Gram Positive Gram Negative

Appear in purple color Appear in pink color

under the microscope under the microscope
Outer membrane is Outer membrane is
present absent
Cell wall is smooth Cell wall is wavy
Staphylococcus Neisseria
➢ Bacteria aureus, streptococcus meningitides,
• Known as prokaryotes pneumoniae, Group B Escherichia coli,
• Single cell organisms that lack a true nucleus in streptococcus, Haemophilus
nuclear membrane Clostridium perfringens influenza
• Have a rigid cell wall
• Structure of the cell wall determines the shape
of the bacteria
• Reproduce via cell division ranging from 12
minutes to 24 hours
• Produce toxins that cause cell lysis; some
bacteria produce the enzyme beta lactamase

Classifications of Bacteria
Appearance or Shape
Bacillus Rod shaped organism

Cocci Spherical shaped organism ANTIBACTERIALS

Staphylococci
• Cocci that appears in clusters
Streptococci
• cocci that appears in chains
Gram • Discovered in 1882 by Hans
Staining Christian Gram (Danish
bacteriologist)
• Commonly used to determine
the chemical make-up of the
cell wall of the bacteria
• It determines the ability of the
bacterial cell wall to retain a
purple stain by using a basic
dye
History
Early civilization
• Ancient Egyptians apply a mouldy bread to
infected wounds and cut in order to heal them
• The mouldy bread is full of bacteria and fungi
which worked as an antibiotic and killed the
species that resulted in the infection
1928
• Discovery of Penicillin by Alexander Fleming
• Fleming was a bit disorderly in his work and
accidentally discovered penicillin. Upon
returning from a holiday is Sophoc (?) in 1928,
he noticed that a fungus called your penicillin
node atom had contaminated a culture plate of
staphylococcus bacteria he had accidentally
left uncovered. The fungus had created
bacteria-free zones wherever it grew on the
plate. Fleming isolated and grew the mold in
pure culture. He found that this penicillin node
atom proved extremely effective even at very
low concentrations, preventing the growth of
your staphylococcus
• Penicillin was nicknamed “miracle drug” since
it is being widely used to treat troops for

