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    15 views12 pages

    Anti-Infective Drugs

    Uploaded by

    Johannes Santos

    Copyright:

    © All Rights Reserved
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    Bese ANTI INFECTIVES: SULFONAMIDES #% HOW DO THEY WORK? “ACTION” ‘Bacteriostatic agents that are used to halt the growth of bacteria. thei abilty to inhibit the activity of folic acid in bacterial call metabolism. They are() often used to control infections ‘caused by both gram-positive and ‘gram-negative bacteria, such as Escherichia col, Staphylococcus ‘aureus, and Klebsiella and Enterobacter species. (Ford 62) INDICATIONS © Urinary trac infections (UTIs) and acute otitis media Ulcerative colts Matenide (Sulfamylon) and silver sulfadiazine Sivadene) are topical sulfonamides used in the treatment and prevention of infections in second and third-degree burns. oe ADVERSE REACTIONS ‘Nausea, vomiting, anorexia Diarrhea, abdominal pain ‘Stomatitis (ifammation of the mouth) Chills, fever CCrystalluria (crystals in the urine) Photosensitivity ‘Steven johnson syndrome TEN Leukopenia —decrease in the number of white blood calls Thrombocytopenia decrease in the number of platelets Aplastic anemia “deficient red blood cel production in the bone eeee 0% e6e ° CONTRAINDICATIONS & NURSING MANAGEMENT CAUTION ek cng wy ib srs sine fee cl tm cimro el candy te Hyperenatvly to sufonamides & Take the crugat he prescbe ener. These tne Direction irl are kop becalse a cara euro te inchiten younger han 2 Imus be nthe ota a tes fr the ection tobe contd © Sortie ar omit te dove ues aie to do 0 by the par eat eae prove + Comite tne ene cours of reer. Do otto the INTERACTIONS cron evcapton tne advice ofa pray heat care prover, : beter the cure of reat comleted eve gnome * —Qralaniconguants: creased Improve or anppen" Fale to complet he pesertond ¢ Selonotteentcongaant Sarencf hearin eat here of seston re eae nee eeen ae REDE npre on before oF 2 hours after a meal. ‘trios Dietngleh between Inedite-andexterded-eease perkonainnee ising otiyeixieaesa mem pooner 4+ Naty the pinay heath cre provi symp of the Inecton become wore of orga eymploms do nat Improve ater 07 dae ot rug therapy + Aciatyepoume rights cnr it Garg . bed, sunampe) whe taking hese cuge an for Several + weeks after completing the course of therapy. Wear sunblock, sunglasses, and protective clothing when exposed to sunight. e ‘ @ Specific instructions Regaraing Sultenamiaes @ Take sulfasalazine (Azulfidine) with food or immediately ator a meal NURSING ALERT & When taking sulfasalazine the skin or urine may turn crange-yellow:; ths is normal. Soft contact lenses may acquire 1 sufonamies are gven nea the end of a permanent yellow stan. It's a good idea to seek the advice pregnancy, significant high Bood vels of of an ophthalmologist regarding disposable lenses while taking the drug may occur, causing jaundice or Guana pones heretic anemia the neonate. In ‘ton, the sulfonamides re ot Used or Infectons caused by group Abeta Peeters a noi Fetal AS HERBAL CONSIDERATIONS 3) ‘Cranborios and cranbery juice are commonly used \Winen dabete patents oe prescribed ‘ok remedies for prevering and relieving symptoms suilonamides, assaas fo a porsble ‘of Ula. The use of eranbemes in combination with Fypoatycemic reaction. Sufenamées may [ntbictes has been recmmended by physician Int the (hepate) metabllsm othe ora! the longterm suppresbcn of Ue. Cranberries hypoglycemic drugs tolbutamide and {tought o prevent bactera om attaching to the orpropamide (.abinese) (Ford 63) wals of ho urinary act The suggested dose is 6 ‘unces of ice twee daly. Cranbory capsules are ‘ol recommended beca.se the fui or hysaton ‘may bo a hepfl a the Doris (Bown, 2072). ‘courrence ofa UT. the use wil pt cure a UT. ‘an individual suspects a UTI mesial attention i necessary. (Ford 63) Uns, chaneroid, acute otis mea, Hasmophius influenzae and meningococcal meningitis, meumatic fever Loading dose: 2-4 g