Antibiotic Therapy

Prof. Lopez, CMSV

Antibiotics Affecting Bacterial Cell Wall

• Bactericidal
• AB Family: BETA-LACTAMS
• PCN
• CEPHALOSPORINS
• CARBAPENEMS
• MONOBACTAMS
Beta-Lactamase

• Enzyme providing a mechanism for bacterial resistance

• Enzyme breaks the chemical bond b/w C and N atoms in the
beta-lactam ring thereby causing all beta-lactam drugs to
lose their antibacterial efficacy
• Beta-lactamase inhibitors added to several of the PCN AB to
make drug more powerful against beta-lactamase producing
bacterial strain.
 Penicillins

• Bactericidal • Antistaphylococcal [Penicillinas-

• Prototype: Amoxicillin [ATI, online] resistant]
• Select Prototype: PCN G potassium: Narrow
spectrum: IM/IV (ATI, ch 44)
• Nafcillin: IM/V
• Natural PCN: NS
• Antipseudomonal [Extended-
• PCN G benzathine: IM
• PCN V potassium: PO
spectrum]
• Aminopenicillins: Broad-spectrum • Ticarcillin-clavulanate acid: IV
• Amoxicillin: PO use
• Ampicillin: PO/IV • Pipercillin-tazobactam: IV
• Amoxicillin-clavulanate [combo of PCN & beta-
lactamase inhibitor]: PO
Action Uses

• Kill bacteria by weakening • Ear, throat and UTI

bacterial cell wall • G+ cocci infections: pneumonia & meningitis
(S. pneumoniae), infectious endocarditis [S.
viridans], pharyngitis [S. pyogenes]

• Meningitis [G- cocci N. meningitides]

• Syphilis [Treponema pallidum spirochete]:

PCN G Benzathine IM

• Pseudomonas, Enterobacter species,

Proteus, Klebsiella

• Prophylaxis: bacterial endocarditis in at risk

client: BEFORE dental and other procedures
Contra Precautions

• H/o severe allergy to PCN, • Allergic to one; cross-sensitivity to

cephalosporins or imipenem other PCN

• Have or at risk: Kidney dysfunction • Risk to cross-sensitivity to

cephalosporins
 Adverse Effects [Complications]

• Allergies, anaphylaxis • Hyperkalemia [>5.0 mEq/L]

• Urticaria, pruritis, angioedema • Cardiac dysrhythmias
• GI effects: most common: n/v/d, taste • High doses of penicillin G potassium
alterations, oral candidiasis
• Interview clients for prior allergy • Hypernatremia [Na >145 mE/L]
• Observe for allergic reactions for 30 min following • IV ticarcillin-clavulanate acid
parenteral administration of penicillin.
• Monitor cardiac status & electrolyte
• Teach: Wear an allergy identification bracelet
levels
• Renal impairment
• Monitor kidney function

• Monitor I&O.
Interactions

• Aminoglycosides [IV] & clavulanate acid

• Oral contraceptives: decrease effect

• Probenecid: prolongs PCN effect

• Warfarin: enhanced anticoagulant effect: Bleeding

• MTX: increased MTX levels

• NSAIDS: more free active pcn levels

• Rifampin: inhibit killing action of pcn

 Nursing

• Instruct clients to report any findings of an allergic
response (dyspnea, a skin rash, itching, and
hives).
• ● Give IM injections cautiously to avoid injecting
into a nerve or an artery.
• Advise to complete entire course of Rx even if
symptoms resolve
• Advise female childbearing age: take additional
contraceptive method
• PCN V, Amoxcillin, amoxicillin-clavulanate: with
meals [GI upset] or with 8 oz water 1 hr before or
2 h post meals: maximize absorption
• Probiotic or cultured diary products, yogurt
• Do not take with acidic juices
• Benzathine Pcn: thick, give IM, 21
gauge, large muscle [do not use
dorsogluteal]
• Infuse IV meds over recommended
times
• Monitor IV site
• Anaphylactic: Stop, Epinephrine or
other drug as per protocol. Have
supportive equipment [O2]
Cephalosporins Action

