Beruflich Dokumente
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Anti-infective Drugs
Antibiotics
REF: Chapter Basic Principles of Antimicrobial Therapy
Mechanism of Action:
Antibiotic Therapy
Empiric therapy: treatment of an infection before specific culture information has been reported or
obtained
Definitive therapy: antibiotic therapy tailored to treat organism identified with cultures
Prophylactic therapy: treatment with antibiotics to prevent an infection, as in surgery or after trauma
Drug resistance:
Selection of antibiotics:
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The goal of drug therapy is 1 to alleviate symptoms, 2 promote healing, 3 prevent
complications (hemorrhage, perforation, obstruction,), and 4 prevent recurrences. Create
conditions conducive to healing.
What role do cultures play in treating infections? When should you obtain a
culture? What should the nurse know about timing of blood cultures when an
antibiotic is ordered?
-Ideally , before beginning antibiotic therapy, the suspected areas of infection should be
cultured to identify the causative organism and potential antibiotic susceptibilities.
Use of multiple antibiotics has several drawbacks, including (1) increased risk of toxic
and allergic reactions, (2) possible antagonism of antimicrobial effects, (3) increased risk
of superinfection, (4) selection of drug-resistant bacteria, and (5) increased cost.
Accordingly, antimicrobial combinations should be employed only when clearly
indicated.
Side effects-Risks of antibiotic therapy:
Antibiotic use is strongly associated with the potential for the development of
diarrhea, why?
Penicillins
Cephalosporins
How are cephalosporins similar to penicillins? Inhibit bacterial cell wall synthesis
Like penicillins, cephalosporins and vancomycin weaken the bacterial cell wall, and can
act in concert with aminoglycosides to enhance bacterial kill
Primary adverse reactions? Think ABC
Allergy, Anemia, Alcohol
Bleeding
Clostridium dif.
Cephalexin (Keflex)
Vancomycin
Inhibits cell wall synthesis and promotes bacterial lysis and death. ONLY AGAINST
GRAM-POSITIVE BACTERIA. Especially active against Staph. Aureus and
Staphlyococcus epidermidis, including strains of both species that are methicillin
resistant.
Major toxicity?
What is Red Man Syndrome? How can it be prevented?
Rapid infusion can cause red man syndrome, characterized by flushing, rash, pruritus,
urticaria, tachycardia, and hypotension. To minimize risk, infuse vancomycin slowly,
over 60 minutes or longer.
The aminoglycosides can produce serious toxicity, especially to the inner ears and
kidneys. The inner ears and kidneys are vulnerable because aminoglycosides become
concentrated within cells of these structures
All aminoglycosides can accumulate within the inner ears, causing cellular injury that can
impair both hearing and balance. Hearing impairment is caused by damage to sensory
hair cells in the cochlea. Disruption of balance is caused by damage to sensory hair cells
of the vestibular apparatus
Nephrotoxicity correlates with (1) the total cumulative dose of aminoglycosides and (2)
high trough levels.
What types of infection/ organisms are commonly treated with aminoglycosides? Why
are they contraindicated in pregnancy?
Narrow-spectrum antibiotics used primarily against aerobic gram-negative bacilli. These
drugs disrupt protein synthesis, resulting in rapid bacterial death. They cause serious
injury to the inner ears and kidneys. Because of these toxicities, indications for these
drugs are limited.
There is evidence that use of aminoglycosides in pregnancy can harm the fetus.
Pregnancy risk category D.
Key Points
Aminoglycosides are narrow-spectrum antibiotics, used primarily against aerobic gram-
negative bacilli.
Aminoglycosides are highly polar polycations. As a result, they are not absorbed from
the GI tract, do not cross the blood-brain barrier, and are excreted rapidly by the kidneys.
Aminoglycosides can cause irreversible injury to sensory cells of the inner ears,
resulting in hearing loss and disturbed balance.
The risk of ototoxicity is related primarily to persistently elevated trough drug levels,
rather than to excessive peak levels.
The risk of nephrotoxicity is related to the total cumulative dose and elevated trough
levels.
Because the same aminoglycoside dose can produce very different plasma levels in
different patients, monitoring serum levels is common. Peak levels must be high enough
to cause bacterial kill; trough levels must be low enough to minimize toxicity to the inner
ears and kidneys.
Fluoroquinolones
Go to the MaTS
(Macrolides,Tetracyclines & Sulfonamides)
Macrolides
Tetracyclines
Adverse Effects:
Why are the tetracyclines contraindicated in children and pregnant women?
Can damage developing teeth, PHOTOSYNSITIVITY
Red Flag!!! Tetracycline antibiotics should not be used in children under the age of 8, and
specifically during periods of tooth development. Tetracyclines are classed as pregnancy
category D. Use during pregnancy may cause alterations in bone development.
Primary indication?
Antitubercular Drugs:
The nurse is counseling a woman who has been diagnosed with TB who will be starting
isoniazide and rifampin. What patient teaching needs to be included?
