WEEK 1

ANTIMICROBIAL DRUGS Antibacterial / Antimicrobial/Antibiotic

DISEASE PRODUCING Antibacterial and antimicrobials - are

MICROORGANISMS substances that inhibit bacterial growth or kill
bacteria and other microorganisms
Gram-positive and gram-negative
Antibiotic - Chemicals produced by one kind
➢ Bacteria of microorganism that inhibit the growth of or
kill another.
➢ Viruses
❖Antibacterial drugs do not act
➢ Protozoans alone in destroying bacteria. Natural
body defenses, surgical procedures
➢ Fungi to excise infected tissues, and
dressing changes may be needed
➢ Helminths
along with antibacterial drugs to
The degree to which they are eliminate the infecting bacteria.
pathogenic depends on the microorganism Antibacterial Drugs
and its virulence
Antibacterial drugs
ANTIMICROBIAL/ ANTI-INFECTIVE
AGENTS 1. Natural sources. The use of moldy bread
on wounds to fight infection dates back 3500
➢ Antibacterial / Antibiotics years.
➢ Antiviral agents 2. Synthetically manufactured
➢ Antifungal agents • 1928, British bacteriologist Alexander
Fleming noted that a mold that had
➢ Antiprotozoal agents contaminated his bacterial cultures was
inhibiting bacterial growth.
➢ Anthelmintics
• The mold was Penicillium notatum, thus
Disease-producing organisms and its
Fleming called the substance penicillin
characteristics:
• Penicillin was used during World War II
Bacteria - reproduce by cell division ranging
and was marketed in 1945; considered
from 12 minutes to 24 hours.
miracle drug.
1. Gram-positive (e.g.,
Antiseptic Herbal medicine (DOH
Staphylococcus aureus,
approved)
Streptococcus pneumoniae, group B
Streptococcus, and etc.) Guava (Psidium guajava L.)
2. Gram-negative (e.g., Neisseria • Common names: Guava, bayabas
meningitides, Escherichia coli, and (Tagalog); Guava (English).
Haemophilus influenzae).
• Indications: antiseptic (disinfect wounds
Viruses –reproduces within living cells and and mouth wash to treat tooth decay and
uses their DNA and RNA to generate more gum infection
viruses. With the exception of HIV and some
viral hepatitis, viruses are self-limiting that do • Found in: Common in the Philippines
not require antiviral (e.g., influenza A, B, & C,
herpes viruses, hepatitis virus, and HIV) • Parts used: Leaves

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WEEK 1
Special precautions:
• Do not cover the pot boiling leaves and
other plant parts and boil in low flame.
• Do not use stainless steel utensils when
boiling decoctions. Earthen, enameled or
glass are allowed
Preparation: For washing wounds
• Wash the leaves with running water before
boiling it for 10 minutes. Wait until the
decoction cools down into lukewarm
temperature before rinsing the wound with it.
Be careful not to use it while it is still hot as it
may cause burn.
• Decoctions loose potency after some time.
Dispose of decoctions after one day. To keep
fresh during the day, keep lukewarm in a
flask or thermos
• Wash affected areas with the decoction of
leaves 2 to 3 times a day.
• Duration of use varies according to the type
of pathogen, site of infection, and
immunocompetence of the host
Note: Once-daily antibacterial dosing (e.g.,
aminoglycosides, macrolides, and
fluoroquinolones has been effective in
eradicating pathogens and has not caused
severe adverse reactions (ototoxicity,
nephrotoxicity) in most cases. Ease of
compliance with Once or twice drug dosing
increases the patient’s adherence to the drug
regimen and speed recovery.
Type of action:
1. Bacteriostatic – stop from reproducing
2. Bactericidal – Kills microorganisms
Body defenses
Body defenses
➢Age

Mechanism of Antibacterial Action ➢Nutrition

Action Effect Drugs ➢Immunoglobulins
Inhibition of Bactericidal effect Penicillin
cell-wall Enzyme breakdown of cell wall Cephalosporins
synthesis Bacitracin ➢WBCs
Vancomycin
Inhibition of enzyme in synthesis
of cell wall ➢Organ function
Alteration of Bacteriostatic or bactericidal Amphotericin B
membrane effect Nystatin ➢circulation influence the body’s
permeability Increase membrane permeability Polymyxin
Cell lysis caused by loss of cellular Colistin ability to fight infection
substances

