Antiinfectives Key Points

N203 ATI (Unit 2) Antiinfectives -

Broad-spectrum vs. narrow-spectrum antibiotics Antimicrobials treat bacterial, viral, and fungal infections Culture and sensitivity specimens should be collected prior to initiation of therapy. Adverse reactions include:

Hypersensitivity & anaphylaxis Organ toxicity (ototoxic, nephrotoxic) efficacy of oral contraceptives

Superinfection warfarin activity

Penicillins

N203 ATI (Unit 2) Antiinfectives -

Expected Action:

-lactam destroys bacteria by weakening cell wall Med of choice for G+ cocci (Strep pneumoniae, S. viridans, S. pyogenes) Med of choice for First choice for meningitis syphilis Prophylaxis against bacterial endocarditis Extended spectrum against Pseudomonas, Proteus, Klebsiella Anaphylaxis / Renal Impairment / Hyperkalemia (w doses) Allergies to Penicillin, Cephalosporin, or Imipenem / Kidney Dysfunction Aminoglycosides / Oral Contraceptives Take orals H2O, food (some may be taken food)

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Cephalosporins

N203 ATI (Unit 2) Antiinfectives -

Expected Action:

-lactam destroy bacteria by destroying cell wall Four generations, each is: against G- and anaerobes more resistant to lactamase more able to reach CSF Broad spectrum with TI for postop infections, meningitis, pelvic infections Anaphylaxis / Bleeding / Thrombophlebitis / Pain IM / cross allergies to penicillins / AA-pseudomembranous colitis Allergies to Penicillin / Kidney Dysfunction Caution with anticoagulants, antiplatelets, and thrombolytics EtOH intolerance (disulfiram reaction) / Probenecid renal excretion Take food

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Carbapenems

N203 ATI (Unit 2) Antiinfectives -

Expected Action:

-lactam destroy bacteria by destroying cell wall Broad spectrum effective for serious infections such as pneumonia, peritonitis, and UTIs. P. aeruginosa develops resistance (use combo) [broadest spectrum available] Allergy / GI symptoms / Superinfection Caution with renal impairment

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Monobactams

N203 ATI (Unit 2) Antiinfectives -

Expected Action:

-lactam destroy bacteria by destroying cell wall MRSA / Antibiotic-associated pseudomembranous colitis by C. difficile Ototoxicity / Infusion Rxn (red man syndrome) / Thrombophlebitis Caution with renal impairment Infuse over 60 minutes Very low therapeutic index

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Tetracyclines

N203 ATI (Unit 2) Antiinfectives -

Expected Action:

Bacteriostatic by preventing protein synthesis Acne / rickettsia / Chlamydia / Helicobacter pylori / periodontal disease / typhus fever / Rocky Mountain spotted fever / Lyme disease / UTI & VI GI symptoms / tooth discoloration / hepatotoxicity / photosensitivity / superinfection of bowel Renal disease (except doxycycline) / Use during pregnancy will stain deciduous teeth but not permanent teeth Milk / Ca2+, Fe3+ supplements / Mg2+ laxatives / antacids (chelates to ) of oral contraceptives Give with water on an empty stomach (except doxycycline & minocycline)

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Bacteriostatic Inhibitors
(Macrolides / Ketolides)

N203 ATI (Unit 2) Antiinfectives -

Expected Action:

Bacteriostatic by inhibiting protein synthesis Bactericidal at high doses Use for pts with penicillin allergies / pertussis / diphtheria / Legionnaires Chlamydia, Mycoplasma pneumoniae, Streptococcus pyogenes GI discomfort / thrombophlebitis Pre-existing liver disease Toxic with: antihistamines, theophylline (asthma med), carbamazepine (anticonvulsant), warfarin Administer on empty stomach with water IV is rarely used

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Aminoglycosides
(Medication List)

N203 ATI (Unit 2) Antiinfectives -

gentamicin tobramycin sulfate streptomycin

amikacin neomycin

kanamycin paromomycin

Aminoglycosides

N203 ATI (Unit 2) Antiinfectives -

Expected Action:

Kill bacteria by disrupting protein synthesis Med of choice against aerobic G- bacilli (E. coli, K. pneumoniae, P. mirabilis, P. aeruginosa) Oral paromomycin use for amebiasis and tapeworm Ototoxicity ()/ nephrotoxicity / neuromuscular blockade / hypersensitivity Streptomycin: Neurologic disorders Renal impairment reduced doses Ethacrynic acid (oto-tox) / amphotericin, cephalosporins, vanco (neph-tox) / tubocurarine / penicillins ( AG)

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Penicillins
(Medication List)

N203 ATI (Unit 2) Antiinfectives -

Penicillin G Augmentin (amoxicillin-clavulanate) - Broad spectrum Nafcillin Antistaphylococcal Carbenicillin Antipseudomonas

Cephalosporins
(Medication List)

N203 ATI (Unit 2) Antiinfectives -

1 Cephalexin (Keflex) 2 Cefaclor (Ceclor) 3 Cefatriaxone (Rocephin) 4 Cefepime (Maxipime)

Cephapirin (Cefadyl) Cefotetan (Cefotan) Cefotaxime (Claforan)

Carbapenems
(Medication List)

N203 ATI (Unit 2) Antiinfectives -

 Imipenem (Primaxin) Meropenem (Merrem IV)

Monobactams
(Medication List)

