IMMUNOLOGIC DRUGS azotemia, flushing, dizziness, ataxia,

Peptides paresthesia, urticaria, fever. Nephrotoxic,

 These are broad-spectrum, powerful defenses that neurotoxic and superimposed infection
kills parasites, fungi and viruses.
Metronidaz Antibacterial peptide, amebicide, reduces
 Peptides are derived from cultures of Baccilus
ole development of drug-resistant
 bacterial cell membrane function causing cell death microorganism. Produces, anti-
 The two group of peptides used as antibiotic are inflammatory, immunosuppressive effects
polymyxins and bacitracin when applied topically.

Groups
 Polymyxins- are polypeptide antibiotic that consists METRONIDAZOLE
of five different chemical compounds. Polymyxins C antiprotozoal., antibiotic
A to E. polymyxins produce a bactericidal effect by
H Treatment with infection
interfering with the cell membrane
 Bacitracin- acts by inhibiting bacterial wall synthesis E Best taken with food
and damaging the cell wall membrane, which results
in cell death. It is effective for most gram bacteria C Avoid alcohol, report GI upset, turns urine brownish
and some gram-negative bacteria
K Interacts with disulfiram(Antabuse) to cause
Additional anti-infective agents psychotic reaction. The drug is teratogenic, it can
 METRONIDAZOLE- is a synthetic antibiotic and cross placental-fetal barrier as well as plasma-milk
anti-protozoal that works by disrupting the barrier
bacterial DNA and inhibiting cell synthesis, which Instruct the patient to take entire recommended dose.
cause cell death.
 Metronidazole as protozoal treats Trichomonas
vaginalis, amebiasis, and giardiasis; as an Pentamidine Isothionate
antibiotic, it is used for anaerobic bacteria C Antiprotozoal, used in treatment and prevention
including H. Pylori. of Pneumocystis carinii pneumonia
 Additionally, this drug has immunosuppressive and
H Treatment for infection
anti-infective properties that treat rosacea. This
drug is added to multidrug regimens to reduce
E Take the medication as prescribed
antibacterial resistance.
Peptides Available topical ointment, ophthalmic C Change position slowly
Bacitracin ointment on eye infection, IM for pediatric
staphylococcus infection. Use caution with K Check the BP, blood test and blood sugar
renal impairment. Monitor BUN creatinine levels(decrease)
at baseline. Adverse reaction includes
injection site pain, rash, proteinuria,
azotemia and diarrhea
Nursing consideration
 Instruct the patient to check signs of superinfection
Colistimeth For gram-negative infections. Adverse
ate sodium reaction include dyspepsia, tingling, slurred  Describe urinary signs that indicate impairment,
speech, vertigo, paresthesia, decrease urine such as decrease urinary flow
output, elevated BUN creatinine. Use with  Use safety measures during activities of mobility
caution with renal impairment, pregnancy,  Encourage self-management skills, reporting sign
concurrent use of nephrotoxic agent effects and adverse reactions.
Polymyxin Indicated for the treatment of infection of  Inform patient to take all prescribed medication
B the urinary tract, meninges, blood-stream,  Monitor patient for altered level of consciousness
cause by susceptible Pseudomonas
aeruginosa. Use with caution in patients
with renal impairment, concurrent use of
nephrotoxic agent. Adverse Reaction
include albuminuria, urinary casts,

Immunologic drugs
HIV
 HIV is spread via intimate(oral, anal, vaginal sex)
contact with blood (shared needles, blood
transfusion), mother-to-child contact through shared
fetal maternal blood circulation, direct blood contact
during delivery and breastmilk.
