IN GENERAL BEFORE THE ADMINISTRATION OF ANY ANTIBIOTIC, IT IS CRUCIAL TO GATHER DATA REGARDING THE HISTORY OF OR SYMPTOMS INDICATIVE OF HYPERSENSITIVITY OR ALLERGIC REACTIONS." THAT CATALYZE THE CHEMICAL OPENING OF THE BETA LACTAM RING STRUCTURES IN BETA LACTAM ANTIBIOTICS ANATOMY PHYSIOLOGY, PATHOPHYSIOLOGY OVERVIEW NURSING PROCESS ASSESSMENT: ● ● ● ● ● ● ● "CRUCIAL" SOMETHING THAT CANNOT BE IGNORED ASSESS FOR HISTORY OF HYPERSENSITIVITY OR ALLERGIC REACTIONS DATA ARE OBTA/NED BEFORE THE ADMINISTRATION OF THE DRUG. DETTERMINE PATIENT'S AGE WEIGHT, VITAL SIGNS, LABORATORY RESULTS NON COMPLIANCE WITH TREATMENT REGIMEN RELATED TO LACK OF INFORMATION DEFICIENT KNOWLEDGE RELATED TO LACK OF INFORMATION RISK OF INFECTION RELATED TO THE PATIENT'S POSSIBLE DEVELOPMENT OF A COMPROMISED IMMUNE STATUS. EVALUATION ● ● ● ● ● ● ● ● BACTERIA MAY TAKE NUMBER OF DIFFERENT SHAPES (MORPHOLOGY) GRAM STAIN PROCEDURE - WAYS OF CATEGORIZING BACTERIA PURPLE (GRAM POSITIVE) RED (GRAM NEGATIVE) LOOK FOR POSITIVE RESPONSES/THERAPEUTIC EFFECTS MONITOR FOR NEGATIVE EFFECTS EDUCATE THE PATIENT ABOUT THE EFFECTS MONITORING OF GOALS, OUTCOME CRITERIA, THERAPEUTIC EFFECTS AND ADVERSE EFFECTS ANTIBIOTICS HEALTH CARE ASSOCIATED INFECTION ANTIBIOTIC - HAVING THE ABILITY TO DESTROY OR INTERFERE WITH THE DEVELOPMENT OF A LIVING ORGANISM. (ANTIBACTERIAL) BETA LACTAM - DESIGNATION OF A BROAD CLASS OF ANTIBIOTICS THAT INCLUDES FOUR SUBCLASSES,;PENICILLINS, CEPHALOSPORINS, CARBAPENEMS AND MONOBACTAMS (BETA LACTAM RING) BETA LACTAMASE - ANY OF A GROUP OF ENZYMES PRODUCED BY BACTERIA ● ● COMMUNITY ASSOCIATED INFECTION - AN INFECTION THAT IS ACOUIRED BY A PERSON WHO HAS NOT RECENTLY BEEN HOSPITALIZED NOSOCOMIAL INFECTION - AN INFECTION THAT A PATIENT ACQUIRES DURING THE COURSE OF RECEIVING TREATMENT FOR ANOTHER CONDITION IN A HEALTH CARE FACILITY. ABOVE 48 HRS AFTER ADMISSION ● ● ● ● ● ● ● ● ● IRECT CONTACT D HANDWASHING: TO PREVENT SPREAD DISINFECTANT, ANTISEPTIC EMPERIC THERAPY - THE ANTIBIOTIC SELECTED IS ONE THAT CAN BEST KILL THE MICROORGANISM KNOWN TO BE THE MOST COMMON CAUSE OF THE INFECTION CULTURE AND SENSITIVITY BROAD SPECTRUM ANTIBIOTIC NARROW SPECTRUM ANTIBIOTIC PROPHYLACTIC ANTIBIOTIC ● ● ● ● -PENICILLINS CEPHALOSPORINS - CARBAPENEMS . MONOBACTAMS BETA LACTAMASE (BETA LACTAM RING) PIC PENICILLINS ● ● ● DERIVED FROM FUNGI OFTEN ON BREAD OR FRUIT BACTERICIDAL ANTIBIOTICS-KILL WIDE VARIETY OF GRAM + AND GRAM - BACTERIA. PENICILLINASES. THE BETA LACTAMASES THAT CAN INACTIVATE PENICILLIN MOLECULES BETA LACTAMASE INHIBITORS ● ● ● CLAVULANIC ACID TAZOBACTAM SULBACTAM SULFONAMIDES