Antibiotics ◙Therapeutic Class: Antibiotic

Things to Remember About Antibiotics

◙Always given: PO
◙ Antibiotics are not helpful in treating viral
infections.
◙REMEMBER
◙They can only be used to treat bacterial >10% of patients who are allergic to
>Penicillin are also allergic to
infections
Cephalosporins

◙It is extremely important to take antibiotics for Cephalexin (Keflex)

the length of time they are prescribed. If we quit
taking antibiotics too soon, bacterial resistance is
more likely to occur.
◙Indicated for infections of the:
> Skin
About Antibiotics >Respiratory Tract
>Urinary Tract
◙Bacteria have become resistant to many
antibiotics. Patients should notify their provider if
no relief of symptoms is noted within 3 days of
◙ Keflex is most effective against gram positive
bacteria like Staph and Strep
taking an antibiotic.
Keflex:
◙Patients can be allergic to any antibiotic. It is ◙First-generation Cephalosporin
extremely important to ask the patient for a
history of any antibiotic allergies.
◙REMEMBER
◙Most PO antibiotics are best taken on an There are first, second and third-generation
cephalosporins
empty stomach. This means 1 hour before or
two hours after meals. ◙With each generation, there is increased activity
against gram negative bacteria.
◙Most IV antibiotics can cause phlebitis. ◙Only third-generation cephalosporins cross the
◙Watch the IV site carefully- check for redness, blood-brain barrier
tenderness, swelling.
Keflex:
◙Do not infuse too rapidly
◙Ideally, a culture and sensitivity sample is ◙Common Side Effects
obtained prior to starting antibiotic therapy >Allergic Reaction
>Affects 5% of all patients

◙Certain antibiotics can be toxic

(ex: Gentamicin). To help ensure safety, peak ◙Signs/Symptoms:
and trough levels of the antibiotic are drawn. >Rash
>Itching
>Fever and Chills
◙ Peak levels of an antibiotic are generally > Anaphylaxis (rare)
drawn 30 minutes after the IV dose is completed.
Trough levels are drawn just prior to the next
dose. ◙Cephalosporins: Allergic Reactions
REMEMBER
◙Many antibiotics cause a superinfection called
“pseudomembranous colitis”. This can be life- ◙ If a patient states an allergy to one cephalosporin,
threatening. he is considered allergic to ALL cephalosporins

Cephalosporin Antibiotics Keflex:

◙Cephalosporins are structurally similar to ◙Common Side Effects

>GI upset:
Penicillin.
>Nausea, Vomiting, Diarrhea, Anorexia
They are:
>May need to take with food
>Beta-Lactam antibiotics
> Need to monitor fluid status
>Bactericidal
>They are the most widely used
REMEMBER
antibiotics today

Cephalexin (Keflex)
◙ Most PO antibiotics are absorbed best on an
empty stomach
◙Pharmacologic Class: First-generation
Cephalosporin ◙Less Common Side Effects: Cephalosporins
 >Pseudomembranous Colitis: Severe When a cephalosporin is taken along with
local tissue inflammation of the colon an aminoglycoside antibiotic, there is increased risk of
caused by antibiotic therapy nephrotoxicity

>Antibiotic use causes an overgrowth of Aminoglycoside antibiotics are known to be

bacteria in the GI tract (superinfection) nephrotoxic.

There is an additive effect

◙Pseudomembranous Colitis: Signs and Cephalosporins and Alcohol
Symptoms
>Diarrhea Patients who take certain cephalosporin
>Abdominal Pain antibiotics and then drink alcohol (ETOH) are at risk
>Abdominal Cramping for an “antabuse- type reaction”
>Low-grade Fever
Certain cephalosporins have a chemical
structure which is similar to Disulfiram
◙What Organism Causes Pseudomembranous
Colitis? >(Antabuse)
>Clostridium Difficile Cephalosporins and Alcohol
>(C. Difficile)
>How is this determined?
>By checking a stool culture ◙What is Antabuse?
>A medication given to people who want to
stop drinking. It keeps them from drinking because it
◙How is this treated? makes them sick when they do consume alcohol
>Vancomycin

◙Treatment of Pseudomembranous Colitis ◙Antabuse Reaction:

>Recognize the signs/symptoms
>Stop the Cephalosporin
>Obtain a stool sample for culture and
sensitivity
◙Signs/Symptoms
>Nausea and Vomiting
>Patient may be started on Vancomycin >Abdominal Pain
>Flushing
>Tachycardia
◙Less Common Side Effects: Cephalosporins
>Nephrotoxicity
>(Kidney Damage)
>Who is most at risk? ◙Advice to Patients:
- Elderly >Don’t consume Alcohol while taking a
-Patients with known Renal cephalosporin antibiotic
Impairment
-Patients taking other nephrotoxic drugs
(ex: Aminoglycoside antibiotics) ◙Cephalosporins: Who needs to be monitored
closely?
>Patients on Coumadin
◙Nephrotoxicity: >Patients on Aminoglycoside Antibiotics
>Patients with Decreased Kidney function
>Elderly Patients (due to decreased kidney
◙How is it Monitored? function)
Need to check:
>Serum BUN/Creatinine Cephalosporins:
>Proteinuria