 The HIV viral load is indicative of the level of virus
circulating in the blood and the best determinant of
treatment efficacy. A key goal is to achieve and
maintain a viral load below the limits of
detection(<20-40copies/mL)
ANTIRETROVIRAL THERAPY
 Goals of initiating Anti Retroviral Therapy
- Reduce HIV-associated mortality and morbidity
- Prolong the duration of quality of life
- Restore and preserve immunologic function
- Maximally and durably suppress plasma HIV
viral load
- Prevent HIV transmissions
CLASSIFICATIONS OF ANTIRETROVIRAL
AGENTS
1.Nucleoside Reverse Transcriptase Inhibitors(“nukes”)
2. Nucleotide Analogues
3. Non-nucleoside Reverse Transcriptase Inhibitors
4.Protease inhibitors
5.Fusion Inhibitors
6.CCR5 Antagonist
7.Integrase Inhibitors
Classification #1:Nucleoside Reverse Transcriptase
Inhibitors(“nukes”)
Indications: HIV/AIDS, Prevention of maternal
transmissions (Zidovudine)
Contraindications: Pregnancy except Zidovudine; use
with caution in patients with hepatic dysfunction, severe
renal impairment, bone marrow suppression
ZIDOVUDINE
C Treatment for HIV infection (together with at
least 2 other anti retroviral agents) and
prevention of feto-maternal HIV transmissions by
slowing down HIV replication
H Absence of fatigue, irritability, pallor,
paresthesia, and headaches,
Improve level of serum ion, total-binding
capacity, reticulocyte count, Hgb, ferritin
E Maybe taken without regard to food however,
doses may be spaced round the clock
C Keep capsule in a cool dry place and protected
from light\
Instruct the patient to maintain an upright
position to prevent esophageal ulceration
Immediately report bleeding from gums, nose,
rectum
Advise patient to have dental works before
therapy of after blood counts have returned to
normal
Adverse effects: neutropenia, severe anemia,
lactic acidosis, severe hepatomegaly with
steatosis
K During therapy, administer the drug with caution
to patients with bone marrow compromise and
renal and hepatic conditions
Arrange for frequent blood test because it may
cause bone marrow depression
Classification #2: NUCLEOTIDE ANALOGUES
Indications: HIV/AIDS
Contraindications: Bone Marrow suppression, hepatic
dysfunction
TENOFOVIR (VIREAD)
C Treatment for HIV-1 infection together with at
least 2 other retroviral drug, treatment of chronic
hepatitis B in patients with hepatic disease
H Decrease viral load, increase CD4 cell count
E Maybe taken without regards to meals
C Given with high-fat meal to increase absorption
Adverse reaction: lactic acidosis, severe
hepatomegaly with steatosis
K Report persistent abdominal pain, nausea,
vomiting
Do not mix with liquid, only with soft food
Classification #3: Non-nucleoside reverse
transcriptase Inhibitors
Indications: HIV/AIDS
Contraindications: Pregnancy(use with caution),
children(delavirdine only)
C Treatment for HIV-1 infection together with at
least 2 other retroviral drug
H Decrease or undetectable viral load
E Best taken with meals to optimize absorption
C Advise continued safe sex practices
Side effects: Prolonged QT interval
Redistribution/accumulation of body fat
(lipodystrophy)
K Administer antacids 2 hours before or after 4
hours rilpivirine
H2-receptor antagonist 12 hours before or 4
hours after rilpivirine

Classification #4:Protease Inhibitors
Indications: HIV/AIDS
Contraindications: Pregnant women(except Saquinavir),
lactating mothers, hepatic dysfunction, patient taking
antidiabetic drugs(darunavir only)
FOSAMPRENAVIR (Levixa)
C Treatment for HIV infections together with at
least 2 other retroviral drug
H Decrease or undetectable viral load
E Maybe taken without regard to meals but should
be evenly spaced (more preferred for children to
take with foods while adults without food)
C Asses for opportunistic infections(onset of fever,
oral mucosa changes, cough, other respiratory
symptoms)
Side effects: severe or life threatening
dermatologic reactions such as Steven-Johnson
syndrome
K Practice caution when administering the drug to
patients with hepatic impairment, diabetes
mellitus, elderly, sulfonamide allergy,
hemophilia, hepa B or C
Classification #5: Fusion Inhibitors
Indications: HIV/AIDS
Contraindications: pregnant and lactating women
Classification #6: CCR5 Antagonist
Indication: HIV/AIDS
Contraindications: Pregnant women and lactating
mothers, renal impairment
MARAVIROC (SELZENTRY)
C Treatment for HIV infection in patients infected only
with detectable chemokine receptor 5 (CCR5)- tropic
HIV-1, with evidence of viral replication
H Decreased or undetectable viral load
E Maybe taken without regard to meals
C Advise against activities that require alertness and
motor skills until response to drug is established. Side
effects include URTI
Adverse effects: MI, ischemia, unstable angina,
coronary artery disease, CVA, hepatic
failure/cirrhosis, neoplasm
Possible drug-induced hepatotoxicity with allergy-
type features reported
K Practice caution when giving drugs to patients with
mild/moderate hepatic/renal impairment, history of
orthostatic hypotension, hepatitis B or C, concurrent
medication known to lower blood pressure, patients at
increased risk of cardiovascular events
Classification #7: Integrase Inhibitors
Indications: HIV/AIDS
Contraindications: Use with caution in pregnant and
patients at risk for rhabdomyolysis or myopathy
DOLUTEGRAVIR (TIVICAY)
C Treatment of HIV-1 infection in adults and children
age 12 yrs and weighing at least 40KG, in
combination with at least two other antiretroviral
agents
H Decreased or undetectable viral load
E Maybe taken without regard to meals
Administer at least 2 hours before or at least 6 hours
after giving medication containing aluminum,
calcium, iron, magnesium (supplements, antacids,
laxatives)
C Advise patient not to breastfed due to risk of post-
natal HIV transmission
Instruct about safe sex using barrier methods or
abstinence
Adverse effects: hypersensitivity(rash, fever,
angioedema, difficulty breathing, skin
blistering/peeling, arthralgia, lethargy), immune
recovery syndrome, lipodystrophy
Drug resistance may result from interruption of
therapy even for a short period of time
K Monitor lab test (CBC,CMP, CD4 count, viral load,
lipid panel, lipase) and assess patient before the
medication
Nursing Considerations
Educate patient about the adherence to the
therapeutic regimen by providing information on drug
and a time table of dosing in patients preferred method
of learning
Explain common emotional responses
For patients with childbearing age, explain how HIV
transmission ot the unborn baby can occur
Teach about safe sex practices, and other ways to
prevent HIV transmission
Assists patient in developing a system taking the
correct dose of the correct drug at the correct time.