MECHANISM OF ACTION ● ● ONE OF THE FIRST GROUPS OF DRUGS USED AS ANTIBIOTICS SULFAMETHOXAZOLE COMBINED WITH TRIMETROPRIN (BACTRIM) OR SMX-TMP IS COMMONLY USED CLINICALLY. MECHANISM OF ACTION ● ● ● ● ● ● INHIBIT RATHER THAN DESTROY BACTERIA BACTERIOSTATIC ANTIBIOTICS INHIBIT THE GROWTH OF SUSCEPTIBLE BACTERIA BY PREVENTING BACTERIAL SYNTHESIS OF FOLIC ACID. FOLIC ACID IS REQUIRED FOR SYNTHESIS OF PURINES ( DNA,RNA). COMPETITIVE INHIBITION (PABA, PTERDINE, GLUTAMIC ACID INDICATIONS ● ● ● CONTRAINDICATION ● ● ● ● DRUGALLERGY TO SULFONAMIDES PREGNANT WOMEN INFANTS YOUNGER THAN 2 MONTHS AGE INHIBITION OF BACTERIAL CELL WALL SYNTHESIS. PENICILLIN BINDING PROTEINS- BY BINDING WITH THESE PROTEINS PENICILLINE INTERFERE WITH NORMAL CELL WALL SYNTHESIS. BACTERIAL DEATH LYSIS (RUPTURE) OF THE BACTERIAL CELLS ● GRAM + BACTERIAL INFECTION STREPTOCOCCUS SP, ENTEROCOCCUS SPPSTAPHYLOCOCCUS SPP. LITTLE ABILITY TO KILL GRAM BACTERIA EXTENDED BROAD SPECTRUM PENICILLINS: PIPERACILLIN/TAZOBACTAM HAVE EXCELLENT GRAM +,GRAM, ANAEROBIC COVERAGE. PNEUMONIA SEPSIS, INTRAABDOMINAL INFECTION CONTRAINDICATIONS BETA LACTAM ANTIBIOTIC ● BETA LACTAM ANTIBIOTICS COMMONLY USED DRUGS. SUBCLASSES: DRUG ALLERGY ARE VERY CEPHALOSPORINS ● RELATED TO PENICILLINS ● ● ● BACTERICIDAL AND WORK BY INTERFERING WITH BACTERIAL CELL WALL SYNTHESIS. BIND WITH PENICILLIN BINDING PROTEINS ACTIVEAGAINTS GRAM +,GRAM - OR ANAEROBIC BACTERIA THE LEVEL OF GRAM - COVERAGE INCREASES WITH EACH SUCCESSIVE GENERATION. ● ● ● THE FIRST GENERATION - MOST GRAM + COVERAGE LATER GENERATION - MOST GRAM COVERAGE SECOND AND THIRD GENERATION ANAEROBIC COVERAGE MONOBACTAMS ● ● ● ● ● ● AZTEONAM (AZACTAM). IS THE ONLY MONOBACTAM ANTIBIOTIC TO BE DEVELOPED SO FAR. SYNTHETIC BETA LACTAM= ACTIVE AGAINST GRAM AEROBIC BACTERIA E COLI, KLEBSIELLASPP, PSEUDOMONAS SPP BACTERIDICAL INHIBITS BACTERIAL CELL WALL SYNTHESIS. INDICATED FOR MODERATELY SEVERE SYSTEMIC INFECTIONS, UTI COMMON ADVERSE REACTIONS: RASH, NAUSEA, VOMITING, DIARRHEA MACROLIDES CEFTAROLINE THE NEWEST CEPHALOSPORIN ST GENERATION,COVERS GRAM +, GRAM - | INCLUDING MRSA ● ● ● 1ST GENERATION: ● CEFAZOLIN 2ND GENERATION ● CEFOXITIN, CEFUROXIME MECHANISM OF ACTION ○ 3RD GENERATION ● CEFTRIAXONE, CEFTAZIDIME ○ 4TH GENERATION ● CEFERIME 5TH GENERATION ● ● ● ● ● ● ● ○ CEFAROLINE CARBAPENEMS BROADEST ANTI BACTERIAL ACTION OF ANY ANTIBITOCS TO DATE. BACTERICIDAL AND INHIBIT CELL WALL SYNTHESIS. RESERVED FOR COMPLICATEDBODY CAVITY AND CONNECTIVE TISSUE INFECTIONS ONE HAZARD OF CARBAPENEM USE IS DRUG INDUCED SEIZURE ACTIVITY (RARE) IMIPENEM,CILASTATIN.MEROPENEM. BACTERIOSTATIC