PHARMACOLOGY

UNIT 2
ANTI-MICROBIAL DRUGS
By Mr Asif Ali Lashari
RN, DP, PostRN BScN
NURSING LECTURER
 Objectives
By the end of the presentation students will be able to
• know common terms and concepts related to
antimicrobial therapy
• Discuss mechanism of action and indication of using
antimicrobial therapy
• State appropriate nursing implication for a client
receiving antimicrobial drugs.
• Discuss general principles and consideration
• Calculate the drug dosage for oral and parental
antimicrobial drugs.
 Terms
• Infection: when a foreign organism enters a person’s body
and causes harm.

• Bacteremia: an invasion of the bloodstream by bacteria.

• Colonization of pathogens: Colonization of bacteria

develops when a pathogen grows on a host's tissues that
would normally not allow such growth.

• Sepsis: a serious condition resulting from the presence of

harmful microorganisms in the blood or other tissues and the
body’s response to their presence, potentially leading to the
malfunctioning of various organs, shock, and death.
Terms
• Inflammation is a defense mechanism in the body
initiated by the immune system recognizes damaged
cells, irritants, and pathogens, and it begins the healing
process.
• Fever or pyrexia, abnormally high body temperature.
Fever is a characteristic of many different diseases
• Antibiotic: Chemical substances that kill or stop the
growth of bacteria.
• Antiseptic: Prevent the growth and development of
pathogens without necessarily killing them.
 Conti…
Prebiotics:
• Non digestible food ingredients that selectively
stimulate growth or activity of limited number of
bacteria in the colon that have the potential to
improve host health.
Probiotics:
• Non pathogenic microorganism resistant to acid and
bile that can adhere to epithelial tissue, transiently
colonize GI, produce antimicrobial, modulate
immune response and influence metabolic activity in
intestinal flora.
 Terms
Transpeptidation:
• Reaction involving the transfer of one or more amino acids
from one peptide chain to another, as by transpeptidase
action, or of a peptide chain itself, as in bacterial cell wall
synthesis.
trans·pep·ti·dase:
• An enzyme catalyzing a transpeptidation reaction; many
proteolytic enzymes (for example, trypsin, papain) act as
transpeptidases in the course of proteolysis, forming an
acylated enzyme as an intermediate in the process; for
example, γ-glutamyl transpeptidase. Peptidoglycan (murein)
is a polymer consisting of sugars and amino acids that forms
a mesh-like layer outside the plasma membrane of most
bacteria, forming the cell wall.
 Terms
Microbiota
• Are "ecological communities” of commensal,
symbiotic and pathogen microorganisms found in
and on all multicellular organisms studied to date
from plants to animals. Micro-biota includes bacteria,
archaea , protists, fungi and viruses. Micro-biota
have been found to be crucial for immunologic,
hormonal and metabolic homeostasis of their host.
• The synonymous term micro-biome describes
either the collective genomes of the microorganisms
that reside in an environmental niche or the
microorganisms themselves.
 Terms
• Empiric: Infecting organism not yet identified.
More broad spectrum.
• Definitive: Organism Identified and specific therapy is chosen.
More narrow spectrum.
• Prophylactic: Prevents initial infection or its recurrence after
infection.
• Antibiotic resistance occurs when bacteria change in some
way that reduces or eliminates the effectiveness of drugs,
chemicals, or other agents designed to cure or prevent
infections. The bacteria survive and continue to multiply
causing more harm. Bacteria can do this through several
mechanisms.
Microbes

• Microbes are tiny living things that are found all around us and
are too small to be seen by the naked eye. They live in water,
soil, and in the air.
• The human body is home to millions of these microbes too,
also called microorganisms.
• Some microbes make us sick (pathogens), others are
important for our health. The most common types are bacteria,
viruses and fungi. There are also microbes called protozoa.
These are tiny living things that are responsible for diseases
such as toxoplasmosis and malaria
Types
• Bacteria, viruses, fungi, protozoa, parasites, and
prions are different types of pathogen. They vary in
their size, shape, function, genetic content, and
how they act on the body.

• For example, viruses are smaller than bacteria,

and they can enter a host and take over cells.
However, bacteria can survive without a host.

• Treatment will depend on the type of pathogen .