Amphotericin B. (Think-ampho-terrible)
Indications?
How is it administered?
What are common side effects or adverse effects that the nurse must be aware of
during administration?
Azoles
Indications?
How administered?
Bottomline:
Review the classes of antibiotics and antifungals. How do they work? What are the major
precautions? Again, keep it simple!
Know the side effects to watch for/ pt teaching for the drug class prototypes
Why are the tetracyclines contraindicated in children and pregnant women? What food
groups must be avoided with this class?
Why is it critical to measure peak (highest) drug levels and trough (lowest) when
administering aminoglycosides? What are the signs of aminoglycocide toxicity?
What types of infection/ organisms are commonly treated with aminoglycosides? Why
are they contraindicated in pregnancy?
What is the current antibiotic of choice for the treatment of MRSA infection?
What is Red Man Syndrome?
Bottomline:
Review the classes of antibiotics. How do they work? What are the major precautions?
Again, keep it simple!
Know the side effects to watch for/ pt teaching for the:
Sulfonamides
Penicillins
Macrolides
Tetracyclines
Aminoglycosides
Fluoroquinalones
Misc - clindamycin, metronidazole (Flagyl), vancomycin
Key Points
In antimicrobial therapy, the term selective toxicity refers to the ability of a drug to
injure invading microbes without injuring cells of the host.
Narrow-spectrum antibiotics are active against only a few microorganisms, whereas
broad-spectrum antibiotics are active against a wide array of microbes.
Bactericidal drugs kill bacteria, whereas bacteriostatic drugs only suppress growth.
Emergence of resistance to antibiotics is a major concern in antimicrobial therapy.
Mechanisms of resistance include increased drug efflux, altered drug targets, and
enzymatic inactivation of drugs.
Bacteria with the NDM-1 gene are resistant to nearly all available antibiotics.
An important method by which bacteria acquire resistance is conjugation, a process in
which DNA coding for drug resistance is transferred from one bacterium to another.
Antibiotics do not cause the genetic changes that underlie resistance. Rather, antibiotics
promote emergence of drug-resistant organisms by creating selection pressures that favor
them.
Broad-spectrum antibiotics promote the emergence of resistance more than do narrow-
spectrum antibiotics.
In the hospital, we can delay the emergence of antibiotic resistance in four basic ways:
(1) preventing infection, (2) diagnosing and treating infection effectively, (3) using
antimicrobial drugs wisely, and (4) preventing patient-to-patient transmission.
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Use of antibiotics to promote growth in livestock is a major force for promoting
emergence of resistance.
Effective antimicrobial therapy requires that we determine both the identity and drug
sensitivity of the infecting organism.
The minimum inhibitory concentration (MIC) of an antibiotic is defined as the lowest
concentration needed to completely suppress bacterial growth.
The minimum bactericidal concentration (MBC) is defined as the concentration that
decreases the number of bacterial colonies by 99.9%.
Host defensesthe immune system and phagocytic cellsare essential to the success
of antimicrobial therapy.
Patients should complete the prescribed course of antibiotic treatment, even though
symptoms may abate before the full course is over.
Although combinations of antibiotics should generally be avoided, they are appropriate
in some situations, including (1) initial treatment of severe infections, (2) infection with
more than one organism, (3) treatment of tuberculosis, and (4) treatment of an infection
in which combination therapy can greatly enhance antibacterial effects.
Appropriate indications for prophylactic antimicrobial treatment include (1) certain
surgeries, (2) neutropenia, (3) recurrent urinary tract infections, and (4) patients at risk of
bacterial endocarditis (eg, those with prosthetic heart valves or congenital heart disease).
Important misuses of antibiotics include (1) treatment of viral infections (eg, the
common cold and most other acute infections of the upper respiratory tract), (2) treatment
of fever of unknown origin (except in the immunocompromised host), (3) treatment in the
absence of adequate bacteriologic information, and (4) treatment in the absence of
appropriate surgical drainage.
Antivirals
REF: Chapter 93 Antiviral Agents I
Know the patient teaching expectations, routes, side effects, and adverse effects of
acyclovir. Acyclovir is indicated in what type of viruses?
What is Tamiflu? When is Tamiflu indicated? How long should a person take Tamiflu?
What is the goal of HIV antiviral therapy? (Cure, decrease symptoms, decrease
opportunistic diseases?) What is an undetectable viral load?
Antitubercular Drugs
REF: Chapter 90 Antimycobacterial Agents
The nurse is counseling a woman who has been diagnosed with TB who will be starting
isoniazide and rifampin. What patient teaching needs to be included?
Antifungals
REF: Chapter 92 Antifungal Agents
Drug focus- amphotericin B. How is it administered, what are common side effects or
adverse effects that the nurse must be aware of during administration? What nursing
interventions may lessen side effects?
GOOD LUCK!