Antibacterial Agents

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bacteria shape: cocci

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spherical

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bacteria shape: bacilli

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rod shape

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bacteria shape: spirella

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spiral shape

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aerobic

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thrives in oxygen rich environment

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anaerobic

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grows optimally without oxygen

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gram positive

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has thick cell wall, retains stain color

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examples of gram positive bacteria

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streptococcus

staphylococcus

enterococcus

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gram negative bacteria

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stain color not retained

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examples of gram negative bacteria

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E. Coli

klebsiella

pseudomonas

salmonella

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bactericidal

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causes bacterial death

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bacteriostatic

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prevents bacterial growth

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common antibiotic side effects

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GI-nausea, vomiting, diarrhea

Nephrotoxicity

Hypersensitivity

Superinfections

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Antibiotics MOAs

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Inhibit cell wall synthesis

Inhibit protein synthesis

Inhibit nucleic acid synthesis

Inhibit metabolic pathways

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Antibiotics that inhibit cell wall synthesis

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Penicillins

Cephalosporins

Carbapenems

Glycopeptides

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Antibiotics that inhibit protein synthesis

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Aminoglycosides

Tetracyclines

Macrolides

clindmycin

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Antibiotics that inhibit nucleic acid synthesis

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fluoroquinolones

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Antibiotics that inhibit metabolic pathways

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sulfonamides

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Types of beta lactams

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penicillins

cephalosporins

monobactams

carbapenems

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Penicillin classes

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Narrow spectrum

Broad spectrum (aminopenicillins)

Extended spectrum (antipseudomonal)

Beta lactamase resistant (antistaphylococcal)

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Narrow spectrum penicillins act on...

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primarily gram positive

gram negative cocci

non-beta lactamase producing aerobes

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Examples of narrow spectrum penicillins

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Penicillin G benzathine (IM only)

Penicillin G procaine (IM only)

Penicillin G potassium (IM, IV)

Penicillin V (oral)

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Which narrow spectrum penicillins are only given IM?

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Penicillin G benzathine

Penicillin G procaine

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Which narrow spectrum penicillin is given orally?

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Penicillin V

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Broad spectrum penicillins act on...

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certain gram negative bacilli (H. influenzae, E. Coli, salmonella, shigella)

very susceptible to beta lactamase

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Examples of broad spectrum penicillins

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Ampicillin (IV, IM, PO)

Amoxicillin (PO only)

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Unasyn

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ampicillin + sulbactam

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Augmentin

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amoxycillin + clavulanate

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Extended spectrum antibiotics act on...

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same as narrow and broad spectrum with added pseudomonas coverage (gram negative bacilli)

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What class of antibiotics are extended spectrum penicillins often combined with, and how far apart should they be dosed?

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aminoglycosides, 2 hours

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Examples of extended spectrum penicillins

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piperacillin, ticarcillin

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Zosyn

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piperacillin + tazobactam

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Timentin

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ticarcillin + clavulanate

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What special consideration should we have with extended spectrum penicillins and CHF patients?

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sodium overload

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Beta lactamase resistant penicillins act on...

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bacteria that produce beta lactamase

not effective for gram negative bacteria

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examples of beta lactamase resistant penicillins

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Dicloxacillin

Nafcillin

Oxacillin

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What bacteria is resistant to the whole class of beta lactamase resistant penicillins?

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MRSA (methacillin resistant staphylococcus aureus)

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Beta lactamase inhibitors

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clavulanate

sulbactam

tazobactam

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Cephalosporins vs. penicillins

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more effective on gram negative

less effective on gram positive

less susceptible to beta lactamase

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How are cephalosporins classified?

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Generations (1-5)

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1st Generation Cephalosporins

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most effective on gram positive

moderate efficacy on gram negative

Cefazolin

Cefalexin

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Cefalexin

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1st generation cephalosporin

first line agent for skin infections

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Cefazolin

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1st generation cephalosporin

surgical prophylaxis

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2nd Generation Cephalosporins

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better gram negative coverage

cefprozil

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3rd Generation Cephalosporins

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broader spectrum on gram negative

pseudomonas coverage

cross BBB

watch for C. diff

ceftazidime

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4th Generation Cephalosporins

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slightly broader and more stable than 3rd

not effective against MRSA

only agent: cefepime (IV only)

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5th Generation Cephalosporins

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active against MRSA

only agent: ceftaroline (IV only)

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Carbapenems act on...

