antibactERial

dRUgs (V.2023)

Manny L. Mamaril, RN, MAN, LPT, PhD

School of Nursing
 PathogEnicity and viRUlEncE
Pathogenicity
✔ Capability of microbes/organisms to
cause a disease
✔ Human pathogens: Viruses, bacteria,
fungi, unicellular organisms
(protozoans), and multicellular animals
(fleas, mites, and worms)
✔ Enter through broken skin, ingestion,
inhalation, or contact with a mucous
membrane such as the nasal, urinary,
or vaginal mucosa
Virulence
✔ A pathogen that is able to produce
disease when present in small
numbers
Virulence Mechanisms
1. Invasiveness
✔ Ability of the pathogen to grow
extremely rapidly and cause
direct damage to surrounding
tissues by sheer numbers
✔ Example: Streptococcus A group
bacteria that cause necrotizing
fasciitis (flesh-eating disease)
2. Production of toxins
✔ Example: Clostridium tetani
which produces tetanospasmin
which interfere with motor neuron
activity which causes tetanus
BACtERiA
 ClAssifiCAtiOn Of bACtERiA
1. GRAft STAIN
✔ Application of dyes on a
bacterial sample to
determine if the bacteria is
gram-positive or gram-
negative
2. CELLULAR SHAPE
✔ Rods – bacilli
✔ Spherical shapes – cocci
✔ Spirals – spirilla
3. ABILTY TO USE OXYGEN
✔ AEROBIC – Thrive on oxygen-
rich environment
✔ ANAEROBIC - Grows best
without oxygen
❖ Importance: It will determine
what type of medications will
be used in treating diseases
GRAM-StAin PROCEDURE
BACtERiAL sHAPEs
 OxygEn
REqUiREMEnts
1. Obligate Aerobes – Grow in
the presence of oxygen
2. Obligate Anaerobes – Grow in
the absence of oxygen
3. Facultative Anaerobes –
Show better growth in the
presence oxygen but can live
without oxygen
4. Aerotolerant Anaerobes – Can
grow in the presence of
oxygen but can live without
oxygen
 Anti-infECtivE DRUgs
✔ Any drug that is effective
against pathogens such as
drugs for bacterial, fungal,
viral, or parasitic infections
✔ Goal: Assist body’s defenses in
eliminating pathogen
Antibiotics
✔ Drugs that eliminate bacteria
✔ Pharmacologic classes are
grouped according to their
mechanism of action
Bactericidal Drugs
✔ Drugs that kill
bacteria
Bacteriostatic Drugs
✔ Slow down growth of bacteria allowing the
body’s
natural defenses to eliminate the
microorganisms
Selective Toxicity
✔ Characteristic of antibiotics to target
bacteria due to their cell walls, different
biochemical pathways, and production of
certain enzymes
 ACqUiRED REsistAnCE
✔ Drug-resistance/ Drug-insensitivity
of certain bacteria
✔ Spontaneous and random
mutations in the bacterial
chromosome during replication
that result in reproductive
advantages
✔ Ability to survive in harsh
conditions such as in the presence
of antibiotics
✔ Cause: Widespread and
unwarranted use of antibiotics
 HOsPitAL-
ACqUiRED
infECtiOns (HAI)/
NOSOCOMIAL
INFECTIONS
 WAys tO COMbAt DRUg-REsistAnCE AnD HAi
1. Prevent infections when possible
✔ Immunizations 4. Advise patients to take anti-
infectives for the full length of
2. Use right drug for infection
therapy
✔ Perform culture and sensitivity
tests 5. Prevent transmission of the
pathogen
✔ Apply standard infection
3. Restrict use of antibiotics to those
conditions deemed medically control procedures
necessary ✔ Teach patient proper hygiene
✔ Use antibiotics for bacterial
infections not viral infections
unless warranted (example:
prophylactic therapy)