◙Late Signs: ◙Nursing Interventions

>Oliguria > Check results of Culture and Sensitivity
>Weight Gain >Monitor BUN/Creatinine levels
>Edema >Offer antibiotic with food or fluids if GI upset
occurs
>Check for potential drug interactions
◙Cephalosporins: Drug Interactions (Anticoagulants, Aminoglycosides, Alcohol)

>Anticoagulants: Macrolide Antibiotics

- When a cephalosporin is taken along [Erythromycin (E-Mycin)]
with an anticoagulant, there is increased risk of
bleeding Pharmacologic Class: Erythromycin
Therapeutic Class: Antibiotic
> Why?
Cephalosporins enhance the effects of
anticoagulants (ex: Coumadin) ◙Note:
>Erythromycin can be bacteriostatic or bactericidal
>Aminoglycoside Antibiotics:
>Erythromycin (E-Mycin)
>Erythromycin works best against gram postive
> Why?
bacteria
◙Indicated for infections of the:
-GU tract (Chlamydia)
- Respiratory Tract (Legionaires’
Disease)
-Prevention of Newborn Eye Infections
◙Erythromycin (E-Mycin)
◙Most Common Side Effects:
>Allergic Reaction
>GI upset
◙Less Common Side Effects:
>Hepatotoxicity
>Use cautiously in Patients with Hepatic
>Insufficiency
Erythromycin:
◙Sudden Cardiac Death
>Recent evidence now shows that certain drugs
can slow the metabolism of
>When this happens, patients can die due to
fatal cardiac arrhythmias
>Verapamil (Calan) is one of these drugs
◙Nursing Interventions:
>Be aware of other drugs the patient may be
taking
>Avoid Erythromycin if patient is taking:
Calcium Channel Blockers
Certain Anti-fungal medications
Certain Antidepressant medications
Erythromycin:
◙Drug Interactions
REMEMBER
>Erythromycin can interfere with the breakdown
and excretion of many different drugs
>This INCREASES the action of drugs like:
Theophylline
Coumadin
Digoxin
◙Drug Interactions: Erythromycin
Nursing Interventions:
>Monitor for signs of toxicity (Ex: A patient
taking Coumadin and Erythromycin would have
to be monitored closely for bleeding)
Aminoglycoside Antibiotics
Gentamicin (Garamycin)
Pharmacologic Class: Aminoglycoside
Therapeutic Class: Antibiotic
◙Note:
>Gentamicin is Bactericidal
>Usually Given: IV
◙REMEMBER:
>Aminoglycoside Excretion
>Gentamicin is excreted by the kidneys
>If kidney function is impaired, this increases
the risk of toxicity
>The very young (neonates) and the elderly
tend to have decreased kidney function
◙REMEMBER: Aminoglycoside Antibiotics
◙The (3) most serious side effects are:
>Nephrotoxicity
>Ototoxicity
>Neurotoxicity
◙Aminoglycoside: Gentamicin
>Indicated for the treatment of serious gram negative
infections of the:
>Kidneys
>Lungs
>Blood
◙REMEMBER: Gentamicin (Garamycin)
>Gentamicin has a NARROW therapeutic index
>This means there is high risk of toxicity
>Need to check Peak and Trough levels as ordered
◙Gentamicin Toxicities
>Nephrotoxicity
>When plasma levels of Gentamicin are
high, it accumulates in the kidneys
>These cells eventually die
>Damage can only be reversed when the
aminoglycoside is stopped
◙Gentamicin: Nephrotoxicity
Who is most at risk?
>Elderly
>Patients who are dehydrated
>Patients with Renal Dysfunction
>Patients on other nephrotoxic drugs
(Ex: Amphotericin B)
◙Nephrotoxicity: How to Monitor
>Check Peak and Trough levels of
Gentamicin
>Adjust doses to stay in the therapeutic
range
>Check BUN/Creatinine
>Check Proteinuria
>Check Oliguria, Weight Gain, Edema
◙Nephrotoxicity: How to Prevent
> Keep doses within the therapeutic range
>Keep patient well hydrated
>Recognize which patients are at highest
risk for nephrotoxicity
◙Aminoglycosides: Ototoxicity
>Gentamicin can also be toxic to cells of the
inner ear
This affects:
>Hearing (Cochlear)
 >Balance (Vestibular)
◙Gentamicin: Ototoxicty
◙Who is most at risk?
>Elderly (due to decreased kidney
function)
>Patients with previous hearing loss or
balance disorder
>Patients taking other ototoxic drugs
(ex: Lasix)
◙Aminoglycosides: Ototoxicty
>Risk factors (con’t):
>Patients with Kidney dysfunction
>Patients who have taken
aminoglycosides in the past
>Patients with elevated plasma levels of
the aminoglycoside
◙Gentamicin: Ototoxicty
◙Signs of Hearing Loss
>(Cochlear Damage):
>Tinnitus
>High-frequency hearing loss
>Can progress to deafness
>Early changes can be reversible
◙Nursing Interventions: Ototoxicity
>Advise patients to report if
signs/symptoms occur >Refer for
baseline hearing test
>Check adequate kidney function
>Check plasma levels of
Aminoglycoside
>Hearing tests may also be needed
during and after antibiotic use
Gentamicin: Ototoxicity
◙Balance Loss
(Vestibular Damage)
◙Signs/Symtoms:
>Dizziness
>Nystagmus
>Persistent Headache
◙Nursing Interventions:
Vestibular Damage
◙REMEMBER
>Ototoxicity can be permanent
>Report signs/symptoms immediately to
the provider
>Aminoglycoside will be stopped
>Educate patients about signs of
ototoxicty
◙Aminoglycosides: Neurotoxicity
>Aminoglycosides can cause muscle
weakness. In high doses they can cause
respiratory paralysis.
◙Who is most at risk?
>Patients with Myasthenia Gravis
>Patients Recovering from Surgery (due to
the use of general anesthetics and
neuromuscular blockers)
◙Aminoglycosides: Neurotoxicity
Nursing Interventions:
>Flag the chart of any patient who receives
Gentamicin prior to surgery
◙Why?
> Prolonged muscle weakness, paralysis or
apnea can occur as Gentamicin interacts with
neuromuscular blockers or anesthetic agents
◙Gentamicin: Neurotoxicity
>Can the neuromuscular effects of
>Gentamicin be reversed?YES
Calcium Salts
Glycopeptide Antibiotic
[Vancomycin (Vancocin)]
Pharmacologic Class: Glycopeptide
Therapeutic Class: Antibiotic
◙Note:
>Vancomycin is the only drug in this class
>It is bactericidal
>It is Usually Given: IV
Vancomycin (Vancocin)
◙Indicated for the treatment of:
>MRSA (Methicillin resistant Staph Aureus)
◙Where is this found?
Blood
Wounds
Lungs
◙Vancomycin (Vancocin)
>MRSA is a serious gram positive infection
>Can Staph become resistant to Vancomycin ?
YES
>Although this has happened, Vancomycin is
still the first choice for treating staph infections
resistant to
◙Penicillin
Vancomycin: Side Effects
>The (2) most serious side effects
associated with Vancomycin are:
>Ototoxicity
>Nephrotoxity
◙Vancomycin: Side Effects
>Ototoxicity
> Associated with high serum levels of
◙Vancomycin
 > Need to check Peak and Trough levels
>Partial or complete hearing loss can
occur

