Chapter 5: Drugs for Bacterial Infections

Adverse Reactions: Tetracyclines

Contraindicated for pregnant women and breast-feeding and in children younger than 8 years old: Inadequate bone or tooth development, produce permanent yellow brown tooth discoloration, or cause permanent damage (skeletal retardation) in a developing fetus. Increased pressure inside the brain: persistent dizziness, blurred vision, ringing in the ears, confusion, and headache.

Drug Interactions: Tetracyclines

Dairy products, aluminum, magnesium, and calcium interfere with intestinal absorption.

Expected Side Effects: Penicillins

Diarrhea of two to four loose stools daily. Nausea and vomiting and epigastric distress.

A common and expected side effects of anti-infective therapy, especially antibacterial drugs is?

Diarrhea. Rationale: The drugs reduces the numbers of bacteria in the intestinal tract that normally help digestion (Normal flora).

Nursing Implications and Patient Teaching: Tetracyclines

Do not give to pregnant women or children under 8 years old. Do not go outside or wear skin protective clothing and sunscreen between 10 am - 4 pm. Take with water on an empty stomach 1 hour before eating or 2 hours after eating. Avoid dairy products.

Bactericidal

Drugs that directly kill the bacteria.

Bacteriostatic

Drugs that limit or slow the growth of the bacteria, weakening or eventually leading to the death of the bacteria.

Aminopenicillins

E.g. ampicillin, amoxicillin. Combat the same bacteria as the natural penicillins but have improved activity against some gram-negative bacteria.

Carboxypenicillins

E.g. carbenicillin, ticarcillin. Increased activity to penetrate the cell wall, and they are used against gram-negative bacteria such as Pseudomonas aeruginosa and Proteus.

Penicillinase-resistant Penicillins

E.g. dicloxacillin, nafcillin, oxacillin. Combat Staphylococcus but are not effective against MRSA (methicillin-resistant Staphylococcus aureus) or MRSE (methicillin-resistant Staphylococcus epidermidis)

Natural Penicillins

E.g. penicillin G, penicillin V. Combat non-beta-lactamase-producing gram-positive cocci.

Ureidopenicillins and Piperazine Penicillin

E.g. piperacillin The latest class of penicillin antibiotics that combat gram-negative bacteria such as Klebsiella.

Drug Interactions: Macrolides

Enhances: digoxin, theophylline, warfarin, cyclosporine, and carbamazepine. Precipitate life-threatening cardiac dysrhythmias: ergotamine (migraines) or pimozide (Tourettes).

Expected Side Effects and Adverse Reactions: Aminoglycosides

Expected Side Effects: IV route: irritate the veins. Nausea, vomiting, rash, lethargy, and fever. Adverse Reactions: Nephrotoxicity. Ototoxicity, hearing impairment, dizziness, loss of balance, ringing in the ears, and persistent headache. Narrow therapeutic range.

Drug Examples: Penicillins

Generic names typically end in the suffix -cillin. amoxicillin (Moxatag) amoxicillin/clavulanic acid (Augmentin) penicillin G benzathine (Bicillin L -A) penicillin G procaine penicillin V potassium (Veetids)

Drug Examples: Fluoroquinolones

Generic names typically ends in -floxacin. ciprofloxacin (Cipro, Cipro XR) levofloxacin (Levaquin)

Drug Examples: Aminoglycosides

Generic names typically ends with -cin. amikacin gentamicin streptomycin

Drug Examples: Tetracyclines

Generic names typically ends with -cycline. doxycyclin minocycline hydrochloride (Minocin) tetracycline

Drug Examples: Macrolides

Generic names typically ends with -mycin. azithromycin (Zithromax) clarithromycin (Biaxin) clarithromycin extended release (Biaxin XL) erythromycin (E.E.S)

Nursing Implications: Carbapenems

Give IM injections using the Z-track method. Aspirate before injecting the IM dose to ensure the drug is not injected into the bloodstream. Monitor patients for confusion and seizure.

Nursing Implications and Patient Teaching: Fluoroquinolones

Give with food (no dairy) to ensure absorption and decrease adverse GI effects. Drink increased fluids to dilute urine. Avoid sunlight to prevent severe sunburn. Check blood glucose levels frequently for diabetic patients.