Counsel patient about the importance of having an
adequate supply of drugs to avoid interruption in the
dosing schedule. Omission of drugs may result in
deterioration of the patients condition
To decrease risk of exposure to infection,
emphasize protective precaution as necessary, such as
frequent handwashing, avoiding crowds, and receiving
influenza vaccines.
Transplant drugs
(Immunosuppressant)
Organ Transplantation
1) Cadaveric transplant: a healthy organ donated
at a time of a person's death is transplanted into
a body of a patient with end-stage organ failure
2) Living-donor transplant: a kidney or a portion
of a liver donated by a living person is
transplanted into the body of a patient with end
stage kidney or liver disease.
3) Transplant rejection: occurs when immune
system of the transplant recipient attacks a
transplanted organ. This happens because the
immune system recognizes foreign tissues and
attempts to destroy them.
Principles of Immunosuppression
Is to use multiple drug that alter different aspects of
the immune system thereby reducing the chances, of
transplant rejection and enabling the use of lower doses
of individuals drug which reduces the likelihood of drug
toxicity
Maintenance therapy:
Calcineurin Inhibitors-suppress the immune system by
binding to cytoplasmic proteins that inhibit calcineurin
phosphatase, ultimately resulting in inhibition of t-
lymphocyte proliferation
Tacrolimus- for prophylaxis of rejection in heart, liver,
kidney transplant.
Costimulation Blockers-it inhibits T-cell activation and
proliferation thereby inhibiting T-lymphocyte
proliferation and production of inflammatory mediators
mTOR inhibitors: it inhibits T-lymphocyte activation
and proliferation and inhibits antibody production
Inosine Monophosphate Dehydrogenase Inhibitors:
Mycophenolate mofetil blocks synthesis of purine
nucleotides thereby preventing the proliferation of T-
cells and lymphocytes and preventing the formation of
antibodies from B cells; it also inhibit recruitment of
leukocytes to inflammatory sites
CYCLOSPORINE ( SANDIMMUNE)
C Immunosuppressant
H Prevents organ rejection and relives symptoms of
psoriasis and arthritis
E Administer as prescribed
C Provide oral hygiene to prevent problems related to
gingival hyperplasia
Advise against taking grapefruit products because it
could increase the concentration, and St. John’s
worth because this can decrease the concentration of
drug
For ophthalmic route, remove contact lens before
administration
Maintain trough levels immediately prior to next
dose
 Therapeutic serum level: 50-400ng/ml
 Toxic serum level: greater than 400ng/ml
K Monitor blood pressure for evidence of hypertension
Monitor serum potassium for possible hyperkalemia
Monitor serum BUN, creatinine, bilirubin, ALT,
AST, LDH levels for signs of
hepatoxicity/nephrotoxicity
Neutropenic precautions(prevent infection
Clean hands frequently
Try to avoid crowded places
Do not share food, cups, utensils and other personal
items
Shower or bathe daily
Cook meat and eggs all the way
Carefully wash raw fruits and vegetables
Protect your skin from direct contact with pet bodily
waste by wearing vinyl or household cleaning gloves
Clean your teeth with soft bristle toothbrush
Try and keep all household surfaces clean
Get seasonal flu shots as soon as it is available
If you go to an emergency room, do not sit in the waiting
room for a long time, tell them right away that you are
receiving immunosuppressant drugs.
Know the sign and symptoms of infection
ANTI- TUBERCULARS
 Prescribed to people with active TB or exposed to
TB streptomycin.
