Antibiotics

whats the difference between bactericidal antibiotics and bacteriostatic

• bactericidal = killing replicating bacteria

• bacteriostatic - slowing the bacteria down

what antibiotics used for

BACTERIA - nothing for viral or fungal infections

• does not matter if the bacteria is rod, cocci, clusters, positive, or negative - BACTERIA IS BACTERIA and ANTIBIOTICS are used

• yes some bacteria are resistant (MRSA, VRE)

are all bacteria treated with the same atb?

NO - antibiotics are specific for each bacteria agent

• strep, staph, clostridium → all caused by bacteria, all treated with different atb

if an antibiotic has wiped out our normal flora (good bacteria), we can develop what?

• secondary infection (like taking and atb for UTI and developing a yeast infection)

• superinfection (we have an infection, then we get another)

  • lining of GI inflamed + bleeding = super infection

how can we potentially prevent secondary or superinfections

• acidophilus: is a type of “good” bacteria that helps maintain a healthy balance. It naturally resides in the digestive tract, urinary tract, mouth, and vagina, where it aids in breaking down food, absorbing nutrients, and preventing the growth of harmful bacteria by maintaining an acidic environment.

• can also suggest pts take a probiotic or eat foods like yogurt (not to treat but ward off symptoms from antibiotics)

what are common atb side effects

• GI distress

  • N/V/D (veryyyy common)

  • caution with diarrhea (clinical judgement) → is it a side effect or sign of secondary/superinfection

• rash (possible hypersensitivity reaction)

what is cross resistance?

resistant to one atb, may be resistant to another

• pt prescribed penicillin, didn’t take medication properly, bacteria learned to resist penicillin and suddenly can resist cephalosporins as well

what is cross-sensitivity

allergic to one atb, may be allergic to another

• someone allergic to penicillin may also be allergic to cephalosporin (vice versa)

what is most important to note about obtaining a C&S in relation to atb

GET C&S BEFORE STARTING ANY ANTIBIOTICS

• give atb first = bound to alter results and course of treatment

what is a culture, what does it determine, how long does this take

cultures determine which bacteria were dealing with

• usually takes less than 24 hrs

what is the sensitivity, what does it determine, how long does this take?

sensitivity determines how the bacteria reacts to different antibodies

• test in lab = introduce dif. atb to the bacteria

  • can take 72 hours for a final result

• sensitive is good = means bacteria is sensitive to that atb

• resistant is bad = means bacteria learned a way around the atb and it wont work

do we have to wait for the C&S to come back to start an atb

no, you can start an antibiotic right after the culture is obtained but you may need to switch after the sensitivity comes back if that bacteria is resistant

whats the difference between narrow and broad spectrum antibiotics? why may one be chose over the other

• narrow = more selective, can fight off one bacteria

• broad = effective against many types of bacteria

  • more likely to start broad if you dont know which bacteria yet

what are the common pencillins (PCNs)

• PCN G/V

• amoxicillin (Augmentin)

• ampicillin

• piperacillin tazobactam (Zosyn)

which pencillin is most commonly used for syphilis STI

PCN G - this is a one time IM injection (long acting)

are pencillins (PCN) broad or narrow? what is the most common side effect?

• most anaphylaxis reactions out of all atb

  • rash and hives

• these are broad spectrum

which organ should be monitored for pencillins

cleared by the kidney

• if kidney is not functioning properly = risk for nephrotoxicity (should change meds)

• monitor BUN and Creatinine

  • Cr > 1.3 = bad kidney

ALL atb have which reaction with oral contraceptives

antibiotics can make birth control ineffective

• should use back up methods

• IUD is okay

are atbs taken with food?

ideally no, should be on empty stomach unless GI upset, then may take with food

why should platelets be monitored while on penicillin

at an increased risk for bleeding and thrombocytopenia

what are the common carbapenems

• ertapenem

• imipenem

• meropenem

what type of infections are carbapenems used for

these are harder hitting atbs, used for more serious infections

what side effects should be monitored for carbapenems? which organ?

• GI distress

• hypersensitivity

• watch for seizures (increased risk but especially for those neuro impaired)

• pay attention to kidney

what are some common cephalosporins

• ceftriaxone (Rocephin) (IM or IV)

• cefepime (IV)

• cephalexin (Keflex)

• cefdinir (PO)

what are common side effects of cephalosporins

• still midful of GI, hypersensitivity, and kidneys

  • diarrhea VERY common (think C-diff/ceph)

• disulfiram like reactions (don’t drink alcohol, caution of vomiting and stomach cramps)

what are common sulfonamides

• trimethoprim-sulfamethoxazole (TMP-SMZ)

• Silver Sulfadiazine

do sulfonamides do anything to the blood sugar?

NO, sulfonylureas is a diabetic medication (NOT SULFA) and this med does nothing for infection like sulfas do

what is important to note about oral and topical sulfonamides

• oral = has a short half life, requires twice daily dosing

• topical (silver sulfadiazine) = used most specifically for burns, more of a preventative measure, consider how to clean before hand and how to cover

what are common side effects of sulfonamides

• crystalluria (think silver = crystals → crystals in urine/kidney stones)

• hematuria

• photosensitivity

• myelosuppression (WBC, RBC..)

• thrombocytopenia (low platelets)

• and everything else previously discussed for atbs

what is TMP-SMZ more commonly used for

veryyyyy common for UTIs

• & E. coli, Klebsiella

• also for pulmonary infections

• is twice daily dosing

what are important nursing interventions and pt ed in relation to sulfonamides

• monitor I&Os

  • want for crystalluria

  • BUN and Cre (incr = kidneys def involved)

  • Encourage fluid intake

• not pregnancy safe

• Recommend taking folic acid daily to help combat bacteria

what is a common nitroimidazole

metronidazole (Flagyl)

what is metronidazole commonly used for

nothing dazzling about C-diff

• used for surgery prophy, C.Diff, GI

• also common for STIs

  • trichomoniasis (caused by parasites - holes in vaginal lining)

what are common side effects of Nitroimidazoles

• disulfiram like reactions (violent vommiting/cramping)

  • avoid ETOH 3 days post completing atb

• dark urine (brown/rusty) and metallic taste are NORMAL

• new rashes, skin peeling are NOT NORMAL = SJS/TENS

what are common macrolides

-thromycin

• azithromycin (if pt is allergic to PCNs, this is often prescribed in place)

• clarithromycin and erythromycin (skin/eye/ear infections)

how are Macrolides (azithromycin and clarithromycin) administered

PO or IV

• NOT IM due to pain

• PO should be taken on empty stomach and followed with full glass of water

what side effects should be monitored with macrolides (-thromycin)

• monitor liver - report elevated AST and ALT level

• watch for ototoxicity in the ears

• can cause prolonged QT waves, monitor ECG (bad arrhythmias)

  • thromycin can throw off ECG waves

• everything else GI and secondary/superinfections

what is a common Oxazolidinone

-zolid

• linezolid

whats important to note about linezolid

is a heavier hitting atb

• SE: everything GI, secondary/superinfections

  • thrombocytopenia

whats important to note about -mycins vs -thromycins

-mycins are heavier hitting (have higher potential for toxicity) than -thromycins

what is a common Lincosamide

Clindamycin

what side effect should be monitored for Clindamycin

must be careful with diarrhea, can lean pretty heavily towards developing pseudomembranous colitis

how are Lincosamides (Clindamycin) administered

• parenteral

• oral = full glass of water, sitting upright

what is a common Glycopeptide

-mycin group, but could also end in -vancin

• vancomycin

what are Glycopeptides (like vancomycin) used for

these are VERY HEAVY HITTING (potential for toxicity)

• often used for MRSA

  • super bug treatment = treating atb resistant bacteria strains

• Vanco can be given orally to treat C-diff

what rate/time is IV Vanco administered? what should we watch out for?

MINIMUM administration over 60 minutes

• risk for Redman syndrome (this is from too much, too fast)

  • = TOXIC REACTION = hypotension, flushing, itching, rash

• if pt is in respiratory distress then this is a sign of an ALLERGIC REACTION not redman

what should be monitored/SE of Vanco (glycopeptides)

• nephrotoxicity (BUN and Cr)

  • report BUN > 20 & Cre > 1.3

• monitor trough levels

  • too high kidneys will die, too low infection will grow

  • ideally 10-20 ; > 20 = hold and notify HCP

• ototoxicity (more at risk with repeated use)

  • tinnitus, dizziness, muffled hearing

• risk for thrombophlebitis

  • thorough assessment before admin and monitor site during

• DOES NOT cause GI distress (typically)

what is a common lipopetide

daptomycin

what are lipopetides (daptomycin) commonly used for

mostly associated with skin infections

• not dapping you up bc you have skin infections

what nursing interventions are done for lipopetides

• which organs? what should the pt report?

• C&S, VS

• labs: trough, kidney function, liver function

• report loose stools (SE or c-diff?)

• report decrease urine output

• report dizziness/tinnitus

what are common tetracyclines

• doxycycline

• tetracycline

• minocycline

what are tetracyclines commonly used for

can be used for acne/skin issues

• acne vulgaris

• herpes?

how are tetracyclines taken? what to avoid?

• doxycycline

• tetracycline

• minocycline

ideally take on empty stomach, stay upright to avoid heartburn and scarring of esophagus

• DO NOT take with calcium products

  • yogurt, milk

  • prevents absorptions, should take 2 hours apart

what are SE of tetracyclines? who should not take?

• photosensitivity & other general atb SE

• NOT for pregnant women

• NOT for children under 8

  • teeth are still developing = irreversible discoloration (gray)

• watch with oral contraceptive (use backup method)

  • will cause accidental pregnancy - IUD is okay

what are common aminoglycosides

-mycin and -micin: used for serious infections

• gentamicin

• neomycin

• tobramycin

how are aminoglycosides administered

not absorbed well orally, must be parenterally

SE:

• ototoxicity

• nephrotoxicity

• muscle aches/crmaping

what are common fluoroquinolones

• ciprofloxacin

• levofloxacin

what are fluoroquinolones (-floxacin) commonly used for

• very common for UTIs and pneumonia

• bone/join infections

• ear, eye gtts (cipro)

why is fluoroquinolones a black box warning

risk for tendon rupture and CNS effects

• report new muscle pain (NOT common)

• very cautious use for children (some of these should not be administered to anyone under 18) & elders