Inhibition of Bacteriostatic or Bactericidal Aminoglycosides Older adults, the very young, and
protein effect Tetracyclines undernourished individuals have less
synthesis Interferes with protein synthesis Erythromycin
without affecting normal cell Lincomycin
resistance to infection than younger, well-
Inhibits steps of protein synthesis nourished populations. If the host’s natural
Inhibition of Inhibits synthesis of RNA and Fluoroquinolones
synthesis of DNA in bacteria
body defense mechanisms are inadequate
bacterial Binds to nucleic acid and enzymes (e.g.,WBCs & immunoglobulins) drug therapy
RNA and needed for nucleic acid synthesis
DNA
might not be as effective. As a result, drug
Interferenc Bacteriostatic effect Sulfonamides therapy may need to be closely monitored or
e with Interferes with steps of Trimethoprim
cellular metabolism within cells Isoniazid
revised.
metabolism Rifampin
HUMAN IMMUNE RESPONSE

Pharmacokinetics of antibacterial drugs • Goal of anti-infective drugs is to reduce the

population of the invading organism until the
Pharmacodynamics body’s immune response can take over.

• Antibacterial drugs are used to achieve • If organism is too aggressive, it

the minimum MEC necessary to halt the can be toxic to the host cell.
growth of a microorganism

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• If the immune system is weak, the Approaches to combat antibiotic
body cannot deal effectively with the resistance
invading organism
• Development of new antimicrobial drugs
Resistance to Antimicrobial Drugs
• Development of drugs that disable the
Bacteria can be either sensitive or resistant to antibiotic resistant mechanism in the bacteria.
certain antibacterial drugs.
• Development of bacterial vaccine
• Sensitive -inhibited or destroyed the
pathogen Antibiotic misuse occurs

• Resistant – pathogen continues to grow When antibiotics are taken:

despite administration of antibacterial drug
• Unnecessarily (e.g., viral infections, when
Bacterial Resistance no bacterial infection is present

➢Natural or inherent - occur without • Incorrectly (e.g., skipping doses, not taking
previous exposure (e.g., P. Aerugenosa) is the full antibiotic regimen), resistance to
inherently resistant to Pen G antibacterial may develop

