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ANTIBIOTICS Principles of Antimicrobial Therapy Terms

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ANTIBIOTICS Principles of Antimicrobial Therapy Terms ANTIBIOTICS Krysia Hudson Diane Aschenbrenner Principles of Antimicrobial Therapy Antivirals treat viruses Antibiotics do NOT treat viruses Antimicrobial drugs are classified by their susceptible organism or by their mechanism of action Empiric or broad spectrum treatment Sensitivity Resistance Selective Toxicity Terms Bacteriostatic Prophylaxis Bactericidal Selective toxicity Culture Peak and Trough Sensitivity Levels Nosocomial Anaerobic Gram – Aerobic Gram + 1 What is an infection? How does it present? Fever above 101F Malaise What is a virus? How does it present? Malaise Temperature below 101F Selection of Antibiotics Effectiveness against specific bacteria causing the infection Sensitivity of the organism to the drug Ability to get to the site of the infection Causing the fewest adverse effects in patients 2 Penicillins (prototype: Penicillin G) PT: treat infections (gram + and some gram -) Prophylaxis bacterial endocarditis Prevvy,ents cell wall synthesis, cell wall swells and bursts PK: oral absorption affected by GI acidity Unchanged thru kidneys Dosing must be round the clock to be effective Penicillins AE: Anaphylaxis , GI complaints Pt Related Variables: allergies, birth control pills Maximize Effects: C & S, give on time, give fllfull course of therapy, Assess s/s of infection Minimize Effects: Treat s/s of GI distress (ice chips, etc) Assess for allergic reactions Other Penicillins Penicillin V Procaine Penicillin (treat gonorrhea) give IM (very thick) keep refidfridgera te d assess for allergy (confusion, agitation) 3 Other Penicillins Aminopenicillins PT: otitis media, URI, tonsillitis, skin infections, pneumonia Effective against Gram – Alternate to Pen G and Pen V (when they don’t work) Examples: ampicillin, amoxicillin, bacampicillin Extended Spectrum Penicillin PT: SERIOUS infections (pseudomonal and proteus infections) AE: Direct tissue toxicity (dose related) muscle twitching, seizures, decreased function of platelets Nsg Mgmt: available of Na salt (possible hypernatremia) Examples: carbenicillin, ticarcillin, pipericillin, mezlocillin Penicillinase - Resistant Penicillin (Methicillin, dicloxacillin, nafcillin) PT: Treat organisms that secrete the enzyme penicillinase Needs C&S, if patient is resistant to methicillin (MRSA), it is resistant to anyyg drug in this class 4 Cephalosporin (Prototype: Cefazolin) PT: Respiratory, urinary, bone, skin, ear infections, Gram + PK: does not cross blood brain barrier, does cross placenta, excreted unchanged in urine PD: chemical structure similar to PCNS, interferes with cell wall synthesis AE: common GI, nephrotoxicity (with those with renal insufficiency), superinfections pseudomembranous colitis, hypersensitivity (rash) Nsg: may be given with food or fluid to decrease GI distress Vancomycin (Tricyclic glycopeptide) PT: SERIOUS INFECTIONS (Gram + infections, PCN and MRSA resistant infections), synergistic use with aminoglycosides for Strep and MRSA PK: oral dose – low bioavailability, used for GI infections (Pseudomembranous colitis) after use of metronidazole With normal renal function ½ life is 4-6 hrs, with IV administration, excreted mostly thru kidneys Vancomycin (Tricyclic glycopeptide) Cautions: Pregnancy, renal issues AE: Ototoxicity, nephrotoxicity Red Man’s Syndrome – histamine release [give over 1 hour] NSG: Peak and Trough (30 min prior to givi ng) , 1 hour after Monitor hearing BUN and creatinine, urine output Ototoxicity can be spurned by excessive dose, prolonged exposure, dehydration, other ototoxic drugs, bacteremia Ototoxicity can also come in the form of ataxia and nystagmus 5 Summary General infection principles Antibiotics: Affect bacterial cell wall PCNs Cephalosporins Vancomycin 6.
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