CHAPTER 9: ANTIBIOTICS Pharmacokinetics

ANTIBIOTICS are defined as: o Poorly absorbed from the GI tract, but rapidly
o Chemicals that inhibit specific bacteria absorbed after IM injection, reaching peak levels
o Made in three ways within 1 hour
1. By living microorganisms o Widely distributed throughout the body, crossing
2. By synthetic manufacture the placenta and entering breast milk
3. Through genetic engineering o Excreted unchanged in the urine and have an
Signs of Infection average half-life of 2 to 3 hours
o Fever o Depend on the kidney for excretion and are toxic
o Lethargy to the kidney
o Slow-wave sleep induction Contraindications- Known allergies, renal or hepatic
o Classic signs of inflammation (redness, swelling, disease, hearing loss
heat, and pain) Adverse Effects- Ototoxicity and nephrotoxicity are the
TYPES OF ANTIBIOTICS most significant
Bacteriostatic Drug-to-Drug Interactions- Diuretics, neuromuscular
o Those substances that prevent the growth of blockers, succinylcholine, or citrate anticoagulated blood
bacteria NURSING CONSIDERATIONS
Bactericidal Assess:
o Those that kill bacteria directly o For possible contraindications or cautions: allergy to
BACTERIA AND ANTIBIOTICS any aminoglycoside
o Gram positive/negative Perform a physical assessment
o Aerobic o Perform culture and sensitivity tests at the site of
o Anaerobic infection
GOAL OF ANTIBIOTIC THERAPY o Conduct orientation and reflex assessment
o Decrease the population of the invading bacteria to a o Assess vital signs
point where the human immune system can effectively o Perform renal and liver function tests
deal with the invader 2. CARBAPENEMS
SELECTING TREATMENT New class of broad-spectrum antibiotics effective against
o Identification of the causative organism gram-positive and gram-negative bacteria
o Based on the culture report, an antibiotic is chosen Common medications:
that has been known to be effective at treating the o Doripenem (Doribax)
invading organism o Ertapenem (Invanz)
BACTERIA CLASSIFICATION o Imipenem– Cilastatin (Primaxin)
Gram-positive o Meropenem (Merrem IV).
o The cell wall retains a stain or resists Bactericidal
decolorization with alcohol Indications- Treatment of serious infections caused by
Gram-negative susceptible bacteria
o The cell wall loses a stain or is decolorized by Actions: Inhibit cell membrane synthesis in susceptible
alcohol bacteria, leading to cell death
Aerobic Pharmacokinetics
o Depend on oxygen for survival o These drugs are rapidly absorbed if given IM and
Anaerobic reach peak levels at the end of the infusion if given
o Do not use oxygen IV.
BACTERIA AND RESISTANCE TO ANTIBIOTICS o They are widely distributed throughout the body,
o Adapt to their environment although it is not known whether they cross the
o The longer an antibiotic has been in use, the placenta or enter breastmilk
greater the chance that the bacteria will develop o Excreted unchanged in the urine and have an
into a resistant strain average half-life of 1 to 4 hours
1. AMINOGLYCOSIDES Contraindications- Known allergy to any of the
A group of powerful antibiotics used to treat serious carbapenms or betalactams; seizure disorders, meningitis,
infections caused by gram-negative aerobic bacilli pregnancy and lactation
Common medications: Adverse Effects- Pseudomembranous colitis, Clostridium
o Amikacin (Amikin), Gentamicin (Garamycin) difficile diarrhea, and nausea and vomiting can lead to serious
o Kanamycin (Kantrex) dehydration and electrolyte imbalances, as well as to new
o Neomycin (Mycifradin) serious infections/Superinfections
o Streptomycin Drug-to-drug interactions- Valproic acid and
o Tobramycin (Nebcin, Tobrex) Meropenem
Bactericidal NURSING CONSIDERATIONS
Indications: Treatment of serious infections caused by Assess:
susceptible bacteria o For possible contraindications or cautions: allergy
Actions: Inhibits protein synthesis in susceptible strains of to any Carbapenem or beta-lactam
gram-negative bacteria causing cell death o Perform physical assessment
 o Perform culture and sensitivity tests
o Conduct orientation and reflex assessment
o VS and renal function tests
3. CEPHALOSPORINS
Similar to penicillin in structure and activity
Common medications
o First generation: cefadroxil (generic) and
cephalexin (Keflex)
o Second : cefaclor (Ceclor), cefoxitin (generic),
cefprozil (generic), and cefuroxime (Zinacef)
o Third: cefdinir (Omnicef), cefotaxime (Claforan),
cefpodoxime (generic), ceftazidime
(Ceptaz,Tazicef), ceftibuten (Cedax),
ceftriaxone (Rocephin)
o Fourth: cefditoren (Spectracef) and ceftaroline
(Teflaro)
Bactericidal and bacteriostatic
Indications- Treatment of infections caused by susceptible
bacteria
Action- Interfere with the cell wall–building ability of
bacteria when they divide
Pharmacokinetics
o Well absorbed from the GI tract
o Metabolized in the liver, excreted in the urine