➢Acquired resistance - prior exposure to

the antibacterial. S Aureus was once sensitive
to Pen G, repeated exposure

➢Penicillinase, an enzyme produced by the

microorganism, is responsible for causing its
penicillin resistance

Antibiotic / Antimicrobial resistance

Methicillin was the first penicillinase-

resistant penicillin developed in 1959 in
response to the resistance of S. aureus.
➢1968, S. Aureus begins to develop
resistance to Penicillin called methicillin-
resistant S. aureus (MRSA)
➢Treatment of choice for MRSA is
vancomycin
➢ vancomycin-resistant Enterococcus
faecium (VREF) - cause death in persons
➢ A strain of MRSA has also been reported to
be resistant to vancomycin (Vancomycin-
resistant S. aureus [VRSA] weakened immune
systems)
Antibiotic resistance is a major problem
• Occurs when antibiotics are used frequently
or when the drug is misuse
Preventing antibiotic resistance
Appropriate utilization of antibiotic, dosage,
and compliance to drug order
The presence of an antibiotic will favor
mutations that render the bacteria resistant
to the drug. The overuse of antibiotics does
gives bacteria the chance to evolve mutations
that favor their survival in the presence of
these drugs
Resistance to Antimicrobial Drugs
Cross-resistance – occur among
antibacterial drugs that have similar actions
such as penicillins and cephalosporins
Management
• Culture and sensitivity – to ascertain the
drug administered is correct
Approaches to treatment of systemic
infections
❖Identify the pathogen by Culture and
sensitivity (C&S) test –this test will detect the
infective microorganism present in a sample
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(e.g., blood, wound, sputum, swab) and
identify the best drug to kill it.
After Culture & Sensitivity test
• If the identified bacteria are sensitive, the
drug could be given. It will either kill or stop
the growth organisms.
• If resistant, the pathogen continues to grow
despite administration of that antibacterial
drug. Thus, the drug should be stop and
prescribed the appropriate antibiotic where
the pathogen is sensitive
Example:
Gentamicin – is a broad spectrum
aminoglycoside use to treat aerobic gram (-)
bacteria such as P. aeruginosa and E.coli. If
after the C&S test, the identified organisms is
sensitive to gentamicin, then the Gentamicin
could be prescribed and administered
provided that the patient is not allergy or
hypersensitive to the drug.
Note: The nurse should ensure that a culture
and sensitivity test was performed to the
infected area before initiating antibiotics and
may begin drug therapy before culture results
are received.
Use of Antibiotic Combinations
Antibiotic combinations should not be
routinely administered except for specific
uncontrollable infections that a combination
of two or three antibiotics may be suggested
Effects of antibiotic combinations
• Additive: effect is doubled.
• Potentiative: one drug potentiates effect of
other increasing effectiveness
• Antagonistic result is achieved if one
bactericidal and one bacteriostatic is
prescribed
General Adverse Reactions of
Antibacterial Drug
1. Allergy or hypersensitivity – could be
mild (rash, pruritus, and hives), treated with
antihistamine or severe (anaphylactic shock,
which results in vascular collapse, laryngeal
edema, bronchospasm, and cardiac arrest).
Shortness of breath is the first symptom of
anaphylactic shock which usually occurs
within 20 minutes.
2. Superinfection - is a secondary infection
that occurs when the normal
microbial flora of the body is disturbed during
antibiotic therapy.
• Superinfections can occur in the mouth,
respiratory tract, intestine,
genitourinary tract, and skin
3. Organ toxicity - the liver and kidneys are
involved in drug metabolism and excretion,
and antibacterials may result in damage to
these organs.
Example: Aminoglycosides can be nephrotoxic
and ototoxic
Classification of antibiotic therapy to a
certain microorganism (MO)
SPECTRUM
• Narrow spectrum antibiotics - effective
against one type of organism(e.g., penicillin
and erythromycin) - treat infections caused
by gram-positive bacteria.
• Broad-spectrum antibiotics - effective
against both gram positive and gram-negative
organisms (e.g., tetracycline and
cephalosporins).
• Broad-spectrum antibiotics are frequently
used to treat infections when the offending
microorganism has not been identified by the
C&S test.
Penicillins and Cephalosporins
Penicillin’s beta-lactam ring structure
interferes with bacterial cell-wall synthesis by
inhibiting the bacterial enzyme.
• The bacteria die of cell lysis (cell
breakdown) and is primarily bactericidal
• The penicillins can be both bacteriostatic
and bactericidal, depending
on the drug and dosage.
• Penicillins are mainly referred to as beta-
lactam antibiotics
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Penicillin bacterial enzyme necessary for cell-wall
synthesis.
• Broad-Spectrum Penicillins
(Aminopenicillins) – used to treat both gram- • For antibacterial activity, the beta-lactam
positive and gram-negative bacteria (e.g., E. ring of cephalosporins is necessary
coli, H. influenzae, Shigella dysenteriae,
Proteus mirabilis, and Salmonella species). • Five groups of cephalosporins have been
developed, identified as generations. Each
• Penicillinase-Resistant Penicillins generation is effective against a broader
(Antistaphylococcal Penicillins) -used to treat spectrum of bacteria
penicillinase producing S. aureus (e.g.,
Dicloxacillin, nafcillin and oxacillin are IM and Generations of Cephalosporins
IV preparations Generatio Example of drug Target pathogens Indication
n
• Extended-Spectrum Penicillins 1st Cephalexin Effective mostly Treating otitis
Generatio Cefazolin sodium against gram (+) media, skin,
(Antipseudomonal Penicillins) - group of n bacteria bone, joint,
broad-spectrum antibiotics effective against (streptococci and respiratory and
most staphylococci) urinary tract
P. aeruginosa (a gramnegative bacillus that is and some gram infections
difficult to eradicate). (-) bacteria (E. coli
and species of
Klebsiella, Proteus,
• useful against many gram-negative Salmonella, and
organisms (e.g., Proteus, Serratia, Shigella)
2nd Cefaclor Same effectiveness For
Enterobacter, and Acinetobacter species also Generatio Cefoxitin sodium as 1st generation but pharyngitis,
Klebsiella pneumonia). n Cefuroxime it broader tonsillitis, otitis
spectrum against media, skin
other gram-(-) structure,
Beta-Lactamase Inhibitors bacteria such as respiratory and
Haemophilus urinary tract
When a broad-spectrum antibiotic such as influenzae, Neisseria infections
gonorrhoeae and
amoxicillin is combined with a beta-lactamase N. meningitidis,
enzyme inhibitor such as clavulanic acid, the Enterobacter species
3rd Cefixime Same effectiveness For otitis
resulting antibiotic combination inhibits the Generatio Cefotaxime as 1st & 2nd media, acute
bacterial beta lactamases, making the n Ceftazidime generations and also sinusitis,
Ceftriaxone effective against tonsillitis,
antibiotic effective and extending its gram (-) bacteria and respiratory
antimicrobial effect. (Pseudomonas and skin
aeruginosa and infections
Serratia and
Three beta-lactamase inhibitors: Acinetobacter
species)
• clavulanic acid 4th Cefepime Similar to 3rd For
Generatio -generation drugs bacteremia,
n with broad-spectrum skin,
• Sulbactam antibacterial activity intraabdominal,
and good penetration and
to cerebrospinal fluid; urinary tract
• Tazobactam effective against E. infections
coli, P. aeruginosa,
These inhibitors are not given alone but are and Klebsiella,
Proteus, and
combined with a penicillinase-sensitive Streptococcus species
penicillin (e.g., amoxicillin, ampicillin, or and certain
staphylococci
piperacillin) 5th Ceftaroline Similar characteristics For skin &
Generatio fosamil of third and fourth respiratory
Cephalosporins n Ceftolozone generations, infections,
& tazobactam also, broad spectrum, intraabdominal
and the only and urinary
• Cephalosporins are a major antibiotic group cephalosporins infections
used in hospitals and in health care offices. effective against
methicillin-resistant
These drugs are bactericidal with actions Staphylococcus
similar to penicillin. aureus (MRSA)

