Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved. Microbiology: A Clinical Approach © Garland Science ANTIBIOTICS ANTIBIOTICS © CDC. - презентация

1 Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved. Microbiology: A Clinical Approach © Garland Science ANTIBIOTICS ANTIBIOTICS © CDC / Gilda L. Jones

2 Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved. WHY IS THIS IMPORTANT? Antibiotics have drastically reduced the number of deaths due to infection.Antibiotics have drastically reduced the number of deaths due to infection. They have changed the face of health care.They have changed the face of health care.

3 Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved. OVERVIEW

4 Anti-Infective Agents Antibiotics:SulfonamidesPenicillinsCephalosporinsTetracyclinesAminoglycosidesQuinolonesMacrolides

5 Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved. Antibiotics Medications used to treat bacterial infectionsMedications used to treat bacterial infections Ideally, before beginning antibiotic therapy, the suspected areas of infection should be cultured to identify the causative organism and potential antibiotic susceptibilities.Ideally, before beginning antibiotic therapy, the suspected areas of infection should be cultured to identify the causative organism and potential antibiotic susceptibilities.

6 Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved. HISTORICAL PERSPECTIVES The discovery of the first antibiotic was an accident.The discovery of the first antibiotic was an accident. –Alexander Fleming accidentally contaminated a plate with a fungus. –He observed a clearly defined region of no bacterial growth where the fungi had contaminated the plate. –The area around the fungus was eventually referred to as a zone of inhibition.

7 Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved. …HISTORICAL PERSPECTIVES It is estimated that over 80 million prescriptions are written in America each year.It is estimated that over 80 million prescriptions are written in America each year. 12,500 tons of antibiotics are produced annually.12,500 tons of antibiotics are produced annually. –25-50 % is fed to livestock to increase the rate of weight gain. From 1900 to 1980, mortality from infectious diseases dropped from 797 per 100,000 persons to 36 per 100,000 persons.From 1900 to 1980, mortality from infectious diseases dropped from 797 per 100,000 persons to 36 per 100,000 persons.

8 Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved. Antibiotics Empiric therapy: treatment of an infection before specific culture information has been reported or obtainedEmpiric therapy: treatment of an infection before specific culture information has been reported or obtained Prophylactic therapy: treatment with antibiotics to prevent an infection, as in intra- abdominal surgeryProphylactic therapy: treatment with antibiotics to prevent an infection, as in intra- abdominal surgery

9 Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved. Antibiotics Bactericidal: kill bacteriaBactericidal: kill bacteria Bacteriostatic: inhibit growth of susceptible bacteria, rather than killing them immediately; will eventually lead to bacterial deathBacteriostatic: inhibit growth of susceptible bacteria, rather than killing them immediately; will eventually lead to bacterial death

10 Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved. …ANTIBIOTIC TARGETS

11 Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved. Antibiotics: Sulfonamides One of the first groups of antibiotics sulfadiazinesulfadiazine sulfamethizolesulfamethizole sulfamethoxazolesulfamethoxazole sulfisoxazolesulfisoxazole

12 Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved. Sulfonamides: Mechanism of Action Bacteriostatic actionBacteriostatic action Prevent synthesis of folic acid required for synthesis of purines and nucleic acidPrevent synthesis of folic acid required for synthesis of purines and nucleic acid Does not affect human cells or certain bacteriathey can use preformed folic acidDoes not affect human cells or certain bacteriathey can use preformed folic acid

13 Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved. Sulfonamides: sulfamethoxazole Therapeutic Uses Azo-Gantanol Combined with phenazopyridine (an analgesic-anesthetic that affects the mucosa of the urinary tract).Combined with phenazopyridine (an analgesic-anesthetic that affects the mucosa of the urinary tract). Used to treat urinary tract infections (UTIs) and to reduce the pain associated with UTIs.Used to treat urinary tract infections (UTIs) and to reduce the pain associated with UTIs.Bactrim Combined with trimethoprim.Combined with trimethoprim. Used to treat UTIs, Pneumocystis carinii pneumonia, ear infections, bronchitis, gonorrhea, etc.Used to treat UTIs, Pneumocystis carinii pneumonia, ear infections, bronchitis, gonorrhea, etc.

