ANTIBIOTICS / ANTIMICROBIAL DRUGS

A. AMINOGLYCOSIDESPrototype: Gentamicin (Garamycin)Action: Acts by suppressing protein synthesis in bacterial cell; bactericidal.Use: serious gram-negative bacterial infections, eye infections.Adverse effect: toxicity, nephrotoxicity, neuromuscular blockade, and hypersensitivity photosensitivity with topical preparationsRelated drugs:1. 2. Amikacin (Amikin)3. kanamycin (Kantrex) are given orally4. Neomycin (Niobiotic) to prepare thebowel for surgery5. Streptomycin6. Tobramycin7. Netilmicin

*Neomycin- given to persons in hepatic failure to reduce ammonia levels.

B. PENICILLINSPrototype: Penicillin G PotassiumAction: inhibits cells wall synthesis of microorganism; bactericidalUse: Systemic infections caused by gram (+) cocci; syphilis, prophylaxis for rheumatic fever and bacterial endocarditisAdverse Effect: Hypersensitivity, G.I upset, potassium poisoning, irritation at injection site.Nursing Implications: give oral form on an empty stomach with a full glass of water; IV solutions are stable at room temperature for 24 hrs. onlyProbenecid: may be given to increase blood levels of penicillin.Related drugs:1. Penicillinase resistant penicillins -used to treat infection caused by penicillinase producing organism.

Examples: a.) Nafcillin sodium b.) Cloxacillin

2. Aminopenicillins -increased effectiveness against gram negative organism.Examples: a.) Ampicillin b.) Amoxicillin c.) Bacampicillin

3. Extended-spectrum penicillins -structurally similar to ampicillin but have an increased spectrum of activity against gram-negative bacteria.

Examples: a.) Carbenicillin sodium b.) Piperacillin

4. Penicillin / beta-lactamase inhibitor combinations -prevents destruction of penicillin by enzymes and extend the penicillins spectrum of antimicrobial activity.Examples: Amoxicillin / potassium clavulanate (Augmentin) Ampicillin/ Sulbactam (Unasyn)C. CEPHALOSPORINSdivided into 4 generations based on their spectrums of activity.Prototype for first generation (ephalozorines- Cefazolin Sodium (Ancef)Action: Inhibits bacterial cell wall synthesis; bactericidal.Use: infection caused by gram-positive cocci; septicemia; serious intraabdominal infection.Adverse Effect: Phlebitis at IV site; diarrhea, pseudomembranous colitis, hypersensitivity, fungal overgrowth, discomfort at IM injection site, nephrotoxicity, hepatoxicity, bone marrow depression.Nursing Implications:1. Assess for hx of penicillin allergy as there is a cross allergy between cephalosporin and penicillin.2. Dose will be reduced with renal and liver impairment3. Probenecid therapy will increase blood levels of cephalosporin.Related drugs:

a.)Cephalexin (keflex)b.)Cephradine (Valosef)

Prototype for 2ndgeneration Cephalosporins Cefoxitin Sodium (Mefoxin)Action: same as aboveUse: infection caused by gram-negative and gram-positive bacteria; septicemia, pelvic skin soft tissue infections, prophylaxis in abdominal or pelvic surgery; gonorrhea.Adverse Effect: same as aboveNursing Implications:Lidocaine is used as diluent for IM injection and helps reduced pain of IM injection.Related drugs:

a.)Cefaclor (Ceclor)b.)Cefuroxime sodiumc.)CefrozilPrototype for 3rdgeneration Cephalosporins Cefotaxime (Claforan)Use: Serious infections caused by gram-negative and gram-positive bacteriaNursing Implication:Dont mix with aminoglycoside solutions; protect IV solution from light.Related drugs:

a.)Ceftazidimeb.)Ceftriaxonec.)Cefixined.)Cefoperazonee.)Cefpodoximef.)Ceftibuten

Prototype for 4thgeneration Cephalosporins Cefepine (maxipene)Use: UTI caused by E. coli or klebsiella pneumonia caused by streptococcus pneumoniae Pseudomonas acryinosa or enterobacter.Nursing Implication:have vit. K available if hypoprothombinemia develops.Related Drug:CefditorenD. MACROLIDESPrototype: ErythromycinAction: Inhibits protein synthesis in bacterial cell, bacteriostatic.Use: person allergic to penicillin, legionnaires Disease, mycoplasma pneumonia, intestinal dysenteric amebiasis, acne, staphylococcal and streptococcal infections.Adverse Effect: G.I irritation, superintations, allergic reactions, hepatitis, reversible hearing loss.Nursing Implications:-Take on empty stomach with a full glass of water.-G.I symptoms are dose related-do not give with acids-IV must be diluted sufficiently and administered slowly to avoid venous irritation and thrombophlebitis.Related drugs:

1.)Erythromycin estolate (Ilosone)2.)Azithromycin (Zithromax)3.)Clarithromycin (Biaxin)4.)Dirithromycin (Dynabac)

