ANTI-INFECTIVE AGENTS/ ANTIBIOTICS

GENERAL AND SPECIFIC OBJECTIVES

AFTER 1 HOUR AND 30 MINUTES OF VARIED – LECTURE DISCUSSION THE BSN 2
STUDENTS WILL BE ABLE TO ENHANCE POSITIVE ATTITUDE, ACQUIRED BASIC KNOWLEDGE
AND SKILLS IN THE CONCEPT OF THE USE OF THE ANTI-INFECTIVE AGENTS/
ANTIBACTERIAL/ ANTIBIOTIC DRUGS.
THE STUDENTS WILL BE ABLE TO:
1. DIFFERENTIATE BETWEEN BROAD SPECTRUM AND NARROW SPECTRUM.
2. DEFINE BACTERIAL RESISTANCE TO ANTIBIOTIC
3. EXPLAIN HOW AN ANTIBIOTIC IS SELECTED FOR USE IN A PARTICULAR
SITUATION;
4. DEVELOP A DRUG STUDY GUIDE, ACTION,
(THERAPEUTIC CONTRAINDICATION, MOST INDICATION, REACTION
COMMON ADVERSE
RESPONSIBILITY) OF EFFECT CLASSES OF ANTIBIOTICS; AND
THE DIFFERENT AND NURSING
5. APPRECIATE THE USE OF ANTIBIOTICS ACROSS THE LIFESPAN
 DEVELOPMENT OF ANTI-INFECTIVE
THERAPY
• 1920S PAUL EHRLICH WORKED ON DEVELOPING A SYNTHETIC CHEMICAL
EFFECTIVE AGAINST INFECTION – CAUSING CELLS ONLY.
• SCIENTIST DISCOVERED PENICILLIN IN A MOLD SAMPLE (MOULDY PETRI
– DISH IN 1928)
• ALEXANDER FLEMING – WAS A PHYSICIAN – SCIENTIST WHO WAS
RECOGNIZED FOR DISCOVERING PENICILLIN. UPON EXAMINING SOME
COLONIES OF STAPHYLOCOCCUS AUREUS, HE NOTED THAT A MOLD CALLED
PENICILLUM NOTATUM CONTAMINATED HIS PETRI – DISH.
• 1935 SULFONAMIDES WERE INTRODUCED
 MECHANISM OF ACTION
• INTERFERE WITH BIOSYNTHESIS OF BACTERIAL CELL WALL
• PREVENT THE CELLS OF THE INVADING ORGANISM FROM USING
SUBSTANCES ESSENTIAL TO THEIR GROWTH AND DEVELOPMENT.
• INTERFERE WITH STEPS INVOLVED IN PROTEIN SYNTHESIS
• INTERFERE WITH DNA SYNTHESIS
• ALTER THE PERMEABILITY OF THE CELL MEMBRANE TO
ALLOW ESSENTIAL CELLULAR COMPONENTS TO LEAK OUT
NARROW SPECTRUM VS BROAD SPECTRUM

• NARROW SPECTRUM OF ACTIVITY – EFFECTIVE

AGAINST ONLY A FEW MICROORGANISM WITH A VERY
SPECIFIC METABOLIC PATHWAY OR ENZYME
• BROAD SPECTRUM OF ACTIVITY – USEFUL IN TREATING
A WIDE VARIETY OF INFECTIONS
PREVENTING RESISTANCE
• LIMIT THE USE OF ANTIMICROBIAL AGENTS TO THE
TREATMENT OF SPECIFIC PATHOGENS SENSITIVE TO THE
DRUG BEING USED.
