UNIVERSITY OF SAINT ANTHONY

(Dr. Santiago G. Ortega Memorial)

Iriga City

HEALTH CARE EDUCATION DEPARTMENT

 UNIVERSITY OF SAINT ANTHONY
(Dr. Santiago G. Ortega Memorial)
Iriga City

HEALTH CARE EDUCATION DEPARTMENT

ANTIBACTERIALS

ANTIBACTERIAL DRUGS
ANTIBACTERIALS/ANTIBIOTICS

Although the terms antibacterial, antimicrobial, and antibiotic are frequently used
interchangeably, there are some subtle differences in meaning. Antibacterial and
antimicrobials are substances that inhibit bacterial growth or kill bacteria and other
microorganism’s microscopic organisms that include viruses, fungi, protozoa, and
rickettsia. Technically,

 the term antibiotic refers to chemicals produced by one kind of microorganism

that inhibit the growth of or kill another. For practical purposes, however, these
terms may be used interchangeably. Several drugs, including anti-infective and
chemotherapeutic agents, have actions similar to those of antibacterial and anti-
microbial agents. Antibacterial drugs do not act alone in destroying bacteria.
Natural body defenses, surgical procedures to excise infected tissues, and
dressing changes may be needed along with antibacterial drugs to eliminate the
infecting bacteria.

 Antibacterial drugs are either obtained from natural sources or are manufactured.
The use of moldy bread on wounds to fight infection dates back 3500 years. In
1928 British bacteriologist Alexander Fleming noted that a mold that had
contaminated his bacterial cultures was inhibiting bacterial growth.
 UNIVERSITY OF SAINT ANTHONY
(Dr. Santiago G. Ortega Memorial)
Iriga City

HEALTH CARE EDUCATION DEPARTMENT

Five mechanisms of antibacterial action are responsible for the inhibition of growth or
destruction of microorganisms:
1. inhibition of bacterial cell-wall synthesis
2. alteration of membrane permeability,
3. inhibition of protein synthesis
4. inhibition of the synthesis of bacterial ribonucleic acid (RNA) and deoxyribonucleic
acid (DNA), and
5. interference with metabolism within the cell
 UNIVERSITY OF SAINT ANTHONY
(Dr. Santiago G. Ortega Memorial)
Iriga City

HEALTH CARE EDUCATION DEPARTMENT

ANTITUBRCULARS, ANTIFUNGALAS, AND ANTIVIRALAS

●Tuberculosis caused by acid-fast bacillus Mycobacterium tuberculosis
●Pathophysiology
○Transmission of TB
■Person to person droplets
■Coughing, sneezing, talking
○Patient at risk
■Immunocompromised (e.g., patients with HIV, diabetes, and renal failure and
those taking certain medications, such as cortisol)
■Living or working in high-risk residential settings
■Injecting illegal drugs
■Health care workers with high-risk patients
○Symptoms
■Not everyone infected w/ TB will develop clinical manifestations
●Some harbor the microorganisms & have latent tuberculosis infection
○Individuals are at risk of developing TB later
■Anorexia
■Cough with sputum production or blood
■Chest pain
■Fever, night sweats, chest pain
■GI distress, weight loss, anorexia
■Positive acid-fast bacilli in the sputum or blood sputum
○Prophylaxis (action to prevent disease) recommended for those
■Close contact with active TB
 UNIVERSITY OF SAINT ANTHONY
(Dr. Santiago G. Ortega Memorial)
Iriga City

HEALTH CARE EDUCATION DEPARTMENT

■HIV positive/ immunocompromised

■Conversion from negative to positive TB
■Latent TB infection
■Injection drug users
■Recent immigrant from high-prevalence country
●Antitubercular drugs
○Include antimycobacterials
○Drug selection
■First-line drug
■Inhibits bacterial cell wall synthesis & blocks pyridoxine (vitamin B6),
which is used for intracellular enzyme production
●Isoniazid (ai·suh·nai·uh·zuhd) - INH
○Pyridoxine may also be prescribed to avoid vitamin B
deficiency and to minimize peripheral neuropathy
○Administered PO
●Rifampin
●Pyrazinamide
●Ethambutol
●Are considered more effective and less toxic than drugs used in the
treatment of drug-resistant TB
○When to treat latent TB infection
■HIV positive
■Recent contact of someone with active TB
■Persons with fibrotic changes on chest radiography consistent with
oldTB
■Organ transplant recipients
 UNIVERSITY OF SAINT ANTHONY
(Dr. Santiago G. Ortega Memorial)
Iriga City

