Ant-Infective DrugsAnt-Infective Drugs

• AntibacterialsAntibacterials• Sulfa DrugsSulfa Drugs

• Urinary Urinary • Anti-tuberculosisAnti-tuberculosis

• AntifungalsAntifungals• AntiviralsAntivirals

Antibacterial DrugsAntibacterial Drugs(Antibiotics & Antimicrobials)(Antibiotics & Antimicrobials)

I. Increased Susceptibility to InfectionI. Increased Susceptibility to InfectionA. AgeA. AgeB. ExposureB. ExposureC. Barrier DisruptionC. Barrier DisruptionD. Immune DefensesD. Immune DefensesE. CirculationE. CirculationF. NutritionF. Nutrition

II. Identification of OrganismsII. Identification of OrganismsA. MicroscopeA. MicroscopeB. Gram StainB. Gram StainC. CultureC. CultureD. SensitivityD. Sensitivity

III. Selection of AgentIII. Selection of AgentA. LocationA. LocationB. Organ Function (liver, kidney)B. Organ Function (liver, kidney)C. Age (very young vs elderly)C. Age (very young vs elderly)D. Pregnancy / LactationD. Pregnancy / LactationE. Resistance (MRSA, VRE)E. Resistance (MRSA, VRE)

F. Know allergyF. Know allergy

IV. ClassificationIV. ClassificationA. ActionA. Action

1. Bacteriocidal 1. Bacteriocidal 2. Bacteriostatic2. Bacteriostatic

B. SpectrumB. Spectrum1. Broad1. Broad2. Narrow2. Narrow

C. Antibiotic vs AntimicrobialC. Antibiotic vs AntimicrobialV. ActionsV. Actions

VI. UsesVI. UsesA. Primary InfectionA. Primary InfectionB. Secondary InfectionB. Secondary InfectionC. Pre-opC. Pre-opD. ProphylaxisD. ProphylaxisE. Virus - no!E. Virus - no!F. Nosocomial infectionsF. Nosocomial infections

VII. Adverse ReactionsVII. Adverse ReactionsA. Hypersensitivity/ AnaphylaxisA. Hypersensitivity/ AnaphylaxisB. Cross-SensitivityB. Cross-SensitivityC. Organ Toxicity - directC. Organ Toxicity - direct

1. Nephrotoxicity1. Nephrotoxicity2. Hepatotoxicity2. Hepatotoxicity3. Ototoxicity3. Ototoxicity

D. Hematological – blood dyscrasiasD. Hematological – blood dyscrasiasE. Superinfection (indirect)E. Superinfection (indirect)F. Pain - phlebitisF. Pain - phlebitisG. GI DistressG. GI DistressH. NeurotonicH. Neurotonic

VII. Antibacterial AgentsVII. Antibacterial AgentsA. PenicillinsA. PenicillinsB. CephalosporinsB. CephalosporinsC. TetracyclinesC. TetracyclinesD. AminoglycosidesD. AminoglycosidesE. SulfonamidesE. SulfonamidesF. Miscellaneous: F. Miscellaneous: 1. Macrolides – erythromycin1. Macrolides – erythromycin

2. Quinolones - Cipro2. Quinolones - Cipro

X. AminoglycosidesX. Aminoglycosides (gentamycin)(gentamycin)A. Action: gram neg & resistantA. Action: gram neg & resistantB. UseB. Use

1. Urinary infections - resist1. Urinary infections - resist2. Pre-op for intestinal OR2. Pre-op for intestinal OR

C. Adverse Effects: N/V/DC. Adverse Effects: N/V/D1. Nephrotoxicity - BUN1. Nephrotoxicity - BUN2. Ototoxicity - tinnitis2. Ototoxicity - tinnitis

D. Interactions: general anesthesiaD. Interactions: general anesthesia (Neuromuscular blocking(Neuromuscular blocking)-flag)-flag

E. Peak & Trough levels (1hr/30min)E. Peak & Trough levels (1hr/30min)

IX. Cephalosporins – semi-synthIX. Cephalosporins – semi-synthA. Use - penicillin resistanceA. Use - penicillin resistanceB. Generations – broad spectrumB. Generations – broad spectrum

1. First - Keflin1. First - Keflin2. Second - Ceclor2. Second - Ceclor3. Third – Claforan (&43. Third – Claforan (&4thth))

C. Cross sensitivity to penicillinC. Cross sensitivity to penicillinD. Adverse reactionsD. Adverse reactions

1. Nephrotonic, rashes1. Nephrotonic, rashes2. GI Distress – food (NVD)2. GI Distress – food (NVD)3. Injection pain - phlebitis3. Injection pain - phlebitis

