Nku Nrs255 - E2 - Anti-Infectives: Antibiotics

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3 Anti-Infectives

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Antibiotics
Antivirals
Antifungals
*To treat known or suspected infection by particular organism, or prophylactically to prevent infection.

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Anti-Infectives: General Precautions

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Resistance - organism adapts; overuse increases risk of resistance.
Superinfection
Toxic to Neurologic and GI systems
High incidence of allergic / hypersensitive reactions

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Chemicals that inhibit specific bacteria.

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Antibiotics

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Antibiotics: Bactericidal vs Bacteriostatic

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Bactericidal - kills / destroys

Bacteriostatic - inhibits growth / cell division

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9 Classes of Antibiotics

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Penicillins
Cephalosporins
Sulfonamides
Carbapenems
Tetracyclines
Fluoroquinolones
Aminoglycosides
Anti-mycobacterials
Other

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Aminoglycosides

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Bactericidal
Inhibits protein synthesis
"-mycin"
*gentamicin - IM, IV - tx Pseudomonas & wide variety gram-neg.
Side effects: Sinusitis, dizziness, rash, fever, nephro-toxicity

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Carbapenems

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Bactericidal
Inhibit cell membrane synthesis (via protein)
"-penem"
*ertapenem - IM, IV - tx community acquired oneumonia, complicated GU & intra-abdominal infections, acute pelvic infections, skin infections.
Side effects: H/A, dizziness, N/V, pseudomembranous colitis, rash, pain at injection site.

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Cephalosporins

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Bacteriostatic(depending on dose)
Interfere with cell wall building
1 - 4 generation
"cef-"
*cefaclor (2nd gen.)- PO - Tx respiratory, dermatological, urinary tract, and middle ear infections.
Side effects: N/V, diarrhea, rash, superinfection, bone marrow depression, pseudomembranous colitis

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Fluoroquinolones

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Gram-neg
Interfere with DNA for growth and reproduction.
"-floxacin"
*ciprofloxacin - PO, IV - tx respiratory, dermatological, urinary tract, ear, eye, bone, and joint infections; tx after exposure to anthrax & typhoid fever.
Side effects: H/A, dizziness, hypotension, N/V, diarrhea, fever, rash.

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Penicillins

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Natural Penicillins (G benzathine, potassium, procaine & V)
Extended Spectrum (amoxicillin)
Penicillin-resistant (nafcillin & oxacillin)

*amoxicillin - PO - tx of infection by susceptible bacteria, post-exposure prophylaxis for anthrax, tx Helicobacter in combination therapy.
Side effects: N/V, diarrhea, glossitis, stomatitis, bone marrow suppression, rash, fever, superinfection, lethargy

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Sulfonamides

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Blocks para-aminobenzoic acid (PABA) needed for folic acid needed for DNA / multiplication.
"sulfa-"
*cotrimoxazole - PO - tx urinary tract infection, acute otitis media in children, chronic bronchitis, traveler's diarrhea, Pneumocystis carnii pneumonia.
Side effects: N/V, diarrhea, hepatocellular necrosis, hematuria, bone marrow suppression, Stevens-Johnson syndrome, rash, urticaria, photophobia, fever, chills

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Tetracyclines

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Inhibit protein synthesis
*tetracycline - PO, Topical - tx of infections caused by susceptible bacteria; acne, or when penicillin is contraindicated.
Side effects: N/V, diarrhea, glossitis, discoloring of teeth, bone marrow suppression, photosensitivity, superinfections, rash, local irritation with topical.

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Anti-mycobacterials

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*mycobacteria - group comtaining the pathogens that cause TB and leprosy

isoniazid - PO- interferes with lipid and nucleic acid synthesis - tx of TB
Side effects: peripheral neuropathies, N/V, hepatitis, bone marrow suppression, fever, gynecomastia, lupus syndrome.

dapsone - PO- tx of leprosy

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Other Antibiotics: Ketolides

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Block protein synthesis
*telithromycin - PO - tx community acquired pneumonia
Aside effects: H/A, dizziness, N/V, pseudomembranous colitis, superinfections

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Other Antibiotics: Lincosamides

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Inhibits protein synthesis
*clindamycin - PO, IM, IV, Topical - tx of serious infections caused by susceptible bacteria, including some anaerobes; useful is septicemia and chronic bone & joint infections.
Side effects: N/V, diarrhea, pseudomembranous colitis, bone marrow suppression, hypotension, cardiac arrest (IV), rash, pain (IM)

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Other Antibiotics: Macrolides

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Interfere with protein synthesis
Bactericidal & Bacteriostatic
"-thromycin"
*erythromycin - PO, IV - tx respiratory, dermatological, urinary tract, & GI infections caused by susceptible bacteria.
Side effects: abdominal cramping,vomiting, diarrhea, rash, superinfection, liver toxicity, pseudomembranous colitis, hearing loss

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Other Antibiotics: Monobactam

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Effective against gram-neg enterobacteria; no effect on gram-pos or anaerobics.
Disrupts cell wall synthesis
*aztreonam - IM, IV - tx lower respiratory, dermatological, urinary tract, intra-abdominal, & gynecological infections by gram-neg.
Side effects: N/V, diarrhea, rash, superinfection, anaphylaxis, local discomfort at injection site

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Vancomycin

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PO & IV
Interferes with cell wall synthesis
Tx Staphylococcal infections resistant to other antibiotics (MRSA) & many gram-pos; C-diff take PO only
Side effects: Ototoxicity, nephrotoxicity, fever, chills, hypotension, erythema of neck and back (Red man syndrome - trunk of body)

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5 inhibit protein synthesis

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Aminoglycosides
Tetracyclines
Lincosamides
Macrolides
Ketolide

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4 inhibit cell wall synthesis

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Penicillins
Cephalosporins
Carbapenems
Monobactam

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2 affect DNA

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Fluoroquinolones
Sulfonamides (folic acid)