg of vitamin B6 daily)


Hepatotoxicity

Contraindications/Precautions:

Liver disease

Interactions:

Phenytoin (accumulates)
INH with EtOH, rifampin, pyrazinamide hepatotoxicity

Education:

Empty stomach but food if needed

Anti-Hansens Disease

N203
ATI (Unit 2)
Antiinfectives -

Expected Action:

Prototype: Dapsone Others: Clofazimine, Rifampin

Prevents synthesis of folate which inhibits M. leprae.

Therapeutic Uses:

Used in combination therapy to treat leprosy

Adverse Effects:

Rifampin: Discoloration of body fluids / Hepatotoxicity


GI discomfort

Contraindications/Precautions:

Use caution with liver dysfunction

Interactions:

Rifampin warfarin / OC / protease inhibitors / NNRTIs (HIV)

Education:

Antiviral

N203
ATI (Unit 2)
Antiinfectives -

Prototype: Acyclovir
Others: ganciclovir, interferon, ribavirin, amantadine

Expected Action:

Prevents reproduction of viral DNA

Therapeutic Uses:

Adverse Effects:

Acyclovir: Phlebitis, nephrotoxicity, nausea & headache


Ganciclovir: Granulocytopenia / thrombocytopenia / reproductive toxicity /
teratogenic

Contraindications/Precautions:

Pregnancy / neutrophil count (<500/cc)

Interactions:

Nursing Info:

Acyclovir: Never give IV bolus, Infuse over 1 hour min.

Fluoroquinolones
(Medication List)

N203
ATI (Unit 2)
Antiinfectives -

Expected Action:

Prototype: Ciprofloxacin

Bactericidal by inhibition of enzyme needed for DNA

Therapeutic Uses:

Broad spectrum / prevention of inhaled anthrax

Adverse Effects:

GI discomfort / Achilles tendon rupture / superinfection

Contraindications/Precautions:

Avoid use in children <18 d/t risk for tendon rupture

Interactions:

Cations ( Cipro absorption) / Theophylline & warfarin ( med plasma levels)

Education:

Infuse slowly over 60 minutes

Antiprotozoals

N203
ATI (Unit 2)
Antiinfectives -

Expected
Action:

Proto: Amphotericin
Others: flucytosine, miconazole, nystatin, griseofulvin, ketoconazole

permeability leakage of intracellular cations (static or cidal)

Therapeutic Uses:

Systemic or cutaneous fungal infections

Adverse Effects:

Amphotericin: Infusion rxn (1-3 hrs) / thrombophlebitis / nephrotoxicity /


hypokalemia / marrow suppression
Ketoconazole: Hepatotoxicity / Sex hormone effects
Contraindications/Precautions: Renal dysfunction

Interactions:

Aminoglycosides (streptomycin, cyclosporine) additive nephrotoxicity


Flucytosine antifungal effects are potentiated with amphotericin
Education: Highly toxic, infuse slowly (2-4 hr)
Renal damage limited by infusing 1 L NS on day of amphotericin infusion

Antiprotozoals

N203
ATI (Unit 2)
Antiinfectives -

Expected Action:

Proto: metronidazole (Flagyl)

Broad spectrum with anaerobic activity

Therapeutic Uses:

Protozoal infections / Bacterial infections against obligate anaerobes


Prophylaxis for surgical procedures at high risk for anaerobic infections (vaginal,
abdominal, colorectal)
H. pylori with tetracycline and bismuth salicylate

Adverse Effects:

GI discomfort / metallic taste / darkening of urine / CNS symptoms

Contraindications/Precautions:

Caution with renal dysfunction / avoid during 1st trimester of pregnancy

Interactions:

Disulfiram-like reaction EtOH


Warfarin Flagyl inhibits inactivation of warfarin

Education: