Antimicrobial Resistance Overview
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Antimicrobial Resistance Overview

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@wgaarder2005

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Questions and Answers

What adverse effect is associated with rapid IV administration of vancomycin?

  • Nephrotoxicity
  • Red man syndrome (correct)
  • Photosensitivity
  • Cholecystitis

    • Which type of antibiotic is primarily used for patients allergic to penicillin?

  • Macrolides (correct)
  • Fluoroquinolones
  • Tetracyclines
  • Aminoglycosides

    • Which of the following is NOT a precaution related to tetracycline use?

  • Discoloration of teeth
  • Suprainfection of the bowel
  • Accumulation in kidney disease
  • Causing renal toxicity (correct)

    • What is the mechanism of action for bacteriostatic antibiotics such as tetracyclines and macrolides?

    <p>Stop bacterial multiplication</p> Signup and view all the answers

    What common drug interaction can decrease the absorption of tetracyclines?

    <p>Iron supplements</p> Signup and view all the answers

    What are aminoglycosides predominantly known for?

    <p>Bacteriocidal action</p> Signup and view all the answers

    Which adverse effect is associated with aminoglycosides?

    <p>Hypersensitivity reactions</p> Signup and view all the answers

    What type of toxicity is particularly monitored in patients receiving vancomycin?

    <p>Nephrotoxicity</p> Signup and view all the answers

    What is the mechanism of selective toxicity in antimicrobials?

    <p>They target bacterial cells without affecting host cells.</p> Signup and view all the answers

    What can lead to acquired resistance in some organisms?

    <p>Consistent exposure to low doses of antibiotics.</p> Signup and view all the answers

    What is a suprainfection?

    <p>A secondary infection due to the normal flora being disrupted.</p> Signup and view all the answers

    Why are older antibiotics being considered for current treatments?

    <p>Resistance has developed against modern antibiotics.</p> Signup and view all the answers

    Which of the following is NOT a mechanism through which antimicrobials achieve selective toxicity?

    <p>Inhibition of host DNA replication</p> Signup and view all the answers

    What is a common result of broad-spectrum antibiotics compared to narrow-spectrum antibiotics?

    <p>They destroy more normal flora.</p> Signup and view all the answers

    Which drug mechanism is illustrated by bacterial enzymes inactivating penicillins?

    <p>Inactivation of the drug</p> Signup and view all the answers

    What is the purpose of prophylactic antibiotic therapy?

    <p>To prevent infections before they occur.</p> Signup and view all the answers

    What clinical sign should a nurse monitor to assess the effectiveness of antimicrobial therapy?

    <p>Reduction of fever.</p> Signup and view all the answers

    Which of the following is a principal adverse effect associated with penicillins?

    <p>Allergic reactions.</p> Signup and view all the answers

    What should patients of child-bearing age be advised when taking antibiotics?

    <p>Alternative methods of birth control should be used during antibiotic treatment.</p> Signup and view all the answers

    Which test values should a nurse monitor to assess renal function during antimicrobial therapy?

    <p>BUN and Creatinine.</p> Signup and view all the answers

    What characteristic is true for penicillins in their role as antibiotics?

    <p>They weaken the bacterial cell wall.</p> Signup and view all the answers

    What is the relationship between penicillin and cephalosporins in terms of allergy?

    <p>Allergic to one means allergic to both.</p> Signup and view all the answers

    Which of the following combinations extends the antimicrobial spectrum when combined with penicillinase-sensitive antibiotics?

    <p>Amoxicillin/clavulanic acid</p> Signup and view all the answers

    What is a significant adverse effect associated with cephalosporins?

    <p>Bleeding</p> Signup and view all the answers

    Which antibiotic class is most widely used and has low toxicity?

    <p>Cephalosporins</p> Signup and view all the answers

    What should be monitored when administering potassium penicillin G?

    <p>K+ levels</p> Signup and view all the answers

    What is the mechanism of action for glycopeptides like vancomycin?

    <p>Inhibition of cell wall synthesis</p> Signup and view all the answers

    In which situation is the oral dose of vancomycin preferred?

    <p>When metronidazole was found ineffective for Clostridium difficile.</p> Signup and view all the answers

    What is a characteristic feature of beta-lactam antibiotics, including cephalosporins?

    <p>They bind to penicillin-binding proteins.</p> Signup and view all the answers

    What is the primary use of sulfonamides?

    <p>Urinary tract infections</p> Signup and view all the answers

    What can occur as an adverse effect of sulfonamides?

    <p>Rash and hypersensitivity reactions</p> Signup and view all the answers

    Which combination of medications inhibits sequential steps in bacterial folic acid synthesis?

