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Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. CHAPTER 39 Antibiotics Part 2.

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Presentation on theme: "Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. CHAPTER 39 Antibiotics Part 2."— Presentation transcript:

1 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. CHAPTER 39 Antibiotics Part 2

2 2 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Antibiotic Therapy: Concepts  Multidrug resistance  Therapeutic drug monitoring  Minimum inhibitory concentration (MIC)  Time-dependent killing  Concentration-dependent killing  Once-daily dosing vs. multi-daily dosing  Peak and trough blood levels  Synergistic effects  Post-antibiotic effect (PAE)

3 3 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Antibiotic Therapy: Toxicities  Ototoxicity  Temporary or permanent hearing loss, balance problems  Nephrotoxicity  Varying degrees of reduced renal function  Rising serum creatinine may indicate reduced creatinine clearance  Monitor trough levels every 5 to 7 days while on therapy or as ordered  Monitor serum creatinine levels at least every 3 days as an index of renal function

4 4 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Aminoglycosides  gentamicin (Garamycin)  neomycin (Neo-fradin)  tobramycin (Nebcin)  amikacin (Amikin)  kanamycin  streptomycin

5 5 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Aminoglycosides (cont’d)  Natural and semisynthetic  Produced from Streptomyces  Poor oral absorption; no PO forms  Very potent antibiotics with serious toxicities  Bactericidal; prevent protein synthesis  Kill mostly gram-negative bacteria; some gram-positive also

6 6 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Aminoglycosides: Indications  Used to kill gram-negative bacteria such as Pseudomonas spp., E. coli, Proteus spp., Klebsiella spp., Serratia spp.  Often used in combination with other antibiotics for synergistic effects  Used for certain gram-positive infections that are resistant to other antibiotics

7 7 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Aminoglycosides: Indications (cont’d)  Aminoglycosides are poorly absorbed through the GI tract, and given parenterally  Exception: neomycin  Given orally to decontaminate the GI tract before surgical procedures  Also used as an enema for this purpose

8 8 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Aminoglycosides: Adverse Effects  Cause serious toxicities  Nephrotoxicity (renal damage)  Ototoxicity (auditory impairment and vestibular impairment [eighth cranial nerve])  Must monitor drug levels to prevent toxicities

9 9 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Aminoglycosides: Adverse Effects (cont’d)  Ototoxicity and nephrotoxicity are the most significant  Headache  Paresthesia  Fever  Superinfections  Vertigo  Skin rash  Dizziness

10 10 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Quinolones  ciprofloxacin (Cipro)  norfloxacin (Noroxin)  levofloxacin (Levaquin)  moxifloxacin (Avelox)

11 11 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Quinolones (cont’d)  Also called “fluoroquinolones”  Excellent oral absorption  Absorption reduced by antacids  Effective against gram-negative organisms and some gram-positive organisms

12 12 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Quinolones: Mechanism of Action  Bactericidal  Alter DNA of bacteria, causing death  Do not affect human DNA

13 13 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Quinolones: Indications  Gram-negative bacteria such as pseudomonas  Respiratory infections  Bone and joint infections  GI infections  Skin infections  Sexually transmitted diseases  Anthrax

14 14 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Fluoroquinolones: Adverse Effects Body SystemAdverse Effects CNSHeadache, dizziness, fatigue, depression, restlessness, insomnia GINausea, vomiting, diarrhea, constipation, thrush, increased liver function studies, others CardiacProlonged QT interval

15 15 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Fluoroquinolones: Adverse Effects (cont’d) Body SystemAdverse Effects IntegumentaryRash, pruritus, urticaria, flushing, photosensitivity (with lomefloxacin) OtherFever, chills, blurred vision, tinnitus Black box warning: increased risk of tendonitis and tendon rupture

16 16 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Other Antibiotics  clindamycin (Cleocin)  linezolid (Zyvox)  metronidazole (Flagyl)  nitrofurantoin (Macrodantin)  quinupristin and Dalfopristin (Synercid)  daptomycin (Cubicin)  vancomycin (Vancocin)  colistimethate (Coly-mycin)

