drugs for bacterial disorders...
TRANSCRIPT
DRUGS FOR
BACTERIAL
INFECTIONS Chapter 34
A Little Terminology
Pathogen/ pathogenic-
able to cause disease
Parasite –
an organism living in, with, or on another
organism
Infestation- to be invaded with worms
What are Microbes?
Are visible only with a microscope
Most are SIMPLE, usually single celled forms of life
Come in many shapes and sizes
Some are harmless, however some are pathogenic and cause infection and disease
More Disease Terminology ETIOLOGY- What caused the disease?
INCIDENCE – The rate or range of occurrence- number of new cases of a disease in a population over a period of time How fast is it spreading?
PREVALENCE- the % of a population that is affected with a particular disease at a given time. How widespread is the occurrence
SEVERITY/DURATION CLASSIFICATION
A. Acute – Usually severe, short term
B. Chronic – less severe, continuous
C. Subacute – somewhere between
More Disease Terminology
VIRULENCE- What is the microorganism’s ability to cause disease;how strong is it?
IDIOPATHIC – having no known cause
COMMUNICABLE-Transmittable from person to person.
A. Epidemic-Many people affected
B. Endemic-Lesser extent/ continuous
C. Pandemic- country/world wide
Bacteria
BACTERIA-
Single celled, lack a nucleus
Found everywhere, different types
Classified by shape, O2 need, Gram stain result
Requirements for life vary, reproduce q20min
Anaerobic – no oxygen needed to grow
Aerobic- requires oxygen for growth
Have cell walls
Spores- resistant forms, tolerate adverse cond.
Flagella- appendages allow bacteria to swim
Some bacteria can form toxins (poisons)
CULTURE AND SENSITIVITY
CULTURE: The body secretion is transferred onto a medium in which it can grow.
SENSITIVITY: test performed to determine the best antibiotic which can kill or alter the growth of microorganisms.
BACTERIAL DISORDERS
Bacteria can cause many disorders (see table in Adam)
Medications have been developed to treat many of them
BACTERIA can replicate extremely rapidly
During this replication genetic mix-ups can occur- causing mutations. Most of these mutations die off but many live to become tougher than their bacterial counterparts- and can resist the medications that were given to kill off the original organism
Medication to Tx Bacterial Infections
Names used interchangeably:
Anti-infective
Antibiotic
Antimicrobial
Antibacterial
They may be classified according to their
chemical class: cell wall inhibitors, protein
synthesis inhibitors; folic acid inhibitors;
and reverse transcriptase inhibitors
IMPORTANT TERMS
BACTERIOCIDAL: meds that actually kill
bacteria
BACTERIOSTATIC: meds that slow growth
of bacteria so body’s natural defenses can kill
bacteria
NOSOCOMIAL INFECTION: now
called Hospital Acquired Infection
•A preventable infection acquired
by patient through contact with
contaminated articles or infected
people while
hospitalized.
The organisms are often
resistant to common
antibiotics and can be life-
threatening
The primary reason for a hospital acquired
infections and the spread of infection is
NOT WASHING HANDS PROPERLY
Broad Spectrum Antibiotics
C&S results often take several days
When therapy is needed immediately and the
pathogen can not be identified patients are
given a broad spectrum antibiotic
They have activity against a wide range of
disease-causing bacteria. Acts against both
Gram-positive and Gram-negative bacteria.
Can Kill Normal Flora
Drug Resistant Bugs!
Resistant to the antibiotics commonly used
These resistant organisms are killing 100,000
or more American patients each year
Methicillin-resistant Staphylococcus aureus
(MRSA)
Newer Bug!, Carbapenem-resistant
Klebsiella pneumoniae (CRKP)
C. Diff- Clostridium difficle
VRE- Vancomycin Resistant Enterococci
PENICILLINS Old School- reliable, safe and effective
1ST MASS-PRODUCED ANTIBIOTIC
Cell wall inhibitors-weakens the cell wall
Adverse effects are minor
Most serious S.E. is allergy (rash, pruritis, fever and possible anaphlaxic reaction)
More people allergic to it than any other antibiotic
Some examples:
Penicillin G; Amoxicllin; Ampicillin
Works well with Gram + bacteria
Tx pneumonia, meningitis, skin and bone dx
TEACHING r/t PENICILLIN
Complete the entire rx’d treatment even if feeling better!