    <p>Trimethoprim and sulfamethoxazole</p> Signup and view all the answers

    Which fluoroquinolone is noted as the drug of choice for treating anthrax?

    <p>Ciprofloxacin</p> Signup and view all the answers

    What is a serious side effect associated with fluoroquinolones?

    <p>Tendon rupture</p> Signup and view all the answers

    What should be avoided when taking ciprofloxacin due to reduced absorption?

    <p>Aluminum antacids</p> Signup and view all the answers

    Which condition is metronidazole specifically used to treat?

    <p>Clostridium difficile infection</p> Signup and view all the answers

    Which statement is true regarding C. difficile treatment?

    <p>The antibiotic that caused C. difficile should be stopped.</p> Signup and view all the answers

    Study Notes

    Antimicrobials

    • Antimicrobials are chemicals toxic to microbes, but harmless to the host.
    • They disrupt bacterial cell walls, inhibit unique bacterial enzymes, and disrupt bacterial protein synthesis.

    Acquired Resistance to Antimicrobial Drugs

    • Over time, some organisms develop resistance.
    • Organisms may have been highly responsive to a drug, but then become less susceptible to it.

    Antibiotic Resistance in Animals and Humans

    • Animals, such as pigs, chickens, and birds, can develop resistance to antibiotics used in humans.
    • Bacteria in animals can develop resistance.
    • Humans can develop infections caused by resistant bacteria.
    • Common antibiotic treatment plans were established between 1960 and 1970.

    Antibiotic Use and Drug-Resistant Microbe Emergence

    • A new infection can occur while a patient is taking medications for a different infection (suprainfection).
    • The primary infection's antibiotics can eliminate the normal flora which causes an imbalance.
    • A second infection can flourish due to the lack of the normal flora bacteria.
    • Broad-spectrum antibiotics destroy more normal flora than narrow-spectrum antibiotics.

    Suprainfection (Superinfection)

    • Examples: C. difficile, thrush, and vaginal infections.

    Microbial Mechanisms of Drug Resistance

    • Inactivate drug
    • Drug antagonist
    • Alters molecule

    Selection of Antibiotics

    • Lab culture and sensitivity tests identify the organism and its drug sensitivity.
    • Drugs may be ruled out if the patient has an allergy or liver/kidney issues.

    Other Selection Rationale

    • Empiric therapy is used before the causative organism is identified.
    • Prophylactic agents are given to prevent infection, rather than to treat an established infection.

    Monitoring of Antimicrobial Therapy

    • Nurses monitor clinical responses and laboratory results.
    • Look for reduction in fever and resolution of infection signs/symptoms in the affected organ/area.
    • Signs should include redness, heat, swelling, pain, and drainage.

    Nurse to Monitor Patient Lab Values

    • Serum drug levels for toxicity (peak and trough levels)
    • Renal function (BUN, creatinine)
    • Hepatic function (ALT, AST)
    • Infection-related values (WBC)

    Patient Teaching

    • Provide information about the purpose, use, specific medications, and side effects.
    • Inform women of childbearing age that antibiotics can reduce the effectiveness of birth control pills.
    • Advise using a second form of birth control until a new pack of pills starts.
    • Check for drug-drug interactions.

    Antibiotic: Types

    • Drugs that weaken the cell wall include penicillins (drug name ends in "-cillin").

    Penicillin (PCN) Uses and Side Effects

    • Uses: syphilis, rheumatic heart disease, gas gangrene, pneumonia, respiratory infections, anthrax, septicemia, and meningitis.
    • Side effects: GI distress, oral or vaginal candidiasis, generalized rash, and anaphylaxis.

    Penicillins

    • Active against many bacteria.
    • Low direct toxicity.
    • Principal adverse effect: allergic reaction.
    • Bacteria take up excess water causing cell wall weakening and rupture.

    Bacterial Resistance: Inactivation of Penicillins by Bacterial Enzymes

    • Beta-lactamases inactivate penicillin (e.g., penicillinase).
    • MRSA (methicillin-resistant Staphylococcus aureus) is a bacteria type.

    Penicillin Combinations

    • Extends the antimicrobial spectrum when combined with penicillinase-sensitive antibiotics.
    • Examples: ampicillin/sulbactam (Unasyn), amoxicillin/clavulanic acid (Augmentin).

    Penicillin Allergy

    • Skin tests for penicillin allergy, and assess for penicillin allergy for each patient.
    • If a patient has a history of anaphylaxis, do not administer penicillin or cephalosporins.
    • Allergic to one means allergic to both.

    Broad-Spectrum Penicillins

    • Examples: ampicillin, amoxicillin.