17 17 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Other Antibiotics (cont’d)  clindamycin (Cleocin)  Used for chronic bone infections, GU infections, intraabdominal infections, other serious infections  May cause pseudomembranous colitis

18 18 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Other Antibiotics (cont’d)  linezolid (Zyvox)  New class: oxazolidinones  Used to treat vancomycin-resistant Enterococcus faecium (VREF, VRE), hospital-acquired skin and skin structure infections, including those with MRSA  May cause hypotension, serotonin syndrome if taken with SSRIs, and reactions if taken with tyramine-containing foods

19 19 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Other Antibiotics (cont’d)  metronidazole (Flagyl)  Used for anaerobic organisms  Intraabdominal and gynecologic infections  Protozoal infections  Several drug interactions

20 20 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Other Antibiotics (cont’d)  nitrofurantoin (Macrodantin)  Primarily used for UTIs (E. coli, S. aureus, Klebsiella spp., Enterobacter spp.)  Use carefully if renal function is impaired  Drug concentrates in the urine  May cause fatal hepatotoxicity  Usually well-tolerated if patient is kept well- hydrated

21 21 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Other Antibiotics (cont’d)  quinupristin and dalfopristin (Synercid)  30:70 combination, work synergistically  Used for bacteremia and infections caused by vancomycin-resistant Enterococcus (VRE) and other complicated skin infections  May cause arthralgias, myalgias

22 22 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Other Antibiotics (cont’d)  daptomycin (Cubicin)  New class: lipopeptide  Used to treat complicated skin and soft-tissue infections

23 23 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Other Antibiotics (cont’d)  vancomycin (Vancocin)  Natural, bactericidal antibiotic  Destroys cell wall  Treatment of choice for MRSA and other gram-positive infections  Must monitor blood levels to ensure therapeutic levels and prevent toxicity  May cause ototoxicity and nephrotoxicity  Should be infused over 60 minutes  Rapid infusions may cause hypotension

24 24 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Other Antibiotics (cont’d)  vancomycin (Vancocin) (cont’d)  Monitor IV site closely  Red man syndrome may occur Flushing/itching of head, neck, face, upper trunk Flushing/itching of head, neck, face, upper trunk Antihistamine may be ordered to reduce these effects Antihistamine may be ordered to reduce these effects  Ensure adequate hydration (2 L fluids/24 hr) if not contraindicated to prevent nephrotoxicity  Monitor trough levels carefully

25 25 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Nursing Implications  Before beginning therapy, assess drug allergies; hepatic, renal, and cardiac function; and other lab studies  Be sure to obtain thorough patient health history, including immune status  Assess for conditions that may be contraindications to antibiotic use or that may indicate cautious use  Assess for potential drug interactions

26 26 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Nursing Implications (cont’d)  It is ESSENTIAL to obtain cultures from appropriate sites BEFORE beginning antibiotic therapy  Instruct patients to take antibiotics exactly as prescribed and for the length of time prescribed; they should not stop taking the medication early when they feel better

27 27 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Nursing Implications (cont’d)  Assess for signs and symptoms of superinfection: fever, perineal itching, cough, lethargy, or any unusual discharge  For safety reasons, check the name of the medication carefully because there are many drugs that sound alike or have similar spellings

28 28 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Nursing Implications (cont’d) Nursing Implications (cont’d)  Each class of antibiotics has specific adverse effects and drug interactions that must be carefully assessed and monitored

29 29 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Nursing Implications (cont’d)  Aminoglycosides  Monitor peak and trough blood levels of these drugs to prevent nephrotoxicity and ototoxicity  Symptoms of ototoxicity include dizziness, tinnitus, and hearing loss  Symptoms of nephrotoxicity include urinary casts, proteinuria, and increased BUN and serum creatinine levels

30 30 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Nursing Implications (cont’d)  Monitor for therapeutic effects  Improvement of signs and symptoms of infection  Return to normal vital signs  Negative culture and sensitivity tests  Disappearance of fever, lethargy, drainage, and redness  Monitor for adverse reactions


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