14 Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved. Sulfonamides: sulfisoxazole Therapeutic Uses Azo-Gantrisin Combined with phenazopyridineCombined with phenazopyridine Used for UTIsUsed for UTIsPediazole Combined with erythromycinCombined with erythromycin Used to treat otitis mediaUsed to treat otitis media

15 Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved. Sulfonamides: Side Effects Body SystemEffect BloodHemolytic and aplastic anemia, thrombocytopenia IntegumentaryPhotosensitivity, exfoliative dermatitis, Stevens-Johnson syndrome, epidermal necrolysis

16 Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved. Sulfonamides: Side Effects Body SystemEffect GINausea, vomiting, diarrhea, pancreatitis OtherConvulsions, crystalluria, toxic nephrosis, headache, peripheral neuritis, urticaria

17 Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved. Antibiotics: Penicillins Natural penicillinsNatural penicillins Penicillinase-resistant penicillinsPenicillinase-resistant penicillins AminopenicillinsAminopenicillins Extended-spectrum penicillinsExtended-spectrum penicillins

18 Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved. Antibiotics: Penicillins Natural penicillins penicillin G, penicillin V potassiumpenicillin G, penicillin V potassium Penicillinase-resistant penicillins cloxacillin, dicloxacillin, methicillin, nafcillin, oxacillincloxacillin, dicloxacillin, methicillin, nafcillin, oxacillin

19 Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved. Antibiotics: Penicillins Aminopenicillins amoxicillin, ampicillin, bacampicillinamoxicillin, ampicillin, bacampicillin Extended-spectrum penicillins piperacillin, ticarcillin, carbenicillin, mezlocillinpiperacillin, ticarcillin, carbenicillin, mezlocillin

20 Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved. Antibiotics: Penicillins First introduced in the 1940sFirst introduced in the 1940s Bactericidal: inhibit cell wall synthesisBactericidal: inhibit cell wall synthesis Kill a wide variety of bacteriaKill a wide variety of bacteria Also called beta-lactamsAlso called beta-lactams

21 Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved. Antibiotics: Penicillins Bacteria produce enzymes capable of destroying penicillins.Bacteria produce enzymes capable of destroying penicillins. These enzymes are known as beta-lactamases.These enzymes are known as beta-lactamases. As a result, the medication is not effective.As a result, the medication is not effective.

22 Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved. Antibiotics: Penicillins Chemicals have been developed to inhibit these enzymes:Chemicals have been developed to inhibit these enzymes: –clavulanic acid –tazobactam –sulbactam These chemicals bind with beta-lactamase and prevent the enzyme from breaking down the penicillinThese chemicals bind with beta-lactamase and prevent the enzyme from breaking down the penicillin

23 Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved. Antibiotics: Penicillins Penicillin-beta-lactamase inhibitor combination drugs:Penicillin-beta-lactamase inhibitor combination drugs: –ampicillin + sulbactam = Unasyn –amoxicillin + clavulanic acid = Augmentin –ticarcillin + clavulanic acid = Timentin –piperacillin + tazobactam = Zosyn

24 Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved. Penicillins: Mechanism of Action Penicillins enter the bacteria via the cell wall.Penicillins enter the bacteria via the cell wall. Inside the cell, they bind to penicillin-binding protein.Inside the cell, they bind to penicillin-binding protein. Once bound, normal cell wall synthesis is disrupted.Once bound, normal cell wall synthesis is disrupted. Result: bacteria cells die from cell lysis.Result: bacteria cells die from cell lysis. Penicillins do not kill other cells in the body.Penicillins do not kill other cells in the body.