◙Vancomycin: Ototoxicity ◙Signs/Symptoms:

◙Who is most at risk?
>Patients with pre-existing hearing loss
>Patients on Prolonged Therapy
>Patients with Renal Impairment
(Vancomycin is excreted by the kidneys)
>Patients taking other Ototoxic drugs
(ex: Aminoglycoside antibiotics)
>Sudden drop in Blood Pressure
>Rash on face, neck, chest and upper
extremities
>Tachycardia, fever, chills
◙ “Red Man Syndrome”
Symptoms are caused by a release of
>Histamine

◙Ototoxicty: Nursing Interventions ◙Treatment:

>Check for early signs of hearing loss: >Stop the infusion
>Tinnitus >Give Antihistamines as needed
>Check also for signs of Vestibular >Give subsequent doses of Vancomycin
damage: over 60 minutes or more Vancomycin IV
Dizziness
Nystagmus
Persistent Headache

>Check baseline hearing test for high-risk ◙REMEMBER

patients >Vancomycin can irritate veins:
>Dilute in at least 100cc of fluid
>Monitor Peak and Trough levels so that doses >It can also irritate surrounding tissues:
can be adjusted as needed >Check for signs of extravasation

>Check for other ototoxic drugs

(ex: Aminoglycoside antibiotic, Lasix,
Aspirin)

◙Vancomycin: Nephrotoxicity
>Vancomycin can be Nephrotoxic

◙Who is most at risk?

>Elderly (due to decreased renal function)

>Patients with Renal Disease

>Patients on Prolonged Therapy
>Patients on other Nephrotoxic Drugs (ex:
Aminoglycoside Antibiotics)

Vancomycin: Nephrotoxicity
>Check BUN/Creatinine
>Check Proteinuria
>Check for late signs of Nephrotoxicity:
Oliguria
Weight Gain
Edema

◙ALWAYS ENCOURAGE FLUIDS

TO PREVENT KIDNEY DAMAGE

◙Vancomycin:
“Red Man Syndrome”

◙REMEMBER
>When giving Vancomycin IV,
- Infuse over 60 minutes
>Why?
-To prevent “Red Man Syndrome”

◙ “Red Man Syndrome”

> Caused by too rapid IV infusion of Vancomycin