 TB is caused by acid-fast bacillus Mycobacterium
tuberculosis that can be transmitted from one person
to another by droplets
 Not everyone infected with TB will develop
manifestations, rather some will harbor the
microorganism that will have what is called latent
tuberculosis infection
 Single drug therapy is ineffective in the treatment of
TB due to drug resistance. Combination has shown
to decrease drug resistance and lessen treatment
from 2 years to 6-9months
CONTRAINDICATIONS
 All except streptomycin: Active hepatic disease
 Pyrazinamide contraindication: porphyria
 Streptomycin contraindication: auditory impairment,
myasthenia gravis and pregnancy
 Ethambutol contraindication: pre-existing optic
neuritis
First line treatment
Amino Administer as a suspension mixed
salicylate in acidic liquid (yogurt,
sodium applesauce, tomato, orange juice)
without chewing. Nonacidic foods
will dissolve acid-resistant coating
of the granules. Most common
side effects include nausea,
vomiting, diarrhea, abdominal
pain
Capreomycin Inject into a large muscle mass.
Because of the possibility of
nephrotoxicity, use caution when
administering to patient with renal
impairment. Also cause
ototoxicity
Ethionamide Contraindicated in sever hepatic
impairment, an ophthalmologic
exam should be done and blood
glucose level should be monitored
periodically as well as hepatic
function
Cycloserine Maybe taken without regard to
food. Pyridoxin can prevent
neurotoxic effects.
Contraindicated with patients with
history of alcohol abuse, severe
anxiety, major depression,
psychosis, severe renal disease
and seizure disorder
Streptomycin Inject into a large muscle mass,
sulfate contraindicated with people with
aminoglycoside sensitivity,
monitor for ototoxicity,
nephrotoxicity and neurotoxicity
Nursing consideration
 Direct patients to take antitubercular drugs as
prescribed. Ineffective treatment and development
of drug resistance might occur if drugs are taken
intermittently or discontinued when s/s are decreased
or disappeared. Adherence to the drug regimen is
essential to prevent the spread of drug resistant M.
Tuberculosis
 Advise patient to keep medical appointments an to
participate sputum testing to monitor the
effectiveness of the drug regimen.
 Warn patients contemplating pregnancy to first
check their health care provider about taking the
drug ethambutol and rifampin
 Advise patients who have active TB that the family
members should get a TB testing test and may
receive a prophylactic drug for 6 months to 1 year
 Provide written sheet for drug and treatment
regimens in the language that patient speaks. Explain
the importance of good hygiene
 Guide patient to report any numbness, tingling or
burning of hands and feet. Vit B6 prevent peripheral
neuropathy
 Encourage patient to avoid direct sunlight.
ANTI FUNGAL DRUGS
 Also called antimycotic drugs and are use to treat
fungal infections. Typically, antifungals are
fungistatic or fungicidal
 Classifications
1. Polyenes: for systemic fungal infection
2. Azole antifungals: for candidiasis,
coccidioidomycosis, histoplasmosis
 3. Antimetabolites: drug that converts drugs into
fluorouracil (antimetabolite that disrupts fungal
DNA & RNA synthesis)
4. Echinocandins: newest class of antifungal that
inhibits biosynthesis of essential components of
fungal cell wall which inhibit growth of candida
and aspergillus species
Polyenes: For variety of systemic fungal
amphotericin infections. May require
deoxycholate pretreatment with an analgesic,
antihistamine, antipyretic or
corticosteroid for pain, fever
chills or rigor. Electrolyte loss
and nephrotoxicity can occur.
Protect drug against light and
infuse slowly via in line filter.
Azole For variety of fungal infections.
antifungals: Take with empty stomach.
Itraconazole Contraindicated for pregnancy
and those who are planning for
pregnancy
Ketoconazole Treatment may last 1-6 months
for systemic infections. Take with
food to avoid GI discomfort.
Higher doses can inhibit adrenal
cortisol synthesis
Posaconazole For oral candidiasis and
prophylactic treatment of invasive
Aspergillus and Candida
infections in immunosuppressed
patients. Do not chew, divide, or
crush delayed release tablet.
Administer with food or as an IV
infusion via a central line with an
in-line filter
Voriconazole For Aspergillus, candidiasis,
fusariosis and sceposporiosis.
Patient with HIV infection may
need higher dose. Grapefruit juice
should be avoided. Take PO does
on empty stomach
Antimetabolite Usually given inconjunction with
s: flucytosine amphotericin B to decrease the
development of resistance to
flucytosine. Fungal resistance
occurs if drug is given alone.
