Notes Antivirals, Antifungals and Abx.docx

**Antiviral, Antifungal & Anti-infective (Abx) Drugs** **1.Antivirals** **General Principles of Virology** - **Viruses**: Tiny infectious microorganisms, much smaller than bacteria. They cannot replicate on their own and must enter host cells to use their machinery (DNA, RNA, proteins)....

**Antiviral, Antifungal & Anti-infective (Abx) Drugs** **1.Antivirals** **General Principles of Virology** - **Viruses**: Tiny infectious microorganisms, much smaller than bacteria. They cannot replicate on their own and must enter host cells to use their machinery (DNA, RNA, proteins). - **Viral Replication**: Viruses live inside host cells, making them difficult to kill without harming the host\'s cells. **Viral Illnesses** - Viral illnesses are mostly survivable but can be reduced with vaccines. Examples include herpes (HSV), varicella-zoster (VZV), cytomegalovirus (CMV), Epstein-Barr, and others. - **Opportunistic Infections**: Common in immunocompromised individuals (e.g., cancer, AIDS) and require long-term treatment. +-----------------------------------+-----------------------------------+ | **Transmission** | Respiratory droplets/aerosols; | | | more infectious than influenza. | +===================================+===================================+ | **Severe Cases** | Can lead to Acute Respiratory | | | Distress Syndrome (ARDS); dyspnea | | | may develop 4-8 days after | | | symptom onset. | +-----------------------------------+-----------------------------------+ | | Pulse oximetry may miss hypoxemia | | | in dark-skinned patients. | +-----------------------------------+-----------------------------------+ | **Clinical Spectrum:** | | +-----------------------------------+-----------------------------------+ | - **Asymptomatic** | Positive test, no symptoms. | +-----------------------------------+-----------------------------------+ | - **Mild** | Fever, cough, sore throat, | | | malaise, headache, muscle pain, | | | N/V, diarrhea, loss of | | | smell/taste (no dyspnea or | | | abnormal imaging). | +-----------------------------------+-----------------------------------+ | - **Moderate** | Lower respiratory disease evident | | | with SpO2 ≥ 94%. | +-----------------------------------+-----------------------------------+ | - **Severe** | SpO2 \< 94%, RR \> 30, lung | | | infiltrates \> 50%. | +-----------------------------------+-----------------------------------+ | - **Critical** | Respiratory failure, septic | | | shock, multiple organ | | | dysfunction. | +-----------------------------------+-----------------------------------+ Herpes Simplex & Varicella-Zoster viruses: **HSV 1** Oral herpes --------------------- -------------------------------------------------------------------- **HSV 2** Genital herpes **HHV 3 (VZV)** Chickenpox and shingles **HHV 4** Epstein-Barr virus **HHV 5** Cytomegalovirus (CMV) **HHV 6 and HHV 7** Not clinically significant; relevant in immunocompromised patients **HHV 8** Kaposi's sarcoma **Antiviral drugs** \- **Function**: Antiviral drugs kill or suppress viruses. Modern antiviral drugs primarily inhibit replication instead of destroying mature virions. \- **Immunoglobulins**: Antibodies that fight viruses. \- **Key Features**: - Enter infected cells. - Block viral DNA/RNA production. - Prevent virus from entering cells (fusion process). - Some boost the immune system. \- **Synergy**: A strong immune system helps antiviral drugs work better. **Types of Antiviral Drugs** 1. **Non-HIV Antivirals**: Treat infections like influenza, herpes, CMV, and hepatitis. 