25 Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved. Penicillins: Therapeutic Uses Prevention and treatment of infections caused by susceptible bacteria, such as:Prevention and treatment of infections caused by susceptible bacteria, such as: –gram-positive bacteria –Streptococcus, Enterococcus, Staphylococcus species

26 Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved. Penicillins: Adverse Effects Allergic reactions occur in 0.7% – 8% of treatmentsAllergic reactions occur in 0.7% – 8% of treatments –urticaria, pruritus, angioedema 10% of allergic reactions are life-threatening10% of allergic reactions are life-threateningand 10% of these are fatal10% of these are fatal

27 Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved. Penicillins: Side Effects Common side effects:Common side effects: –nausea, vomiting, diarrhea, abdominal pain Other side effects are less commonOther side effects are less common

28 Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved. Antibiotics: Cephalosporins First GenerationFirst Generation Second GenerationSecond Generation Third GenerationThird Generation Fourth GenerationFourth Generation

29 Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved. Antibiotics: Cephalosporins Semisynthetic derivatives from a fungusSemisynthetic derivatives from a fungus Structurally and pharmacologically related to penicillinsStructurally and pharmacologically related to penicillins Bactericidal actionBactericidal action Broad spectrumBroad spectrum Divided into groups according to their antimicrobial activityDivided into groups according to their antimicrobial activity

30 Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved. Cephalosporins: First Generation cefadroxilcefadroxil cephalexincephalexin cephradinecephradine cefazolincefazolin cephalothincephalothin cephapirincephapirin –Good gram-positive coverage –Poor gram-negative coverage

31 Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved. Cephalosporins: First Generation cefazolincephalexin (Ancef and Kefzol)(Keflex and Keftab) IV and POPO used for surgical prophylaxis, URIs, otitis media

32 Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved. Cephalosporins: Second Generation cefaclor cefonicidcefaclor cefonicid cefprozil ceforanidecefprozil ceforanide cefamandole cefmetazolecefamandole cefmetazole cefoxitin cefotetancefoxitin cefotetan cefuroximecefuroxime –Good gram-positive coverage –Better gram-negative coverage than first generation

33 Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved. Cephalosporins: Second Generation Cefoxitincefuroxime (Mefoxin)(Kefurox and Ceftin) IV and IMPO Used prophylactically forSurgical prophylaxis abdominal or colorectal surgeriesDoes not kill Also kills anaerobesanaerobes

34 Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved. Cephalosporins: Third Generation cefixime ceftizoximecefixime ceftizoxime cefpodoxime proxetil ceftriaxonecefpodoxime proxetil ceftriaxone cefoperazone ceftazidimecefoperazone ceftazidime cefotaxime moxalactamcefotaxime moxalactam –Most potent group against gram-negative –Less active against gram-positive

35 Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved. Cephalosporins: Third Generation cefixime (Suprax) Only oral third-generation agentOnly oral third-generation agent Best of available oral cephalosporins against gram-negativeBest of available oral cephalosporins against gram-negative Tablet and suspensionTablet and suspension ceftriaxone (Rocephin) IV and IM, long half-life, once-a-day dosingIV and IM, long half-life, once-a-day dosing Easily passes meninges and diffused into CSF to treat CNS infectionsEasily passes meninges and diffused into CSF to treat CNS infections

36 Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved. Cephalosporins: Third Generation ceftazidime (Ceptaz, Fortaz, Tazidime, Tazicef) IV and IMIV and IM Excellent gram-negative coverageExcellent gram-negative coverage Used for difficult-to-treat organisms such as Pseudomonas spp.Used for difficult-to-treat organisms such as Pseudomonas spp. Eliminated renally instead of biliary routeEliminated renally instead of biliary route Excellent spectrum of coverageExcellent spectrum of coverage

37 Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved. Cephalosporins: Fourth Generation cefepime (Maxipime) Newest cephalosporin agents.Newest cephalosporin agents. Broader spectrum of antibacterial activity than third generation, especially against gram-positive bacteria.Broader spectrum of antibacterial activity than third generation, especially against gram-positive bacteria.