Don’t take with acidic liquid (juice) take with full glass of water
Might decrease Birth Control effectiveness
Wear an ID badge!
Don’t breast feed while on the med
CEPHALOSPORINS It is the largest class of antibiotics (more than 20)
Bacteriocidal—inhibit bacterial cell-wall synthesis
MOST COMMON SE IS AN ALLERGIC REACTION
Primary use is to tx Gram Neg infections and those allergic to PCN
Classified by generation 1-4. Examples: 1ST GENERATION
CEFAZOLIN (KEFZOL)
2ND GENERATION
CEFOTETAN (CEFOTAN)
3RD GENERATION
CEFTRIAXONE (ROCEPHIN)
4TH GENERATION
CEFEPIME (MAXIPIME)
TEACHING r/t CEPHALOSPORINS
Eat yogurt like products to suppress GI-related superinfections
Avoid alcohol ( may give an antabuse like reaction)
Caution with bleeding disorders & patients taking NSAIDS (may affect platelet inhibition and prothrombin time
Report flu like symptoms, seizures, dec urine output, hearing loss, rash and difficulty breathing
TETRACYCLINES
It’s over usage in the 50-60’s caused large numbers of resistant strains that now limit the drug’s therapeutic use
Inhibit the bacteria’s protein synthesis
Used for treating acne, Rocky mountain spotted fever. Lyme Disease, H pylori, rickettsiae, and chlamydial infections
Have serious side effects and cause risk for Superinfections
Examples:
Tetracycline
Doxycycline
TEACHING r/t TETRACYCLINES
To decrease GI upset take with full glass of water-not with milk products, antacids or iron supplement
Pregnancy Category D
Can enhance the activity of Coumadin-monitor PT/INR
Cautious use in children--Common Side effect is discoloration of teeth
Photosensitivity
Take full course of medication
Watch with kidney and liver disorders
MACROLIDES Tx only a few bacteria but good alternative
to Penicillin
Inhibit the bacteria’s protein synthesis
Commonly used for Pertusis, Chlamydia, Legionnarie’s Disease
Examples: Azithromycin (Zpack)
Erythromycin
TEACHING r/t MACROLIDES
COMPLETE COURSE OF MEDICATION
AVOID TAKING WITH, OR IMMEDIATELY
BEFORE OR AFTER, JUICES
DO NOT TAKE ANY OTHER PRODUCT WITHOUT
CONSULTING PRESCRIBER
REPORT SIDE EFFECTS: DIFFICULTY
BREATHING OR SWALLOWING, RASH, ITCHING,
DARK URINE & PALE STOOLS, YELLOWING OF
EYES OR SKIN
AMINOGLYCOSIDES
They are bacteriocidal
They affect bacteria protein synthesis
Examples: Gentamycin
Streptomycin
Streptomycin is now restricted to the Tx of Tuberculosis
Reserved for serious infections: E. coli, serratia, proteus, klebsiella and pseudomonas
Serious S.E. possible- 2 of the most serious: Nephrotoxicity and Ototoxicity
TEACHING r/t AMINOGLYCOSIDES
Assessing hearing and renal prior to tx
Tell patient to report hearing loss, tinnitus or
urinary issues
Complete the full course of meds
Increase fluids
Tell patient you will be drawing for Peak and
Trough levels if on Gentamycin- (tests the
amount of the medication in the body)
PEAK & TROUGH
A lab test, done when the drugs could have
serious side effects
Peak is done approx. ½- 1 hour after dose of
medication is given (will show the highest amt.
