UD22 Infection.docx

Infection

Antibacterial/Antibiotics Overview:

When selecting an antibiotic, factors that are considered: ​

  1. Identity of the causative agent​
  2. Sensitivity of the infecting organism to an antimicrobial​
  3. Other factors (location of infection, age, allergies, and immune status of host) 

Narrow vs broad spectrum antibiotics:

Narrow Spectrum

Broad Spectrum

Antibiotic primarily effective against limited types of organism.

Effective against multiple types of organisms

Special Considerations

  • Organ decline - adjustments may be made based on organ system declines (example, renal failure)

Teaching Point: Complete entire prescription

Penicillin

  • amoxicillin (amoxil)

Use: Treats broad-spectrum infections

Adverse Drug Reactions:

Drug Allergy

GI Upset (oral routes)

Superinfections

  • Potential cross sensitivity to cephalosporins
  • Nausea
  • Vomiting
  • Diarrhea
  • Candidiasis
  • C Diff

Contraindications:

  • Previous allergic reaction

Nursing Implications:

Interactions:

  • Penicillin can reduce the effectiveness of oral contraceptives.

Administration:

  • After administration by IM/IV routes, keep at facility for 30 minutes

Cephalosporin

  • cephalexin (Keflex)
  • Categorized by generations

Adverse Drug Reactions

GI Symptoms

Allergic Reactions

  • Diarrhea
  • Nausea, vomiting
  • C. Diff Infection
  • Previous allergic reaction to cephalosporin or penicillin

Vancomycin

  • vancomycin (vancocin)

Use: MRSA, C. Diff, Alternative for clients allergic to penicillin

Adverse Drug Reactions:

Toxicities

Red Man Syndrome

Thrombophlebitis

  • Renal failure
  • Ototoxicity

Tachycardia, hypotension, flushing

  • At IV site

Monitor:

  • Anaphylaxis
  • Superinfections

Labs:

Creatinine

Normal ranges:

Urine output

Normal ranges:

Vancomycin Lab Levels

Trough level – help to determine if drug is at therapeutic dose

Drawn minutes before next dose

  • High range = toxic level
  • Normal range = therapeutic level
  • Low range = too low of dose

Administration

  • For treatment of C-diff, oral route the only effective
  • Unpleasant taste

Macrolides

  • erythromycin

Use:

  • Broad spectrum antibiotic

Adverse Drug Reactions

GI symptoms

Ototoxicity

  • Hearing loss
  • Vertigo
  • Tinnitus

Superinfections

Monitor:

Assess for history of prolonged QT

Report any signs & symptoms of adverse reactions

    • Heart palpitations
    • Fainting spells

Education

  • Monitor PT/INR if also taking warfarin (blood thinner)
    • PT/INR – lab that monitors the clotting ability of the blood

Aminoglycosides

  • gentamicin

Ototoxicity

Nephrotoxicity

  • Tinnitus
  • Headache
  • Ataxia
  • Vertigo

Monitor:

  • Blood levels
  • Kidney function

Education:

  • Client should immediately call the provider for the onset of tinnitus, headache, vertigo, or hearing loss

Fluoroquinolones

  • ciprofloxacin (Cipro)

Use

  • Wide range of bacterial infection
    • Severe urinary tract infections

Adverse Drug Reactions:

Mild CNS Symptoms

Rupture of Achilles Tendon

Photosensitivity

  • Dizziness
  • Headaches
  • Rare
  • Avoid direct sun exposure to skin
  • Wear at least SPF 30

Caution:

  • When administering to clients receiving warfarin

Administration:

  • For oral administration – separate antacids, iron and calcium supplements, and sucralfate 2 hours after or 6 hours before ciprofloxacin

Sulfonamides

  • trimethoprim and sulfamethoxazole (Bactrim, Septra)

Use:

  • UTI
  • Acute otitis media
  • Chronic bronchitis

Adverse Drug Reactions:

Education:

Urinary Tract Antiseptics:

  • nitrofurantoin (Macrodantin)

Use:

  • Treat and prevent lower urinary tract infections
  • Prophylaxis for recurrent UTI’s

Adverse Drug Reactions:

Antimycobacterials:

  • rifampin (Rifadin)

Use: Treatment of Mycobacterium tuberculosis (TB)

Adverse Drug Reaction:

  • Liver toxicity
    • Monitor liver enzyme levels

Education:

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Antiparasites

  • metronidazole (flagyl)

Use: Treatment of bacterial and protozoal infections

Adverse Drug Reaction:

Education:

  • Darkening of urine
    • Harmless
  • Drug interactions: can cause disulfiram - type reaction
    • Client might exhibit: facial flushing, vomiting, dyspnea, tachycardia
    • Avoid alcohol
    • Reacts with several types of drugs

Antifungals

  • ketoconazole

Use:

  • Treatment of fungal infections

Adverse Drug Reactions

  • Topical
    • Burning, itching, redness
  • Oral
    • Liver toxicity
    • GI upset

Monitor

  • Liver function tests: ALT, AST

Interventions

  • Avoid antacids, proton-pump inhibitors, and H2-antagonists at least 2 hours before
    • Oral azoles require acidic environment in stomach for absorption.
      • Consume with soft drink

Antivirals

  • acyclovir (zovirax)

Use

  • Herpes simplex virus
  • Herpes zoster virus

Adverse drug reactions – vary based on the route

Topical

Oral

IV

  • Burning
  • Itching

GI symptoms (N, V, D)

  • Renal toxicity
  • Thrombophlebitis

Interventions

  • Kidney function:
    • BUN, Creatinine
  • IV administration:
    • Hydrate during infusion and 2 hours after
  • Wear gloves when applying topical:
    • Prevents cross contamination

Education

  • Instruct client to use condoms during sexual contact and avoid sexual activity while lesions are present