38 Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved. Cephalosporins: Side Effects similar to penicillinssimilar to penicillins

39 Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved. Antibiotics: Tetracyclines demeclocycline (Declomycin)demeclocycline (Declomycin) oxytetracyclineoxytetracycline tetracyclinetetracycline doxycycline (Doryx, Doxy-Caps, Vibramycin)doxycycline (Doryx, Doxy-Caps, Vibramycin) minocyclineminocycline

40 Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved. Antibiotics: Tetracyclines Natural and semi-syntheticNatural and semi-synthetic Obtained from cultures of StreptomycesObtained from cultures of Streptomyces Bacteriostaticinhibit bacterial growthBacteriostaticinhibit bacterial growth Inhibit protein synthesisInhibit protein synthesis Stop many essential functions of the bacteriaStop many essential functions of the bacteria

41 Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved. Antibiotics: Tetracyclines Bind to Ca 2+ and Mg 2+ and Al 3+ ions to form insoluble complexesBind to Ca 2+ and Mg 2+ and Al 3+ ions to form insoluble complexes Thus, dairy products, antacids, and iron salts reduce absorption of tetracyclinesThus, dairy products, antacids, and iron salts reduce absorption of tetracyclines

42 Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved. Tetracyclines: Therapeutic Uses Wide spectrum:Wide spectrum: –gram-negative, gram-positive, protozoa, Mycoplasma, Rickettsia, Chlamydia, syphilis, Lyme disease Demeclocycline is also used to treat SIADH, and pleural and pericardial effusionsDemeclocycline is also used to treat SIADH, and pleural and pericardial effusions

43 Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved. Tetracyclines: Side Effects Strong affinity for calcium Discoloration of permanent teeth and tooth enamel in fetuses and childrenDiscoloration of permanent teeth and tooth enamel in fetuses and children May retard fetal skeletal development if taken during pregnancyMay retard fetal skeletal development if taken during pregnancy

44 Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved. Tetracyclines: Side Effects Alteration in intestinal flora may result in: Superinfection (overgrowth of nonsusceptible organisms such as Candida)Superinfection (overgrowth of nonsusceptible organisms such as Candida) DiarrheaDiarrhea Pseudomembranous colitisPseudomembranous colitis

45 Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved. Tetracyclines: Side Effects May also cause: Vaginal moniliasisVaginal moniliasis Gastric upsetGastric upset EnterocolitisEnterocolitis Maculopapular rashMaculopapular rash

46 Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved. Antibiotics: Aminoglycosides gentamicin (Garamycin)gentamicin (Garamycin) kanamycinkanamycin neomycinneomycin streptomycinstreptomycin tobramycintobramycin amikacin (Amikin)amikacin (Amikin) netilmicinnetilmicin

47 Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved. Aminoglycosides Natural and semi-syntheticNatural and semi-synthetic Produced from StreptomycesProduced from Streptomyces Poor oral absorption; no PO formsPoor oral absorption; no PO forms Very potent antibiotics with serious toxicitiesVery potent antibiotics with serious toxicities BactericidalBactericidal Kill mostly gram-negative; some gram-positive alsoKill mostly gram-negative; some gram-positive also

48 Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved. Aminoglycosides Used to kill gram-negative bacteria such as Pseudomonas spp., E. coli, Proteus spp., Klebsiella spp., Serratia spp.Used to kill gram-negative bacteria such as Pseudomonas spp., E. coli, Proteus spp., Klebsiella spp., Serratia spp. Often used in combination with other antibiotics for synergistic effect.Often used in combination with other antibiotics for synergistic effect.

49 Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved. Aminoglycosides Three most common (systemic): gentamicin, tobramycin, amikacinThree most common (systemic): gentamicin, tobramycin, amikacin Cause serious toxicities:Cause serious toxicities: –Nephrotoxicity (renal failure) –Ototoxicity (auditory impairment and vestibular [eighth cranial nerve]) Must monitor drug levels to prevent toxicitiesMust monitor drug levels to prevent toxicities

50 Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved. Aminoglycosides: Side Effects Ototoxicity and nephrotoxicity are the most significant HeadacheHeadache ParesthesiaParesthesia Neuromuscular blockadeNeuromuscular blockade DizzinessDizziness VertigoVertigo Skin rashSkin rash FeverFever SuperinfectionsSuperinfections

51 Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved. Antibiotics: Quinolones ciprofloxacin (Cipro)ciprofloxacin (Cipro) enoxacin (Penetrex)enoxacin (Penetrex) lomefloxacin (Maxaquin)lomefloxacin (Maxaquin) norfloxacin (Noroxin)norfloxacin (Noroxin) ofloxacin (Floxin)ofloxacin (Floxin)

