COMMON ANTIBIOTICS DANA BARTLETT, RN, BSN, MSN, MA Dana Bartlett is a professional nurse and author. His clinical experience includes 16 years of ICU and ER experience and over 20 years of as a poison control center information specialist. Dana has published numerous CE and journal articles, written NCLEX material, written textbook chapters, and done editing and reviewing for publishers such as Elsevire, Lippincott, and Thieme. He has written widely on the subject of toxicology and was recently named a contributing editor, toxicology section, for Critical Care Nurse journal. He is currently employed at the Connecticut Poison Control Center and is actively involved in lecturing and mentoring nurses, emergency medical residents and pharmacy students. ABSTRACT There are many antibiotics available in the United States to treat various forms of infection. Understanding the benefits and risks of antibiotic therapy, such as adverse effects associated with specific antibiotics, and the safe administration and monitoring of patients receiving antibiotics can appear daunting. However, issues of antibiotic therapy may be approached by knowing the adverse effects common to all antibiotics, those at risk of having adverse effects and the level of severity of adverse effects as well as any testing required for detection. The main classes of antibiotics and the specific antibiotics available in the U.S., in particular, the aminoglycoside, carbapenem, cephalosporin, glycopeptide, lincosamide, macrolide, penicillin, quinolone, sulfonamide, tetracycline, metronidazole and nitrofurantoin antibiotics are discussed. nursece4less.com nursece4less.com nursece4less.com nursece4less.com nursece4less.com nursece4less.com 1 Continuing Nursing Education Course Planners William A. Cook, PhD, Director, Douglas Lawrence, MA, Webmaster, Susan DePasquale, CGRN, MSN, FPMHNP-BC, Lead Nurse Planner Policy Statement This activity has been planned and implemented in accordance with the policies of NurseCe4Less.com and the continuing nursing education requirements of the American Nurses Credentialing Center's Commission on Accreditation for registered nurses. It is the policy of NurseCe4Less.com to ensure objectivity, transparency, and best practice in clinical education for all continuing nursing education (CNE) activities. Continuing Education Credit Designation This educational activity is credited for 3 hours. Nurses may only claim credit commensurate with the credit awarded for completion of this course activity. Pharmacology content is credited for 3 hours. Statement of Learning Need Properties of antibiotics influence medical guidelines for the treatment of an infectious process and follow up care in terms of antibiotic use and monitoring of treatment outcomes. The rise of antibiotic resistance poses a significant health risk, which health professionals must consider when deciding treatment in terms of antibiotic type and drug qualities. nursece4less.com nursece4less.com nursece4less.com nursece4less.com nursece4less.com nursece4less.com 2 Course Purpose To provide nurses with knowledge of common antibiotics, as well as the indications and the correct and safe administration of antibiotics. Target Audience Advanced Practice Registered Nurses and Registered Nurses (Interdisciplinary Health Team Members, including Vocational Nurses and Medical Assistants may obtain a Certificate of Completion) Course Author & Planning Team Conflict of Interest Disclosures Dana Bartlett, RN, BSN, MSN, MA, William S. Cook, PhD, Douglas Lawrence, MA, Susan DePasquale, CGRN, MSN, FPMHNP-BC – all have no disclosures Acknowledgement of Commercial Support There is no commercial support for this course. Activity Review Information Reviewed by Susan DePasquale, CGRN, MSN, FPMHNP-BC Release Date: 12/12/2015 Termination Date: 12/12/2018 Please take time to complete a self-assessment of knowledge, on page 4, sample questions before reading the article. Opportunity to complete a self-assessment of knowledge learned will be provided at the end of the course. nursece4less.com nursece4less.com nursece4less.com nursece4less.com nursece4less.com nursece4less.com 3 1. Antibiotic-associated diarrhea a. can have a delayed onset and cause serious complications. b. occurs after the first dose and is always mild and self-limiting. c. only occurs in women >age 60. d. typically affects hospitalized neonates. 2. Allergic reactions to antibiotics a. always happen within one hour after a dose. b. can be delayed in onset. c. are always severe and life-threatening. d. only occur in people who have a compromised immune system. 3. True or false: Someone who is allergic to penicillin may be allergic to cephalosporins. a. True b. False. 