Nursing Implications and Patient Teaching: Cephalosporins

Given IV or IM route. Assess for allergic reactions. Cross-sensitivity: penicillin. Aspirate before injecting the IM dose to ensure the drug is not injected into the bloodstream. Give IM cefazolin, cefuroxime, ceftriaxone, and cefepime using Z-track method.

Nursing Implications and Patient Teachings: Aminoglycosides

Given parenterally because they are poorly absorbed from the GI tract. Monitor for ototoxicity (ringing of ears) and nephrotoxicity (BUN, creatinine, and glomerular filtration rates). Drug levels peak and trough is closely monitored.

Expected Side Effects: Sulfonamides

Headache, drowsiness, fatigue, dizziness, insomnia, anorexia, nausea, vomiting, and abdominal pain. More problematic: vertigo, tinnitus, hearing loss, and stomatitis.

Mycosis

A fungal infection.

Antimicrobial Drug

A general term for any drug that has the purpose of killing or inhibiting the growth of pathogenic microorganisms.

(Drug) Generation

A new group of drugs developed from other similar drugs and each new group have become more refined, purified, and sensitive.

Action and Uses: Cephalosporins

Action: Cell wall synthesis inhibitors. Broad-spectrum activity. Uses: Uncomplicated skin and soft tissue infections; lower respiratory tract, CNS, genitourinary system, joints, and bones; serious infections: bacteremia and septicemia.

Action and Uses: Fluoroquinolones

Action: Destroy bacteria by inhibiting two enzymes needed for DNA synthesis and reproduction. Bactericidal DNA synthesis inhibitor. Uses: Effective against gram-negative pathogens. Newer ones are effective against gram-positive. Treats complicated urinary tract infections. Ciprofloxacin is the drug of choice for anthrax exposure.

Action and Uses: Sulfonamides

Action: Metabolism inhibitors. Enter the bacteria and prevent them from making the final form of folic acid. Bacteriostatic action. Use: Broad-spectrum of activity. Treating acute and chronic urinary tract infections. Preoperative and postoperative therapy for GI surgery.

Action and Uses: Penicillins

Action: One type of class drugs known as cell wall synthesis inhibitors. They interfere with the creation and repair of bacterial cell walls and bind or stick to specific enzymes. Use: Used for infections that occur in the mouth, throat, skin, other soft tissues, heart, lungs, and ears. Also used for prophylactic treatment against bacterial endocarditis in patients with rheumatic or heart disease.

Action and Use: dalfopristin/quinupristin (Synercid)

Action: Protein Synthesis Inhibitors Use: IV only and is reserved for patients with bacteremia or sepsis.

Action and Use: clindamycin

Action: Protein Synthesis Inhibitors. Use: Given orally for skin infections such as impetigo and cellulitis and for complicated skin and soft tissue infections such as diabetic foot ulcers. An older drug and more organisms are resistant to it. More likely to cause antibiotic-associated diarrhea, C-diff colitis.

Action and Use: linezolid (Zyvox)

Action: Protein Synthesis Inhibitors. Use: Orally or IV. Used for MRSA, VRE (vancomycin resistant Staphylococcus aureus), and sepsis after vancomycin failed.

Action and Uses: Macrolides

Action: Protein synthesis inhibitors. Either bactericidal or bacteriostatic. Uses: Alternatives for patients who are allergic to penicillin. Effective against aerobic and anaerobic gram-positive cocci.

Action and Uses: Tetracyclines

Action: Protein synthesis inhibitors. Enter the bacterium and interfere with the bacterial processes used to make important proteins needed for growth. Usually have only bacteriostatic action. Use: Broad-spectrum drug effective against many gram-negative and gram-positive organisms. Acne, urinary tract infections, infections of the skin and respiratory tract, Lyme disease, stomach ulcers cause by H. pylori, Chlamydia, Rocky Mountain spotted fever, typhoid fever, STD, and inhalation anthrax exposure.

Action and Uses: Aminoglycosides

Action: Protein synthesis inhibitors. Weaken bacteria by limiting the production of protein, which is essential for life. Uses: Serious aerobic gram-negative infections: E. coli, Serratia, Proteus, Klebsiella, and Pseudomonas.

Adverse Reactions: Cephalosporins

Acute hypersensitivity. Cross-sensitivity: penicillin. Nephrotoxicity.

