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• Medications used to treat bacterial infectionsMedications used to treat bacterial infections
• Ideally, before beginning antibiotic therapy, Ideally, before beginning antibiotic therapy, the suspected areas of infection should be the suspected areas of infection should be cultured to identify the causative organism cultured to identify the causative organism and potential antibiotic susceptibilities.and potential antibiotic susceptibilities.
• Empiric therapy: treatment of an infection Empiric therapy: treatment of an infection before specific culture information has been before specific culture information has been reported or obtainedreported or obtained
• Prophylactic therapy: treatment with Prophylactic therapy: treatment with antibiotics to prevent an infection, as in intra-antibiotics to prevent an infection, as in intra-abdominal surgeryabdominal surgery
• Bacteriostatic: inhibit growth of susceptible Bacteriostatic: inhibit growth of susceptible bacteria, rather than killing them immediately; bacteria, rather than killing them immediately; will eventually lead to bacterial deathwill eventually lead to bacterial death
Sulfonamides: Mechanism of ActionSulfonamides: Mechanism of Action
• Bacteriostatic actionBacteriostatic action
• Prevent synthesis of folic acid required for Prevent synthesis of folic acid required for synthesis of purines and nucleic acidsynthesis of purines and nucleic acid
• Does not affect human cells or certain Does not affect human cells or certain bacteria—they can use preformed folic acidbacteria—they can use preformed folic acid
Azo-GantanolAzo-Gantanol• Combined with phenazopyridine Combined with phenazopyridine
(an analgesic-anesthetic that affects the mucosa (an analgesic-anesthetic that affects the mucosa of the urinary tract).of the urinary tract).
• Used to treat urinary tract infections (UTIs) and to Used to treat urinary tract infections (UTIs) and to reduce the pain associated with UTIsreduce the pain associated with UTIs..
BactrimBactrim• Combined with trimethoprim.Combined with trimethoprim.
• Used to treat UTIs, Pneumocystis carinii pneumonia, Used to treat UTIs, Pneumocystis carinii pneumonia, ear infections, bronchitis, gonorrhea, etc.ear infections, bronchitis, gonorrhea, etc.
• Chemicals have been developed to inhibit Chemicals have been developed to inhibit these enzymes:these enzymes:
– clavulanic acidclavulanic acid
– tazobactamtazobactam
– sulbactamsulbactam
• These chemicals bind with beta-lactamase These chemicals bind with beta-lactamase and prevent the enzyme from breaking down and prevent the enzyme from breaking down the penicillinthe penicillin
• Prevention and treatment of infections Prevention and treatment of infections caused by susceptible bacteria, such as:caused by susceptible bacteria, such as:
Cephalosporins: Second GenerationCephalosporins: Second Generation
CefoxitinCefoxitin cefuroximecefuroxime
(Mefoxin)(Mefoxin) (Kefurox and Ceftin)(Kefurox and Ceftin)
IV and IMIV and IM POPO
Used prophylactically forUsed prophylactically for Surgical prophylaxisSurgical prophylaxisabdominal or colorectalabdominal or colorectalsurgeriessurgeries Does not killDoes not killAlso kills anaerobesAlso kills anaerobes anaerobesanaerobes
• Broader spectrum of antibacterial activity than Broader spectrum of antibacterial activity than third generation, especially against gram-positive third generation, especially against gram-positive bacteria.bacteria.
• Bind to CaBind to Ca2+2+ and Mg and Mg2+2+ and Al and Al3+3+ ions to ions to form insoluble complexesform insoluble complexes
• Thus, dairy products, antacids, and iron Thus, dairy products, antacids, and iron salts reduce absorption of tetracyclinessalts reduce absorption of tetracyclines
• Demeclocycline is also used to treat SIADH, Demeclocycline is also used to treat SIADH, and pleural and pericardial effusionsand pleural and pericardial effusions
• Used to kill gram-negative bacteria such as Used to kill gram-negative bacteria such as Pseudomonas spp., E. coli, Proteus spp., Pseudomonas spp., E. coli, Proteus spp., Klebsiella spp., Serratia spp. Klebsiella spp., Serratia spp.
• Often used in combination with other Often used in combination with other antibiotics for synergistic effect.antibiotics for synergistic effect.
• Before beginning therapy, assess drug allergies; Before beginning therapy, assess drug allergies; hepatic, liver, and cardiac function; and other lab hepatic, liver, and cardiac function; and other lab studies.studies.
• Be sure to obtain thorough patient health history, Be sure to obtain thorough patient health history, including immune status.including immune status.
