es

Oxazolidinones
Inhibit protein synthesis on the 50S ribosomal subunit of bacteria.
This action prevents formation of 70S initiation complex, which is
BB
necessary for bacterial reproduction

Linezolid and Tedizolid

Bacteriostatic or bactericidal -against gram-positive infections

es
Oxazolidinones

BB
es
Oxazolidinones

BB Reactions
Side Effects and Adverse
Include headache, nausea, vomiting, diarrhea, anemia, and
thrombocytopenia

Severe adverse reactions include CDAD and serotonin syndrome

s
Lincosamides
Inhibit bacterial protein synthesis

BB
Bacteriostatic and bactericidal actions, depending on drug Dosage

Clindamycin and lincomycin are examples of lincosamides

Clindamycin
active against most gram-positive organisms
absorbed better than lincomycin through the GI tract and maintains a
higher serum drug concentration
considered more effective than lincomycin and fewer toxic effects
s
Lincosamides

BB
s
Lincosamides
Side Effects and Adverse Reactions
BB
• GI irritation, which may manifest as nausea, vomiting, and stomatitis
• Rash may also occur.
• Severe adverse reactions include colitis and anaphylactic shock

Drug Interactions
• incompatible with aminophylline, phenytoin, barbiturates, and ampicillin
s
Glycopeptides
Vancomycin
BB
Widely used in the 1950s to treat staphylococcal infections

Against drug-resistant S. aureus and in cardiac surgical prophylaxis for individuals

with penicillin allergies

Ineffective for treating enterococci

s
Glycopeptides
Quinupristin-dalfopristin
combined antibacterial used to treat life threatening VREF infections.
BB
Antibiotic-resistant enterococci can cause staphylococcal endocarditis

Telavancin
a glycopeptide, treats selected gram-positive bacteria and skin infections.
This drug is a semisynthetic derivative of vancomycin with bactericidal
action against MRSA. Telavancin has an advantage of once-daily dosing.

Oritavancin
has the further advantage of being administered in a single dose
s
Glycopeptides

BB
s
Glycopeptides
Pharmacokinetics

BB
• Orally for treatment of staphylococcal enterocolitis and antibiotic-
associated pseudomembranous colitis due to C. difficile

• Excreted in the feces

• Given intravenously for septicemia; for severe infections due to MRSA; and
for bone, skin, and lower respiratory tract infections that do not respond
or are resistant to other antibiotics.
s
Glycopeptides
Pharmacokinetics

BB
• Intermittent vancomycin doses should be diluted in 100 mL for 500 mg and
200 mL for 1 g of D5W, NS, or lactated Ringer’s (LR)

• Should be administered over 60 to 90 minutes

• Excreted in the urine when given by IV route

• It is 55% protein bound with half-life of 4 to 6 hours

s
Glycopeptides
Pharmacodynamics
BB
Inhibits bacterial cell-wall synthesis and is active against
several gram-positive microorganisms

The peak action is 30 minutes after the end of the infusion.

s
Glycopeptides
Side Effects and Adverse Reactions
BB
May cause nephrotoxicity and ototoxicity

May include headache, dizziness, fatigue, fever, nausea,vomiting, flatulence,

abdominal pain, diarrhea, back pain, peripheral

Red man syndrome or red neck syndrome if given rapidly

s
Glycopeptides
Side Effects and Adverse Reactions
BB
Include hypotension, tachycardia, wheezing, dyspnea, paresthesias,
erythema, pruritus, and urticaria, and may lead to cardiac arrest

Adverse effects include eosinophilia, neutropenia, phlebitis, CDAD,

hypokalemia, renal failure, and Stevens-Johnson syndrome.
s
Glycopeptides
Drug Interactions

BB
• Dimenhydrinate can mask ototoxicity when taken with vancomycin
• Nephrotoxicity and ototoxicity may be potentiated when vancomycin is
taken with furosemide, aminoglycosides, amphotericin B, colistin,
cisplatin, and cyclosporine
• Vancomycin may inhibit methotrexate excretion and can increase
methotrexate toxicity.
• Absorption of oral vancomycin may be decreased when given with
cholestyramine and colestipol.
des
Ketolides and Lipopeptides

BB
 Tetracyclines
Isolated from Streptomyces aureofaciens in 1948, were the first broad-spectrum
antibiotics effective against gram-positive and gram-negative bacteria, and many
other organisms
BB
Act by inhibiting bacterial protein synthesis and have a bacteriostatic effect

Oral and topical tetracyclines have been used to treat severe acne vulgaris

Listed according to whether they are short-,intermediate-, or long-acting drugs.

