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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
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)
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
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
Copyright © 2007 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 6
Adverse Reactions
• Hypersensitivity
• Anaphylaxis
• Direct toxicity
• Indirection toxicity
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
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
Copyright © 2007 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 9
Cephalosporins
• Interactions
• Patient education
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
Copyright © 2007 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 11
Penicillins
• Produced from fungus
• Uses
• Semisynthetic penicillins
• Serious side effects
• Contraindications or extreme cautions
Copyright © 2007 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 12
Penicillins
• Interactions
• Patient education
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Quinolones
• When used
• Increased resistance
• Side effects
• Contraindications or caution
• Interactions
• Patient education
Copyright © 2007 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 14
Tetracyclines
• Broad-spectrum
• When used
• Side effects
• Contraindications
• Interactions
• Patient education
Copyright © 2007 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 15
Antifungals
• Amphotericin B
• Fluconazole
• Griseofulvin
• Nystatin
• Patient education
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
Copyright © 2007 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 17
Other Anti-Infectives
• Clindamycin
• Metronidazole
• Vancomycin
Copyright © 2007 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 18
Antivirals
• Acyclovir
• Amantadine
• Neuraminidase inhibitors
• Ribavirin
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
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
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
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