Drug Anti-Infective

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What are Anti-infectives?

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Any agent that combats infection

Include the following classes:Antibiotics, Antivirals, Antifungals

Basic Goal:To reduce pathogen population to a size that body’s immune response can overtake.

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Bateriostatic

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Prevent growth of bacteria

Less toxic, longer time to work

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Bacteriocidal

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Kills bacteria

More toxic to human cells

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Broad Spectrum

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Affects gram + and -

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Gram Stain (-)

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Has LPS

Common with GU/GI infection (Ex: Neisseria, Klebsiella, Pseudomonas, E coli)

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Gram Stain (+)

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Common with respiratory (Ex: Staph aureus, strept, enterococcus, clostridium)

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Aerobic or Anaerobic

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Bacteria requiring oxygen or no oxygen

Anaerobic: tetanus

Aerobic: pseudomonas, mycobacterium tuberculosis

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Pharmokinetics of Antibiotics

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Inhibit cell wall synthesis

Disrupt cell membrane

Block protein synthesis

Interfere with DNA synthesis

Prevention of folic acid synthesis

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Nursing Considerations for Antibiotics

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Can cause allergic reactions (Allergy, not side effects)

Often best if given on empty stomach

Often cause GI side effects

Must give around the clock

FINISH ENTIRE COURSE!!

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Aminoglycosides

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Prototype: Gentamycin(Garamycin®)

Effective against Gram neg infection.

Bacteriocidal.

Inhibit protein synthesis.

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Indications for Aminoglycosides

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PseudomonasE. ColiStaph aureus (Gram pos)

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Pharmacokinetics for Aminoglycosides

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Poorly absorbed in GI tract → IV

Cross the placenta and breast milk.

Should be used with great caution

Excreted through kidney

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Interactions for Aminoglycosides

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Potent diuretics (causes ototoxicity, nephrotoxicity , neurotoxiticy)

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Side Effects for Aminoglycosides

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Ototoxicity (irreversible)Renal toxicity (leading to renal failure)

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Implications for Aminoglycosides

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Watch peaks/troughs

Daily renal function tests (BUN/Creat, Creat clearance)

Periodic blood levels

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Penicillin "Fun" facts

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Around since 1920sInexpensiveMost effective against Gram + bacteria (pharyngitis, tonsillitis, OM, endocarditis) Some bacteria have developed penicillinase (become resistant)

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Prototype of Penicillin

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Amoxicillin (Amoxil®)

Extended spectrum penicillins

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Indications for Penicillin

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Treatment of Gram pos infections (Staph, Strep), Syphilis

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Adverse Effects for Penicillin

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Primarily GI symptoms secondary to reduction of normal flora

Prophylaxis before dental procedure or minor surgery to prevent endocarditis with history of rheumatic fever (inflammation following strept. Infection)

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Side Effects for Penicillin

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HSR (Hypersensitivity Reaction) to PCN: may occur 2-30 minutes after administration

10% of population allergic

5% cross allergic to cephalosporins

S/S: N/V, pruritis, rash and fever, can progress to anaphylaxis and death with repeated exposure

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Nursing Considerations for Penicillin

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Assess for allergic reaction

Take on empty stomach with 8-oz of water

Watch for Drug-Drug Interactions

Avoid concurrent use with tetracyclines (decreases effectiveness of PCN)

Avoid concurrent IV use with any IV aminoglycoside. Results in deactivation of aminoglycoside

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Prototype of Penicillinase- Resistant Antibiotics

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Nafcillin (Unipen®)

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Indications for Penicillinase- Resistant Antibiotics

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Resistant bacterial species

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1st Generation Cephalosprins

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Gram pos > neg

Cephalexin (Keflex), Cefazolin (Ancef)

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2nd Generation Cephalosprins

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Gram pos > neg

Cefaclor (Ceclor)

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3rd Generation Cephalosprins

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Gram pos < neg CSF penetration

Ceftriaxone (Rocephin) Ceftazidime (Fortaz)

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4th Generations Cephalosprins

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Gram neg & pos, Resistant Staph and Pseudomonas. *5th generation is coming up (Zeftera)*

Cefepime (Maxipime)

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Pharmacokinetics of Cephalosprins

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Well absorbed in GI tract (given PO)

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Adverse Effects of Cephalosprins

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Bone Marrow Depression and Pseudomembranous colitis (by C diff)

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Mechanism of Actions of Cephalosprins

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Similar to penicillins; interfere with bacterial cell wall synthesis. Causing bacteria to swell and burst (bacteriocidal).