o Cross the placenta and enter breast milk (see
Contraindications
Contraindications - Allergies to cephalosporins or
penicillin, hepatic or renal impairment
Adverse Effects - Most significant -GI track
Drug-to-Drug Interactions - Aminoglycosides, oral
anticoagulants, ETOH
NURSING CONSIDERATIONS
Assess:
o For possible contraindications or cautions: known
allergy to any cephalosporin or penicillin
o Perform physical assessment
o Skin for any rash or lesions
o Culture and sensitivity tests
o Renal function tests
4. FLUOROQUINOLONES
Relatively new class of antibiotics with a broad spectrum of
activity
Common medications
o ciprofloxacin (Cipro), which is the most widely
used
o fluoroquinolone, gemifloxacin (Factive),
levofloxacin (Levaquin), moxifloxacin
(Avelox),norfloxacin (Noroxin), ofloxacin (Floxin,
Ocuflox), and finafloxacin (Xtoro)
Bactericidal
Indications: Treating infections caused by susceptible
strains of gram-negative bacteria. Includes: urinary track,
respiratory track, and skin infections
Actions: Interferes with DNA replication in susceptible
gram-negative bacteria, preventing cell reproduction
Pharmacokinetics: Absorbed in GI tract, metabolized in
the liver, excreted in urine and feces and cross the placenta
and enter breastmilk
Contraindications - Known allergy, pregnancy, or
lactating women and renal dysfunction
Adverse Effects - Most common: Headache, dizziness,
insomnia and depression
Drug-to-Drug Interactions - Antacids, quinidine,
theophylline
NURSING CONSIDERATIONS
Assess:
o Known allergy to any fluoroquinolone
o Perform physical assessment
o Examine the skin for any rash or lesions
o Perform culture and sensitivity tests
o Orientation, affect, and reflexes
o VS, and renal function tests
5.PENICILLINS AND PENICILLINASE -
RESISTANT ANTIBIOTICS
and First antibiotic introduced for clinical use
Common medications
o G benzathine (Bicillin, Permapen), penicillin G
potassium (Pfizerpen), penicillin G procaine
(Wycillin), penicillin V (generic), amoxicillin
(Amoxil, Trimox), and ampicillin (Principen)
Bactericidal
Indications- Severe infections caused by sensitive
organisms and broad spectrum use
Actions- Interfere with the ability of susceptible bacteria
to build their cell walls
Pharmacokinetics- rapidly absorbed from the GI tract,
reaching peak levels in 1 hour. Excreted unchanged in the
urine and enter breast milk
Contraindications - Allergies to penicillin or
cephalosporins, renal disease, use cautiously in patients who
are pregnant or lactating
Adverse Effects- Most significant GI tract
Drug–Drug Interactions- Tetracyclines, parenteral
aminoglycosides
NURSING CONSIDERATIONS
Assess:
o Known allergy to any cephalosporins and
penicillins
o Physical
o Skin and mucous membranes for any rashes or
lesions
o Culture and sensitivity tests
o Respiratory status
o Abdomen and renal function
6.SULFONOMIDES
Drugs that inhibit folic acid synthesis
Common medications
o sulfadiazine (generic)
o sulfasalazine (Azulfidine)
o cotrimoxazole (Septra, Bactrim)
Bacteriostatic
Action- block para-aminobenzoic acid to prevent the
synthesis of folic acid in susceptible bacteria
Indications- Treatment of infections caused by gram-
negative and gram-positive bacteria
Pharmacokinetics
o Well absorbed from the GI tract
o Metabolized in the liver, excreted in the urine and
are teratogenic
Contraindications- Known allergy to any sulfonamide,
thiazide diuretics and pregnancy
Adverse Effects- GI symptoms; renal effects related to
the filtration of the drug
Drug-to-Drug Interactions- tolbutamide, tolazamide,
glyburide, glipizide, or chlorpropamide and cyclosporine
NURSING CONSIDERATIONS
Assessment:
o Known allergy to any sulfonamide, sulfonylureas,
or thiazide diuretics
o Physical status
o Skin and mucous membranes for any rash or
lesions
o Specimens for culture and sensitivity tests
o Respiratory status
o Orientation, affect, and reflexes
o Abdomen
o Renal function tests
o Complete blood count
7.TETRACYCLINES
Developed as semisynthetic antibiotics based on the
structure of a common soil mold
Common medications
o Tetracycline (generic)
o demeclocycline (generic)
o doxycycline (Doryx, Vibromycin)
o minocycline (Arestin, Minocin)
Bacteriostatic
Action- Inhibits protein synthesis in susceptible bacteria,
preventing cell replication
Indications- Treatment of various infections caused by
susceptible strains of bacteria; acne when penicillin is
contraindicated for eradication of susceptible organisms and
when penicillin is contraindicated
Pharmacokinetics
 Adequately absorbed from the GI tract
 Concentrated in the liver, excreted unchanged in
the urine
 Cross the placenta and pass into breast milk
Contraindications- Known allergy to tetracyclines or to
tartrazine, pregnancy, lactation and renal and hepatic
dysfunction, Penicillin G, oral contraceptive therapy,
methoxyflurane, digoxin
Adverse Effects- Most GI, but possible damage to the
teeth and bones.
