Antibiotics

Antibiotics are agents made from living microorganisms, synthetic

manufacturing, and genetic engineering that are used to inhibit specific
bacteria. They can be bacteriostatic, bactericidal, or both.

The major classes of antibiotics include: aminoglycosides, penicillins and

penicillinase-resistant drugs, sulfonamides, tetracyclines, and antimycobacterials
(e.g. antitubercular and leprostatic)

Others include ketolides, lincosamides, lipoglycopeptides, macrolides, and

monobactams.

• Antibiotics: Generic and Brand Names

• Spotlight: Bacteria and Antibiotics
• Aminoglycosides
o Therapeutic Action
o Indications
o Pharmacokinetics
o Contraindications and Cautions
o Adverse Effects
o Interactions
• Carbapenems
o Therapeutic Action
o Indications
o Pharmacokinetics
o Contraindications and Cautions
o Adverse Effects
o Interactions
• Cephalosporins
o Therapeutic Action
o Indications
o Pharmacokinetics
o Contraindications and Cautions
o Adverse Effects
o Interactions
• Fluoroquinolones
o Therapeutic Action
o Indications
o Pharmacokinetics
o Contraindications and Cautions
 o Adverse Effects
o Interactions
• Penicillins and Penicillinase-Resistant Antibiotics
o Therapeutic Action
o Indications
o Pharmacokinetics
o Contraindications and Cautions
o Adverse Effects
o Interactions
• Sulfonamides
o Therapeutic Action
o Indications
o Pharmacokinetics
o Contraindications and Cautions
o Adverse Effects
o Interactions
• Tetracyclines
o Therapeutic Action
o Indications
o Pharmacokinetics
o Contraindications and Cautions
o Adverse Effects
o Interactions
• Antimycobacterials
o Therapeutic Action
o Indications
o Pharmacokinetics
o Contraindications and Cautions
o Adverse Effects
o Interactions
• Other Antibiotics
o Therapeutic Action
o Pharmacokinetics
o Contraindications and Cautions
o Adverse Effects
o Interactions
• Nursing Considerations for Antibiotics
o Nursing Assessment
o Nursing Diagnoses
o Implementation with Rationale
o Evaluation
Antibiotics: Generic and Brand Names
Here is a table of commonly encountered antibiotics, their generic names, and
brand names:

Classification Generic Name Brand Name

amikacin Amikin

gentamicin Garamycin

kanamycin Kantrex
Aminoglycosides
neomycin Mycifradin

streptomycin generic

tobramycin TOBI, Tobrex

Doripenem Doribax

Ertapenem Invanz
Carbapenems
Imipenem-cilastatin Primaxin

meropenem Merrem IV

Cephalosporins

cefadroxil generic
• First-Generation cefazolin Zolicef
cephalexin Keflex
cefaclor Ceclor
cefoxitin generic
• Second-Generation
cefprozil generic
cefuroxime Zinacef
• Third-Generation cefdinir generic
 cefotaxime Claforan
cefpodoxime Vantin
ceftazidime Ceptaz, Tazicef
ceftibuten Cedax
ceftizoxime Cefizox
ceftriaxone Rocephin
cefditoren Spectracef
• Fourth-Generation cefepime Maxipime
ceftaroline Teflaro
ciprofloxacin Cipro
gemifloxacin Factive
levofloxacin Levaquin
Fluoroquinolones
moxifloxacin Avelox
norfloxacin Noroxin
ofloxacin Floxin, Ocuflox
Penicillins and Penicillinase- Resistant Antibiotics
penicillin G benzathine Bicillin, Permapen
penicillin G potassium Pfizerpen
• Penicillins
penicillin G procaine Wycillin
penicillin V Veetids
• Extended-Spectrum amoxicillin Amoxil, Trimox
Penicillins ampicillin Principen
• Penicillinase-Resistant nafcillin
Antibiotics oxacillin
sulfadiazine generic
Sulfonamides sulfasalazine Azulfidine
cotrimoxazole Septra, Bactrim
demeclocycline Declomycin
doxycycline Doryx, Periostat
Tetracyclines
minocycline Minocin
tetracycline Sumycin
Antimycobacterials
Antituberculosis
ethambutol Myambutol
• First-line
pyrazinamide Nydrazid
 rifampin generic
rifapentine Rifadin, Rimactane
streptomycin generic
capreomycin Capastat
cycloserine Seromycin
• Second-line
ethionamide Trecator-SC
rifabutin Mycobutin
Leprostatic dapsone generic
Other Antibiotics
Ketolide telithromycin Ketek
clindamycin Cleocin
Lincosamides
lincomycin Lincocin
Lipoglycopeptides telavancin Vibativ
azithromycin Zithromax
Macrolides clarithromycin Biaxin
erythromycin Ery-Tab, Eryc
Monobactam aztreonam Azactam