Drug Interactions: Vancomycin

Adds to the toxicity, ototoxic or nephrotoxic, of antibiotics such as aminoglycosides.

Normal Flora

Aka nonpathogens. Types of organisms that are always present on or in the skin, mouth, intestinal tract, and vagina of a healthy person. The bacteria usually do not cause infection unless the person has very low immunity, when the organism is excessive in amounts and overwhelm, or then they are in the wrong place.

Superinfection

Aka secondary infection. Yeast infection occurs after antibiotic therapy. To prevent superinfection, take probiotics with antibiotic. Foods with probiotics: yogurt, dark chocolate, miso soup, pickles, and sauerkraut.

Drug Interactions: Cephalosporins

Alcohol may produce a disulfiram reaction (prevent alcohol use by producing a severe sensitivity to alcohol) resulting in flushing, vomiting, throbbing headache, dyspnea, tachycardia, hypotension, and chest pain. Anything containing alcohol, ie mouthwash, shaving cream.

Pseudomembranous Colitis

An abnormal intestinal reaction to a strong antibiotic that causes excessive water, bloody diarrhea, abdominal cramps, and low-grade fever; it can lead to dehydration and damage the walls of the intestinal tract.

What is an infection?

An invasion of body tissue by disease-producing pathogens that multiply and produce toxins that react in a dangerous way and produce illness in a host organism.

Pathogen

An organism that is expected to cause infection even among people with a strong immune system.

Parasite

An organism that lives on or in a human and relies on the human for its food and other functions.

What type of drugs affect oral contraceptives?

Antibiotic

Broad-Spectrum

Antibiotics that are effective against more types of bacteria, including both gram-negative and gram-positive bacteria.

Narrow-Spectrum

Antibiotics that are effective against only a few types of bacteria.

Antibacterials

Antimicrobial drugs that kill or slow the reproduction of bacteria only; often used interchangeably with antibiotics.

Antibiotic

Any drug that can destroy or interfere with the development of a living organism; often used interchangeably with the term antibacterial.

Adverse Reactions: Fluoroquinolones

Arthropathy. Cardiac arrhythmias if patients is on antidysrhythmic. Tingling, burning, and numbness in the feet and hands (peripheral neuropathy).

Nursing Implications and Patient Teaching: Penicillins

Assess for signs of infection and allergies. Take patient's vital signs (baseline) before giving medication and keep patient 30 minutes to observe for signs of adverse reactions. Give Moxatag within 1 hour after the patient completes a meal for best absorption and fewer GI side effects. Use the Z-track method of IM injective for penicillin G.

Infections can be cause by what organisms?

Bacteria, viruses, parasites, fungi, and insects (parasites)

Drug Interactions: Penicillins

Other bacteriostatic antibiotics, ie tetracycline and erythromycin, decrease the bactericidal effect. Ampicillin reduces the effectiveness of oral contraceptives.

Empiric Treatment/Empiric Therapy

Prescribing a drug without identification of the specific organism and it is based on experience and clinical expertise.

Adverse Reactions: Penicillins

Rash, erythema, urticaria, angioedema, laryngeal edema, and anaphylaxis. Cross-sensitivity: cephalosporins.

Drug Interactions: linezolid (Zyvox)

Selective serotonin reuptake inhibitor antidepressant: risk of serotonin syndrome is increased. Monoamine oxidase inhibitor antidepressants: Can cause severe cardiac problems. Alcohol and tyramine-containing foods: avoid severe hypertension.

Virus

Small infections agent that can replicate only inside the living cells of organisms.

Nursing Implications: Vancomycin

Solutions contain dextrose, caution patients with allergy or hypersensitivity to corn. Regularly assess hearing and monitor urine; assess BUN, creatinine, and urine output. IV must be infused over at least 60 minutes and at a rate of no more than 10 mg/min to avoid a histamine response called Red Man Syndrome.

Nursing Implications and Patient Teaching: Sulfonamides

Stay out of sun because of severe photosensitivity. Take with food, milk, or a full glass of water to minimize stomach irritation. To prevent formation of crystals in the urine, patient must drink 1.5 L/day.

Antimicrobial Resistance

The ability of an organism to resist the killing or growth-suppressing effects of anti-infective drugs.