2. **Antiretrovirals**: Treat HIV infections -- virus that cause AIDS. **Antivirals MOA** - Antiviral drugs mainly **inhibit viral replication**, often by blocking enzyme polymerase, which limits the virus and allows the immune system to fight it. **Adverse effects:** vary with each drug. Healthy cells can be killed by antiviral drugs, leading to significant toxicities. **Contraindications:** - [Amantadine:] Lactating women, children under 12 months, patients with eczematous rash. Narrow antiviral spectrum, active only against influenza A but no longer recommended due to resistance. CNS adverse effects and ortho hypotension. - [Cidofovir:] Severe renal impairment, concurrent use with other nephrotoxic drugs **Interactions:** minimal when used topically. **Common Antiviral Drugs** - **Acyclovir (Zovirax)**: Treats HSV 1, HSV 2, and VZV. Available in oral, topical, and parenteral forms. Adverse effects: n/v, h/a, and burning sensation when applied topically. - **Oseltamivir** (Tamiflu) & **Zanamivir** (Relenza): Effective against influenza A and B. Reduce its duration, causes n/v (oral), and Zanamivir (inhalation) causes nausea, diarrhea, and sinusitis. Treatment must start within 2 days of symptom onset. - **Ribavirin**: Treats hepatitis C (oral), and RSV- *respiratory syncytial virus-* in hospitalized infants (nasal inhalation). Adverse effects include rash, conjunctivitis, anemia, and mild bronchospasm. **Antiretrovirals** **Therapeutic effects of antiretrovirals:** Delayed progression of HIV infection **HIV and AIDS** - The risk of HIV transmission to healthcare workers from needle-stick injuries is about 0.3%, making hand hygiene and standard precautions essential. - HIV is treated with **antiretrovirals**, which target enzymes: reverse transcriptase and integrase (retrovirus enzymes) to prevent viral replication. - Retroviruses use reverse transcriptase to create complementary DNA *"mirror image"*, and integrase facilitates the integration of this viral DNA into the host\'s DNA. *\"Mirror image\" describes how the newly synthesized DNA strand complements the original RNA template, ensuring accurate copying of genetic information (A, T, C, G) for replication.* - There are **[4 stages of HIV infection]**, progressing from asymptomatic (stage 1) to AIDS-defining illnesses. **Mnemonic: \"Rabbits Play Football @ Every Island"** +-----------------------------------+-----------------------------------+ | 1. **Reverse Transcriptase | Block reverse transcriptase, | | Inhibitors** | preventing new viral DNA | | | production. | +-----------------------------------+-----------------------------------+ | 2. **Protease Inhibitors** | Inhibit protease enzyme, | | | preventing viral replication. | +-----------------------------------+-----------------------------------+ | 3. **Fusion Inhibitors** | Inhibit viral fusion, [preventing | | | viral entry] | +-----------------------------------+-----------------------------------+ | 4. **Entry Inhibitors (CCR5 | Block CCR5 co-receptors, | | Antagonists)** | [preventing viral | | | entry] | +-----------------------------------+-----------------------------------+ | 5. **Integrase Inhibitors** | Prevent integration of viral DNA | | | into host DNA. | +-----------------------------------+-----------------------------------+ **Adverse Effects & Goal (balance)** - Vary and are specific to each drug, may require modification of therapy to have a balance between tolerance of adverse effects and control of infection. **2.Antifungal Drugs** Fungi Large group of microorganisms including [yeasts] and [molds.] Normal flora: Found in the skin, mouth, intestines, vagina. Fungal infections = "mycoses": +-----------------------+-----------------------+-----------------------+ | **General Types of | **Area Affected** | **Description** | | mycotic | | | | Infection/fungi** | | | +=======================+=======================+=======================+ | 6. **Cutaneous** | Hair & nails | Affects the | | | | keratinized areas of | | | | the body (skin, hair, | | | | nails) | +-----------------------+-----------------------+-----------------------+ | 7. **Subcutaneous** | Deep tissue | Affects the deeper | | | | layers beneath the | | | | skin | +-----------------------+-----------------------+-----------------------+ | 8. **Superficial** | Outermost layer of | Affects the surface | | | skin (epidermis) | of the skin | +-----------------------+-----------------------+-----------------------+ | 9. **Systemic** | Blood (and internal | Can spread through | | | organs) | the bloodstream and | | | | be life-threatening, | | | | especially in | | | | immunocompromised | | | | patients | +-----------------------+-----------------------+-----------------------+ +-----------------------+-----------------------+-----------------------+ | **Main Types of | **Characteristics** | **Usage/Details** | | mycotic | | | | infection/Fungi** | | | +=======================+=======================+=======================+ | 1. **Yeasts** | \- Single-cell | \- Reproduce by | | | organisms | budding | +-----------------------+-----------------------+-----------------------+ | | \- Used in baking and | | | | brewing | | +-----------------------+-----------------------+-----------------------+ | 2. **Molds** | \- Multicellular | \- Have branching | | | organisms | filaments (hyphae) | +-----------------------+-----------------------+-----------------------+ | | \- Common in mold | | | | infections (mycotic | | | | infections) | | +-----------------------+-----------------------+-----------------------+ Common Mycotic Infections - **Candida albicans:** - **Vaginal candidiasis** (aka yeast infection): Common in pregnant women, women with diabetes, and oral contraceptive users. Two types of Antifungal Drugs: 1. Systemic (e.g., amphotericin BPolyene and fluconazoleTriazole). 2. Topical (e.g., nystatinPolyene). **Polyenes** +-----------------------------------+-----------------------------------+ | MOA | \- Bind to sterols in fungal cell | | | membranes, causing cell death.\ | | | - Selective toxicity: Does not | | | bind to human cell membranes. | +===================================+===================================+ | Key Medications | \- **Amphotericin B (IV):** | | | Preferred for severe systemic | | | fungal infections.\ | | | **- Nystatin (oral/topical):** | | | Common for oral candidiasis | | | (thrush), especially in | | | immunocompromised patients. | +-----------------------------------+-----------------------------------+ | Adverse Effects | **Amphotericin B**:\ | | | - Cardiac dysrhythmias\ | | | - Neurotoxicity (tinnitus, visual | | | disturbances, paresthesias, | | | convulsions)\ | | | - Kidney toxicity | | | (nephrotoxicity) - low K & Mg\ | | | - Electrolyte imbalance | | | (potassium loss, hypomagnesemia)\ | | | - Pulmonary infiltrates\ | | | - High incidence of nausea, GI | | | upset, and anemia\ | | | **Nystatin (topical):** easily | | | becomes toxic !\ | | | - n/v, anorexia, diarrhea, rash, | | | urticaria | +-----------------------------------+-----------------------------------+ | Nursing Considerations | **Amphotericin B:**\ | | | - [Pre-medicate] with | | | antipyretics, antihistamines, | | | antiemetics, and corticosteroids | | | to reduce infusion-related | | | reactions. [Do an ECG | | | prior.]\ | | | - [Extend infusion | | | times] (2-6 hours) to | | | minimize adverse effects. | | | | | | **-IV infusion pumps** are | | | required for safe | | | administration.\ | | | - Watch for kidney function, | | | electrolyte levels, and cardiac | | | signs.\ | | | **Nystatin**:\ | | | - Primarily used for topical and | | | oral infections like thrush. | +-----------------------------------+-----------------------------------+ **Triazoles** ------------------------------------------------------------------------------------------------------------------------------------------------------------------ MOA \- Inhibit cytochrome P450 enzyme, leading to fungal cell membrane leaks and cell death.