in the body
Trough is done immediately/ ½ hr before dose
of medication is given ( will show the lowest
amt.in system)
MEDICATIONS REGULARLY MONITORED FOR
THIS ARE GENTAMYCIN (AMINOGLYCIDES),
AMIKACIN, VANCOMYCIN
FLUOROQUINOLONES
Classified by generation 1-4. Examples:
ONE OF BIGGEST ADVANTAGE TO THESE IS THAT MOST NEED TO BE TAKEN ONLY ONCE DAILY; SOME ARE TAKEN TWICE DAILY
THEY ARE VERY EFFECTIVE WHEN GIVEN ORALLY
4 GENERATIONS OF THESE DRUGS
SOME ARE EFFECTIVE AGAINST GRAM-NEGATIVE ORGANISMS; SOME AGAINST GRAM-POSITIVE
THEY ARE BACTERIOCIDAL
1ST GENERATION NALIDIXIC ACID (NeoGram)
2ND GENERATION *CIPROFLOXACIN (Cipro; Septra)
3RD GENERATION LEVOFOXACIN (Levaquin)
4TH GENERATION GEMIFLOXACIN (Factive)
TEACHING r/t
FLUOROQUINOLONES INCREASE FLUID INTAKE
REPORT DECREASED URINARY OUTPUT
MONITOR WBC (THEY MAY DECREASE LEUKOCYTE COUNTS)
DO NOT TAKE IF PREGNANT OR LACTATING
USE CAUTIOUSLY IN CHILDREN
BE VERY CAREFUL WHEN ADMINISTERING WITH OTHER DRUGS (MAY NEED TO ADJUST TIMING)
NAUSEA, VOMITING, DIARRHEA ARE MOST COMMON SIDE EFFECTS
PHOTOPHOBIA MAY OCCUR
MISCELLANEOUS ANTIBIOTICS
AS WITH OTHER MISCELLANEOUS
CATEGORIES, THESE DRUGS DO NOT
“FIT” ANYWHERE ELSE
SOME ARE COMMONLY USED, OTHERS
ARE NOT
EXAMPLES OF MISCELLANEOUS
ANTIBIOTICS
COMMONLY USED ONES: CLINDAMYCIN (CLEOCIN)
IMIPENEM-CILASTIN (PRIMAXIN)
NITROFURANTOIN (MACROBID, MACRODANTIN, FURADANTIN)
VANCOMYCIN (VANCOCIN) [reserved for severe infections that have not responded to other antibiotics; used for MRSA]
LINEZOLID (ZYVOX)
RED MAN SYNDROME
AN UNUSUAL REACTION TO THE RAPID
IV INFUSION OF VANCOMYCIN
SYMPTOMS: FLUSHING, HYPOTENSION,
RED RASH ON FACE, UPPER TRUNK AND
DECREASED URINE OUPUT--
HOLD THE NEXT DOSE
CALL THE PHYSICIAN
TUBERCULOSIS
A highly contagious infection
Very challenging disorder to treat
Patient required to be on med at least 6-12 months or longer if multi-drug resistant infections occur
The patient is on multiple antibiotics at the same time
A dx of TB is made when the pt has 3 Positive Sputum results
SPECIFIC DRUGS USED TO TREAT
TUBERCULOSIS
ISONIAZID (INH) IS PROTOTYPE; PATIENT MUST
AVOID TYRAMINE-CONTAINING FOODS WHILE
TAKING IT.
RIFAMPIN IS GAINING IN POPULARITY; THIS
MED MAY TURN BODY FLUIDS RED; PATIENT
NEEDS TO KNOW THIS
MANY OHER DRUGS AVAILABLE (MYAMBUTOL,
AMIKACIN, CIPRO, KANTREX STREPTOMYCIN,
ETC.)
REMEMBER TO WASH
THOSE HANDS!!
HAVE A GOOD
DAY!!