Ant-Infective Drugs AntibacterialsAntibacterials Sulfa DrugsSulfa Drugs UrinaryUrinary Anti-tuberculosisAnti-tuberculosis AntifungalsAntifungals AntiviralsAntivirals

Antibacterial Drugs (Antibiotics & Antimicrobials) I. Increased Susceptibility to Infection A. Age B. Exposure C. Barrier Disruption D. Immune Defenses E. Circulation F. Nutrition

II. Identification of Organisms A. Microscope B. Gram Stain C. Culture D. Sensitivity III. Selection of Agent A. Location B. Organ Function (liver, kidney) C. Age (very young vs elderly) D. Pregnancy / Lactation E. Resistance (MRSA, VRE) F. Know allergy F. Know allergy

IV. Classification A. Action 1. Bacteriocidal 2. Bacteriostatic B. Spectrum 1. Broad 2. Narrow C. Antibiotic vs Antimicrobial C. Antibiotic vs Antimicrobial V. Actions

VI. Uses A. Primary Infection B. Secondary Infection C. Pre-op D. Prophylaxis E. Virus - no! F. Nosocomial infections

VII. Adverse Reactions A. Hypersensitivity/ Anaphylaxis B. Cross-Sensitivity C. Organ Toxicity - direct 1. Nephrotoxicity 2. Hepatotoxicity 3. Ototoxicity D. Hematological – blood dyscrasias E. Superinfection (indirect) F. Pain - phlebitis G. GI Distress H. Neurotonic

VII. Antibacterial Agents A. Penicillins B. Cephalosporins C. Tetracyclines D. Aminoglycosides E. Sulfonamides F. Miscellaneous: 1. Macrolides – erythromycin 1. Macrolides – erythromycin 2. Quinolones - Cipro 2. Quinolones - Cipro

X. Aminoglycosides(gentamycin) A. Action: gram neg & resistant B. Use 1. Urinary infections - resist 2. Pre-op for intestinal OR C. Adverse Effects: N/V/D 1. Nephrotoxicity - BUN 2. Ototoxicity - tinnitis D. Interactions: general anesthesia (Neuromuscular blocking )-flag (Neuromuscular blocking )-flag E. Peak & Trough levels (1hr/30min) E. Peak & Trough levels (1hr/30min)

IX. Cephalosporins – semi-synth A. Use - penicillin resistance B. Generations – broad spectrum 1. First - Keflin 2. Second - Ceclor 3. Third – Claforan (&4 th ) C. Cross sensitivity to penicillin D. Adverse reactions 1. Nephrotonic, rashes 2. GI Distress – food (NVD) 3. Injection pain - phlebitis

XIV. Macrolide -Erythromycin (E-mycin) A. Action - bacteriostatic B. Uses: oral therapy for penicillin substitute (least toxic) substitute (least toxic) 1. Respiratory infections 2. Soft tissue (gums) infections 3. Mycoplasms, chlamydia (STD) C. S/E: 1. N/V/D 2. Skin rash, superinfection D. Helicbacoter pylori D. Helicbacoter pylori E. Dangerous interactions – ie,Diflucan E. Dangerous interactions – ie,Diflucan

VIII.Penicillins – from fungus (treat Streph, Staph& Pseudo – resp, intestinal infections, helicobacter pylori) A. Overuse Penicillin B. Natural vs synthetic C. Routes: oral, IM, IVs D. Units, grams, mgs E. S/E: GI (NVD), allergy, superinf F. Example: Amoxicillin G. Inhibits estrogen – BCP/avoid alcohol G. Inhibits estrogen – BCP/avoid alcohol

XVII. Quinolones - Ciprofloxacin: Cipro A. Resistance by son Pseudomonas B. Use:UTI, Resp, GI C. S/E: some serous 1. N/V/D, rash 1. N/V/D, rash 2. Photosensitivity (toxic) 3. CNS: H/A, dizzy, tremor-caffeine 4. Crystalluria – drink fluids! 4. Crystalluria – drink fluids! 5. Collitis – in elderly 5. Collitis – in elderly 6. Cartilage damage in children 6. Cartilage damage in children 7. Tendon damage – no strenuous exercise 7. Tendon damage – no strenuous exercise D. Interactions: Many drugs!