Spotlight: Bacteria and Antibiotics

• Bacteria are microorganisms that invade the human body through

many routes like respiratory, gastrointestinal, and skin.
• Human immune response is activated once bacteria invade the body.
As the body tries to rid itself of bacteria, classic signs of inflammation
(e.g. swelling, heat, redness, and pain), fever, and lethargy begin to
show up.
• The goal of antibiotic therapy is to decrease the population of invading
bacteria to a point at which the human immune system can effectively
deal with the invader.
Aminoglycosides

• Aminoglycosides are a group of antibiotics indicated for infections

caused by gram-negative aerobic bacilli.
• They were replaced by newer, less-toxic drugs in treating less serious
infections because these drugs have potentially serious adverse
effects.

Therapeutic Action

The desired and beneficial action of aminoglycosides is:

• Exert bactericidal effect through inhibition of protein synthesis in

susceptible strains of gram-negative bacteria. Specifically, they bind to
a unit of the bacteria ribosomes and cause misreading of the genetic
code leading to cell death.

Indications

Aminoglycosides are indicated for the following medical conditions:

• Infections caused by susceptible strains: Pseudomonas aeruginosa,

Escherichia coli, Proteus spp., Klebsiella-Enterobacter-Serratia group,
Citrobacter spp., and Staphylococcus spp.
• Serious infections susceptible to penicillin when penicillin is
contraindicated.
Here are some important aspects to remember for indication of antibiotics in
different age groups:

Children

This age group is very sensitive to GI and CNS adverse effects of antibiotics.
Therefore, it is important to monitor their nutritional and hydration status while on
therapy. Oral candidiasis as a superinfection is common in this age group which
makes eating and drinking difficult. Fluoroquinolones are associated with
damage to developing cartilage and are not recommended for growing
children. In addition to this, pediatric dosages should be double-checked to
decrease the risk for adverse effects. Most of all, parent education is important
in cutting down the unnecessary use of antibiotics in children.
Adults

This age group has the tendency to cure simple manifestations with antibiotics.
Therefore, it is important to educate them that antibiotics are effective only for
certain bacteria and not for simple manifestations like common colds, which
may be viral. Storage of unused pills for future infections and sharing antibiotics
with symptomatic friends should be avoided and emphasized in health
teachings.

Older adults

Assessing the problem and obtaining appropriate specimens for culture is

especially important with this population. Older patients may be more
susceptible to adverse effects of antibiotic therapy.

Pharmacokinetics

Here are the characteristic interactions of aminoglycosides and the body in

terms of absorption, distribution, metabolism, and excretion:

Route Onset Peak Duration

IM, IV Rapid 30-90 min N/A

T1/2: 2-3 h
Metabolism: liver
Excretion: kidney (urine)

Contraindications and Cautions

The following are contraindications and cautions for the use of aminoglycosides:

• Known allergy to aminoglycosides.

• Renal or hepatic disease. Can be exacerbated by aminoglycosides
and may interfere wih metabolism and excretion of these drugs.
• Preexisting hearing loss. Can be intensified by toxic drug effects on the
auditory nerve.
 • Active infection with herpes or mycobacterial infections. Can be
worsened by the effects of an aminoglycoside on normal defense
mechanisms.
• Myasthenia gravis or parkinsonism. Can be exacerbated by the effects
of a particular aminoglycosides on the nervous system.
• Lactation. Aminoglycosides are excreted in the breast milk and can
potentially cause serious effects in the infant.
• Amikacin should not be used for longer than 7-10 days because it is
particularly toxic to the bone marrow, kidneys, and GI.
• Streptomycin is only for special situations because it is very toxic to the
8th cranial nerve and kidney.