• Assess for conditions that may be contraindications Assess for conditions that may be contraindications to antibiotic use, or that may indicate cautious use.to antibiotic use, or that may indicate cautious use.
• Assess for potential drug interactions.Assess for potential drug interactions.
• It is ESSENTIAL to obtain cultures from It is ESSENTIAL to obtain cultures from appropriate sites BEFORE beginning appropriate sites BEFORE beginning antibiotic therapy.antibiotic therapy.
• Patients should be instructed to take antibiotics Patients should be instructed to take antibiotics exactly as prescribed and for the length of time exactly as prescribed and for the length of time prescribed; they should not stop taking the prescribed; they should not stop taking the medication early when they feel better.medication early when they feel better.
• Assess for signs and symptoms of superinfection: Assess for signs and symptoms of superinfection: fever, perineal itching, cough, lethargy, or any fever, perineal itching, cough, lethargy, or any unusual discharge.unusual discharge.
• For safety reasons, check the name of the For safety reasons, check the name of the medication carefully since there are many medication carefully since there are many agents that sound alike or have similar agents that sound alike or have similar spellings.spellings.
• Each class of antibiotics has specific side Each class of antibiotics has specific side effects and drug interactions that must be effects and drug interactions that must be carefully assessed and monitored.carefully assessed and monitored.
• The most common side effects of antibiotics The most common side effects of antibiotics are nausea, vomiting, and diarrhea.are nausea, vomiting, and diarrhea.
• All oral antibiotics are absorbed better if All oral antibiotics are absorbed better if taken with at least 6 to 8 ounces of water.taken with at least 6 to 8 ounces of water.
• Should be taken with at least 2400 mL of fluid Should be taken with at least 2400 mL of fluid per day, unless contraindicated.per day, unless contraindicated.
• Due to photosensitivity, avoid sunlight and Due to photosensitivity, avoid sunlight and tanning beds.tanning beds.
• These agents reduce the effectiveness of These agents reduce the effectiveness of oral contraceptives.oral contraceptives.
• Any patient taking a penicillin should be carefully Any patient taking a penicillin should be carefully monitored for an allergic reaction for at least 30 monitored for an allergic reaction for at least 30 minutes after its administration.minutes after its administration.
• The effectiveness of oral penicillins is decreased The effectiveness of oral penicillins is decreased when taken with caffeine, citrus fruit, cola beverages, when taken with caffeine, citrus fruit, cola beverages, fruit juices, or tomato juice.fruit juices, or tomato juice.
• Orally administered forms should be given with food Orally administered forms should be given with food to decrease GI upset, even though this will delay to decrease GI upset, even though this will delay absorption.absorption.
• Some of these agents may cause an Antabuse-like Some of these agents may cause an Antabuse-like reaction when taken with alcohol.reaction when taken with alcohol.
• Milk products, iron preparations, antacids, and other Milk products, iron preparations, antacids, and other dairy products should be avoided because of the dairy products should be avoided because of the chelation and drug-binding that occurs.chelation and drug-binding that occurs.
• All medications should be taken with 6 to 8 ounces All medications should be taken with 6 to 8 ounces of fluid, preferably water.of fluid, preferably water.
• Due to photosensitivity, avoid sunlight and Due to photosensitivity, avoid sunlight and tanning beds.tanning beds.
• Monitor peak and trough blood levels of these Monitor peak and trough blood levels of these agents to prevent nephrotoxicity and ototoxicity.agents to prevent nephrotoxicity and ototoxicity.
• Symptoms of ototoxicity include dizziness, tinnitus, Symptoms of ototoxicity include dizziness, tinnitus, and hearing loss.and hearing loss.
• Symptoms of nephrotoxicity include urinary casts, Symptoms of nephrotoxicity include urinary casts, proteinuria, and increased BUN and serum proteinuria, and increased BUN and serum creatinine levels.creatinine levels.
• Should be taken with at least 3 L of fluid per day, Should be taken with at least 3 L of fluid per day, unless otherwise specifiedunless otherwise specified
• These agents are highly protein-bound and will These agents are highly protein-bound and will cause severe interactions with other protein-bound cause severe interactions with other protein-bound drugs.drugs.
• The absorption of oral erythromycin is enhanced The absorption of oral erythromycin is enhanced when taken on an empty stomach, but because when taken on an empty stomach, but because of the high incidence of GI upset, many agents of the high incidence of GI upset, many agents are taken after a meal or snack.are taken after a meal or snack.