• SELECT PROTOTYPE MEDICATION:

Cephalexin, first generation
• Cephalosporins are beta-
• OTHER MEDICATIONS
lactam antibiotics, similar to
penicillins, that destroy
• ● First generation: Cefazolin for IM or IV use
bacterial cell walls causing
• ● Second generation: Cefaclor, cefotetan for
PO use destruction of micro-
• ● Third generation: Ceftriaxone, cefotaxime
organisms.
for IM or IV use

• ● Fourth generation: Cefepime for IM or IV

• Cephalosporins comprise
use five generations
• ● Fifth generation: Ceftaroline for IV use- only
cephalosporin that is effective against MRSA • Administered IV or IM
Use
Adverse/Complicatios

• UTI • Allergy, hypersensitivity, possible cross-

sensitivity PCN
• Postop infections
• Bleeding tendencies: cefotetan &
• Pelvic infections ceftriaxone

• Thrombophlebitis [IV infusion]

• Meningitis
• Renal insufficiency
• MRSA [5th generation,
ceftaroline] • Pain with IM injection

• Antibiotic-associated
pseudomembraneous colitis
Contras/Precautions

• H/O PCN allergy • Disulfiram reaction [intolerance to

ETOH]
• Cautious: Renal impairment or • Instruct not to consume alcohol while
bleeding tendencies taking these drugs

• Probenecid delays renal excretion

• Monitor I&O
Nursing

• Assess baseline labs: WBC, BUN/Creatinine, bleeding history

• Thorough assessment of allergy history to PCN

• PO meds give with food to decrease GI upset

• Avoid alcohol and alcohol containing products: potentiation of disulfiram-like

reaction [acute alcohol intolerance]

• Instruct client to report unresolved GI upset

• Store oral suspensions in refrigerator

 Carbapenem Use

• SELECT PROTOTYPE MEDICATION: • Serious infections: PNA, peritonitis,

• Imipenem-cilastatin for IM or IV use UTI, bone, joint and soft tissue
infections
• OTHER MEDICATIONS:
• Bacterial endocarditis
• Meropenem for IV use
• Pelvic infections
• Ertapenem IV once a day

• Doripenem IV • Bacterial septicemia

• Newest • Bacterial meningitis: Meropenem only
• Less seizure potentil

• Intra-abdominal infections, pyelonephritis, UTIs

• DO not use for PNA-increased mortality rate

AE Contra/Prec/Interaction

• SEIZURES • Imipenem-cilastatin- Preg. C

• Same as cephalosporins, PcN • Cautious use in renal clients

• GI: n/v/d

• Superinfection
• NURSING
• ASSESS FOR H/O SEIZURES
• Interaction
• Valproic acid: reduced levels;
breakthrough SEIZURES
• Avoid using concurrently; if unavoidable-
monitor for increased seizure activity
Monobactam

• Aztreonam

• Used when gram negative coverage is needed in pt with PCN allergy

• Use: moderately severe systemic infections & UTIs

• Intra-abd. and gyn infections in combo w/other AB

• Route: IV/IM

• Ok to use in patient w/PCN allergy

• Common AE: rash, n/v/d

Vancomycin

• Class: Glycopeptide

• Action: Bactericidal; inhibitor of cell wall synthesis

• Uses: MRSA & gram + infections [IV]; PO: C. difficile; staphylococcal enterocolitis

• AE:

• NEPHROTOXICITY: Baseline kidney function, U.O.