XIV. Macrolide -Erythromycin (E-mycin)XIV. Macrolide -Erythromycin (E-mycin)A. Action - bacteriostaticA. Action - bacteriostaticB. Uses: oral therapy for penicillinB. Uses: oral therapy for penicillin

substitute (least toxic)substitute (least toxic)1. Respiratory infections1. Respiratory infections2. Soft tissue (gums) infections2. Soft tissue (gums) infections3. Mycoplasms, chlamydia (STD)3. Mycoplasms, chlamydia (STD)

C. S/E: C. S/E: 1. N/V/D1. N/V/D2. Skin rash, superinfection2. Skin rash, superinfection

D. Helicbacoter pyloriD. Helicbacoter pylori E. Dangerous interactions – ie,DiflucanE. Dangerous interactions – ie,Diflucan

VIII.VIII.Penicillins – from fungusPenicillins – from fungus(treat Streph, Staph& Pseudo – resp, (treat Streph, Staph& Pseudo – resp,

intestinal infections, helicobacter intestinal infections, helicobacter pylori)pylori)A. Overuse PenicillinA. Overuse PenicillinB. Natural vs syntheticB. Natural vs syntheticC. Routes: oral, IM, IVsC. Routes: oral, IM, IVsD. Units, grams, mgsD. Units, grams, mgsE. S/E: GI (NVD), allergy, superinfE. S/E: GI (NVD), allergy, superinfF. Example: AmoxicillinF. Example: Amoxicillin

G. Inhibits estrogen – BCP/avoid alcoholG. Inhibits estrogen – BCP/avoid alcohol

XVII. Quinolones - Ciprofloxacin: CiproXVII. Quinolones - Ciprofloxacin: CiproA. Resistance by son PseudomonasA. Resistance by son PseudomonasB. Use:UTI, Resp, GIB. Use:UTI, Resp, GIC. S/E: some serousC. S/E: some serous

1. N/V/D, rash 1. N/V/D, rash 2. Photosensitivity (toxic)2. Photosensitivity (toxic)3. CNS: H/A, dizzy, tremor-caffeine3. CNS: H/A, dizzy, tremor-caffeine

4. Crystalluria – drink fluids!4. Crystalluria – drink fluids! 5. Collitis – in elderly5. Collitis – in elderly 6. Cartilage damage in children6. Cartilage damage in children 7. Tendon damage – no strenuous 7. Tendon damage – no strenuous exerciseexercise

D. Interactions: Many drugs!D. Interactions: Many drugs!

XI. Tetracyclines (tetracycline) – broad specXI. Tetracyclines (tetracycline) – broad specA. Uses: (incr. resistance) uncommonA. Uses: (incr. resistance) uncommon

1. Alternative to penicillin1. Alternative to penicillin2. Richettsiae, Lyme, chr bronchitis2. Richettsiae, Lyme, chr bronchitis

B. Adverse effects:B. Adverse effects:1. N/V/D1. N/V/D2. Superinfection2. Superinfection3. Photosensitivity, rash3. Photosensitivity, rash

4. Discolored teeth, retarded bone4. Discolored teeth, retarded boneC. Contraindications: binds toC. Contraindications: binds to calcium & iron - not w/ foodcalcium & iron - not w/ food

D. Pregnancy, under 8 yrs of ageD. Pregnancy, under 8 yrs of age E. Outdated - nephrotoxicE. Outdated - nephrotoxic

XV. Chloramphenicol:XV. Chloramphenicol:A. Use: serious life-threatening A. Use: serious life-threatening infections (typhoid) & topicalinfections (typhoid) & topical ocular infections (toxic!)ocular infections (toxic!)B. S/E &Adverse reactions:B. S/E &Adverse reactions:

1. Fatal blood dyscrasias or 1. Fatal blood dyscrasias or bone marrow depressionbone marrow depression

2. N/V/D2. N/V/D3. Superinfections3. Superinfections

C. Contraindic: Infants under 2 mosC. Contraindic: Infants under 2 mos (Immature livers)(Immature livers)

XVI. Miscellaneous: (Toxic)XVI. Miscellaneous: (Toxic) A. Vancomycin - (MRSA) variousA. Vancomycin - (MRSA) various 1. organ toxicities (oto, nephro)1. organ toxicities (oto, nephro) 2. IV - necrosis2. IV - necrosis

B. Flagyl - antibacterial & B. Flagyl - antibacterial & antiprotozoan (Trichomonas) antiprotozoan (Trichomonas) – – very toxicvery toxic

1. neurological 1. neurological 2. Avoid alcohol – disulfiram rx 2. Avoid alcohol – disulfiram rx

C. Cleocin (clindomycin)- C. Cleocin (clindomycin)-

1. Colitis (life treatening) – d/c if1. Colitis (life treatening) – d/c if N/V/DN/V/D

AntiviralsAntiviralsA. Natural immunity or vaccinationA. Natural immunity or vaccinationB. Many viruses do not produceB. Many viruses do not produce immunity & vaccines not availableimmunity & vaccines not availableC. Viral infectionsC. Viral infections