E. TETRACYCLINESPrototype: Tetracycline hydrochloride (Acromycin V)Action: broad-spectrum with bateriostatic action and, at higher doses, bactericidal action; inhibits bacterial wall synthesis, reduces free fatty acids from triglycerides thus reducing acne lesionsUse: Chlamydia, mycoplasma, rickettsia, acne vulgaris, gonorrhea, spirochetesAdverse Effect: hypersensitivity, superinfection chelating to teeth and new bome, N/V, diarrhea, colitis, headache, dizziness, abdominal cramping, photosensitivity.Nursing Implications:a.)Avoid use during pregnancy, in nursing women, and in children under age 8 as drug binds to calcium in teeth and new bone growth, which results in tooth discoloration of permanent teeth and retarded bone growthb.)Give deep IMDischarge Teaching:a.)Take 1hr. before or 2 hrs. After meals and avoid taking with dairy products, antacids, vitamins and minerals.b.)Avoid the sun while taking drug and for a few days after therapy is terminatedc.)Use meticulous hygiene to reduce super infections.Related Drugs:1. Doxycycline (Vibramycin) can be administered with food.2. Minocycline (Minocin) can be taken with food. Dizziness and fatigue may occur.3. Demeclocycline (Declomycin) administer on an empty stomach; foods high in calcium and iron interfere with absorption.F. CHLORAMPHENICOLPrototype: Chloramphenicol (Chloramycetin)Action: a synthetic broad-spectrum agent primarily bacteriostatic but is bactericidal in higher dose; inhibits protein synthesisUse: Haemophilus influenzae meningitis, rickettsia, salmonella typhi, mycoplasma, bactereoides, typoid fever.*Chloramphenicol is used only in severe infections when other antibiotics can not be used due to its severe adverse effect of aplastic anemia.*Gray baby syndrome: abdominal distention, vomiting, pallor, irregular respiration; circulatory collapse.Adverse Effect: Aplastic Anemia; neurotoxicity; gray baby syndrome (seen in premature infants, newborn and children less than 2yrs old), hypersensitivity, N&V, enterocolitis, superinfections, bitter taste especially after IV injection.Nursing Implications:Do not give by IM injectionDischarge Teaching:1.) inform physician immediately of fever, fatigue, sore throat, or bruising.2.) Take drug on empty stomach unless upset.G. SULFONAMIDESPrototype: Sulfisoxazole (Gantrisin)Action: prevents conversion of para-amino benzoic acid (PABA) to folic acid, which is required for bacterial growth; bacteriostatic, can be bactericidal in high urinary concentrationsUse: UTI, Otitis media, nocardiosis, vaginitisAdverse effects: hypersensitivity, Sterens-Johnson syndrome (acute onset of fever,bullae on skin and ulcers in mucous membranes of lips, eyes, mouth, nasal passages, and genetalia, pneumonia, joint pain ad prostratin are also seen fever 7 to 10 days after starting therapy may indicate sensitization or hemolytic anemia; renal dysfunction hematologic reaction, G.I reaction; photosensitivityNursing Implications:Give oral form on empty stomach with full glass of water.Discharge Teaching:a.)avoid direct sunlightb.)increased hypoglycemic reactions for patients taking OHAc.)Oral contraceptives may be unreliable while client is receiving sulfonamides.Related drugs:1.)Sulfasalazine (Azulfidine)-used in treatment of ulceratives colitis, constains aspirin, so it is contraindicated in clients allergic to salicylates.2.)Sulfamethoxazole-can be given in combination with trimethoprim. (bactrim)-used in treatment of UTI, bronchitis, pneumocystis pneumonia.H. URINARY ANTI-INFECTIVES1.Methenamine (mandelamine) -converted to formaldehyde (which is bactericidal) in the presence of acidic urineAdverse Effect: N&V, diarrheaNursing Implications: -give with food-avoid foods, fluids, and medications that alkalinize urine2.Nalidixic Acid (Neg Gram) -bactericidal effect in gram-negative bacteria by preventing transmission of genetic informations.Adverse Effect: Photosensitivity, headache, dizzinessNursing Implication: give with food.3.Nitrofurantoin (Macrodantin) -interferes with carbohydrates metabolism of bacteria; bacteriostatic in low concentration, and bactericidal in high concentrations.I. VANCOMYCINPrototype: Vancomycin hydrochloride (Vancocin)Action: interferes with cell membrane synthesis and exhibits a bactericidal and bacteriostatic effect.Use: staphylococcus infections, pseudomembranous colitis, grain positive organism s, penicillin and methicillin resistant bacteriaAdverse Effect: Ototoxicity, nephrotoxicity, hypersensitivity, thrombophlebitis, red-neck syndrome: (flushing and hypotension from rapid infusion), superifection.J. FLUOROQUINOLONESPrototype: Ciprofloxacin (Cipro)Actions: Inhibits DNA-syrase (an enzymes needed for replication of bacterial DNA) bactericidalUse: pseudomonas infections, gram-negative urinary tract infections or gram-negative systemic infectionsAdverse Effect: N&V, diarrhea, headache, tremorsNursing Implications:a.)administer with a large glass of water to prevent crystalluriab.)Do not give with antacids.c.)Give 2hrs after meals.Related drugs:1. 2. Norfloxacin3. Gatifloxacin (Tequin)4. Leofloxacin5. Sparfloxacin (Zagam)

K. ANTITUBERCULAR DRUGSPrototype: Isoniazid (INH)Action: Bacteriostatic and in high concentration becomes bactericidalUse: initial treatment of tuberculosis; prophylactic treatment of tuberculosis in high risks group.Adverse Effect: peripheral neuritis, jaundice, nausea, blood dyscrasisNursing Implications:give vit B6; on empty stomach, tyramine rich foods should be avoided; avoid histamine-containing foods as they may cause an exaggerated drug response; avoid alcoholRelated drugs:1.) EthambutolAdverse Effect: optic neuritis, a loss of red green color discrimination, and decreased visual acuity can occur with dosages of 250mg2.) Rifampicinbody fluids may turn orange.3.) Streptomycindamage to cranial nerve VIII -renal toxicity4.) Pyrazinamideexcess uric acid levels, w/c can cause gout or hepatic