Antimicrobial Therapy, Antibacterial, and Antifungal Agents

Penocollin G (benzylpeniciiin)

MOA targets binding protein, breaks bacterial cell wall

Class: Penicillinase- sensitive penicillin

Indicated: infection caused by gram + bacteria (strep, enterococcus, staph) 

AE IM route related pain, peripheral nerve issue. 
NC assess for hx of allergic reaction. monitor CBC, vitals, infection s/s. associated with drug interactions, can change absorption

s/s of penicillin allergy

can be immediate, accelerated, or delayed.

tight throat, bronchospasm, laryngeal edema. tingling and swelling in throat.

stop the medication, admin epi, respiratory support

penicillin resistance

genes that are transferred from one bacterium to another to promote spread of PCN resistance. Beta-lactamases inhibit PCN moleculres cannot be broken down for the antibiotic to effeciency.

Piperacillin/tazobactam (Zosyn)

MOA: has penicillin actions and inhibits bacterial beta-lactamase with tazobactam

Class: Beta-lactam antibiotic + beta-lactamase inhibitor

Indications: extended spectrum (penicillin suceptible organism and gram - and anaerobic coverage, including pseudomonas, enterobacter, klebsilla)
AE: low toxicity, allergic reaction, diarrhea, nausea, headache

NC: same as penicillin G, parenteral route only, monitor IV infusion site and compatibility with other IV meds.

Cephalosporin Generations

MOA: Bing to penicillin-binding proteins to disrupt cell wall synthesis and activate autolysins.

Class:

Indications: depend on type of coverage needed/type of bacteria involved

• 1st gen: cefazolin- surgical prophylaxis

• 2nd gen: cefaclor 

• 3rd gen: ceftriaxone

• 4th gen cefepime- resistant organisms 

• 5th gen ceftaroline- skin infections and HCAP

AE: allergic reaction, bleeding tendecies through interference with vitamin K metabolism, reaction with alcohol

NC: assess for s/s of allergic reaction, monitor CBC for effectiveness, vital signs, s/s of infection

Imipenem/cilastatin (Primaxin)

MOA: binds to PBP (penecillin bonding protein) 1&2 weaken cell wall and resists beta-lactamases

Class: Carbapenem

Indications: broad spectrum with activity against most pathogens, for bone, joint, skin, and soft tissue infections, UTIs, intraabdominal, and pelvic infections
AE: GI effects N/V/D. Seizures primarily with renal impairments, super-infections

NC: co-administed with cilastatin for rapid breakdown in kidneys, reserve use in patients with infections not covered by other antibiotics, SEIZURE PRECAUTION

Vancomycin (Vancocin)

MOA: inhibits cell wall synthesis binding to molecules that are precursors of the cell wall.

Class: Glycopeptide
Indications: gram + bacteria coverage only for bone, joint, bloodstream infections, particularly MRSA, c-diff

AE: nephrotoxicity leading to renal failure, ototoxicity, red man syndrome, vancomycin resistant enterococci

NC: usually IV, PO for c-diff. monitor trough levels appropriately and CMP renal function, and CN VIII function. 

dont use with other nephrotoxic meds, hygiene and cleaning with c-diff.

infuse slowly, harsh on veins

Doxycycline

MOA: bacteriostatic, inhibits binding of transger rNA to mRNA to inhibit protein synthesis

Class: Tetracycline

Indications: broad spectrum + and -

AE: GI, N/V/D, supression of bone growth and color discoloration in teeth in children. Infants can have yellow teeth. Fatty liver infiltration and renal impairment exacerbation. Photosensitivity

NC: decreased absorption; do not use with Ca, Fe (iron), Mg. empty stomach as tolerated. interacts with contraceptives and anticoagulants. oral care for teeth yellowing. hepatic and renal monitoring. sunlight exposure

Erythromycin

MOA: bacteriostatic, binds to block addition to new amino acids to growing peptide chain

Indication: gram + and -

Class: macrolide

AE: N/V/D, QT prolongation (ventricular arrythmia) = cardiac death, hepatotoxicity and ototoxicity, drug interactions

NC: often first line to pCN sensitive bacterial infections with allergy. PO on empty stomach maximize absorption. avoid in patients with cardiac conditions, increases half life medications such as theophylline and warfarin. 

Clindamycin (Cleocin)

MOA: bacteriostatic bings to ribosomal subunit to block addition of new amino acids to growing peptide chain

Indication: gram + and -, anaerobes and most gram + aerobes

 Class: Lincosamide

AE: severe to fatal c.diff colitis (abdominal pain, fever, leukocytosis) non-c.diff bacteria

NC: monitor and educate educate patients on monitor stool and fluid status, > 5 loose stools per day for c-diff associated diarrhea. consider d/c ( do not use with GI slowing meds) clindamycin treatment. Vigorous fluid and electrolyte replacement with vancomycin treatment. 

