MICROBIAL INFECTION

A person is normally able to remain healthy and resistant to infectious microorganisms because of the
existence of certain host defenses. These defenses take various forms.

Microorganisms are everywhere in both the external environment and many parts of the internal
environment of our bodies. Every known major class of microbes has member organisms that can infect
humans. This includes bacteria, viruses, fungi and protozoa.

Bacteria come in a number of different shapes, this property of bacteria is called morphology. One of the
most important ways of categorizing different bacteria is on the basis of their response to the Gram stain
procedure.

Bacteria species that stain purple with gram stain dyes are classified as gram-positive organisms.
Those bacteria that stain red are classified as gram-negative organisms.

Gram positive organisms have cell walls with a much thicker constituent known as peptidoglycan, the
name of which refers to the protein (peptido-) and sugar (-glycan) components of its chemical
structure. In addition, gram positive organisms have a thicker outer cell capsule.

Gram negative organisms have a cell wall structure that is more complex, with a smaller outer capsule
and peptidoglycan layer but with two cell membranes : an outer and an inner membrane. These
differences usually make gram-negative bacterial infections more difficult to treat because the drug
molecules have a harder time penetrating the more complex cell walls of gram-negative organisms.

When a person’s normal host defenses are breached or somehow compromised, that person becomes
susceptible to infection. The patient then usually manifests the following classic signs and symptomsof
infection : fever, chills, sweats, redness, pain and swelling, fatigue, weight loss, increased white blood cell
(WBC) count, and the formation of pus. Not all patients will exhibit signs of infection. This is especially
true in elderly and immunocompromised patients.

GENERAL PRINCIPLES OF ANTIBIOTIC THERAPY

ANTIBIOTIC drug therapy should begin with a clinical assessment of the patient to determine whether he
or she has the common signs and symptoms of infection. The antibiotic selected is one that can best kill
the microorganisms known to be the most common causes of infection. This is called empiric therapy.

Antibiotics are also given for prophylaxis. This is often the case, for example, when patients are
scheduled to undergo a procedure in which the likelihood of dangerous microbial contamination is high
during or after the procedure. Prophylactic antibiotic therapy is used to prevent an infection.

To optimize antibiotic therapy, the patient should be continuously monitored for both the therapeutic
efficacy and adverse drug effects. A therapeutic response to antibiotics is one in which there is a
decrease in the specific signs and symptoms of infection compared with the baseline findings.( e.g. fever,
elevated WBC count, redness, inflammation).

Antibiotic therapy is said to be subtherapeutic when these signs and symptoms do not improve. This can
result from use of an incorrect route of drug administration, inadequate drainage of an abscess, poor drug
penetration to the infected area, insufficient serum levels of the drug, or bacterial resistance to the drug.

ANTI-INFECTIVES AGENTS
- Are drugs that are designed to act selectively on foreign organisms that have invaded and infected
the body of a human host
- Ideally, these drugs would be toxic to the infecting organisms only and would have no effect on
the host cells
- In other words, they would possess SELECTIVE TOXICITY

Selective toxicity
 - the ability to affect certain proteins or enzyme systems that are used by bacteria but not by
human cell. May act on the cells of the invading organism in several ways.
- The goal is interference with the normal function of the invading organism to prevent it from
reproducing & to cause death without affecting host cells.

Specific agents used to treat particular infections:

1. Antibiotics – used to treat particular infections caused by bacteria
2. Antivirals
3. Antifungals
4. Antiprotozoals- used to treat infections caused by specific protozoa, including malaria

Spectrum of Activity
1. Narrow spectrum drugs
- Effective against only a few microorganisms with a very specific metabolic enzyme
2. Broad spectrum drugs
- Interfere with biochemical reactions in many different kinds of microorganisms, making them
useful in the treatment of a wide variety of infections
Antimicrobial activity
1. Bactericidal drug
- Cause the death of the cells they affect (Kills)
2. Bacteriostatic drug
- They interfere with the ability of the cells to reproduce or divide but does not kill them
* Several drugs are both bactericidal & bacteriostatic.

Resistance
-Many microorganisms that do not use that system or process are not affected by a particular anti-
infective drug. These organisms are said to have a natural or intrinsic RESISTANCE to that drug. The
selected drug should be the one that is known to affect the specific microorganism that is causing the
infection.