oral; maintenance ose: 2-4 gay oaly mn 4-6 divided ‘oes | suttacataine | Anite, cuirw EN LUT, acute otis media, Hemophiusinfiverzae, Initia horapy: 1-4 glday oral in vided meningococcal meningitis. doses; mainiance dose: 2 gfday orally =: DRUGS THAT DISRUPT THE CELL HOW DO THEY WORK? “ROTON” se Ponicilin is a widely used antibiotic prescribed to treat staphylococci and streptococci bacterial infections. Pencilin belongs to the beta-lactam family of antibiotics the members of which use a similar mechanism of action to inhibit bacterial cell growth that eventually kils the bactera INDICATIONS Urinary tact infections (UTIs) Septicemia Meningitis Intra-abdominal infections ‘Sexually transmitted infections (syphilis) Preumonia and other respiratory infections © Prophylaxis for anticipated bacterial infections teeee + ADVERSE REACTIONS © Glossits inflammation ofthe tongue) when given orally ‘Stomaitis (rflammation of the mouth), cry mouth Gastritis Nausea, veritng Diarhea, abdominal pain [An anaphylactic reaction ‘Anemia ow red blood cell, count) Thrombocytopenia (ow platelet count) © —Leukopenia (ow white blood cell count) © Bone marrow depression eeeee 6 ° Anaphylaxis ©=[—> penicillin G (aqueous) CONTRAINDICATIONS & CAUTION Hypersensitivity to penicitin or ‘cephalosporins INTERACTIONS Oral contraceptives (with estrogen): Decreased effectiveness of contraceptive agent (with ampicilin, peniciin V). Tetracyclines: Decreased effectiveness of penicilins ‘Anticoagulants: increased bleeding risks (wih large doses of peniciins) B-adrenergic blocking drugs: May Increase the risk for an anaphylactic. = Se PENICILLIN B-LACTAMASE INHIBITORS Augmentin—combination of amoxicilin and lavulanic acid Timentin—combination of tcarilin and clavulanic acid Unasyn—combination of ampicilin and sulbactam Zosyn—combinaton of piperacilin and tazobactam (Ford 71) WALL: PENTCILLINS NURSING MANAGEMENT 2) ‘View th cuts and seity ruts Monitor symptoms of hypersenstty or angphyaxis Prophylans~Take the rug as prescribed unt be primary hoalth care provider decortinues therapy. © _Infecton~ Completa he ful ccurse of therapy. Do not stop {king the crug. even if the symptoms have disappeared ‘© Tako the rug atthe prsorbed times of day because is important to keep an adequate amount of rug inthe body ‘troughout th entire 24 hours ofeach day ‘® Perici oh —Take the drug on an empty stomach ether + hour bore or 2 hours after meals exceptions: peniclin V and amenician, Take each dose wih aful €-ounce glass of water. '% Avoid drinking sleahole beverages when taking the ‘cephalosporins and for 3 days after completing the course ‘of terapy, because severe reactions may ocour ® _Toreduce the risk of superinfection during antibiotic ‘merapy. take yogurt, uttermik 9° Adophius capsule. © youarea woman who has been preserbed ampli ad percilin Vand who takes bith contol pis containing ‘trogen use adctonal contraception measures. ‘= Netty the primary heath eae prover mmclstly should ‘one o mote of te folowing oesur skin rash: ves (tiara severe canes; vagal ot ana tehing: black, ‘her tongue sores inthe mou: eweling around the mouth ‘or eyes: breathing dificay.o Gl sturbances such as nausea, vorting, and cares. Do not take tne next dose ‘Ofte drug unt he problem has boon discussed wih the ‘penary healthcare provide. © Never give this drug to aothorindvval ven though his hor symptoms appear tobe the same as yours. "© Never skip doses or stop therapy ures tld to do so by the primary health care provider (se Ptint Teaching for Improved Patent Outcomes: Provertng Antlnecty Resistance) When a pein sto be taken for along tne for prophylaxis, you may fa wel despite the ned for Tong-term antibiotic therapy. There may be a tendency to ‘mi one of more doses or oven neglect fo take he ug for sn exended te. (Ford 77) 3 HERBAL CONSIDERATIONS Goldenseal (Hycrastis canadensis) san her found growing in tertan areas othe narmeaster Unies State, parla the (Ono River valley. Goldenseal hasbeen used fo wash flamed ‘ot nlected eyes and in making yelow dye. Tere are many ‘ote taitonal uses of the er. clung as an antopte for ‘he skin as smouthaash for saer sores and inte testment of sinus infections and digestive problems such 28 pepe cers and gastritis. nthe 19th contr. gokdonceal was touted as an “herbal antbiotc for eating gnomes and UTIs. Though used overtime by Amenian indian Wbes as on insect repel. Stmulart, and dure here's no scenic evaence to support is bent for these purposes. Another mh surtounding goldenseal uso thal aking te herb masks the prosence of Mot drags nthe une. Evidence dee suppor te use of goldenseal 1o West carhea caused by Becton or nestinal Parasites, such 25 Garda. The herbs contandiatea dure pregnancy and in paints with hypertension, Adverse reactions fr rare when te hero ls ured ae dreciod. However tis hero Should not be taken for more thant week (ard 72) Infections due to susceptible | Up to 20-30 milion Units/day IV microorganisms; meningococcal dotage may also be based ‘meningitis, septicemia ‘on weight, penicilin V 425-500 mg orally q 6 hr or q 8 hr a ANTI INFECTIVES: CEPHALOSPORINS How 00 THEY WORK? “ACTION” CCephalosporins have a Bulactam ring and target the bacterial cell wal, making it detective and unstable. This Action i similar tothe action of penicilin. The cephalosporins ‘are usually bactericidal. Ford 73) INDICATIONS Respiratory infections tts media (ear infection) Bone/joint infections Genitourinary tract and other infections caused by bacteria ooee ADVELSE REACTIONS ‘Nephrotoxicity Malaise ‘Steven johnson syndrome Nausea Vomiting Diarrhea Headache Dizziness Heartburn Fever Aplastic anemia (ficient ‘6d blood cell production) Toxic epidermal necrolysis (death of the epidermal layer ofthe skin) PHOTOES OOS ° CONTRATNDICATIONS & CAUTION . Do not administer cephalosporins if * the pationt nas a history of allergies to cephalosporins. CCephalosporins should be used cautiously in patients with renal * disease, hepatic impairment, bleeding disorder, pregnancy (pregnancy category 8), and known Penicilin allergy. (Ford 73) * INTERACTIONS & —Aminoglycosides: Increased risk for nephrotoxicity % — oralanticoagulants: Increased risk for bleeding % loop diuretics: Increased cephalosporin blood level NURSING ALERT % —Apatient whois allemic to penicin also may be allergic to the cephalosporins. © A disulirarmike (Antabuse) reaction may occur if ‘alcohols consumed within 72 hours ater ‘administration of certain cephalosporins & Symptoms of a disulfiram-like reaction : include flushing, throbbing in the head and neck, respiratory ificulty, vomiting, sweating, chest pain, and hypotension. Severe reactions may cause dysthythmias and unconsciousness. © People witn phenylketonuria (PKU) need to be ‘aware that the oral suspension cefprozil (Getz) Contains phenylalanine, a substance that people with PKU cannot process, NURSING MANAGEMENT Before administering any antbiotic be sure to evaluate ‘the results ofthe culture and sensitivity test. Be sure to question the patient about allergy to Penicilin or cephalosporins before administering the first dose, even when an accurate drug history has been taken After administering penicilin IM in the outpatient ‘setting, ask the patient to wat inthe area for atleast 30 minutes. Anaphylactc reactions are most likely ‘occur within 30 minutes after injection. Take the drug atthe prescribed time intervals, Compete the entice course of treatment. Do not stop. the drug, except on the advice ofa primary health ‘care provider, before the course of treatment is ‘completed, even if symptoms improve or disappear. Fallre to complete the prescribed course of treatment may resut in a return ofthe infection. “Take drugs that must be taken on an empty stomach ‘hour before or 2 hours after a meal Distinguish between immediate- and ‘extended-release medications, Do not break, chew, oF ‘rush extended-release medications, Be GENERATIONS OF CEPHALOSPORINS First generation—cephalexin (Keflex), cefazolin (Ancef) # Second generation —cefaclor (Raniclor) cefoxitin (Mefoxin) cefuroxime Zinacef) & Third generation—ca‘operazone (Cefobid), cefotaxime (Ciaforan), ceftriaxone (Rocephin) Fourth generation —cefepime (Maxipime) cofadroxi na Infections due to susceptible microorganisms, | 1-2 glday orally in divided doses ccofoxitin Metoxin Infections due to suscoptible microorganisms , 250mg orally q 8 hr perioperative prophylaxis Meo ANTI INFECTIVES: TETRACYCLINE Gey HOW DO THEY WORK? “ACIION” ‘etracyolines interere with protein ‘synthesis and are composed of ‘natural and semisynthetic ‘compounds. They are used in feu of penicilin when there isan allergy resent to penicilin or cephalosporins. INDICATIONS ¢ Rickettsial aiseases (Rocky ‘Mountain spotted fever, typhus fever, and tick fevers) ¢ Intestinal amebiasis @ Some skin and soft tissue infections ® Uncomplicated urethral endocervical, of rectal infections ‘caused by Chlamydia trachomatis ® Severe acne as an adjunctive treatment + Infection with Helicobacter pyr in ‘combination with metronidazole ‘and bismuth subsalcylate ADVERSE REACTIONS Nausea or vomiting Diarrhea Epigastric distress ‘Stomatitis ‘Sore throat ‘Skin rashes Photosensit Poo ooee CONTRAINDICATIONS & CAUTION Hypersensitivity to sulfonamides During lactation & pregnancy Inchiidren younger than 9 ‘because it can discolor the teeth INTERACTIONS 2 antacids containing aluminum, zinc, magnesium, or bismuth ‘alts: Decreased effectiveness of tetracycline oral anticoagulants: increases Fisk for bleeding % oral contraceptives: Decreased effectiveness of contraceptive agent (breakthrough bleeding or pregnancy) 4 Digoxin: Increased tsk for digitalis toxicity NURSING ALERT & Women of childbearing age should be assassed for oral contraception use ‘whenever tevacycines are proscribed. @ Donat give teracyeines along wih dary products (nik or cheese), antacids, oe lxatves, or prowoctscontaring won '@ When the aforementoned drugs are preserved, make sure ey are given 2 hours before or afer the administration of B evacyeine. Food of drugs contains aclu, magneslm, auminom, or eon revert the absorption of th etacyines FFingesaa concuenty (Ford 83) (Gemeclocyctine seems to cause the ‘most serious photosensitivity reaction, whereas minocyctine is least likly to cause this type of reaction) o> NURSING MANAGEMENT Before administering any antibiotic be sure to evaluate the results ofthe culture and sensitivity test “Take the drug atthe prescribed time intervals. These time intervals are important because a certain amount ofthe drug must be inthe body at al times for the infection to be controled. ‘Always report serious adverse reactions, such as a ‘sovore hypersensitity reaction, respiratory ificutty, severe ciarhea, or a decided drop in blood pressure, to the primary health care provider Immediately, because a serious adverse reaction ‘may require emergency intervention \Whon a tetracycline has been prescribed, avoid ‘exposure to the sun or any type of tanning lamp or bed. When exposure to direct sunlight is ‘unavoidable, completely cover the arms and legs ‘and wear a wide-brimmed hat to protect the face ‘and neck. Application ofa sunscreen may or may not be effective. Therefore, consuit the primary health care provider before using a sunscreen to prevent a photosensitity reaction. EDUCATION Diarrhea may be an indication of a superinfection or pseudomembranous colts, both of which can be ‘serious. Inspect all stools for blood or mucus. If diarrhea is dark or there is mucus inthe stool, save ‘a sample and test for occut blood using atest such ‘as Hemoccut. If the stool tests positive for blood, ‘save a sample ofthe stool for possible further laboratory analysis Teach the patient to avoid the following dairy Product fore or after tkingttracycine: Milk (whole, low fat, skim, condensed, or evaporated) and mikshakes © Cream (half-and-half, heavy, igh, sour ‘cream, coffee creamers, and creamy salad dressings, @ Eggnog & Cheese (natural and processed) and cottage