• MAKE SURE DOSES ARE HIGH ENOUGH, AND
DURATION OF DRUG THERAPY LONG ENOUGH
• BE CAUTIOUS ABOUT THE INDISCRIMINATE USE OF
ANTI- INFECTIVE
ADVERSE REACTIONS TO ANT-INFECTIVE THERAPY
• KIDNEY DAMAGE
• GASTROINTESTINAL (GI) TRACT
TOXICITY
• NEUROTOXICITY
• HYPERSENSITIVITY REACTIONS
• SUPERINFECTIONS
TYPES OF ANTIBIOTICS
• BACTERIOSTATIC – SUBSTANCES THAT
PREVENT THE GROWTH OF BACTERIA
• BACTERICIDAL – SUBSTANCES THAT KILL
BACTERIA DIRECTLY
SIGNS OF INFECTION
• FEVER
• LETHARGY
• SLOW – WAVE SLEEP INFECTION
• CLASSIC SIGN OF INLAMMATION (REDNESS
(RUBOR), SWELLING (TUMOUR), HEAT
(CALOR), AND PAIN (DOLOR)
GOAL OF ANTIBIOTIC THERAPY

• DECREASE THE POPULATION OF THE

INVADING BACTERIA TO A POINT
WHERE THE HUMAN IMMUNE
SYSTEM CAN EFFECTIVELY DEAL WITH
THE INVADERS.
 BACTERIAL CLASSIFICATION
• GRAM POSTIVE – THE CELL WALL RETAINS A STAIN
OR RESISTS DECOLORIAZATION WITH ALCOHOL
• GRAM NEGATIVE – THE CELL WALL LOSES A STAIN OR
IS DECOLORIZED BY ALCOHOL
• AEROBIC – DEPEND ON OXYGEN SURVIVAL
• ANAEROBIC – DO NOT USE OXYGEN
 CLASSIFICATION/ CLASSES
• AMINOGLYCOSIDES
• CEPHALOSPORINS
• FLUOROQUINOLONES /
QUINOLONES
• MACROLIDES
• LINCOSAMIDES
• MONOBACTAMS
• PENICILLINS
• SULFONAMIDES
• TETRACYCLINES
• ANTIMYCOBACTERIALS
 AMINOGLYCOSIDES
• A GROUP OF POWERFUL ANTIBIOTICS USED TO TREAT SERIOUS INFECTIONS
CAUSED BY GRAM – NEGATIVE AEROBIC BACILLI
• COMMON MEDICATIONS: GENTAMYCIN (GARAMYCIN), STREPTOMYCIN,
AMIKACIN (AMIKIN), KANAMYCIN (KANTREX) NEOMYCIN
(MYCIFRADIN) TOBRAMYCIN (NEBCIN, TOBREX)
• BACTERICIDAL (E. COLI, PROTEUS, & PSEUDOMONAS)
• INDICATIONS: TX OF SERIOUS INFECTIONS CAUSED BY SUSCEPTIBLE
BACTERIA
• ACTION: INHIBIT PROTEIN SYNTHESIS IN SUSCEPTIBLE STRAINS OF GRAM
– NEGATIVE BACTERIA CAUSING CELL DEATH
 AMINOGLYCOSIDES
• PHARMACOKINETICS
- POORLY ABSORBED FROM GI TRACT BUT RAPIDLY ABSORBED AFTER IM INJECTION,
REACHING PEAK LEVELS WITHIN 1 HOUR
- WIDELY DISTRIBUTED THROUGHOUT THE BODY, CROSSING THE PLACENTA AND ENTERING
BREAST MILK
- EXCREATED UNCHANGED IN THE URINE AND HAVE AN AVERAGE HALF – LIFE OF 2 TO
3 HOURS
- DEPEND ON THE KIDNEY FOR EXCRETION AND ARE TOXIC TO KIDNEY
• CONTRAINDICATIONS: KNOWN ALLERGIES, RENAL OR HEPATIC DISEASE, AND
HEARING LOSS
• ADVERSE EFFECTS: OTOTOXICITY AND NEPHROTOXICITY ARE THE MOST
SIGNIIFICANT
• DRUG TO DRUG INTERACTIONS: DIURETICS AND NEUROMUSCULAR BLOCKERS
