DRUGS FOR

BACTERIAL

INFECTIONS Chapter 34

A Little Terminology

Pathogen/ pathogenic-

able to cause disease

Parasite –

an organism living in, with, or on another

organism

Infestation- to be invaded with worms

What are Microbes?

Are visible only with a microscope

Most are SIMPLE, usually single celled forms of life

Come in many shapes and sizes

Some are harmless, however some are pathogenic and cause infection and disease

More Disease Terminology ETIOLOGY- What caused the disease?

INCIDENCE – The rate or range of occurrence- number of new cases of a disease in a population over a period of time How fast is it spreading?

PREVALENCE- the % of a population that is affected with a particular disease at a given time. How widespread is the occurrence

SEVERITY/DURATION CLASSIFICATION

A. Acute – Usually severe, short term

B. Chronic – less severe, continuous

C. Subacute – somewhere between

More Disease Terminology

VIRULENCE- What is the microorganism’s ability to cause disease;how strong is it?

IDIOPATHIC – having no known cause

COMMUNICABLE-Transmittable from person to person.

A. Epidemic-Many people affected

B. Endemic-Lesser extent/ continuous

C. Pandemic- country/world wide

Bacteria

BACTERIA-

Single celled, lack a nucleus

Found everywhere, different types

Classified by shape, O2 need, Gram stain result

Requirements for life vary, reproduce q20min

Anaerobic – no oxygen needed to grow

Aerobic- requires oxygen for growth

Have cell walls

Spores- resistant forms, tolerate adverse cond.

Flagella- appendages allow bacteria to swim

Some bacteria can form toxins (poisons)

CULTURE AND SENSITIVITY

CULTURE: The body secretion is transferred onto a medium in which it can grow.

SENSITIVITY: test performed to determine the best antibiotic which can kill or alter the growth of microorganisms.

BACTERIAL DISORDERS

Bacteria can cause many disorders (see table in Adam)

Medications have been developed to treat many of them

BACTERIA can replicate extremely rapidly

During this replication genetic mix-ups can occur- causing mutations. Most of these mutations die off but many live to become tougher than their bacterial counterparts- and can resist the medications that were given to kill off the original organism

Medication to Tx Bacterial Infections

Names used interchangeably:

Anti-infective

Antibiotic

Antimicrobial

Antibacterial

They may be classified according to their

chemical class: cell wall inhibitors, protein

synthesis inhibitors; folic acid inhibitors;

and reverse transcriptase inhibitors

IMPORTANT TERMS

BACTERIOCIDAL: meds that actually kill

bacteria

BACTERIOSTATIC: meds that slow growth

of bacteria so body’s natural defenses can kill

bacteria

NOSOCOMIAL INFECTION: now

called Hospital Acquired Infection

•A preventable infection acquired

by patient through contact with

contaminated articles or infected

people while

hospitalized.

The organisms are often

resistant to common

antibiotics and can be life-

threatening

The primary reason for a hospital acquired

infections and the spread of infection is

NOT WASHING HANDS PROPERLY

Broad Spectrum Antibiotics

C&S results often take several days

When therapy is needed immediately and the

pathogen can not be identified patients are

given a broad spectrum antibiotic

They have activity against a wide range of

disease-causing bacteria. Acts against both

Gram-positive and Gram-negative bacteria.

Can Kill Normal Flora

Drug Resistant Bugs!

Resistant to the antibiotics commonly used

These resistant organisms are killing 100,000

or more American patients each year

Methicillin-resistant Staphylococcus aureus

(MRSA)

Newer Bug!, Carbapenem-resistant

Klebsiella pneumoniae (CRKP)

C. Diff- Clostridium difficle

VRE- Vancomycin Resistant Enterococci

PENICILLINS Old School- reliable, safe and effective

1ST MASS-PRODUCED ANTIBIOTIC

Cell wall inhibitors-weakens the cell wall

Adverse effects are minor

Most serious S.E. is allergy (rash, pruritis, fever and possible anaphlaxic reaction)

More people allergic to it than any other antibiotic

Some examples:

Penicillin G; Amoxicllin; Ampicillin

Works well with Gram + bacteria

Tx pneumonia, meningitis, skin and bone dx

TEACHING r/t PENICILLIN

Complete the entire rx’d treatment even if feeling better!