Adverse Effects

Use of aminoglycosides may result to these adverse effects:

• CNS: ototoxicity, irreversible deafness, vestibular

paralysis, confusion, depression, disorientation, numbness, tingling,
weakness
• Renal: renal failure
• Hematology: bone marrow depression, leading to immunosuppression
and resultant superinfections
• GI: nausea, vomiting, diarrhea, weight loss, stomatitis, hepatotoxicity
• CV: palpitations, hypotension, hypertension
• Hypersensitivity reactions: purpura, rash, urticaria, exfoliative dermatitis

Interactions

The following are drug-drug interactions involved in the use of aminoglycosides:

• Penicillins, cephalosporins, ticarcillin: synergistic bactericidal effect

• Diuretics: increased incidence of ototoxicity, nephrotoxicity, and
neurotoxicity
• Anesthetics, nondepolarizing NM blockers, succinylcholine, citrate
anticoagulated blood: increased NM blockade with paralysis
Carbapenems

• Carbapenems are a relatively new class of broad-spectrum antibiotics

effective against gram-positive and gram-negative bacteria.

Therapeutic Action

The desired and beneficial action of carbapenems is:

• Exert bactericidal effect by inhibiting cell membrane synthesis in

susceptible bacteria, leading to cell death.

Indications

Carbapenems are indicated for the following medical conditions:

• Serious intra-abdominal, urinary tract, skin and skin structure, bone and
joint, and gynecological infections.
• Infections caused by susceptible strains: S.pneumoniae, H.influenzae,
E.coli, K.pneumoniae, B.fragilis, P.mirabilis, P.aeruginosa, and P.bivia.

Pharmacokinetics

Here are the characteristic interactions of carbapenems and the body in terms
of absorption, distribution, metabolism, and excretion:

Route Onset Peak Duration

IM, IV Rapid 30-120 min N/A

T1/2: 4 h
Metabolism: N/A
Excretion: kidney (urine); unchanged
Contraindications and Cautions

The following are contraindications and cautions for the use of carbapenems:

• Known allergy to carbapenems or beta-lactams.

• Seizure disorders. Exacerbated by drugs.
• Meningitis. Safety is not established.
• Lactation. Not known whether drug can cross into breast milk or not.
• Ertapenem is not recommended for use in patients younger than 18
years of age.
• Meropenem is associated with development of pseudomembranous
colitis and should be used in caution in patients with inflammatory
bowel disease.

Adverse Effects

Use of carbapenems may result to these adverse effects:

• GI: pseudomembranous colitis, C.difficile diarrhea, nausea,

vomiting, dehydration and electrolyte imbalance
• CNS: headache, dizziness, altered mental state
• Superinfections

Interactions

The following are drug-drug interactions involved in the use of carbapenems:

• Valproic acid: Carbapenems reduce serum valproic acid and this can
increase risk of seizures.
• Imipenem and ganciclovir can cause seizures.
• Meropenem and probenecid can lead to toxic levels of meropenem.
Cephalosporins

• Cephalosporins were first introduced in the 1960s. There are currently

four generations of cephalosporins, each with specific spectrum of
activity.
• These drugs are similar to penicillins in structure and activity.

Therapeutic Action

The desired and beneficial action of carbapenems is:

• Exert bactericidal and bacteriostatic effects by interfering with the cell-

wall building ability of bacteria during cell division. Therefore, they
prevent the bacteria from bio synthesizing the framework of their cell
walls.

