Unit 8: Antimicrobial Drugs/Antibacterials

NOTE: “STUDY THE CONTENTS OF THE WHOLE UNIT/CHAPTER AND DON’T

JUST RELY ON THE NOTES PRESENTED BELOW. SELF DISCOVERY AND
SELF RELIANCE TO STUDY ARE THE KEYS TO PASS THIS COURSE”
ANTIBACTERIALS AND ANTIINFECTIVES
1. Penicillins - “mold”: Penicillium notatum
2. Cephalosporins – “fungus” Cephalosporium acremonium
- inhibit the bacterial enzyme necessary for bacterial cell wall synthesis
3. Macrolides – fungus like bacteria: Streptomyces erythreus
- bind to the 50S ribosomal subunits & inhibit protein synthesis
4. Lincosamides – inhibit bacterial protein synthesis
5. Vancomycin – “glycopeptides”: Inhibit bacterial cell wall synthesis
6. Ketolides – Block protein synthesis
7. Tetracycline – Streptomyces aureofaciens: inhibit bacterial protein synthesis
8. Glycylcyclines – Synthetic tetracycline analogue: block protein synthesis
9. Aminoglycosides – inhibit bacterial protein synthesis
10. Fluoroquinolones – interfere with enzyme DNA gyrase needed for bacterial DNA
synthesis
11. Sulfonamides – “coal tar derivatives” inhibit bacterial synthesis of folic acid
12. Metronidazole – Impair DNA function of susceptible bacteria

ANTIBACTERIALS AND ANTIINFECTIVES

1. PENICILLINS (McCUISTION ET AL, 2018 PAGES 346-349)
From mold genus penicillium
Has beta lactam ring
Beta lactam antibiotic
Interferes with bacterial cell synthesis by inhibiting bacterial enzymes necessary for
cell division and synthesis.
BACTERICIDAL AND BACTERIOSTATIC
Can be inactivated by beta lactamases: Penicillinase
Ex. A. Broad Spectrum Penicillins
1. Amoxicillin 2. Ampicillin
B. Betalactamase Inhibitor Penicillins- (BLIP)
 - drug with protection from beta lactamases.

NURSING MANAGEMENT:
1. Culture and sensitivity testing.
2. Examine for allergic reactions.
3. High doses lead to decreased platelet aggregation: CHECK FOR BLEEDING
.
4. Check for S/Sx of superinfection.
5. With meals and increase water intake for oral route.
6. Watch out for side effects: nausea, vomiting, diarrhea, rash and adverse
reactions: anaphylaxis and super infection.
7.Complete course of therapy.
2. CEPHALOSPORINS(McCUISTION ET AL, 2018 PAGES 351-354)

NURSING MANAGEMENT:
1. Culture and sensitivity testing.
2. Examine for allergic reactions.
3. MIO
4. Refrigerate oral suspensions
5. Report side effects: N/V, dizziness and rash
6. Watch out for bleeding and super infection
7. With meals for oral route.

3. MACROLIDES (McCUISTION ET AL, 2018 PAGES 355-357)

From fungus like bacteria streptomyces erythrus
Binds to 50S ribosomal subunits and inhibits protein synthesis
Broad spectrum antibiotics
Ex. Azithromycin, Clarithromycin, and Erythromycin
Added with acid resistant SALT (Stearate Estolate) to decrease dissolution
BACTERIOSTATIC and BACTERICIDAL
NURSING MANAGEMENT:
1. Culture and sensitivity testing.
2. Watch out for hepatoxicity, super infection.
3. Monitor V/S, Urine Output and Liver enzymes
4. Side Effects: N/V, Abdominal Cramps, Rash
5. Give the drug with meals with a full glass
of water.
6. Parenteral: DO NOT GIVE IM
4. Lincosamides (McCUISTION ET AL, 2018 PAGE 358)– Ex. Clindamycin and
Lincomycin
- Watch out for leukopenia and thrombocytopenia
- Decreases WBC and Platelet count
- Give with a full glass of water
- May cause Pseudomembranous colitis
- Maintain adequate hydration and report if Diarrhea occurs

5. Vancomycin (McCUISTION ET AL, 2018 PAGE 355)

- Ototoxic
- Report presence of Tinnitus
- Monitor for: REDMAN or REDNECK SYNDROME: sudden decrease in BP, fever and
chills with paresthesia and erythema of neck and back

