ANTIINFECTIVES: SULFONAMIDES BY: Randy Bonnell

ACTION:Sulfonamides are antibacterial agents, meaning they are active against bacteria. Another term that may be used to describe the general action of these drugs is anti-infective because they are used to treat infections caused by certain bacteria. Examples are sulfadiazine, sulfisoxazole, sulfamethizole, USES:They are often used to control UTI’S caused by certain bacteria such as Escherichia coli, staphylococcus aureus and klebsiella-enterobacter. Sulfamylon and silver sulfadiazine (silvadene) are topical sulfonamides used in the treatment of 2nd and 3rd degree burns ADVERSE REACTIONS:The following hematologic changes may occur – agranulocytosis, thrombocytopenia, aplastic anemia, leucopenia these are examples of serious adverse reactions. Other mild reactions are anorexia, Stevens Johnson syndrome, urticaria, pruritus. Other may include nausea, vomiting, diarrhea, abdominal pain, chills, fever and inflammation of the mouth. Some times these reactions may be serious and sometimes they are mild. CONTRAINDICATIONS:Are contraindicated in patients with a hypersensitivity to sulfonamides, and during lactation and in kids less that 2 years old. Also not used near the end of pregnancy and for infections caused by group A beta-hemolytic streptococci because they are effective in preventing the complications of rheumatic fever or glomerulonephritis INTERACTIONS:When given with an oral anti-coagulant, the action of the anti-coagulant may be enhanced. The risk of bone marrow suppression may be increased when sulfonamide is given with methotrexate. May also inhibit the hepatic metabolism of the oral hypoglycemic drugs tolbutamide (orinase) and chlorpropamide (diabinese). This would increase the possibility of a hypoglycemic reaction. GENERIC TRADE Sulfadiazine generic Sulfamethizole thiosulfilSulfamethoxazole gantanolTrimethoprim (TMP) bactrim Silver sulfadiazine silvadene

Beta-Lactam Rings of Penicillins, Cephalosporins, Imipenem, and Clavulanate

PENICILLINS

ACTION:The penicillin’s have the same type of action against bacteria. Penicillin’s prevent bacteria from using a substance that is necessary for the maintenance of the bacteria’s outer cell wall. Unable to use this substance for cell wall maintenance the bacteria swell and rupture then die. USES:The natural and semi synthetic penicillin’s are used in the treatment of bacterial infections due to susceptible microorganisms. Penicillin’s may be used to treat infections such as UTI’S, septicemia, meningitis, intra abdominal infection, gonorrhea, syphilis pneumonia and other respiratory infections ADVERSE REACTIONS:Common adverse reactions include mild nausea, vomiting diarrhea, sore tongue or mouth, fever and pain at injection site. Penicillin can stimulate a allergic reaction within the body. Another adverse reaction that may be seen is a super infection (a secondary infection that occurs during antibiotic treatment)CONTARIANDICATIONSContraindicated in patients with a H/O hypersensitivity to penicillin or cephalosporin’s INTERACTIONS:Should be used cautiously in patients with renal disease, pregnancy, lactation and those with H/O reactions. Also used with caution in patients with asthma, renal disease, bleeding disorders an GI disease. Some penicillin’s may interfere with the effectiveness of birth control pills that’s containing estrogen. Large doses of penicillin can increase bleeding risk of patients taking anticoagulant agents. In general penicillin’s should be given 1 hour before or 2 hours after meals

GENERIC TRADEPenicillin G benzathine bicillin l-a Penicillin v beepen vkAmoxicillin amoxil, trimoxBacampicillin spectrobid

CEPHALOSPORINS

ACTION:Affect the bacterial cell wall, making it defective and unstable. This action is similar to the action of penicillin. The cephalosporins are usually bactericidal.USES:Are used in the treatment of infections caused by susceptible microorganisms. Examples of organisms are streptococci, staphylococci, citrobacters, gonococci, shigella and clostridia. Tonsillitis lower respiratory infections and UTI’S are examples of infections that cephalosporin’s may be used. They may also be used perioperatively, that is, during preoperative, intraoperative and postoperative periods, to prevent infection in patients having surgery on a contaminated or potentially contaminated area, such as the GI system or the vagina ADVERSE REACTIONS The most common adverse reaction seen with administration of cephalosporin’s are GI disturbances such as nausea vomiting and diarrhea. Allergic reactions may occur ranging from mild to life threatening. Mild reaction may include pruritus, urticaria, skin rashes; more serious reaction is Stevens Johnson syndrome heptic and renal dysfunction, aplastic anemia, and epidermal necrolysis.CONTRAINDICATIONS The nurse should not give if pt has H/O allergies to cephalosporin’s or penicillin’s. INTERACTIONSThe risk of nephrotoxicity increases when the cephalosporins are given with aminoglycosides. The risk for bleeding increases when oral anticoagulants are taken. A disulfiram-like reactions May occur within 72 hours after cephalosporin are given. When given with aminoglycosides the risk for nephrotoxicity increases

GENERIC TRADE

Cefadroxil duricefCephalexin keflexCefaclor ceclor Loracarbef lorabidCefepime maxipime Ceftizoxime cefizox