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gram positive, gram negative, most beta lactamases, anaerobes (broadest spectrum beta lactam antibiotic)

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Example of carbapenem

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Imipenem/cilistatin

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In imipenem/cilistatin, what does the cilistatin do?

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prevents destruction of imipenem in the kidneys

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Monobactams act on....

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gram negative aerobes

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Only drug in monobactam class

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Aztreonam (parenteral only)

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advantage of monobactams over aminoglyocsides?

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no ototoxicity

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Glycopeptides act on...

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gram positive cocci (staphylococcus)

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What is the only reason to give a glycopeptide orally and why?

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C. Diff infection, poorly absorbed

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Common uses of glycopeptides

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MRSA sepsis

endocarditis

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Example of glycopeptide

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vancomycin

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Uses of tetracyclines

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Rocky Mountain Spotted Fever

typhus

cholera

Lyme disease

H. Pylori

Chlamidia

syphilis

acne

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When should you administer PO tetracyclines, and what types of foods should be avoided?

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before meals

avoid milk, Fe supplements, and Mg laxatives and antacids

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Why are tetracyclines contraindicated in pregnant/nursing women and children under 8 years old?

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causes yellow-brown teeth and slows growth rate

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Examples of tetracyclines

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tetracycline

doxycycline

minocycline

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Macrolides act on...

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gram positive bacteria

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Why do macrolides cause many drug interactions?

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inhibit hepatic metabolism (CYP3A4 inhibitor)

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Examples of macrolides

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eryhromycin

clarithromycin

azithromycin (z-pack)

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Newest macrolide, only used for C. diff colitis

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fidaxomycin (Dificid)

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What macrolide is commonly known as a Z-pack and why is it used this way?

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azithromycin

long half life allows for short (5 day) therapy

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Clindamycin acts on...

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strep, staph (including some CA-MRSA), pneumococci, and anaerobes

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Aminoglycosides act on...

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aerobic gram negative

some specific gram positive cocci (staph)

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Aminoglycosides are reserved for use on...

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serious systemic infections from aerobic gram negative bacteria (pseudomonas, E.coli, serratia, proteus, klebsiella)

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Preferred rout of administration for aminoglycosides

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IV, can be given IM

only given PO for bowel clearance prior to surgery

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Adverse effects of aminoglycosides

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nephrotoxicity, ototoxicity

neuromuscular blockade (rare, but serious)

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What class of antibiotics increases aminoglycoside invasion into cell?

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Penicillins

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Fluoroquinolones act on...

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gram negative organisms (early generations)

gram positive (later generations)

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1st Generation Fluoroquinolones

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used for uncomplicated UTI

naldixic acid

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2nd Generation Fluoroquinolones

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ciprofloxacin (PO, ophthalmic, IV)

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3rd Generation Fluoroquinolones

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levofloxacin (PO, ophthalmic, IV)

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4th Generation Fluoroquinolones

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moxifloxacin (PO, ophthalmic)

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Fluoroquinolone common uses

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respiratory, GU, GI, bone/joint, skin infections

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What is an adverse effect of fluoroquinolones?

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cartilage toxicity, risk for tendon rupture

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Primary use of sulfonamides

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treatment of UTI

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What nursing consideration should we keep in mind when administering sulfonamides?

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lots of water to prevent crystalluria

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What percentage of the population actually has sulfa allergy?

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3-6%

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Common drug interaction with sulfonamides

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warfarin and potassium sparing diuretics (CYP450 inhibitor)

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Examples of sulfonamides

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Septra, Bactrim

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Classes of antibiotics most likely to cause a drug interaction

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Macrolides

Sulfonamides

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Most toxic class of antibiotics

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Aminoglycosides (nephrotoxic, ototoxic)

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Antibiotics effective against beta lactamase producing bacteria

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Anti-staphylococcal penicillins

3rd generation and up cephalosporins

penicillins combined with beta lactamase inhibitor

any antibiotic that doesn't have a beta lactam ring

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Antibiotics effective against MRSA

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vancomycin

5th generation cephalosporin

Linezoloid (Zyvox)

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Antibiotics most likely to cause a superinfection

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any very broad spectrum

clindamycin

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Antibiotics that should not be taken with calcium or other minerals

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quinolones

tetracyclines