Antibiotic Therapy Nursing 488 Fall 2024 PDF

Antibiotic Therapy Nursing 488 Fall 2024 Catherine Fox RN, MN, CON(C) Bemi Lawal RN, MScN/ADM Shelley de Boer, RN, MN Hillary Selkirk RN, MN, NP  Develop a solid understanding of the key principles of antibiotic therapy....

Antibiotic Therapy Nursing 488 Fall 2024 Catherine Fox RN, MN, CON(C) Bemi Lawal RN, MScN/ADM Shelley de Boer, RN, MN Hillary Selkirk RN, MN, NP  Develop a solid understanding of the key principles of antibiotic therapy. Classify antibiotics by categories and mechanisms of action. Class Objectives Explain indications, contraindications, and adverse effects of each class. Discuss important nursing considerations in the administration and management of antibiotic therapy.  Anti-Infective Agents Drugs used to prevent or treat infections antibiotics antivirals antifungals antiprotozoals Focus:- Bacterial infections and antibiotic use. Overview of Bacteria Gram-positive and negative strains of bacteria. Gram-negative infections are generally harder to treat because of the more complex cell walls.  Major Antibiotic Categories Mechanism of Action Antibiotic class/Antibiotic Interfere with cell wall synthesis. Beta-Lactams & vancomycin Inhibit protein synthesis. Macrolides, Aminoglycosides, Tetracyclines, & clindamycin Interfere with DNA replication and Fluoroquinolones, metronidazole RNA synthesis. Interfere with folic acid synthesis Sulfonamides or cell metabolism (act as antimetabolites). Bactericidal vs. Bacteriostatic Antibiotics Bactericidal antibiotics Bacteriostatic antibiotics (it simply kills bacteria) (does not kill, it inhibits growth) Macrolides (in high concentrations) Sulfonamides Penicillin Macrolides Cephalosporins Tetracyclines Monobactams Aminoglycosides Carbapenems Clindamycin Aminoglycosides Fluoroquinolones Vancomycin Metronidazole  Antibiotic Resistance: Occurs when bacteria evolve and become less sensitive to antibiotics. Antibiotic Resistance Causes: Overuse and misuse of antibiotics. Example: MRSA, VRE, MDR-TB Impact: Leads to more difficult-to-treat infections.  An advanced and complex infection that can occur during or after antimicrobial treatment for another infection. This can occur when antibiotic therapy is sub- therapeutic. Superinfections In antibiotic therapy, normal bacterial flora in the gut may be killed, allowing other types of bacteria to take over. For example, MRSA, VRE, C. Diff.  Sub-therapeutic Therapy Can be due to: Incorrect route of administration Occurs when signs & Inadequate drainage symptoms do not seem of an abscess Poor drug penetration to be improving. Insufficient levels of serum drug levels Bacterial resistance to the drug  Beta-Lactams (Penicillins, Cephalosporins,) : Respiratory, skin, and urinary tract infections. Macrolides (Erythromycin, Clarithromycin): Resp. Indications infections, some STIs. for Each Aminoglycosides( Gentamicin, Tobramycin, Streptomycin): Serious Infections GI/GU, Endocarditis, Antibiotic Resp. tract infections Tetracyclines (Tetracycline, Doxycycline, Minocycline Class (acne) : Acne, respiratory, STI and tick-borne diseases. Fluoroquinolones (Ciprofloxacin, Levofloxacin): UTIs, respiratory, and GI infections. Contraindications: - Beta-Lactams: Avoid in patients with known allergies to penicillin/cephalosporins. - Tetracyclines: Contraindicated in children and pregnancy (affects bone/teeth). - Fluoroquinolones: Use caution in older adults (tendon rupture risk). - Sulfonamides: Avoid in patients with sulfa allergies. Adverse Effects by Antibiotic Class - Beta-Lactams: *Allergic reactions, *GI upset. - Macrolides: *GI upset, QT prolongation. - Tetracyclines: Photosensitivity, GI discomfort. - Fluoroquinolones: Tendonitis, photosensitivity, QT prolongation. - Aminoglycosides: Nephrotoxicity, ototoxicity. * Common adverse effects of antibiotic β-Lactam Antibiotics Characterized by the particular chemical structure that involves a β- lactam ring. Time dependent killing action  relies on time versus a specific concentration of antibiotic. Penicillins, Cephalosporins, Monobactams, and Carbapenems (bactericidal antibiotics) Antibiotics: Penicillin Indications Broad spectrum antibacterial activity against gram-positive and limited activity with gram-negative bacteria. Narrow spectrum activity as well. Streptococcus, Enterococcus, and Staphylococcus Ear infections, pneumonia, UTIs, prophylaxis