 HOst fACtORs AffECting AntibiOtiC tREAtMEnt
1. Host Defenses 4.
✔ Patient’s immune system condition ✔
✔ Patients with compromised or
✔
suppressed immune system will
need stronger drugs
2. Local Tissue Conditions
✔ Conditions at the infection site
✔ CNS infections require stronger
drugs to cross the blood-brain
barrier
3. Allergy History
✔ Allergy to antibiotics can be fatal
✔ Always take the drug history
Other Patient Variables
Age, pregnancy status, and
genetics
Very young and very old cannot
metabolize or excrete antibiotics;
doses should be lowered
✔ Drugs can cross placenta –
Tetracyclines
✔ Patients with G6PD cannot receive
sulfonamides, chloramphenicol or
nalidixic acid because their RBC
may rupture
 MECHAnisMs
Of ACtiOn Of
AntibACtERiAL
DRUgs
MECHANISMS OF ACTION OF ANTIBIOTICS

1. Cell Wall Synthesis Inhibitors

✔ Interfere with peptidoglycan synthesis

2. Protein Synthesis Inhibitors

3. Use the Biochemical Pathways of the Bacteria
to Form ftetabolites
4. RNA Synthesis Inhibitors
5. DNA Synthesis Inhibitors
PEniCiLLins
 PEniCiLLins
✔ First mass-produced antibiotic
✔ Isolated from the fungus, Penicillium
in 1942
✔ MOA: Weakens bacterial cell wall by
binding to penicillin-binding
receptor, which causes water to
enter the cell killing the organism
✔ Gram + bacteria are commonly
affected including the
staphylococci and streptococci
 PEniCiLLins
✔ Penicillin G potassium
✔ Indications: Pneumonia;
meningitis; skin, bone and
joint infections; stomach
infections; blood and valve
infections; gas gangrene;
tetanus; anthrax; and sickle-
cell anemia in infants
✔ One of the safest class of
antibiotics
✔ Adverse Effects: ftinor:
Allergy – rash, pruritus, and
fever; Less common AEs -
Lowered RBC, WBC, or
platelet counts
❖ Allergy to one penicillin
increases risk of allergy to
other drugs in the same
class
❖ Bactericidal
PEniCiLLin-
REsistAnCE
✔ Beta-lactam ring is
responsible for
antibacterial activity
✔ Beta-lactamase or
penicillinase is secreted by
some resistant bacteria,
which splits the ring into
two and inhibits
antibacterial activity
CHEMiCALLy-MODifiED PEniCiLLins vs REsistAnt bACtERiA
1. Penicillinase-Resistant Penicillin
✔ Oxacillin and dicloxacillin
(antistaphylococcal drugs)
2. Broad-Spectrum Penicillin
(Aminopenicillin)
✔ Amoxicillin and ampicillin
✔ Effective against a wide
range of
microorganisms
✔ For upper respiratory and
genitourinary tract infections
3. Extended-Spectrum Penicillins
✔ Piperacillin
✔ Effective against more microbial
species than aminopenicillins, which
include Enterobacter, Klebsiella, and
Bacteroides fragilis, and
Pseudomonas aeruginosa, which is
responsible for cases HAIs
4. Beta-Lactamase Inhibitors
✔ Available as fixed-dosed combinations
with other penicillins
✔ Clavulanate + amoxicillin = Co-
Amoxiclav(Augmentin)
✔
Clavulanate + ticarcillin = Timentin
✔ Sulbactam + ampicillin = Sultamicillin
(Unasyn)
✔ Tazobactam + piperacillin = Zosyn
 NURsing PROCEss nOtEs: PEniCiLLins
In-Patient ftanagement Out-Patient ftanagement
✔ Assess for allergy to penicillin or ✔ Educate patient to finish entire
cephalosporins prescription
✔ Liver enzymes: ALP, ALT, and AST ✔ Inform healthcare staff about
✔ Urine output of >30ml/h or >600ml a medications and drug allergies
day ✔ Discontinue drug if there are
✔ ftonitor vital signs particularly signs of allergy and consult the
temperature doctor right away
✔ ftonitor infected area ✔ Keep drugs away from children
✔ Have epinephrine available for ✔ Increase fluid intake
✔
severe allergic reactions
Take medications with food
✔ Evaluate drug side effects
CEPHALOsPORins
 CEPHALOsPORins
✔ One of the largest antibiotic class (20
available)
✔ Classified by generation
✔ Bactericidal
✔ MOA: Contain a beta-lactam ring
which attach to penicillin-binding
proteins and inhibit bacterial wall
synthesis
✔ Indications: Often used for gram-
negative infections and for patients
who cannot tolerate penicillins
✔ CI: Patients who have
experienced penicillin allergy
✔ AE: Allergic reactions – skin
rashes, GI complaints; Earlier
generations can cause kidney
toxicity
❖ Safe drugs with similar AEs to