Linezolid (Zyvox)

MOA: bacteriostatic, binds to 23S of 50S ribosomal subunit to block formation of initiation complex

Indication: broad spectrum, including MDRO

Class: Oxazolidinone

AE: HA, N/V/D, myelosupression (anemia, leukopenia, thrombocytopenia), pancytopenia. optic and peripheral neuropathy

NC: monitor CBC and I/O, especially with existing myelosupression or on other myelosuppressive agents. Give with food to limit GI irritations. Monitor for drug interactions with hypertensive crisis and SSRI (seritonin syndrome)

Gentamicin

MOA: inhibits protein synthesis, premature termination of protein synthesis, and abnormal proteins. Bactericidal activity that persist via post-antibiotic effect

Indication: gram + cocci, and aerobic gram - bacilli. used for serious infections

Class: aminoglycoside

AE: nephrotoxicity due to proximal renal tubule injury. ototoxicity

NC: assess serum peak and trough, urine output, ae monitoring. CMP. neuro focused assessment including hearing and balance. increase fluid intake. Usually IV. do not mix with PCN

Ciprofloxacin (Cipro)

MOA: inhibits 2 enzymes needed for DNA replication and cell division

Indication: broad spectrum most aerobic + and some gram -

Class: fluoroquinolones

AE: N/V/D, and CDI. Tendon rupture particularly Achilles, CNS effects(dizziness, HA, confusion), phototoxicity

NC: educate on tendon injury and report early sign. Utilize sunscreen, separate from dairy products at least 6 hrs before or 2 hrs after

Daptomycin (Cubicin)

MOA: intracellular K+ to depolarize cell, inhibits synthesis of DNA, RNA, and protein to cause cell death.

Indication: Gram + bacterial infections only; can cover MRSA and VRE

Class: Cyclic lipopeptide

AE: N/V/D, constipation. Myopathy, hypotension and hypertension

NC: Monitor for new onset muscle pain or weakness. Monitor v/s closely for changes in BP

Metronidazole (Flagyl)

MOA: after activation into active form, interacts with bacterial FNA to cause strand breakage. Inhibits synthesis and cell death

Indication: anaerobic bacteria infections, particularly c-diff. antiprotozoal infections

Class: Nitromidazole

AE: GI effects, HA, dry mouth, fatigue. Interacts with alcohol

NC: dont drink alcohol, monitor closely with drug interactions from altered metabolism. give with food 

Sulfamethoxazole/Trimethoprim (Bactrim)

MOA: inhibits tetrahydrofolate synthesis needed to make DNA, RNA, and protein

Indication: broad spectrum with gram + and -, commonly used for UTI

Class: Sulfonamide

AE: Sulfonamide- photo-&hypersensitivity reactions, including SJS/TENS, hemolytic anemia, kernicterus in newborns. Renal damage from crystalline aggregates

NC: Monitor for rash, cross allergies with other sulfa-containing meds. Monitor CBC and CMP and progression of infection s/s

Nitrofurantoin (Macrobid)

MOA: conversion to active form, bacterial injury d/t inhibition of protein, DNA, RNA protein synthesis and energy metabolism

Indication: broag spectrum against gram + and -. treatment and prophylaxis acute lower UTI

Class: Nitrofuran

AE: N/V/D, pulmonary reactions from hypersensitivity; dyspnea, cough. Hematologic effects, including agranulocytosis, leukopenia, thrombocytopenia, and megaloblastic anemia

NC: not indicated for upper UTI (higher than the bladder), increase water intake and cranberry juice and avoid other potential nephrotoxic drugs

Amphotericin B (Abelect)

MOA: Binds to components of fungal cell membrane to increase permeability, causes leakage 

Indication: broad spectrum fungi coverage, and DOC for systemic mycoses 

Class: Polyene

AE: infusion reactions (fever, chills, urticaria, nausea, HA)

NC: V/s closelt (every 15 min), heart rhythm on telemetry, CMP, i/o kidney function

Nyastatin

MOA: causes fungal cell permeability. leaking

Indication: limited use for toxicity, oropharyngeal candidiasis prophylaxis in neutropenia. oral and vaginal candidiasis

Class: Polyene

AE:n/v/d PO. rash and urticaria topical

NC: PO route carefully in peds patients, lonzenge/troche. patient ed on proper admin

Intraconazole (Sporanox)

MOA: inhibits synthesis of ergosterol to cause increased membrane permeannility and leakage

Class: Azole

Indication: broad spectrum fungal coverage, mycoses of esophageal, oropharyngeal, peritoneal, urinal tract, vaginal, and systemic candida

AE: N/v/d cardiac suppression= decreased ventricular EF. med associated liver injury
NC: assess med use due to many drug interactions. admin with food for absorption. Monitor s/s liver injury and HF prior to and after med admin.