CHAPTER 7 Immunizations and Antimicrobials 7-2

Introduction This chapter covers ─Disease terminology/concepts ─Immunizations ─Antimicrobials ─Active and passive immunity ─Proper use of anti-infective agents 7-3

Disease –Not (dis) at ease –Body fails to function properly –Numerous causes –Many due to infections Sign –Objective –Measurable –Definitive (Continues) General Disease Terminology 7-4

Symptom –Subjective –Based on perception –Cannot be measured consistently Syndrome –Specific grouping of signs/symptoms (S/S) Diagnosis –Identification of disease (Continues) General Disease Terminology 7-5

Prognosis –Prediction of outcome of disease process Chief complaint –Concern that caused patient to seek medical help Etiology –Cause of disease (Continues) General Disease Terminology 7-6

Chronic condition –Long term Acute condition –Short term Remission –S/S of chronic disease may subside Relapse –Recurrence of S/S (Continues) General Disease Terminology 7-7

Exacerbation –Acute return of S/S Mortality –Measure of deaths attributed to specific disease Morbidity –Measure of disability/problems related to illness (Continues) General Disease Terminology 7-8

Epidemiology –Study of patterns, causes, spread, and effects of disease conditions (as determined by CDC) Endemic –Disease continually present within a specific population/region Epidemic –Disease occurs suddenly over specific geographic region (Continues) General Disease Terminology 7-9

General Disease Terminology Pandemic –Disease spreads throughout country or world- wide Reminder –It is better to prevent infections (such as with the use of vaccinations) than it is to treat them 7-10

Immunity Immune response produces antibodies against foreign microbes; inherited, acquired, induced Two broad types –Active: produced artificially (vaccination), or naturally (by contracting illness); long-lasting –Passive: administration of immunoglobulins; short-lived 7-11

Resistance occurrence may be due to –Antibiotic being destroyed by bacterial enzymes –Alteration in protein binding –Bacteria pumping antibiotic out, preventing it from destroying bacteria –Use of antibiotics when not needed Microbial Resistance Mechanisms 7-12

Antibacterial Drug Classification Bacteriostatic (inhibits replications) versus bactericidal (actively destroys bacteria) Broad-spectrum (effective against wide range of bacteria) versus narrow spectrum (used after specific organism is identified) Mechanism of action (commonly used to classify HIV medications) 7-13

Antibacterial Agents Refer to text for in-depth information concerning these agents Beta-lactams –Chemically related drugs –Inhibit materials needed for bacterial cell wall synthesis –For example, penicillins, cephalosporins, monobactams, carbacephems, carbapenems (Continues) 7-14

Antibacterial Agents Quinolones –Block two enzymes responsible for DNA growth, leading to breakage of DNA, which results in bactericidal activity –Prolonged use may cause superinfection –May cause tendon inflammation with rupture, even after medication is discontinued –Example of fluoroquinolones: ciprofloxacin (Continues) 7-15

Antibacterial Agents Aminoglycosides –Gram-negative coverage –Bactericidal –Dosage based on patient weight, renal function, and serum blood levels –May cause hearing loss and kidney failure –For example, amikacin, gentamicin, tobramycin (Continues) 7-16

Antibacterial Agents Glycopeptides –Bactericidal –Bind to portion of cell wall of microorganism, preventing cell wall development –Effective against gram-positive cocci –For example, vancomycin (monitor serum blood levels), telavancin (has long duration; given once daily) (Continues) 7-17

Antibacterial Agents Macrolides –Inhibit bacterial protein synthesis –Commonly used for pulmonary infections Tetracyclines –Broad spectrum –Bacteriostatic –Can cause permanent tooth discoloration (Continues) 7-18

Antibacterial Agents Folate inhibitors –Bacteriostatic –Primary use: treatment of UTIs –Sulfonamides Quinupristin-Dalfopristin –Inhibit bacterial protein synthesis –Bacteriostatic against gram-positive bacteria –Administered IV (Continues) 7-19

Antibacterial Agents Daptomycin –Bactericidal against gram-positive bacteria –Interferes with electrical activity of cell membrane –Useful in treatment of MRSA Clindamycin –Oral or IV –Active against gram-positive cocci, anaerobes (Continues) 7-20

Antibacterial Agents Metronidazole –Synthetic drug –Anaerobic spectrum of activity –Inhibits bacterial protein synthesis resulting in cell death –Part of cocktail drug to treat peptic ulcer disease (PUD) due to H. pylori 7-21

Antituberculosis Drugs TB –May affect lungs, kidneys, spine, and brain; air-borne transmission; chronic MDR TB –Due to suboptimal treatment (inappropriate drug doses/noncompliance) Treatment –For example, rifampin, isoniazid 7-22

Antivirals Vaccinations as prevention are preferred over treatment of viruses HSV –Treatment interferes with viral DNA synthesis, thus inhibiting viral replication –For example, valacyclovir Influenza –Prevention available through oral administration, inhalation, or vaccination (Continues) 7-23

Antivirals RSV –Major cause of lung disease in children –Treatment includes: ribavirin (inhibits RNA and DNA viruses) HCV –Most common blood-borne infection in the United States –Treatment examples: simeprevir, peginterferon (Continues) 7-24

Antivirals HIV –Infects cells of immune system –May progress to AIDS –Treatment: antiretrovirals that include several drug classes NRTIs (e.g., abacavir) NNRTIs (e.g., efavirenz) PIs (e.g., ritonavir) 7-25

Antifungal Agents Two basic forms of fungi in humans –Yeasts –Molds Fungi may be local or systemic Treatments prevent production of ergosterol Example: nystatin (oral or topical cream), miconazole (topical) 7-26

Summary Learn and understand general disease terminology to lay the foundation for discussions on infectious diseases Immunity –Passive –Active 7-27

Summary Microbial resistance mechanisms Anti-infective agents –Antibacterial agents –Antituberculosis drugs –Antivirals –Antifungals 7-28