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TETRACYCLINES
Isolated from AMINOGLYCOSIDES
1st broad spectrum antibiotics effective against
gram (+) bacteria & many organisms
Not effective against S. aureus, Pseudomonas or Examples:
Proteus 1)paromomycin -useful in treating
Can be used against Mycoplasma pneumoniae intestinal amebiasis & tapeworm
2)neomycin- used as preoperative bowel
Combined with Metronidazole and bismuth antiseptic
subsalicylate == Others: (treat pseudomonas)
gentamicin (1963)[IM/IV] - against gram (-) esp.
ORAL and TOPICAL tetracycline – used to treat pseudomonas
kanamycin[PO/IM/IV]- for hepatic coma
MOA tobramycin (1970)[IM/IV] - kill Pseudomonas
INHIBIT BACTERIAL PROTEIN SYNTHESIS amikacin (1970) [IM/IV] - effective against
continuous use of tetra – resulted in bacterial Pseudo esp. if resistant to gentamicin &
resistance; increased resistance in the treatment tobramycin
of pneumococci & gonococci infections netilmicin (1980)[IM/IV] - less toxic compared to
other aminoglycosides
CLASSIFICATIONS
 SHORT ACTING SIDE EFFECTS :
tetracycline {Tetracyn, Panmycin} gram (+), gram GI- NAV; rash, numbness, tremors
(-), RT & skin disorders,
[t ½ = 6-12 hrs] ADVERSE REACTIONS:
oxytetracycline Hcl {terramycin} for UTI URTICARIA, PALPITATIONS
 INTERMEDIATE Thrombocytopenia
demeclocycline HCl (Declomycin) - broad Superinfections
spectrum Liver damage
[t ½ = 10-17 hrs] Most serious:
 LONG-ACTING OTOXICITY –
doxycycline hyclate (Vibramycin) for bacterial NEPHROTOXICITY –
infection & acne NEUROTOXICITY-
minocycline HCl (Minocin) [t ½ = 11-20 hrs]
DRUG INTERACTIONS :
Frequently prescribed for ORAL use, available also Penicillin – less effective aminoglycoside
for IM ,IV route – Anticoagulant (Warfarin)– increased its activity =
BLEEDING
newer ORAL drugs : DOXYCYCLINE, MINOCYCLINE,
METHACYCLINE : rapidly & complete absorbed, NURSING INTERVENTIONS
not to be taken with MAGNESIUM and Monitor periodical audiograms, BUN/creatinine &
ALUMINUM preparation (antacids), MILK- vestibule function studies over 10 days therapy
PRODUCTS containing calcium or Iron-containing Adjust renal insufficiency
drugs == Monitor VS, peak and serum levels
TAKEN on EMPTY STOMACH – 1 hr ac or 2 hrs pc For IV admin., dilute and administer slowly to
(except doxycycline & minocycline) prevent toxicity
Monitor I & O,
SIDE EFFECTS and ADVERSE REACTIONS
GI- NVD If anorexia or nausea occurs,
PHOTOSENSITIVITY Establish plan for safely if
TERATOGENIC EFFECT – not taken 1st trimester –
PC : D Administer other antibiotics 1 hour before/after
Discolors teeth (irreversible) == not taken last amino
trimester & children < 8yrs Recommend using sunblock & protective clothing
Balance difficulty – when exposed to the sun.
NEPHROTOXICITY
SUPERINFECTION
MACROLIDES
Education Used fr Mild to moderate infections of the RT
S unlight sensitivity sinuses, GIT, skin, soft tissues; diphtheriae,
T ake full glass of H20 impetigo, STD
Θ antacid, IRON & MILK
P ut drug into empty stomach  ERYTHROMYCIN (1950s) (Erythrocin,
Erymax)
DRUG INTERACTIONS derived from S
ANTACIDS, IRON containing drugs, MILK – prevent most commonly prescribed if with allergy to
absorption of Tetra {take 2 hrs apart}
ORAL CONTRACEPTIVES – effective against gram (+) and some gram (-)
PENICILLIN – except S. aureus
AMINOGLYCOSIDES – DRUG OF CHOICE:
Nephrotoxicity
 2

Prevention of Rheumatic Fever

PC: B
MOA: inhibits CHON synthesis, BACTERIOSTATIC Side Effects: NAVDA is common, TAKE with
/BACTERICIDAL FOOD, or within 1 hr of eating
CI: Hepatic disease, Lactation
NURSING CARE
PHARMACOKINETICS Do not refrigerate suspension form of
PO form is well-absorbed in the duodenum; ACID Klarithromycin
resistant salts (ETHYLSUCCINATE STEARATE, Monitor liver enymes –
ESTOLATE) are added to decrease dissolution, Administer IV slowly
increase absorption in the intestines; FOOD does Give IM into deep muscle
not hamper absorption of ACID resistant Avoid fruit juices
macrolides. Manage NAVDA
Check for superinfections.