HEALTH CARE EDUCATION DEPARTMENT

■Immunosuppressed for other reasons; those taking tumor necrosis

factor alpha [TNF-α] antagonists
○Prophylactic antituberculars
■Drugs to prevent TB disease in individuals with latent TB infection
■Recommended for significant result on tuberculin skin testing (≥5 mm
for immunocompromised individuals or ≥10 mm for high-risk
groups)
■Positive IGRA result
■Pts who converted from a (-) to (+) TB skin test (TST)
■Pts who converted from a (+) to (-) TB skin test (TST)
■Contraindications
●Liver disease
○May cause INH-induced liver damage
■Using a combination of antitubercular drugs has been shown to
decrease bacterial resistance
●Also decreases the duration of the treatment
■Drug combinations with INH
●Rifampin
●Ethambutol
●Pyrazinamide
○Combination therapy
■Minimum of 3-5 drugs
■Initial phase
●Lasts 2 months
■Continuation phase
●Next 4-7 months
 UNIVERSITY OF SAINT ANTHONY
(Dr. Santiago G. Ortega Memorial)
Iriga City

HEALTH CARE EDUCATION DEPARTMENT

○Side effects
■For INH
●Peripheral neuropathy
○Pts who are malnourished, have DM, or are alcoholics are at a higher risk
○Condition can be prevented if pyridoxine (vitamin B6) is administered
■For Rifampin
●Turns body fluids orange
●Thrombocytopenia (low blood platelet count)
●GI intolerance
■For ethambutol
●Dizziness, confusion, hallucinations, and joint pain
■ For streptomycin
●Ototoxicity
●Optic nerve toxicity
●Encephalopathy
●Angioedema
●(CNS) and respiratory depression
●Nephrotoxicity
●Hepatotoxicity
■More general
■Urine, sweat, stool may turn red orange color
■Headaches, blood dyscrasias, paresthesias, gastrointestinal (GI) distress
■Ocular toxicity
●Ophthalmic exam before and during treatment is warranted
■Tremors, rash, blurred vision
■Dizziness, GI disturbances
 UNIVERSITY OF SAINT ANTHONY
(Dr. Santiago G. Ortega Memorial)
Iriga City

HEALTH CARE EDUCATION DEPARTMENT

■Hypophosphatemia, and hypocalcemia

○Adverse Reactions
■Hepatotoxicity, yellow discoloration of the skin
●Pts should have hepatic transaminases monitored closely
■Thrombocytopenia, agranulocytosis
■Seizures, peripheral neuropathy
○Nursing process for Antitubercular drugs
■Assess
●Last purified protein derivative (PPD) tuberculin test and the reaction or the serum
IGRA result
●CXR (chest radiograph) & result
●Allergies
●Labs and abnormal s/s - liver function studies, bilirubin, blood urea nitrogen (BUN),
and serum creatinine
●Last ophthalmic exam
○Assess for hearing changes if regimen includes streptomycin (aminoglycoside)
○Drug- induced ototoxicity is the major irreversible toxicity aminoglycosides
●Health hx - most antitubercular drugs are contraindicated if the patient
has severe hepatic disease
●s/s of paresthesia (tingling, numbness, or burning) (
■Interventions
●Administer INH 1 hour before or 2 hours after meals; food decreases the absorption
rate
●Give pyridoxine (vitamin B6) w/ INH to prevent peripheral neuropathy
●Monitor hepatic function tests
●Collect sputum specimens for acid-fast bacilli early in the morning
●Encourage eye examinations for patients taking INH and ethambutol
 UNIVERSITY OF SAINT ANTHONY
(Dr. Santiago G. Ortega Memorial)
Iriga City

HEALTH CARE EDUCATION DEPARTMENT

because these anti tubercular drugs may cause visual disturbances

●Emphasize the importance of complying with drug regimen,
take all meds as ordered
●Fungal infections