ANTIBIOTICS/ANTIBACTERIALS

- Are agents made from living microorganisms, synthetic manufacturing, and genetic engineering that are used to inhibit specific bacteria.
- They can be bacteriostatic, bactericidal, or both.
- The goal of antibiotic therapy is to decrease the population of invading bacteria.

BACTERIA

- Microorganisms that invade human body.

CLASSES OF THERAPEUTIC ACTION INDICATIONS CONTRAINDICATIONS AND ADVERSE EFFECTS NURSING CONSIDERATION
ANTIBIOTICS CAUTIONS
I. AMINOGLYCOSIDE Exert bactericidal effect Infections caused by Known allergy to CNS: ototoxicity, CHILDREN
S through inhibition of susceptible strains: aminoglycosides. irreversible deafness, Monitor nutritional and
gentamicin protein synthesis in Pseudomonas aeruginosa, Renal or hepatic vestibular hydration status while
kanamycin susceptible strains of Escherichia coli, Proteus spp., disease. Can be paralysis, confusion, dep on therapy.
neomycin
gram-negative Klebsiella-Enterobacter- exacerbated. ression, disorientation,  WOF superinfection
streptomycin
bacteria. Specifically, Serratia group, Citrobacter Preexisting hearing loss. C numbness, tingling, (oral candidiasis).
tobramycin
they bind to a unit of spp., and Staphylococcus an be intensified by toxic weakness  Dosages are double
the bacteria ribosomes spp. drug effects on the auditory Renal: renal failure checked to decrease
and cause misreading nerve. Hematology: bone risk of adverse
of the genetic code Myasthenia gravis or marrow depression, effect.
leading to cell death. parkinsonism. Can be leading to  Parent education –
exacerbated by the effects immunosuppression and cut down
of a particular resultant superinfections unnecessary use of
aminoglycosides on GI: nausea, antibiotics in
the nervous system. vomiting, diarrhea, children.
Lactation. Aminoglycosides weight loss, stomatitis, ADULTS
are excreted in the breast hepatotoxicity  Health education:
milk and can potentially CV: simple colds maybe
cause serious effects in the palpitations, hypotensio viral and does not
infant. n, hypertension need antibiotic
Amikacin should not be Hypersensitivity therapy.
used for longer than 7-10 reactions: purpura, rash,  Do not share

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 days because it is urticaria, antibiotics with
particularly toxic to the exfoliative dermatitis symptomatic
bone marrow, kidneys, and friends.
GI. OLDER ADULTS
Streptomycin is only for  Assessing the
special situations because it problem and
is very toxic to the 8th obtaining
cranial nerve and kidney. appropriate
specimens for
culture is important.
 Maybe more
susceptible to
adverse effects of
antibiotic therapy.
II. CARBAPENEMS Exert bactericidal effect  Serious intra-abdominal,  Known allergy to  GI: 
ertapenem by inhibiting cell urinary tract, skin and carbapenems or beta- pseudomembranous
imipenem membrane synthesis in skin structure, bone and lactams. colitis, C.difficile
meropenem susceptible bacteria, joint, and gynecological  Seizure disorders. Exacer diarrhea, nausea,
leading to cell death. bated by drugs.
infections. vomiting,
 Meningitis. Safety is not
 Infections caused by dehydration and
established.
susceptible strains:  Lactation. Not known electrolyte
S.pneumoniae, whether drug can cross imbalance
H.influenzae, E.coli, into breast milk or not.  CNS: headache,
K.pneumoniae, B.fragilis,  Ertapenem is not dizziness, altered
P.mirabilis, P.aeruginosa, recommended for use in mental state
and P.bivia. patients younger than 18  Superinfections
years of age.
 Meropenem is associated
with development of
pseudomembranous
colitis and should be used
in caution in patients with
inflammatory bowel
disease
III. CEPHALOSPORINS Exert bactericidal Cephalosporins are Known allergy to  GI: nausea, vomiting,  Drug-drug

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1st Generation: and bacteriostatic effective against the cephalosporins and beta- diarrhea, anorexia, interaction:
cefazolin effects by interfering lactams. abdominal pain, Aminoglycosides:
cephalexin same gram-positive Hepatic or renal impairment. flatulence, increased risk for
with the cell-wall
bacteria affected by Pregnancy and lactation. pseudomembranous nephrotoxicity
2nd Generation: building ability of colitis  Oral anticoagulants:
cefoxitin bacteria during cell penicillin G, as well as  CNS: headache, increased bleeding
cefprozil division. gram-negative dizziness, lethargy,  Alcohol: avoided for
cefuroxime paresthesias 72 hours after
bacteria P.mirabilis,
 Nephrotoxicity in discontinuation of the
rd
3 Generation: K.pneumoniae, E.coli. patients who have drug to prevent
cefotaxime predisposing renal disulfiram-like
cefpodoxime insufficiency reaction (e.g. flushing,
ceftazidime  Superinfections throbbing headache,
ceftibuten  Phlebitis and local nausea and vomiting,
ceftizoxime abscess at the site of chest pain,
ceftriaxone IM injection and/or IV palpitations, dyspnea,
administration. syncope, vertigo,
4th Generation: convulsions, etc.)
cefepime
ceftaroline