Monitor liver transaminases and
renal function
Echinocandins For Candida infections. Patient
: Micafungin with HIV coinfection may require
higher dose. To minimize
excessive foaming, do not shake
vigorously the vial, Infuse slowly
over 1 hour. Rapid infusion may
cause histamine mediated
reactions
NYSTATIN
C Antifungal, antibiotic
H Treatment for candidiasis
E Administer as prescribed
C Report development of pruritus, urticaria,
rash, hyperglycemia
K Assess for angioedema, bronchospasm, sinus
tachycardia
NURSING CONSIDERATION
 Advise patients to take drugs as prescribed.
Compliance is of the utmost importance because
discontinuing the drug too soon may cause relapse
 Advise patient not to consume alcohol
 Teach patient to avoid operating hazardous
equipment or motor vehicle when taking antifungals
that may cause visual changes, sleepiness, dizziness
or lethargy
 Encourage the patient to report side effects such as
nausea, vomiting, diarrhea, dermatitis, rash, tinnitus,
edema and flatulence.
ANTI MALARIALS
 Drug that provide treatment and prophylaxis
 Malaria is caused by Plasmodium that is carried by
infected Anopheles mosquitos.
Chloroquine Treatment and
phosphate prophylaxis of malaria.
Malaria prophylaxis:
begin therapy 2 week
before entering endemic
area, then continue for 8
weeks after leaving
endemic area
Contraindications:
cardiac, renal disease,
psoriasis, ocular disease
Avoid use with food
Side Effects: anorexia,
 vomiting, diarrhea,
abdominal cramps,
fatigue, pruritus,
headache, nervousness,
photosensitivity
Hydrochloroquine Use to treat and prevent
sulfate malaria and an alternative
to chloroquine sensitivity.
Administer with milk or
meal to reduce GI distress
Monitor blood count,
ECG, and opthal exam
Caution: renal, hepatic,
and ocular disturbances,
history of alcoholism
Can cause sensorimotor
neuropathies,
hypoglycemia and
cardiomyopathy
Mefloquine Use to treat malaria
hydrochloride Contraindication: people
with cardiac conditions,
seizures, psychosis,
hepatic disease.
Adverse reaction: nausea,
vomiting, abdominal pain,
diarrhea, anxiety, paranoia
-Is secreted in breastmilk
Primaquine Use to treat malaria and
phosphate prevention of relapse
Adverse reaction: GI
distress, rash, WBC
production
(granulocytopenia), cute
hemolytic anemia in
patients with G6PD
deficiency
Contraindications: cardiac
disease, SLE
Quinine Sulfate Use to treat malaria
(chloroquine- Combination with drug
resistant malaria) therapy includes
tetracycline, clindamycin,
or doxycycline,
Avoid patients with
hepatic or cardiac
impairment,
hypoglycemia (blood
glucose levels should be
monitored bec. It
stimulates insulin);
monitor platelet count
(thrombocytopenia)
Nursing Considerations:
 monitor renal function by checking urine output
 Report if liver enzymes are elevated and if renal
function test are abnormal
 Advise patient travelling to malaria-endemic area to
receive prophylactic doses of an anti malarial drug
before leaving, during the visit and upon return
 Teach patient to take antimalarial with food if GI
upset occurs
 Monitor patient returning from malaria endemic area
for s/s of nausea, vomiting, diarrhea, abdominal
cramps, pruritus, visual changes and dizziness
 Provide patient with information that herbal
supplements may be harmful when taking prescribed
medication
ANTI HELMINTIC DRUGS
NURSING CONSIDERATIONS
 Discuss benefits of handwashing before eating and
after working in the soil with animals
 Monitor patient for fluid and urinary output during
anthelmintic medication checking for fluid loss
 Collect stool specimen in a clean container. Avoid
having stool that come in contact with water, urine,
chemical.
 Monitor adverse reaction that includes wheezing,
abdominal pain and distention and high fever
 Advise the patient to take daily showers and not
baths
 Encourage the patient to change sheets bedclothes,
towels and underwear daily
 Warn the patient that drowsiness may occur and that
operating car or machinery should be avoided.
 Emphasize the importance of taking the prescribed
drug at designated time and keeping appointments
ANTIMICROBIAL DRUGS
Antibacterial and antimicrobials
 Substance that inhibit bacterial growth and other
microorganism
 Antibiotic refers to chemicals produced by one kind
of microorganism that inhibit the growth of or kill
another
 Antibacterial do not act alone in destroying bacteria
Classification #:Aminoglycosides
 Aminoglycosides: act by inhibiting bacterial growth
synthesis.
 They are used against gram-negative bacteria such
as E. Coli and Proteus and Pseudomonas species.