Preventing Resistance
1. Limit the use of antimicrobial agents to the treatment of specific pathogens known to be sensitive
to the drug being used
2. Drug dosage is important in preventing the development of resistance.
*doses- High enough
*duration- long enough

Culture
 Identification of the infecting pathogen through culture of a tissue sample from the infected area.
 Bacterial cultures are performed in a laboratory, where a swab of infected tissue is allowed to
grow on an agar plate
 Correct identification of the organism causing the infection is an important first step in
determining which anti-infective drug should be used

Sensitivity testing
- Experience influences selection of the drug, based on the presenting signs & symptoms
- Shows which drugs are capable of controlling the particular microorganism
- Identify the causal pathogen & the most appropriate drug for treating the infection

ANTIMICROBIAL AGENTS
- Are chemicals that eliminate living microorganisms that are pathogenic to the patient .
- May be of chemical origin or derived from other living organisms.
- Those derived from other living microorganisms are called antibiotics.
- Are classified according to the type of pathogen to be destroyed.
Antibiotics - Chemical substance that is derived from mold or bacteria & has the ability to destroy or
inhibit the growth of one or more causative pathogens in the treatment of infectious conditions

The four most common mechanisms of antibiotic action are :

1. Interference with bacterial cell wall synthesis
2. Interference with protein synthesis
3. Interference with replication of nucleic acid (deoxyribonucleic acid (DNA) and ribonucleic acid
(RNA)
4. Antimetabolite action that disrupts critical metabolic reactions inside the bacterial cell

Adverse Reactions to Anti-infective therapy

- Most common encountered adverse effects are direct toxic effects on the kidneys,
gastrointestinal tract(GI)tract, & nervous system. Hypersensitivity reactions &
superinfections also can occur

1. Kidney damage
- Most frequently with drugs that are metabolized by the kidneys & eliminated in the urine
- To prevent any accumulation of the drug in the kidney, patients should also be well hydrated
throughout the course of the drug therapy
2. Gastrointestinal toxicity
- Is very common with many of the anti-infectives.
- Direct toxic effects on the cell lining of the GI tract causing N&V, stomach upset or diarrhea,
3. Neurotoxicity
- It damage or interfere with the function of nerve tissue, usually in areas where drugs tend to
accumulate in high concentrations.
- Dizziness, vertigo, loss of hearing, blindness, lethargy, changes in reflexes
4. Hypersensitivity
- Allergic or hypersensitivity reactions Occur in many antimicrobial agents
5. Superinfections
- The use of anti-infectives esp. broad spectrum anti-infectives is destruction of normal flora
- Once normal flora is destroyed, opportunistic pathogens have the opportunity to invade tissues &
cause infections
- Eg: vaginal or GI yeast infections

Nursing Implications
1. Check the IM site for evidence of local abscess & the IV site for phlebitis, rotate sites
2. Teach the patient to continue the full course of treatment
3. Instruct to take the medication with a small meal or snack to decrease GI effects
4. Frequent oral care & sucking ice chips or sugar-less candy may relieve stomatitis discomfort
5. Dose will be reduced with renal impairment and decreased liver function
6. Monitor renal, liver function studies and I&O
7. Advise the patient to report difficulty breathing, severe headache, severe diarrhea, dizziness,
weakness & superinfections

SULFONAMIDES
ACTION:
- Sulfonamides(sulfa drugs) are synthetic derivatives that are bacteriostatic, which means they have
the ability to inhibit the formation of new bacteria but have no effect on bacteria that are already formed

INDICATIONS :
- Sulfonamides are bacteriostatic against a wide range of gram-positive & gram-negative bacteria
- Urinary tract infections, otitis media, systemic infections, vaginitis, superficial eye infections
CONTRAINDICATIONS:
- In cases of known drug allergy to Sulfonamides or to chemically related drugs such as the
sulfonylureas (used to treat diabetes)
- Also to pregnant women at term and in infants younger than 2 months of age

