Antibiotics

Lincosamides

• MOA: inhibits 50s ribosome

• ex: clindamycin

• treat: MRSA, dental infections

• target: Gram-positive bacteria.

Pt teaching and Considerations for Lincosamides

• Liver toxicity can occur

• take with full glass of water for PO

• Nausea and vomiting can occur (take w food)

• C diff risk increases (report diarrhea immediately)

• Option for PNC allergic pts

Oxazolidines

• MOA: inhibits protein synthesis by binding to the 50S ribosomal subunit

• ex: linezolid, tedilizoid 

• treat: pneumonia, VRE, MRSA

• target: Gram-positive bacteria including resistant strains.

Considerations for Oxazolinones 

• increases risk of mylesupression (watch for decreased WBC & RBC)

• Look for neuropathy (assess vision, sensations) if long term use

• Monitor for serotonin syndrome when combined with SSRIs (tremors, sweating, fever)

PT Oxazolinones

• Report bruising/bleeding, vision changes; review antidepressants with provider.

• Don’t eat tyramine rich foods (increase HTN)

Nitroimidazoles

• MOA:breaks DNA strands

• Targets: anaerobic bacteria and certain protozoa.

• treats: C.diff, trichomoniasis, BV

• ex: Metronidazole

Nitroimidazoles pt teaching

• Disifurum reaction: no alcohol during or 48 -72 hrs after

• Avoid in 1st trimester

• Leaves metallic taste in mouth , GI upset, dark urine

• seizures/neuropathy

Penicillins

• MOA: inhibits bacterial cell wall synthesis (bactericidal)

• Treat: strep, syphillis, ear infections

• ex: amoxicillin , ampicillin

Penicillin Pt teaching and Considerations

• Penicillin allergy is common (assess for hives or rashes)

• Cross sensitivity with cephalosporin

• Nausea can occur take w food

• Suprainfections: watch for C.diff , oral thrush, yeast infections

• Must complete entire course of antibiotics to prevent resistance.

• Monitor renal function and electrolytes.

Cephalosporins 

• MOA: inhibits bacterial cell wall synthesis 

• targets: primarily Gram + (1st gen)

• treat: pneumonia, UTI, skin infections, pre-op, meningitis 

• Example: ceftriaxone, cephalexin 

Cephalosporins Pt teaching and Considerations

• Creatine and BUN: monitor kidneys

• ETOH intolerance: no alcohol

• Pseudomembrane colitis can occur : diarrhea and fever

• Hypersensitivity to penicillin allergy (rash/anaphylaxis)

• Lower prothrombin : can cause bleeding (INR-PTR)

Aminoglycosides

• MOA: inhibits protein synthesis of 30S

• Targets: gram - bacteria

• treat: sepsis, respiratory infection, intra-abdominal infections

• ex: end in mycin or micin (gentamicin, tobramycin)

Aminoglycosides Pt and Considerations 

• Assess peak levels & monitor trough (low therapeutic index)

• Monitor Kidney (neprotoxicity BUN, I&O, creatine) and hearing loss due to potential ototoxicity.

• Avoid use in pregnancy unless necessary.

• Neuromuscular blockade: watch for muscle weakness/ respiratory failure (not for myasthenia gravis)

Fluroquinolones

• MOA: inhibits DNA gyrase/topoisomerase → bactericidal.

• Targets: gram - and some gram + bacteria

• Treat: urinary tract infections, respiratory infections, skin infections

• Ex: ciprofloxacin, levofloxacin, moxifloxacin

Fluroquinolones Pt teaching and considerations

• Fluid intake w ciprox to prevent crystalluria

• Long Qt intervals (caution w/ amiodorone)

• Older adults at risk for tendonitis (Achilles rupture)

• X (don’t) take with antacids, Ca, Fe, dairy

• Avoid in children & pregnancy

• C.diff risk

• Increased sun sensitivity

• Neuro effect: dizziness, HA, confusion

Macrolides

• MOA: inhibits 50s subunit (bacteriostatic)

• treats: Atypical pneumonia, strep in PCN allergy, pertussis, some STIs.

• ex: azithromycin, clarithromycin, erythromycin

Macrolides Pt teaching and Considerations

• Liver toxicity (monitor LFT)

• Increased QT interval (risk of arrhythmia)

• Drug interactions: with warfarin, statins, theophylline

• Suprainfections

• Key Teaching Report palpitations/fainting; separate antacids if directed; complete course

Sulfonamides 

• MOA: inhibits folic acid synthesis 

• treats: gram +/-; protozoal infections 

• treat: UTI, MRSA, parasitic infections.

• Examples include sulfamethoxazole and Bactrim.

Sulfonamides

• Sensitivity to sun, allergic reactions (Steven Johnsons): use suncreen

• Use caution with warfarin (increase bleeding), phenytoin (increases nephrotoxicity), sulfonyureas (risk of hypoglycemia)

• Liver toxicity

• Folic acid blocked - do not use in pregnancy

• Adequate fluid intake and monitor urine output due to potential crystallization.

• Key Teaching Hydrate well; sun protection; report rash/peeling; avoid in late pregnancy; potential ↑
  K+ (watch ACEI/ARBs/spironolactone).

Tetracyclines

• MOA: inhibit 30S ribosomal subunit → bacteriostatic.

• treat: Acne, tick-borne illnesses, CAP alternatives, MRSA skin (community)

• target: gram+, -, protozoal

tetracycline pt teaching and considerations

• Tetrogenic : avoid in pregnancy

• Empty stomach w full glass of water (no antacids)

• Take upright for 30 mins after dose (esophagitis)

• Risk of photosensitivity and teeth discoloration

• Avoid in kids (slows bone growth)

Glycopeptides 

• MOA: inhibit cell wall synthesis in gram-positive bacteria, leading to lysis.

• treat; MRSA, C.diff, bone infections, endocarditis 

Glycopeptides Pt teaching and Consideration

• V: Very toxic (narrow t.i)

• Administer slowly to prevent infusion reactions. (red man syndrome_

• Nephrotoxic: assess BUN, creatine, urine function

• C diff only treated w oral form

• ototoxicity risk: report tinnitus, hearing loss, vertigo

• Caution with other nephrotoxins (aminoglycosides, IV contrast).

Carbapenems

• MOA: inhibits cell wall synthesis

• targets: gram +/-, anaerobes, ESBL

• treats: severe resistant infections

• ex: Imipenem, Meropenem, Ertapenem

Carbapenems pt teaching and considerations 

• For resistant infections as a last option, risk of seizures, monitor renal function

• Allergy potential with cephalosporins

• Key Teaching Hospital-directed therapy; report confusion/seizure activity promptly

Monobactam

• MOA β-lactam targeting gram-negatives.

• Indications Gram-negative infections, alternative in severe PCN allergy.

• Major Side Effects GI upset, rare hepatotoxicity
  -Monitoring LFTs with prolonged therapy; renal function.
  Key Teaching Often used when β-lactam allergy present; complete course.