Indications

Cephalosporins are indicated for the following medical conditions:

• First-generation cephalosporins are effective against the same gram-

positive bacteria affected by penicillin G, as well as gram-negative
bacteria P.mirabilis, K.pneumoniae, E.coli.
• Second-generation cephalosporins are effective against previously
mentioned strains as well as H.influenzae, E.aerogenes, and Neisseria
spp. These drugs are less effective against gram-positive bacteria.
• Third-generation cephalosporins are effective against all of the
previously mentioned strains. They are relatively weak against gram-
positive bacteria but are more potent against gram-negative bacilli, as
well as S.marcescens.
• Fourth-generation cephalosporins are active against gram-negative
and gram-positive organisms, including cephalosporin-resistant
staphylococci and P.aeruginosa.
Pharmacokinetics

Here are the characteristic interactions of cephalosporins and the body in terms
of absorption, distribution, metabolism, and excretion:

Route Onset Peak Duration

Oral N/A 30-60 min 8-10 h

T1/2: 30-60 min

Metabolism: N/A
Excretion: kidney (urine); unchanged

Contraindications and Cautions

The following are contraindications and cautions for the use of cephalosporins:

• Known allergy to cephalosporins and bea-lacams. Cross-reacions are

common.
• Hepatic or renal impairment. These drugs are toxic to the kidneys and
could interfere with the metabolism and excretion of the drugs.
• Pregnancy and lactation. Potential effects on the fetus and infant are
not known; use only if benefits clearly outweigh the potential risk of
toxicity to the fetus or infant.
• Reserve cephalosporins for appropriate situations because
cephalosporin-resisant bacteria are appearing in increasing numbers.
Perform culture and sensitivity test before start of therapy.

Adverse Effects

Use of cephalosporins may result to these adverse effects:

• GI: nausea, vomiting, diarrhea, anorexia, abdominal pain, flatulence,

pseudomembranous colitis
• CNS: headache, dizziness, lethargy, paresthesias
• Nephrotoxicity in patients who have predisposing renal insufficiency
 • Superinfections
• Phlebitis and local abscess at the site of IM injection and/or IV
administration.

Interactions

The following are drug-drug interactions involved in the use of cephalosporins:

• Aminoglycosides: increased risk for nephrotoxicity

• Oral anticoagulants: increased bleeding
• Alcohol: avoided for 72 hours after discontinuation of the drug to
prevent disulfiram-like reaction (e.g. flushing, throbbing headache,
nausea and vomiting, chest pain, palpitations, dyspnea, syncope,
vertigo, convulsions, etc.)

Fluoroquinolones

• Fluoroquinolones are a relatively new synthetic class of antibiotics with

a broad spectrum of activity.

Therapeutic Action

The desired and beneficial action of fluoroquinolones is:

• Interfere with the action of DNA enzymes necessary for growth and
reproduction of the bacteria.
• Has little cross-resistance but misuse of this drug for a short time will lead
to existence of resistant strains.

Indications

Fluoroquinolones are indicated for the following medical conditions:

• Treating infections (respiratory, urinary tract, and skin) caused by

susceptible strains: E.coli, P.mirabilis, K.pneumoniae, P.vulgaris,
M.morganii, P.aeruginosa, H.influenzae, S.aureus, S.epidermidis,
N.gonorrhoeae, and group D streptococci.
 • Ciprofloxacin was approved in 2001 for prevention of anthrax infection
in areas that might be exposed to germ warfare. It is also effective
against typhoid fever.

Pharmacokinetics

Here are the characteristic interactions of fluoroquinolones and the body in

terms of absorption, distribution, metabolism, and excretion:

Route Onset Peak Duration

Oral Varies 60-90 min 4-5 h

IV 10 min 30 min 4-5 h

T1/2: 3.5-4 h
Metabolism: liver
Excretion: liver (bile), kidney (urine)

Contraindications and Cautions

The following are contraindications and cautions for the use of fluoroquinolones:

• Known allergy to fluoroquinolones.

• Pregnancy and lactation. Potential effects on the fetus and infant are
not known; use only if benefits clearly outweigh the potential risk of
toxicity to the fetus or infant.
• Seizures. Can be exacerbated by the drugs’ effects on cell membrane
channels

Adverse Effects

Use of fluoroquinolones may result to these adverse effects:

• GI: nausea, vomiting, diarrhea, dry mouth

• CNS: headache, dizziness, insomnia, depression
 • Immunological: bone marrow depression
• Risk for tendinitis and tendon rupture in patients over age 60, on
concurrent steroids, and those with renal, heart, or lung transplants
• Photosensitivity and severe skin reactions so advise patient to avoid sun
and ultraviolet light exposure and to use protective clothing and
sunscreens.