Nowts ni Estelle :>

 infection both in the field and in hospitals
throughout Europe and during World War 2.
1935
• The introduction of Sulfonamide by Leonard
Colebrook
• Sulfonamide is a class of antibacterial drugs
which worked as an effective treatment for
pure peril fever (a bacterial infection that can
occur in the uterus of a pregnant woman after
giving birth)
1939
• Evolution of Penicillin by Howard Florey
• Expanded Fleming’s findings about Penicillin
• He purified penicillin so that it can be used
commercially
** One innovation that has greatly changed the
expansion of medicinal drugs in science was the
improvement of antibacterials. Modern-day
medicine has made untreatable diseases like
pneumonia and tuberculosis curable due to
antibiotics.
** Antibiotics have been called as the single most
important therapeutic discovery in the history of
medicine.
Mechanism of Actions
1. Inhibition of the bacterial cell wall synthesis
• involves bactericidal effect breaking down of cell
wall and preventing the enzymes to form cell
wall.
2. Alteration of membrane permeability
• Involves bacteriostatic or bactericidal effect;
increases the cell wall permeability and induces
cell breakdown from the loss of cellular
substances
3. Inhibition of protein synthesis
• Involves bacteriostatic or bactericidal effects; it
interferes with protein synthesis without affecting
normal cells. It disrupts the process of protein
synthesis.
4. Inhibition of bacterial RNA and DNA
synthesis
• Inhibits the synthesis or RNA and DNA in
bacteria
• It binds to nucleic acid and enzymes needed for
nucleic acid synthesis
Nowts ni Estelle :>
5. Interference with cellular metabolism
• This involves bacteriostatic effect, and it disrupts
the steps of cellular metabolism
** The longer the drug remains at the binding sites,
the more it increases the effect of the antibacterial
action.
** The efficacy of the use of antibiotics does not
solely depend on the medication itself. The host’s
defense mechanism should also be considered.
Body defenses and antibiotics should work together
to put a stop to the ongoing infection.
• The clients age and nutritional status – since
older adults and undernourished individuals
have less resistance to infection than younger
and well-nourished population.
• Immune function – if the patient’s natural body
defenses declines, drug therapy might not be as
effective
• Circulation – if the circulation is impeded, the
distribution of the medication to the different
body parts cannot be distributed properly.
Antibiotic Combination
• Should not be routinely prescribed or
administered since usually a single antibiotic can
successfully treat a bacterial infection. But, there
are some cases that we need to combine such
antibiotics.
• Combining two or more antibiotics in a single
person
• Used for a specific uncontrollable infection,
infection that persists, infection that is
unsuccessfully treated with several single
antibiotics, antibiotics with unknown origin.
• Bacterial culture should be obtained prior to the
start of antibiotic combination.
Examples:
• Clarithromycin (a macrolide) and amoxicillin-
clavulanate (a penicillin)
Effects:
1. Additive – is equal to the sum of the effects of
two antibiotics (clarithromycin and amoxicillin)
2. Potentiative – occurs when one antibiotic
potentiates the effect of the second antibiotic
increasing its effectiveness (amoxicillin and
clavulanate, wherein clavulanate increases
the effect of amoxicillin)
3. Antagonistic – the combination of a
bactericidal and bacteriostatic medications,
decreasing its effectiveness [penicillin
(bactericidal) and tetracycline medications
(bacteriostatic)]
 • It further inhibits the bacterial enzyme
necessary for cell division
3 Major Adverse Reactions to Antibacterials • Can be both bacteriostatic or bactericidal,
Hypersensitivity depending on the drug and dosage
• Commonly known as allergy
• May result to anaphylactic shock Types:
• May cause vascular collapse, laryngeal edema, • Basic Penicillins
bronchospasm, cardiac arrest • Broad Spectrum Penicillins
• Signs and symptoms: • Penicillinase-Resistant Penicillins
o Rash, pruritus, hives • Extended-Spectrum Penicillins
• Make sure before starting an antibiotic • Beta-Lactamase Inhibitors
therapy, you need to obtain a thorough history Basic Penicillins
of the patient. This is to make sure that the
patient is not sensitive towards the antibiotic. ➢ Penicillin G
Superinfection o Primarily bactericidal
• Secondary infection that is a result of the o First penicillin administered orally and
disruption of the normal microbial flora of the body parenterally (IV or IM) and is more
from the antibiotic therapy effective than the oral route
• If there is already an ongoing infection, then you o Available in aqueous drug solution (for
provided an antibiotic. That specific antibiotic short duration)
disrupts the normal microbial flora of the body o Painful IM route
therefore leading to another infection.
Organ Toxicity ➢ Procaine Penicillin
• The insult to the liver and kidney because of their o Milky color
involvement in drug metabolism and excretion o Longer acting form
o Decreases pain sensation related to
injection since your procaine is a local
Classifications: Narrow and Broad anesthesia
Spectrum Antibiotics
Narrow • Acts against one type of organism ➢ Penicillin V
Spectrum • More active against single o Effective against mild to moderate
organism infections compared to infections, including anthrax
broad spectrum o Less potent antibacterial drug than
• Ex.: penicillin and Erythromycin are Penicillin G
used to treat gram-positive
infections Penicillinases
Broad • Acts against both gram positive • Enzymes (beta-lactamases) produced by a
Spectrum and negative bacteria bacteria that can inactivate penicillin
• Used to treat infections when the • Lead to the development of a new broad
offending microorganism has not spectrum of penicillin to combat infection
been identified resistant to Penicillin G and V
• Ex.: Tetracyclines, 3rd & 5th Broad Spectrum Penicillins
generation Cephalosporins (Aminopenicillins)
• Are used to treat both gram positive and
negative bacteria
Penicillins • Costlier than penicillin
• Was first introduced to treat staphylococcus • NOT penicillinase resistant
infections • Ineffective against S. aureus
• Referred as beta-lactam antibiotics (since the
penicillin’s beta-lactam ring structure ➢ Amoxicillin
interferes with bacterial cell wall synthesis) o For the treatment of severe respiratory
• MOA: interferes with bacterial cell wall infections
synthesis o Decreased effect when taken with acidic
fruits and juices
o Adult dose: 500 mg q8H or 875mg q12H
Nowts ni Estelle :>
 ➢ Amoxicillin-Clavulanate ➢ Sulbactam
o For the treatment of otitis media, sinusitis, o Combined with Ampicillin: Ampicillin
lower respiratory, skin and urinary tract sulbactam
infections o Sulbactam blocks the enzyme which
o Combination of amoxicillin (500-875mg) breaks down ampicillin
and clavulanic acid (125mg)
➢ Tazobactam
➢ Ampicillin o Combined with Piperacillin: Piperacillin
o For the treatment of meningitis, tazobactam
endocarditis, septicemia, gastroenteritis, o Tazobactam inhibits beta lactamase
anthrax, skin, respiratory, intraabdominal,
and severe infections Side Effects and Adverse Reactions
• Nausea
➢ Ampicillin-sulbactam • Vomiting
o Primarily used for skin infections • Diarrhea
o Given parenterally (IM or IV) • Anorexia
o Combination of ampicillin (1g) and • Hypersensitivity
sulbactam (0.5g) • Superinfection
Extended-Spectrum Penicillins Drug Interactions
(Antipseudomonal Penicllins)
• Broad spectrum penicillins, amoxicillin and
• Effective against Pseudomonas aeruginosa ampicillin may decrease the effectiveness of
(gram-negative bacteria difficult to eradicate) oral contraceptives.
and other gram-negative organism: Proteus, • Make sure that you do your proper health teaching
Serratia, Enterobacter and Acinetobacter to women taking contraceptives
species and Klebsiella pneumoniae • Potassium supplement can increase serum
• NOT penicillinase resistant potassium levels when taken concurrently with
potassium Penicillin G or V.
➢ Piperacillin tazobactam • When penicillin is mixed with an
o For the treatment of community aminoglycoside in IV solution, the actions of
acquired pneumonia both drugs are inactivated.
o Administered via IV route
o Combination of piperacillin (4g) and Nursing Interventions
tazobactam (0.5g) to run for 30 mins 1. Obtain a specimen for laboratory culture
incorporated to 100cc NSS and antibiotic sensitivity testing.
• When you will have your actual duty rotation soon in the
- This is to identify the infective organism
hospital, you will be able to notice that this medication
needs longer time to melt. It requires a lot of shaking. before starting the antibiotic therapy
Usually in the area, we prepare this medication 1 hour 2. Instruct client to take antibiotics with
before the time it should be administered. meals
- Since GI disturbances is a common side effect
3. Monitor for signs and symptoms of
Beta-Lactamase Inhibitors hypersensitivity and superinfection.
• Drugs combined to a penicillinase-sensitive 4. Assess for bleeding if high doses of
penicillins such as amoxicillin, ampicillin, and penicillin is given.
piperacillin - A decrease in platelet aggregation may
• Should NOT be given alone result
5. Strictly adhere to the prescribed duration
of treatment.
➢ Clavulanic Acid
o Combined with Amoxicillin: Amoxicillin-
clavulanate
o Clavulanic acid stops bacteria from
breaking down amoxicillin, which
enhances the action of your amoxicillin

Nowts ni Estelle :>

 Proteus, Salmonella, and
Other Beta-Lactam Antibiotics Shigella)
• Are considered bactericidal 2nd Same effectiveness as • Cefaclor
• Bind to specific penicillin-proteins located first generation but with a • Cefoxitin
inside the bacterial cell wall broader spectrum
sodium
against other gram
• Are effective against a broader spectrum of negative bacteria • Cefuroxime
activity than many other beta-lactam (Haemophilus influenzae, • Cefotetan
antibacterials Neisseria gonorrhoeae & • Cefprozil
meningitidis, monohydrate
Enterobacter species,
➢ Aztreonam and several anaerobic
o For the treatment of skin infections organisms)
3rd Same effectiveness as • Cefdinir
➢ Imipenem and Cilastatin first and second • Cefixime
o For the treatment of UTI generations but also
effective against gram-
• Ceftibuten
negative bacteria • Cefotaxime
➢ Meropenem (Pseudomonas • Ceftazidime
o For the treatment of meningitis, aeruginosa, Serratia and and
intraabdominal, respiratory and skin Acinetobacter species) Avibactam
infections but with increased • Cefpodoxime
resistance to destruction
• The mentioned medications are less nephrotoxic • Ceftazidime
by beta-lactamases
than any other anitbacterials • Ceftriaxone
4th Similar to third- • Cefepime
generation drugs and
Side Effects and Adverse Reactions highly resistant to most
• Headache beta-lactamase bacteria
• Nausea with broad-spectrum
antibacterial activity and
• Vomiting good penetration to CSF;
• Diarrhea effective against
• Anemia Escherichia coli,
• Eosinophilia Pseudomonas
aeruginosa, Klebsiella,
• Neutropenia Proteus, and
• Rash Streptococcus species,
• Angioedema and certain staphylococci
• Seizure 5th Similar characteristics of • Ceftaroline
third and fourth fosamil
• CDAD – Clostridium difficile-Associated- generations, also broad
• Ceftolozane
Diarrhea spectrum, and the only
and
cephalosporins effective
against methicillin- tazobactam
resistant Staphylococcus
Cephalosporins aureus (MRSA)
• Discovery: a fungus called Cephalosporium
acremonium that is found to be active against
gram positive and negative bacteria and Cephalosporins
resistant to beta-lactamase Side Effects and Adverse Reactions
• MOA: inhibit bacterial enzymes necessary for • Nausea
bacterial cell wall synthesis • Vomiting
• Causes cell lysis • Diarrhea
• Are considered bactericidal • Increased bleeding tendency
• Nephrotoxicity
Generation Description Medications
Nursing Interventions
1st Effective mostly against • Cefadroxil
1. Culture the infecting bacteria before
gram-positive bacteria • Cefazolin
(streptococci and mostly
sodium cephalosporin therapy is started.
staphylococci) and some 2. Monitor for signs and symptoms of
gram-negative bacteria • Cephalexin
superinfection.
(Escherichia coli and
species of Klebsiella, 3. Instruct client to avoid consuming alcohol.