6. TETRACYCLINES (McCUISTION ET AL, 2018 PAGES 359-361)

From streptomyces aureofacieus
Inhibit bacterial protein synthesis
BACTERIOSTATIC
NURSING MANAGEMENT:
1. Culture and sensitivity testing.
2. Watch out for photosensitivity, nephrotoxicity, super infection.
3. Wear sunscreen protection.
4. Monitor V/S, I and O
5. Oral Hygiene
6. ORAL FORM: 1 hour before meals or 2 hours after meals with a full glass of
water
7. NO milk products, iron, antacids
8. Store medication away form light and extreme heat: Tetracycline
decomposes in light and heat causing drug to become toxic.

7. AMINOGLYCOSIDES (McCUISTION ET AL, 2018 PAGES 362-364)

Inhibits bacterial protein synthesis
Ex. A. Streptomycin Sulfate
- from bacterium streptomyces griseus
- for Tuberculosis (IM route)
B. Gentamycin, Tobramycin, Amikacin (IV)
- for Pseudomonas infection
C.Neomycin (Oral)
-Preoperative bowel antiseptic
NURSING MANAGEMENT:
1. Culture and sensitivity testing.
2. MIO, urine output at least 600ml/day
3. Watch out for ototoxicity, neurotoxicity, nephrotoxicity and
photosensitivity
4. Monitor for S/Sx of super infection
 8. FLUOROQUINOLONES (QUINOLONES) (McCUISTION ET AL, 2018
PAGES 364-366)
- Inhibits bacterial RNA and DNA synthesis
- BACTERICIDAL
- Prescribed for UTI
- Ex. A. Ciprofloxacin- UTI, LRTI
B. Levofloxacin- Respiratory Problems
NURSING MANAGEMENT:
1. Culture and sensitivity testing.
2. MIO, urine output at least 750ml/day
3. Watch out for super infection
4. Oral drug with meals and a full glass of water.
5. Monitor for side effects: Rash, N/V and dizziness
6. Avoid operating hazardous machinery
7. Increase water intake
8. Watch out for photosensitivity
9. Monitor blood sugar level if given with anti-diabetic drugs.

9. Chloramphenicol: (McCUISTION ET AL, 2018 PAGE 367) chloromycetin (

Oral, IV, Opthalmic and Otic )
- Causes GRAY SYNDROME in neonates and premature babies: Abdominal
distention, pallid cyanosis, vasomotor collapse and irregular respiration
- Agranulocytosis: report sorethroat, tiredness and flulike symptoms
- give on empty stomach
- Bone marrow suppressions
10. SULFONAMIDES (McCUISTION ET AL, 2018 PAGES 367-370)
From coal tar derivative: Not an antibiotic
Inhibit bacterial synthesis of folic acid
which is essential for bacterial growth.
Preferred treatment for UTI
BACTERIOSTATIC
Ex. A. Sulfadiazine
B. Co-trimoxazole (TMP-SMZ)
NURSING MANAGEMENT:
1. Culture and sensitivity testing.
2. Side effects: skin rash and itching, N/V
3. Watch out for blood dyscrasia, crystalluria, photosensitivity and cross
sensitivity or allergy
4. Give 1 hour before meals or 2 hours after meals and a full glass of water
5. Increase water intake 1,500-3,000ml/day
6. Monitor CBC and kidney function
7. Protect from sunlight, injury and infection.
8. Watch out for severe hypersensitivity reaction.
a. ERYTHEMA MULTIFORME
- vesicle eruption
b. EXFOLIATIVE DERMATITIS
- scaling and itching of skin
References:
* McCuistion, Linda, Vuljoin-DiMaggio, Kathleen, Winton, Mary and Yeager, Jennifer,
Pharmacology: A Patient-Centered Nursing Process Approach (2019) 9th
Edition, Elsevier (Singapore) (Main Textbook)

* Karch, Amy Morrison, Focus on Nursing Pharmacology (2017). 7th Edition

(Philadelphia) (supplementary reference)

* Adams, M.P., Holland, L.N., Urban, C. Pharmacology for Nurses: A

Pathophysiologic Approach, (2013).
4th Edition (USA) (supplementary reference)