TETRACYCLINES,MACROLIDES,LINCOSAMIDES TETRACYCLINESACTION: exert their effect by inhibiting bacterial protein synthesis, which is a process necessary for reproduction of the microorganism. Bacteria is either destroyed or slowed USES: are used in infections caused by rocky mountain spotted fever, typhus fever, and tick fevers, tetracycline’s are also used in situations in which penicillin is contraindicated.ADVERSE REACTION: a photosensitivity reaction may be seen with this group of drugs, manifested by an exaggerated sunburn reaction when the skin is exposed to sunlight even for a brief moment. They are not given to children younger than 9 years -old unless necessary because this drug can cause yellow-grey stains on the teeth.CONTRAINDICATIONS: these drugs are contraindicated if the patient is known to be hypersensitive to any of the tetracyclines. Contraindicated during pregnancy because of toxic effects to the fetus. INTERACTIONS: antacids containing aluminum, zinc, magnesium, or bismuth salts, or foods high in calcium impair absorption of the tetracyclines

MACROLIDESACTION: the drugs act by binding to cell membranes and causes changes in protein function USES: these antibiotics are effective in the treatment of infections caused by a wide range of gram negative and gram positive microorganisms. In addition these drugs are used to treat acne vulgaris and skin infections ADVERSE REACTIONS: most adverse reaction is related to the GI tract and includes nausea vomiting diarrhea and abdominal pain. There appears to be a low incidence of adverse reactions associated with normal oral doses of erythromycin. INTERACTION: most macrolides increases serum levels of digoxin and increases the effects of anticoagulants. Use of antacids decreases absorption of most macrolides.

LINCOSAMIDESACTION: act by inhibiting protein synthesis in susceptible bacteria, causing deathUSES: these antibiotics are effective in the treatment of infections caused by gram negative and gram positive microorganisms. Also used for more serious infections and may be used in conjunction with other antibiotics ADVERSE REACTIONS: abdominal pain, esophagitis, nausea, vomiting, diarrhea, skin rash, and blood dyscrasias may be seen with the use of these drugs.CONTRAINDICATIONS: contraindicated in patients with a known hypersensitivity to the lincosamides those with minor bacterial or viral infections and during lactation and infancy.INTERACTIONS: when kaolin or aluminum is given with lincosamides, the absorption of the lincosamide is decreased, when give with neuromuscular blocking drugs the action of the neuromuscular drug may be enhanced, possibly leading to severe and profound respiratory depression

TETRACYCLINES MACROLIDES Generic trade generic tradeDemeclocyline declomycin azithromycin zithromaxDoxycycline vibra-tabs erythromycin ery ped Tetracycline panmycin

LINCOSAMIDES

Generic trade

Clindamycin cleocinLincomycin lincocin

FLUOROQUINOLONES AND AMINOGLYCOSIDES

FLUOROQUINOLONESACTION:Exert their bactericidal effect by interfering with an enzyme needed by bacteria for synthesis of DNA. This interference prevents cell reproduction leading to death of the bacteria.USES:These are used in treatment of infections caused by susceptible microorganisms. Mainly used in lower respiratory infections, infections of the skin, UTI, and STDs ADVERSE REACTION:Bacterial or fungal super infections and pseudomembranous colitis may occur with the use of both of these drugs. Most common reactions seen are nausea diarrhea headache abdominal pain and dizziness. A more serious reaction is a photosensitivity reaction when exposed to ultraviolet rays.CONTRAINDICATIONS:These are contraindicated in patients with H/O hypersensitivity and in children younger than 18 years and in pregnant women.INTERACTIONS:

Concurrent use of fluoroquinolones with theophylline causes an increase in serum theophylline levels. Used concurrently with cimetidine the cimetidine may interfere with the elimination of the fluoroquinolones. When used with an anticoagulant it may increase the effect of the anticoagulant. When given with antacids, iron salts, or zinc will decrease absorption. If given with NSAIDS there is a chance of seizure.

GENERIC TRADECiprofloxacin cipro Enoxacin penetrexNorfloxacin noroxin

AMINOGLYCOSIDES

ACTION:They block a step in protein synthesis necessary for bacterial multiplication. They disrupt the functional ability of the bacterial cell membrane causing cell death.USES:Mainly used in treatment of gram-negative microorganisms. Because this drug is so poorly absorbed they are useful to suppressing GI bacteria. Most are used preop as a bowel prep.ADVERSE REACTIONS:Capable of causing nephrotoxicity and ototoxicity. S/S of nephrotoxicity is protein in the urine, increased BUN level, decrease urine output, and increase in creatinine levels.S/S of ototoxicity is tinnitus, dizziness roaring in the ears, vertigo, and mild to severe loss of hearing. Another adverse reaction may include neurotoxicity CONTRAINDICATIONS:In pt with know hypersensitivity. Should not be given to patients requiring long-term therapy because of the potential for ototoxicity and nephrotoxicity. Contraindicated in patients with preexisting hearing loss, myasthenia gravis, Parkinsonism and during lactation or pregnancy INTERACTIONS:When given with cephalosporins may increase the risk of nephrotoxicity. When given with loop diuretics there is an increase risk of ototoxicity. If given with anesthetics there may be paralysis of the respiratory muscles

GENERIC TRADE Amikacin amikinGentamicin garamycinKanamycin kantrexNeomycin mycifradin