 Antimicrobial Therapy

• The terms antimicrobial, antibiotic, and anti-infective

encompass a wide variety of pharmaceutical agents
that include antibacterial, antifungal, antiviral, and
anti parasitic drugs. Of these, antibacterial agents
are by far the most commonly used.
• Use of specific chemical or pharmaceutical agents to
control or destroy microorganisms, either
systemically or at specific sites is known as
antimicrobial therapy.
Basic concepts
• Antibiotic therapy has made many advances that
has given veterinary medicine a large number of
effective drugs and provided pharmacokinetic and
pharmacodynamics information to guide dosing.

• New approaches to bacterial identification and

susceptibility testing has helped to provide
information for the most appropriate drug selection.

Veterinary: relating to disease,injury and treatment

Basic concepts
• Bacteria may be identified when a patient has an
infection using a culture and sensitivity test or a
gram stain test.
• Antimicrobials may be classified as broad-spectrum
or narrow-spectrum, based on the variety of bacteria
they effectively treat.
• Additionally, antibiotics may be bacteriostatic or
bactericidal in terms of how it targets the bacteria.
Finally, the mechanism of action is also considered
in the selection of an antibiotic.
Concepts
Culture and Sensitivity:

• A culture is a test performed to examine different

body substances for the presence of bacteria or
fungus. These culture samples are commonly
collected from a patient’s blood, urine, sputum,
wound bed, etc. Nurses are commonly responsible
for the collection of culture samples and must be
conscientious to collect the sample prior to the
administration of antibiotics
Conti…

