Ati Meds For Infection (Mycobacterial, Fungal, And Parasitic Infections)

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antimycobacterial (antituberculosis)

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proto: isoniazid (INH, Nydrazid)
other: pyrazinamide (PZA)
ethambutol (Myambutol) bacteriostatic only to M. tuberculosis
rifapentine (Priftin)

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antimycobacterial MOA

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highly specific for mycobacteria, Isoniazid inhibits growth of mycobacteria by rpeventing synthesis of mycolic acid in the cell wall

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antimycobacterial use

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indicated for active and latent tuberculosis only

latent: Isoniazid only 6-9 months
contraindicated in clients under age 2, HIV, pregnant, clients resistant to either med

active: several meds must be used to treat client in order to decrease med resistance- includes Isoniazid for a minimum of 6 months

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antimycobacterial adverse

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peripheral neuropathy
hepatotoxicity
hyperglycemia and decreased glucose control in clients who have diabetes

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antimycobacterial contraindications

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liver disease
older clients, DM, or alcohol use disorder (caution)

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antimycobacterial interactions

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isoniazid inhibits metabolism of phenytoin, leading to the buildup of medication and toxicity, ataxia and incoordination may indicate toxicity
concurrent use of alcohol, rifampin, and pyrazinamide increases risk for hepatotoxicity

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antimycobacterial admin

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inject deeply into large muscle
take isoniazid one hour before meals or 2 hours after

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rifampin (Rifadin) antimycobacterial MOA

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bactericidal as a result of inhibition of protein synthesis

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rifampin

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broad-spectrum effective for gram + and gram- bacteria M. tuberculosis and M. leprae
given in combination with at least one other antituberculosis med to help prevent antibiotic resistance

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rifampin adverse

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discoloration of body fluids
hepatotoxicity
mild GI discomfort

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rifampin contraindications

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liver dysfunction

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rifampin interactions

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accelerates metabolism of warfarin, oral contraceptives, protease inhibitors, and NNRTIs (HIV meds) resulting in diminished effectiveness
concurrent use with isoniazid and pyrazinamide increase hepatotoxicity

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antiprotozoals

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metronidazole (Flagyl)

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metronidazole MOA

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bactericidal acitivty against anaerobic micro-organisms

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metronidazole use

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protozoal infections (intestinal amebiasis, giardiasis, trichomoniasis
obligate anaerobi bacteria- C. dif
prophylaxis for clients who will have surgical procedures and are high-risk for anaerobic infection
treatment of H. pylori in combination with tetracycline, and bismuth salicylate in clients who have PUD

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metronidazole adverse

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GI discomfort
darkening of urine
CNS symptoms

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metronidazole contraindications

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active CNS disorders, blood dyscrasias, during lactation, contraindicated in the first trimester of pregnancy in clients who have trichomonaisis
renal, cardiac, or seizure disorder, older adults

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metronidazole interactions

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alcohol causes a disulfuriam-like reaction
inactivation of warfarin

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antifungals

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amphotericin B (Fungizone) - polyene antibiotic for systemic mycoses
ketoconazole (Nizoral) an azole for treating both superficial and systemic mycoses

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antifungal meds

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other: flucytosine (Ancobon)
Nystatin (Mycostatin)
miconazole (Monistat)
clotrimazole (Lotrimin)
terbinafine (Lamisil)
fluconazole (Diflucan)
greseofulvin (Grifulvin)

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amphotericin B

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acts on fungal cell membranes to cause cell death
can be fungistatic or fungicidal

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amphotericin uses

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treatment of choice for systemic fungal infection (Candidiasis, aspergilliosis, cryptococcoids, mucomycosis)
some antifungals treat superficial fungal infections

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amphotericin B adverse

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infusion reactions 1-3 hours after initiation- pretreat with diphenhydramine (Benadryl) and acetaminophen
thrombophelebitis- administer in large vein and administer heparin before infusing amphotericin B
nephrotoxicity
hypokalemia
bone marrow suppression

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ketoconazole adverse

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hepatotoxicity
effects on sex hormones- male- gynecomastia, female-menstrual irregularity

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antifungal contraindications

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renal dysfunction

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antifungal interactions

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aminoglycosides have additive nephrotoxic risk whe nused concurrently with antifungal meds
antifungal effects of flucytosine are potentiated with concurrent use of amphotericin B
floconazole contraindicated with amphotericin B
azole antibiotics increase levels of multiple medications, including digoxin, warfarin, and sulfonylurea antidiabetic meds

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antifungal admin

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amphotericin b is highly toxic and should be reserved for severe life-threatening fungal infections
should be infused slowly over 2-4 hr by IV route because oral preparation is poorly absorbed into the GI tract

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antifungal effectiveness

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improvement of systemic fungal infections