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Indications for Cephalosprins

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Respiratory infections, GU, skin, septicemia, surgical prophylaxis, 3rd generation for CNS infections

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Nursing Considerations for Cephalosprins

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Cross sensitivity to penicillin

GI effects but OK with food

Interferes with Vit K: caution with anticoagulants, NSAIDs

Phlebitis at IV site – give slowly

Avoid alcohol – even up to 72 hours after stopping medication

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Prototype of Fluroquinolones

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:Ciprofloxacin (Cipro®), Levofloxacin (Levaquin®) Broad spectrum (Gram neg and some Gram pos)

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Indications for Fluroquinolones

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GU, respiratory and skin infections

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Adverse Effects of Fluroquinolones

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GI upset, tendinitis (Levaquin), photosensitivity, CNS (HA, dizziness, insomnia, depression)

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Nursing Considerations for Fluroquinolones

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sun screen, protective clothing, Bone marrow suppression

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Macrolidies (-mycins)

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Bacteriostatic at lower levels and cidal at higher: Affect bacterial cell wall.

Erythromycin (Ery-Tab®) Azithromycin (Z-pack: Zithromax®)

-->Daily dosing

-->Full course of treatment is 5 days.

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Indications for Macrolidies

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Treatment of infections in persons allergic to Penicillin, respiratory tract infections, Lyme disease, STD’s

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Side Effects of Macrolidies

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GI upset, bitter taste, skin rash

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Nursing Considerations for Macrolidies

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Adequate fluids

No IM

Give on empty stomach

Check drug interactions: digoxin, anticoagulants

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Lincosamides

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Prototype: Clindamycin (Cleocin)

PO or topical

Similar to macrolides except more toxic

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Indications for Lincosamides

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Similar to macrolides, serious abdominal and pelvic infections

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Side Effects of Lincosamides

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GI (pseudomembranous colitis)

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Nursing Considerations for Lincosamides

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Same as Macrolides:

Adequate fluidsNo IMGive on empty stomachCheck drug interactions: digoxin, anticoagulants

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Sulfonamides

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Prototype: cotrimoxazole (Septra®, Bactrim®)

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Mechanism of Actions for Sulfonamides

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Blocks para-aminobenzoic acid (PABA), essential component of folic acid required for bacterial intracellular proteins.

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Indications for Sulfonamides

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eatment and prophylaxis of Pneumocystis jiveroci pneumonia (PJP), UTIs, some STD

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Contraindications for Sulfonamides

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Allergies to sulfa drugs and thiazide diuretics (cross sensitivity).

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Side Effects of Sulfonamides

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N/V, HA, anorexia, rash, crystalluria

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Nursing Considerations for Sulfonamides

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Empty stomach

Fluid intake

CBC secondary to bone marrow suppression

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Indications for Tetracycline

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Tetracycline (Sumycin®)

Wide variety of infections when penicillin is contraindicated.

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Contraindications for Tetracycline

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Pregnacy, lactating women, children under 8 years old because of potential damage to bone, teeth and enamel.

Do not give with antiacids.

Cause dermatologic photosensitivity and rash

Sexually active women of childbearing age currently taking birth control pills must use second form of BC (barriers).

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Antimycobacterial Drugs

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Antituberculosis drugs

Example: Isoniazid (INH, Nydrazid) and Rifampin (Rifadin, Rimactane)

Also prophylactic treatment of household members (INH)

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Drug-drug Interactions of Antimycobacterial Drugs

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Rifampin and PI or NNRTI (both are HIV drugs) are always contraindicated. (Alternative is Streptomycin)

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Nursing Considerations of Antimycobacterial Drugs

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Peripheral neuropathies, red discoloration of body fluids -- tears and urine with Rifampin

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Indications for Leprostatics

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Dapsone (Dapsone®)

Leprosy, and P. jiveroci pneumonia (PJP) in AIDS patients.

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Adverse Effects of Leprostatics

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Erythema nodosum (red nodules) leprosum is an inflammation of the fat cells under the skin.

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Mechanism of Actions for Vancomycin

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Interferes with cell wall synthesis. Used when patient is intolerant or allergic to PCN/cephalosporins, C. Diff, MRSA (last resort)

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Side Effects of Vancomycin

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Quite toxic: Renal failure, ototoxicity, superinfection (Peak/Troughs)

Red Man Syndrome (reaction to vancomycin) : Sudden hypotension, fever, chills, paresthesia, and redness of the neck and back, extremities.