\ - Known as \"hole-punchers\" due to their effect on the cell membrane. ------------------------ ----------------------------------------------------------------------------------------------------------------------------------------- Key Medications \- **Fluconazole:** Effective for systemic infections, particularly cryptococcal meningitis, as it passes into the cerebrospinal fluid. Adverse Effects \- Gastrointestinal issues: Nausea, vomiting, stomach pain, diarrhea.\ - [Increased liver enzymes].\ - Caution in patients with liver or kidney dysfunction. Nursing Considerations \- Monitor liver enzyme levels due to potential liver damage.\ - Fluconazole is [effective in treating cryptococcal meningitis] due to CNS penetration.\ - Use caution in patients with kidney or liver dysfunction. ------------------------------------------------------------------------------------------------------------------------------------------------------------------ **Common Contraindications** - **Liver failure**, **kidney failure**, and **drug allergy** are common contraindications for antifungals. **Nursing Considerations:** - Many antifungal drugs are metabolized by the **cytochrome P450 enzyme system**, leading to potential drug interactions. - Co-administration of two drugs that use this enzyme system can lead to **drug accumulation** and **toxicity**. - Monitor vital signs every 15-30 minutes during infusion of IV antifungals. - Assess all prescribed and over-the-counter medications to avoid drug interactions. - Some oral antivirals need meals; others require an empty stomach. Always check instructions. - Warn patients about possible **dizziness** and advise them to avoid **OTC drugs** or **natural remedies** without consulting their provider. **Summary:** - **Mechanism**: Most antivirals **inhibit virus replication**. - **Uses**: Antivirals treat **Herpes simplex**, **Herpes zoster**, **Influenza**, **RSV**, and **Cytomegalovirus**. - **Antiretrovirals**: Specifically used for **HIV** treatment. **3.Antibiotics** +-----------+-----------+-----------+-----------+-----------+-----------+ | **Antibio | **Mechani | **Indicat | **Contrai | **Adverse | **Example | | tic | sm | ions** | ndication | Effects** | s** | | Class** | of | | s** | | | | | Action** | | | | | +===========+===========+===========+===========+===========+===========+ | 1. **Sul | [Broad | UTIs | Allergy, | [Allergic | Septra | | fonamides | spectrum] | | pregnancy | reactions | (Sulfamet | | ** | {.underli | | , | to | hoxazole/ | | | ne}, | | infants | "sulfa",] | Trimethop | | | inhibits | | \< 2 | {.underli | rim) | | | bacterial | | months | ne} | [combinat | | | growth | | | hematolog | ion]{.und | | | | | | ical | erline} | | | | | | issues, | | | | | | | [photosen | | | | | | | sitivity] | | | | | | | {.underli | | | | | | | ne}, | | | | | | | GI issues | | +-----------+-----------+-----------+-----------+-----------+-----------+ | 2. **Pen | Disrupts | Infection | Known | n/v, | Penicilli | | icillins* | cell wall | s | allergy, | diarrhea, | n | | * | synthesis | caused by | specific | abdominal | G, V | | | , | [gram-pos | reactions | pain. | ,Amoxicil | | | leading | itive]{.u | to | [Interact | lin, | | | to | nderline} | penicilli | s | | | | bacterial | bacteria | ns | with oral | Piperacil | | | lysis | (e.g., | | contracep | lin | | | | Strepto[c | | tives]{.u | | | | | occus]{.u | | nderline} | | | | | nderline} | | , | | | | | ) | | decrease | | | | | -- part | | efficienc | | | | | of normal | | y | | | | | flora. | | | | +-----------+-----------+-----------+-----------+-----------+-----------+ | 3. **Cep | Similar | Surgical | Allergy | Mild | Cefazolin | | halospori | to | prophylax | (potentia | diarrhea, | , | | ns** | penicilli | is, | l | abdominal | | | | ns, | skin | cross-rea | cramps, | Cefuroxim | | | disrupts | infection | ctivity | rash. | e, | | | cell wall | s, | with | [Interact | | | | synthesis | broad | penicilli | s | Ceftriaxo | | | | spectrum, | ns) | with oral | ne | | | | have 5 | | contracep | | | | | generatio | | tives]{.u | | | | | ns. | | nderline} | | | | | | | , | | +-----------+-----------+-----------+-----------+-----------+-----------+ | 4. **Car | [Broadest | [Complica | [risk for | mild | Meropenem | | bapenems* | spectrum | ted | seizures] | toxicity | | | * | of | infection | {.underli | | | | | all]{.und | s | ne} | | | | | erline}, | in | with | | | | | disrupts | hospitali | inappropr | | | | | cell wall | zed | iate | | | | | synthesis | patients] | dosage. | | | | | | {.underli | | | | | | | ne} | | | | +-----------+-----------+-----------+-----------+-----------+-----------+ | 5. **Mac | Inhibits | [Strep | Known | [Neurotox | Erythromy | | rolides** | protein | infection | drug | icity, | cin\*, | | | synthesis | s, | allergy | GI | Azithromy | | | | STDs]{.un | | effects | cin, | | | | derline} | | (with | Clarithro | | | | (e.g., | | erythromy | mycin, | | | | syphilis, | | in),]{.un | | | | | gonorrhea | | derline} | [Fidaxomi | | | | ) | | cardiac | cin | | | | | | arrhythmi | (Dificid) | | | | | | as | -]{.under | | | | | | [(QT]{.un | line} | | | | | | derline} | new, for | | | | | | prolongat | C diff | | | | | | ion) | diarrhea, | | | | | | | narrow | | | | | | | spectrum | +-----------+-----------+-----------+-----------+-----------+-----------+ | 6. **Tet | Inhibits | [Broad | [Pregnanc | [GI | Doxycycli | | racycline | protein | spectrum] | y, | upset, | ne, | | s** | synthesis | {.underli | children | tooth | Minocycli | | | | ne} | \< 8 | discolora | ne, | | | | (e.g., | years]{.u | tion]{.un | | | | | chlamydia | nderline} | derline} | Tigecycli | | | | , | | in | ne | | | | Lyme | | babies, | | | | | disease) | | fetal | | | | | | | skeletal | | | | | | | developme | | | | | | | nt | | | | | | | issues | | +-----------+-----------+-----------+-----------+-----------+-----------+ | 7. **Ami | Disrupts | [For the | Known | [**Nephro | Gentamici | | noglycosi | bacterial | most | allergy | toxicity* | n, | | des** | cell wall | serious | | * | Streptomy | | | synthesis | infection | | (check | cin, | | | | s]{.under | | creatinin | | | | | line} | | e), | Amikacin | | | | (mostly | | **ototoxi | | | | | gram-nega | | city**]{. | | | | | tive) | | underline | | | | | [very | | } | | | | | potent]{. | | | | | | | underline | | | | | | | } | | | | +-----------+-----------+-----------+-----------+-----------+-----------+ | 8. **Flu | Alters | UTIs, | Known | Photosens | Ciproflox | | oroquinol | bacterial | respirato | drug | itivity, | acin, | | ones** | DNA, | ry | allergy | [tendonit | Levofloxa | | | causing | infection | | is/ruptur | cin, | | | cell | s | | e]{.under | Moxifloxa | | | death. | | | line} | cin | | | [Potent | | | (d/t | | | | broad | | | affinity | | | | spectrum, | | | to | | | | good oral | | | connectiv | | | | absoption | | | e | | | | ]{.underl | | | tissue) | | | | ine} | | | | | +-----------+-----------+-----------+-----------+-----------+-----------+ | 9. **Mis | Varies | Complicat | Drug | Varies by | Clindamyc | | cellaneou | (e.g., | ed | allergy | drug | in, | | s** | protein | UTIs, | | | Metronida | | | synthesis | mainly | | | zole, | | | inhibitio | | | | Nitrofura | | | n, | | | | ntoin, | | | DNA | | | | Vancomyci | | | interfere | | | | n | | | nce) | | | | | +-----------+-----------+-----------+-----------+-----------+-----------+ x8 ABX **Mnemonic:** \"Please Come Catch My Tiger And Save my Friends.\" **FYI: Synthesis = the "building of"** **1. Inhibit Cell Wall Synthesis** prevent bacteria from building or maintaining their cell wall. **Burst their cell wall.