Interactions

The following are drug-drug interactions involved in the use of fluoroquinolones:

• Iron salts, sucralfate, mineral supplements, antacids: increased

therapeutic effects of fluoroquinolones. Administration should be
separated by at least 4 hours.
• Quinidine, procainamide, pentamidine, tricyclics, phenothiazines:
severe-to-fatal cardiac reactions due to increased QTc interval and/or
torsades de pointes
• Theophylline: increased theophylline levels because these two drugs
have the same metabolic pathway
• Steroids: increased CNS stimulation

Penicillins and Penicillinase-Resistant Antibiotics

• Penicillin was the first antibiotic introduced for clinical use. Various
modifications were subsequently made to address resistant strains and
to decrease drug adverse effects.
• Penicillinase-resistant antibiotics were developed to address penicillin-
resistant bacteria.

Therapeutic Action

The desired and beneficial action of penicillins and penicillinase-resistant

antibiotics is:

• Exert bactericidal effect by interfering with the ability of susceptible

bacteria to build their cell walls when they are dividing. These drugs
prevent the bacteria from bio synthesizing the framework of the cell
 wall, and the bacteria with weakened cell walls swell and then burst
from osmotic pressure within the cell.

Indications

Penicillins and penicillinase-resistant antibiotics are indicated for the following

medical conditions:

• Treatment of streptococcal infections (e.g. pharyngitis, tonsillitis, scarlet

fever, endocarditis).
• Treatment of meningococcal meningitis if given at high doses

Pharmacokinetics

Here are the characteristic interactions of penicillins and penicillinase-resistant

antibiotics and the body in terms of absorption, distribution, metabolism, and
excretion:

Route Onset Peak Duration

Oral Varies 1h 6-8 h

T1/2: 1-1.4 h
Metabolism: N/A
Excretion: kidney (urine)

Contraindications and Cautions

The following are contraindications and cautions for the use of penicillins and
penicillinase-resistant antibitiotics:

• Known allergy to penicillins and cephalosporins.

• Renal disease. Drug excretion is reduced.
• Pregnancy and lactation. No adequate studies on the effect on fetus
but these drugs can cause diarrhea and superinfectons may occur in
the infant.
Adverse Effects

Use of penicillins and penicillinase-resistant antibiotics may result to these

adverse effects:

• GI: nausea, vomiting, diarrhea, abdominal pain, glossitis, stomatitis,

gastritis, sore mouth, furry tongue
• Pain and inflammation at the injection site can occur with injectable
forms of the drugs.
• Hypersensitivity reactions: rash, fever, wheezing, anaphylaxis with
repeated exposures
• Superinfections, e.g. yeast infections.

Interactions

The following are drug-drug interactions involved in the use of penicillins and
penicillinase-resistant antibiotics:

• Tetracyclines: decrease in effectiveness of penicillins

• Parenteral aminoglycosides: inactivation of aminoglycosides

Sulfonamides

• Sulfonamides are drugs that inhibit folic acid synthesis.

Therapeutic Action

The desired and beneficial action of sulfonamides is:

• Inhibit folic acid synthesis required as precursors of RNA and DNA. They
competitively block paraaminobenzoic acid to prevent synthesis of
folic acid in susceptible bacteria that synthesize their own folates for
the production of RNA and DNA.
Indications

Sulfonamides are indicated for the following medical conditions:

• Treatment of infections caused by susceptible strains: C.trachomatis,

Nocardia, and some strains of H.influenzae, E.coli, and P.mirabilis.
• No longer used much but they remain an inexpensive and effective
treatment for UTIs and trachoma, especially in developing countries
where cost is an issue.
• Can also be used in treatment of sexually transmitted diseases.
• Sulfasalazine is used in treatment of ulcerative colitis and rheumatoid
arthritis.