They cross the blood brain barrier in children but not
in adults
 Indications: infections caused by gram-negative
aerobic bacilli
 Contraindications: allergy to aminoglycosides, renal
or hepatic disease, preexisting hearing loss, MG or
parkinsonism, lactation
Resistance to Antibacterial
 When bacteria are sensitive to a drug, the pathogen
is inhibited or destroyed; if bacteria is resistant, the
pathogen continues to grow despite administration of
antibiotics
 Use of antibiotic combination: usually a single
antibiotic will successfully treat a bacterial infection;
however, when severe infection persist and is of an
unknown origin or has been unsuccessfully treated
with several single antibiotic.
 Before beginning therapy, a culture should be taken
to verify the bacteria
 Additive effect: is equal to the sum of the effects of
2 antibiotics
 Potentiative effect occurs when antibiotic
potentiates the effect of the second antibiotic
increasing its effectiveness
 Antagonistic result is achieved when a combination
of drug that is bactericidal such as penicillin and a
drug that is bacteriostatic sch as tetracycline are used
together( desired effect will greatly reduced)
Mechanism of action
Gentamicin
C Aminoglycoside: bactericidal
H Treatment for infection
E Administer as prescribed
C Increase fluid intake; tinnitus indicates
ototoxicity
K Monitor for s/s of ototoxicity, nephrotoxicity
and neurotoxicity. Obtain specimen for peak
and trough levels. Specimens for peak level is
obtained 15-30 minutes after drug
administration. Specimen for trough level is
obtained 15-30 minutes before the next dose
Neomycin Sulfate
C Aminoglycoside; used to reduce ammonia
forming bacteria in the GI tract of a patient in
hepatic coma
H Treatment for infection, decreased ammonia
levels in patient with hepatic encephalopathy
E Administer as prescribed
C Report hearing changes or tinnitus
K Assess the patient for patient for s/s of
neurotoxicity, nephrotoxicity, and ototoxicity
STREPTOMYCIN
C Aminoglycoside; used to destroy the vestibular
apparatus to decrease vertigo in a patient with
Meniere's disease
H Treatment for infection
E Best taken after meals to decrease GI upset
C Report oliguria; indicates nephrotoxicity
K Increase fluids
Monitor BP and Pulse rate
The drug causes ototoxicity, nephrotoxicity and
neurotoxicity
 Amikacin For treating meningitis, septicemia,
sulfate bacteremia and respiratory, urinary
bone/joint and intraabdominal
infection. May cause fever headache,
rash, nausea, vomiting anemia and
superinfection
Tobramycin For treating bacteremia, septicemia,
meningitis and respiratory, urinary
tract, intraabdominal, skin, bone/joint
infection. May cause headache,
dysphonia, weakness, chest painfever,
pharyngitis, rhinitis, hemoptysis and
superinfection
Nursing Considerations
 Send a sample from the infected area for culture
 Monitor intake and output. Urine should be at least
600ml/day. Immediately report decrease urine output
 Check for hearing loss (ototoxicity)
 Monitor for s/s of superinfection: stomatitis, genital
discharge(vaginitis) and anal and genital itching
 Direct patients to use sunblock and protective
clothing during sun exposure bec. Aminoglycosides
can cause photosensitivity
CLASSIFICATION #2:Cephalosphorins
 Indication: wide range infections(caused by gram
positive and gram negative bacteria)
 Contraindications: allergy to cephalosporins,
hepatic, renal impairment
 First generation: effective against most gram
negative bacteria and are destroyed by beta
lactamases
 Second generation: effective against gram positive
and some gram negative bacteria
 Third generation: resistant to beta lactamases
 Fourth generation: highly resistant to beta
lactamases and has good penetration to CSF
 Fifth generation: broad spectrum drugs against
MRSA
First gen: For treating pharyngitis, tonsilitis,
cefazolin UTI, skin infections. May cause rash,
pruritus, nausea, vomiting,
superinfection, well absorbed in the
Gi and not affected by food
Second For pharyngitis, tonsilitis, otitis
gen: media, skin and skin structures,
Cefaclor respiratory and UTI. May cause
headache, pharyngitis, rhinitis, rash,
nausea, pruritus and superinfection
cefuroxime For meningitis, Lyme disease, otitis
media, gonorrhea, septicemia,
pharyngitis, tonsilitis, bone/joint
infection. May cause rash, phlebitis,
vaginitis, injections site reaction and
superinfection
Third gen: For treating bacteremia, septicemia,
Cefotaxime meningitis, typhoid fever, gynecologic
rash, pruritus, fever, vomiting,
diarrhea, colitis, injection site reaction
and superinfection
ceftriaxone Treating otitis media, appendicitis,
gonorrhea, septicemia, surgical
infection prophylaxis, skin, bone/joint
infection, intrabdominal and UTI.