ADVERSE EFFECTS : Common

CNS : headache, fever, convulsions
GIT : anorexia, nausea & vomiting, abdominal pain, diarrhea
Renal : toxic nephrosis
Hematologic : agranulocytosis, thrombocytopenia
Skin : photosensitivity, rash , Stevens-Johnson syndrome
Sulfonamide Trade names Uses
Sulfisoxazole Gantrisin Treatment of conjunctivitis, otitis media, UTI &
meningococci
Cotrimoxazole (Trimethoprim- Bactrim Treatment of UTI, otitis media, & bronchitis
sulfamethoxazole) Septra

PENICILLINS
The Penicillins are a very large group of chemically related antibiotics that are derived from a mold
fungus often seen on bread or fruit.
Classified as pregnancy Category B drugs

ACTION :
- Natural Penicillins inhibition of enzymes that are required for bacterial cell wall synthesis; thus
they kill bacteria. It is bactericidal
INDICATIONS:
- For the prevention and treatment of infections caused by susceptible bacteria
- Penicillins affect gram-positive and gram-negative aerobes, anaerobes, streptococci,
staphylococcus, bacilli and enterococci.
USES:
- Used for the treatment of pharyngitis, tonsillitis, otitis media, pneumonia, endocarditis, soft tissue
infections, meningitis, scarlet fever, UTI, syphilis, gonorrhea
- Prophylactically, penicillins may be given before surgery or dental procedures in patients with a
history of rheumatic fever.

ADVERSE EFFECTS: Most common cause of drug allergy

Hypersensitivities- urticarial, pruritus, angioedema, maculopapular rash
GI system- N&V, diarrhea , mouth sores (stomatitis), abdominal pain,
Neurologic toxicities- lethargy, twitching, confusion, hallucinations
Hematologic toxicity – anemia, increased bleeding time, bone marrow depression
Subclass Generic Drug Names Uses
Natural penicillins penicillin G, penicillin Treatment of moderate-to-severe systemic
V infections
Penicillin G injectable form for IV or IM use
Penicillin V PO dosage form (tablet and liquid)
Penicillinase-resistant oxacillin, cloxacillin, Treatment of staphylococcal infections
penicillin dicloxacillin
Broad-spectrum Amoxicillin, Treatment of mild-to-moderate infections
penicillin(aminopenicillin) ampicillin
Extended-spectrum piperacillin, Treatment of septicemia & intraabdominal, skin,
penicillin carbenicillin soft tissue & respiratory & GU tract infections
 CEPHALOSPORINS
Are semisynthetic antibiotics derivatives of cephalosporin C, a substance produced by a fungus but
synthetically altered to yield an antibiotic.

ACTIONS:
- Are divided into four groups or generations based on their spectrum of activity
- Each generation has increasing activity against gram-positive, gram-negative bacteria &
anaerobes
- Are both bactericidal and bacteriostatic, depending on the dose and the specific drug involved.
First generation Cephalosporins
- Are primarily used for gram-positive bacteria but limited activity against gram-negative bacteria,
available both parenteral and oral forms
Second generation
- Have enhanced activity against bacteria that are susceptible to the first generation cephalosporins,
as well as gram-negative bacteria, available both parenteral and oral forms
Third generation
- Have enhanced activity against bacteria that are susceptible to first-& second generation, ,more
potent of the first three generations
- Serious infections both gram positive & negative
Fourth generation
- Have a greater spectrum of antibiotic activity than third-generation
- Are also active against both gram-positive & gram-negative bacteria

ADVERSE EFFECTS:
* Vascular :Phlebitis at IV site, Discomfort at IM injection site
* GIT : Diarrhea, Hepatotoxicity
*Hematologic: Bone marrow depression
* Renal : Nephrotoxicity
* Immune: Secondary infections, Fungal overgrowth

NURSING RESPONSIBILITIES:
1. Check the IM site for evidence of local abscess & the IV site for phlebitis, rotate sites
2. Teach the patient to continue the full course of treatment
3. Instruct to take the medication with a small meal or snack to decrease GI effects
4. Frequent oral care & sucking ice chips or sugar-less candy may relieve stomatitis discomfort
5. Dose will be reduced with renal impairment and decreased liver function
6. Monitor renal, liver function studies and I&O
7. Advise the patient to report difficulty breathing, severe headache, severe diarrhea, dizziness,
weakness & superinfections