IV. FLUOROQUINOLO New synthetic class of Treating infections (respiratory,  Known allergy to  GI: nausea, vomiting, Drug-drug interaction:
NES antibiotics with a urinary tract, and skin) caused fluoroquinolones. diarrhea, dry mouth  Iron salts, sucralfate,
gemifloxacin broad spectrum of by susceptible strains: E.coli,  Pregnancy and lactation.  CNS: headache, mineral supplements,
levofloxacin activity. P.mirabilis, K.pneumoniae, Potential effects on the dizziness, insomnia, antacids: increased
moxifloxacin Interfere with the action P.vulgaris, M.morganii, fetus and infant are not depression therapeutic effects of
norfloxacin of DNA enzymes P.aeruginosa, H.influenzae, known; use only if  Immunological: bone fluoroquinolones.
ofloxacin necessary for growth S.aureus, S.epidermidis, benefits clearly outweigh marrow depression Administration should
and reproduction of the N.gonorrhoeae, and group D the potential risk of  Risk for tendinitis and be separated by at
bacteria. streptococci. toxicity to the fetus or tendon rupture in least 4 hours.
Has little cross- infant. patients over age 60,  Quinidine,
resistance but misuse of  Seizures. Can be on concurrent procainamide,
this drug for a short time exacerbated by the drugs’ steroids, and those pentamidine,
will lead to existence of effects on cell membrane with renal, heart, or tricyclics,
resistant strains. channels lung transplants phenothiazines:
 Photosensitivity and severe-to-fatal cardiac
severe skin reactions reactions due to

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 so advise patient to increased QTc interval
avoid sun and and/or torsades de
ultraviolet light pointes
exposure and to use  Theophylline:
protective clothing increased
and sunscreens. theophylline levels
because these two
drugs have the same
metabolic pathway
 Steroids: increased
CNS stimulation.
V. PENICILLIN & Exert bactericidal effect Treatment of streptococcal  Known allergy to  GI: nausea, vomiting,
PENICILLIN- by interfering with the infections (e.g. pharyngitis, penicillins and diarrhea, abdominal
RESISTANT ability of susceptible tonsillitis, scarlet fever, cephalosporins. pain, glossitis,
ANTIBIOTICS bacteria to build their endocarditis).  Renal disease. Drug stomatitis, gastritis,
penicillin G cell walls when they are Treatment of meningococcal excretion is reduced. sore mouth, furry
penicillin V dividing. meningitis if given at high  Pregnancy and lactation. tongue
doses. No adequate studies on  Pain and
Extended- the effect on fetus but inflammation at the
spectrum these drugs can cause injection site can
Penicillin diarrhea and occur with injectable
ampicillin superinfectons may occur forms of the drugs.
in the infant.  Hypersensitivity
Penicillin- reactions: rash, fever,
Resistant wheezing, anaphylaxis
Antibiotics with repeated
oxacillin exposures
 Superinfections, e.g.
yeast infections.
VI. SULFONAMIDES Inhibit folic acid Treatment of infections caused  Known allergy to  GI: nausea, vomiting,
Sulfasalazine synthesis. by susceptible strains: sulfonamides, diarrhea, abdominal
cotrimoxazole C.trachomatis, Nocardia, and sulfonylureas, or thiazide pain, anorexia,
some strains of H.influenzae, diuretics. Cross-sensitivity stomatitis, and
E.coli, and P.mirabilis. can occur. hepatic injury
No longer used much but they  Renal disease. Increased  Renal: crystalluria,
remain an inexpensive and toxic effects of the drug. hematuria,
effective treatment for UTIs and  Pregnancy. Can cause proteinuria, toxic
trachoma, especially in birth defects. nephrosis

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 developing countries where  Lactation. Increased risk  CNS: headache,
cost is an issue. for kernicterus, diarrhea, dizziness, vertigo,
Can also be used in treatment and rash in infants. ataxia, convulsions,
of sexually transmitted depression
diseases.  Bone marrow
Sulfasalazine is used in depression
treatment of ulcerative colitis  Dermatological:
and rheumatoid arthritis. photosensitivity, rash,
hypersensitivity
reactions
VII. TETRACYCLINES Inhibit protein synthesis Treatment of infections caused  Known allergies to  GI: nausea, vomiting,  Oral
doxycycline leading to inability of the by susceptible strains: tetracyclines or to diarrhea, abdominal contraceptives: decre
minocycline bacteria to multiply. Ricketssiae, M.pneumoniae, tartrazine pain, ased effectiveness of
tetracycline B.recurrentis, H.influenzae,  Pregnancy and glossitis, dysphagia, oral contraceptives
H.ducreyi, Bacteroides spp., lactation. Effect on fatal hepatotoxicity and additional form of
V.comma, Shigella spp., developing bones and  Skeletal and birth control is
D.pneumoniae, and S.aureus. teeth bones: weakening the needed
Adjunct in treatment of  Fungal, mycobacterial, or structure and causing  Digoxin: increased
protozoal infections. viral ocular staining and pitting of digoxin toxicity
infections. Ophthalmic teeth and bones
preparations can kill both  Dermatological:
undesired bacteria and photosensitivity and
normal flora rash
 Use in caution in children  Superinfection
below age of 8. Can  Local: pain and
potentially damage stinging with topical
developing bones and or ocular applications
teeth.  Hematologic:
 Hepatic or renal hemolytic anemia,
dysfunction.  bone marrow
depression
 Hypersensitivity
reactions:
urticaria, anaphylaxis
 Intracranial hypertens
ion