52 Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved. Quinolones Excellent oral absorptionExcellent oral absorption Absorption reduced by antacidsAbsorption reduced by antacids First oral antibiotics effective against gram-negative bacteriaFirst oral antibiotics effective against gram-negative bacteria

53 Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved. Quinolones: Mechanism of Action BactericidalBactericidal Effective against gram-negative organisms and some gram-positive organismsEffective against gram-negative organisms and some gram-positive organisms Alter DNA of bacteria, causing deathAlter DNA of bacteria, causing death Do not affect human DNADo not affect human DNA

54 Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved. Quinolones: Therapeutic Uses Lower respiratory tract infectionsLower respiratory tract infections Bone and joint infectionsBone and joint infections Infectious diarrheaInfectious diarrhea Urinary tract infectionsUrinary tract infections Skin infectionsSkin infections Sexually transmitted diseasesSexually transmitted diseases

55 Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved. Quinolones: Side Effects Body SystemEffects CNSheadache, dizziness, fatigue, depression, restlessness GInausea, vomiting, diarrhea, constipation, thrush, increased liver functionstudies

56 Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved. Quinolones: Side Effects Body SystemEffects Integumentaryrash, pruritus, urticaria, flushing, photosensitivity (with lomefloxacin) Otherfever, chills, blurred vision, tinnitus

57 Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved. Antibiotics: Macrolides erythromycinerythromycin azithromycin (Zithromax)azithromycin (Zithromax) clarithromycin (Biaxin)clarithromycin (Biaxin) dirithromycindirithromycin troleandomycintroleandomycin –bactericidal action

58 Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved. Instructors may wish to insert EIC Image #102: Erythromycin Formulations

59 Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved. Macrolides: Therapeutic Uses Strep infections Streptococcus pyogenes (group A beta-hemolytic streptococci)Streptococcus pyogenes (group A beta-hemolytic streptococci) Mild to moderate URI Haemophilus influenzaeHaemophilus influenzae Spirochetal infections Syphilis and Lyme diseaseSyphilis and Lyme disease Gonorrhea, Chlamydia, Mycoplasma

60 Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved. Macrolides: Side Effects GI effects, primarily with erythromycin: nausea, vomiting, diarrhea, hepatotoxicity, flatulence, jaundice, anorexianausea, vomiting, diarrhea, hepatotoxicity, flatulence, jaundice, anorexia Newer agents, azithromycin and clarithromycin: fewer side effects, longer duration of action, better efficacy, better tissue penetrationNewer agents, azithromycin and clarithromycin: fewer side effects, longer duration of action, better efficacy, better tissue penetration

61 Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved. Antibiotics: Nursing Implications Before beginning therapy, assess drug allergies; hepatic, liver, and cardiac function; and other lab studies.Before beginning therapy, assess drug allergies; hepatic, liver, and cardiac function; and other lab studies. Be sure to obtain thorough patient health history, including immune status.Be sure to obtain thorough patient health history, including immune status. Assess for conditions that may be contraindications to antibiotic use, or that may indicate cautious use.Assess for conditions that may be contraindications to antibiotic use, or that may indicate cautious use. Assess for potential drug interactions.Assess for potential drug interactions.

62 Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved. Antibiotics: Nursing Implications It is ESSENTIAL to obtain cultures from appropriate sites BEFORE beginning antibiotic therapy.It is ESSENTIAL to obtain cultures from appropriate sites BEFORE beginning antibiotic therapy.

63 Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved. Antibiotics: Nursing Implications Patients should be instructed to take antibiotics exactly as prescribed and for the length of time prescribed; they should not stop taking the medication early when they feel better.Patients should be instructed to take antibiotics exactly as prescribed and for the length of time prescribed; they should not stop taking the medication early when they feel better. Assess for signs and symptoms of superinfection: fever, perineal itching, cough, lethargy, or any unusual discharge.Assess for signs and symptoms of superinfection: fever, perineal itching, cough, lethargy, or any unusual discharge.