** **Bacterial lysis** +-----------------+-----------------+-----------------+-----------------+ | **Antibiotic | **Suffix** | **Examples** | **Indications** | | Class** | | | | +=================+=================+=================+=================+ | 1. **Penicilli | -cillin | Penicillin, | Infections | | ns** | | Amoxicillin, | caused by | | | | Ampicillin | susceptible | | | | | gram-positive | | | | | bacteria | +-----------------+-----------------+-----------------+-----------------+ | 2. **Cephalosp | -cef or -ceph | Cephalexin, | Skin | | orins** | | Cefuroxime | infections, | | | | | surgical | | | | | prophylaxis, | | | | | UTIs, broad | | | | | spectrum with | | | | | long life. | +-----------------+-----------------+-----------------+-----------------+ | **Have 5 | 1^st^ surgical | | | | generations** | prophylaxis, | | | | | [parenteral and | | | | | oral]{.underlin | | | | | e} | | | | | | | | | | 2^nd^ for (+) | | | | | gram and better | | | | | at (-) gram | | | | | than first | | | | | | | | | | 3^rd^ most | | | | | potent against | | | | | (-)ve gram. | | | | | [IV/IM. | | | | | Ceftriaxone | | | | | (Rocephin)- | | | | | surgical | | | | | prophylaxis & | | | | | ceftazidime | | | | | (Fortaz)]{.unde | | | | | rline} | | | | | | | | | | 4^th^ broad | | | | | spectrum | | | | | cefepime | | | | | hydrochloride | | | | | (Maxipime) | | | | | | | | | | 5^th^ interact | | | | | with [oral | | | | | contraceptives] | | | | | | | | | | and penicillins | | | +-----------------+-----------------+-----------------+-----------------+ | 3. **Carbapene | -enem | Meropenem | Complicated | | ms** | | | infections, | | | | | including | | | | | intra-abdominal | | | | | infections. | | | | | [Broadest | | | | | spectrum of | | | | | all, risk for | | | | | seizure d/t | | | | | incorrect | | | | | dosage.]{.under | | | | | line} | +-----------------+-----------------+-----------------+-----------------+ **2. Inhibit Protein Synthesis** prevent bacteria from building protein -- inhibits growth and reproduction -- "bacteriostatics" +-----------------+-----------------+-----------------+-----------------+ | **Antibiotic | **Suffix** | **Examples** | **Indications** | | Class** | | | | +=================+=================+=================+=================+ | 4. **Macrolide | -thromycin | Erythromycin\*, | "Strep" | | s** | | Azithromycin, | infections & | | | | | sexually | | | | [Fidaxomicin | transmitted | | | | (Dificid)-]{.un | diseases | | | | derline} | | | | | new | | +-----------------+-----------------+-----------------+-----------------+ | 5. **Tetracycl | -cycline | Doxycycline, | Broad | | ines** | | Minocycline | spectrum[, no | | | | | in Pregnancy, | | | | | children \< 8 | | | | | years -- | | | | | discoloration | | | | | of | | | | | teeth]{.underli | | | | | ne} | +-----------------+-----------------+-----------------+-----------------+ | 6. **Aminoglyc | -mycin or | Gentamicin, | Serious | | osides** | -micin | Amikacin | gram-negative | | | | | infections | | | | | mostly, very | | | | | potent, [IV/IM | | | | | only]{.underlin | | | | | e}- | | | | | poor oral | | | | | absoption. *"a | | | | | mean old | | | | | mycin"* | +-----------------+-----------------+-----------------+-----------------+ **3. Inhibit Bacterial Folate Synthesis** prevent bacteria from making Folate, which is essential for their replication +-----------------+-----------------+-----------------+-----------------+ | **Antibiotic | **Suffix** | **Examples** | **Indications** | | Class** | | | | +=================+=================+=================+=================+ | 7. **Sulfonami | -sulfa (not | Sulfamethoxazol | UTIs, broad | | des** | always) | e | spectrum | | | | (Septra) | | +-----------------+-----------------+-----------------+-----------------+ **4. Inhibit Bacterial DNA Synthesis** prevent bacteria from making DNA they need to survive/replicate-bacterial death +-----------------+-----------------+-----------------+-----------------+ | **Antibiotic | **Suffix** | **Examples** | **Indications** | | Class** | | | | +=================+=================+=================+=================+ | 8. **Fluoroqui | -floxacin | Ciprofloxacin, | [Complicated | | nolones** | | Levofloxacin | UTIs]{.underlin | | | | | e}, | | | | | respiratory, | | | | | bone, and joint | | | | | infections, | | | | | \*rupture | | | | | tendons & | | | | | tendonitis | +-----------------+-----------------+-----------------+-----------------+ FYI: Aminoglycosides are PRIMARILY bactericidals ! **x4 Miscellaneous Abx:** **Mnemonic:** \"Clowns Make Nice Vacations\" **Clindamycin (Dalacin C®)** \- **Action**: Bacteriostatic or bactericidal (depends on concentration and pathogen) ------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- \- **Mechanism**: Inhibits bacterial protein synthesis \- **Effective against**: Most gram positive bacteria and several anaerobes \- **Uses**: Chronic bone infections, genitourinary infections, intra-abdominal infections, and other serious infections \- **Contraindications**: Ulcerative colitis, enteritis, infants \< 30 days \- **Adverse Effects**: May cause pseudomembranous colitis (C. difficile infection) \- **Interactions**: Potential interaction with vecuronium bromide (neuromuscular blocking properties) **Metronidazole (Flagyl®)** \- **Mechanism**: Interferes with microbe DNA synthesis \- **Uses**: Intra-abdominal and gynecological infections \- **Contraindications**: Pregnancy (first trimester), avoid alcohol (causes cramps, n/v, h/a) \- **Adverse Effects**: Dizziness, h/a, GI pain, reversible neutropenia or thrombocytopenia \- **Drug Interactions**: many. Ex.Increased toxicity with lithium, benzodiazepines, cyclosporine, calcium channel blockers, warfarin **Nitrofurantoin (MacroBID®)** \- **Mechanism**: Disrupts bacterial wall and interferes with enzymes regulating bacterial metabolism \- **Primarily used for**: Urinary tract infections (UTIs) \- **Excretion**: Excreted by kidneys in active form; contraindicated in severe renal impairment \- **Form**: Only available orally; take with [food or milk] to minimize GI upset \- **Adverse Effects**: GI pain, dizziness, h/a, skin reactions; very rare fatal hepatotoxicity **Vancomycin hydrochloride (Vancomycin)** \- **Mechanism**: Bactericidal by binding to and destroying bacterial cell wall \- **Uses**: Treatment of choice for MRSA; oral vancomycin for antibiotic-induced colitis (C. difficile) \- **Adverse Effects**: Nephrotoxicity (particularly with other nephrotoxic drugs), red man syndrome (if IV dose given too quickly), thrombophlebitis (burning- d/t its potency) \- **Monitoring**: Must monitor blood levels (troughs) to ensure therapeutic levels and prevent toxicity; use cautiously in renal impairment - **Bacteriostatic** antibiotics **[inhibit the growth]** or replication of bacteria but don\'t kill them outright. They essentially \"stall\" bacterial growth, allowing the immune system to eliminate the bacteria. - **Bactericidal** antibiotics **[kill bacteria directly]**, leading to bacterial cell death. **[Intro]** - Antivirals- treat viruses - Antibiotics: treat bacterial infections Nosocomial infections: - \>48 hr after admission - 1 of the most causes of death in Canada - Difficult to treat, often drug-resistant and very virulent - MRSA (most common), VRE - Prevention: handwashing, disinfection, antiseptic use [C&S culture before treatment] - helps identify appropriate antibiotic, often broad-spectrum (effective against both gram + and - bacteria) are used in the meantime until C&S results are back. Gram -ve bacteria harder to kill [Common adverse effect for all antibiotics]: [diarrhea] so take them with food to prevent it and with [180 ml] of **water** for better absorption! [Check for allergic reaction q30 min at least. Better absorption of oral erythromycin when taken on an empty stomach but -- GI upset so don't] [Check Lab Markers:] Cr, urine output and GRF Helpful to prevent drug induced kidney injuries, for all abx but specially with aminoglycosides [Bacteria are highly adaptive & mutate which can lead to drug resistance] [important patients complete antibiotic treatments]