1. Herpes simplex I & II1. Herpes simplex I & II2. Herpes zoster (shingles), 2. Herpes zoster (shingles), chicken pox chicken pox3. Flu, cold3. Flu, cold4. AIDS, hepatitis4. AIDS, hepatitis

D. Drugs:D. Drugs:1. Zovirax - cutaneous & genital1. Zovirax - cutaneous & genital

Herpes, herpes zoster (acyclovir)Herpes, herpes zoster (acyclovir)2. Zidovudine (AZT, Retrovir) -2. Zidovudine (AZT, Retrovir) - AIDS & CMVAIDS & CMV3. Symmetrel (amantadine) – Flu3. Symmetrel (amantadine) – Flu

4. Tamiflu - inhalation4. Tamiflu - inhalationE. Action - prohibits viral attachment E. Action - prohibits viral attachment or protein synthesisor protein synthesisF. S/E: N/V, lethargy, fatigue, H/AF. S/E: N/V, lethargy, fatigue, H/A

XII. Sulfonamides (precursor to antibiotics)XII. Sulfonamides (precursor to antibiotics)A. Use: limited A. Use: limited

1. Non-obstr. UTI’s1. Non-obstr. UTI’s2. Burns - topical2. Burns - topical

B. Action - bacteriostatic B. Action - bacteriostatic C. Med’s: Bactrim, Septra (comb.),C. Med’s: Bactrim, Septra (comb.), Silvadene (topical)Silvadene (topical)D. S/E: N/V/D, crystalluria (water),D. S/E: N/V/D, crystalluria (water),

allergy, photosensitivity, blood allergy, photosensitivity, blood dyscrasias, yellow urine, hepatotoxic, dyscrasias, yellow urine, hepatotoxic, hypersensitivityhypersensitivity

E. Steven-Johnson syndrome- rashE. Steven-Johnson syndrome- rash F. Interactions: Coumadin, hypoglycemicsF. Interactions: Coumadin, hypoglycemics

XVI. Macrodantin (Urinary Anti-infective)XVI. Macrodantin (Urinary Anti-infective)A. Use: Chronic UTI’sA. Use: Chronic UTI’sB. Not sulfonamide or antibioticB. Not sulfonamide or antibioticC. Action: does not achieveC. Action: does not achieve significant elevation of bloodsignificant elevation of blood levels to be effective for systemiclevels to be effective for systemic

infections.infections. Interfers with bacterial multip in Interfers with bacterial multip in the the urine.urine.

D. S/E: N/V/D, anorexia, neuritisD. S/E: N/V/D, anorexia, neuritis respir.allergy (wheezing), dark urinerespir.allergy (wheezing), dark urine

AntifungalsAntifungals

A. Plant-like: yeasts or moldsA. Plant-like: yeasts or moldsB. SystemicB. Systemic mycotic mycotic Infections Infections

1. Serious1. Serious2. Immunosuppressed2. Immunosuppressed

C. Dermatophytic - hair, nails, skinC. Dermatophytic - hair, nails, skin (athlete’s foot, ring worm)(athlete’s foot, ring worm)D. Candida albicans - superinfectionD. Candida albicans - superinfection

E. Meds:E. Meds:1. Fungizone (amphotericin B) -1. Fungizone (amphotericin B) -

systemic infectionssystemic infections2. Griseofulvin - hair, skin, nails2. Griseofulvin - hair, skin, nails3. Mycostatin (nystatin) candida3. Mycostatin (nystatin) candida4. Diflucan – one dose med (fluconazole)4. Diflucan – one dose med (fluconazole)

F. Action: usually fungicidalF. Action: usually fungicidalG. Adverse Effects: G. Adverse Effects:

1. N/V/D1. N/V/D2. H/A & dry mouth2. H/A & dry mouth

H. Hospitalized for IV systemic trmtH. Hospitalized for IV systemic trmt (serious side effects)(serious side effects)

XIII. Ioniazid: (INH - DOT therapy)XIII. Ioniazid: (INH - DOT therapy)A. Use - tuberculosis (mycobacterium)A. Use - tuberculosis (mycobacterium)

1. Asymtomatic: 6-12 months1. Asymtomatic: 6-12 months2. Active: 2-3 agents (6-9 mos+)2. Active: 2-3 agents (6-9 mos+)

B. Other first line agents:B. Other first line agents:1. Rifampin1. Rifampin2. Ethanbutol2. Ethanbutol

C. S/E or Adverse Rx: (ioniazid)C. S/E or Adverse Rx: (ioniazid)1. hepatotoxicity1. hepatotoxicity2. N/V - give with food2. N/V - give with food3. Neuro - numbness, tingling3. Neuro - numbness, tingling

(given with B6)(given with B6)