Ant-Infective Drugs

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Ant-Infective Drugs

• Antibacterials
• Sulfa Drugs
• Urinary
• Anti-tuberculosis
• Antifungals
• Antivirals

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Antibacterial Drugs(Antibiotics Antimicrobials)
I. Increased Susceptibility to Infection A.
Age B. Exposure C. Barrier Disruption D.
Immune Defenses E. Circulation F. Nutrition
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II. Identification of Organisms A.
Microscope B. Gram Stain C. Culture D.
Sensitivity III. Selection of Agent A.
Location B. Organ Function (liver, kidney) C.
Age (very young vs elderly) D. Pregnancy /
Lactation E. Resistance (MRSA, VRE) F.
Know allergy
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IV. Classification A. Action 1.
Bacteriocidal 2. Bacteriostatic B.
Spectrum 1. Broad 2. Narrow C.
Antibiotic vs Antimicrobial V. Actions
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VI. Uses A. Primary Infection B. Secondary
Infection C. Pre-op D. Prophylaxis E. Virus
- no! F. Nosocomial infections
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VII. Adverse Reactions A. Hypersensitivity/
Anaphylaxis B. Cross-Sensitivity C. Organ
Toxicity - direct 1. Nephrotoxicity 2.
Hepatotoxicity 3. Ototoxicity D.
Hematological blood dyscrasias E.
Superinfection (indirect) F. Pain -
phlebitis G. GI Distress H. Neurotonic
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VII. Antibacterial Agents A. Penicillins B.
Cephalosporins C. Tetracyclines D.
Aminoglycosides E. Sulfonamides F.
Miscellaneous 1. Macrolides
erythromycin 2. Quinolones - Cipro
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X. Aminoglycosides (gentamycin) A. Action
gram neg resistant B. Use 1. Urinary
infections - resist 2. Pre-op for intestinal
OR C. Adverse Effects N/V/D 1.
Nephrotoxicity - BUN 2. Ototoxicity -
tinnitis D. Interactions general anesthesia
(Neuromuscular blocking)-flag E.
Peak Trough levels (1hr/30min)
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IX. Cephalosporins semi-synth A. Use -
penicillin resistance B. Generations broad
spectrum 1. First - Keflin 2. Second -
Ceclor 3. Third Claforan (4th) C. Cross
sensitivity to penicillin D. Adverse
reactions 1. Nephrotonic, rashes 2. GI
Distress food (NVD) 3. Injection pain -
phlebitis
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XIV. Macrolide -Erythromycin (E-mycin) A.
Action - bacteriostatic B. Uses oral therapy
for penicillin substitute (least
toxic) 1. Respiratory infections 2. Soft
tissue (gums) infections 3. Mycoplasms,
chlamydia (STD) C. S/E 1. N/V/D 2.
Skin rash, superinfection D.
Helicbacoter pylori E. Dangerous
interactions ie,Diflucan
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• Penicillins from fungus
• (treat Streph, Staph Pseudo resp, intestinal
  infections, helicobacter pylori)
• A. Overuse Penicillin
• B. Natural vs synthetic
• C. Routes oral, IM, IVs
• D. Units, grams, mgs
• E. S/E GI (NVD), allergy, superinf
• F. Example Amoxicillin
• G. Inhibits estrogen BCP/avoid alcohol

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XVII. Quinolones - Ciprofloxacin Cipro A.
Resistance by son Pseudomonas B. UseUTI, Resp,
GI C. S/E some serous 1.
N/V/D, rash 2. Photosensitivity
(toxic) 3. CNS H/A, dizzy, tremor-caffeine
4. Crystalluria drink fluids!
5. Collitis in elderly
6. Cartilage damage in children
7. Tendon damage no strenuous exercise D.
Interactions Many drugs!
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XI. Tetracyclines (tetracycline) broad
spec A. Uses (incr. resistance) uncommon 1.
Alternative to penicillin 2. Richettsiae,
Lyme, chr bronchitis B. Adverse effects 1.
N/V/D 2. Superinfection 3.
Photosensitivity, rash 4.
Discolored teeth, retarded bone C.
Contraindications binds to calcium
iron - not w/ food D. Pregnancy,
under 8 yrs of age E. Outdated -
nephrotoxic
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XV. Chloramphenicol A. Use serious
life-threatening infections (typhoid)
topical ocular infections (toxic!) B.
S/E Adverse reactions 1. Fatal blood
dyscrasias or bone marrow
depression 2. N/V/D 3. Superinfections C.
Contraindic Infants under 2 mos
(Immature livers)
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XVI. Miscellaneous (Toxic) A.
Vancomycin - (MRSA) various 1.
organ toxicities (oto, nephro) 2.
IV - necrosis B. Flagyl - antibacterial
antiprotozoan (Trichomonas)
very toxic 1. neurological 2.
Avoid alcohol disulfiram rx C.
Cleocin (clindomycin)- 1. Colitis (life
treatening) d/c if N/V/D
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Antivirals
A. Natural immunity or vaccination B. Many
viruses do not produce immunity vaccines
not available C. Viral infections 1. Herpes
simplex I II 2. Herpes zoster (shingles),
chicken pox 3. Flu, cold 4. AIDS,
hepatitis
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D. Drugs 1. Zovirax - cutaneous genital
Herpes, herpes zoster (acyclovir) 2.
Zidovudine (AZT, Retrovir) - AIDS CMV 3.
Symmetrel (amantadine) Flu 4. Tamiflu
- inhalation E. Action - prohibits viral
attachment or protein synthesis F. S/E
N/V, lethargy, fatigue, H/A
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XII. Sulfonamides (precursor to antibiotics) A.
Use limited 1. Non-obstr. UTIs 2.
Burns - topical B. Action - bacteriostatic C.
Meds Bactrim, Septra (comb.),
Silvadene (topical) D. S/E N/V/D,
crystalluria (water), allergy,
photosensitivity, blood
dyscrasias, yellow urine, hepatotoxic,
hypersensitivity E. Steven-Johnson
syndrome- rash F. Interactions
Coumadin, hypoglycemics
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XVI. Macrodantin (Urinary Anti-infective) A.
Use Chronic UTIs B. Not sulfonamide or
antibiotic C. Action does not achieve
significant elevation of blood levels to
be effective for systemic
infections. Interfers with
bacterial multip in the urine. D.
S/E N/V/D, anorexia, neuritis
respir.allergy (wheezing), dark urine
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Antifungals
A. Plant-like yeasts or molds B. Systemic
mycotic Infections 1. Serious 2.
Immunosuppressed C. Dermatophytic - hair, nails,
skin (athletes foot, ring worm) D.
Candida albicans - superinfection
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E. Meds 1. Fungizone (amphotericin B) -
systemic infections 2. Griseofulvin -
hair, skin, nails 3. Mycostatin (nystatin)
candida 4. Diflucan one dose med
(fluconazole) F. Action usually fungicidal G.
Adverse Effects 1. N/V/D 2. H/A dry
mouth H. Hospitalized for IV systemic trmt
(serious side effects)
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XIII. Ioniazid (INH - DOT therapy) A. Use -
tuberculosis (mycobacterium) 1. Asymtomatic
6-12 months 2. Active 2-3 agents (6-9
mos) B. Other first line agents 1.
Rifampin 2. Ethanbutol C. S/E or Adverse Rx
(ioniazid) 1. hepatotoxicity 2. N/V - give
with food 3. Neuro - numbness, tingling
(given with B6)