• Like penicillin, cephalosporins have a beta-

lactam structure and act by inhibiting the

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Other Classifications of antibiotic and its bacteroides species, vibrio
comma, vibrio
indication fetus, Brucella species,
E.coli, E. aurogenes,
Classification Example Indication Shigella, Klebsiella,
Diplococcus, S. aureus,
Aminoglycoside Amikacin Broad spectrum antibiotic.
s sulfate, For gram (-) bacteria it is
Gentamicin indicated for aerobic
sulfate, bacilli such as P.
Neomycin aeruginosa; e.coli,
ADVERSE REACTIONS
sulfate, Proteus species,
Streptomycin Klebsiella-Enterobacter- • Superinfection
sulfate, Serratia
Tobramycin
sulfate • Peripheral neuropathy
Cephalosphorins Cefazolin, both gram (+) & (-)
Cephalexin, depending on the • Laryngeal edema
Cefaclor, generation of
Cefoxitin, cephalosphorin. Treat
Cefuroxime, respiratory, • Hypokalemia
Cefotaxime, urinary, skin, bone, joint,
Ceftriaxone, and genital infections • Hypomagnesemia
Ceftazidine
Fluoroquinoles Ciprofloxacin, Wide spectrum of gram
Levofloxacin, (-) bacteria • Hyponatremia
Norfloxacin,
Ofloxacin
Macrolides azithromycin, S. pneumoniae, M.
• Neurotoxicity
clarithromycin, pneumoniae, Listeria
erythromycin, Monocytogenes, • Hyperbilirubinemia
dirithromycin Legionella pneumophilia,
grp A
beta hemolytic AMINOGLYCOSIDES
streptococci, N.
gonorrhea, H. influenzae, Life threatening:
Lincosamides Clindamycin, Severe infections when
Lincomycin penicillin cannot be used
Monobactam Aztreonam, UTI, Skin, intra-abdominal • Anaphylaxis
Tigemonam, and gyne infections;
Carumonam, E.coli, Enterobacter, • Thrombocytopenia
Nocardicn A Serratia, Proteus,
Salmonella, Providencia,
Pseudomonas, • Anemia
Citrobacter, Haemophilus,
Neisseria, Klebsiella
Penicillins -Penicillin G -Narrow spectrum
• Agranulocytosis
benzathine, Introduced to kill
potassium, Staphylococcus • Leukopenia
procaine, and -Broad spectrum both
Penicillin V, gram (-) and gram (-)
- Amoxcillin, organisms such as E. coli, • Hepatic dysfunction
Ampicillin, H. influenzae,
Carbenicillin Shigella dysenteriae, • Increased intracranial
Proteus mirabilis, and
Salmonella species
Penicillinase- -Dicloxacillin, -Used to treat pressure
resistant nafcillin and penicillinase-producing S.
Extended Oxacillin aureus • Steven’s Johnson syndrome
spectrum - Piperacillin- - Against gran (-)
penicillins tazobactam Pseudomonas aeruginosa,
(Zosyn) Proteus spp., Serratia SERIOUS ADVERSE REACTIONS
spp., Klebsiella
pneumoniae,
Enterobacter spp., and
• Hearing loss (ototoxicity)
Acinetobacter spp
Sulfonamides Sulfadiazine, C. trachomatis, Nocardia, • Nephrotoxicity
sulfsalazine, H influenzae, E coli,
cotrimoxazole, P.mirabilis
sulfizoxazole gram (+) & (-) bacteria
Antimicobac ethambutol, Mycobacterium
Terial pyrazinamide, tuberculosis,
/Antitubercular rifampin, Mycobacterium leprae
pyrazinamide,
dapsone
Tetracyclines Doxycycline, Ricketssiae,
tetracycline, M.pneumoniae, Borrelia
demeclocycline, recurrentis, H. influenzae,
minocycline, haemophilus ducreyi,
oxytetracycline pasteurella tularensis,
Bartonella bacilliformis,