Carbapenems

Use: Broadest spectrum of antibacterial activity against gram-positive and gram-negative bacteria. Used to treat infections caused by MDR bacteria in hospitalized patients. Drug: imipenem (Primaxin), meropenem (Merrem), ertapenem (Invanz) Expected Side Effects/Adverse Reactions: Nausea, vomiting, diarrhea, headache, rash, fever, and chills. Adverse CNS effect: confusion and seizures. High doses can produce nephrotoxicity and ototoxicity.

Vancomycin

Use: To treat MRSA and pseudomembranous colitis caused by C-diff. Drug: vancomycin (Vancocin) Expected Side Effects/Adverse Reactions: Nausea, vomiting, diarrhea, headache, rash, fever, and chills. Flushing and hypotension. Red Man Syndrome: deep red rash on the upper body. Nephrotoxicity and ototoxicity.

Drug Interactions: Aminoglycosides

Vancomycin: increases risk of nephrotoxicity. Aspirin, furosemide and ethacrynic acid: increases risk of ototoxicity.

Nursing Implications and Patient Teaching: Macrolides

Keep the patient well hydrated, drink extra fluids to ensure 1500 mL urine output to decrease renal toxicity. Consult a drug reference book or pharmacist for drug interactions.

Adverse Reactions: Sulfonamides

Kidney damage, allergic reactions: anaphylaxis, increased sun sensitivity: cause severe sunburn. Suppress bone marrow function: increasing risk of anemia, bleeding, and reduced immunity.

Bacteria

Large domain of single-celled microorganisms that exists everywhere.

Expected Side Effects: Cephalosporins

Nausea and vomiting, and mild diarrhea.

Expected Side Effects: Fluoroquinolones

Nausea, vomiting, diarrhea, abdominal pain, and headache. Urine incontinent: skin in the genital area can become red and sore.

Adverse Reactions: Macrolides

Impair the liver and cause jaundice. IV: phlebitis and other types of vein irritation are common.

Drug Interactions: Sulfonamides

Increase effect of sulfonylureas (treat Type II DM) and cause hypoglycemia (s/s: sweat, cold, clammy, confused, irritable). Decrease effectiveness of Penicillins. Increase neurotoxic effects of phenytoin. Increase warfarin drug levels: leads to excess bleeding. Phenothiazine antipsychotic drugs: lethal cardiac dysrhythmias.

Fungus

Member of a large group of microorganisms that include yeasts and molds, which have cell features similar to those of human cells.

Expected Side Effects: Macrolides

Mild abdominal pain, nausea, flatulence, and diarrhea. Increase sensitivity to sunlight.

Expected Side Effects: Tetracyclines

Mild episodes of nausea, vomiting, and diarrhea as a result of irritation of the GI tract, changes in the normal bacteria and overgrowth of yeast (mouth and vagina). Increase sensitivity of the skin to the sun and severe sunburns are possible.

Nursing Implications: dalfopristin/quinupristin (Synercid)

Mix the drug according to the manufacturer's instructions and give the infusion over 60 minutes to reduce vein irritation and injection-site reactions. Consult with pharmacist and healthcare provider if patient's are taking other IV or oral drugs.

Drug Examples: Cephalosporins

Most drugs have prefix ceph-, cef- in their names. First Generation: cefazolin, cephalexin (Keflex): gram-positive coverage, limited gram-negative. Second Generation: cefaclor, cefuroxime (Ceftin): more effective against gram-negative and anaerobic organisms. Third Generation: cefdinir (Omnicef), ceftriaxone: more potent against gram-negative bacteria but less active against gram-positive bacteria. Fourth Generation: cefepime (Maxipime): only IV. Broadest spectrum against both gram-positive and gram-negative bacteria. The only one that can treat MRSA.

Drug Examples: Sulfonamides

Most drugs have prefix sulf- in their names. sulfamethoxazole/trimethoprim (Bactrim, Septra)

Drug Interactions: Fluoroquinolones

Multivitamins, minerals, antacids, and iron reduce the absorption. Warfarin: increase the anticoagulant effects. Dairy products and enteral tube feedings reduce the absorption. Antidiabetic drugs: hyperglycemia or hypoglycemia.

Superbug/Multidrug-resistant organism

When an organism is resistant to three or more different types of drugs to which it was once susceptible.