prior to surgery, STIs. Mechanism of Action Bactericidal: They inhibit bacteria cell wall synthesis  Adverse Effects GI upset are the most common side effects witnessed (diarrhea, nausea & emesis). Antibiotics: Penicillin Allergic reactions include urticaria, pruritus, and angioedema (most commonly seen). Unpredictable drug reactions  maculopapular eruptions, eosinophilia, Stevens-Johnson syndrome, and exfoliative dermatitis. Antibiotics: Penicillin Contraindications/ Drug interactions Other antibiotics (aminoglycosides, macrolides, tetracyclines)  have additive effects/ inhibitory effects. NSAIDs compete for protein binding, which could result in more active and free penicillin. Oral contraceptives- decrease effectiveness Potassium supplements- may increase the effects of hyperkalemia Warfarin  Nursing Implications Antibiotics: Monitor skin & bowel function Penicillin Re-evaluate lab work Therapeutic response?  Antibiotics: Cephalosporins Example:- Ancef, cefazolin first generation Mechanism of Action Bactericidal action Inhibit bacteria cell wall synthesis by infiltrating the cell (and binding to PBPs), on bacteria, disrupting cell wall formation and leading to bacterial cell death. Indications Broad spectrum antibacterial activity against gram-positive and some gram-negative bacteria. Each new generation that is created can focus on different bacterial strains. Surgical prophylaxis, UTI’s and respiratory infections Antibiotics: Cephalosporins Adverse Effects Similar to penicillin antibiotics Contraindications/ Drug interactions Similar to penicillin antibiotics Nursing Implications Similar to penicillin antibiotics  Antibiotics: Macrolides Example:- Erythromycin, Clarithromycin Mechanism of Action Bacteriostatic antibiotics, however, in high enough concentrations, can be considered bactericidal. Inhibits protein synthesis inside of the bacteria cell. Indications Primarily effective against gram-positive bacteria. Upper and lower respiratory tract infections Skin and soft tissue infections infections Sexually transmitted infections Antibiotics: Macrolides Adverse Effects GI upset most common Contraindications/ Drug interactions Competes for liver metabolism with many different types of drugs because it is highly protein bound. Examples: carbamazepine, cyclosporine, digoxin, theophylline and warfarin. Decrease the efficiency of oral contraceptives. Geriatric patients Antibiotics: Macrolides Nursing Implications Severe allergies? Monitor skin & bowel function Re-evaluate lab work  may see elevated liver enzymes Therapeutic response?  Antibiotics: Tetracyclines Example:- Doxycycline, Tetracycline Mechanism of Action Bacteriostatic Protein synthesis inhibitor Indications Wide range antibiotic (Both Gram +/-) Acne, Chlamydia, Pneumonia’s, UTI’s, Skin Infections Antibiotics: Tetracyclines Adverse Effects Contraindications/ Drug interactions Discolouration of teeth in fetuses and Pregnancy/nursing mother children Children under 8 years old. Fetus skeletal development if taken during When taken with calcium & iron pregnancy. Anticoagulants Photosensitivity (sunburn) Bactericidal antibiotics & oral contraceptives Upset GI (Diarrhea) Allergy Yeast Infection Change in urine colour Antibiotics: Tetracyclines Nursing Implications Take 1 hour before or 2 hours after meals/snack Take at least 4 hours after an antacid Do not take it with food, especially dairy products. Administer around the clock.  Antibiotics: Aminoglycosides Example:- Gentamicin, Tobramycin, Neomycin, Amikacin Mechanism of Action Bactericidal Protein synthesis inhibitor Disrupt cell membrane Indications Mostly Gram negative some Gram positive Serious Infections Gastrointestinal/ Genitourinary Endocarditis Respiratory tract infections Antibiotics: Aminoglycosides Adverse Effects Ototoxicity Nephrotoxicity Drug Toxicity Contraindications/ Drug Interactions Pregnancy/Nursing Mother Allergy Renal impairment Loop Diuretics Oral Anticoagulants Antibiotics: Aminoglycosides Nursing Implications Renal Assessment Neurological assessment Dizziness, vertigo, tinnitus, roaring in ears, hearing loss. Therapeutic drug monitoring  Antibiotics: Fluoroquinolones Example:- Ciprofloxacin, Levofloxacin Mechanism of Action Very potent Bactericidal. Interfere with DNA replication Broad-spectrum antibiotic Indications Mostly gram negative some gram positive Complicated UTI’s Respiratory tract infections Skin, GI, Bone, Joint Infections STI’s Antibiotics: Fluoroquinolones Contraindications/ Drug Interactions Adverse Effects Antacids Central Nervous Iron/Zinc Preparations Dermatologic Calcium/Magnesium Gastrointestinal Anticoagulants Elevated ALT/AST levels Bronchodilators Prolongation of QT interval Cardiac Dysrhythmias Allergy Antibiotics: Fluoroquinolones Nursing Implications May be taken with meals (Expect dairy alone) Reduce caffeine if excessive cardiac or CNS stimulation occurs. Maintain hydration/urine output.  