CHAPTER 7 Immunizations and Antimicrobials

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Introduction

• This chapter covers─Disease terminology/concepts─Immunizations─Antimicrobials─Active and passive immunity─Proper use of anti-infective agents

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• Disease– Not (dis) at ease– Body fails to function properly– Numerous causes– Many due to infections

• Sign– Objective– Measurable – Definitive (Continues)

General Disease Terminology

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• Symptom– Subjective– Based on perception– Cannot be measured consistently

• Syndrome– Specific grouping of signs/symptoms (S/S)

• Diagnosis– Identification of disease

(Continues)

General Disease Terminology

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• Prognosis– Prediction of outcome of disease process

• Chief complaint– Concern that caused patient to seek medical

help

• Etiology– Cause of disease

(Continues)

General Disease Terminology

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• Chronic condition– Long term

• Acute condition– Short term

• Remission– S/S of chronic disease may subside

• Relapse– Recurrence of S/S

(Continues)

General Disease Terminology

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• Exacerbation– Acute return of S/S

• Mortality– Measure of deaths attributed to specific

disease

• Morbidity– Measure of disability/problems related to

illness (Continues)

General Disease Terminology

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• Epidemiology– Study of patterns, causes, spread, and effects of

disease conditions (as determined by CDC)

• Endemic– Disease continually present within a specific

population/region

• Epidemic– Disease occurs suddenly over specific

geographic region

(Continues)

General Disease Terminology

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General Disease Terminology

• Pandemic– Disease spreads throughout country or world-

wide

• Reminder– It is better to prevent infections (such as with

the use of vaccinations) than it is to treat them

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Immunity

• Immune response produces antibodies against foreign microbes; inherited, acquired, induced

• Two broad types – Active: produced artificially (vaccination), or

naturally (by contracting illness); long-lasting– Passive: administration of immunoglobulins;

short-lived

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• Resistance occurrence may be due to– Antibiotic being destroyed by bacterial

enzymes– Alteration in protein binding– Bacteria pumping antibiotic out, preventing it

from destroying bacteria– Use of antibiotics when not needed

Microbial Resistance Mechanisms

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Antibacterial Drug Classification

• Bacteriostatic (inhibits replications) versus bactericidal (actively destroys bacteria)

• Broad-spectrum (effective against wide range of bacteria) versus narrow spectrum (used after specific organism is identified)

• Mechanism of action (commonly used to classify HIV medications)

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Antibacterial Agents

• Refer to text for in-depth information concerning these agents

• Beta-lactams – Chemically related drugs– Inhibit materials needed for bacterial cell wall

synthesis– For example, penicillins, cephalosporins,

monobactams, carbacephems, carbapenems

(Continues)

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Antibacterial Agents

• Quinolones– Block two enzymes responsible for DNA

growth, leading to breakage of DNA, which results in bactericidal activity

– Prolonged use may cause superinfection– May cause tendon inflammation with rupture,

even after medication is discontinued– Example of fluoroquinolones: ciprofloxacin

(Continues)

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Antibacterial Agents

• Aminoglycosides– Gram-negative coverage– Bactericidal– Dosage based on patient weight, renal function,

and serum blood levels– May cause hearing loss and kidney failure– For example, amikacin, gentamicin, tobramycin

(Continues)

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Antibacterial Agents

• Glycopeptides– Bactericidal– Bind to portion of cell wall of microorganism,

preventing cell wall development– Effective against gram-positive cocci– For example, vancomycin (monitor serum blood

levels), telavancin (has long duration; given once daily)

(Continues)

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Antibacterial Agents

• Macrolides– Inhibit bacterial protein synthesis– Commonly used for pulmonary infections

• Tetracyclines– Broad spectrum– Bacteriostatic – Can cause permanent tooth discoloration

(Continues)

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Antibacterial Agents

• Folate inhibitors– Bacteriostatic– Primary use: treatment of UTIs– Sulfonamides

• Quinupristin-Dalfopristin– Inhibit bacterial protein synthesis– Bacteriostatic against gram-positive bacteria– Administered IV

(Continues)

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Antibacterial Agents

• Daptomycin– Bactericidal against gram-positive bacteria– Interferes with electrical activity of cell membrane– Useful in treatment of MRSA

• Clindamycin– Oral or IV– Active against gram-positive cocci, anaerobes

(Continues)

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Antibacterial Agents

• Metronidazole– Synthetic drug– Anaerobic spectrum of activity– Inhibits bacterial protein synthesis resulting in

cell death– Part of cocktail drug to treat peptic ulcer

disease (PUD) due to H. pylori

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Antituberculosis Drugs

• TB – May affect lungs, kidneys, spine, and brain;

air-borne transmission; chronic

• MDR TB– Due to suboptimal treatment (inappropriate

drug doses/noncompliance)

• Treatment– For example, rifampin, isoniazid

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Antivirals

• Vaccinations as prevention are preferred over treatment of viruses

• HSV– Treatment interferes with viral DNA synthesis,

thus inhibiting viral replication– For example, valacyclovir

• Influenza– Prevention available through oral

administration, inhalation, or vaccination

(Continues)

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Antivirals

• RSV– Major cause of lung disease in children– Treatment includes: ribavirin (inhibits RNA and

DNA viruses)

• HCV– Most common blood-borne infection in the

United States– Treatment examples: simeprevir, peginterferon

(Continues)

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Antivirals

• HIV– Infects cells of immune system– May progress to AIDS– Treatment: antiretrovirals that include several

drug classes• NRTIs (e.g., abacavir)• NNRTIs (e.g., efavirenz)• PIs (e.g., ritonavir)

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Antifungal Agents

• Two basic forms of fungi in humans– Yeasts– Molds

• Fungi may be local or systemic

• Treatments prevent production of ergosterol

• Example: nystatin (oral or topical cream), miconazole (topical)

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Summary

• Learn and understand general disease terminology to lay the foundation for discussions on infectious diseases

• Immunity– Passive– Active

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Summary

• Microbial resistance mechanisms

• Anti-infective agents– Antibacterial agents– Antituberculosis drugs– Antivirals– Antifungals

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