VIII. ANTIMYCOBACTE  Act on the DNA  Treatment of tuberculosis  Known allergies to  CNS: neuritis,  Rifampin, rifabutin,

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 RIALS and/or RNA of the and leprosy. antimycobacterials.  dizziness, headache, and rifapentine can
Antituberculosis bacteria, leading to  Pregnancy. Adverse malaise, drowsiness, cause discoloraion of
rifampin lack of growth and effects on fetus. Safest and hallucinations body fluids from urine
rifapentine eventually to antituberculosis regimen  GI: nausea, vomiting, to sweat and tears.
isoniazid bacterial death. in pregnancy isoniazid, anorexia, stomach They may stain
pyrazinamide ethambutol, and upset, abdominal pain orange-tinged and
ethambutol rifampin. may permanently
 Severe CNS stain contact lenses.
dysfunction. Exacerbated
by the effects of the drug
 Hepatic or renal
dysfunction. I

IX. OTHER GI: nausea, vomiting,

ANTIBIOTICS potential for
A. KETOLIDES - Ketolides a class of pseudomembranous colitis,
telithromycin antibiotics introduced in superinfections, taste
2004. It is indicated for alterations, risk for C.difficile
treatment of mild to diarrhea
moderate community-
acquired pneumonia cau
sed by susceptible
bacteria.

Lincosamides are similar

B. LINCOSAMIDES –
to macrolides but they
clindamycin
are more toxic. They are
used to treat severe
infections when
penicillin or other less
toxic antibiotics cannot
be used.

Lipoglycopeptides are
C. LIPOGLYCOPEPTID antibiotics introduced in
ES – telavancin 2010. They are used to
treat complicated skin

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 and skin-structure
infections caused by
susceptible strains of
gram-positive organisms.

Macrolides are used to

treat respiratory
D. MACROLIDES –
infections and urethritis
azithromycin,
in adults and otitis media
clarithromycin,
and
erythromycin
pharyngitis/tonsillitis in
children.
Eythromycin is the drug
of choice for
Legionnaire’s disease
and infections caused by
C.diphtheriae,
Ureaplasma spp.,
mycoplasma pneumonia,
and chlamydial
infections.

Monobactam antibiotics
are indicated for
E. MONOBACTAMS - treatment of gram-
astreonam negative enterobacterial
infections.

Nursing Considerations for Antibiotics

Nursing Assessment

1. Assess for the mentioned cautions and contraindications (e.g. drug allergies, CNS depression, CV disorders, etc.) to prevent any untoward
complications.

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2. Perform a thorough physical assessment (other medications taken, CNS, skin, respirations, and laboratory tests like renal functions tests
and complete blood count or CBC) to establish baseline data before drug therapy begins, to determine effectiveness of therapy, and to
evaluate for occurrence of any adverse effects associated with drug therapy.

3. Perform culture and sensitivity tests at the site of infection to ensure appropriate use of the drug.

4. Conduct orientation and reflex assessment, as well as auditory testing to evaluate any CNS effects of the drug (aminoglycosides).

Nursing Diagnoses

 Acute pain related to GI or CNS drug effects

 Deficient fluid volume and imbalanced nutrition: less than body requirements related to diarrhea

 Disturbed sensory perception (auditory) related to CNS drug effects

 Risk for infection related to bone marrow suppression (aminoglycosides) and repeated injections (cephalosporins).

Implementation with Rationale

1. Check culture and sensitivity reports to ensure that this is the drug of choice for this patient.

2. Ensure that patient receives full course of aminoglycosides as prescribed, divided around the clock to increase effectiveness and decrease
the risk for development of resistant strains of bacteria.

3. Monitor infection site and presenting signs and symptoms throughout course of drug therapy because failure of these manifestations to
resolve may indicate the need to reculture the site.

4. Provide safety measures to protect the patient if CNS effects (e.g. confusion, disorientation, numbness) occur.

5. Educate client on drug therapy to promote understanding and compliance.

6. Provide the following patient teaching: safety precautions (e.g. changing positions, avoiding hazardous tasks, ec.), drinking lots of fluids and
to maintain nutrition even though nausea and vomiting may occur, report difficulty breathing, severe headache, fever, diarrhea, and signs of
infection.

Evaluation

1. Monitor patient response to therapy (decrease in signs and symptoms of infection).

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2. Monitor for adverse effects (e.g. orientation and affect, hearing changes, bone marrow suppression, renal toxicity, hepatic dysfunction, etc).

3. Evaluate patient understanding on drug therapy by asking patient to name the drug, its indication, and adverse effects to watch for.

4. Monitor patient compliance to drug therapy.

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