those of penicillin
 CEPHALOsPORins
1st Generation – Cephalexin, Cefazolin
✔ ftost effective against gram-positive organisms
including staphylococci and streptococci
✔ Beta-lactamase bacteria is
resistant 2nd Generation – Cefaclor,
Cefuroxime
✔ ftore potent and more resistant to beta-lactamase
✔ Broader spectrum against gram-negative
organisms 3rd Generation – Cefixime,
Ceftriaxone
✔ Broader spectrum than second-generation drugs
✔ Longer duration of action and resistant to beta-
lactamase
✔ DOC for Pseudomonas,
Klebsiella, Neisseria, Salmonella,
Proteus and H. influenza
4th and 5th Generation – Cefepime,
Ceftaroline
✔
Effective against organisms that
developed resistance to earlier
cephalosporins
✔ 4th Gen – Can enter CSF to treat
CNS infections
✔ 5th Gen – To treat ftRSA infections
 NURsing PROCEss nOtEs: CEPHALOsPORins
In-Patient ftanagement
✔ Assess for allergy to
cephalosporins or penicillins
✔ Record elevated temperature or
decreased urine output
✔ Renal and Liver labs: BUN, serum
creatinine, AST, ALT, ALP and
bilirubin
✔ Perform culture and sensitivity
tests
Out-Patient ftanagement
✔ Educate patient to finish entire
prescription
✔ Inform healthcare staff about
medications and drug allergies
✔ Discontinue drug if there are signs of
allergy and consult the
doctor right away
✔ Keep drugs away from children
✔ Report superinfections
✔ Ingest buttermilk, yogurt, or
acidophilus supplement to prevent
superinfection of intestinal flora
✔ Drink adequate amounts of fluids
tEtRACyCLinEs
 tEtRACyCLinEs
✔ MOA: Bind to bacterial ribosomes and inhibit bacterial protein synthesis
✔ Bacteriostatic – slow down microbial growth
✔ Indications: Rocky fmountain spotted fever, typhus, cholera, Lyme
disease, peptic ulcers cause by H. pylori and chlamydial infections;
Acne vulgaris when used topically or in PO low doses
✔ Contraindications: Patients younger than 8 years old and pregnant
women; Not to be taken with milk or iron supplements; Patients with
pre-existing liver disease
✔ AE: Gastric distress, photosensitivity; Yellow discoloration in
teeth of children; Fetal bone and teeth malformation ; Superinfection in
high doses
 TEtRACyCLinEs
✔ Doxycycline and minocycline have longer
duration of action and are more lipid-soluble
which make them enter the CSF
✔ Tigecycline (newest) used for drug-resistant
intra-abdominal infections especially caused by
ftRSA; AE are nausea and vomiting; Available
IV infusion
❖ Certain drugs can be hepatotoxic
❖ Discard when outdated because it can be
 NURsing PROCEss nOtEs: TETRACYCLINES
In-Patient ftanagement
✔
Labs: Renal and Liver function
(BUN, serum creatinine, AST, ALT,
bilirubin)
✔ Drug and diet history; Dairy
product, antacids, iron, calcium,
magnesium, and digoxin
✔
Culture and sensitivity tests
✔ Administer tetracycline 1 hour
before or 2 hours after meals for
optimum absorption
Out-Patient ftanagement
✔
Educate patient to finish entire prescription
✔ Inform healthcare staff about medications and drug
adverse effects
✔ Store tetracycline away from light and extreme heat
✔ Check expiration dates
✔ Explain teratogenic effects to pregnant patients
✔ Explain side effects like yellowing of teeth to
parents with children younger than 8 years old
✔ Use sun block and protective clothing during sun
exposure
✔ Report signs of superinfection
✔ Oral hygiene
✔ Avoid milk products, iron, and antacids
MACROLiDEs
 MACROLiDEs
Erythromycin, azithromycin, ✔ positive bacteria and many
Effective against gram-
✔
clarithromycin gram-negative species
✔ Isolated from Streptomyces ✔ Drugs are used against
in a soil sample in 1952 bacteria residing INSIDE host
✔ Safe alternatives to penicillin cells (intracellular parasites)
such as Listeria, Chlamydia,
✔ Low doses- bacteriostatic; Neisseria, and Legionella
higher doses in susceptible ✔ Indications: Whooping
organisms – bactericidal cough, Legionnaire’s
✔ MOA: Inhibit protein synthesis disease, and infections by
streptococcus, H. influenza,
by binding to the bacterial and ft. pneumoniae
ribosomes
MACROLiDEs
✔ Clarithromycin – Used to treat
✔ Broad-spectrum peptic ulcer disease due to its
