ANTIMICROBIAL DRUGS

Prof. Mayla D. Rivera, MAN, RN, IPC

FEU-IN Faculty
Learning Outcomes
At the end of the discussion, the student will be able to:
 Explain various antimicrobial drugs and antiseptic
medicine use relevant to the present health condition
of the patient.
 Analyze the importance of appropriate antimicrobial
drugs and antiseptic herbal medicine administration
 Integrate knowledge of nursing process and
pharmacology in administering antimicrobial drugs and
antiseptic herbal medicine
Disease-producing organisms and its characteristics:

Fungi –reproduce by both sexually and asexually & disperses by

spores (e.g., Aspergillosis, moniliasis, histoplasmosis, and
mucormycosis)

Protozoan –reproduce by both sexually and asexually. It could

be aerobic or anaerobic species that lives mostly in moist areas
(e.g., Plasmodium falciparum, Plasmodium vivax, Plasmodium
malariae and Plasmodium ovale)

Helminths- are large parasitic worms that live and lay eggs in
warm, moist soil where sanitation and hygiene are poor (e.g.,
Cestodes (tapeworms), Intestinal nematodes (roundworms),
Trematodes (flukes), and Tissue-invading nematodes (tissue
roundworms and filarae)
Fungal Infection
An infection caused by a fungus may also be called mycosis, tinea, or
candidiasis
Types of fungal infection
• local or systemic
Local fungal infections - can be acquired by contact with an infected
person
Systemic fungal infections - usually transmitted to an individual
through inhalation into the lungs.
Types of fungal infection
1. Local infection
• dermatophytes can cause local fungal infections
involving the integumentary system including mucous
membranes, hair, nails, and moist skin areas.
2. Systemic infection
• may involve the lungs, CNS, or abdomen and are
usually transmitted to an individual through inhalation
into the lungs.
Category of fungal infection
• Mild fungal infection (e.g., tinea pedis (athlete’s
foot)
• Severe fungal infection- (e.g.,disease of the lungs or
fungal meningitis).
Classification of Fungal infection

1. Opportunistic - usually occur in the immunocompromised or debilitated

population (e.g., cancer or AIDS) or in those taking antibiotics,
corticosteroids, chemotherapy, or other immunosuppressives.
 Other opportunistic infections are aspergillosis and pneumocystis
pneumonia
 Opportunistic infection, such as systemic candidiasis, may occur
when the body’s defense mechanisms are impaired such that they
allow overgrowth of the fungus
2. Primary - occur in immunocompetent persons and result from inhaled
spores. Primary infections include coccidioidomycosis, blastomycosis,
histoplasmosis, and etc
Antifungal / Antimycotic Drugs
Antifungal / Antimycotic drugs - are used to treat fungal infections such as
the superficial infections (mucous membranes, hair, nails, and moist skin
areas, oral candidiasis or thrush, and vaginal candidiasis); and systemic
infections (lungs, CNS, abdomen)

Types of Antifungal / Antimycotic

1. Fungistatic
2. Fungicidal depending upon the susceptibility of the fungus and the
dosage.).
Classification of Antifungal
Classification Example
Polyenes Amphotericin B, Nystatin
Amphotericin – drug of choice for severe infection
Nystatin – Treat Candida infection
Azoles Fluconazole - effective in candidiasis,
coccidioidomycosis, histoplasmosis,
Ketoconazole – variety of fungal infections
Antimetabolites Flucytosine - used in combination with other
antifungal drugs (DNA/RNA
Echinocandins Caspofungin – newest class of antifungal; treat
Aspergillus Candida infections
Miscellaneous Griseolfulvin – for tinea infection
Antifungal Drugs
Antifungal Herbal medicine (DOH approved)
Akapulko (Cassia alata)
• Common names - also known as "bayabas-bayabasan" and "ringworm bush" or Acapulko
in English
• Indications: used to treat ringworms and skin infections. It contains chrysophanic acid, a
fungicide used to treat fungal infections, like tinea pedis, scabies, and eczema.
• Found in: Common in the Philippines
• Parts used: Leaves
Special precautions if given orally for other diseases:
• A strong decoction of Akapulko leaves is an abortifacient. Pregnant women should not
take decoction of the leaves or any part of this plant orally
Preparation: For external use
• Pound the leaves of the Akapulko plant, squeeze the juice and apply on affected areas.
• Pounded leaves may be applied thinly on the affected part twice a day. Marked
improvement may be expected after two to three weeks of continuous application
 Other herbal medicine with fungicidal effect: Bayabas
Antiprotozoan

Protozoa
• Are able to multiply in humans, which contributes to their
survival and also permits serious infections
• Transmission of protozoa that live in a human’s intestine to
another human typically occurs through a fecal-oral route
• Protozoa that live in the blood or tissue of humans are
transmitted to other humans by an arthropod vector (e.g.,
through the bite of a mosquito such as the anopheles
mosquitoes in malaria).
Protozoa

Protozoa - one-celled organisms that can be free-living or

parasitic in nature.
Classifications of protozoa
• Mastigophora – the flagellates (e.g., Gardia, Leishmania)
• Ciliophora – the ciliates (e.g., Balantidium)
• Sarcodina – the ameba(e.g., Entamoeba)
• Sporozoa – organisms whose adult stage is not motile
(e.g., Cryptosporidium, Plasmodium)
Antiprotozoa

