Antibiotics

• Bacteriostatic

  Slows bacterial growth but does not cause cell death
• Bactericidal

  Directly lethal - kills the bacteria
• Differentiate between natural and acquired antibiotic resistance

  • Natural resistance - occurs naturally without previous exposure to the antibacterial drug; like gram-negative bacterium
  • Acquired resistance - caused by previous antibiotic exposure
• Prevention strategies for antibiotic resistance

  • The CDC 12 Step Action Plan
  • Prevent Infection: Vaccinate, Get the catheters out(ASAP)
  • Diagnose and Treat the Infection Effectively: Target the pathogen, Access the experts, Use antimicrobials wisely, Practice antimicrobial control, Use local data, Treat infection not contamination, Treat infection not colonization, Know when to say no to vanco, Stop treatment when infection is cured or unlikely
  • Prevent Transmission: Isolate the pathogen and break the chain of infection
• General side effects/adverse reactions associated with use of antibacterial drugs

  • Anaphylaxis → allergic reaction
  • Superinfection→ Candida (yeast infection), C.diff
  • N/V/D
• Narrow spectrum

  Active only against a few microorganisms (attacks a specific bacteria)
• Broad spectrum

  Active against a wide variety of microbes. Leads to more resistance
• Healthcare providers order peak and trough serum levels for certain antibiotics to ensure the lowest dose with max effect (drug with the highest potency) and to prevent damage to body & toxicity, usually with Aminoglycosides (Gentamycin, Vancomycin)
• Superinfection


  A secondary infection that occurs when the normal microbial flora of the body are disturbed during antibiotic therapy (broad-spectrum, prolonged use, or combination antibiotics) Vaginal or GI yeast infections or C. diff
• Key education points regarding antibiotic use to a client

  • Take the entire dose
  • Report diarrhea and signs of superinfection or anaphylaxis
  • Maintain up to date immunization status
  • Follow up to see the effectiveness of the treatment
  • Make sure you are treating infections, not viruses, watch for SE (especially penicillin)
  • Increase intake of probiotic to decrease change of superinfection
• Penicillin mechanism of action

  Inhibits cell-wall synthesis during bacterial multiplication, weakens the cell wall, causing bacteria to take in excessive amounts of water and rupture
• Types of penicillin

  • Basic
  • Broad Spectrum
  • Penicillinase-resistant penicillin
  • Extended-spectrum penicillin
• Penicillin side effects

  • Hypersensitivity, anaphylaxis
  • GI: N/V/D, abdominal pain, stomatitis, tongue and tooth discoloration
  • MS: arthralgia
  • Superinfection: overgrowth of normal flora (candida)
• Penicillin allergy

  The most common cause of drug allergy; prior exposure is required (may be caused by exposure to fungi or some animal origin foods)
• Types of penicillin allergy

  • Immediate → 2-30 minutes
  • Accelerated → 1-72 hours
  • Late → days or weeks
• Anaphylaxis

  A severe allergic reaction with signs and symptoms of laryngeal edema, bronchoconstriction, and severe hypotension
• Anaphylaxis treatment

  • IV → Epinephrine (open airways, raise BP)
  • Steroids→ (decrease inflammation)
  • Antihistamine → (decrease swelling)
  • Fluids
  • Respiratory support
• Penicillin patient teaching/nursing interventions

  • Assess for allergy to this or cephalosporins
  • Evaluate lab results (liver enzymes, ALT, AST, ALP)
  • Record urine output (30ml per hour)
  • Monitor for S/S of superinfection
  • If the first dose, observe for allergic reaction; assess for bleeding with high doses (decrease in platelet aggregation)
  • Monitor temperature and infected area
  • Check culture and sensitivity for results
  • Educate on finishing the entire prescription (strep can cause major damage to body organs if you don't take it)
• Glycopeptides

  Inhibits cell wall synthesis, only active against gram-positive bacteria
• Glycopeptide drugs

  • Vancomycin
  • Oritavancin
  • Telavancin
  • Telavancin
• Glycopeptide side effects

  • IMMUNOLOGIC: anaphylaxis
  • CNS: HA, ototoxicity, tinnitus
  • CV: chest pain, peripheral edema
  • GI: N/V/D
  • HEM: leukopenia, neutropenia, thrombocytopenia, hypokalemia
  • Nephrotoxicity
  • Red man syndrome
• Red man syndrome

  An adverse effect of glycopeptides that happens when it's infused too rapidly via IV, causing tachycardia, hypotension, tingling, and red blotching
• Glycopeptide nursing interventions/patient teaching

