3. Bacteria
Bacteriostatic -Inhibits the growth of bacteria
Bactericidal -Kills the bacteria
Bacteriostatic drugs-Tetracycline and sulfa drugs
Bactericidal drugs- Penicillin and cephalosporin
4. Antibacterial Drugs Mechanism of
action
Inhibition of cell wall synthesis
Alteration of membrane permeability
Inhibition of protein synthesis
Inhibition of the synthesis of bacterial ( RNA) &DNA
Interference with metabolism within the cell
5. 3 main adverse reactions with
antibiotics:
1) superinfections -secondary infection: normal flora killed, therefore other organisms can proliferate and
cause infection
-ex: Candida and Clostridium difficile
-sites: mouth, skin, respiratory tract, vagina, intestines
-usually occurs when treated with longer courses of therapy
2) allergic reactions or hypersensitivity
3) Organ toxicity-ototoxicity (ear)
-hepatotoxicity (liver)
-nephrotoxicity (kidney
CAUTION
When antibiotics are taken unnecessarily, incorrectly or stopped before the entire prescription is completed,
resistance to the antibiotic can and does occur.
Viruses are not destroyed by antibiotics
8. Body Defenses
Age
-Nutrition
-Immunoglobulins
-Circulation, WBCs
-Organ function
9. MRSA
First line treatment of MRSA infection -vancomycin (Vancocin)
Effective treatment choices for MRSA
vancomycin (Vancocin)
linezolid (Zyvox)
daptomycin (Cubicin)
trimethoprim/sulfamethoxazole
(Bactrim)
doxycycline (Vibramycin)
clindamycin (Cleocin)
Telavancin (Vibativ)- a glycopeptides antiinfective, treats gram negative
bacteria (including MRSA)
10. Resistance to Antibacterials
Natural or inherent resistance- naturally has resistance
Acquired resistance- repeat exposure has caused resistance
Nosocomial infections- Infections acquired while patients are hospitalized.
Many are due to drug-resistant bacteria
Cross-resistance-Can occur between antibacterial drugs that have similar
actions such as (penicillin and cephalosporin)
MRSA
11. ANTIBIOTIC RESISTANCE
Narrow spectrum antibiotics are
Effective against a few bacteria types
Penicillin & Erythromycin
Broad spectrum antibiotics are
Effective against gram positive & gram negative
organisms Carbapenems & cephalosporin
Why would a nurse practitioner give a broad
spectrum rather than a narrow spectrum
antibacterial?
12. Cephalosporins
structurally similar to penicillins
-cef, -ceph
inhibit cell wall
respiratory, urinary, skin, bone, joint, genital infection
allergy to penicillin
13.
14. Cephalosporins
Cephalosporins drugs
cefepime (psuedo)
ceftazidime (psuedo)
ceftaroline (MRSA)
Cephalosporins side effects
pruritus, GI distress, increased
bleeding, seizures
check renal and liver function
cross sensitivity to penicillins
15. Cephalosporins Nursing Interventions
- Nursing Process
Cephalosporins Assessment
-obtain allergy information prior to
administration of a cephalosporin
-be aware of potential cross-
sensitivity in penicillin allergic patients
Cephalosporins Nursing Interventions
-assess for allergy
-assess renal and liver function
(dosage adjustment may be
necessary in patients with
renal/hepatic impairment)
-monitor for superinfection (diarrhea
may indicate C difficile infection)
-counsel patients on oral
contraceptives of the need to utilize
back-up contraception
16. What is Penicillin?
Penicillin is a natural antibacterial agent obtained from the mold genus
Penicillium, was introduced to the military during World War II and is
considered to save many soldiers' lives; used to treat various bacterial
infections
18. Penicillin
1928 Alexander Fleming a bacteriologist accidentally realized that mold was
contaminating his bacterial cultures by inhibiting bacterial growth.
The mold was called penicillium notatum
In 1939 Howard Florey expanded on Fleming’s findings
After testing on rabbits and a soldier with an infected eye after World War II penicillin was finally
marketed in 1945
19. Penicillin action
interferes with bacterial cell-wall synthesis (inhibits bacterial enzyme
necessary for cell division/synthesis)
-bactericidal/bacteriostatic
-penicillin G: bactericidal
Interaction
may decrease effectiveness of oral contraceptives
21. Penicillin
Interventions for Penicillins
-Check for allergies
-Use a back up birth control method
-Monitor for bleeding
-Culture and sensitivity
-Increase fluids
-Check for superinfection (looking in
their mouth)
-Take 1 hour before or 2 hours after
meals (foods can mess with the
effects)
Side effects of penicillin
hypersensitivity is common
N/V/D
superinfection
stomatitis
pseudo colitis
Life threatening: blood dycrasias and
SJS
24. Macrolides use to treat ?
Respiratory Community acquired pneumonia
COPD exacerbation
Sinusitus
Mycoplasmal pneumonia
25. Side affect for macrolides
QT segment prolongation
Nurse Must monitor which type of
patient is taking Macrolides
Cardiac --> they should wear EKG
Interaction for Azithromycin
Macrolides
NO ANTACIDS ( Blocks absorption of
antibiotics )
26. Lincosamides Drug ( Gram Positive
drug )
Clindamycin ( Cleocin)
Lincosamides Action:
Inhibits bacterial Protein Synthesis
Lincosamides is highly associated with C difficle Infection
28. Vancomycin ( Vancocin) ( Side affect )
Red Man syndrome
Occurs When IV infused at too rapid a rate of
administration
red blotching of face , neck , check , and
extremities
Hypotension
Tachycardia
29. Tetracycline ( Long Acting Drugs )
Broad Spectrum (+,-)
Doxycycline (Vibramycin)
Minocycline HCl (Minocin)
Side effects of Tetracycline:
Discoloration of permanent teeth in pediatric patient
Caution in children younger than 8 years
Avoid milk, contraceptives, and antacids when taking tetracycline's
Store out of light and extreme heat.
31. Aminoglycosides
Adequate Hydration
Ototoxicity and nephrotoxicity at supratherapeutic levels
Requires close monitoring of drug levels and renal function
When should you take Aminoglycosides?
Through --> Half a hour before Administration
Peak --> Should be obtained 1 hours following completion of infusion
33. Fluoroquinolones Drugs
Ciprofloxacin ( Cipro)
Gram negative
UTI , and Lower respiratory Tract infection and skin , soft tissue , bone , joint infection
Levofloxacin (Levaquin)
Community acquired pneumonia , chronic bronchitis , acute sinusitis , UTI &
UNCOMPLICATED SKIN INFECTION
Moxiflocacin ( Avelox )
road spectrum , including activity against anaerobic organism
once a day oral and parental dosing
use to treat the same infection other Fluoroquinolones are effective against
34. Side effect for Fluoroquinolones
(Quinolones)
High Associated with C diff infection
TENDONITIS /TENDON RUPTURE
PHOTOSENSITIVE
QT PROLONGATION
Interaction:
Antacids decrease absorption
No Milk or diary
35. Lipopeptides Drugs
Daptomycin ( Cubicin
Daptomycin is the alternative to Vancomycin for MRSA
Lipopeptides Treat:
Complicated skin infectious due to gram positive microorganism ,
septicemia --> S aureus
and ineffective endocarditis due to MRSA
36. Side Effect of Lipopeptides
Elevation in Creatinine Phosphokinase (CPK ) , and Myopathy
