Anti Microbial Drugs NamesPenicillins | Cephalosporins | Macrolides | Fluoroquinolones | Glycopeptide Antibiotic | Sulfonamides and Trimethoprim |
PenicilinsDrug Name Penicillin G, Penicillin V, Amoxicillin, Ampicillin | Common Name Almost all end in “cillin” | Indications (why we use the drug) Pneumonia
Meningitis
Endocarditis
Pharyngitis
Syphilis
Prophylaxis- against bacterial endocarditis in at-risk clients prior to dental procedures | Potential Side Effects Diarrhea, epigastric distress, nausea, vomiting, rash, pain at IM injection site, phlebitis at IV injection site | Life threatening Side Effects Allergic reaction(anaphylaxisis)
amoxicillin specific : seizures (high doses), clostridium difficile (CDIF) assoc. diarrhea | Nursing Implications -Ask about allergies to penicillins
-monitor for allergic reaction
assess for infection before and after therapy
-obtain specimen for culture BEFORE therapy
-monitor for bowl function for CDIF and report to PCP
-monitor kidney function(nephrotic)
-if PT is taking PO(by mouth)penicillins advise PT to take with food and finish entire course of antibiotic , even if symptoms are resolved | mechanism of action Binds to bacterial cell wall membrane, causing a cell death . Known as “beta-lactam” | Notes 1st class if antibiotics
high levels of antibiotic resistance to early penicillins
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FluoroquinolinesDrug Names Ciprofloxacin
Ofloxacin
Moxifloxacin
Levofloxacin
Norfloxacin | Name Commonality Almost all end in “oxacin” | Indication -UTI
-respiratory infections
-GI tract infections
-Infections of bones, joints, skin, soft tissues
-Anthrax prophylaxis in those that have inhaled anthrax spores | Potential Side Effects Dizziness, headache, insomnia, diarrhea, nausea, Achilles’ tendon rupture, phototoxicity (severe sunburn) | Life threatening Side Effects Elevated intracranial pressure(ICP)
seizures
suicidal thoughts
hepatoxicity
Clostriudim Difficule (CDIF) assoc. diarrhea
hypersensitivity reaction
SJS
Torsade de Pointes | Nursling Implications -Monitor for allergic reaction
-Assess for infection before and after therapy
-Obtain specimen for culture before therapy
-Monitor for skin rash and SJS
-Monitor bowel function for CDIF assoc. diarrhea
-Advise PT to observe and report swelling, pain, or inflammation at Achilles’ tendon side and to stop taking med
-Teach PT to avoid prolonged sun exposure | Mechanism of Action | Inhibit enzymes necessary for bacterial DNA replication (DNA gyrase and topoisomerase IV) |
| | CephalosporinsDrug Name 1st gen: Cephalexin
2nd gen: Cefaclor
3rd gen:Ceftraixone
4th gen: Cefepime
5th gen: Ceftaroline | Name Commonaility All start with “cef” | Indications Note: dependent on generation
-skin and skin structure infections
-bone and joint infections
-complicated and uncomplicated UTIs
-Gynecological infections
-lower respiratory tract infections
- intra-abdominal infections
-septicemia
-meningitis
-Otitis Media
-Perioperative (surgery) prophylaxis | Potential Side Effects Pain at IM injection site
phlebitis at IV injection site
rash | Life threatening Side Effects Seizures(at high doses), CDIF associated diarrhea, allergic reaction (anaphylaxis), SJS(Steven-Johnson Syndrome) | Nursing Implications -Ask about Allergies both Cephalosporins and Penicillins
-monitor for allergic reactions
-assess for infection before and after therapy
-Obtain specimen for culture before therapy
-Monitor bowel fucntion for CDIF assoc. diarrhea
-Monitor for skin rash frequently and discontinue at 1st sign of use(SJS)
-Monitor for kidney fucntion(nephrotic) | Mechanism of Action Bind to the bacterial cell wall membrane causing cell death . (Aka beta-lactam) |
Note: each generation is likely to reach cerebrospinal fluid(CSF), less susceptible to antibiotic resistance and more effective against gram-negative organisms.