• A sensitivity analysis is often performed in order to

select an effective antibiotic to treat the
microorganism. If the organism shows resistance to
the antibiotics used in the test, it is determined that
those antibiotics will not provide effective treatment
for the patient’s infection. Sometimes a patient may
begin antibiotic treatment for an infection, but will be
switched to a different, more effective antibiotic
based on the culture and sensitivity results.
Conti…
• Streptococcus, the name which comes from the
Greek word for twisted chain, is responsible for
many types of infectious diseases in humans.
Streptococcus is an example of a Gram +
infection and is identified by its ability to lyse, or
breakdown, red blood cells when grown on blood
agar.
Conti…
• Gram negative bacteria often grow between aerobic and
anaerobic areas (such as in the intestines). Some gram
negative bacteria cause severe, sometimes life-
threatening disease. The genus Neisseria , for example,
includes the bacteria N. gonorrhoeae, the causative agent
of the sexually transmitted infection gonorrhea, and N.
meningitides, the causative agent of bacterial meningitis.
Broad-Spectrum vs. Narrow-Spectrum
Antimicrobials
• A narrow-spectrum antimicrobial targets only
specific subsets of bacterial pathogens. For
example, some narrow spectrum drugs only target
gram-positive bacteria, but others target only gram-
negative bacteria.
• A broad-spectrum antimicrobial targets a wide
variety of bacterial pathogens, including both gram-
positive and gram-negative species, and is
frequently used as empiric therapy to cover a wide
range of potential pathogens while waiting on the
laboratory identification of the infecting pathogen .
Problem, or Resistant Bacteria
• If the organism is Pseudomonas aeruginosa,
Enterobacter, Klebsiella, Escherichia coli, or
Proteus, resistance to many common antibiotics is
possible and a susceptibility test is advised. For
example, a recent report showed that among
nonenteric E. coli, only 23% were sensitive to a 1st
generation cephalosporin, and less than half were
sensitive to ampicillin.
Concepts….
• BACTERIAL SUSCEPTIBILITY
• Susceptibilty:the state or fact of being likely or
liable to be influenced or harmed by a particular
thing.
• If the bacteria is accurately identified, antibiotic
selection is simplified because the susceptibility
pattern of many organisms is predictable. For
example, if the bacteria is likely to be Pasteurella,
Streptococcus , or Actinomyces, susceptibility is
expected to penicillin or an aminopenicillin such as
ampicillin, amoxicillin, or amoxicillin-clavulanic acid
(Clavamox).
 PENETRATION TO THE SITE OF INFECTION
• For most tissues, antibiotic drug concentrations in the serum
or plasma, approximate the drug concentration in the
extracellular space (interstitial fluid). This is because there is
no barrier to drug diffusion from the vascular compartment to
extracellular tissue fluid.
Diffusion Into Tissues
• Diffusion of most antibiotics from plasma to tissues is limited
by tissue blood flow, rather than drug lipid solubility. This has
been called “perfusion-rate limited” drug diffusion. If adequate
drug concentrations can be achieved in plasma, it is unlikely
that a barrier in the tissue will prevent drug diffusion to the
site of infection as long as the tissue has an adequate blood
supply.
Conti…
• In some tissues, a lipid membrane (such as tight
junctions on capillaries or continuous basement
membrane) presents a barrier to drug diffusion.
This has been called “permeability-rate limited”
drug diffusion. In these instances, a drug must be
sufficiently lipid-soluble or be actively carried
across the membrane in order to reach effective
concentrations in tissues. These tissues include:
the central nervous system, eye, and prostate.
There also is a barrier between plasma and
bronchial epithelium.
Conti…
• Intracellular Infections
 Most bacterial infections are located extracellular, and
a cure can be achieved by attaining adequate drug
concentrations in the extracellular (interstitial) space
rather than intracellular space. However, intracellular
infections present another problem. For drugs to reach
intracellular sites, they must be carried into the cell or
diffuse passively. If cell penetration relies on passive
diffusion, only lipid-soluble drugs will be able to diffuse
through the cell membrane. Intracellular organisms such
as Brucella, Chlamydia, Rickettsia, Bartonella, and
Mycobacteria are examples of intracellular pathogens.
Concepts…
LOCAL FACTORS THAT AFFECT ANTIBIOTIC
EFFECTIVENESS
• Local tissue factors may decrease antimicrobial
effectiveness. For example, pus and necrotic debris
may bind and inactivate vancomycin or
aminoglycoside antibiotics (gentamicin or amikacin),
causing them to be ineffective. Cellular material also
can decrease the activity of topical agentsn such as
polymyxin B. Foreign material in a wound (such as
material surgically implanted) can protect bacteria
from antibiotics and phagocytosis by forming a biofilm
(glycocalyx) at the site of infection
Generation of antibiotics
• Generation term comes only in case of penicillin and
cephalosporin's (Beta lactam antibiotic) and depending on
their action on the cell wall of gram positive and gram negative
bacteria. They are classified by using terms broad spectrum
and narrow spectrum antibiotics.
1st Generation Antibiotics
• Have a narrow spectrum of clinical use (this means there are
only a few organisms that they are able to successfully treat
with this class of penicillin) • good for common gram-positive
bacteria that cause ear and throat infections, venereal
diseases of gonorrhea and syphilis, and staph infections due
to Staphylococcus aureus that cause abscesses, endocarditis
and pneumonia. A very high number of the drugs in this group
are resistant to organisms that produce Penicillinase.
1st Generation Antibiotics
2nd Generation Antibiotics:
• Have an extended or Intermediate spectrum of clinical use (Some
gram +ve and gram-ve). • Work equally as well as penicillin G class
plus effective against Escherichia coli, Proteus mirabilis and
Haemophilus influenzae which are associated with urinary,
respiratory and ear infections • Not very effective against
penicillinase producing organisms.
Third generation:
• cephalosporin drugs are broad spectrum and the effective against
both gram positive and gram negative bacteria. However their
optimum activity is against gram negative bacteria. • used in the
treatment of serious urinary, respiratory and bacteremic infections
due to gram-negative Pseudomonas aeruginosa and Proteus
vulgaris
• Not resistant to penicillinase-producing organisms
Conti…
4th Generation Antibiotics:
• These are extended spectrum antibiotics. They are not
resistant to Beta lactumase producing microorganisms. used
for serious infections due to Pseudomonas aeruginosa,
Proteus vulgaris, Klebsiella pneumoniae and Bacteroides
fragilis in combination with other antibiotics.

5th Generation Antibiotics:

• Extended spectrum Antibiotics. Examples: Cephtaroline:
Pneumonia, skin and soft tissue infection Cephtobiprole:
Methicillin resistant Staphylococcus aureus.
Mechanism of antimicrobial therapy
• Antimicrobial therapy takes the advantage of the biochemical
differences that exist between human beings and
microorganisms.

• Antimicrobial drugs are effective in the treatment of the

infections because of their selective toxicity.

• That is why they have the ability to injure or kill invading

microorganism without harming the cells of the host.

• Antimicrobial agents may exert their bacteriostatic or

bactericidal effects in one of four major ways:
Conti…
A. Bactericidal
• 1. Inhibit bacteria cell wall synthesis: affect the integrity of cell
wall that maintain osmotic pressure for transportation.
• 2. Disrupt or alter membrane permeability: leakage of
essential metabolic substance.