May cause, dyspepsia, dysgeusia,
stomatitis, vomiting, abdominal
cramps, edema, injection site reaction,
diaphoresis, pruritus, vaginitis.
Epistaxis, chills.
Fourth For treating, bacteremia, respiratory,
gen: skin, abdominal, UTI. May cause
cefepime headache, pharyngitis, rhinitis, rash,
nausea, pruritus and superinfection
Fifth gen: For treating intraabdominal pain, and
ceftolozane UTI May cause headache,insomnia,
and nausea, vomiting, fever,
tazobatam superinfection, hypokalemia,
CEFAZOLIN (Ancef)
C antibiotic
H Treatment for infection
E Administer per IV or IM
C Report development of rash
K Assess s/s of nephrotoxicity. It is given per IV
or IM. It is not administered by IV push
CEPHALEXIN (Keflex)
C antibiotic
H Treatment for infection
E Usually taken with or without food every 6-12
 hours for 7-14 days
C Avoid alcohol
Complete full course of the drug
Report severe diarrhea, dyspepsia and bleeding
K Assess for severe diarrhea, difficulty of
breathing
CEFOXITIN SODIUM (Mefoxin)
C Antibiotic
H Treatment for infection
E Injected intravenously every 6-8 hours
C Report development of rash, severe diarrhea,
fatigue,
Pain at the injection site
K Probenecid may inhibit excretion of the drug.
Ave vitamin K at the bedside if prothrombin
levels decrease
Monitor renal status; I&O, serum creatinine
Ceftriaxone sodium(Rocephin)
C Antibiotic
H Treatment for infection
E Administer as prescribed
C Avoid alcohol
Stomach upset and diarrhea may occur
K Discontinue if hypersensitivity reaction occurs.
Keep epinephrine at the bedside
Nursing considerations
 Culture infected area
 Report signs of superinfection
 Advise patient to ingest buttermilk, yogurt or an
acidophilus supplement to prevent superinfection of
the intestinal flora
 Instruct patient to complete course of treatment even
if s/s of infection have ceased
 Infuse cephalosporins over 30 mins as ordered to
prevent pain and irritation
 Observe hypersensitivity reactions
Classification #3: Penicillin and Penicillinase-
resistant antibiotics
 Indications: Streptococcal infections and
meningococcal meningitis
 Contraindications: allergy to penicillin and
cephalosporins, renal disease
AMPICILLIN
C Antibiotic
H Treatment for infection
E Best taken on an empty stomach
C Report development of rash
K Perform a sensitivity test before initiating a
therapy
Probenecid, increase the effect of the drug
Give it around the clock
PENICILLIN
C ANTIBIOTIC
H TREATMENT FOR INFECTION
E BEST TAKEN ON AN EMTPY STOMACH
C REPORT FOR DEVELOPMENT OF RASH
K KEEP ANTIDOTE, EPHINEPRINE AT THE
BEDSIDE
NURSING CONSIDERATIONS
 Teach the patient to always take the entire prescribed
penicillin product
 Advise patient to carry a card that indicates
penicillin allergy or wear a medical alert bracelet
 Encourage the patient to increase fluid intake; fluids
can aid in regulating body temperature and in
excreting the drug.
 Warn the parent of the patients that chewable tablets
must be chewed or crushed before swallowing
 Advise female patients of childbearing years to use
an additional form of birth control while taking
penicillin
Classification #4: Sulfonamides
 They inhibit bacterial synthesis of folic acid, which
is essential for bacterial growth. Humans do not
synthesize folic acid, rather they acquire it through
diet, therefore sulfonamides selectively inhibit
bacterial growth without affecting normal cells. This
are alternative drug for patient who are allergic to
penicillin
 Indications: UTI’s, STI’s
 Contraindications: Allergy to sulfonamides,
sulfonylureas or thiazide diuretics, renal disease,
pregnant women, lactating mothers
SULFASALAZINE(AZULFIDINE)
C Antibiotic; used as a treatment for ulcerative
colitis
H Treatment for infection
E Best taken with meals to decrease GI upset
C Report blood in the urine, rash, ringing in the
ear, sore throat. Wear protective clothing, the
drug causes photosensitivity. Turns the urine
orange yellow
K Discontinue immediately if hypersensitivity
occurs
Increase fluid intake
Cotrimoxazole (Bactrim)
C Antibiotic
H Treatment for infection
E Best taken before meals
C Changes in color of the urine to red orange
Report signs of rash
K Assess for signs and symptoms of
nephrotoxicity
Nursing Considerations:
 encourage patient to increase fluid intake to avoid
crystalluria
 Advise pregnant patient to avoid sulfonamides
during pregnancy
 Counsel patients NOT to take antacids with
sulfonamides because antacids decrease
absorption rate of sulfonamide drugs
 Instruct patient to report bruising or bleeding that
could be a result of drug induced blood disorder.