Don’t take with acidic liquid (juice) take with full glass of water

Might decrease Birth Control effectiveness

Wear an ID badge!

Don’t breast feed while on the med

CEPHALOSPORINS It is the largest class of antibiotics (more than 20)

Bacteriocidal—inhibit bacterial cell-wall synthesis

MOST COMMON SE IS AN ALLERGIC REACTION

Primary use is to tx Gram Neg infections and those allergic to PCN

Classified by generation 1-4. Examples: 1ST GENERATION

CEFAZOLIN (KEFZOL)

2ND GENERATION

CEFOTETAN (CEFOTAN)

3RD GENERATION

CEFTRIAXONE (ROCEPHIN)

4TH GENERATION

CEFEPIME (MAXIPIME)

TEACHING r/t CEPHALOSPORINS

Eat yogurt like products to suppress GI-related superinfections

Avoid alcohol ( may give an antabuse like reaction)

Caution with bleeding disorders & patients taking NSAIDS (may affect platelet inhibition and prothrombin time

Report flu like symptoms, seizures, dec urine output, hearing loss, rash and difficulty breathing

TETRACYCLINES

It’s over usage in the 50-60’s caused large numbers of resistant strains that now limit the drug’s therapeutic use

Inhibit the bacteria’s protein synthesis

Used for treating acne, Rocky mountain spotted fever. Lyme Disease, H pylori, rickettsiae, and chlamydial infections

Have serious side effects and cause risk for Superinfections

Examples:

Tetracycline

Doxycycline

TEACHING r/t TETRACYCLINES

To decrease GI upset take with full glass of water-not with milk products, antacids or iron supplement

Pregnancy Category D

Can enhance the activity of Coumadin-monitor PT/INR

Cautious use in children--Common Side effect is discoloration of teeth

Photosensitivity

Take full course of medication

Watch with kidney and liver disorders

MACROLIDES Tx only a few bacteria but good alternative

to Penicillin

Inhibit the bacteria’s protein synthesis

Commonly used for Pertusis, Chlamydia, Legionnarie’s Disease

Examples: Azithromycin (Zpack)

Erythromycin

TEACHING r/t MACROLIDES

COMPLETE COURSE OF MEDICATION

AVOID TAKING WITH, OR IMMEDIATELY

BEFORE OR AFTER, JUICES

DO NOT TAKE ANY OTHER PRODUCT WITHOUT

CONSULTING PRESCRIBER

REPORT SIDE EFFECTS: DIFFICULTY

BREATHING OR SWALLOWING, RASH, ITCHING,

DARK URINE & PALE STOOLS, YELLOWING OF

EYES OR SKIN

AMINOGLYCOSIDES

They are bacteriocidal

They affect bacteria protein synthesis

Examples: Gentamycin

Streptomycin

Streptomycin is now restricted to the Tx of Tuberculosis

Reserved for serious infections: E. coli, serratia, proteus, klebsiella and pseudomonas

Serious S.E. possible- 2 of the most serious: Nephrotoxicity and Ototoxicity

TEACHING r/t AMINOGLYCOSIDES

Assessing hearing and renal prior to tx

Tell patient to report hearing loss, tinnitus or

urinary issues

Complete the full course of meds

Increase fluids

Tell patient you will be drawing for Peak and

Trough levels if on Gentamycin- (tests the

amount of the medication in the body)

PEAK & TROUGH

A lab test, done when the drugs could have

serious side effects

Peak is done approx. ½- 1 hour after dose of

medication is given (will show the highest amt.