N203 ATI (Unit 2) Antiinfectives -

 Vancomycin (Vancocin) Aztreonam (Azactam) Fosfomycin (Monurol)

Tetracyclines
(Medication List)

N203 ATI (Unit 2) Antiinfectives -

 Tetracycline hydrochloride (Sumycin) Doxycycline (Vibramycin) Minocycline

Macrolides / Ketolides
(Medication List)

N203 ATI (Unit 2) Antiinfectives -

 Azithromycin (Zithromax) Clarithromycin (Biaxin) Dirithromycin Erythromycin Clindamycin (Cleocin)

Sulfonamides & Trimethoprim

(Medication List)

N203 ATI (Unit 2) Antiinfectives -

SulfamethoxazoleTrimethoprim (TMP-SMZ, Bactrim) Cotrim Septra Sulfadiazine Sulfamethoxazole Sulfisoxazole

Sulfonadmides-Trimethoprim

N203 ATI (Unit 2) Antiinfectives -

Expected Action:

Bacteriostatic by inhibiting folate synthesis Med of choice for UTI by E. coli and Pneumocystis carinii. Hypersensitivity (sulfonamides, thiazide diuretics, tolbutamide, loop diuretics) Blood dyscrasias / crystalluria / kernicterus ( bilirubin) / photosensitivity Avoid in: folate deficiency / pregnancy / creatinine clearance < 15 mL/min Reduce dosages with renal dysfunction Warfarin / phenytoin / tolbutamide ( effects of these) Empty stomach with full glass of water

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Urinary Tract Aseptics

N203 ATI (Unit 2) Antiinfectives -

Expected Action:

Damages DNA

Prototype: Nitrofurantoin

Static a@ doses, Cidal @ doses Acute UTIs / Prophylaxis for recurrent lower UTI GI / hypersensitivity / blood dyscrasias / peripheral neuropathy Renal dysfunction creatinine clearance < 40

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Urine will be brown

Antimycobacterial

N203 ATI (Unit 2) Antiinfectives -

Expected Action:

Prototypes: isoniazid (INH), streptomycin, ethambutol, pyrazinamide

Prevents synthesis of mycolic acid Active and latent tuberculosis Peripheral neuropathy (administer 50-200 mg of vitamin B6 daily) Hepatotoxicity Liver disease Phenytoin (accumulates) INH with EtOH, rifampin, pyrazinamide hepatotoxicity Empty stomach but food if needed

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Anti-Hansens Disease

N203 ATI (Unit 2) Antiinfectives -

Expected Action:

Prototype: Dapsone Others: Clofazimine, Rifampin

Prevents synthesis of folate which inhibits M. leprae. Used in combination therapy to treat leprosy Rifampin: Discoloration of body fluids / Hepatotoxicity GI discomfort Use caution with liver dysfunction Rifampin warfarin / OC / protease inhibitors / NNRTIs (HIV)

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Antiviral

N203 ATI (Unit 2) Antiinfectives -

Prototype: Acyclovir Expected Action:

Others: ganciclovir, interferon, ribavirin, amantadine

Prevents reproduction of viral DNA

Therapeutic Uses:

Adverse Effects:

Acyclovir: Phlebitis, nephrotoxicity, nausea & headache Ganciclovir: Granulocytopenia / thrombocytopenia / reproductive toxicity / teratogenic Pregnancy / neutrophil count (<500/cc)

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Nursing Info:

Acyclovir: Never give IV bolus, Infuse over 1 hour min.

Fluoroquinolones
(Medication List)

N203 ATI (Unit 2) Antiinfectives -

Expected Action:

Prototype: Ciprofloxacin

Bactericidal by inhibition of enzyme needed for DNA Broad spectrum / prevention of inhaled anthrax GI discomfort / Achilles tendon rupture / superinfection Avoid use in children <18 d/t risk for tendon rupture Cations ( Cipro absorption) / Theophylline & warfarin ( med plasma levels) Infuse slowly over 60 minutes

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Antiprotozoals

N203 ATI (Unit 2) Antiinfectives -

Expected Action:

Proto: Amphotericin Others: flucytosine, miconazole, nystatin, griseofulvin, ketoconazole

permeability leakage of intracellular cations (static or cidal) Systemic or cutaneous fungal infections

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Adverse Effects:

Amphotericin: Infusion rxn (1-3 hrs) / thrombophlebitis / nephrotoxicity / hypokalemia / marrow suppression Ketoconazole: Hepatotoxicity / Sex hormone effects Contraindications/Precautions: Renal dysfunction

Interactions:

Aminoglycosides (streptomycin, cyclosporine) additive nephrotoxicity Flucytosine antifungal effects are potentiated with amphotericin Education: Highly toxic, infuse slowly (2-4 hr) Renal damage limited by infusing 1 L NS on day of amphotericin infusion

Antiprotozoals

N203 ATI (Unit 2) Antiinfectives -

Expected Action:

Proto: metronidazole (Flagyl)

Broad spectrum with anaerobic activity Protozoal infections / Bacterial infections against obligate anaerobes Prophylaxis for surgical procedures at high risk for anaerobic infections (vaginal, abdominal, colorectal) H. pylori with tetracycline and bismuth salicylate GI discomfort / metallic taste / darkening of urine / CNS symptoms Caution with renal dysfunction / avoid during 1st trimester of pregnancy Disulfiram-like reaction EtOH Warfarin Flagyl inhibits inactivation of warfarin

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