AZITRHOMYCIN. CLARYTHROMYCIN ERYTHROMYCIN AZITHROMYCIN AND CLARYTHROMYCIN - WIDELY USED LONGER DURATION OF CATION, MILDER GIT ADVERSE EFFECTS BETTER EFFICACY INHIBIT PROTEIN SYNTHESIS BY BINDING REVERSIBLY TO THE 50S SUBUNITS OF SUSCEPTIBLE MICROORGANISM. USED FOR UPPER AND LOWER RESPIRATORY TRACT INFECTIONS,SKIN AND SOFT TISSUE INFECTIONS. (STREPTOCOCCUS, HAEMOPHILUS, SPIROCHETAL INFECTIONS ETC) GONOCCOCAL INFECTIONSIN COMBINATION WITH CEPHALOSPORIN ANTIBIOTICS FOR RESISTANT INFECTIONS (HARD TO TREAT) ● MULTI DRUG RESISTANT ORGANISMS ORGANISMS RESISTANT TO ONE OR MORE CLASSES OF ANTIBIOTICS (MRSA, VRE, ESBLKPC) ● ● ● CONTACT ISOLATION UNTREATABLE SPREAD BY CONTACT PROPER HANDWASHING PATIENT AMINOGLYCOSIDES ● ● ● ● 1. 2. 3. 4. ● ● ● GROUP OF NATURAL AND SYNTHETIC ANTIBIOTICS CLASSIFEID AS BACTERICIDAL. POTENT ANTIBIOTICS DRUG OF CHOICE FOR VIRULENT INFECTIONS AMKACIN GENTAMYCIN TOBRAMYCIN NOT GIVEN ORALLY-POOR ORAL ABSORPTION THERAPEYTIC DRUG MONITORING (NEPRHOTOXICITY AND OTOTOXICITY BELOW I MCG/ML) MECHANISM OF ACTION ● ● BIND TO RIBOSOMES, PREVENT PROTEIN SYNTHESIS IN BACTERIA. OFTEN USED IN COMBINATION WITH OTHER ANTIBIOTICS SUCHAS BETA LACTAMS OR VANCOMYCIN IN THE TREATMENT OF VARIOUS INFECTIONS. (SYNERGISTIC EFFECT) ➔ BETA LACTAMS ARE GIVEN FIRST BECAUSE IT BREAKS DOWN THE BACTERIAL CELL WAL LAND ALLOW AMINOGLYCOSIDES TO GAIN ACCESS TO RIBOSOMES. ● ● OTOTOXICITY - NOT REVERSIBLE DIZZINESS, TINNITUS, HEARING LOSS, HEADACHE, PARESTHESIA, SKIN RASH NOTE GENTAMYCIN - THE MOST COMMONLY USED AMINOGLYCOSIDE CLINICALLY TODAY QUINOLONES ○ ○ ○ ○ ALSO KNOWN AS FLUOROQUINOLONES VERY POTENT BACTERICIDAL BROAD SPECTRUM ANTIBIOTICS. NORFLOXACIN, CIPROFLOXACIN, LEVOFLOXACIN, MOXIFLOXACIN EXCELLENT ORAL ABSORPTION EXCEPT NORFLOXACIN MECHANISM ● ● ● ● DESTROL BACTERIA BY ALTERING THEIR DNA. THEY DO THIS BY INTERFERING WITH THE BACTERIAL ENZYMES DNA GYRASE AND TOPOISOMENRASE IV. GRAM + GRAM - ORGANISMS SOME QUINOLONES DIFFUSE INTO HUMAN NEUTROPHILS TO KILL BACTERIA SUCHAS S.AUREUS, MYCOBACTERIUM FORTUITUM BACTERIAL RESISTANCE HAS BEEN IDENTIFIED. INDICATIONS ● ● ● ● ● ● ● ● GRAM PSEUDOMONAS SPR. ENTEROBACTERIACEAE (E. COLI,PROTEUS SPPKLEBSIELLA) GRAM+ ENTEROCOCCUS SPP STAPH AUREUS, BACTERIAL ENDOCARDITIS USED IN COMBINATION (SYNERGY) PROPHYLAXIS PROCEDURES INVOLVONG GIT,GUT ADMINISTER IN CAUTION IN PREMATURE, NEONATES - RENAL IMMATURITY SEROUS PEDIATRIC CONDITONS PNEUMONIA, MENINGITIS,UTI ADVERSE EFFECTS ● NEPHROTOXICITY - REVERSIBLE MISCELLANEOUS ANTIBIOTICS ● UNIQUE INDICATIONS, SEPECIALLY PREFERRED FOR A PARTICULAR TYPE OF INFECTION