Pharmacokinetics

Here are the characteristic interactions of sulfonamides and the body in terms of
absorption, distribution, metabolism, and excretion:

Route Onset Peak Duration

Oral Rapid 1-4 h N/A

T1/2: 8-10 h
Metabolism: N/A
Excretion: kidney (urine)

Contraindications and Cautions

The following are contraindications and cautions for the use of sulfonamides:

• Known allergy to sulfonamides, sulfonylureas, or thiazide diuretics. Cross-

sensitivity can occur.
• Renal disease. Increased toxic effects of the drug.
• Pregnancy. Can cause birth defects.
• Lactation. Increased risk for kernicterus, diarrhea, and rash in infants.
Adverse Effects

Use of sulfonamides may result to these adverse effects:

• GI: nausea, vomiting, diarrhea, abdominal pain, anorexia, stomatitis,

and hepatic injury
• Renal: crystalluria, hematuria, proteinuria, toxic nephrosis
• CNS: headache, dizziness, vertigo, ataxia, convulsions, depression
• Bone marrow depression
• Dermatological: photosensitivity, rash, hypersensitivity reactions

Interactions

The following are drug-drug interactions involved in the use of sulfonamides:

• Tolbutamide, tolazamide, glyburide, glipizide, chlorpropamide:

increased risk of hypoglycemia
• Cyclosporine: increased risk of nephrotoxicity

Tetracyclines

• Tetracyclines are semisynthetic antibiotics based on the structure of a

common soil mold.

Therapeutic Action

The desired and beneficial action of tetracyclines is:

• Inhibit protein synthesis leading to inability of the bacteria to multiply.

The affected protein is similar to protein found in human cells so these
drugs can be toxic to humans at high concentrations.
Indications

Tetracyclines are indicated for the following medical conditions:

• Treatment of infections caused by susceptible strains: Ricketssiae,

M.pneumoniae, B.recurrentis, H.influenzae, H.ducreyi, Bacteroides spp.,
V.comma, Shigella spp., D.pneumoniae, and S.aureus.
• Adjunct in treatment of protozoal infections.

Pharmacokinetics

Here are the characteristic interactions of tetracyclines and the body in terms of
absorption, distribution, metabolism, and excretion:

Route Onset Peak Duration

Oral Varies 2-4 h N/A

Minimal absorption
Topical N/A N/A
occurs

T1/2: 6-12 h
Metabolism: N/A
Excretion: kidney (urine)

Contraindications and Cautions

The following are contraindications and cautions for the use of tetracyclines:

• Known allergies to tetracyclines or to tartrazine

• Pregnancy and lactation. Effect on developing bones and teeth
• Fungal, mycobacterial, or viral ocular infections. Ophthalmic
preparations can kill both undesired bacteria and normal flora
• Use in caution in children below age of 8. Can potentially damage
developing bones and teeth.
 • Hepatic or renal dysfunction. Drugs are concentrated in the bile and
are excreted in urine.

Adverse Effects

Use of tetracyclines may result to these adverse effects:

• GI: nausea, vomiting, diarrhea, abdominal pain, glossitis, dysphagia,

fatal hepatotoxicity
• Skeletal and bones: weakening the structure and causing staining and
pitting of teeth and bones
• Dermatological: photosensitivity and rash
• Superinfection
• Local: pain and stinging with topical or ocular applications
• Hematologic: hemolytic anemia, bone marrow depression
• Hypersensitivity reactions: urticaria, anaphylaxis
• Intracranial hypertension

Interactions

The following are drug-drug interactions involved in the use of tetracyclines:

• Penicillin G: decreased effectiveness of penicillin G

• Oral contraceptives: decreased effectiveness of oral contraceptives
and additional form of birth control is needed
• Digoxin: increased digoxin toxicity
• Calcium salts, magnesium slats, zinc salts, aluminum salts, bismuth salts,
iron, urinary alkalinizers, and charcoal: decreased absorption of
tetracyclines
Antimycobacterials

• Antimycobacterials are antibiotics used in the treatment of infections

caused by pathogens responsible for tuberculosis and leprosy.
• Mycobacterium tuberculosis causes tuberculosis, the leading cause of
death from infectious disease in the world.
• Mycobacterium leprae causes leprosy or Hansen’s disease,
characterized by disfiguring skin lesions and destructive effects on the
respiratory tract.

Therapeutic Action

The desired and beneficial action of antimycobacterials is:

• Act on the DNA and/or RNA of the bacteria, leading to lack of growth
and eventually to bacterial death.

Indications

Tetracyclines are indicated for the following medical conditions:

• Treatment of tuberculosis and leprosy.