in the body

Trough is done immediately/ ½ hr before dose

of medication is given ( will show the lowest

amt.in system)

MEDICATIONS REGULARLY MONITORED FOR

THIS ARE GENTAMYCIN (AMINOGLYCIDES),

AMIKACIN, VANCOMYCIN

FLUOROQUINOLONES

Classified by generation 1-4. Examples:

ONE OF BIGGEST ADVANTAGE TO THESE IS THAT MOST NEED TO BE TAKEN ONLY ONCE DAILY; SOME ARE TAKEN TWICE DAILY

THEY ARE VERY EFFECTIVE WHEN GIVEN ORALLY

4 GENERATIONS OF THESE DRUGS

SOME ARE EFFECTIVE AGAINST GRAM-NEGATIVE ORGANISMS; SOME AGAINST GRAM-POSITIVE

THEY ARE BACTERIOCIDAL

1ST GENERATION NALIDIXIC ACID (NeoGram)

2ND GENERATION *CIPROFLOXACIN (Cipro; Septra)

3RD GENERATION LEVOFOXACIN (Levaquin)

4TH GENERATION GEMIFLOXACIN (Factive)

TEACHING r/t

FLUOROQUINOLONES INCREASE FLUID INTAKE

REPORT DECREASED URINARY OUTPUT

MONITOR WBC (THEY MAY DECREASE LEUKOCYTE COUNTS)

DO NOT TAKE IF PREGNANT OR LACTATING

USE CAUTIOUSLY IN CHILDREN

BE VERY CAREFUL WHEN ADMINISTERING WITH OTHER DRUGS (MAY NEED TO ADJUST TIMING)

NAUSEA, VOMITING, DIARRHEA ARE MOST COMMON SIDE EFFECTS

PHOTOPHOBIA MAY OCCUR

MISCELLANEOUS ANTIBIOTICS

AS WITH OTHER MISCELLANEOUS

CATEGORIES, THESE DRUGS DO NOT

“FIT” ANYWHERE ELSE

SOME ARE COMMONLY USED, OTHERS

ARE NOT

EXAMPLES OF MISCELLANEOUS

ANTIBIOTICS

COMMONLY USED ONES: CLINDAMYCIN (CLEOCIN)

IMIPENEM-CILASTIN (PRIMAXIN)

NITROFURANTOIN (MACROBID, MACRODANTIN, FURADANTIN)

VANCOMYCIN (VANCOCIN) [reserved for severe infections that have not responded to other antibiotics; used for MRSA]

LINEZOLID (ZYVOX)

RED MAN SYNDROME

AN UNUSUAL REACTION TO THE RAPID

IV INFUSION OF VANCOMYCIN

SYMPTOMS: FLUSHING, HYPOTENSION,

RED RASH ON FACE, UPPER TRUNK AND

DECREASED URINE OUPUT--

HOLD THE NEXT DOSE

CALL THE PHYSICIAN

TUBERCULOSIS

A highly contagious infection

Very challenging disorder to treat

Patient required to be on med at least 6-12 months or longer if multi-drug resistant infections occur

The patient is on multiple antibiotics at the same time

A dx of TB is made when the pt has 3 Positive Sputum results

SPECIFIC DRUGS USED TO TREAT

TUBERCULOSIS

ISONIAZID (INH) IS PROTOTYPE; PATIENT MUST

AVOID TYRAMINE-CONTAINING FOODS WHILE

TAKING IT.

RIFAMPIN IS GAINING IN POPULARITY; THIS

MED MAY TURN BODY FLUIDS RED; PATIENT

NEEDS TO KNOW THIS

MANY OHER DRUGS AVAILABLE (MYAMBUTOL,

AMIKACIN, CIPRO, KANTREX STREPTOMYCIN,

ETC.)

REMEMBER TO WASH

THOSE HANDS!!

HAVE A GOOD

DAY!!