Antibiotics /anti-Infectives/ Antivirals

Front 1

Aminoglycosides
Common examples:
Gentamicin (Garamycin)
Tobramycin (Nebcin)
Neomycin, Amikacin (Amikin),
Streptomycin

Back 1

*Indicated for serious Gram (-) infections
*Given parenterally for systemic use, because poorly absorbed from the GI tract
*Irreversible Ototoxicity, Nephrotoxicity
*Baseline hearing test recommended.
*Peak and trough levels indicated.
*Monitor BUN and creatinine levels.
*Increase fluids 1500-2000 ml/day.
*Adverse effects include GI complaints, rash, fever, pain or swelling at the injection site, dizziness,
tinnitus, suprainfections and anaphylaxis.
*Neomycin available in topical form
*Streptomycin generally restricted to the treatment of TB

Front 2

Cephalosporins
Common examples:
1st Generation
Cefazolin (Ancef, Kefzol)
Cephalexin (Keflex)
2nd Generation
Cefaclor (Ceclor)
Cefoxitin (Mefoxin)
Cefprozil (Cefzil)
3rd Generation
Cefatoxamine ( Claforan)
Ceftriaxone (Rocephin)
Cefpodoxime (Vantin)
4th Generation
Cefepime (Maxipime)

Back 2

*Indicated for Gram (-) infections and those patients who cannot tolerate Penicillins
*5-15% incidence of Cross-sensitivity to Penicillins, however, may be a good alternative when
Penicillins not tolerated.
*Contraindicated for patients who have had an anaphylactic allergic reaction to penicillin.
*4 Generations – generally the higher the generation the better the Gram (-) coverage.
*1st and 2nd generations Do Not cross the blood/brain barrier – ineffective for neurological infections.
*Adverse reactions commonly include: skin rashes, GI complaints. More rarely seen: suprainfections,
pseudomembraneous enterocolitis and anaphylaxis.
*Specific adverse reactions: Bleeding tendencies (monitor PT), IM injection pain (consider
administration with Xylocaine), thrombophlebitis (administer over 60 minutes).
*Over 50% are administered parenterally, refrigerate oral suspensions.
*Monitor use in renal patients.

Front 3

Macrolides
Common examples:
Azithromycin (Zithromax, Z-Pak)
Clarithromycin (Biaxin)
Erythromycin (Erythrocin)

Back 3

*Broad-spectrum antibiotic
*Good alternative for patients allergic to Penicillin.
*Administer on an empty stomach, destroyed by gastric acids and acidic fruit juice.
*Contraindicated with known liver disease, increased liver function tests with prolonged use.
*Adverse effects include GI complaints, suprainfections, hepatotoxicity, dysrhythmias, ototoxicity,
pseudomembranous colitis, and anaphylaxis.

Front 4

Penicilllins
Common examples:
Penicillin G (Bicillin)
Penicillin V (Pen VK)
Nafcillin, Oxacillin
Ampicillin (Principen)
Amoxicillin (Amoxil,
Trimox)
Ampicillin/Sulbactam
(Unasyn)
Amoxicillin/Clavulanate
(Augmentin)
Ticarcillin (Ticar)
Peperacillin/Tazobactam
(Zosyn)

Back 4

*Treatment of Gram (+) infections
*5-15% incidence of Cross-sensitivity to Cephalosporins.
*Give separately from Aminoglycosides, may inactivate.
*Generally well tolerated. Adverse reactions range from mild rash, N/V, to severe anaphylaxis.
*Monitor use in renal patients
*Oral absorption limited by the presence of food, empty stomach preferred, administer with H20, not
acidic juices.

Front 5

Fluoroquinolones
(Quinolones)
Common examples:
Ciprofloxacin (Cipro, Septra)
Gatifloxacin (Tequin, Zymar)
Levofloxacin (Levaquin)
Moxifloxacin (Avelox

Back 5

*Treatment of Gram (-) organisms and some Gram (+) infections
*Generally not used as a first-line antibiotic
*Antacids, mineral supplements and multivitamin interfere with absorption up to 90% when given
together
*Monitor BUN and creatinine levels.
*Monitor I&O
*Adverse effects include: GI complaints, dizziness, headache, sleep disturbances, suprainfections,
phototoxicity, cardiotoxicity, and tendon/joint toxicity (associated with small risk of tendon rupture).
*Contraindicated in pregnancy and patients < 18 years of age, except with Anthrax exposure.
*Cipro DOC for Anthrax exposure