CEPHALOSPORIN Generic/Trade Name Uses

S
First generation cefazolin (P) (Ancef) Treatment of respiratory, GU, soft tissue, skin & bone
cephalexin (O) Keflex, infections & otitis media in children
Biocef
Second generation cefoxitin (P) Mefoxin Treatment of lower respiratory, GU tract, skin, bone and
cefuroxime sodium (P) joint infections
Zinacef
Third generation ceftriaxone (P) Treatment of perioperative prophylaxis of GI & GU &
Rocephin lower respiratory, meningitis, skin, bone, joint, pelvic, &
intraabdominal infection
Fourth generation Cefepime(P)Maxipime Treatment of pneumonia & skin structure infections &
complicated UTIs infections
 CARBAPENEMS
ACTIONS:
*The carbapenems are extremely potent broad-spectrum antibiotics resistant to beta-lactamase
enzymes secreted by bacteria. They act by inhibiting bacterial cell wall synthesis.

ADVERSE REACTIONS : COMMON

• GI: severe diarrhea
• CNS: Dizziness, confusion, drug-induced seizure activity (hazard)
• Vascular : phlebitis
GENERIC BRAND USES
NAME NAME
Imipenem- Primaxin Treatment of bone, joint, skin, soft tissue infections(gram-positive,
cilastatin gram-negative, anaerobic bacteria)
Meropenem Merrem IV Used alone by the IV route for the only treatment of bacterial
meningitis
Ertapenem Invanz Broad spectrum, approved to treat infections caused by aerobic &
anaerobic gram positive bacteria

MONOBACTAM
Its structure is unique, and little cross-resistance occurs
Safe alternative for treating infections caused by susceptible bacteria in patients who might be allergic to
penicillins or cephalosporin
ACTION :
Aztreonam (Azactam) – disrupts cell wall synthesis of bacteria that causes leakage of intracellular
contents & cell death.
- Is the only antibiotic in the monobactam classification & is bactericidal against gram-negative
aerobic bacteria including E. coli, Klebsiella & Pseudomonas species

MACROLIDES
ACTION:
- Inhibits protein synthesis in bacterial cell
- Bacteriostatic, however in high enough concentration it may be bactericidal
- Has broad spectrum of activity
INDICATIONS :
- used in treating mild-to moderate infections
- Drug of choice in pertussis, dipththeria, Legionnaires’ disease, atypical viral pneumonia,
intestinal dysenteric amebiasis, acne, staphylococcal and streptococcal infections
- For persons allergic to penicillin
ADVERSE EFFECTS:
CVS: palpitations, chest pain
CNS : headache, dizziness, vertigo Reversible hearing loss
GIT : nausea, vomiting, Hepatitis, hearburn
Integumentary : rash , pruritus, Allergic reactions
Other : hearing loss, superinfection

Macrolides Trade Name Uses

Erythromycin E-mycin Treatment of ocular infections
Azithromycin Zithromax Treating mild to moderate respiratory infection, urethritis in adults
and otitis media, tonsillitis in children
Clarithromycin Biaxin Expensive oral agent for respiratory, skin, sinus and maxillary
infections
 KETOLIDES
ACTIONS:
• Telithromycin (Ketek) is the first of a new family of antimicrobial agents known as the ketolides.
• They are chemically related to the macrolide antibiotics and have similar mechanism of
bactericidal action by preventing bacterial ribosomes from translating its RNA, preventing its
synthesis.
INDICATION:
 To treat acute lung (pneumonia) infections caused by susceptible strains of gram-positive bacteria
such as S. pneumonia
Adverse effects: Common
 GIT : gastric irritations
Serious Adverse effects:
o Neurologic: Fainting, headache
o Sensory: visual disturbances
o GIT: hepatotoxicity

TETRACYCLINES
ACTIONS:
- Broad spectrum drug with bacteriostatic action and at higher doses, bactericidal action.
- Inhibits bacterial wall synthesis.
- Reduces free fatty acids from triglycerides, thus reducing acne lesion.
INDICATIONS :
- Are useful in treating several uncommon infections
- Are considered the first-line drug defense for Rickettsia (Rocky Mountain spotted fever), as well
as pneumonia, typhus, trachoma, peptic ulcer disease, urethritis, cervicitis, Chlamydia and
cholera, Mycoplasma organisms, acne vulgaris, gonorrhea, spirochetes
- available in oral & topical forms
- Also available as an opthalmic agent to treat superficial ocular lesions & prophylactic agent for
OPTHALMIA NEONATORUM caused by N. gonorrheae