SIDE EFFECTS : NAVDA, PRURITUS, RASH, Check drug interactions.
TINNITUS Evaluate effectiveness: WBC level , temperature,
ADVERSE EFFECTS : Superinfections, Urticaria, cultures
Hearing loss, Hepatotoxicity [“yellow sclera”],
jaundice, anaphylaxis LINCOSAMIDES
Similar to macrolides but more toxic
Change CHON function & prevent cell division or
DRUG INTERACTIONS: cause cell death (both)
Acetaminophen, Phenothiazine, Sulfonamide -----
↑ HEPATOTOXICITY (reversible) Examples:
↑ Effect of DIGOXIN, CARBAMAZEPINE, 1. CLINDAMYCIN [Cleocin]
THEOPHYLLINE, CYCLOSPORINE, WARFARIN, widely prescribed against most gram (+) organism;
TRIAZOLAM absorbed better, more effective, fewer toxic
↓Effect of PCN, CLINDAMYCIN for severe infections caused by same strains of
↓ absorption if taken with ANTACIDS bacteria that are susceptible to macrolides
Erythromycin + Verapami, Diltiazem, [A] rapidly absorbed from GIT or from IM
Clarithromycin, Fluconazole = elevate Erythro injections
concentration = [D] t ½ = 2-3 hrs – PB: 94%; crosses the
placenta & enters breastmilk
PC : B
EXTENDED MACROLIDE GROUP [M] liver – caution – HEPATIC & RENAL
1. azithromycin (ZITHROMAX) impairment
Indications: mild-moderate streptomycin infection, [E] urine & feces
RTI, gonorrhea, chancroid {STD}, H. influenzae, SIDE EFFECTS = GI reaction- pseudomembranous
Strep. , S. aureus colitis; GI irritation
PC:C
2. LINCOMYCIN (Lincocin)
to treat severe infections when penicillin cannot
be given
[A] rapidly absorb in GIT or from IM
injections
Side Effects: [D] t ½ = 5 hrs
NAVDA is uncommon, give AC./ 1 hr ac or 2 hr pc [M] liver – caution – hepatic & renal
impairment
IV PREP – must be diluted in NSS or D5W – [E] urine & feces
TOXIC EFFECTS : GI reaction, Pain, Skin infection,
BM depression
2. Clarithromycin (KLARICID) NSG CARE: SAME WITH MACROLIDES –
Indications: RTI, gram (-) & (+), tissue infections, CAREFUL MONITORING
H. pylori GI activity & fluid balance
PC :C STOP if with bloody diarrhea

VANCOMYCIN HCl (Vancocin)

Side Effects:NAVDA is common, TAKE with
MILK/MEAL
used against drug-resistant S. aureus and in
3. dirithromycin (DYNABAC) cardiac surgical prophylaxis with PEN allergies;
Indications: CHRONIC BRONCHITIS, URTI, CAP, potentially life-threatening infections not
Skin Infections, H. pylori, Legionnaire’s disease, responding to other less toxic antibiotics.
Chlamydia MODE OF ACTION: BACTERICIDAL
PC : C Pharmacokinetics:
ORAL – not absorbed systemically, excreted in the
feces

IV – for severe infections due to MRSA, septicemia,
bone, skin and lower respiratory tract infections
that are resistant to other antibiotics
- excreted in the urine
PB: 30% Half-life : 6 hours
DRUG INTERACTIONS:
= if with amphotericin B, polymycin, furosemide,
cisplatin - ↑ NEPHROTOXICITY
= if with methotrexate - ↑ methotrexate toxicity
Side effects and Adverse reactions:
- chills, dizziness, fever, rashes, nausea, vomiting,
thrombophlebitis @ injection site
DOSE RELATED TOXICITY:
tinnitus, high tone deafness, hearing loss &
nephrotoxicity.