    Potassium penicillin G

    • Least toxic and contains potassium.
    • Monitor potassium levels.

    Other Antibiotics That Weaken the Bacterial Cell Wall II

    • Classification: Cephalosporin (e.g., Keflex)
    • Classification: Glycopeptide (e.g., Vancomycin)

    Cephalosporins

    • Most widely used group of beta-lactam antibiotics.
    • Similar to penicillin structure.
    • Low toxicity.
    • Watch for effects like rash, anorexia, hypersensitivity, and GI pain.

    Cephalosporins: Drug Interactions

    • Drugs that promote bleeding (ASA, NSAIDs, Warfarin)
    • Interferes with vitamin K level causing increased anti-coagulation.
    • Vitamin K causes coagulation.
    • Adverse effects: allergy, bleeding, thrombophlebitis.

    Glycopeptide: Vancomycin

    • Action: Inhibits cell wall synthesis.
    • Uses: Severe infections, methicillin-resistant Staphylococcus aureus, Clostridium difficile if metronidazole doesn't work.

    Vancomycin

    • Adverse effects: ototoxicity (reversible or permanent), red man syndrome (IV administration), renal toxicity.
    • Avoid rapid infusion of the IV administration.

    Bacteriostatic Protein Inhibitors of Synthesis

    • Tetracyclines
    • Macrolides

    Tetracyclines

    • Drug and food interaction: Absorption is decreased with milk products, calcium supplements, and most antacids (reduce the absorption of tetracycline).
    • Precautions: Avoid giving to patients with kidney disease, due to tetracycline accumulating in the urine.
    • Potential side effects: discoloration of teeth, diarrhea (potentially life-threatening C. Diff suprainfection), photosensitivity.

    Macrolides (Erythromycin)

    • Broad-spectrum antibiotic.
    • Inhibits bacteria protein synthesis.
    • Use if allergic to penicillin.
    • Adverse effects include gastrointestinal issues, dysrhythmias, and superinfection.

    Bactericidal Inhibitors of Protein Synthesis: Aminoglycosides

    • Bactericidal (kills bacteria).

    Aminoglycosides

    • Commonly used: gentamicin, tobramycin, amikacin.
    • Adverse effects (peak and trough levels): nephrotoxicity, ototoxicity, hypersensitivity reactions, neuromuscular blockade, and blood dyscrasias.
    • Excreted unchanged in the urine (80–90% recoverable).

    Sulfonamides

    • Inhibits synthesis of folic acid (bacteria need folic acid to replicate).
    • Primary use: urinary tract infections.
    • Adverse effects: rash, hypersensitivity reactions (Stevens-Johnson syndrome), mortality rate of 25%. Blisters will be present on mucous membranes and skin.

    Trimethoprim

    • Suppresses bacterial DNA synthesis.
    • Combined with sulfonamides.
    • Uses: urinary tract infections.

    Trimethoprim-Sulfamethoxazole (TMP-SMZ)

    • Combination of trimethoprim and sulfamethoxazole.
    • Trade names: Bactrim and Septra.
    • Inhibits sequential steps in bacterial folic acid synthesis.
    • Primary use: urinary tract infections.

    Antibacterial Drugs: Fluoroquinolone and Metronidazole

    Fluoroquinolones

    • Disrupts DNA replication and cell division.
    • Side effects: tendon rupture (Black Box Warning for prescribers).
    • Usually affects Achilles tendon; inflammation or rupture possible.

    Fluoroquinolones: Ciprofloxacin (Cipro)

    • Drug of choice for anthrax.
    • Used to treat respiratory, urinary tract (UTI), gastrointestinal (GI) infections, bone, joint, skin, and soft tissue infections.
    • Adverse effects include GI (mild; nausea, vomiting, diarrhea, abdominal pain), central nervous system (CNS) issues (dizziness, headache, restlessness, confusion, seizures), and confusion, lethargy, and visual issues in older adult patients.

    Fluoroquinolones: Drug and food interactions

    • Absorption may be reduced with aluminum, magnesium antacids, iron salts, zinc salts, sucralfate, and milk/dairy products.

    Metronidazole (Flagyl)

    • Inhibits nucleic synthesis (DNA/RNA)
    • Used to treat Clostridium Difficile (C. Diff).
    • C. Diff Treatment: stop the precipitating antibiotic, hand sanitizers are ineffective, do not give anti-diarrheal drugs.

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    Description

    This quiz explores the nature of antimicrobials, their toxic effects on microbes, and the evolution of resistance in both humans and animals. It highlights the implications of antibiotic use and the emergence of drug-resistant microbes, detailing how resistant infections can occur. Test your knowledge on these crucial topics in microbiology and pharmacology.

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