4. Patients who are receiving antibiotic therapy should be monitored for a. osteoporosis. b. polycythemia. c. diabetes mellitus. d. nephrotoxicity. 5. Which of these antibiotics is well known for causing ototoxicity? a. Carbapenems. b. Metronidazole. c. Aminoglycosides. d. Quinilones. nursece4less.com nursece4less.com nursece4less.com nursece4less.com nursece4less.com nursece4less.com 4 Introduction This learning module discusses antibiotic therapy as well as specific antibiotics. In particular, the aminoglycoside, carbapenem, cephalosporin, glycopeptide, lincosamide, macrolide, penicillin, quinolone, sulfonamide, and tetracycline antibiotics, and metronidazole and nitrofurantoin are covered in the following sections. Antibiotics that are not available in the United States will not be covered. Specific aspects of antibiotic therapy raised in the following sections include: 1. Mechanism of action 2. Considerations for administration 3. Adverse effects/warnings including the U.S. boxed warning, more common, i.e., >10% reporting rate, adverse effects of specific antibiotics, and, adverse effects or warnings that are reported for all of the antibiotics of a particular class (frequency of an adverse reaction not reported in commonly used drug reference sources is not discussed) 4. Labeled uses In addition, issues that are important for the safe administration of antibiotics will be covered in this course: adverse effects common to all antibiotics, allergic reactions and cross-reactivity, and antibiotic resistance. nursece4less.com nursece4less.com nursece4less.com nursece4less.com nursece4less.com nursece4less.com 5 Learning Break: The term antibiotic is defined as a drug that is used to treat an infection, but it is commonly used to refer to drugs that are used to treat bacterial infections. This is technically incorrect but, given the widespread and commonly accepted use of the term antibiotic in that context, its common use will be retained in this module. Discussion of drug dosages, interactions, off-label uses, and all of the possible adverse effects of each antibiotic and/or class of antibiotics would not be practical here, and that information can easily be found in drug reference books and package inserts. Information that is particular to each of the antibiotic classes and important for safe administration will be the primary focus. The primary source of information is Lexi-Comp® or Lexi-Drugs® unless citations shown in the following sections specifically indicate otherwise. A Boxed Warning, sometimes called a black box warning, is a warning that is required by the Food and Drug Administration (FDA) to be included and prominently featured in the prescribing information of a drug if there is potential for a severe adverse reaction (death, permanent disability, a life-threatening event) in proportion to the potential benefit of the drug, which requires cautious assessment of the drug’s risks and benefits; or if there is a serious adverse reaction that can be prevented or reduced in severity by appropriate use of the drug, i.e., patient selection, careful monitoring, avoiding certain concomitant therapy. nursece4less.com nursece4less.com nursece4less.com nursece4less.com nursece4less.com nursece4less.com 6 Mechanism Of Antibiotic Action Antibiotics are used to treat infections caused by susceptible bacteria and all of the antibiotics interfere with some aspect of the biochemical processes that are necessary for these microorganisms to survive. The mechanisms of action of antibiotics are quite complex and are specific to each class of antibiotic but the essential action of most antibiotics is disruption of the bacteria cell membrane, most often by inhibiting protein synthesis and making it impossible for the bacteria to maintain intracellular homeostasis. Antibiotics are not effective treatment for fungal or viral infections. Adverse Effects Reference books and package inserts provide extensive lists of adverse effects associated with and/or caused by a drug, but these information sources seldom quantify how likely it is that a specific adverse effect will occur or which patients are at risk. Clinicians want to know what adverse effects are of a practical concern and what to do about them, but the drug information references do not often provide this type of guidance. For example, package inserts for antibiotics warn that these drugs can cause kidney and liver damage and should be used with caution if the patient has, or is at risk for, hepatic and/or renal impairment. The clinician wants to know how frequently and to whom these adverse effects will occur but very often this information is not given. A more specific example is that a commonly used drug information source lists 37 adverse effects associated with cephalexin; these range in severity from nausea to anaphylaxis