Front 6

Sulfonamides
Common examples:
Trimethoprim/Sulfamethoxazole
(Bactrim, Septra)
Sulfisoxazole (Gantrisin)
Sulfisoxasole/Erythromycin
(Pediazole)
Silver Sulfadiazine (Silvadene)
**Topical form
Sulfacetemide (Cetamide)
**Opthalmic drops

Back 6

*Broad spectrum activity
*Oftenprescribed for the treatment of UTIs
*Increase fluids to 2000-3000 ml/day
Adverse effects include GI complaints, skin rashes, suprainfections, crystalluria, renal damage,
phototoxicity, hyperkalemia, blood dyscrasias, Stevens-Johnson syndrome, anaphylaxis.

Front 7

Tetracyclines
Common examples:
Doxycycline (Vibramycin)
Tetracycline (Sumycin)
Tigecycline (Tygacil)

Back 7

*Broad spectrum activity
*Take on an empty stomach to maximize absorption, although may not be tolerated unless
administered with food.
*Strong affinity for Calcium, do not administer with antacids or dairy products.
*Contraindicated during pregnancy, lactation and children < 8 years (May cause permanent staining
of teeth and/or delayed bone growth).
*Photosensitivity and GI disturbances common.
Adverse reactions include multiple GI complaints, skin rashes, suprainfections, phototoxicity,
hepatotoxicity, anaphylaxis.

Front 8

Vancomycin

Back 8

Severe Gram (+) infections
*DOC for treatment of MRSA
*Ototoxicity, Nephrotoxicity
*Baseline hearing test recommended.
*Peak and trough levels indicated.
*Monitor BUN and creatinine levels.
*Infuse over at least 60 minutes on an infusion pump and monitor BP and HR during administration
due to risk of hypotension.
*Adverse reactions include GI disturbance, skin rashes, fever and chills, confusion, seizures,
ototoxicity,

Front 9

Daptomycin (Cubicin)
Class: Cyclic-lipopeptide

Back 9

*Reserved for serious skin, wound and abscess infections
*Adverse effects include GI complaints, fever, headache, dizziness, insomnia and rash

Front 10

Imipenem-cilastin
(Primaxin)
Class: Carbapenems

Back 10

*One of the broadest spectrums of any antibiotic class
*Low incidence of adverse effects. Rash and GI complaints most common

Front 11

Imipenem-cilastin
(Primaxin)
Class: Carbapenems

Back 11

*One of the broadest spectrums of any antibiotic class
*Low incidence of adverse effects. Rash and GI complaints most common

Front 12

Clindamycin (Cleocin)

Back 12

*Broad spectrum antibiotic
*Often used for oral infections
*Associated risk of Pseudomembranous colitis limits use
*Other adverse effects include rash, pruritis, difficulty swallowing

Front 13

Quinupristin/Dalfopristin
(Synercid)
Class: Streptogramins

Back 13

*Primary use for the treatment of Vancomycin-resistant Enterococcus
*Hepatotoxic, nephrotoxic
*Other adverse effects include pain and irritation at IV site, GI complaints, muscle pain and rash

Front 14

Linezolid (Zyvox)
Class: Oxazolidinones

Back 14

*Effective for Vancomycin resistant MRSA infections
*Cautious use in patients with history of hypertension or patient’s taking serotonin reuptake
inhibitors; may precipitate a hypertensive crisis
*Other adverse effects include thrombocytopenia, bleeding, GI complaints, fever

Front 15

Antihelminthics
Common examples:
Mebendazole (Vermox)
Pyrantel (Antiminth, Pinworm
caplets, Pin-X)

Back 15

*Treat entire family and close personal contacts to prevent reinfestation
*Teach good personal hygiene, handwashing, frequent laundering of clothes and bed linens
*Adverse effects are rare, may experience GI complaints as the worms die, look for S&S of intestinal
blaockage.
Not recommended during pregnancy or for patients < 2 years.