• OTOTOXCITY: Assess for tinnitus, hearing loss

• REDMAN SYNDROME: Flushed, rashes, tachycardia, hypotension

• Cautious use: pre-existing kidney disease or hearing loss

• Interactions: other nephrotoxic drugs: Aminoglycosides, cyclosporine, contrast media, loop diuretics
(furoseminde)
 Nursing

• Baseline labs: BUN/Creatinine, WBC, stool sample, Cr Clearance

• Hearing assessment, vital signs with focus on BP

• Assess skin color

• Instruct to notify if changes in acuity of hearing

• Monitor vanco levels: Peak & trough

• Optimal peak level: 18-50 mcg/mL; trough 10-20 mcg/mL

• Infuse over 60 minutes on a PUMP

• Rotate injection sites

• Monitor injection sites: redness, swelling, inflammation

• Monitor I&O
Antibiotics: Affect Protein
Synthesis
Antibiotics Affecting Protein Synthess

• Bacteriostatic

• Inhibit growth of bacteria by preventing protein synthesis

• Broad-spectrum

• Family
• Tetracyclines
• Macrolides
• Aminoglycosides [Bactericidal]
 Tetracyclines

• Select Prototype: Tetracycline • Acne vulgaris (topically and orally)

• Others • Periodontal disease (topically)

• Rickettsial infections (typhus fever, Rocky

• Doxycycline: PO; sclerosing Mountain spotted fever)
agent for instillation into pleural
• Infections of the urethra or cervix due to
space Chlamydia trachomatis

• Demeclocycline: PO • Brucellosis

• Tigecycline [New]: IV [Glycycline] • Pneumonia due to Mycoplasma pneumonia

• ● Lyme disease

• ● Anthrax

• ● GI infections due to Helicobacter pylori

AE Contra/Caution

• GI: cramping, n/v/d, esophageal • Cat. C

ulceration
• Must be AVOIDED in pregnancy,
• Yellow or brown tooth discoloration nursing women and children younger
than 8 y
• Hypoplasia of tooth enamel
• After 4th month preg can stain
• Hepatotoxicity: jaundice/lethargic deciduous teeth not affect permanent.
• Avoid high IV daily doses

• Photosensitivity: intense sunburn

• Superinfection

• Dizziness/lightheaded: minocycline
Interactions

• Interaction with
• milk products,antidiarrhea [Kaopectate] calcium and iron supplements, laxatives
containing magnesium, and antacids, thus reducing the absorption of tetracycline
• PO warfarin: monitor PT/INR, bleeding
• Oral contraceptives
• Need alterative form of birth control

• Digoxin toxicity: both minocycline and doxycycline increase risk

• Monitor dig level if taking concurrently
• Normal Digoxin 0.5-2 ng/dL
Nursing

• Avoid administration to children younger than 8 ys & women who are

pregnant

• Advise to wear protective clothing and use sunscreen, hat while outdoors

• Teach to notify provider if diarrhea or signs of a yeast infection

• Take on empty stomach [Tetracycline] w/8 oz water

• Gastric upset then take with food

• Cautious with ambulation: dizziness/lightheadedness & report to provider

• Monitor for n/v/d, I&O

Nursing

• Suggest taking doxycycline with meals

• Avoid taking at bedtime or taking before lying down: reduce risk of

esophageal ulceration

• Instruct to complete full course

• Teach to maintain 2 hr interval between taking a chelating agent and

tetracycline

• Assess for whitish, sore patches on oral mucosa, vaginal itching pain, cottage
cheese like discharge
Macrolides Action

• Prototype: Erythromycin: • Bacteriostatic

• 250-500 mg PO 4x a day, IV • Slow growth of bacteria by inhibiting
• Others protein synthesis by binding to the
50S ribosomal suunits
• Azithromycin: PO/IV

• Z-pack
• 500 mg Day 1; then 250 mg/day x4 days

• Long half-life; long duration of action

• Clarithromycin: 500 mg PO twice a day

Contra/Caution Interactions

• Liver disease • Warfarin

• QT prolongation • Digoxin

• Theophylline

• Carbamazepine

• Cyclosporine

• Oral contraceptives

• Antifungal, HIV protease inhibitors,

verapamil, diltiazem
 Uses AE

• Use in patients w/PCN allergy • Sores, Metallic taste mouth:

Clarithromycin
• Prophylaxis: rheumatic fever & bacterial
endocarditis • GI: nausea, vomiting, epigastric pain