COMMON ADVERSE EFFECTS

• CNS :Headache, dizziness
• GIT : Nausea and vomiting, diarrhea, colitis, abdominal cramping, Hepatotoxicity
• SKIN : Photosensitivity
• Hypersensitivity, superinfection
Generic Name Uses
Natural Tetracyclines All chemically derived from Streptomyces by fermentation
Demeclocycline (Declomycin) process
oxytetracycline Treatment of skin infections and respiratory, GI, & GU tract
tetracycline infections
Semisynthetic Tetracyclines Treatment of gram-negative infections like rickettsial infection such
Doxycycline (Vibramycin) as Rocky Mountain spotted fever, chlamydial and mycoplasmal
minocycline infections

PATIENT TEACHING :
1. Educate the patient about foods and beverages that may interact negatively with antibiotics, such
as alcohol, acidic fruit juices, and dairy products
2. The patient should be instructed to report severe adverse effects to the physician. Follow-up visits
should be needed to monitor the infection and its treatment. Laboratory tests may also be
performed.
3. Instructed to increase fluid intake to up to 3000 mL/day.
4. Educate about foods that may help prevent superinfections such as yogurt, buttermilk
 AMINOGLYCOSIDES
ACTIONS:
• Aminoglycoside antibiotics kill bacteria primarily by binding to ribosomes and thereby prevent
protein synthesis in bacteria

INDICATIONS :
• The Aminoglycoside are used primarily against gram-negative microorganisms that cause urinary
tract infections, meningitis, wound infections.
• Because aminoglycosides are potent, they are usually reserved for more serious, life-threatening
infections.
• These medications kill aerobic gram-positive & gram-negative bacteria, mycobacteria, aerobic
gram-negative bacilli, & some protozoa
• Used to treat serious nosocomial infections
• A synergic effect may be achieved in combination with cephalosporin, penicillin
CONTRAINDICATIONS
Aminoglycosides are contraindicated for patients with known allergies, renal or hepatic disease,
preexisting hearing loss, active herpes, mycobacterial infections, myasthenia gravis &
Parkinsonism

ADVERSE REACTIONS
- Are potent antibiotics & are capable of producing potentially serious toxicities
- Nephrotoxicity such as proteinuria & increased BUN & serum creatinine level
- Ototoxicity or 8th cranial nerve damage include dizziness, tinnitus, vertigo, nystagmus

NURSING RESPONSIBILITIES:
1. Administer an aminoglycoside & a penicillin at least 2 hours apart
2. Monitor renal function tests
3. Teach the patient safety precautions (eg. Avoidance of driving or operating hazardous machinery
4. Monitor the patient’s signs & symptoms of infection.

Aminoglycosides Trade Name Uses

Natural
Gentamicin Garamycin Treatment of wide variety of infections, including pseudomonal
disease
Kanamycin sulfate Kantrex Used to treat coma when ammonia-producing bacteria in the GI
tract cause serious illness
Tobramycin Nebcin Used for short term IM or IV treatment of very serious infections.
Also available in opthalmic form for treatment of ocular infections
Semisynthetic
Amikacin Amikin Treatment of serious infections, especially gram-negative

FLUOROQUINOLONES
ACTION :
- Bactericidal against a broad spectrum of bacteria
- It interfere with DNA gyrase, which is an enzyme that is required to synthesize or replicate of
bacterial DNA

INDICATIONS:
• Pseudomonas infections
• Wide variety of Gram-negative urinary tract infections
• Gram negative systemic infections
CONTRAINDICATION:
- For women during pregnancy & lactation & for children under 18 years of age

ADVERSE EFFECTS:
• Nausea, vomiting, diarrhea, flatulence
• Headache, tremors, dizziness
• Confusion, dizziness, insomnia, fever
• Rash, pruritus , urticaria
• Elevated BUN, SGOT, SGPT, creatinine, decreased WBC, hematocrit

Fluoroquinolone Trade names Uses

Ciprofloxacin Cipro Treatment of STDs & lower respiratory, GU, bone,
skin, & joint infections, Pseudomonas
Levofloxacin Levaquin Treatment of respiratory, GU, skin infections