Nowts ni Estelle :>

 4. Advise patient to ingest buttermilk, yogurt o Absorbed in the duodenum
to prevent superinfection of the intestinal o For extended-release formulation: given
flora. one a day for 1 week
5. Strictly adhere to the prescribed duration o For immediate-release formulation: given
of treatment, even when symptoms of twice a day for 1 week
infection have ceased.
6. Infuse all IV cephalosporins over 30 ➢ Azithromycin
minutes or as ordered to prevent pain and o For the treatment of upper and lower RTI,
irritation. STIs and uncomplicated skin infections
o If Given IV: intermittent infusion diluted in
NSS
Macrolides o If given orally: administer 1 hour before
• Referred as broad spectrum antibiotics meals or 2 hours after meals
• MOA: inhibit protein synthesis in susceptible
bacteria Side Effects and Adverse Reactions
• Considered as bacteriostatic when given in • Nausea
low doses • Diarrhea
• Considered as bactericidal when given in high • Vomiting
doses • Abdominal cramping
• Can be administered orally and IV (never IM • Superinfection: CDAD
since this is too painful. If administering via IV • Conjunctivitis
route, make sure to infuse it slowly to avoid • Hepatotoxicity
unnecessary pain or phlebitis)
• Active against most gram-positive bacteria Drug Interactions
and are moderately active against some gram- • Erythromycin should not be taken with
negative bacteria clindamycin or lincomycin because they
• Used to treat mild to moderate to moderate compete for receptor sites.
respiratory, GI, skin & soft tissue infections, • Increases serum levels of theophyllines (a
diphtheria, impetigo contagiosa, STIs bronchodilator), carbamazepine (an
anticonvulsant), and warfarin (an
➢ Erythromycin anticoagulant).
o First macrolide discovered • Constant monitoring of these serum levels must be
o Derived from a fungus-like bacteria, prioritized
Streptomyces erytheus • Antacids may reduce azithromycin peak levels
o Introduced in the early 1950s when taken at the same time.
o Oral preparation contains acid-resistant • Administer antacids two hours before or after
salts to decrease dissolution in the administration of azithromycin.
stomach
o Since the gastric acid destroys the Nursing Interventions
erythromycin in the stomach, the addition of
1. Obtain a sample from the infected area for
this acid-resistant salts allow the absorption of
drug in the intestine.
C&S before starting azithromycin therapy.
o Absorbed in the duodenum 2. Monitor vital signs, urine output and
o If given IV: intermittent infusion diluted in laboratory values.
NSS (to prevent phlebitis) 3. Specific to oral preparation of
o DOC (drug of choice) for the treatment of azithromycin: administer with water not
mycoplasmal pneumonia and fruit juice, administer with food when GI
Legionnaire’s disease upset occurs, chewable tablets should not
be swallowed.
Extended Macrolide Group 4. Dilute IV preparation in an appropriate
amount of solution.
• Medications that contain derivatives of
5. Instruct to take the full course of antibiotic
erythromycin
therapy.
➢ Clarithromycin
o For the treatment of URTI caused by
Streptococcus pyogenes & pneumoniae
Nowts ni Estelle :>
 Oxazolidinones
• MOA: inhibit protein synthesis
• Can be bactericidal or bacteriostatic
Glycopeptides
• Effective against gram-positive infections • Are considered bactericidal antibiotic