• Legionnaires’ disease, pertussis • Give with meals

• Monitor for and report adverse effects

• Acute diptheria
• Prolonged QT interval
• Chlamydial infections: urethritis, cervicitis
• Dysrhythmias; possible sudden cardiac
• Pneumonia from Mycoplasma death
pneumoniae
• Ototoxic [high dose therapy]
• Strep infections
• Monitor for hearing loss, vertigo, tinnitus
Nursing

• Assess baseline cardiac function, vs: potential for chest pain, palpitation and EKG changes

• Baseline hearing

• Monitor PT/INR, bleeding [warfarin], digoxin level or theophylline to avoid toxicity ingestion

• Except for Azithro: take on empty stomach 1 h before meals or 2 h after w/8 oz water unless GI
upset

• E-mycin IV for severe infections or for those who cannot take PO

• Finish full oral course

• Monitor liver function for treating lasting more than 2 weeks

• Do not give with or immediately before or after fruit juices to avoid interaction with drug

• Teach about many drug to drug interactions

 Aminoglycosides Action

• DOC for treatment of virulent infections • Bactericidal potent AB

• Given IV except for neomycin [PO] • Destroy microbes by disrupting

protein synthesis
• Select prototype: GENTAMICIN

• Other Family members

• Amikacin [D]

• Tobramycin

• Neomycin po

• Streptomycin

• Paromomycin po
 Uses
• Gram negative infections, E. coli,
Klebsiella, proteus and pseudamonas
• Intestinal amebiasis and tapeworm
(Paromomycin PO)
• Neomycin PO: suppress normal flora of
GI tract preop in preparation for colorectal
surgery
• Neomycin topical: infections eye, ear, skin
• Streptomycin: TB in combo w/INH,
Rifampin, PZA and Ethambutol; plague,
tularemia, brucellosis
AE
• OTOTOXIC
• Cochlear damage [hearing loss], vestibular
damage [loss of balance
• NEPHROTOXIC
• High cumulative effects: acute tubular
necrosis: proteinuria, casts in urine, dilute
urine, high BUN/Creatinine
• Intense neuromuscular blockade
• RESPIRATORY DEPRESSION, muscle weakness
• Hypersensitivity
• Rash, pruritis, paresthesia of hands, feet, uriticaria
AE Contra/Caution

• Streptomycin • Cautious use

• Neurological disorder • Kidney impairment, hearing loss,
• Peripheral neuritis optic nerve myasthenia gravis
dysfunction
• Cautious client taking ethnacrynic acid,
• Tingling and numbness of hands and
feet amphotericin B, cephalosporin,
vancomycin, neuromuscular blocking
• Teach client to report any agents [turbocurarine]
manifestations to provide
Interactions

• PCN inactivates aminoglycosides when in same IV solution

• NSG: DO not mix aminos and pcns in same IV solution

• Concurrent use with other ototoxic drugs: Loop diuretic (Furosemide),

Vancomcyin: increased risk for hearing loss.
• Baseline and periodic
• Loss of hearing D/C med

• Concurrent use with Vanco: increased for renal problems

• Baseline kidney function

• Trough levels
 Nursing

• Baseline labs for kidney involvement: BUN/Creatinine, CrCl, urine output

• Intake and output

• Baseline hearing

• Use a pump for IV infusion

• TROUGH LEVELS: ____________ BEFORE THE DOSE

• Therapeutic goal: Trough at or below 1 mcg/mL; Levels > 2 mcg/mL: greater risk for ototoxicity and
nephrotoxicity

• PEAK: 30 minutes post administration of aminoglycoside IV; vanco: 60 post completion

• Provide & encourage adequate hydration: 3000 mL/day if not contraindicated

• Dosing is adjusted on estimate of CrClearance

Urinary Tract Drugs Action

• Broad spectrum of antibacterial activity • Do not destroy bacteria but

• Family inhibit their growth:
Bacteriostatic
• Sulfonamides

• Sulfamethoxazole/Trimethoprim • Inhibit growth of bacteria by

[SMZ-TMP] [Bactrim] preventing bacterial synthesis
of folic acid
• Trimethroprim
• Sulfadiazine
• Treat ulcerative colitis,
rheumatoid arthritis
• Not used as an antibiotic
 Uses AE