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Nursing Process: Patient-Centered
Collaborative Care
Assessment
 Record vital signs and urine output.
Compare these results with future vital
signs and urine output. Nephrotoxicity is
an adverse reaction to most
aminoglycosides.
 Assess laboratory results to determine
renal and liver function, including BUN,
serum creatinine, ALP, ALT, AST, and
bilirubin. Serum electrolytes should also
be checked. Aminoglycsides may
decrease serum potassium and
magnesium levels.
 Obtain a medical history related to renal
or hearing disorders. Large doses of
aminoglycosides could cause
nephrotoxicity or ototoxicity.
Patient Problems
• Tissue injury
• Nausea
• Vomiting
Planning
• The patient’s white blood cell will be within
normal limits
Nursing Interventions
 Send a sample from the infected area to
the laboratory for culture to determine
the organism and its antibiotic sensitivity
before the aminoglycoside is started.
 Monitor intake and output. Urine output
should be at least 600 mL/day.
Immediately report any decrease in urine
output. Urinalysis may be ordered daily,
and results should be checked for
proteinuria, casts, blood cells, and
appearance.
 Check for hearing loss. Aminoglycosides
can cause ototoxicity
 Evaluate laboratory results and compare
with baseline values. Report abnormal
results.
 Monitor vital signs. Note whether body
temperature has decreased.
Patient Teaching
General
Encourage to increase fluid intake unless
contraindicated
Side Effects
• Advise the patient to report side effects of
the drug
• Advise to use sunblock and protective
clothing because aminoglycosides can cause
photosensitivity
Evaluation
• Evaluate whether the infection has ceased
and whether any side effects occurred
Antiviral
Virus is an obligate intracellular organism
that must reside within a living host cell to
survive and reproduce
• Use their DNA and RNA to generate more
viruses.
• With the exception of HIV and certain kinds
of viral hepatitis, viruses are self-limiting
illnesses that usually do not require treatment
with a specific antiviral
Antiviral Drugs - are used to prevent or
delay the spread of viral infections. They
inhibit viral replication by interfering with viral
nucleic acid synthesis in the cell.
• Some groups of antiviral drugs are effective
against various viruses, such as influenzas A
and B, herpesviruses, HBV and HCV, and HIV.
• With the exception of HIV and some viral
hepatitis, viruses are self-limiting that do not
require antiviral
INFLUENZA
Highly contagious viral infections. Mostly
seasonal and more prevalent from fall to
spring.
• MOT - Droplets begin to enter to the
respiratory tract and begin replication in 24
hours before the appearance of symptoms.
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WEEK 1
• Symptoms include high fever, headache,
fatigue, and myalgia (muscle ache). Chills,
sore throat, non-productive cough, watery
nasal discharge, weakness, red watery eyes,
and photophobia

COVID 19

Emerging infectious disease and considered

one of the respiratory diseases that is highly
virulent

• MOT – Contact, droplet, and airborne

• Symptoms include fever or chills, cough,

shortness of breath, fatigue, muscle or body
aches, headache, loss of taste or smell, sore
throat, congestion or runny nose, nausea or
vomiting, and diarrhea

Types of Viruses
VIRUSES TYPES

Influenza (FLU) A – moderate to severe infection,

Subtypes B – usually causes mild illness in
• H1N1, H3N2 children,
C – infection is a mild respiratory
illness not thought to cause
epidemics
COVID 19 Virus that cause Covid 19 (2019);
(SARS-CoV-2) first case in the Philippines in 2020.
Considered one of the
respiratory diseases that is highly
virulent.
Herpesviruses Herpes simplex virus (HSV1&2) -
HSV 1 (cold sores; lession) HSV2
(genetal herpes-lesions and
ulceration in genetalia),
Varicella Zoster Virus (VZV) -
chicken pox/shingles
Epstein-Barr Virus (EBV) or human
herpesvirus (HHV-4) - infectious
mononucleosis-fever,
tonsillitis, enlarged lymphnodes
Cytomegalovirus (CMV) – mostly
asymptomatic. Common in patient
with weakened immune
system (HIV, transplant,
immunosuppressant drugs,
pregnant, neonates
HAV, HBV, HCV, HDV, HEV
HAV&HEV – self-limiting (A-vaccine)
HBV&HCV – chronic, co-infected
with HDV (B-vaccine, C – no
vaccine, common those who inject
drugs)

Hepatitis

HIV Virus that attacks the immune

system. If not treated appropriately,
may lead to AIDS (CD4 cell
count drops below 200 cells/mm)