antibiotics activity against H. pylori
✔ Contraindications: ✔ Azithromycin – Newer drug;
Drug allergy Longer half- life and cause
✔ AE: mild GI upset, less gastric irritation;
Administered only for 5 days;
diarrhea, and
Single dose effective against
abdominal pain; gonorrhea
Superinfection
 NURsing PROCEss nOtEs: MACROLiDEs
In-Patient Management Out-Patient Management
✔ Vital signs and urine output ✔ Educate patient to finish
✔ Liver enzymes entire prescription
✔
✔ Inform healthcare staff about
Drug history; Antacids affect peak level
of azithromycin
✔ Culture and sensitivity tests
medications and adverse
effects (nausea, vomiting,
✔ Signs of liver damage
diarrhea, abdominal cramps,
✔ Administer oral azithromycin 1 hour
before or 2 hours after meals; Give with
itching)
water, not fruit juice ✔ Report superinfection
✔ Antacids such be given 2 hours (stomatitis or vaginitis)
before or after azithromycin ✔ Report onset of diarrhea
AMinOgLyCOsiDEs
 AMinOgLyCOsiDEs
✔ MOA: Act by inhibiting
✔ Streptomycin, gentamicin, bacterial protein synthesis
neomycin, kanamycin,
✔ Indications: Treatment of aerobic
amikacin
gram- negative bacteria,
✔ Streptomycin was discovered mycobacteria, and some
in 1942 and named after protozoans
Streptomyces griseus, a soil
microorganisms ✔ Sometimes administered
concurrently with penicillin,
✔ Bactericidal
cephalosporin, or vancomycin to
✔ Toxic than other antibiotics
treat enterococcal infections
 AMinOgLyCOsiDEs
✔ Given parenterally – Poorly ✔
absorbed in GI tract
✔ If given oral, this is to sterilize
GI tract prior to bowel surgery✔
✔ CI: Patients with ear and
kidney problems
✔ AE: Ototoxicity (hearing ✔ Streptomycin – Restricted
impairment to deafness) and
nephrotoxicity but reversible
(abnormal urinary function
tests – elevated BUN)
Neomycin – Topical use for
infections of the skin,
eyes, and ears
Paromomycin – Oral use
for treatment of parasitic
infections
to treatment of
tuberculosis because
emergence of bacterial
resistance
 NURsing PROCEss nOtEs: AMinOgLyCOsiDEs
In-Patient Management
✔ Vital signs and urine output
✔ Labs: Renal and liver function
tests such as BUN, serum
creatinine, ALT, ALP, AST and
bilirubin; Electrolytes
✔ ftedical history related to renal
or hearing disorders
✔ ftonitor intake and output,
should be at least 600ml/day
✔ Check for hearing loss
✔ Monitor for superinfection
Out-Patient
Management
✔ Increase fluid intake unless
restricted
✔ Report side effects (nausea,
vomiting, tremors, tinnitus,
pruritus, and muscle
cramps)
✔ Must wear sunblock and
protective clothing during sun
exposure
fLUOROqUinOLOnEs
 FLUOROqUinOLOnEs (QUINOLONES)
✔ Nalidixic acid, ciprofloxacin, ✔ Indications: Infections of the
respiratory, GI, and genitourinary
moxifloxacin tracts, and some skin and soft-
✔ Bactericidal tissue infections
✔ Effective against gram-negative ✔ Preferred drugs for
treatment of
pathogens; uncomplicated UTI
Newer drugs are more effective
✔ Well-absorbed orally and
against administered either once or twice a
gram-positive microbes such as day
staphylococci, streptococci, and ✔ Taken with food; But not with
enterococci multivitamins, or mineral
supplements because it can reduce
✔ ftOA: Inhibit 2 bacterial enzymes: absorption
DNA gyrase and topoisomerase
IV; Affect DNA synthesis
 FLUOROqUinOLOnEs (QUINOLONES)
✔ CI: Age 60 and above and those
using corticosteroids; Not
approved for children under age
18 because it interferes cartilage
development; Pregnancy and
lactation
✔ AE: Nausea, vomiting, and
diarrhea; Dysrhythmia
(moxifloxacin) and potential
hepatotoxicity; CNS effects;
Cartilage toxicity with risk for
tendonitis and tendon rupture
(Achilles tendon)
✔ Ciprofloxacin is used for post-
exposure prophylaxis against
Bacillus anthracis (anthrax),
Yersinia pestis (plague),
Francisella tularensis
(tularemia), and Brucella
melitensis (brucellosis)
✔ Gatifloxacin and
besifloxacin are available in
drops to treat infections of
the external eye
 NURsing PROCEss nOtEs: FLUOROqUinOLOnEs
In-Patient Management
Out-Patient Management
✔ Vital signs and urine output
✔ Increase fluid intake (6-8 glasses)