• UTIs [E. coli infection] • Hypersensitivity: Sulfa allergy

• Blood dyscrasias
• Otitis media
• Different types of anemias: Hemolytic, aplastic,
• Chancroid thrombocytopenia, agranulocytosis

• Crystalluria
• Pertussis
• Kernicterus
• Shigellosis
• Hyperkalemia
• Pneumocystitis jiroveci
• Photosensitivity
pneumonia [HIV infection]
• Steven Johnson syndrome [toxic epidermal
• Outpatient Staphylococcal necrolysis]
infections
• N/V/D, pancreatitis, hepatoxicity
 Contras/Caution
• Folate/folic acid deficiency: increases risk
of megaloblastic anemia
• Cautious use in impaired kidney: give
lower dose]
• Administer cautiously to adults >65 y who
take ACEI [pril] or Angiotensin II receptor
blockers: risk for hyperkalemia.
Interactions
• Warfarin, phenytoin, sulfonylurea, oral
hypoglycemics: INCREASED effects
• Nsg
• Give lower dosages during
Sulfamethoxazole-trimethoprim
• Monitor PT, INR, blood glucose and
phenytoin [Dilantin] levels.
Nursing

• Assess for sulfa allergy and or sulfites • Skin assessment

or sulfa-like drug: sulfonylurea, oral
diabetic agents and thiazide diuretics • Assess renal function
[HCTZ\
• Baseline urine output, c/s,
• Adequate hydration

• Take on empty stomach with 8 or

more ounces water

• Complete entire course

• Obtain urine C/S

Urinary Analgesic
• Phenazopyridine [Pyridium]
• Action: local anesthetic on mucosa of
urinary tract
• Uses: burning with urination,
frequency, urgency, pain, spasm
associated with a UTI
• Route : PO
• Short-term use only: 3 days
• NSG:
• Instruct to take while on antibiotic
• Teach that all body fluids will turn
reddish-orange.
• Stains clothes and contact lenses
reddish-orange
• Take with or after meals to minimize GI
discomfort
 Urinary Tract Antiseptic AE

• Broad spectrum • GI discomfort: anorexia, n/v/d

• Family • Nsg: Give with milk or meals

• Prototype: Nitrofurantoin: PO use • Hypersensitivity reactions

• Fever, chills, severe pulmonary manifestations
• Other: Methenamine dyspnea, cough, chest pain, pulmonary
infiltrations
• Action
• Blood dyscrasias: different anemia
• Bacteriostatic and bactericidal action
• Peripheral neuropathy
• Uses: UTIs, prophylaxis for recurrent
lower UTIs • Headache, drowsiness, dizziness

• EKG changes, hepatoxic

Contra Nursing

• Impaired kidney function • Instruct urine turns rust-yellow t o

brown & can stain teeth
• CrCl < 40 mL/min
• Encourage to take with food if GI
• Pregnancy: AVOID: Birth defects occurs

• Complete full course

• Recommend client avoid crushing,

chewing, or opening capsules: tooth
staining
Fluoroquinolones [Quinolones] Action

• Prototype: CIPROFLOXACIN: PO/IV • Bactericidal by alterating DNA

use [C]
of bacterial
• Others
• Do not inhibit production of
• Ofloxacin human DNA
• Moxifloxacin • Have great oral absorption
• Levoflcin: PO/IV [C]
• Norflooxaxacin
• Gemifloxacin
• Delafloxacin [new]
 Uses AE

• Broad spectrum against gram positive and • GI discomfort

negative bacteria
• PROLONGS QT INTERVALS [EKG]
• Complicated UTI • ACHILLES TENDON RUPTURE

• Respiratory, skin, GI, bone and joint • Nsg

infections • Tell client to observe and report pain,
swelling and redness at Achilles
• Anthrax prevention [inhalation of
• Instruct to stop taking ciprofloxacin and
spores] avoid exercise until inflammation subsides