➢ Linezolid ➢ Vancomycin hydrochloride

o For the treatment of nosocomial o Used against drug-resistant S. aureus
pneumonia, bacteremia, MRSA, VREF, o Serves as prophylaxis for cardiac surgical
respiratory and skin infections procedure to patients allergic to penicillins
o Can be given orally or IV
o When you will be administering this medication
➢ Tedizolid IV, administer it slowly because too rapid IV
o For the treatment of skin infections injection can cause Red Man Syndrome or
Redneck Syndrome
Side Effects and Adverse Reactions
• Nausea ➢ Telavancin
• Headache o Treats selected gram-positive bacteria and
• Diarrhea skin infections
• Vomiting o A semisynthetic derivative of vancomycin
• Anemia o Has bactericidal action against MRSA
• Thrombocytopenia o Given once daily
• CDAD
• Serotonin syndrome Side Effects and Adverse Reactions
• Nephrotoxicity
• Ototoxicity (damage to auditory or vestibular
branch of cranial nerve XIII)
Lincosamides • Headache
• MOA: inhibit bacterial protein synthesis • Dizziness
• Can be bactericidal or bacteriostatic • Fatigue
depending on the dosage of the medication • Fever
• Nausea
➢ Clindamycin • Vomiting
o Active against most gram-positive • Flatulence
organisms, including S. Aureus and • Abdominal pain
anaerobic organisms • Diarrhea
o More widely prescribed than lincomycin • Back pain
o Not effective against gram-negative • Peripheral edema
bacteria • Injection site reaction
• Red Man Syndrome
➢ Lincomycin • Hypotension
o For the treatment of bacteremia, • Tachycardia
septicemia, and intraabdominal,
• Wheezing
respiratory, bone/joint, skin infections
• Dyspnea
• Paresthesia
Side Effects and Adverse Reactions
• Erythema
• Nausea
• Pruritus
• Vomiting
• Urticaria
• Stomatitis
• Eosinophilia
• Rashes
• Neutropenia
• Colitis
• Phlebitis
• Anaphylactic shock
Drug Interactions • CDAD
• Hypokalemia
• Clindamycin and lincomycin are incompatible
with aminophylline, phenytoin, barbiturates, • Renal failure
and ampicillin. • Stevens-Johnson syndrome
Nowts ni Estelle :>
 Drug Interactions (because these can lead to toxicity. They are
• Dimenhydrinate can mask ototoxicity when contraindicated to patients taking telithromycin)
taken with vancomycin. • Digoxin, metoprolol, midazolam, ritonavir,
• Increased risk for nephrotoxicity when sirolimus, and tacrolimus levels are increased
vancomycin is taken with furosemide, when taken with telithromycin.
aminoglycosides, amphotericin B, colistin, • Leads to ergot toxicity when taken with ergot
cisplatin, and cyclosporine. alkaloid derivates.
• Vancomycin inhibits methotrexate excretion
and can increase methotrexate toxicity. Signs of Ergo Toxicity: severe peripheral
• Oral vancomycin absorption may decrease vasospasm and impaired sensation
when taken with cholestyramine and
colestipol.
Lipopeptides
• MOA: bind to the bacterial membrane causing
Ketolides rapid depolarization of its membrane potential;
• MOA: binds to sites on bacterial ribosomes inhibit protein, DNA, and RNA synthesis.
(causing the change in protein function leading to • These actions lead to cellular death
cell death)
• Can be bactericidal or bacteriostatic ➢ Daptomycin
o For the treatment of skin infections,
➢ Telithromycin MRSA, endocarditis, bacteremia
o First and only drug under this classification o Given via IV at a dose of 4mg/kg daily
o Used for adults 18 years of age and older
for the treatment of mild to moderate Side Effects and Adverse Reactions
community-acquired pneumonia (caused • Hypertension
by staphylococcus pneumoniae and • Hypotension
haemophilus influenzae) • Anemia
o Given orally (since it is well absorbed in the • Numbness
GI tract and unaffected by food intake) • Tingling
• Dizziness
Side Effects and Adverse Reactions • Insomnia
• Visual disturbances (blurred vision and • Pain or burning on urination
diplopia
• Nausea
• Headache
• Vomiting
• Dizziness
• Diarrhea
• Altered taste
• Constipation
• Nausea
• Pallor
• Vomiting
• Chest pain
• Diarrhea • Hypokalemia
• Liver failure
• Hyperkalemia
• Exacerbation of myasthenia gravis
• Hyperglycemia
• Hypoglycemia
Drug Interactions
• Bleeding
• Telithromycin levels are increased when taken
• Rhabdomyolysis
concurrently with antilipidemics (simvastatin,
lavastatin, atorvastatin), itraconazole, • Pleural effusion
ketoconazole, benzodiazepines
• Class 1A or III antidysrhythmics may lead to Drug Interactions
life-threatening dysrhythmias • Increase risk of rhabdomyolysis and elevated
• Blood levels of telithromycin are decreased level of creatinine phosphokinase if given with
when taken with rifampin, phenytoin, 3-hydroxi-3-methylglutaryl coenzyme A
(HMG-CoA) reductase inhibitors
carbamazepine.
• Daptomycin toxicity may be increased when
• Increased blood levels of cisapride and
given with tobramycin.
pimozide when taken with telithromycin