 CEPHALOSPORINS
• SIMILAR TO PINICILLIN IN STRUCTURE AND ACTIVITY
• BACTERIA: 3RD GENERATION (P. AERUGINOSA)
• ACTION: INTERFERE WITH CELL – WALL – BUILDING ABILITY TO BACTERIA
WHEN THEY DIVIDE
• INDICATION: TX OF INFECTION CAUSED BY SUSCEPTIBLE BACTERIA
• PHARMACOKINETICS
- WELL ABSORBED FROM GI TRACT
- METABOLIZED IIN THE LIVER, EXCRETED IN THE URINE
• CONTRAINDICATIONS: ALLERGIES TO CEPHALOSPORINS OR PENICILLIN
• ADVERSE EFFECT: GI TRACT
• DRUG TO DRUG INTERACTIONS: AMINLOGLYCOSIDES, ORAL
ANTICOAGULANTS,AND ETOH
 FLUOROQUINOLONES
• RELATIVELY NEW CLASS OF ANTIBIOTICS WITH A BROAD SPECTRUM OF
ACTIVITY
• INDICATIONS: TX INFECTIONS CAUSED BY SUSCEPTIBLE STRAINS OF GRAM
– NEGATIVE BACTERIA, INCLUDING URINARY TRACT, RESPIRATORY TRACT,
AND SKIN INFECTIONS
• ACTIONS: INTERFERES WITH DNA REPLICATION IN SUSCEPTIBLE GRAM –
NEGATIVE BACTERIA, PREVENTING CELL PRODUCTION
• PHARMACOKENITICS
- ABSORBED IN THE GI TRACT
- METABOLIZED IN THE LIVER
- EXCRETED IN THE URINE AND FECES
 FLUOROQUINOLONES
• CONTRAINDICATIONS: KNOWN ALLERGY, PREGNANCY, AND LACTATION
• ADVERSE EFFECTS: HEADACHE, DIZZINESS, AND GI TRACT
• DRUG-TO-DRUG INTERACTION: ANTACIDS, QUINIDINE, AND
THEOPHYLLINE
• BACTERIA: S. PNEUMONIAE, H. INFLUENZAE, P. AERUGINOSA, SALMONELLA,
& SHIGELLA
 MACROLIDES
• ANTIBIOTICS THAT INTERFERES WITH PROTEIN SYNTHESIS IN SUSCEPTIBLE BACTERIA
• INDICATIONS: TX OF RESPIRATORY, DERMATOLOGIC, URINARY TRACT, & GI
INFECTIONS CAUSED BY SUSCEPTIBEL STRAINS OF BACTERIA
• ACTIONS: BINDS TO CELL MEMBRANES CAUSING A CHANGE IN PROTEIN
FUNCTION AND CELL DEATH; CAN BE BACTERIOSTATIC OR BACTERIOCIDAL
• PHARMACOKENITICS
- ABSORBED IN THE GI TRACT
- METABOLIZED IN THE LIVER, EXCRETED IN THE BILE AND FECES
• CONTRAINDICATIONS: ALLERGY AND HEPATIC DYSFUNCTION
• ADVERSE EFFFECTS: GI SYMPTOMS
• DRUG-TO-DRUG INTERACTIONS: DIGOXIN, ORAL
ANTICOAGULANTS, THEOPHYLLINE, & CORTECOSTERIODS
 LINCOSAMIDES
• SIMILAR TO MACROLIDES BUT MORE TOXIC
• INDICATIONS: SEVERE INFECTIONS
• ACTIONS: SIMILAR TO MACROLIDES
• PHARMACOKENITICS
- WELL ABSORBED FROM GI TRACT OR IM
- METABOLIZED IN THE LIVER, EXCRETED IN URINE AND
FECES
• CONTRAINDICATIONS: HEPATIC & RENAL IMPAIRMENT
• ADVERSE EFFFECTS: GI REACTIONS
 MONOBACTAMS
• UNIQUE STRUCTURE WITH LITTLE CROSS - RESISTANCE
• INDICATIONS: TX OF INFECTIONS CAUSED BY SUSCEPTIBLE BACTERIA; UTI,