✔ Fluid intake should be 2L a day unless restricted
✔ Labs: BUN and serum creatinine for
✔ Avoid caffeinated drinks
renal function
✔ Avoid operating motor vehicles or
✔ Drug and diet history: Antacids, iron hazardous machinery
preparations, caffeine intake, NSAIDs
✔ Wear sunglasses, sun block, and
✔ Culture and sensitivity tests protective clothing when in the sun
✔ ftonitor intake and output; urine pH
✔ Report side effects
✔ Check for superinfection
✔ Monitor theophylline and blood glucose
levels
SULFONAMIDES
 sULfOnAMiDEs
✔ Older drugs / Folic acid
inhibitors
✔ Bacteriostatic
✔ Broad-spectrum
✔ Limited use due to resistant
bacteria
✔ NOA: Inhibit bacterial growth
by inhibiting the synthesis of
folic acid or folate
✔ Indications: UTI, Pneumocystis
carinii pneumonia, and shigella
infections of the small bowel
✔ AE: Crystalluria, hypersensitivity
reactions, nausea and vomiting;
Rare: Aplastic anemia (loss of
bone marrow function), acute
hemolytic anemia and
agranulocytosis
 sULfOnAMiDEs
Sulfamethoxazole-Trimethoprim Silver sulfadiazine
(TMP-SMZ)
✔ Brand: Bactrim ✔ Topical cream used to
✔ Used for UTIs treat infections in
✔ Do culture and sensitivity tests patients with serious
first before administration
burns
✔ Absorbed readily when given
orally and excreted rapidly via
✔ Can cause allergic
kidneys reactions due to sulfur
 NURsing PROCEss nOtEs: sULfOnAMiDEs
In-Patient Management Out-Patient Management
✔ Assess renal function by checking urinary ✔ Encourage patient to drink several quarts of
output, BUN, and serum fluids daily to avoid
creatinine crystalluria
✔ Medical history: Contraindicated in liver and ✔ Tell pregnant patients to avoid sulfonamides
renal disease during the last 3 months of pregnancy
✔ Determine if patient is hypersensitive to ✔ No antacids during therapy
✔
sulfonamides Report allergic reactions
✔ Drugs history
✔ Take sulfonamides 1 hour before or 2 hours
✔ Labs: CBC after meals with full glass of water
✔ Administer with full glass of water ✔ Report bruising or bleeding
✔ Record intake and output ✔ CBC
✔ Note temperature
✔ Wear sunglasses, avoid direct sunlight, use
✔ Observe for hematologic reactions – Check sun block and protective clothing to
CBC decrease photosensitive reactions
✔ Check for superinfection
CARBAPENEMS
 CARBAPEnEMs
✔ Imipenem,ertapenem, ✔ Disadvantage: Can only
doripenem, meropenem be given parenterally
✔ Bactericidal ✔ AE: Diarrhea,
✔ Broadest antimicrobial spectrum nausea, rashes,
✔ MOA: Contain beta-lactam ring and
and inhibit bacteria by inhibiting thrombophlebitis at
construction of cell wall injection sites
✔ Very resistant to beta-lactamase
 CARBAPEnEMs
Imipenem Ertapenem
✔ Broadest antimicrobial ✔ Narrow spectrum but
spectrum longer half-life
✔ Administered fixed-dose ✔ Used for serious
with cilastatin abdominopelvic and skin
Meropenem infections, community-
acquired pneumonia, and
✔ Used for peritonitis
complicated UTI
and bacterial
meningitis
MISCELLANEOUS

ANTIBIOTICS
 CLinDAMyCin
✔ Effective against gram-positive and ✔ AE:
gram- negative bacteria (Fusobacterium Pseudomembranous
and Clostridium perfringens)
colitis
✔ DOC for abdominal infections caused
by
Bacteroides
✔ CI: Hypersensitivity, regional enteritis,
or ulcerative colitis
 MEtROniDAzOLE
✔ Effective against anaerobes that
are common causes of ✔ Prototype drug for
abscesses, gangrene, diabetic antiprotozoal
skin ulcers and deep wound
infections medications
✔ Also used for H. pylori infections ✔ AE: Oral – Nausea, dry
of the stomach associated with
PUD
mouth, and headache:
✔ Have activity against both
High doses -
bacteria and multicellular neurotoxicity
parasites
 VAnCOMyCin
✔ Reserved for severe infections ✔ Other AE: Hypotension,
from gram- positive organisms superinfections,
such as S. aureus and generalized tingling
Streptococcus pneumoniae after IV administration,
✔ Used after bacteria has become chills, fever, skin rash,
resistant to safer antibiotics hives, hearing loss and
✔ Indications: MRSA infections nausea
✔ AE: Ototoxicity and nephrotoxicity:
Red-man syndrome –Occurs
with rapid administration and
histamine is released in the body