Nowts ni Estelle :>

 • Warfarin may lead to increased bleeding when
taken with daptomycin.
Tetracyclines
• MOA: inhibit bacterial protein synthesis
• Considered to have a bacteriostatic effect
• The first broad spectrum of antibiotics effective
against gram-positive and negative bacteria
and many other organisms (which include
mycobacteria, ricket shape, spirocae,
chlamydiae)
• Most effective against Helicobacter pylori
(together with Metronidazole and Bismuth
subsalicylate); Mycoplasma pneumoniae
• Not effective against S. Aureus (except the
newer tetracyclines), Pseudomonas and
Proteus species)
1. Short Acting
• Tetracycline
o For the treatment of URTI
o Should be taken on an empty stomach
1 hour before or 2 hours after meals
2. Intermediate Acting
• Demeclocycline hydrochloride
o For the treatment of respiratory
infection
o Should be taken on an empty stomach
1 hour before or 2 hours after meals
3. Long Acting
• Doxycycline hyclate
o Primarily for the treatment of acne vulgaris
o Should be taken with food
o Best absorbed with milk (since this is a lipid
soluble tetracycline)
• Minocycline hydrochloride
o For the treatment of respiratory infection
o Should be taken with food
o Best absorbed with milk
4. Miscellaneous
• Omadacycline
o For the treatment of community-acquired
pneumonia
o Should be taken on an empty stomach 1
hour before or 2 hours after meals
➢ Eravacycline
o For the treatment of complicated
intraabdominal infections
Nowts ni Estelle :>
o Should be taken on an empty stomach 1 hour
before or 2 hours after meals
• Pregnant women should not take tetracycline
during the first trimester and last trimester of
pregnancy (because of its teratogenic effect
and may cause fetal anomaly).
• Children younger than 8 years old should
avoid taking tetracyclines (because of the
irreversible discoloration of the permanent
and teeth).
Side Effects and Adverse Reactions
• Nausea
• Vomiting
• Diarrhea
• Photosensitivity (Sunburn reactions) –
especially with Demeclocycline
• Difficulty maintaining balance (Minocycline
causes damage to the vestibular part of the
ear)
• Nephrotoxicity (results from the high doses of
tetracycline)
• Superinfection
Drug Interactions
• Avoid taking with antacid, calcium and iron
containing products. This can prevent
absorption.
• Decreased action of oral contraceptives when
taken concurrently with tetracyclines.
• Decreased action of penicillin if given with
tetracyclines. (since tetracyclines cause a
bacterial resistance to the action of penicillin)
• When administered with aminoglycosides,
increased risk for nephrotoxicity.
Nursing Interventions
1. Obtain a sample from the infected area for
C&S before starting therapy
2. Instruct client to store tetracycline away
from light and extreme heat. Tetracyclines
decompose in light and heat and causes
drug to become toxic.
3. Advise to complete the course of
tetracycline as prescribed.
Glycyclines
• Synthetic analogue of tetracyclines
• MOA: block protein synthesis in bacterial cells
• Considered to have a bacteriostatic action
 ➢ Tigecycline Drug Interactions
o For the treatment of CAP (community, 1. When administered concurrently with
complicated skin, and intraabdominal penicillins, aminoglycosides’ effects are
infections greatly reduced.
2. Increases drug action of warfarin.
Side Effects and Adverse Reactions 3. High risk of ototoxicity when taken with
• Nausea etacrynic acid.
• Vomiting
• Abdominal pain
• Diarrhea Fluoroquinolones
• CDAD • MOA: interfere with DNA gyrase (an enzyme
• Same as tetracyclines needed to synthesize bacterial DNA)
• Considered to have a bactericidal action on
Drug Interactions both gram-negative and positive organisms
• Oral contraceptives may be less effective
when given concurrently with tigecycline. ➢ Ciprofloxacin
• Warfarin levels may be increased and may • A synthetic antibacterial related to nalidixic
lead to bleeding when taken with tigecycline. acid
• Has a broad-spectrum action
• Specifically for the treatment of UTI, LRTI,
skin, soft tissue bone & joint infections
Aminoglycosides
• MOA: inhibit bacterial protein synthesis ➢ Levofloxacin
• Used against serious infections of gram- • For the treatment of CAP, chronic bronchitis,
negative bacteria such as E. coli, Proteus, and acute sinusitis, uncomplicated skin infections,
Pseudomonas UTI
• Can’t be absorbed by the GI tract and CSF
➢ Moxifloxacin
• Cross the blood brain barrier in children
• For the treatment of UTI, bone & joint
• Primarily administered IM and IV
infections, bronchitis, pneumonia,
gastroenteritis, gonorrhea
➢ Streptomycin sulfate
• More effective against S. pneumoniae than
• Derived from the bacterium Streptomyces
levofloxacin
griseus
• Not effective against VREF
• The first aminoglycoside for clinical use to
treat tuberculosis
Side Effects and Adverse Reactions
• DOC for tularemia and plague
• Dizziness
• Causes ototoxicity and bacterial resistance.
• Syncope
Thus, this medication is infrequently used
• Anxiety
➢ Amikacin sulfate, Tobramycin sulfate • Irritability
• For the treatment of meningitis, septicemia, • Flushing
bacteremia, respiratory, urinary, bone/joint, • Dry mouth
and intraabdominal infections • Anorexia
• Dysgeusia
➢ Neomycin sulfate
• For the treatment of skin infections and for pre- Nursing Interventions
operative bowel preparation 1. Obtain a sample from the infected area for
• Given orally (for bowel preparation) and C&S before starting therapy.
topically (for skin infection) 2. Monitor urine output. Urine output should
be at least 750mL per day.
Side Effects and Adverse Reactions 3. Instruct to increase oral fluid intake of more
• Ototoxicity than 2L/day.
• Nephrotoxicity 4. Check laboratory results especially BUN
and serum creatinine.
• Superinfection
Nowts ni Estelle :>
 5. Check for signs and symptoms of ➢ Sulfacetamide sodium
superinfection. • Ophthalmic preparation: liquid drops and
ointment
• Used for the treatment of ocular infections,
Unclassified Antibacterial Drugs after an eye injury
• Do not belong to a major drug group • Topical preparation: cream, gel, lotion, or
Chloramphenicol cleanser
• Considered to have a bacteriostatic effect • Used for the treatment of seborrheic dermatitis
• MOA: inhibits bacterial protein synthesis and acne
• Used to treat serious infections
• Due to its toxic effects, blood dyscrasias related to Side Effects and Adverse Reactions
bone marrow suppression • Skin rashes
• Itching
Quinupristin-dalfopristin • Hemolytic anemia
• Effective for treating VREF, skin infection • Aplastic anemia
• MOA: disrupt the protein synthesis • Leukopenia
• Administered IV (watch out for signs of pain, • Anorexia
edema, phlebitis since they are common to occur) • Crystalluria
• Hematuria
Obiltoxaximab
• Photosensitivity (instruct patient to avoid direct
• First approved for the prophylaxis and sunlight exposure, wear lotion, wear long sleeves)
treatment of anthrax • Cross sensitivity (being allergic to one
• MOA: inhibit the binding of the protective sulfonamides which later might occur to another
antigen of Bacillus anthracis toxin to cellular sulfonamide, but does not occur with other
receptors. antibacterial drugs)
• Administered via IV as a single dose over 1
hour and 10 minutes Nursing Interventions
1. Administer sulfonamides with a full glass
of water
Sulfonamides 2. Increase oral fluid intake at least 2L/day.
• Not classified as an antibiotic (Since they were 3. Closely monitor for urine output.
not obtained from biologic substance. Rather from 4. Check signs and symptoms of infections.
a cold derivative compound)
• MOAL inhibit bacterial synthesis of folic acid
(which is essential for bacterial growth)
• Selectively inhibit bacterial cell wall without Nitroimidazoles
affecting the normal cells • MOA: disrupt DNA and protein synthesis
• Since human do not naturally synthesize folic acid, • Effective against H. pylori and bacterial
we get it from our diet. species (bacteroids, clostridium gardinella,
• May be used as an alternative for patients who provitela, Streptococcus, giardia) and protozoa
are allergic to penicillin (Trichomonas vaginalis)
• For the treatment of UTI, ear infections, • Used a prophylaxis for surgical infections to
newborn eye prophylaxis treat CDAD, anaerobic infections, amoebiasis,
giardiasis, trichomoniasis, bacterial vaginosis,
• Sulfadiazine acne rosacea
• Sulfasalazine
• Trimethoprim-sulfamethoxazole ➢ Metronidazole
➢ Tinidazole
Topical and Ophthalmic Preparations ➢ Secnidazole
➢ Mafenide acetate
• Used for the prevention of sepsis in cases of Side Effects and Adverse Reactions
2nd and 3rd degree burns • Headache
• Dizziness
➢ Silver Sulfonamide • Insomnia
• For the treatment of burns
Nowts ni Estelle :>
 • Weakness o Always continue and complete drug regimen
• Dry mouth
• Anorexia
• Dysgeusia
ANTITUBERCULAR
• Vomiting • Medications that fight off tuberculosis
• Diarrhea
• Tongue, urine discoloration ➢ Tuberculosis
• Superinfection
• Highly communicable disease caused by
Mycobacterium tuberculosis
Resistance to Antibiotics • Via airborne by droplet infection
• Example: when an infected person coughs, laughs,
• Bacteria can be either sensitive or resistant to sneezes or sings, droplet nuclei containing
certain antibacterials. tuberculosis bacteria enter the air and may be inhaled
by others
Sensitive Resistant • An exudative response causes a nonspecific
• The pathogen is • The pathogen pneumonitis and the development of granulomas
inhibited or continues to grow in the lung tissue as an insidious onset (many
destroyed despite
clients are not aware of the symptoms until the
• They can’t grow administration of an
disease is well advanced).
with the presence antibacterial drug
of the antibacterial • Continue to grow
drug even if the drug is ➢ M. Tuberculosis
present • Aerobic, nonmotile, nonsporulating, acid-fast rod
that secretes niacin
Antibiotic Resistance – can either be inherent or • Multiplies freely
natural resistance and acquired resistance. • Given that the bacteria is considered an aerobic
organism, it primarily affects the pulmonary
Inherent/Natural Acquired system, especially the upper lobes. This is where
• Naturally acquired • Caused by prior the oxygen content is at its highest. But it can
• Occurs without exposure to also affect other areas of the body such as the
previous exposure to antibacterial
brain, intestines, peritoneum, kidney, joints and
antibacterial drug • Ex. Repeated
liver.
• Ex. Gram negative exposure of S.
bacterium Aureus to Penicillin G
Pseudomonas caused the organism ➢ Latent TB Infection
aeruginosa is to evolve and • Having the TB infection but not manifesting it
inherently resistant become resistant to (positive with TB skin test, TB blood test;
to penicillin. the antibacterial drug. however, the person does not manifest the
Making the drug to symptoms of TB)
become ineffective.
➢ Multi Drug Resistant (MDR) Tuberculosis
• Caused by an organism that is resistant to at
MRSA & VREF
least isoniazid and rifampin, the two most potent
➢ Methicillin-resistant Staphylococcus TB drugs.
aureus • Improper or noncompliant use of treatment
➢ Vancomycin-resistant enterococcal program resulting to the development of
faecium mutations in the tubercle bacilli
o Very common antibiotic resistance • Meaning they already started with the therapy;
o Causes: taking of antibiotics for viral however, they were not compliant with it.
infection, incorrect taking (skipping dose, Therefore, this resulted to the mutation of the
not taking full regimen) tubercle bacilli
o Viral infection should be given with antiviral
and not antibiotics