Tetracyclines

BB
 Nursing Process
Assessment

BB
• Assess vital signs and urine output. Report abnormal findings
• Check laboratory results, especially those that indicate renal and liver function
• Obtain a history of dietary intake and drugs the patient currently takes
 Nursing Process
Patient Problems
• Tissue injury
• Nausea
• Vomiting
BB
Planning
• The patient’s white blood cells (WBCs) will be within normal limits.
 Nursing Process
Nursing Interventions

BB
• Obtain a sample for culture from the infected area and send it to
the laboratory for culture and sensitivity (C&S). Antibiotic therapy
can be started after the culture sample has been taken.
• Administer tetracycline 1 hour before or 2 hours after meals for
optimum absorption.
• Monitor laboratory values to assess liver and kidney function (in
particular, liver enzymes, BUN, and serum creatinine).
• Record vital signs and urine output.
 Nursing Process
Patient Teachings (General)

BB
• Instruct patients to store tetracycline away from light and extreme heat.
Tetracycline decomposes in light and heat and causes the drug to become
toxic
• Advise patients to check expiration dates on boĴles of tetracycline; out-of-
date tetracycline can be toxic.
• Inform female patients who are contemplating pregnancy to avoid taking
tetracycline because of possible teratogenic effects.
 Nursing Process
Patient Teachings (General)

BB
• Warn parents that children younger than 8 years of age should not take
tetracycline because it can cause discoloration of permanent teeth.

• Encourage patients to take the complete course of tetracycline as prescribed

 Nursing Process
Side Effects
• Advise patients to use a sun block and protective clothing during sun
BB
exposure. Photosensitivity is associated with tetracycline.
• Encourage patients to report signs of a superinfection (mouthulcers, anal or
genital discharge).
• Advise patients to use additional contraceptive techniques and not to rely on
oral contraceptives when taking the drug because contraceptive effectiveness
may decrease.
• Teach patients to use effective oral hygiene several times a day to
prevent or alleviate mouth ulcers (stomatitis).
 Nursing Process
Diet

BB
• Educate patients to avoid milk products, iron, and antacids. Tetracycline should
be taken 1 hour before or 2 hours after meals with a full glass of water. If
gastrointestinal (GI) upset occurs, the drug can be taken with nondairy foods.

Evaluation

• Evaluate the effectiveness of tetracycline by determining whether the infection

has been controlled or has ceased and that there are no side effects
 Glycylcyclines
Tigecycline is an antibiotic in a category called glycylcyclines

BB
Acts by blocking protein synthesis in bacterial cells (Bacteriostatic)

Used for community-acquired pneumonia,complicated skin infections, and

intraabdominal infections, including S.aureus, E. coli, S. pyogenes,
K. pneumoniae, and C. perfringens.
Glycylcyclines

BB
 Glycylcyclines
Pharmacokinetics

Tigecycline is administered IV BB
The protein binding capacity of tigecycline ranges from 71% to 89%

Half-life is 27 to 42 hours

Eliminated from the body in bile, feces and urine

Biliary excretion is the primary route.

 Glycylcyclines
Pharmacodynamics
BB
Binds to the 30S ribosomal subunit and causes cell death

Broad-spectrum activity against gram-positive and gram-negative bacterial

pathogens.
 Glycylcyclines
Side Effects and Adverse Reactions
BB
GI tract and include nausea, vomiting,abdominal pain, and diarrhea

CDAD may occur but is rare.

photosensitivity, headache, dizziness, insomnia,hypertension, hypotension,

anemia, leukocytosis, and thrombocythemia.

Hyperglycemia, hypokalemia, elevated BUN, and elevated liver enzymes may

 Glycylcyclines

Drug InteractionsBB
Oral contraceptives may be less effective

Warfarin levels may be increased and may lead to bleeding

 Aminoglycosides
• Act by inhibiting bacterial protein synthesis

BB
• Used against gram-negative bacteria such as E. coli and Proteus and
Pseudomonas species

• Streptomycin sulfate
 derived from the bacterium Streptomyces griseus
 first aminoglycoside available for clinical use
 was used to treat tuberculosis
 Aminoglycosides
Pharmacodynamics
BB
Gentamicin inhibits bacterial protein synthesis-bactericidal effect

The onset of action is rapid or immediate, and the peak action for gentamicin is 30
minutes to 1 hour for IM and 30 minutes for IV administration.