Front 16

Antimalarials
Common examples:
Hydroxychloroquine
(Plaquenil)

Back 16

*Easier to prevent the disease of malaria than to treat it. Persons traveling to infested areas should take
prophylactic antimalarials prior to travel.
*Adverse effects include GI complaints, headache, agitation, photophobia, agranulocytosis, EKG
changes.
*Baseline CBC and EKG indicated with long-term therapy

Front 17

Antiprotozoals
(nonmalarial)
Common examples:
Metronidazole (Flagyl)

Back 17

*Dual activity against bacteria and parasites
*May cause dark or reddish brown discoloration of urine
*Cautious use with known hepatic disease
*Adverse effects include GI complaints, headache, dizziness, thrombophlebitis, bone marrow
suppression.

Front 18

Herpesviruses
Common examples:
Acyclovir (Zovirax)
Valacyclovir (Valtrex)
Famiciclovir (Famvir)

Back 18

*Indicated for the treatment of HSV-1, HSV-2, CMV (Cytommeegalovirus), EBV (Epstein Barr),
VZV (Varicella)
*Do not cure patients of the virus. Used to relieve symptoms and decrease recurrence rate
*For IV routes: Monitor I&O and encourage fluids, monitor BUN and creatinine.
*Adverse effects vary with drug.

Front 19

Influenza
Common examples:
Oseltamivir (Tamiflu)
Zanamivir (Relenza)
Prophylaxis
Amantadine (Symmetrel)
Rimantidine (Flumadine)

Back 19

*Prophylactic medications should be started within 48 hours after exposure.
*Screen for history of substance abuse and/or suicide, may exacerbate preexisting mental disease.
*Prevention of influenza through annual vaccination is the best alternative

Front 20

Hepatitis
Common examples:
Antivirals
Adefovir dipivoxil (Hepsera)
Entecavir (Baraclude)
Tenofovir (Viread)
Lamivudine (Epivir HBV)

Back 20

*Indicated for the treatment of chronic Hepatitis B infections
*Adverse effects include GI complaints, fatigue, and hepatotoxicity.
*Monitor ALT, AST and blood counts.

Front 21

Inteferons
Peginterferon alfa-2a (Pegasys)
Antivirals
Ribavirin (Copegus, Virazole,
Rebetol, Ribasphere)

Back 21

*Indicated for the treatment of Hepatitis C
*Adverse effects include fatigue, headache, malaise, anorexia, diarrhea, suprainfections,
thrombocytopenia, suicidal thoughts
*Flulike symptoms likely after IV administration.
*Increase fluids to 2500ml or more/day and monitor I&O.

Front 22

Fusion and Integrase Inhibitors
Raltegravir (Isentress)
Maraviroc (Selzentry)
Enfuvirtide (Fuzeon)

Back 22

*Monitor CD4+ Tcell counts and HIV RNA viral load with all Antiretrovirals

Front 23

Protease Inhibitors
Saquinavir mesylate (Invirase)
Nelfinavir (Viracept)
Iopinavir/Ritonavir (Kaletra)

Back 23

*Administer in combination therapy only.
*Adverse effects include abdominal pain, fatigue, GI complaints, neutropenia, thrombocytopenia,
nephrotoxicity,cough, dizziness, pyrexia, rash, upper respiratory infections, hepatotoxicity and
increased risk of myocardial infaction.
*Use caution when administering to patients with known cardiac disease.
*Monitor ALT and AST.
*Subq injection site reactions occur in nearly all patients
*Resistance develops rapidly, always administer in combination therapy with at least one NRTI.
*St John's Wort contraindicated, greatly reduces efficacy.
*Adverse effects include GI complaints specifically severe diarrhea, anemia, leucopenia,
lymphadenopathy, hemorrhagic colitis, and pancreatitis

Front 24

Nucleoside/Nucleotide Reverse
Transcriptase Inhibitors
(NRTIs)
Zidovudine or AZT (Retrovir)

Back 24

*Adverse effects include rash, malaise, GI complaints, bone marrow suppression, neutropenia,
anemia, neurotoxicity

Front 25

Non-Nucleoside Reverse
Transcriptase Inhibitors
(NNRTIs)
Efavirenz (Sustiva)
Delavidrine (Rescriptor)

Back 25

**Adverse effects include rash, GI complaints, parasthesia, hepatotoxicity, Stevens-Johnson
syndrome.
*Monitor ALT and AST.