Nowts ni Estelle :>

 Clinical Manifestations
• May be asymptomatic in primary infection
• Fatigue
• Lethargy
• Anorexia
• Weight loss
• Low-grade fever
• Chills
• Night sweats
• Persistent cough
• Hemoptysis
• Chest tightness and a dull, aching chest pain
Disease Progression
1. Droplets enter the lungs, and the bacteria
from a tubercle lesion.
2. The defense system of the body
encapsulates the tubercle, leaving a scar.
3. If encapsulation does not occur, bacteria
may enter the lymph system, travel to the
lymph nodes, and cause an inflammatory
response termed granulomatous
inflammation.
4. Primary lesion forms; the primary lesions
may become dormant but can be
reactivated and become a secondary
infection when re-exposed to the
bacterium.
5. In an active phase, tuberculosis can cause
necrosis and cavitation in the lesions,
leading to rupture, the spread of necrotic
tissue, and damage to various parts of the
body.
Antitubercular Drugs
• Medications prescribed to people with active
TB and those exposed to it.
Prophylactic Antituberculars
• Drugs given to prevent tuberculosis disease
in individuals with latent TB infection.
• Indicated for those with clinically significant
result on tuberculin skin testing
o > or equal to 5mm for
immunocompromised person
o > or equal to 10mm for high-risk groups
o Or patients with positive IGRA TB test,
patients who converted from negative to
positive IGRA or from positive to negative
TB skin
• Contraindicated to patients with liver disease
because your isoniazid is the primary drug
Nowts ni Estelle :>
used and may cause isoniazid induced liver
damage
** Single Drug Therapy is ineffective in the
treatment of TB disease due to drug resistance.
Combined Antitubercular Drugs
➢ First-Line Drugs
• The core of treatment regimen for TB
• Treatment regimen is divided into two phases:
o Initial phase: 2 months
o Continuation phase: 4 or 7 months
• RIPE (Rifampin, Isoniazid (INH), Pyrazinamide,
Ethambutol)
• Total drug regimen can be up to 9 months or
longer, that depends to the response to the drug
therapy
➢ Rifampin
o MOA: inhibits bacterial RNA synthesis
o Best taken on an empty stomach
▪ Side Effects and Adverse Reactions:
▪ Orange colored body secretions
▪ Soft contact lenses may be
permanently discolored
➢ Isoniazid (INH)
o Bactericidal drug
o Also called “miracle drug”
o MOA: inhibit tubercle cell-wall synthesis and
block Vit B6
o Pyridoxine should also be given to prevent
deficiency and minimize peripheral
neuropathy
o This is why isoniazid should be given
alongside pyridoxin
▪ Peripheral Neuropathy
▪ Pyridoxine Deficiency
➢ Pyrazinamide
o May be bacteriostatic or bactericidal
▪ Hepatotoxicity
▪ Photosensitivity
➢ Ethambutol
o Bacteriostatic drug
o MOA: inhibit 1 or more metabolites in
susceptible organism
o Therefore interfering with the cell wall
metabolism and multiplication
▪ Optic Neuritis
• Combination therapy for MDR Tuberculosis
consists of a minimum of three drugs, but
preferably four to five drugs.
➢ Drugs for MDR Tuberculosis Adult with • Isoniazid daily for 9 months
• Aminoglycosides: HIV and
o Streptomycin, Kanamycin, Amikacin Latent TB
• Fluoroquinolones: Infection
o Levofloxacin, Ciprofloxacin, Ofloxacin
Adult with • Initial phase: RIPE (Rifabutin
• Aminosalicylate sodium
HIV and because it has a longer half-life
• Capreomycin
Active TB compared to Rifampin) for 6
• Cycloserine Infection months
• Ethionamide
• Continuation phase: RI
(Rifabutin, Isoniazid) for 4
** In administering these medications, it would
months
depend on the case of our clients.
A pregnant • Should be treated the same as
woman a nonpregnant woman but with
Special Conditions with HIV concerns for the fetus when
➢ Tuberculosis and Pregnancy and TB choosing the therapy
• Women with untreated pulmonary
tuberculosis are at risk for passing the ➢ Tuberculosis and Pediatrics
infection to the fetus and delivering a newborn • Children are more likely than adults to become
with low birth weight. Therefore, the benefits of sick more quickly by TB
treating a pregnant woman with TB disease • Focus more on prevention
outweigh the risk of treatment. Children • Isoniazid daily for 9 months
• The drugs used in initial treatment of TB cross with Latent
the placenta but do not appear to harm the TB Infection
fetus.
Pregnant • Isoniazid daily or twice weekly • We have TB DOTS available in our respective
woman for 9 months with pyridoxine barangays.
with Latent supplement.
TB • 3HP (Isoniazid with rifapentine
Infection for 3 months) is not Nursing Interventions (RIPE)
recommended to pregnant Rifampin
women or those planning to 1. Assess for hypersensitivity.
become pregnant within 3 2. Evaluate CBC, uric acid, and liver function.
months 3. Assess for signs of hepatitis
Pregnant 1. RIE: Rifampin, Isoniazid, 4. Inform patient that orange discoloration of
woman Ethambutol daily for 2 secretions is a side effect of the
with Active months followed by medication.
TB 2. RI: Rifampin, Isoniazid daily
infection or twice weekly for 7 Isoniazid
months 1. Assess for hypersensitivity.
3. A total of 9 months 2. Assess for hepatic dysfunction.
• Streptomycin should not be used due to its 3. Assess for sensitivity to nicotinic drug
potential harmful effects to fetus. acid.
• Pyrazinamide is also not recommended due to 4. Monitor liver function test results.
its unknown effects on fetus. 5. Monitor for signs of hepatitis (such as
anorexia, nausea and vomiting, weakness,
➢ Tuberculosis and HIV Coinfection fatigue, dark urine, jaundice. If these
• TB is one of the leading cause of death for symptoms occur, make sure to withhold the
people coinfected with HIV. medication and call your healthcare provider.)
• HIV is also a risk factor for the development of 6. Monitor for tingling, numbness or burning
TB. of extremities.
• Once a person is diagnosed with HIV, there is 7. Administer medication 1 hour before or 2
a low immune system which causes or triggers hours after meals. (food may delay the
absorption of the medication)
the Mycobacterium tuberculosis to infect that
person leading to TB.
Nowts ni Estelle :>
 8. Administer pyridoxine as prescribed to Systemic Usually acquired through
reduce risk for neurotoxicity. fungal inhalation into the lungs and
Pyrazinamide Infection infects the blood stream
1. Assess for hypersensitivity. Usually occur in the
2. Evaluate CBC, uric acid, and liver function. immunocompromised,
3. Observe signs of hepatotoxicity. debilitated population or in those
4. Assess for painful and swollen joints. taking immunosuppressive
5. Evaluate blood glucose level because drugs
diabetes mellitus may be difficult to control Examples:
while client is taking the medication. • Candida species could occur
6. Instruct client to avoid sun exposure. Opportunistic when the body’s defense
7. Apply lotions with SPF 30 or more. Infections mechanisms are impaired
(such as that they allow
Ethambutol overgrowth of the fungus; the
1. Assess for hypersensitivity. overgrowth will cause the
2. Evaluate CBC, uric acid, and liver function. infection)
3. Monitor for visual changes such as altered Other Examples:
color perception and decreased visual • Aspergillosis, Mucormycosis,
acuity. Pneumocystis, pneumonia,
** Always remember to strictly adhere to the Fusariosis
treatment plan to prevent multi-drug resistant TB. • The first exposure to an
** When you are the nurse in-charge to patients infected pathogen
having these medications, make sure that you will • Occur in the
observe a proper timing in giving the medication. immunocompetent person and
If the drug is given at 8AM, the next day make sure Primary a result from inhaled spores
to give it also at 8AM. Infections Examples:
• Coccidioidomycosis,
Blastomycosis,
ANTIFUNGALS Paracoccidioidomycosis,
Cryptococcosis, Hitoplasmosis
Fungal Infection