cheese Yogurt and frozen yogurt & lee cream, ice mik, and frozen custard (Ford 91) Doxycycline Atridox, Doryx, Monodox, ‘Treatment of infections due to 150 mg orally QID or 300 mg Periostat, Oracea, Vibra-Tabs, ‘susceptible microorganisms orally BID; gonorrhea: 600 mg Vibramycin ‘orally initially then 300 mg orally 12h for 4 days tetracyctine nla ‘Treatment of infections due to | 1-2 g/day orally in 2-4 divided ‘susceptible microorganisms doses ne ANTI INFECTIVES:AMINOGLYCOSIDES CONTRAINDICATIONS & CAUTION HOW DO THEY WORK? “ACTION” ° + typersenstity * ‘The aminogycosdes exert hi Bactrcda effect by Hocking he Peeing Hearing oss ‘ibgsome from reading te mRNA, a ‘Myasthenia grav ttopin poten syne necessary roo forbactera mutisleaton. 3. Presnaney lactation . . ee % \ INTERACTIONS ° ce % — Gophalosporins: increased risk @ ci neptrtonely oop dures (water is): INDICATIONS enlace Snesthetie) increased rk of 4 fectons caused by gram peuromcta blockade negate organme * 4+ Before abdominal surgery to reduce normal flora in the bowel a) a NURSING MANAGEMENT Before administering any antibiotic be sure to evaluate the results ofthe culture and sensitivity test. “Take the drug atthe prescribed time intervals. These time intervals are important because a certain amount ofthe drug ‘must be in the body at all imes for the infection to be controled. ‘Always report serious adverse reactions, such as a severe hhypersensitiity reacton, respiratory dtfeuity, severe diarthea, (ra decided crop in blood pressure, to the primary heaith care provider immediately, because a serious adverse reaction may require emergency intervention. Monitor temperature and evaluate the effectiveness of the treatment via labs and vitals. Neuromuscular blockade or respiratory paralysis may occur vith the administration of aminoglycosides. Itis imperative to ‘monitor respiratory status and report any respiratory dificulty immediately. To detect ototoxicity, carefully evaluare the patient's complaints or comments related to hearing, such as a ringing ‘or buzzing inthe ears. ADVERSE REACTIONS . _ pov O 2 a FAVORABLE. OUTCOMES o Sees pete see sa Ss 3 Aeros Sout comers : Sani ioe aaer in 7 Scucianyocnateas auditory disturbances, Patient does not experience diarrhea. (Ford 91) ‘Treatment of serious infections caused by susceptible strains of ‘3:mg/ka/day in3 divided doses IM or IV For life-threatening infection: 5 ‘mg/kg/day in divided doses 15 molkgiday IM or 25-30 mg/kg IM 2-3, times per week ‘Tobramycin ‘3-5 mg/kg/day IM, IV in 3 equal doses HOW DO THEY WORK? “ACTION” ‘The macrolides are bacteriostatic or bactericidal n susceptible bacteria ‘The drugs act by causing changes in protein function and synthesis. eeeee = INDICATIONS ‘A wide range of gram-negative and gram-positive infections ‘Acne vulgaris and skin infections Upper respiratory infections ‘caused by Haemophilus influenzae (with sulfonamides) (Ford 86) 2p ADVERSE REACTIONS . ANTI INFECTIVES: CONTRAINDICATIONS & CAUTION ‘These drugs are contraindicated in patients with hypersensitivity tothe ‘macrolides and in patients with pre-existing liver disease. Telithromycin (Ketek) should not be ordered if a patient 's taking cisapride Propulsia) or pimozide (Crap) (Ford 86) INTERACTIONS Antacids (kaolin, aluminum salts, or ‘magaldrate): Decreased absorption and effectiveness of the macrolides Digoxin:Increased serum levels Anticoagulants: Increased risk of bleeding — Clindamycin, incomycin, or chloramphenicol: Decreased therapeutic activity of the macroides ‘Theophylline: increased serum theophyline ee Nausea Vomiting * Diarrhea ‘Abdominal pain or cramping és ° Visual disturbances (associated vith telithromycin) may also occur. MACKOLIDES NURSING MANAGEMENT Before administering any antibiotic be sure to evaluate ‘the results ofthe culture and sensitivity test. Take the drug atthe prescribed time intervals. These time intervals are important because a certain amount of the

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