XI. Tetracyclines (tetracycline) – broad spec A. Uses: (incr. resistance) uncommon 1. Alternative to penicillin 2. Richettsiae, Lyme, chr bronchitis B. Adverse effects: 1. N/V/D 2. Superinfection 3. Photosensitivity, rash 4. Discolored teeth, retarded bone 4. Discolored teeth, retarded bone C. Contraindications: binds to calcium & iron - not w/ food calcium & iron - not w/ food D. Pregnancy, under 8 yrs of age D. Pregnancy, under 8 yrs of age E. Outdated - nephrotoxic E. Outdated - nephrotoxic

XV. Chloramphenicol: A. Use: serious life-threatening infections (typhoid) & topical infections (typhoid) & topical ocular infections (toxic!) ocular infections (toxic!) B. S/E &Adverse reactions: 1. Fatal blood dyscrasias or bone marrow depression bone marrow depression 2. N/V/D 3. Superinfections C. Contraindic: Infants under 2 mos (Immature livers) (Immature livers)

XVI. Miscellaneous: (Toxic) A. Vancomycin - (MRSA) various A. Vancomycin - (MRSA) various 1. organ toxicities (oto, nephro) 1. organ toxicities (oto, nephro) 2. IV - necrosis 2. IV - necrosis B. Flagyl - antibacterial & B. Flagyl - antibacterial & antiprotozoan (Trichomonas) antiprotozoan (Trichomonas) – very toxic – very toxic 1. neurological 2. Avoid alcohol – disulfiram rx C. Cleocin (clindomycin)- C. Cleocin (clindomycin)- 1. Colitis (life treatening) – d/c if N/V/D N/V/D

Antivirals A. Natural immunity or vaccination B. Many viruses do not produce immunity & vaccines not available immunity & vaccines not available C. Viral infections 1. Herpes simplex I & II 2. Herpes zoster (shingles), chicken pox 3. Flu, cold 4. AIDS, hepatitis

D. Drugs: 1. Zovirax - cutaneous & genital Herpes, herpes zoster (acyclovir) Herpes, herpes zoster (acyclovir) 2. Zidovudine (AZT, Retrovir) - AIDS & CMV AIDS & CMV 3. Symmetrel (amantadine) – Flu 4. Tamiflu - inhalation 4. Tamiflu - inhalation E. Action - prohibits viral attachment or protein synthesis or protein synthesis F. S/E: N/V, lethargy, fatigue, H/A

XII. Sulfonamides (precursor to antibiotics) A. Use: limited 1. Non-obstr. UTI’s 2. Burns - topical B. Action - bacteriostatic C. Med’s: Bactrim, Septra (comb.), Silvadene (topical) Silvadene (topical) D. S/E: N/V/D, crystalluria (water), allergy, photosensitivity, blood allergy, photosensitivity, blood dyscrasias, yellow urine, hepatotoxic, dyscrasias, yellow urine, hepatotoxic, hypersensitivity hypersensitivity E. Steven-Johnson syndrome- rash F. Interactions: Coumadin, hypoglycemics F. Interactions: Coumadin, hypoglycemics

XVI. Macrodantin (Urinary Anti-infective) A. Use: Chronic UTI’s B. Not sulfonamide or antibiotic C. Action: does not achieve significant elevation of blood significant elevation of blood levels to be effective for systemic levels to be effective for systemic infections. infections. Interfers with bacterial multip in Interfers with bacterial multip in the urine. the urine. D. S/E: N/V/D, anorexia, neuritis respir.allergy (wheezing), dark urine respir.allergy (wheezing), dark urine

Antifungals A. Plant-like: yeasts or molds B. Systemic mycotic Infections 1. Serious 2. Immunosuppressed C. Dermatophytic - hair, nails, skin (athlete’s foot, ring worm) (athlete’s foot, ring worm) D. Candida albicans - superinfection

E. Meds: 1. Fungizone (amphotericin B) - systemic infections systemic infections 2. Griseofulvin - hair, skin, nails 3. Mycostatin (nystatin) candida 4. Diflucan – one dose med (fluconazole) F. Action: usually fungicidal G. Adverse Effects: 1. N/V/D 2. H/A & dry mouth H. Hospitalized for IV systemic trmt (serious side effects) (serious side effects)

XIII. Ioniazid: (INH - DOT therapy) A. Use - tuberculosis (mycobacterium) 1. Asymtomatic: 6-12 months 2. Active: 2-3 agents (6-9 mos+) B. Other first line agents: 1. Rifampin 2. Ethanbutol C. S/E or Adverse Rx: (ioniazid) 1. hepatotoxicity 2. N/V - give with food 3. Neuro - numbness, tingling (given with B6) (given with B6)