• Infections caused by fungus Antifungal Drugs

• May also be called mycosis, tinea, or candidiasis • Also called Antimycotic drugs
Classification of Fungal Infection • Used to treat fungal infections
Acquired through contact with an • Can be fungistatic (they inhibit the growth of
infected person fungus without killing it) or fungicidal (the
killing of the fungus)
Examples:
Dermatophytes
Polyenes
• Involve integumentary
• MOA: bind to the fungal cell membrane to form
system, mucous
Local fungal open channels that increase cell permeability
membranes, hair nails
infection and leakage of intracellular components,
especially potassium.
Candida albicans
• Oral Candidiasis/Oral thrush
➢ Amphotericin B deoxycholate
• Affecting the mouth
• DOC for severe systemic infection
• Administered via IV route
Vaginal Candidiasis
• Highly toxic (close monitoring is
• Common to women who are
recommended)
pregnant, diabetic,
immunocompromised, taking
➢ Nystatin
medication (antibiotics, oral
contraceptives) • For the treatment of Candida infection
• Administered orally or topically
Nowts ni Estelle :>
 • Available in oral suspension, creams, ANTIVIRALS
ointments
For oral suspension preparation: Swish and Spit ➢ Viruses
or Swish and Swallow (depending on the severity of • An obligate intracellular organism that must
the oral fungal infection) reside within a living host’s cell to survive and
Azole Antifungals reproduce
• MOA: interfere with the formation of ergosterol • Enter healthy cells, live and reproduce within
• Ergosterol is a major sterol in the fungal cell living cells.
membrane. Cell permeability and leakage are • They use their DNA and RNA to reproduce
increased; therefore it prevents the ergosterol
to form.
➢ Influenza
• Effective against Candidiasis
• Commonly known as flu
Examples: • Droplet transmission (coughing, sneezing,
• Ketoconazole talking)
• Fluconazole • Signs and Symptoms:
• Itraconazole o High fever
• Posaconazole o Headache
• Voriconazole o Fatigue
• Ends with -zole or -nazole o Myalgia
o Chills
Antimetabolites o Sore throat
• MOA: penetrate to the fungal cell, which o Non-productive cough
converts the drug into fluorouracil o Watery nasal discharge
• Disrupts fungal DNA and RNA synthesis o Weakness
o Red watery eyes
Example: o Photophobia
• Flucytosine
Echinocandins Types of Influenza
• MOA: inhibit biosynthesis of essential Influenza A Causes a moderate to severe
components of the fungal cell wall which infection
interferes with the growth and reproduction of Influenza B Causes mild illness to children
Candida and aspergillus species Influenza C Causes a mild respiratory illness
• Newest class of antifungals not thought to cause epidemics
• Administered intravenously

