Antibiotics: Usage and Guidelines

• Before administering antibiotics for an infection, perform a culture and sensitivity test to identify the specific pathogen and its sensitivities.
• A culture and sensitivity test should be performed before the first dose of antibiotics is administered.

Ciprofloxacin

• Ciprofloxacin use is restricted for individuals under 18 due to the risk of tendon damage, particularly Achilles tendon rupture.
• Ciprofloxacin is the preferred drug for post-exposure prophylaxis of inhalation anthrax during a biological attack.

Amikacin

• Amikacin is an aminoglycoside antibiotic that can cause nephrotoxicity, requiring monitoring of BUN and creatinine levels.
• It can also cause ototoxicity, leading to hearing loss and tinnitus.

Penicillin

• Penicillin allergy assessment is crucial before administration due to its high allergy potential.
• Patients with penicillin allergies have a 30% cross-sensitivity to first and second-generation Cephalosporins because of the shared beta-lactam ring.

Medications to Treat Fungal Infections

• Fluconazole (Diflucan) is an azole antifungal used for oral thrush, vaginal yeast infections, esophageal candidiasis, and systemic fungal infections. Liver function tests (LFTs) should be monitored during use.
• Amphotericin B is a polyene antifungal used to treat severe systemic fungal infections.
• Amphotericin B carries a high risk of infusion reactions like fever, chills, and hypotension, premedication with acetaminophen or antihistamines is recommended.
• Monitor patients on Amphotericin B for nephrotoxicity and electrolyte imbalances, especially potassium and magnesium.

Signs of allergic reaction

• Signs of an allergic reaction: rash, hives, itching, shortness of breath, facial swelling, lip or tongue swelling, chest tightness, hypotension, tachycardia, and dizziness.

Steps to decrease the probability of Amphotericin B infusion reaction:

• Premedicate patients 30–60 minutes before infusion with acetaminophen to reduce fever/chills and diphenhydramine (Benadryl) to prevent allergic-type reactions.
• Hydrate with normal saline before and after infusion to protect the kidneys and reduce nephrotoxicity.
• Administer infusion slowly over 2-6 hours.
• Monitor patients closely and check vital signs every 15-30 minutes during the infusion.
• If an infusion reaction occurs, stop the infusion immediately and assess vital signs, notify the provider, administer emergency medications if ordered, and document.
• Broad-spectrum antibiotics can alter the normal flora, leading to superinfections like C. difficile and oral thrush or yeast infections, patients should maintain hydration and report any persistent diarrhea.
• Clindamycin can cause C. difficile overgrowth, resulting in severe diarrhea by killing good bacteria in the gut.
• Certain antibiotics can interfere with oral contraceptives by altering gut flora, patients should be informed to use an additional form of birth control.

Aminoglycosides

• Aminoglycosides include tobramycin, amikacin, neomycin, gentamycin, and streptomycin.
• Medications ending in "cillin" are penicillins.

Patient being administered Vancomycin Considerations

• For patients on vancomycin, draw a peak level 1-2 hours after the end of the infusion.
• Tobramycin can cause nephrotoxicity and ototoxicity, BUN and creatinine levels, peak and trough levels, and hearing tests should be monitored regularly.
• Vancomycin is the drug of choice for methicillin-resistant Staphylococcus aureus (MRSA).
• IV Vancomycin is administered for MRSA whereas oral Vancomycin for C. difficile.
• Vancomycin infusions should take place over 60 minutes.

Tetracycline considerations

• Tetracycline can increase sensitivity to sunlight, leading to higher risk of severe sunburns and rashes.
• Patients on tetracycline should avoid prolonged sun exposure, use sunscreen, and take on an empty stomach.
• Patients on antiviral therapy (acyclovir) should increase water intake to prevent nephrotoxicity.
• HAART therapy is used in HIV management to attack the virus at multiple stages and prevent resistance.

Tamiflu consideration

• Tamiflu (oseltamivir) is used during flu seasons, typically fall through spring, but it is not a vaccine.
• Tamiflu should be taken within 48 hours of the first flu symptoms, twice a day for 5 days.
• For prevention, Tamiflu is taken once daily for 7-10 days.
• Tamiflu reduces the severity of flu symptoms by about 1 to 2 days, but will not cure or prevent further infections.
• Tamiflu works against influenza A and B, yearly vaccination is still necessary.

Bactrim considerations

• Bactrim (sulfamethoxazole/trimethoprim) should be taken with a full glass of water and for the entire course.
• Direct sunlight or tanning beds should be avoided when taking Bactrim due to risk of photosensitivity.
• Antacids or supplements with magnesium/aluminum and sulfa-containing drugs should be avoided.
• Always treat infections with the most narrow spectrum antibiotic, starting broad-spectrum to control the infection quickly until the specific bacteria is identified.
• Selective toxicity enables a drug to only attack systems found in foreign cells.
• Penicillin destroys bacterial cells without disrupting normal function.
• Antibiotics are often given empirically or prophylactically to prevent infection in high-risk situations, like before surgery.
• Antibiotic dosing should be adjusted with caution for elderly patients to avoid toxicity and renal insufficiency, monitor BUN, creatinine, and GFR.

Antibiotic Administration Patient Education

• Antibiotics should be taken as prescribed, without skipping doses or doubling.
• Drink plenty of water and complete the entire course.
• Hand hygiene prevents antimicrobial resistance in healthcare.

AZT

• AZT (zidovudine) is an antiviral medication for HIV treatment and prevention, part of HAART therapy, and should be taken with food.
• Patients taking AZT should eat a balanced diet rich in iron and B12.
• Nephrotoxic antibiotics: BUN, creatinine, urine output, and peak and trough levels should be monitored.
• Monitor BUN, creatinine, urine output, and peak and trough levels for amikacin, gentamycin, vancomycin, and amphotericin B.

Clindamycin

• Clindamycin (pindamycin) requires monitoring in elderly patients due to the risk of C. difficile infection, fever, abdominal pain, and patients should be educated to report diarrhea immediately.
• Peak levels are drawn 30 minutes after infusion ends to show drug effectiveness.
• Trough levels are drawn 30 minutes before the next dose to show risk of toxicity.

Oral Teracycline Patient Education

• Oral tetracycline is taken on an empty stomach, either one hour before or two hours after meals.
• It shouldn't be taken with dairy, antacids, or iron supplements.
• Use sunscreen and avoid during pregnancy or in children under 8 years old because they cause teeth discoloration and bone issues.
• Gentamycin can cause nephrotoxicity and ototoxicity, monitor BUN, creatinine, urine output, and tinnitus, hearing loss, and vertigo, respectively.

Broad-Spectrum Antibiotics Risk

• Broad-spectrum antibiotics can increase the risk of vaginal yeast infections by killing normal flora, allowing Candida to overgrow.

Yeast Infection Symptoms

• Signs to watch for are vaginal itching, white, cottage cheese-like discharge, and burning with urination, all of which should be reported.
• These are treated with fluconazole (Diflucan) or topical antifungal cream.
• HIV mother-to-child transmission is prevented by administering zidovudine (AZT) during labor and delivery (intrapartum).
• AZT is given postpartum to the newborn for full protection.

Metronidazole Patient education

• Metronidazole (Flagyl) requires avoiding alcohol during and 48–72 hours after completing therapy due to risk of a disulfiram-like reaction, causing severe nausea, vomiting, headache, and flushing.