B. Bacteriostatic
• 3. Inhibit protein synthesis: Induce the formation of defective
protein Molecules.
• 4. Inhibit the essential metabolites: Resemble physiologic
compound act as competitive inhibitors in a metabolic
pathway.
BACTERICIDAL & BACTERIOSTATIC ACTIVITY
• In some clinical situations, it is essential to use a bactericidal
drug rather than a bacteriostatic one. A bactericidal drug kills
bacteria, whereas a bacteriostatic drug inhibits their growth but
does not kill them (Figure).
• The salient features of the behavior of bacteriostatic drugs are
that (1) the bacteria can grow again when the drug is
withdrawn, and (2) host defense mechanisms, such as
phagocytosis, are required to kill the bacteria. Bactericidal
drugs are particularly useful in certain infections (e.g., those
that are immediately life-threatening; those in patients whose
polymorphonuclear leukocyte count is below 500/μL; and
endocarditis, in which phagocytosis is limited by the fibrinous
network of the vegetations and bacteriostatic drugs do not
effect a cure).
BACTERICIDAL & BACTERIOSTATIC ACTIVITY
Figure elaboration
• Bactericidal and bacteriostatic activity of antimicrobial
drugs. Either of them is added to the growing
bacterial culture at the time indicated by the arrow.

• After a brief lag time during which the drug enters the
bacteria, the bactericidal drug kills the bacteria and
decrease in the number of viable bacteria occurs.

• The bacteriostatic drug causes the bacteria to stop

growing, as indicated by the dotted line, but if the
bacteriostatic drug is removed from the culture, the
bacteria resume growing.
Mechanism
Mechanism
MECHANISMS OF ACTION
1. Inhibition of Bacterial Cell Wall Synthesis
• Penicillins (and cephalosporins) act by inhibiting
transpeptidases, the enzymes that catalyze the final cross-
linking step in the synthesis of peptidoglycan. penicillin binds
to a variety of receptors in the bacterial cell membrane and cell
wall. Penicillin is bactericidal, but it kills cells only when they
are growing. When cells are growing, new peptidoglycan is
being synthesized, and transpeptidation occurs.
2. INHIBITION OF PROTEIN SYNTHESIS
• Several drugs inhibit protein synthesis in bacteria without
significantly interfering with protein synthesis in human cells.
This selectivity is due to the differences between bacterial and
human ribosomal proteins, RNAs, and associated enzymes.
Bacteria have 70S ribosomes with 50S and 30S subunits,
whereas human cells have 80S ribosomes with 60S and 40S
subunits.
• The S stands for svedberg unit. It characterizes the behavior of
a particle type in sedimentation processes, notably
centrifugation. The svedberg is technically a measure of time,
and is defined as exactly 10-13 seconds (100 fs).
• Basically 70S and 80S ribosomes have different sedimentation
coefficients meaning it takes a different amount of time to form a
pellet when centrifuged.
Conti…
SYNTHESIS:
• Several drugs inhibit protein synthesis in bacteria without
significantly interfering with protein synthesis in human cells.
This selectivity is due to the differences between bacterial
and human ribosomal proteins, RNAs, and associated
enzymes. Chloramphenicol, erythromycin, clindamycin, and
linezolid act on the 50S subunit, whereas tetracyclines and
minoglycosides act on the 30S subunit.
Guide lines/Principles of antimicrobial
therapy

• 1. SELECTING AND INITIATING AN ANTIBIOTIC

REGIMEN:
• Obtaining an accurate infectious Disease Diagnosis. An
infectious disease diagnosis is reached by determining the site
of infection, defining the host (eg, immunocompromised,
diabetic, of advanced age), and establishing, when possible, a
microbiological diagnosis.
• It is critical to isolate the specific pathogen in many serious,
life-threatening infections, especially for situations that are
likely to require prolonged therapy (eg, endocarditis, septic
arthritis, disk space infection, and meningitis).
Conti….
• To optimize an accurate microbiological diagnosis, clinicians
should ensure that diagnostic specimens are properly
obtained and promptly submitted to the microbiology
laboratory, preferably before the institution of antimicrobial
therapy.

