1. Chapter 17 Anti-Infective Drugs

2. Copyright © 2007 by Thomson Delmar Learning. ALL RIGHTS RESERVED.2 Treatment by Anti-Infectives Need to identify causative organism Determine sensitivity Culture and sensitivity –24-48 hours Broad spectrum antibiotics

3. Copyright © 2007 by Thomson Delmar Learning. ALL RIGHTS RESERVED.3 Resistance What is resistance? Misuse of antibiotics Nosocomial infections MRSA (Methicillin-Resistant Staphylococcus Aureus) VRE (Vancomycin-Resistant Enterococcus)

4. Copyright © 2007 by Thomson Delmar Learning. ALL RIGHTS RESERVED.4 Strategies to Prevent Resistance Appropriate use of antibiotics Accurate diagnosis Targeted treatment of bacterial infections Preventive measures

5. Copyright © 2007 by Thomson Delmar Learning. ALL RIGHTS RESERVED.5 Selection of Anti-Infective Drugs Status of hepatic and/or renal function Age of patient Pregnancy or lactation Likelihood of organisms developing resistance Know allergies

6. Copyright © 2007 by Thomson Delmar Learning. ALL RIGHTS RESERVED.6 Adverse Reactions Hypersensitivity Anaphylaxis Direct toxicity Indirection toxicity

7. Copyright © 2007 by Thomson Delmar Learning. ALL RIGHTS RESERVED.7 Aminoglycosides Gram-negative and gram-positive bacteria Toxicity Peak and trough levels Serious side effects Contraindications Interactions Patient education

8. Copyright © 2007 by Thomson Delmar Learning. ALL RIGHTS RESERVED.8 Cephalosporins Semisynthetic Broad-spectrum First, second, third, or fourth generation Side effects Contraindication or extreme caution

9. Copyright © 2007 by Thomson Delmar Learning. ALL RIGHTS RESERVED.9 Cephalosporins Interactions Patient education

10. Copyright © 2007 by Thomson Delmar Learning. ALL RIGHTS RESERVED.10 Macrolides Used when there is allergy to penicillin Less toxicity Side effects Contraindications Interactions Patient education

11. Copyright © 2007 by Thomson Delmar Learning. ALL RIGHTS RESERVED.11 Penicillins Produced from fungus Uses Semisynthetic penicillins Serious side effects Contraindications or extreme cautions

12. Copyright © 2007 by Thomson Delmar Learning. ALL RIGHTS RESERVED.12 Penicillins Interactions Patient education

13. Copyright © 2007 by Thomson Delmar Learning. ALL RIGHTS RESERVED.13 Quinolones When used Increased resistance Side effects Contraindications or caution Interactions Patient education

14. Copyright © 2007 by Thomson Delmar Learning. ALL RIGHTS RESERVED.14 Tetracyclines Broad-spectrum When used Side effects Contraindications Interactions Patient education

15. Copyright © 2007 by Thomson Delmar Learning. ALL RIGHTS RESERVED.15 Antifungals Amphotericin B Fluconazole Griseofulvin Nystatin Patient education

16. Copyright © 2007 by Thomson Delmar Learning. ALL RIGHTS RESERVED.16 Antituberculosis Agents Treat asymptomatic infection Treat active clinical tuberculosis CDC recommendations Side effects Contraindications or caution Interactions Patient education

17. Copyright © 2007 by Thomson Delmar Learning. ALL RIGHTS RESERVED.17 Other Anti-Infectives Clindamycin Metronidazole Vancomycin

18. Copyright © 2007 by Thomson Delmar Learning. ALL RIGHTS RESERVED.18 Antivirals Acyclovir Amantadine Neuraminidase inhibitors Ribavirin

19. Copyright © 2007 by Thomson Delmar Learning. ALL RIGHTS RESERVED.19 HIV/AIDS Treatment Incurable with current medications Suppression of viral load Restore and/or preserve immunologic function Improve quality of life Reduce HIV-related morbidity and mortality

20. Copyright © 2007 by Thomson Delmar Learning. ALL RIGHTS RESERVED.20 HIV/AIDS Medications Anti-retroviral protease inhibitors Nucleoside reverse transcriptase inhibitors Non-nucleoside reverse transcriptase inhibitors Treatment of opportunistic infections

21. Copyright © 2007 by Thomson Delmar Learning. ALL RIGHTS RESERVED.21 Sulfonamides Among oldest anti-infectives Increasing resistance Used in combination with other drugs Side effects Contraindications Interactions Patient education

22. Copyright © 2007 by Thomson Delmar Learning. ALL RIGHTS RESERVED.22 Urinary Anti-Infectives Usually bacteriostatic instead of bactericidal Nitrofurantoin (Furadantin & Macrodantin) Side effects Contraindication or caution

23. Copyright © 2007 by Thomson Delmar Learning. ALL RIGHTS RESERVED.23 Urinary Anti-Infectives Interactions Patient education