MISCELLANEOUS ANTIBIOTICS

1. CLINDAMYCIN (CLEOCIN, CLEOCIN PEDIATRIC

- Is a semisynthetic derivative of lincomycin, an older antibiotic
- Can be either bactericidal or bacteriostatic

CONTRAINDICATION : in patients with a known hypersensitivity

GI : N&V, abdominal pain, diarrhea, anorexia
2. DAPSONE (generic)
- Is an antibiotic of the sulfone class, which is structurally different from the sulfonamides
- It is official indications include Leprosy and another skin condition known as dermatitis
herpetiformis. This is an idiopathic (cause unknown) recurring inflammatory skin condition with
lesions that can resemble herpes blisters.
Leprosy is an infectious skin condition also known as Hansen’s disease caused by
Mycobacterium leprae
3. ANTITUBERCULAR AGENTS
Mycobacteria a group of bacteria that contain the pathogens that cause tuberculosis and leprosy.
They are called Acid-fast bacteria
Mycobacterium tuberculosis or Koch’s bacilli
-treatment must be continued for 6 months to 2 years

Combination drug: Tuberculosis Drugs

a. Isoniazid (INH)
b. Rifampicin-alter DNA & RNA of the bacteria
Second line drugs (in combination of the above drugs)
a. Ethambutol-inhibit cellular metabolism
b. Pyrazinamide- both bactericidal &bactetiostic
4. OXAZOLIDINONES

ACTIONS:
- Linezolid is the first of a new family of antimicrobial agents known as the oxazolidinones. It acts
by inhibiting protein synthesis in bacterial cells
- It is bactericidal in certain strains of bacteria and bacteriostatic in others. The only currently
available agent in this class
USES:
- Used in the treatment of serious or life-threatening infections caused by gram-positive
microorganisms.
- May also used to treat community-acquired pneumonia caused by penicillin-susceptible
Streptococcus pneumoniae.

Adverse effects: Common

- GIT : gastric irritation
- Neurologic : headache, seizures, visual neuropathy
Serious Adverse Effects:
- GIT : severe diarrhea
- Hematologic: bone marrow suppression
- Immune system ( Opportunistic infections) : secondary infections (oral thrush, genital
and anal pruritus)

ANTIVIRAL AGENT

VIRUS
- Are intracellular parasites with no metabolic machinery of their own, they lack both a cell wall
and a cell membrane & do not carry out metabolic processes.
- To replicate, viruses must attach to and enter a living host cell-animal, plant, or bacterium- and
use its metabolic processes.
- All viruses require cells to replicate. Once a virus has injected its DNA into the host cell, that cell
is altered- it is “programmed” to control the metabolic processes that the virus needs to survive.
- The virus , including the protein coat, replicates in the host cell when the host cell can no longer
carry out its own metabolic functions because of the viral invader, the host cell dies & releases
the new viruses into the body to invade other cells.

INTERFERONS – are released by the host in response to viral invasion of a cell & prevent the
replication of that particular virus

Viruses that respond to some antiviral therapy includes:

- Influenza A and some respiratory viruses
- Herpes viruses
- Cytomegalovirus (CMV)
- Human immunodeficiency virus (HIV) that causes AIDS

Agents for HIV and AIDS

- The HIV mutates over time, presenting a slightly different configuration with each new
generation
- Treatment of AIDS and ARC has been difficult for 2 reasons:
1. The length of time the virus can remain dormant within the T cells (months to years)
2. The adverse effects of many potent drugs, which may include further depression of the immune
system
Protease Inhibitors
USES:
- Protease inhibitors interfere with HIV protease enzyme(necessary for maturation of virus) thereby
impeding the viral replication of retroviruses, including HIV type 1 and type II (HIV-2)

Protease Inhibitors Trade Names Uses

Saquinavir Invirase Treatment of advanced HIV infection
Nelfinavir Viracept Treatment of HIV infection
Contraindicated:
- For patients with hypersensitivity or hemophilia
Adverse effects:
- Headche
- Alopecia
- Dizziness
- Hyperglycemia
Nursing responsibilities:
1. Instruct the patient to take the drug with water or milk 1 hour before meals or 2 hours after meals.
If the patient develops GI distress, the medication may be taken with a light snack, such as dry
toast with jelly
2. Encourage the patient to drink at least 1.5 liters of fluids within a 24 hr period to prevent
nephrolithiasis