RAPID IV INFUSION:
NURSING CARE
Refrigerate IV solution after reconstruction, use
within 96 hrs.
Flush IV line in between antibacterials. Evaluate IV
site for phlebitis, avoid extravasation.
Ensure safety
Check baseline hearing. Refer to EENT. Report
ringing in ears or hearing loss, fever and
sorethroat.
Monitor blood pressure during administration
Monitor renal function tests- Creatinine, BUN and
urine output ;and Liver enzymes
Yogurt for superinfection.
Check for pregnancy & lactation
FLUOROQUINOLONES
MODE OF ACTION: interfere with the enzyme DNA
gyrase; Broad spectrum bactericidal
I. NALIDIXIC ACID (Negram) / CINOXACIN
(Cinobac)
II. CIPROFLOXACIN (Cipro) / NORFLOXACIN
(Noroxin)
III. LEVOFLAXACIN (Levaquin)/SPARFLOXACIN
(Zagam)/ TROVAFLOXACIN (Trovan)
Treat respiratory problems (CAP), chronic
bronchitis, acute sinusitis, UTI & skin infections.
IV. GATIFLOXACIN (Tequin)/
MOXIFLOXACIN (Avelox) = 1999
OD dosing more active than Levofloxacin against S.
pneumoniae
Side Effects:
photosensitivity ->>> use sunglasses, sunblock,
protective clothing
Dizziness, N/V, diarrhea, flatulence, abdominal
cramps, tinnutis, rash
NURSING MANAGEMENT
Assess RENAL function
Drug & diet history
Avoid caffeine
3
Antacids & Iron prep = decreases absorption of
Fluoroquinolones
Monitor serum theophylline & blood glucose
levels- with Theo, caffeine, Oral hypoglycemics =
With NSAIDS =
Administer 2 hrs ac or after antacids
With IRON preparation =
IV – infuse over 30 mins, dilute with approximate
amount
Check signs & symptoms of SUPERINFECTIONS
Check symptoms of CNS stimulation =
nervousness, insomnia, anxiety & tachycardia
SULFONAMIDES
“sulfa drugs”
First isolated from a COAL TAR derivative
compound in early 1900; produced for clinical use
against coccal infections in 1935.
First group of drugs used against bacteria
MODE OF ACTION
Inhibit bacterial synthesis of FOLIC ACID, essential
for bacterial growth, necessary for synthesis of
PURINE & PYRIMIDINES, which are precursors of
RNA & DNA
Remain inexpensive & effective against UTI,
trachoma, ear infection, newborn eye prophylaxis
90% effective against E. coli; useful in treatment
of meningococcal meningitis & against organisms
Chlamydia & Toxoplasma gondii; not effective
against viruses & fungi
PHARMACOKINETICS
[A] well absorbed by the GIT;
[M] liver
[D] well distributed to body tissues and brain
[E] urine
PHARMACODYNAMICS
Many for ORAL administration
Also in solution & ointment for ophthalmic use
and in cream form = SILVER SULFADIAZINE
(silvadene) and MAFENIDE ACETATE (Sulfamylon)
Most – highly protein bound & displaced other
drugs by competing for CHON sites
2 CLASSIFICATIONS
I. SHORT ACTING:
A. SULFADIAZINE - ORAL AGENT W/
BROAD SPECTRUM USE
- slowly absorbed from GIT,
peak 3-6 hr
- poorly soluble in urine, cause
crystallization; can damage
kidneys if < H20 intake
B. SULFISOXAZOLE (Gantrisin) – broad
spectrum ; recommended by CDC for
treatment of STD
- useful with Sulfadiazine in
prophylactic treatment of streptococcal infection-
Rheumatic fever; hypersensitive to Penicillin
- rapidly absorbed from GIT,
peak 2 hr
- excreted in urine, t ½ = 4.5 -7.8
hrs
II. INTERMEDIATE
a. SULFAMETHOXAZOLE (Gantanol)

- poorer water solubility than Sulfisoxazole