 Evaluate the effectiveness of sulfonamide therapy by
determining whether the infection has been
alleviated and the Blood count is within normal
range
Classification #5: MACROLIDES
 Active against most gram positive bacteria and are
moderately active against some gram negative
bacteria
 They are called broad spectrum antibiotics.
 Macrolides can be administered orally or by IV
(slowly) bit not intramuscularly because it is too
painful
 Indications: Wide range of infections
 Contraindications: Allergy to macrolides,
contamitant administration with astemizole,
cisaprode, primozide or terfenadine(leads to fetal
cardiac arrhythmia.
ERYTHROMYCIN
C Antibiotic
H Treat for infection, drug of choice for
mycoplasmal pneumonia and
Legionnaires disease
E Best taken on an empty stomach
C Report development of rash
K Monitor liver function
Administer round the clock
Assess for sign and symptoms of secondary
infection
Azithromycin
C Antibiotic
H Treatment for infection
E Can be taken with or without food
C Side effects: nausea, vomiting, diarrhea,
abdominal pain, anemia, rash
Adverse effect: hepatotoxicity, angioedema
Check: AST, CBC. ALT
Report: sore throat, fever, diarrhea, fatigue
K Monitor for signs of superinfection (diarrhea,
perineal itching, oral ulcers)
Chloramphenicol
C Antibiotic
H Treatment for infection
E Best taken on an empty stomach
C Report sore throat and tiredness
K Antagonizes the bacterial action of penicillin
The drug may depress the bone marrow

Rifabutin
C Antibiotic, used for prevention of disseminated
mycobacterium avium complex (MAC) disease
in patients
H Treatment for infection
E Take once daily with or without food
C Report nausea, vomiting, diarrhea to the health
care provider. Body fluids may turn reddish;
contact lenses may be stained
K Monitor CBC; it may cause bone marrow
depression
Sulfamylon (Mafenide)
C Antibiotics; used to prevent and treat wound
infections in patient with sever burns
H Treatment for infection
E Apply every 6-8 hours usually at the same time
each day as directed
C Cover burns at all times with the drug
K Apply the debrided wound with gloved hands
Monitor toxicity (nephrotoxicity, bone marrow
depression, metabolic acidosis)
Vancomycin
C Antibiotic; drug of choice of MRSA(methicillin
resistant staphylococcus aureus
H Treatment for infection
E Administer per IV
C Report ringing in the ears, difficulty voiding,
rash and flushing. May cause nausea and
hypotension
K Dilute contents of 500mg vial injection in 30
ml of water of oral or gastric tube
administration
Monitor: Renal function test with prolonged
therapy for signs of “red neck” or “red man
Syndrome” (sudden and profound fall in BP,
fever, chills, paresthesia's, erythema of the neck
and back. Give antihistamine if this occurs
Notify the health care worker if signs of
superinfection, such as sore throat, fever, or
fatigue appear
OTHER Classifications
 Fluoroquinolones(quinolones):this group of
antimicrobials are effective against some gram-
negative and some gram-positive organisms such as
S. pneumoniae, and H. Influenzae, P. Aeruginosa,
Salmonella and Shigella species. This group of
antibiotics is useful in the treatment of UTI, bone
and joint infection, bronchitis, pneumonia,
gastroenteritis and gonorrhea. Ciprofloxacin and
Moxifloxacin , Levofloxacin are examples of drug
that belongs to this group
Nursing Considerations
 Teach patient to drink at least 6-8 glasses if fluid
daily
 Encourage patient to avoid caffeinated products
 Inform patient that photosensitivity is one of the side
effects. They should wear sunglasses, sunblock and
protective clothing
 Direct patients to avoid operating motor vehicles
because of drug related dizziness
 Encourage patient to report dizziness, nausea,
vomiting, flatulence, abdominal cramps, tinnitus and
tendon rupture(very rare)
NITROIMIDAZOLES
 This are used as prophylaxis for surgical infections
and treat CDAD(difficile-associated disease),
anaerobic infections, amebiases, trichomoniasis,
bacterial vaginosis, and acne rosacea.
Metronidazole and tinidazole are two of the most
effective drug available to treat anerobic bacterial
infections.
 Side effects include headache dizziness, insomnia,
diarrhea, tongue/urine discoloration and
superinfection
 Most serious reaction are leukopenia, seizure, Steven
Johnson syndrome and disulfiram-like reaction.
Disulfiram like reactions include flushing,
throbbing, headache, visual disturbances, confusion,
dyspnea, tachycardia, syncope and circulatory
collapse