Antibiotics: Sulfonamides Example:- (sulfamethoxazole/trimethoprim) Bactrim, Septra. Mechanism of Action Bacteriostatic Inhibit bacteria growth rather than destroy it by affecting the bacteria cells metabolism (folic acid). Indications Broad spectrum antibacterial activity against gram-positive and gram-negative bacteria. Used commonly for UTIs, respiratory tract infections, and general prophylaxis. Antibiotics: Sulfonamides Adverse Effects “Sulfa allergy” starts with a fever and then can proceed to a rash. Photosensitivity  exposure to sunlight  rash Reported reactions: anemias, skin reactions, Stevens-Johnson syndrome, N&V, diarrhea, pancreatitis, convulsions, headaches, crystalluria, and toxic nephrosis. Antibiotics: Sulfonamides Contraindications/ Drug interactions Sulfonylureas (for diabetes) Cyclosporine  can inhibit immunosuppressant effects Pregnant woman and children under 2 years old Geriatric patients Phenytoin  It can increase the toxicity Warfarin  increase the anticoagulant effects  bleeding Antibiotics: Sulfonamides Nursing implications: Severe allergies? Monitor skin & bowel function. Do they have history of renal disease? Re-evaluate lab work. Therapeutic response?  Clindamycin (Dalacin C) Antibiotics: Miscellaneous Vancomycin (Vancocin) Metronidazole (Flagyl)  Antibiotics: Clindamycin Indications Gram-negative and Gram-positive Chronic Bone Infections UTI’s Intra-abdominal infections Anthrax Endocarditis Malaria Mechanism of Action Can be both Bactericidal/static based on the dose Protein synthesis inhibitor Contraindications/drug interaction Ulcerative colitis or enteritis Allergy Neuromuscular drugs Adverse effect GI: Nausea, vomiting, abdominal pain, diarrhea, pseudomembranous colitis, anorexia. Joint pain Thrush Yeast infection Antibiotics: Clindamycin Nursing Implications It may be taken with food Bowel assessment  Antibiotics: Metronidazole Indications Intra-abdominal Gynecological infections Gram-positive and Gram-negative bacteria Mechanism of Action Bactericidal Alter DNA of bacteria, which interferes with DNA replication and synthesis Contraindications/drug interaction Alcohol Lithium Benzodiazepine Cyclosporine Calcium channel blockers Antidepressants Allergy Lactating Mother Adverse effect Dizziness, Headache, GI discomfort, Neutropenia, Thrombocytopenia Antibiotics: Metronidazole Nursing Implications Keep hydrated Take on full stomach to avoid digestive upset  Antibiotics: Vancomycin Indications MRSA C-Difficile Bone Infections Bloodstream Infection Gram-positive bacteria Mechanism of Action Bactericidal Interferes with cell wall synthesis: Destroys bacteria cell wall, causing cell death. Contraindications/drug interaction Neuromuscular Blockers Allergy Hearing Condition Kidney Dysfunction Caution: Neonates/ Older Adults Adverse effect Ototoxicity, Nephrotoxicity, ‘Red Man Syndrome’, Neutropenia Antibiotics: Vancomycin Nursing Implications Therapeutic drug dose Stay hydrated Urine output Antibiotic Class Examples Indications Contraindications Adverse Effects Beta-lactams Penicillins, Cephalosporins Resp infections, skin infections, UTIs, Penicillin allergy, history of Allergic reactions (rash, anaphylaxis), GI upset (Cefazolin septicemia anaphylaxis Inhibits cell wall synthesis Macrolides Azithromycin, Erythromycin, Resp infections, skin infections, STI Liver disease, history of QT GI disturbances (nausea, diarrhea), QT prolongation Clarithromycin prolongation Inhibits protein synthesis Aminoglycosides Gentamicin, Tobramycin, Severe Gram -ve infections, sepsis, Renal impairment, myasthenia Nephrotoxicity, ototoxicity (hearing loss, balance issues) Streptomycin hospital-acquired pneumonia gravis, pregnancy Inhibits protein synthesis Tetracyclines Doxycycline, Tetracycline Resp infections, acne, Lyme disease, Children