Drug-to-Drug Interactions – penicillin G, oral
contraceptives, Digoxin
NURSING CONSIDERATIONS
Assess:
o Known allergy to any tetracycline or to tartrazine
o Physical examination
o Skin for any rash or lesions
o Culture and sensitivity tests
o Respiratory status
o Renal and liver function test reports
8.ANTIMYCOBACTERIAL
Contain pathogens causing TB and leprosy
Common medications- Rifabutin (Mycobutin), isoniazid
(generic), rifampin (Rifadin), pyrazinamide (generic),
ethambutol, (Myambutol), streptomycin (generic), and
rifapentine, (Priftin)
Action- Act on the DNA of the bacteria leading to lack of
growth and eventual bacterial death for TB and Leprosy
Indications- Treatment of TB and Leprosy
Pharmacokinetics-
o Well absorbed from the GI tract
o Metabolized in the liver, excreted in the urine,
cross the placenta and enter breast
Contraindications - Allergy, renal or hepatic failure, CNS
dysfunction and pregnancy
Adverse Effects - CNS effects and GI irritation
Drug-to-Drug Interactions - Rifampin and INH can
cause liver toxicity
NURSING CONSIDERATIONS
Assess:
o Known allergy to any antimycobacterial drug
o History of renal or hepatic disease and CNS
dysfunction
o Physical examination
o Skin for any rash or lesions
o Culture and sensitivity testing
o Respiratory status and evaluate renal and hepatic
function tests
9.Ketolides, Lincosamides, Lipoglycopeptides,
Macrolides, Oxazolidinones, Monobactam, (Other
Antibiotics)
Antibiotics that do not fit into the large antibiotic classes
Common medications- telithromycin (Ketek),
telithromycin, Clindamycin (Cleocin) televancin (Vibativ),
dalbavancin (Dalvance), and oritavancin (Orbactiv),
azithromycin (Zithromax), clarithromycin (Biaxin), Tedizolid
(Sivextra) and linezolid (Zyvox), and aztreonam (Azactam)
Bactericidal and bacteriostatic
Actions and Indications- Treatment of severe infections
Pharmacokinetics- All rapidly absorbed, metabolized by
the liver and excreted in urine or feces and may cross the
placenta, and does pass into breast milk
Contraindications and Cautions- Known allergy,
hepatic or renal impairment, Myasthenia Gravis, pregnant
and lactating patients, phenylketonuria, MAO inhibitors,
Adverse Effects- Most significant CNS and GI, hepatic
enzyme elevation and superinfections
Drug to -Drug Interactions- Pimozide, simvastatin,
lovastatin, or atorvastatin, NSAIDs, nafcillin, cephradine,
and metronidazole, foods containing tyramine with
Oxazolidinones and MAO inhibitors
NURSING CONSIDERATIONS
Assess
o Known allergy to ketolides, lincosamides,
lipoglycopeptides, macrolides, oxazolidinones,
and monobactams
o History of renal and hepatic disease
o Physical assessment
o Skin for any rash or lesions
o Culture and sensitivity testing
o Temperature to detect infection
o Liver and renal function test values
o Baseline electrocardiogram
New Classes of Antibiotics and Adjuncts
o Daptomycin
o Linezolid (Zyvox)
o Fidaxomicin (Dificid)
o Tigecycline