Antimalarial - Used to treat Malaria. A life threatening disease

caused by multiple species of protozoan parasites of Genus
Plasmodium.
 Malaria is caused by multiple species of protozoan parasites of
the genus Plasmodium that are carried by infected Anopheles
mosquitoes, and it remains one of the most prevalent
protozoan diseases
Plasmodium Specie causing Malaria:

• Plasmodium falciparum - is the most severe

• Plasmodium vivax – most prevalent
• Plasmodium malariae
• Plasmodium ovale
Life cycle of protozoa (malaria)
After the mosquito infects the human, the
protozoan parasite passes through two phases
1. Tissue phase (invasion of body tissue) -
produces no clinical symptoms in the human
2. Erythrocytic phase (invasion of the red
blood cells) - causes symptoms of chills,
fever, and sweating.
• Incubation period is 10 to 35 days, followed
by flulike symptoms.
• Preventing transmission of malaria can be
done by controlling the mosquito firstly
through insecticide-treated mosquito nets
and secondly with spraying
Antimalarial drugs
• Antimalarial drugs provide treatment and prophylaxis
• Chloroquine is a commonly prescribed drug for malaria.
• When drug-resistant malaria occurs, combinations of antimalarials
are used to facilitate effective treatment.
• If drug resistance to chloroquine occurs, another antimalarial such as
mefloquine hydrochloride (HCl) or combinations of antimalarials with or
without antibiotics (e.g., tetracycline, doxycycline, clindamycin) may be
prescribed
Three methods used to eradicate malaria
1. Prophylaxis (prevention) and prevention of relapse.
• Example of prophylaxis are chloroquine and primaquine.
2. Treatment for the acute attack
• Chloroquine and mefloquine are frequently used to treat an acute malarial
attack.
3. Combinations of antimalarial drug
• Mefloquine HCl and the combination drug atovaquone-proguanil are used to
treat chloroquine-resistant P. falciparum.
Note: Chloroquine and hydroxychloroquine can be toxic to children and
may even cause death, therefore the drug dose should be closely
monitored
Antimalarial Drugs
Antimalarial Drugs
General Side Effects and Adverse
Reactions to Antimalarial drugs

• GI upset
• Cranial nerve VIII involvement (quinine and
chloroquine)
• Renal impairment (quinine),
• Cardiovascular effects (quinine).
Antihelmintic
Helminths are large parasitic worms that live and lay eggs in warm,
moist soil where sanitation and hygiene are poor
Transmission occurs from infected soil to the person, whereupon the
helminth then feeds on host tissue. It enter to the human hosts via
contaminated food, bites of carrier insects, or direct penetration to skin.
Most common site for helminthiasis (worm infection) is the intestine.
Other sites for parasitic infection
• lymphatic system blood vessels, and liver.
• These parasites cause disability and developmental delays in
children and adolescents
4 Major groups of parasitic worms
1. Cestodes (tapeworms) – enter to the intestine via contaminated food (pork,
beef, fish, and dwarf) Taenia solium (pork tapeworm), T. saginata (beef
tapeworm), Diphyllobothrium latum (fish tapeworm), and Hymenolepis nana
(dwarf tapeworm)..
2. Trematodes (flukes) - feed on the host. Fasciola hepatica (liver fluke),
Fasciolopsis buski (intestinal fluke), Paragonimus westermani (lung fluke),
and Schistosoma species (blood flukes)
3. Intestinal nematodes (roundworms) - may feed on intestinal tissue (Ascaris
lumbricoides (giant roundworm), Necator americanus (hookworm),
Enterobius vermicularis (pinworm), Strongyloides stercoralis (threadworm),
and Trichuris trichiura (whipworm).
4. Tissue-invading nematodes (tissue roundworms and filarae) - Trichinella
spiralis (pork roundworm) and Wuchereria bancrofti (filariae)
Anthelmentic Drugs)
Side Effects and Adverse Reactions of
anthelmintics
• Side effects
• GI distress (e.g., anorexia, nausea, vomiting, and occasionally diarrhea and
stomach cramps).
• Neurologic problems (e.g., dizziness, weakness, headache, and drowsiness.
• Adverse reactions do not occur frequently because the drugs usually
are given for a short period (1 to 3 days).
Anthelmentic Herbal medicine (DOH approved)
Akapulko (Cassia alata)
• Common names - also known as "bayabas-bayabasan" and "ringworm bush" or Acapulko
in English
• Indications: As a laxative to expel intestinal parasites and other stomach problems.
contains saponin, a laxative that is useful in expelling intestinal parasites.
• Found in: Common in the Philippines
• Parts used: Leaves and
Special precautions if given orally for other diseases:
• A strong decoction of Akapulko leaves is an abortifacient. Pregnant women should not
take decoction of the leaves or any part of this plant
Preparation: For internal use
• Cut the plant parts (roots, flowers, and the leaves) into a manageable size then prepare a
decoction. soak and boil for 10 to 15 minutes) of Akapulko leaves.
 Other herbal medicine with anthelmentic effect: Bayabas
Reference
Center for Disease Control and Prevention (2020). Parasites.
https://www.cdc.gov/parasites/about.html#protozoa
Department of Health (2020). Philippine herbal medicine.
http://www.philippineherbalmedicine.org/doh_herbs.htm
McCuistion, L., DiMaggio, K., Winton, M., and Yeager, J. (2021).
Pharmacology: A Patient-Centered Nursing Approach. (10th
edition). Elsevier, USA