SKIN, INTRA-ABDOMINAL, & GYNECOLOGIC INFECTIONS
• ACTIONS: DISRUPTS BACTERIA WALL SYNTHESIS, WHICH PROMOTES THE
LEAKAGE OF CELLULAR CONTENT AND CELL DEATH
• PHARMACOKENITICS
- WELL ABSORBED FROM THE IM INJECTION
- EXCRETED UNCHANGED IN THE URINE
• CONTRAINDICATIONS: ALLERGY
• ADVERSE EFFFECTS: GI & HEPATIC ENZYME ELEVATION
 PENICILLINS
• FIRST ANTIBIOTICS INTRODUCED FOR CLINICAL USE
• INDICATIONS: TX OF INFECTIONS CAUSED BY STREPTOCOCCAL, PNEUMOCOCAL,
STAPHYLOCOCCAL, AND OTHER SUSCEPTIBLE BACTERIA
• ACTIONS: INHIBIT SYNTHESIS OF THE CELL WALL IN SUSCEPTIBLE
BACTERIA, CAUSING CELL DEATH
• PHARMACOKENITICS
- WELL ABSORBED FROM THE GI TRACT
- EXCRETED UNCHANGED IN THE URINE
• CONTRAINDICATIONS: ALLERGY; CAUTION IN PATIENTS WITH RENAL
DISEASE
• ADVERSE EFFFECTS: GI EFFECTS
• DRUG-TO-DRUG INTERACTIONS: TETRACYCLINES & AMINOGLYCOSIDES
 SULFONAMIDES
• DRUGS THAT INHIBIT FOLIC ACID SYNTHESIS
• INDICATIONS: TX OF INFECTIONS CAUSED BY GRAM – NEGATIVE BACTERIA
AND GRAM POSITIVE BACTERIA
• ACTIONS: INTERFERES WITH CELL-WALL-BUILDING ABILITY OF DIVIDING
BACTERIA
• PHARMACOKENITICS
- WELL ABSORBED FROM THE GI TRACT
- METABOLIZED IN THE LIVER & EXCRETED IN THE URINE
• CONTRAINDICATIONS: ALLERGY & PREGNANCY
• ADVERSE EFFFECTS: GI SYMPTOMS & RENAL EFFECTS RELATED TO THE FILTRATION
OF THE DRUG
• DRUG-TO-DRUG INTERACTIONS: CROSS SENSITIVITY WITH THIAZIDE
DIURETICS; SULFFONYLUREAS
 TETRACYCLINES
• DEVELOPED AS SEMISYNTHETIC ANTIBIOTICS BASED ON THE STRUCTURE OF COMMON SOIL
MOLD
• INDICATIONS: TX OF INFECTIONS CAUSED BY SUSCEPTIBLE STRAINS OF BACTERIA AND ACNE,
WHEN PENICILLIN IS CONTRAINDICATED FOR ERADICATION OF SUSCEPTBLE ORGANISM
• ACTIONS: INHIBIT PROTEIN SYNTHESIS IN SUSCEPTIBLE BACTERIA, PREVENTING CELLL
REPLICATION
• PHARMACOKENITICS
- ADEQUATELY ABSORBED FROM THE GI TRACT
- CONCENTRATED IN THE LIVER & EXCRETED UNCHANGED IN THE URINE
• CONTRAINDICATIONS: ALLERGY, PREGNANCY, & LACTATION
• ADVERSE EFFFECTS: GI , SKELETAL: DAMAGE TO BONES & TEETH
• DRUG-TO-DRUG INTERACTIONS: PENICILLIN G, ORAL CONTRACEPTIVE THERAPY,
METHOXYFLURANE, & DIGOXIN
 ANTIMYCOBACTERIALS
• CONTAIN PATHOGENS CAUSING TUBERCULOSIS AND LEPROSY
• INDICATIONS: TX OF ACID-FAST BACTERIA (MYCOBACTERIUM TUBERCULOSIS)
• ACTIONS: ACT ON THE DNA OF THE BACTERIA, LEADING TO LACK OF
GROWTH AND EVENTUAL BACTERIAL DEATH