Pharmacokinetics

Here are the characteristic interactions of antimycobacterials and the body in

terms of absorption, distribution, metabolism, and excretion:

Route Onset Peak Duration

Oral Varies 1-2 h 24 h

T1/2: 1-4 h
Metabolism: liver
Excretion: kidney (urine)
Contraindications and Cautions

The following are contraindications and cautions for the use of

antimycobacterials:

• Known allergies to antimycobacterials.

• Pregnancy. Adverse effects on fetus. Safest antituberculosis regimen in
pregnancy isoniazid, ethambutol, and rifampin.
• Severe CNS dysfunction. Exacerbated by the effects of the drug
• Hepatic or renal dysfunction. Interfere with the metabolism and
excretion of drugs.

Adverse Effects

Use of antimycobacterials may result to these adverse effects:

• CNS: neuritis, dizziness, headache, malaise, drowsiness, and

hallucinations
• GI: nausea, vomiting, anorexia, stomach upset, abdominal pain
• Rifampin, rifabutin, and rifapentine can cause discoloraion of body
fluids from urine to sweat and tears. They may stain orange-tinged and
may permanently stain contact lenses.

Interactions

The following are drug-drug interactions involved in the use of

antimycobacterials:

• Rifampin and INH in combination: increased toxic liver reactions

• Rifampin and rifabutin with beta blockers, corticosteroids, OCPs, oral
anticoagulants, methadone, phenytoin, verapamil, ketoconazole, and
cyclosporine: increased metabolism and decreased drug effectiveness
Other Antibiotics

• Ketolides is a class of antibiotics introduced in 2004. It is indicated for

treatment of mild to moderate community-
acquired pneumonia caused by susceptible bacteria.
• Lincosamides are similar to macrolides but they are more toxic. They
are used to treat severe infections when penicillin or other less toxic
antibiotics cannot be used.
• Lipoglycopeptides are antibiotics introduced in 2010. They are used to
treat complicated skin and skin-structure infections caused by
susceptible strains of gram-positive organisms.
• Macrolides are antibiotics that interfere with protein synthesis in
susceptible bacteria. They are used to treat respiratory infections
and urethritis in adults and otitis media and pharyngitis/tonsillitis in
children. Eythromycin is the drug of choice for Legionnaire’s disease
and infections caused by C.diphtheriae, Ureaplasma spp.,
mycoplasma pneumonia, and chlamydial infections.
• Monobactam antibiotics are indicated for treatment of gram-negative
enterobacterial infections.

Therapeutic Action

The desired and beneficial actions of other antibiotics are:

• Ketolides and lincosamides block protein synthesis leading to cell

death. Ketolamides are structurally the same with macrolides.
• Lipoglycopeptides inhibit bacterial cell wall synthesis by interfering with
polymerization and cross-linking of peptidoglycans. They bind to the
bacterial membrance and disrupt the membrane barrier function
causing bacterial cell death.
• Macrolides bind to the bacterial cell membrane and change protein
function. This prevents bacteria from dividing and cause their cell
death.
• Monobactam disrupts bacterial cell wall synthesis and promote
leakage of cellular contents and cell death.
Pharmacokinetics

Here are the characteristic interactions of other antibiotics and the body in
terms of absorption, distribution, metabolism, and excretion:

Route Onset Peak Duration

Ketolides

Oral Rapid 0.5-4 h N/A

T1/2: 10 h
Metabolism: N/A
Excretion: kidney (urine), colon (feces)

Lincosamides

Oral Varies 1-2 h 8-12 h

IM 20-30 min 2-3 h 8-12 h

IV Immediate Minutes 8-12 h

Topical Minimal absorption N/A N/A

T1/2: 2-3 h
Metabolism: liver
Excretion: kidney (urine), colon (feces)

Lipoglycopeptides

IV Rapid End of infusion N/A

T1/2: 8-9.5 h
Metabolism: unknown
Excretion: kidney (urine)
 Macrolides

Oral 1-2 h 1-4 h N/A

IV Rapid 1h N/A

T1/2: 3-5 h
Metabolism: liver
Excretion: liver (bile), kidney (urine)

Monobactam antibiotics

IM Varies 60-90 min 6-8 h

IV Immediate 30 min 6-8 h

T1/2: 1.5-2 h
Metabolism: N/A
Excretion: kidney (urine)