Common-class because they are broad-spectrum , well tolerated, and easy to administer. Sulfonamides & TrimethoprimDrug Names Trimethoprim-sulfamethoxazole
Sulfadiazine
Trimethoprim | Name Commonailty N/A | Indications -UTI
-Otitis Media
-Chancroid
-Pertussis (Whooping cough) -
-Shingellosis
-Pneumocystic jirovecii pneumonia
-Bronchitis | Potential Side Effects Nausea, vomiting, rash, phlebitis | Life threatening Side Effects CDIF assoc diarrhea
Hepatic Necrosis
erythema multiforme
toxic epidermal necrolysis
Agranulocytosis
Aplastic Anemia
Hypersensitivity reaction
SJS | Nursing Implications -Assess for infection before and after therapy
-Obtain Specimen for culture before therapy
-Monitor IV site closely
-Monitor for allergic reaction
-Do not administer to PT w/ allergy to sulfa drugs, thiazide diuretics, loop diuretics, solfonylurea-type oral hypoglycemics(glipizide)
-Assess for rash and stop at sign of SJS
-Encourage liberal fluid intake
-Monitor urine output
-DO NOT give to women who are pregnant or breastfeeding, or to infants younger than 2 months
-Monitor K+ levels (hyperkalemia)
-Obtain regular CBC to monitor for hematologic disorders {{nl} -Monitor bowel fucntion for CDIF assoc diarrhea and provide to PCP | Mechanism of Action Inhibits bacterial growth by stopping synthesis of tetrahydrofolate, which is essential for DNA, RNA, and protein production |
| | MacrolidesDrug Name Erythromycin
Azithromycin
Clarithromycin | Name Commonalitiy Almost all end in “mycin” | Indications Alternative for PTs who have a penicillin allergy
Legionnaries’ Disease
Pertuesis(whooping cough) and other respiratory infections
acute diphtheria
chlamydial infections
Pneumonia (due to Mycoplasma pneumoniae)
Streptococcal infections | Potential Side Effects Abdominal Pain
Diarrhea
Nausea
Vomitting | Life-Threatening Side Effects Ventricular arrhythmias
Torases de Pointes
Hepatoxicicity
CDIF assoc. diarrhea
acute generalized exanthermatous pustulosis
drug reaction with eosinophilia and systemic symptoms(DRESS)
SJS
toxic epidermal necrolysis | Nursing Implications -Monitor for allergic reactions
-Assess for infection before and after therapy
-Obtain specimen for culture before therapy
-Monitor for skin rash frequently and discontinue at first sign of SJS
-May cause increase in certain labs (serum bilirubin, AST,ALT,LDH, alkaline phophatase)
-administer with meals
-monitor for CDIF assoc. diarrhea and report to PCP
-monitor for ototoxicity
-monitor for dysrhythmias
-Erythromycin inhibits metabolism if antihistamines, theophylline, Carbamazepine, warfarin, and digoxin | Mechanism of Action Inhibits bacterial protein synthesis |
Glycopeptide AntibioticDrug Names Vancomycin | Name Commonality N/A | indications -Treatment of potential life-threatening infections when less toxic antiFestive are contraindicated
-Particularly useful in staphylococcal infections (MRSA, methicillin resistant staphylococcus aureus)
-Endocarditis
-Meningitis
-Pneumonia
-Septicemia
-Soft tissue infections in Pt who have allergies to penicillins or infections w/penicillin resistance | Potential Side Effects Nephrotoxicity, phlebitis, Nausea, Vomitting, Hypotension, Ototoxicity | Life Threatening Side Effects Hypersensitivity reaction(Anaphylaxis) | Nursing Implications -Assess for infection before and after therapy
-Obtain specimen for culture before therapy
-Monitor IV site closely (vanxomycin very irritating) and rotate infusion site
-Monitor BP during therapy for hypotension
-Monitor for otoxcicity (toxic to ear and auditory nerve)
-Monitor for nephrotoxicity
-Monitor for allergic reaction | Mechanism of Action Binds to bacterial cell wall, resulting in cell death |
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