• Phototoxicity

• Superinfection
 Contra/Caution
• Children <18 y: risk of Achilles tendon rupture
unless treatment is for E. coli infection of
urinary tract or anthrax
• Increases risk for C.difficile: destroys normal
gut flora
• CNS: Dizziness, headache, restlessness,
confusion
Cautious use with older adults and w/children
with cardiovascular disorders
Interaction
• Magnesium antacids, iron salts,
sucralfate, dairy products: decrease
absorption of cipro
• NSG: give 6 h before or 2 h post
• Theophylline: increase levels
• Monitor theophylline levels & adjust
dosage
• Normal theorphylline serum 10-20
mg/dL
• Warfarin: increase: Monitor PT/INR
and adjust
Nursing

• Assessment of CNS

• Assess for existing neuropathies

• Assess for cardiac history, note if pt on any antidysrhythmic agents: potential for dangerous
cardiac irregularities

• Baseline liver test: liver injury

• Ask about use of antacids, iron pills, zinc preps and sucralfate

• Instruct to take as prescribed and for full course

• IV cipro: D/C other infusions and use separate site

• Give lower dosages to clients with impaired kidney function

• IV cipro over 60 minutes in a large vein; inhalation cipro for anthrax: every 12 h x 60 days
Antimycobacterial: Selective Antituberculosis

• Prototype: Isoniazid [INH] • Highly specific for mycobacteria

• OTHERS • Inhibit growth of mycobacteria
• Rifampin [RIF] by preventing synthesis of
• Pyrazinamide [PZA] mycolic acid in cell wall
• Ethambutol [ETH]

• Streptomycin

• Rifapentin
 Uses
• Active and latent tuberculosis
• Active: 4 med regimen
• INH [C], RIF [C], PZA [C], ETH [B]
• Latent
• INH: 9 months or INH with
rifapetine once weekly for 3
months
• Contra: children under 2 y; HIV
clients, pregnant women
AE
• ALL CAUSE HEPATOXICITY
• Elevate glucose levels and lower glucose
control
• INH: PERIPHERAL NEURITIS/NEUROPATHY
• Tingling, numbness, burning, pain from lack of
pyridoxine [Vit B-6]
• Must take DAILY DOSE PYRIDOXINE-B6
• RIF: Body fluids reddish-orange
• PZA: Hyperuricemia
• ETM: Optic neuritis, altered color perception,
blindness
CONTRA INTERACTIONS

• LIVER DISEASE • Concurrent use of tyramine foods,

alcohol, rifampin and pza increase risk for
hepatotoxicity

• Nursing

• Tell client to a avoid food w/high

levels of tyramine
• Instruct to avoid alcohol
• Monitor Liver function: ALT/AST
Nursing

• Baseline Liver Function, vs, lung assessment, uric acid levels, glucose level

• Must take exactly as ordered as same time each day

• Monitor for liver involvement: jaundice, dark urine, anorexia, n/v, fatigue

• Notify if visual acuity changes, altered color perception: report immediately esp.
ETH

• Ensure patient with active TB hospitalized is on AIRBORNE ISOLATION,

• Ensure patient is observed taking the medication if hospitalized with active TB

• Obtain sputum specimen for M. tuberculosis first morning sample, three

consecutive mornings
Nursing

• Critical that full course of medication regimen is complete even if

manifestation clear up

• Take INH 1 h before or 2 h after meals

• Gastric discomfort, take with meals

• All given PO; if IM warm to room temperature to ensure solution is free of

crystals; inject deep large muscle
Antiprotozoals

• Prototype: Metronidazole [B] • AE:

• GI discomfort: n/v, dry mouth, metallic taste

• Action: Broad spectrum with
bactericidal properties • Darkens urine: harmless effect-tell patient

