Ant-Infective Drugs
• Antibacterials
• Sulfa Drugs
• Urinary
• Anti-tuberculosis
• Antifungals
• Antivirals
Antibacterial Drugs
(Antibiotics & Antimicrobials)
I. Increased Susceptibility to
Infection
A. Age
B. Exposure
C. Barrier Disruption
D. Immune Defenses
E. Circulation
F. Nutrition
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
IV. Classification
A. Action
1. Bacteriocidal
2. Bacteriostatic
B. Spectrum
1. Broad
2. Narrow
C. Antibiotic vs Antimicrobial
V. Actions
VI. Uses
A. Primary Infection
B. Secondary Infection
C. Pre-op
D. Prophylaxis
E. Virus - no!
F. Nosocomial infections
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
VII. Antibacterial Agents
A. Penicillins
B. Cephalosporins
C. Tetracyclines
D. Aminoglycosides
E. Sulfonamides
F. Miscellaneous:
1. Macrolides – erythromycin
2. Quinolones - Cipro
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)
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
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
VIII.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
XVII. Quinolones - Ciprofloxacin: Cipro
A. Resistance by son Pseudomonas
B. Use:UTI, 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!
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
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)
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
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
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
XII. Sulfonamides (precursor to antibiotics)
A. Use: limited
1. Non-obstr. UTI’s
2. Burns - topical
B. Action - bacteriostatic
C. Med’s: 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
XVI. Macrodantin (Urinary Anti-infective)
A. Use: Chronic UTI’s
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
Antifungals
A. Plant-like: yeasts or molds
B. Systemic mycotic Infections
1. Serious
2. Immunosuppressed
C. Dermatophytic - hair, nails, skin
(athlete’s foot, ring worm)
D. Candida albicans - superinfection
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)
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)