Contraindications and Cautions

The following are contraindications and cautions for the use of other antibiotics:

• Ketolides: telithromycin with antiarrhythmics and antilipidemics can

cause serious adverse effects. It might also cause potentially fatal
respiratory failure in patients with myasthenia gravis.
• Lincosamides: use in caution in patients with hepatorenal insufficiency.
Usage in pregnancy and lactation is only indicated if benefit clearly
outweighs the risk to the fetus or neonate. The same is true with
lipoglycopeptides, macrolides, and monobactams.
Adverse Effects

Use of other antibiotics may result to these adverse effects:

• GI: nausea, vomiting, potential for pseudomembranous colitis,

superinfections, taste alterations, risk for C.difficile diarrhea

Interactions

The following are drug-drug interactions involved in the use of other antibiotics:

• Ketolides: loss of therapeutic effects if combined with rifampin,

phenytoin, carbamazepine, phenobarbital; increased serum levels of
digoxin and metoprolol; increased GI toxicity with theophylline
• Lipoglycopeptides: increased risk for prolonged QT interval if combined
with drugs known to cause prolonged QT interval
• Macrolides: food in the stomach decreases absorption of oral
macrolifes. Antibiotic should be taken on an empty stomach with a full,
8-oz glassof water 1 hour before or at least 2-3 hours after meals.
• Monobactams: incompatible in solution with nafcillin, cephradine,
and metronidazole.
Nursing Considerations for Antibiotics

Here are important nursing considerations when administering antibiotics:

Nursing Assessment

These are the important things the nurse should include in conducting
assessment, history taking, and examination:

• Assess for the mentioned cautions and contraindications (e.g. drug

allergies, CNS depression, CV disorders, etc.) to prevent any untoward
complications.
• Perform a thorough physical assessment (other medications taken,
CNS, skin, respirations, and laboratory tests like renal functions tests
and complete blood count or CBC) to establish baseline data before
drug therapy begins, to determine effectiveness of therapy, and to
evaluate for occurrence of any adverse effects associated with drug
therapy.
• Perform culture and sensitivity tests at the site of infection to ensure
appropriate use of the drug.
• Conduct orientation and reflex assessment, as well as auditory testing
to evaluate any CNS effects of the drug (aminoglycosides).

Nursing Diagnoses

Here are some of the nursing diagnoses that can be formulated in the use of this
drug for therapy:

• Acute pain related to GI or CNS drug effects

• Deficient fluid volume and imbalanced nutrition: less than body
requirements related to diarrhea
• Disturbed sensory perception (auditory) related to CNS drug effects
• Risk for infection related to bone marrow suppression (aminoglycosides)
and repeated injections (cephalosporins).
Implementation with Rationale

These are vital nursing interventions done in patients who are taking antibiotics:

• Check culture and sensitivity reports to ensure that this is the drug of
choice for this patient.
• Ensure that patient receives full course of aminoglycosides as
prescribed, divided around the clock to increase effectiveness and
decrease the risk for development of resistant strains of bacteria.
• Monitor infection site and presenting signs and sympoms throughout
course of drug therapy because failure of these manifestations to
resolve may indicate the need to reculture the site.
• Provide safety measures to protect the patient if CNS effects (e.g.
confusion, disorientation, numbness) occur.
• Educate client on drug therapy to promote understanding and
compliance.
• Provide the following patient teaching: safety precautions (e.g.
changing positions, avoiding hazardous tasks, ec.), drinking lots of fluids
and to maintain nutrition even though nausea and vomiting may
occur, report difficulty breathing, severe headache, fever, diarrhea,
and signs of infection.

Evaluation

Here are aspects of care that should be evaluated to determine effectiveness

of drug therapy:

• Monitor patient response to therapy (decrease in signs and symptoms

of infection).
• Monitor for adverse effects (e.g. orientation and affect, hearing
changes, bone marrow suppression, renal toxicity, hepatic dysfunction,
etc).
• Evaluate patient understanding on drug therapy by asking patient to
name the drug, its indication, and adverse effects to watch for.
• Monitor patient compliance to drug therapy.