IV aminoglycosides can be given concurrently with penicillins and cephalosporins

 Aminoglycosides
Pharmacokinetics
Gentamicin is administered IM and IV
BB
This drug has a short half-life

Given three to four times a day

Excretion of this drug is primarily unchanged in the urine

Aminoglycosides

BB
Aminoglycosides

BB
Aminoglycosides

BB
 Nursing Process
Assessment
Record vital signs and urine output
BB
Assess laboratory results to determine renal and liver function

Serum electrolytes should also be checked. Aminoglycosides may decrease

serum potassium and magnesium levels

Obtain a medical history related to renal or hearing disorders

 Nursing Process
Patient Problems
• Tissue injury
• Nausea
BB
• Vomiting

Planning
• The patient’s white blood cells (WBCs) will be within normal
limits
 Nursing Process
Patient Problems
• Tissue injury
• Nausea
BB
• Vomiting

Planning
• The patient’s white blood cells (WBCs) will be within normal
limits
 Nursing Process
Nursing Interventions
• Send a sample from the infected area to the laboratory for culture and
sensitivity
BB
• Monitor intake and output. Urine output should be at least 600
mL/day.
• Check for hearing loss
• Evaluate laboratory results and compare with baseline values.
• Monitor vital signs. Note whether body temperature has decreased.
• Dilute gentamicin in 50 to 200 mL of normal saline (NS) or 5%dextrose in
water (D5W) solution and administer intravenously over 30 to 60 minutes
 Nursing Process
Nursing Interventions

BB
• Check that therapeutic drug monitoring (TDM) has been
ordered for peak and trough drug levels

• Monitor for signs and symptoms of superinfection

 stomatitis (mouth ulcers)
 genital discharge (vaginitis)
 genital itching
 Nursing Process
Patient Teaching (General)

BB
• Encourage patients to increase fluid intake unless fluids are
restricted.

Side Effects
• Report side effects that include nausea, vomiting, tremors, tinnitus,
pruritus, and muscle cramps.
• Use a sun block and protective clothing during sun exposure
es)
Fluoroquinolones (Quinolones)

BB
• Interfere with the enzyme DNA gyrase, needed to synthesize bacterial DNA

• Bactericidal action on both gram positive and gram-negative organisms

• Ciprofloxacin is a synthetic antibacterial related to nalidixic acid

es)
Fluoroquinolones (Quinolones)

BB
es)
Fluoroquinolones (Quinolones)

BB
es)
Fluoroquinolones (Quinolones)
Pharmacokinetics

•
BB
Ciprofloxacin is rapidly absorbed from the GI tract
• It has a low protein binding effect of 20% to 40%
• Moderately short half-life of 4 hours
• Ciprofloxacin is excreted in the urine feces
es)
Fluoroquinolones (Quinolones)
Pharmacodynamics
•
• BB
Inhibits bacterial DNA synthesis by inhibiting the enzyme DNA gyrase
Should be taken before meals, food slows the absorption rate
• Antacids also decrease the absorption rate
• Ciprofloxacin increases the effect of theophylline and caffeine
• Ciprofloxacin has an average onset of action of 30 minutes to 1 hour
• Peak concentration time is 1 to 2 hours
• The duration of action is unknown
es)
Fluoroquinolones (Quinolones)

BB
es)
Fluoroquinolones (Quinolones)

BB
es)
Nursing Process
Assessment
• Record vital signs along with intake and urine output. Compare
these results with future vital signs and urine output. Fluid intake
should be at least 2000 mL/day.BB
• Assess laboratory results to determine renal function.
• Obtain a drug and diet history.
 Antacids and iron decrease absorption
 increase the effects of theophylline and caffeine
 increase the effects of oral hypoglycemics. When
 levofloxacin with nonsteroidal antiinflammatory drugs can cause CNS effect
such as seizure
es)
Nursing Process
Patient Problem

• Tissue injury
• Nausea BB
• Vomiting

Planning
• The patient’s white blood cells (WBCs) will be within
normal limits.
es)
Nursing Process
Nursing Interventions

• Obtain a specimen from the infected site, and send it to the

BB
laboratory for culture and sensitivity (C&S)
• Monitor intake and output.
• Record vital signs and report any abnormal findings.
• Check laboratory results, especially BUN and serum creatinine.
• Administer levofloxacin 2 hours before or after antacids and iron
products for best absorption.
• Dilute intravenous (IV) levofloxacin in recommended amount of
solution (NS, D5W, D5NS). Infuse over 60–90 minutes
es)
Nursing Process
Nursing Interventions

• Check for signs and symptoms of superinfection: stomatitis (mouth

BB
ulcers), furry black tongue, and anal or genital discharge or itching
• Monitor serum theophylline levels when taken concurrently
with levofloxacin, which can increase theophylline levels. Check for
symptoms of CNS stimulation such as nervousness, insomnia,
anxiety, and tachycardia.
• Monitor blood glucose. Levofloxacin can increase the effects of
oral hypoglycemics.
es)
Nursing Process
Patient Teachings

• Check for signs and symptoms of superinfection: stomatitis (mouth

BB
ulcers), furry black tongue, and anal or genital discharge or itching.