• Although the microbiological diagnosis is ideally based on

data such as bacterial or fungal culture or serologic testing,
frequently the “most likely” microbiological etiology can be
inferred from the clinical presentation. For example, cellulitis is
most frequently assumed to be caused by streptococci or
staphylococci, and antibacterial treatment can be administered
in the absence of a positive culture.
2. Timing of initiation of antimicrobial therapy
• The timing of initial therapy should be guided by the
urgency of the situation. In critically ill patients, such
as those in septic shock, febrile neutropenic patients,
and patients with bacterial meningitis, empiric therapy
should be initiated immediately after or concurrently
with collection of diagnostic specimens. In more
stable clinical circumstances, antimicrobial therapy
should be deliberately withheld until appropriate
specimens have been collected and submitted to the
microbiology laboratory.
• Neutropenia: decreased neutrophils in blood.
Conti…
• Premature initiation of antimicrobial therapy in some
circumstances can suppress bacterial growth and preclude
the opportunity to establish a microbiological diagnosis.,
which is critical in the management of these patients, who
require several weeks to months of directed antimicrobial
therapy to achieve cure.
3. Empiric vs Definitive antimicrobial therapy

• Because microbiological results do not become available for

24 to 72 hours, initial therapy for infection is often empiric and
guided by the clinical presentation. It has been shown that
inadequate therapy for infections in critically ill, hospitalized
patients is associated with poor outcomes, including greater
morbidity and mortality as well as increased length of stay.
Therefore, a common approach is to use broad-spectrum
antimicrobial agents as initial empiric therapy.

• Once microbiology results have helped to identify the etiologic

pathogen and/or antimicrobial susceptibility data are available,
every attempt should be made to narrow the antibiotic
spectrum
4. Interpretation of antimicrobial susceptibility testing
results
• When a pathogenic microorganism is identified in
clinical cultures, the next step performed in most
microbiology laboratories is antimicrobial
susceptibility testing (AST). Antimicrobial
susceptibility testing measures the ability of a specific
organism to grow in the presence of a particular drug
in vitro and is performed using guidelines established
by the Clinical and Laboratory Standards Institute
• In vitro: procedure performed in controlled environment outside living
• body
5. Bactericidal vs bacteriostatic therapy
• A commonly used distinction among antibacterial
agents is that of bactericidal vs bacteriostatic agents.
• Bactericidal drugs, which cause death and disruption
of the bacterial cell, include drugs that primarily act
on the cell wall (eg, b-lactams), cell membrane (eg,
daptomycin), or bacterial DNA (eg, fluoroquinolones ).
• Bacteriostatic agents inhibit bacterial replication
without killing the organism.
• The distinction is not absolute, and some agents that
are bactericidal against certain organisms may only
be bacteriostatic against others and vice versa.
6. use of antimicrobial combinations
• Although single-agent antimicrobial therapy is generally
preferred, a combination of 2 or more antimicrobial agents is
recommended in a few scenarios.
• A. When agents exhibit synergistic activity (work to together in
benefit of result) against a microorganism.
• B. When critically ill Patients require empiric therapy before
microbiological etiology and/or antimicrobial susceptibility can
be determined.
• C. To extend the antimicrobial spectrum beyond that achieved
by use of a single agent for treatment of polymicrobial
Infections.
• D. To prevent emergence of resistance.
7. Host factors to be considered in selection of
antimicrobial agents
• A. Renal and Hepatic function
• B. Age: differences in body size and kidney function.
Most pediatric drug dosing is guided by weight.
• C. Genetic variation: glucose-6-phosphate
dehydrogenase (G6PD) deficiency, which can result
in hemolysis in individuals when exposed to certain
antimicrobial G6PD(enzyme, carry important
biochemical functions)
• D. Pregnancy and Lactation.
• E. History of Allergy or Intolerance
• F. History of Recent Antimicrobial Use
8. Oral vs intravenous therapy
• Patients hospitalized with infections are often treated
with intravenous antimicrobial therapy because their
admission is often prompted by the severity of their
infection. However, patients with mild to moderate
infections who require hospitalization for other reasons
(eg, dehydration, pain control, cardiac arrhythmias) and
have normal gastrointestinal function are candidates for
treatment with well-absorbed oral antimicrobial agents
(eg, treatment of pyelonephritis and community-
acquired pneumonia with oral fluoroquinolones).
Furthermore, patients initially treated with parenteral
therapy can be safely switched to oral antibiotics when
they become clinically stable.
9. Pharmaco-dynamic characteristics
• Along with host factors, the pharmacodynamics
properties of antimicrobial agents may also be
important in establishing a dosing regimen.
Specifically, this relates to the concept of time-
dependent vs concentration-dependent killing.