Agents for Herpes & Cytomegalovirus

Herpes virus – account for a broad range of conditions including cold sores,encephalitis, shingles &
genital infections
Cytomegalovirus- slightly different from herpes virus, it affect the eye, respiratory tract, & liver

Nucleoside Analog
Nucleoside Trade Names Uses
Acyclovir Zovirax Treatment of herpes simplex viruses, varicella zoster & genital
herpes
Famciclovir Famvir Treatment of herpes simplex, herpes zoster & genital herpes

Nursing responsibilities:
1. Avoid sexual intercourse if genital herpes is being treated because these drugs do not cure the
disease
2. Wear gloves when applying topical agents to decrease risk of exposure of the drug

Agents for Influenza A & Respiratory viruses

ACTION:
- Prevent shedding of the viral protein coat and entry of the virus into the cell. This action prevents
viral replication, causing viral death.
Nursing Responsibilities:
Children:
- Are very sensitive to the effects of most antiviral drugs
- Dosage should lowered according to body weight
Adults:
-patients with HIV infections need to be taught that these drugs do not cure the disease, that
opportunistic infections can still occur.

Antiviral Trade Name Uses

Amantadine Symmetrel Parkinson’s disease, not used for both treatment & prevention of
respiratory viral infections
Oseltamivir Tamiflu Uncomplicated influenza infections that have been symptomatic for
less than 2 days
Ribavirin Virazole Against influenza A, RSV & herpes viruses. It is teratogenic
Rimantadine Flumadine Prevention and treatment of influenza A
ANTIFUNGAL AGENT

FUNGAL infections in human range from conditions such as the “athlete’s foot” to potentially fatal
systemic infections
- An infection caused by a fungus is called a MYCOSIS.
- Fungi differ from bacteria in that the fungus has a rigid cell wall that is made up of chitin and
various polysaccharides & a cell membrane that contains ERGOSTEROL.
- The composition of the protective layers of the fungal cell makes the organism resistant to
antibiotics.
- Conversely, because of their cellular make up, bacteria are resistant of antifungal drugs.

Two main groups of fungi

1. Molds – (filamentous fungi)
- Grow as long filaments that intertwine to form a mycelium
Eg of molds are the dermatophytes & aspergillus fumigatus
- Cause infections of the skin, nails, hair
2. True yeasts either unicellular round or oval fungus
Eg of yeast: Cryptococcus neoformans which may cause meningitis or pulmonary infections
usually in immunocompromised

Systemic Antifungals
- Used to treat systemic fungal infections & can be toxic to the host & are not to used
indiscriminately.
- It is important to get a culture of the fungus causing the infection to ensure that the right drug is
being used

ACTION:
- Alter cell permeability of the fungis leading to cell death & prevention of replication
Systemic antifungals
Amphotericin B (amphotec
Fungizone)
Griseofulvin
Nystatin (Mycostatin)
Ketoconazole (nizoral)
Fluconazole (Diflucan)
Uses
Used to treat resistant Candida infections, first line antifungal , a wide
spectrum antifungal
Oral drug that is used for the treatment of ring-worm, tinea capitis, tenia
pedis
Used orally for the treatment primarily for intestinal candidiasis
Used orally to treat many of the same mycoses as amphotericin. Also
used topically as a shampoo to reduce the scalling associated with
dandruff
Successfully as prophylactic agent for reducing the incidence of
candidiasis in bone marrow transplant recipients

Topical antifungal
- Some antifungal drugs are available only in topical forms for treating a variety of the mycoses of
the skin & mucous membrane.
Fungi that cause this infections are called DERMATOPHYTES
- These diseases include a variety of tinea infections which are often referred to as ringworms,
although the causal organism is a fungus, not a worm.
Types of tinea
1. Tinea pedis – athlete’s foot
2. Tinea cruris – affects scrotal, anal or genital called “jock itch”
3. Tinea corporis – affects the body called “ringworm”
Examples of Topical
1. Amphotericin B 3. Miconazole (Monistat)
2. Clotrimazole
ANTIPROTOZOAL AGENTS

Protozoa thrive in tropical climates, but they may also survive and reproduce in any area where people
live in very crowded and unsanitary conditions.