• Monitor serum theophylline levels when taken concurrently

with levofloxacin, which can increase theophylline levels. Check for
symptoms of CNS stimulation such as nervousness, insomnia,
anxiety, and tachycardia.

• Monitor blood glucose. Levofloxacin can increase the effects of

oral hypoglycemics.
es)
Nursing Process
Evaluation

BB
• Evaluate the effectiveness of the fluoroquinolone by determining
whether the infection has resolved and the body temperature has
returned within normal range.
ugs
Unclassified Antibacterial Drugs

BB
 Sulfonamides
• Isolated from a coal tar derivative
• Produced for clinical use against coccal infections in 1935
• First group of drugs used against bacteria, although they are not
classified as antibiotics BB
• Bacteriostatic because they inhibit bacterial synthesis of folic acid
Sulfonamides

BB
 Sulfonamides
Pharmacokinetics
• Well absorbed by the GI tract BB
• Well distributed to body tissues and the brain

• Liver metabolizes the sulfonamide drug

• Kidneys excrete it
 Sulfonamides
Pharmacodynamics
• BB
Mostly oral administration because they are absorbed readily by the GI
tract

• Also available in solution and as ointments for ophthalmic use and in

cream form (silver sulfadiazine and mafenide acetate) for burns

• The two categories of sulfonamides are short-acting and intermediate-

acting sulfonamides
 Sulfonamides
Side Effects and Adverse Reactions

•
•
Skin rash and itching BB
Hemolytic anemia, aplastic anemia, and low WBC and platelet counts.
• GI disturbances such as anorexia, nausea, and vomiting may also occur.
• Crystalluria (crystals inthe urine)
• Hematuria (blood in the urine)
• Photosensitivity
• Cross-sensitivity might occur
• Avoid during pregnancy to avoid congenital malformations, neural tube
defects, and kernicterus.
 Sulfonamides
Side Effects and Adverse Reactions

•
•
Skin rash and itching BB
Hemolytic anemia, aplastic anemia, and low WBC and platelet counts.
• GI disturbances such as anorexia, nausea, and vomiting may also occur.
• Crystalluria (crystals inthe urine)
• Hematuria (blood in the urine)
• Photosensitivity
• Cross-sensitivity might occur
• Avoid during pregnancy to avoid congenital malformations, neural tube
defects, and kernicterus.
 Trimethoprim-Sulfamethoxazole
Prototype drug for sulfonamides

BB
contains one part trimethoprim and five parts sulfamethoxazole to produce
a synergistic effect that increases the desired drug response.
Trimethoprim-Sulfamethoxazole

BB
Trimethoprim-Sulfamethoxazole

BB
 Nursing Process
Assessment

BB
• Assess the patient’s renal function
• Obtain a medical history from the patient
• Determine whether the patient is hypersensitive to sulfonamides.
• Obtain a history of drugs the patient currently takes. Oral antidiabetic
drugs (sulfonylureas) given with sulfonamides increase the hypoglycemic
effect; use of warfarin with sulfonamides increases the anticoagulant effect.
• Assess baseline laboratory results, especially complete blood count
(CBC).
 Nursing Process
Nursing Interventions

• Administer sulfonamides with a full glass of water

• Record intake and output BB
• Monitor vital signs
• Observe the patient for hematologic reactions that may lead to life-
threatening anemias. Check CBC, and compare values with baseline findings.
• Check for signs and symptoms of superinfection
 Nursing Process
Patient Teaching (General)

• Encourage patients to drink several quarts of fluid daily

BB
• Advise pregnant patients to avoid sulfonamides during the last 3
months of pregnancy.
• Counsel patients not to take antacids
• Warn patients with an allergy to one sulfonamide that all
sulfonamide preparations should be avoided
 Nursing Process
Self-Administration

• Teach patients to take sulfonamides 1 hour before or 2 hours after

meals with a full glass of water.
BB
Side Effects

• Direct patients to report bruising or bleeding

• Advise patients to have their blood cell count monitored on a regular
basis
• Warn patients to wear sunglasses, avoid direct sunlight, and use
• sun block and protective clothing to decrease the risk of
•
 Nursing Process

Evaluation
BB
• Evaluate the effectiveness of sulfonamide therapy by determining
whether the infection has been alleviated and the blood cell count
is within normal range.
 Nitroimidazoles
Act by disrupting DNA and protein synthesis in susceptible bacteria and
protozoa
BB
Metronidazole and tinidazole are two of the most effective drugs
available to treat anaerobic bacterial infections

Primarily administered orally, parenterally, and topically

Given IV intermiĴently, it should be administered slowly over 30 to 60

minutes
Nitroimidazoles

BB