Examples: ➢ Herpesvirus
• Anidulafungin • Large viruses that can cause infections
• Caspofungin
Herpes Simplex • Associated with cold
• Micafungin
Virus 1 (HSV-1) sores
Herpes Simplex • Genital herpes
Nursing Interventions Virus 2 (HSV-2) • Associated with vesicular
1. Obtain a culture to determine the fungus
lesions and small
type.
ulcerations on the
2. Monitor patient’s urinary output.
genitalia
3. Check laboratory results for BUN, serum
creatinine, ALP, ALT, AST, bilirubin, and
Varicella Zoster • Causes shingles and
Virus (VZV) chickenpox
electrolytes.
4. Record vital signs. • Highly contagious
infection that causes
generalized pruritic
vesicles and fever

Nowts ni Estelle :>

 Epstein-Barr • Causes infectious ANTIMALARIALS
Virus (EBV) mononucleosis
• Manifested by fever, Antimalarial Drugs
tonsillitis, enlarged lymph • For the prevention and treatment of malaria
nodes due to P. vivax, malariae, ovale, falciparum
Cytomegalovirus • Common viral infection • MOA: inhibit parasite replication by forming
that affects all ages complexes with DNA of parasite
• Results in the transcription of DNA to RNA
➢ Quinine
Non-HIV Antivirals • Only antimalarial drug available from 1820
• MOA: inhibit viral replication by interfering with until the early 1940s
viral nucleic acid
• Used to prevent or delay the spread of viral ➢ Chloroquine
infection • Synthetic antimalarial drugs
• As effective as quinine with fewer side effects
➢ Influenza Antivirals
• For the treatment of influenza type A and B ➢ Chloroquine, Primaquine
• Zanamivir, Oseltamivir • Commonly prescribed drug for malaria
o Are neuraminidase inhibitors • Can also be given as prophylaxis
o Decreases the release of virus from
infected cells by inhibiting the activity of ➢ Mefloquine hydrochloride with
neuraminidase Atovaquone-Proquanil
o Should be taken within 48 hours of flu • Used for the treatment of chloroquine
symptoms resistant P. falcifarum

➢ Herpes Antivirals Side Effects and Adverse Reactions

• For the treatment of herpes simplex virus • GI upset
(HSV1, HSV2) and VZV • Retinal damage
• Famciclovir • Cranial nerve VIII involvement
• Ganciclovir sodium • Renal impairment
• Penciclovir • Cardiovascular affectations
• Ribavirin
• Valacyclovir Nursing Interventions
• Valganciclovir • Monitor renal and liver function.
• Trifluridine • Assess for the urine output (>600mL/day)
• Acyclovir • Move away sharp objects (since there is retinal
damage).
➢ Cytomegalovirus Antivirals • Clear pathways where the client is walking.
• For the treatment of CMV retinitis in persons
with HIV
• Ganciclovir ANTIHELMINTHICS
• Cidofovir
• Foscarnet ➢ Helminth
• Parasitic worms that cause disease worldwide
➢ Hepatitis Antivirals • Transmission occurs in areas of poor sanitation
• For the treatment of Hepatitis B, C, D and hygiene from infected soil to the person.
• Lamivudine • Common site: intestine
• Adefovir • Infestation is called helminthiasis
• Entecavir
• Tenofovir Classifications of Helminths
• Peginterferon Alfa-2a Cestodes • Have heads and
(tapeworms) hooks/suckers
• Enter the intestine via
contaminated food
Nowts ni Estelle :>
 • Types:
o Taenia solium (pork
tapeworm)
o Taenia saginata (beef
tapeworm)
o Diphyllobothrium
latum (fish tapeworm)
o Hymenolepis nana
(dwarf tapeworm)
Trematodes • Flat parasites that feed on
(flukes) the host
• Types:
o Fasciola hepatica
(liver fluke)
o Fasciolopsis buski
(intestinal fluke)
o Paragonimus
westermani (lung
fluke)
o Schistosoma specie
(blood fluke)
Intestinal • Infect and feed on
nematodes intestinal tissue
(roundworms) • Types:
o Ascaris lumbricoides
(giant roundworm)
o Necator americanus
(hookworm)
o Enterobius
vermicularis (pinworm)
o Strongyloides
stercoralis
(threadworm)
o Trichuris trichiuria
(whipworm)
Extraintestinal • Tissue invading
tissue-invading • Types:
nematodes o Trichinella spiralis
(trichinosis, (pork roundworm)
onchocerciasis, o Onchocerciasis
filariae) volculus (river
blindness)
Anthelminthic Drugs
• MOA: bind with chloride ions, increase cell
permeability to kill parasite
➢ Ivermectin
• For the treatment of intestinal strongloidiasis
and onchoceriasis
Side Effects and Adverse Reactions
• Pruritis, urticaria, fever, arthralgia, dizziness,
diarrhea, nausea, skin irritation, xerosis, ocular
Nowts ni Estelle :>
irritation, back pain, lethargy, rash, asthenia,
fatigue, vomiting, anorexia, abdominal pain,
vertigo, tremor, drowsiness
Nursing Interventions
1. Discuss benefits of handwashing before
and after working in soil or with animals.
2. Instruct client to cook food thoroughly.
3. Collect stool specimen in a clean
container. Avoid having stool come in
contact with water, urine, or chemicals.
(this may destroy the parasitic worms)
PEPTIDES
Antimicrobial Peptides
• Broad spectrum, powerful defenses that kill
parasites, fungi, and viruses
• Include antiviral, antimicrobial, antifungal and
antiparasitic
• Derived from cultures of Bacillus subtilis
➢ Colistimethate
• A polypeptide antibiotic
• Used for the treatment of Pseudomonas
aeruginosa, CRE (carbapenem resistant
enterobacterialis), and Klebsiella & Shigella
species
➢ Polymyxins
• Polypeptide antibiotic
• Used for the treatment of P. aeruginosa, E.
coli, Klebsiella & Shigella species
• Consist of 5 chemical compounds: Polymyxin
A to E
• Increased risk for nephrotoxicity and
neurotoxicity
➢ Bacitracin
• For the treatment of most gram-positive and
some gram-negative bacteria
• Ointment preparation is available as OTC
• Can cause renal damage and ototoxicity
➢ Metronidazole
• A synthetic antibiotic and antiprotozoal
• Antiprotozoal: for the treatment of
Trichomonas vaginalis, amoebiasis, giardiasis
• Antibiotic: anaerobic bacteria, Helicobacter
pylori
• For the treatment of rosacea
• Can be added to multidrug regimen to reduce
antibiotic resistance