Malaria is a parasitic disease spread via the bite of an Anopheles mosquito which harbors the protozoal
parasite and carries it to humans. This is the only known method of disease transmission. Four protozoal
parasites, all in the genus Plasmodium as causes of malaria

Amebiasis
- An intestinal infection caused by Entamoeba histolytica, is often known as amebic dysentery.
- The organism exists in two stages:
a. cystic, dormant stage, in which the protozoan can live for long periods outside the body or in the
human intestine
b. Tropozoite stage in the ideal environment- the human large intestine

Trichomoniasis
- Caused by another flagellated protozoan, Trichomonas vaginalis, is a common cause of vaginitis.
- This infection is usually spread during sexual intercourse by men who have no signs and
symptoms of infection.
- In women, this protozoan causes reddened, inflamed vaginal mucosa, itching, burning, and a
yellowish-green discharge.

Pneumocystis Carinii Pneumonia

- Pneumocystic carinii is an endemic protozoan that does not usually cause illness in humans.
- When an individual’s immune system becomes suppressed, because of acquired immune
deficiency syndrome (AIDS) or AIDS- related compelx(ARC), the use of immunosuppressant
drugs, or advanced age, this parasite is able to invade the lungs, leading to severe inflammation &
the condition known as Pneumocystic carinii pneumoni (PCP). This is the most common
opportunistic infection in patients with AIDS

ACTION
- Inhibit DNA synthesis in susceptible protozoa, leading to the inability to reproduce and
subsequent cell death
Contraindications:
- Hypersensitivity
- During pregnancy & lactation
- CNS disease
- Hepatic disease

Antiprotozoal Trade Names Uses

Atovaquone Mepron Prevention and treatment of Pneumocystic carinii
pneumonia
Metronidazole Flagyl, Metrogel, Amebiasis, trichomoniasis, giardiasis
noritate
Pentamidine Nebupent, Pentam As inhalation treatment of PCP

ANTHELMINTIC AGENTS
• The helminths that mostly infect humans are two kinds:
a. NEMATODES- roundworms
b. PLATYHELMINTHS- flatworms
* Many of the worms that infect human live only in the intestinal tract
Proper diagnosis requires stool examination for ova(eggs) & parasites
• Treatment of a helminth infection entail the use of an anthelmintic drug
• Another important part of the therapy involves the prevention of reinfection or spread of an
existing infection
Preventive measures:
1. Thorough hand washing after use of the toilet
2. Frequent laundering of bed linens & underwear in very hot
3. Chlorine treated water
4. Disinfection of toilets & bathroom areas after each use
5. Good personal hygiene to wash away ova

NEMATODES
1. Pinworms
- Stay in the intestine, cause little discomfort except for perianal itching or occasionally vaginal
itching.
- Most common helminthic infection among school-age children
Dx: Test tape
2. Whipworms
- Attach themselves to the wall of the colon
- When large numbers of them in the intestine, they cause colic & bloody diarrhea
- In severe cases, may result to prolapse of the intestinal wall & anemia related to blood loss
- Dx: S/E
3. Threadworms
- More pervasive than most of the other helminths
- After burrowing into the wall of the small intestine, female worms lay eggs, which hatch into
larvae that invade many body tissues including lungs, liver & heart
- In severe case, death may occur from pmeumonia or from lung or liver abscess due to larval
invasion
4. Ascaris
- Most prevalent helminthic infection
- It may occur whenever sanitation is poor
- Initially, the individual ingest fertilized round worms which hatch in the small intestine & goes to
the lungs where they cause cough, fever, & other signs of pulmonary infiltration
- Larvae migrate back to the intestine where they grow as adult size & cause abdominal distention
& pain
- In severe case, int obstruction by masses of worms (ball of worms)
5. Hookworms
- Attach themselves to the small intestines of infected individuals & suck blood from the walls of
the intestine
- This damage the intestinal wall & cause severe anemia with lethargy, weakness & fatigue

PLATYHELMINTHS

Or flatworms include the CESTODES (tapeworms) that live In the human intestine & the flukes
(SCHISTOSOMES) that invade other tissues as part of their life cycle
Cestodes are segmented flatworms with a head, or scolex & a variable number of segments that grow
from the head.