10. Efficacy at the site of infection

• Many antibiotics (eg, aminoglycosides) are less
active in the low-oxygen, low-pH, and high-protein
environment of abscesses, and drainage of
abscesses to enhance antimicrobial efficacy is
recommended when possible.
11. selection of antimicrobial agents for
outpatient parenteral antimicrobial therapy
• To decrease cost, and with the help of advances both
in antimicrobial agents and in technology to assist
antimicrobial administration, prolonged treatment of
serious infections with intravenous or parenteral
antimicrobial agents has increasingly shifted away
from the hospital to the outpatient setting, and
guidelines to assist with delivery of high-quality
outpatient parenteral antimicrobial therapy (OPAT)
have been developed.
12. use of therapeutic drug monitoring
• Monitoring serum concentrations for drugs is most
useful for medications that have a fairly narrow
therapeutic index, which is the ratio of the toxic to
the therapeutic dose.
CONSIDERATIONS FOR CONTINUING
ANTIBIOTIC THERAPY & Nursing management
1. Duration of antimicrobial therapy
• In view of the deleterious effects of prolonged courses
of antimicrobial agents, including the potential for
adverse reactions, problems with adherence,
selection of antibiotic-resistant organisms, and high
cost, a number of studies have tried to define the
optimal duration of therapy, with an emphasis on
shorter courses of therapy.
2. Assessment of response to treatment
• Response to treatment of an infection can be
assessed using both clinical and microbiological
parameters. Clinical parameters of improvement
include symptoms and signs (eg, a decrease in fever,
tachycardia, or confusion), laboratory values (eg,
decreasing leukocyte count), and radiologic findings
(eg, decrease in the size of an abscess).
3. Side effects/Allergic or hypersensitivity reaction

• Although there has been advances in drug

therapy, these drugs have adverse and toxic
effects. A nurse must be aware of these effects.
• Allergic or hypersensitivity reaction may occur
with all types of antimicrobial agents.
Hypersensitivity is a state of altered reactivity in
which the reacts with an exaggerated immune
response. Such response include rash, fever,
urticarial with pruritus, chills etc
4. Toxicity
• The most important consideration underlying
antimicrobial therapy is selective toxicity (i.e.,
selective inhibition of the growth of the
microorganism without damage to the host).
Selective toxicity is achieved by exploiting the
differences between the metabolism and structure of
the microorganism and the corresponding features of
human cells. For example, penicillins and
cephalosporins are effective antibacterial agents
because they prevent the synthesis of peptidoglycan,
thereby inhibiting the growth of bacterial but not
human cells.
Conti…
• There are four major sites in the bacterial cell that
are sufficiently different from the human cell that
they serve as the basis for the action of clinically
effective drugs: cell wall, ribosomes, nucleic acids,
and cell membrane
5. Secondary infection
• Super infection, a secondary infection in a patient
having a preexisting infection. A super infection
develops when the antibacterial intended for the
preexisting infection kills the protective microbiota,
allowing another pathogen resistant to the
antibacterial to proliferate and cause a secondary
infection.
Indication
• 1. for foreign body (For the definitive management of
active infection disease) associated infections
Prosthetic implants and devices are increasingly
being used in modern medical treatment.
• 2. as prophylactic or suppressive therapy
• 3. Pre-surgical Antimicrobial Prophylaxis
• 4. Antimicrobial Prophylaxis in Immunocompromised
Patients. particularly those with HIV infection/AIDS,
those who are undergoing chemotherapy for cancer,
or those who are receiving immunosuppressive
therapy after organ transplant, are at increased risk
of infection.
Conti…
• 5. to Prevent Transmission of Communicable
Pathogens to Susceptible Contacts
• 6. Before Dental and Other Invasive Procedures
in Patients Susceptible to Bacterial
• 7. Traumatic Injuries With a High Probability of
Infectious Complications.
Nursing Management
• Nursing intervention in antimicrobial therapy
generally relate to
• 1. assessing the client
• 2. assisting in identification of infecting organism
• 3. actual administration of the drug
• 4. monitoring the client response
• 5. client education
• 6. providing comfort
• 7. prevention and treatment of adverse reactions
Assignment

• Nursing Process
• Critical thinking 1 , 2…

Ref:
• Mosbey’s
• Pharmacology in Nursing