64 Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved. Antibiotics: Nursing Implications For safety reasons, check the name of the medication carefully since there are many agents that sound alike or have similar spellings.For safety reasons, check the name of the medication carefully since there are many agents that sound alike or have similar spellings.

65 Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved. Antibiotics: Nursing Implications Each class of antibiotics has specific side effects and drug interactions that must be carefully assessed and monitored.Each class of antibiotics has specific side effects and drug interactions that must be carefully assessed and monitored. The most common side effects of antibiotics are nausea, vomiting, and diarrhea.The most common side effects of antibiotics are nausea, vomiting, and diarrhea. All oral antibiotics are absorbed better if taken with at least 6 to 8 ounces of water.All oral antibiotics are absorbed better if taken with at least 6 to 8 ounces of water.

66 Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved. Antibiotics: Nursing Implications Sulfonamides Should be taken with at least 2400 mL of fluid per day, unless contraindicated.Should be taken with at least 2400 mL of fluid per day, unless contraindicated. Due to photosensitivity, avoid sunlight and tanning beds.Due to photosensitivity, avoid sunlight and tanning beds. These agents reduce the effectiveness of oral contraceptives.These agents reduce the effectiveness of oral contraceptives.

67 Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved. Antibiotics: Nursing Implications Penicillins Any patient taking a penicillin should be carefully monitored for an allergic reaction for at least 30 minutes after its administration.Any patient taking a penicillin should be carefully monitored for an allergic reaction for at least 30 minutes after its administration. The effectiveness of oral penicillins is decreased when taken with caffeine, citrus fruit, cola beverages, fruit juices, or tomato juice.The effectiveness of oral penicillins is decreased when taken with caffeine, citrus fruit, cola beverages, fruit juices, or tomato juice.

68 Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved. Antibiotics: Nursing Implications Cephalosporins Orally administered forms should be given with food to decrease GI upset, even though this will delay absorption.Orally administered forms should be given with food to decrease GI upset, even though this will delay absorption. Some of these agents may cause an Antabuse-like reaction when taken with alcohol.Some of these agents may cause an Antabuse-like reaction when taken with alcohol.

69 Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved. Antibiotics: Nursing Implications Tetracyclines Milk products, iron preparations, antacids, and other dairy products should be avoided because of the chelation and drug-binding that occurs.Milk products, iron preparations, antacids, and other dairy products should be avoided because of the chelation and drug-binding that occurs. All medications should be taken with 6 to 8 ounces of fluid, preferably water.All medications should be taken with 6 to 8 ounces of fluid, preferably water. Due to photosensitivity, avoid sunlight and tanning beds.Due to photosensitivity, avoid sunlight and tanning beds.

70 Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved. Antibiotics: Nursing Implications Aminoglycosides Monitor peak and trough blood levels of these agents to prevent nephrotoxicity and ototoxicity.Monitor peak and trough blood levels of these agents to prevent nephrotoxicity and ototoxicity. Symptoms of ototoxicity include dizziness, tinnitus, and hearing loss.Symptoms of ototoxicity include dizziness, tinnitus, and hearing loss. Symptoms of nephrotoxicity include urinary casts, proteinuria, and increased BUN and serum creatinine levels.Symptoms of nephrotoxicity include urinary casts, proteinuria, and increased BUN and serum creatinine levels.

71 Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved. Antibiotics: Nursing Implications Quinolones Should be taken with at least 3 L of fluid per day, unless otherwise specifiedShould be taken with at least 3 L of fluid per day, unless otherwise specified

72 Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved. Antibiotics: Nursing Implications Macrolides These agents are highly protein-bound and will cause severe interactions with other protein-bound drugs.These agents are highly protein-bound and will cause severe interactions with other protein-bound drugs. The absorption of oral erythromycin is enhanced when taken on an empty stomach, but because of the high incidence of GI upset, many agents are taken after a meal or snack.The absorption of oral erythromycin is enhanced when taken on an empty stomach, but because of the high incidence of GI upset, many agents are taken after a meal or snack.

73 Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved. Antibiotics: Nursing Implications Monitor for therapeutic effects: Disappearance of fever, lethargy, drainage, and rednessDisappearance of fever, lethargy, drainage, and redness