• Route: PO, IV • Neurotoxicity, CNS effects: stop if numbness, ataxia,

seizures
• Uses: protozoal infections: intestinal
• THROMBOCYTOPENIA: WATCH CBC: PLTS
amebiasis, giardiasis, trichomoniasis,
C. DIFFICILE, prophylaxis for surgical • PSEUDOMEMBRANOUS Colitis
procedures: vaginal abdominal,
• Nsg:
colorectal, high risk anaerobic
infections, treat H. pylori with • Instruct to report fever, diarrhea, abd. Pain, or blood
tetracycline and bismuth subsalicylate stool
in clients who PUD • Stop medication
Contra/Caution
• FIRST TRIMESTER PREGNANCY
• ACTIVE CNS disorders, blood
dyscrasias, during lactation
• Cautious use in clients with kidney,
cardiac, fungal, candida infections or
seizures
• Cautious use: older adults, 2nd and 3rd
trimester
Interaction
• ALCOHOL: DISULFIRAM-LIKE
REACTION; FACIAL FLUSHING,
VOMITING, DYSPNEA, TACHYCARDIA
• NSG: AVOID ALCOHOL, ALCOHOL-
CONTAINING PRODUCTS
• NO ALCOHOL 24 H BEFORE AND 36-72
hours post completion of regimen
• Inhibits activation of Warfarin, phenytoin,
lithium
• NSG: Monitor PT/INR. Adjust accordingly
Nursing

• Administer as directed either via PO or IV

• Must complete full course

• Advise client to use condoms if using this medication for treatment of

trichomoniasis.

• MUST AVOID ALCOHOL 24 HRS BEFORE INITIATION & FOR AT LEAST

36-72 HOURS POST COMPLETION OF LAST DOSE TAKEN
 Antifungals

• Prototype: AMPHOTERICIN B [polyene AB systemic mycoses]

• Ketoconazole: treat both superficial and systemic mycoses

• Others
• Fluconazole
• Nystatin
• Clotrimazole
• MIconazole
• Terbinafine
• Griseofulvin, Flucytosine
Antifungals

• Ampho B: acts on fungi cell membrane to cause cell death

• Fungistatic or fungicidal: depends on concentration

• Use: Drugs are treatment of choice for system fungal infections: candiasis,
aspergillosis, cryptococcosis

• Other: treat superficial fungal infections: tinea pedia [athletes food], tinea
cruris [ringworm groin-jock itch], candida infections of skin, mucous
membranes and fungal infections of nails [onchomycosis]
 AE
• Ampho B: SHAKE AND BAKE EFFECT
• FEVER, CHILLS, RIGORS, HEADACHES 1-3
H POST INITIATION
• Cardiac dysrhythmias
• NSG; TEST DOSE OF 1 MG AMPHO B
INFUSED SLOWLY IV, ASSESS FOR
REACTION
• PRETEAT WITH DIPHENHYDRAMINE,
ACETAMINOHEN, CORTICOSTEROID
[PREDNISONE]
• Administer meperidine, dantrolene or
hydrocortisone for rigors
• Thrombophlebitis
• Electrolyte imbalances: POTASSIUM & MG
LOSS [HYPOKALEMIA,
HYPOMAGNESEMIA]
• NSG: Supplement if needed
• Bone marrow suppression: Obtain baseline
CBC, hematocrit and monitor weekly
• Ketoconazole: Heptotoxic
• Effects on sex hormones
• Men-gynecomastia, decreased libido, ED
• Women: irregular menses
FLUCANAZOLE NYSTATIN

• Better choice than Ampho B • Polyene antifungal

• Excellent coverage • Topically for diaper rash

• ROUTE: PO, IV • PO: candidial infections

• Single oral dose: 150 mg for vaginal • Route: PO

candidiasis infection
• SWISH around oral cavity AND
SWALLOW FOR ORAL
CANDIDIASIS
Terbinafine

• Uses: superficial dermatologic fungus: athlete’s foot

[tinea pedia], tinea cruris [jock itch], tinea corporis
[ringworm]
• PO tablet: treat nail fungus [onchyomycosis
Nursing

• Ampho B is toxic: reserve for severe life-threatening fungal infections

• Infuse Ampho B slowly over 2-4 Hours IV on pump

• Premedicate client to lessen Shake and Bake effect

• Observe solution and discard if precipitates are present. Use a filter

• Less kidney injury: infuse with 1 L 0.9%NS IV on day of Ampho B infusion

• Apply antifungal for topical to treat superficial vulvovaginal candidiasis as

vaginal suppository