• PHARMACOKENITICS
- ADEQUATELY ABSORBED FROM THE GI TRACT
- METABOLIZED IN THE LIVER & EXCRETED IN THE URINE
• CONTRAINDICATIONS: ALLERGY & RENAL OR HEPATIC FAILURE
• ADVERSE EFFFECTS: CNS EFFECT & GI IRRITATION
• DRUG-TO-DRUG INTERACTIONS: RIFAMPIN AND INH(ISONIAZID) CAN CAUSE
LIVER TOXICITY
 COMMON CLASSES/CLASSIFICATION
MNEMONICS
• THE
• QUEENS
• GUIDANCE
• COUNSELLO
R
• SAID
• ANTIBIOTIC
S
• CAN
• PROTECT
• MANY
• MOST
• ROYAL
 COMMON CLASSES/CLASSIFICATION
MNEMONICS
• (THE) TETRACYLINE
• (QUEENS) QUINOLONE OR
FLUOROQUINOLONE
• (GUIDANCE) GLYCOPEPTIDE
• (COUNSELLOR) CEPHALOSPORIN
• (SAID) SULFONAMIDES
• (ANTIBIOTICS) AMINOGLYCOSIDES
• (CAN) CARBAPENEM
• (PROTECT) PENICILLIN
• (MANY) MACROLIDES
• (MOST) MONOBACTAM
• (ROYAL) RIFAMPIN
• (MEMBERS)METRONIDAZOLE
 TARGET BACTERIA
• (THE) TETRACYLINE – GRAM +/-
• (QUEENS) QUINOLONE OR FLUOROQUINOLONE - GRAM
+/-
• (GUIDANCE) GLYCOPEPTIDE - GRAM +
• (COUNSELLOR) CEPHALOSPORIN - GRAM +/-
• (SAID) SULFONAMIDES - GRAM +/-
• (ANTIBIOTICS) AMINOGLYCOSIDES - GRAM -
• (CAN) CARBAPENEM - GRAM +/-
• (PROTECT) PENICILLIN - GRAM +/-
• (MANY) MACROLIDES - GRAM +
• (MOST) MONOBACTAM - GRAM -
• (ROYAL) RIFAMPIN- GRAM +/-
• (MEMBERS)METRONIDAZOLE - GRAM +/-
 COMMON MEDICATION
• (THE) TETRACYLINE – TETRACYCLINE / DOXYCYLINE
• (QUEENS) QUINOLONE OR FLUOROQUINOLONE - NALEDIXIC ACID /
CIPROFLAXECIN
• (GUIDANCE) GLYCOPEPTIDE - VANCOMYCIN
• (COUNSELLOR) CEPHALOSPORIN – CEFDINIR (3RD GENERATION)
• (SAID) SULFONAMIDES - SULFOMETHOXAZOLE
• (ANTIBIOTICS) AMINOGLYCOSIDES – GENTAMYCIN / STREPTOMYCIN
• (CAN) CARBAPENEM - MEROPENEM
• (PROTECT) PENICILLIN – PENICILLIN / AMOXICILLIN
• (MANY) MACROLIDES - ERYTHROMYCIN
• (MOST) MONOBACTAM - AZTREONAM
• (ROYAL) RIFAMPIN- RIFAMPIN OR REFAMPICIN
• (MEMBERS)METRONIDAZOLE - METRONIDAZOLE
 MECHANISM OF ACTION
• (THE) TETRACYLINE – 30S SUBUNIT
• (QUEENS) QUINOLONE OR FLUOROQUINOLONE - DNA SYNTHESIS II
& IV
• (GUIDANCE) GLYCOPEPTIDE – INHIBIT CELL WALL
• (COUNSELLOR) CEPHALOSPORIN – INHIBIT CELL WALL
• (SAID) SULFONAMIDES – FOLIC ACID SYNTHESIS
• (ANTIBIOTICS) AMINOGLYCOSIDES – 30S SUBUNIT
• (CAN) CARBAPENEM – INHINIT CELL WALL
• (PROTECT) PENICILLIN – INHIBIT CELL WALL
• (MANY) MACROLIDES – 50S SUBUNIT
• (MOST) MONOBACTAM – INHIBIT CELL WALL
• (ROYAL) RIFAMPIN- RNA POLYMERASE
• (MEMBERS)METRONIDAZOLE – DAMAGE DNA (OXIDASE)