  • Obtain baseline hearing screening
  • Tell patient to report s&s (superinfection)
  • Monitor patient fluid balance
  • Watch for oliguria and cloudy urine
  • Monitor for Red Man syndrome
  • Evaluate lab results (CBC, renal labs)
  • Monitor peak and trough levels
  • Monitor pt for sign of pseudomembranous colitis
• Sulfonamides

  Inhibit folic acid synthesis, which is necessary for bacterial growth (not bactericidal), primary used for UTIs
• Sulfonamide drugs

  • Sulfadiazine- short acting
  • Sulfasalazine- intermediate acting
• Sulfonamide side effects

  • Allergic reactions: skin rash, itching (anaphylaxis is rare)
  • CNS: insomnia, headache, edema
  • Dermatologic: rash
  • GI: stomatitis, N/V/D
  • GU: toxic nephrosis w/ oliguria, hematuria, renal failure, crystalluria
  • Hematology effects: blood dyscrasias, elevated hepatic enzyme
  • Photosensitivity
• Sulfonamide contraindications

  • Avoided during pregnancy- avoid congenital malformation, neural tube defects
  • Breastfeeding- kernicterus (excess bilirubin gets into the brain)
• Sulfonamide nursing interventions

  • Assess baseline labs (CBC, BUN, creatinine, LFTs, K+)
  • Give with full glass of water
  • Record vitals
  • I&O
  • Observe for hematology reactions
  • Check for s/s of superinfection
• Sulfonamide patient education

  • Make sure they increase fluid intake
  • Report any reaction and educate how to work with photosensitivity (wear sunglasses, sunscreen, avoid direct sunlight)
  • Avoid use in pregnancy and breastfeeding
  • Do not take w/ antacids
• Fluoroquinolone drugs

  • Ciprofloxacin
  • Levofloxacin
  • Moxifloxacin
• Fluoroquinolone uses

  • Anthrax
  • Sinusitis
  • Skin
  • Typhoid
  • STI
  • Treat UTI
  • Bone and joint infections
  • Bronchitis
  • Pneumonia
• Fluoroquinolone side effects

  • Anaphylaxis & Superinfection
  • CNS: headache, dizziness, insomnia, hearing loss
  • CV: peripheral edema
  • Dermatologic: photosensitivity
  • GI: N/V/D, dysgeusia
  • GU: crystalluria
  • Hematologic: hypertriglyceridemia
  • MS: tendon rupture
  • Ocular: eye damage, visual disturbances
• Fluoroquinolone patient education

  • Increase risk of tendonitis and tendon rupture
  • Mental health side effects (disturbances of attention, disoriented, agitation, nervousness, memory loss, and delirium)
  • Disabling and potentially permanent side effects including tremors, muscles, joints, and the CNS
  • Black box warning - BE CAUTIOUS!! Hepatotoxicity, Fatal hypersensitivity reaction, Hypoglycemia/Hyperglycemia, Increase risk of aortic dissection/rupture
• Aminoglycosides


  Bactericidal - effect lasts for several hours and are usually delivered in divided doses to ensure 24 hour coverage
• Aminoglycoside side effects/patient education

  • Ototoxicity, neurotoxicity, neurotoxicity, photosensitivity, anemia, dermatitis, GI distress, seizures, visual changes, vertigo
  • Increase fluids
  • Be careful about drug interactions which can be beneficial or adverse
  • Cautious about impaired renal function, and taking any other nephro or ototoxic medication
• Aminoglycoside nursing interventions

  • Check for hearing loss and renal function
  • Monitor peak and trough levels
  • Watch for S/S of superinfection (especially upper respiratory tract)
  • Report adverse effects
  • Drink lots of water
  • Avoid hazardous activities if adverse CNS reactions occur
• Tetracyclines

  Broad spectrum, bacteriostatic antibiotic that works on both gram-positive and gram negative
• Tetracycline uses

  • Acne, anthrax, plaque, gingivitis, cholera, STIs, skin, and urinary, and respiratory infections
• Tetracycline side effects/patient education

  • Immunologic: Anaphylaxis
  • Dental: discolor teeth in children <8 (DO NOT GIVE)
  • GI: stomatitis, swollen tongue
  • CNS: HA
  • Dermatologic: photosensitivity
  • Superinfection: C-diff
  • Hepatotoxic, nephrotoxic
  • Better absorbed on empty stomach with short and intermediate acting agents
  • Provide an adequate amount of fluid at least 1 hour before bedtime to prevent Esophageal or ulceration
  • Effectiveness reduced when taken with milk or dairy products, antacids, or iron
• Tetracycline nursing interventions

  • Monitor renal and hepatic function
  • Record vitals and urine output
  • Avoid during pregnancy due to discoloration
  • Avoid excessive sunlight