b. SULFASALAZINE (Azulfidine)
- used to treat ULCERATIVE COLITIS and CROHN’s
disease
- carried by AMINOSALICYLIC ACID (Aspirin)
- rapidly absorbed from GIT, peak levels 2-6 hrs
c. COTRIMOXAZOLE (Septra, Bactrim)
- combination drug of Sulfamethoxazole &
trimethoprim (synergistic effect)
- effective in treating otitis media, bronchitis, UTI
and pneumonitis by Penumocystis Carinii
- DOC : Penumocystis Carinii Pneumonia (PCP)
- infused over 60-90 minutes; no IM
[A] rapidly from the GIT; peak 2 hrs
[M] liver
[E] urine ;t ½ 7-12 hrs
PC : Teratogenic- birth defects -
Kernicterus ;
III. LONG ACTING SULFA
sulfametopyrazine PO - dermatitis herpetiformis
& malaria
sulfameter - leprostatic agent & UTIs
THERAPEUTIC ACTION:
Competitively block PARA-AMINOBENZOIC
ACID(PABA) to prevent synthesis of Folic acid in
susceptible bacteria that synthesize their own
folates for production of DNA & RNA
ADVERSE EFFECTS/SIDE EFFECTS
rash, itching
BLOOD : hemolytic anemia, aplastic anemia,
pancytopenia (prolonged and high dosages)- due
to BM depression
GI : anorexia, N/V
CRYSTALLURIA (crystals in urine); hematuria
(sulfonamides are insoluble in acid urine)
{Increase OFI – dilutes the drug}
Adverse effects…
Photosensitivity
Cross-sensitivity – with different sulfonamides
Hepatotoxicity & nephrotoxicity
Superinfections
Hypersensitivity reaction = STEVEN’S JOHNSONS
SYNDROME {D/C drug}
CNS effects : HA, dizziness, vertigo, ataxia,
convulsions, depressions
DRUG INTERACTIONS:
Increase effects of Warfarin
Decrease absorption if taken with antacids
Increase hypoglycemic effect of sulfonylureas
Decrease effectiveness of contraceptives
NURSING CARE
Baseline S. crea, BUN, urine output
Increase OFI- 2,000 ml/day or administer with full
glass of H20
Baseline CBC, liver enzymes
Monitor VS, check for fever & bleeding
Observe for hematologic reaction that may lead
to life-threatening anemias; monitor signs of
sorethroat, purpura
Check for signs of superinfections
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Administer 1 hr ac or 2 hrs pc with 1 glass of water
Avoid/limit sun exposure, use sunblock
Not to be taken with antacids
Avoid during last trimester of pregnancy
S unlight sensitivity
U ndesirable effects –
RASH, RENAL TOXICITY
L ook for urine output,
fever, sore throat & bleeding
F luids galore
A norexia, anemia
UNCLASSIFIED ANTIBACTERIAL DRUGS
SPECTINOMYCIN HYDROCHLORIDE (Trobicin)
I
QUINUPRISTIN / DALFOPRISTIN (Synercid)
Treat VREF –
Disrupts CHON synthesis of the organism
When administered through peripheral IV line =
SE: N/V, diarrhea, pseudomembranous colitis
NURSING CARE :
Check for DHN, monitor stools
Check for patency of IV line; infuse over 1 hr in
D5W
Check for S/S of anaphylaxis
Monitor ALT, AST, jaundice, icteric eyes
Give ice chips, SFF
PEPTIDES
- derived from cultures of
 POLYMYXIN
Interferes with cellular membrane
Affects gram (-) like E. coli, P. auruginosa,
klebsiella, shigella
Not absorbed orally
IM causes pain;Best given slow IV
SE: dizziness
AE: nephrotoxicity/ neurotoxicity
 BACITRACIN
Inhibits cell wall synthesis
Most gram (+), some gram (-), can treat meningitis
Not absorbed by GIT
Given IM/IV
SE: N/V
AE: nephrotoxicity, respiratory paralysis, blood
dyscrasia, anaphylaxis