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Introduction
Antiinfective
TERMINOLOGIES
CHEMOTHERAPY
Terminologies
ANTIMICROBIAL
Terminologies
Bacteriostatics
Terminologies
Broad
spectrum
antibiotics
These are antibiotics that
interfere with a biochemical
reaction common to many
organisms.
Principle of selective
toxicity
Toxicity
of biochemical differences
between the parasite and the host cell.
The more closely the unwanted cell or
parasite resembles the host the more
difficult it is to achieve selective toxicity
Mechanism of action of
antimicrobials
Inhibition
Alteration
Inhibition
of protein synthesis
Inhibition
of synthesis of essential
metabolites
CLASSIFICATION OF
ANTIBACTERIAL DRUGS
A.
Classification by susceptible
organism
Narrow-spectrum antibiotics
Broad spectrum antibiotics
B.
Classification by mechanism of
action
Sulfonamides
Sulfonamides
Mechanism of action
All
Mechanism of action
Because
Mechanism of action
Sulphonamides
Clinical uses
Simple
UTI
Ophthalmic preps for
bacterial conjunctivitis
Chronic inflammatory bowel
disease (IBD)
Contraindications
Newborns
Adverse reaction
Nausea
and vomiting.
hypersensitivity reactions e.g. rashes,
fever, crystalluria (nephrotoxicity)
haemolytic anaemia in G-6PD
patients.
Kernicterus in newborns,
Nursing implications
Check
Nursing intervention
Administer
Trimethoprim
In
structure, trimethoprim
resembles folate
It antagonizes the enzyme
dihydrofolate reductase.
It is active against most common
bacterial pathogens, and it is
bacteriostatic.
Trimethoprim
It
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Penicillins
Cephalosporins
Vancomycin
Fosfomycin
-lactams
Beta-lactam antibiotics
Beta-lactam antibiotics
Beta-lactam
characteristics
Same Mechanism of Action : Inhibit cell
wall synthesis
Bactericidal (except against Enterococcus
sp.); time-dependent killers
Short elimination half-life
Primarily renally eliminated
Cross-allergenicity - except aztreonam
Mechanism of action
Mechanism of Resistance
1.
2.
Trapping mechanism
3.
4.
5.
6.
Mechanisms of Resistance
Production of -lactamase enzymes
1.
Trapping mechanism.
2.
Mechanisms of Resistance
Modification of target PBPs
3.
4.
Mechanism of Resistance
The shortage of autolytic enzyme.
5.
6.
PENICILLINS
Introduction
Alexander Fleming
discovered penicillin in
1928
Penicillin is a antibiotic
used in the treatment
of bacterial infections
caused by susceptible.
Introduction
The structure of the
penicillins consists of a
thiazolidine ring connected
to a beta-lactam ring, which
is attached to a side chain.
The various penicillins differ
in their side chain structure
Mechanism of action
Penicillin belongs to the beta-lactam
family of antibiotics (the members of
which use a similar mechanism of action)
Bacteria cells are surrounded by cell wall.
One of the primary components of the
bacterial cell wall is peptidoglycan (a
net-like composition that provides rigidity
and support)
Mechanism of action
Classification of penicillin
Spectrum of activity
Both bacteriostatic and bactericidal
agents.
Types of penicillin
natural and semisynthetic penicillin.
penicillia.
1. Penicillin G (benzyl penicillin)
prototype
2. Penicillin V. (phenoxymethylpenicillin)
. Derived from the mold penicillium
Examples of natural
penicillins
Penicillin G benzathine:
Penicillin G (Benzyl
Penicillin)
Penicillin G (Benzyl
Penicillin)
This was the first penicillin to be used
clinically
Characteristics
Acid labile
Inactivated rapidly in the GIT
Absorbed erratically if taken orally
Hence given by parenteral route
Penicillin V
Acid stable (suitable for oral use)
Less potent than penicillin G
Other penicillins are either wholly or
Penicillinase-resistant penicillins
Exs. are Cloxacillin, methicillin &
flucloxacillin
chemical modifications of the prototype;
provide protection against penicillinase
Hence, Flucloxacillin is not inactivated by
penicillinase and therefore used in the
treatment of Staph infections.
Extended Spectrum
penicillins
e.g. amoxicillin and ampicillins
Effective against numerous species of
gram-negative bacteria
They are inactivated by penicilinase
Amoxicillin is a derivative of ampicillin;
amox is better absorbed by mouth
Examples of extended
spectrum penicillin
Ampicillin
hourly,
250mg-500mg IM or IV 6
500mg PO 6 hourly
250-500mg PO 8 hourly
Pharmacokinetics
Rapidly absorbed from the GIT
Should be taken on an empty stomach to
ensure adequate absorption.
Uses or indication
Streptococcal pharyngitis,
Pneumococcal pneumonia,
Endocarditis,
Meningitis,
Otitis media
Adverse Reactions
1. Hypersensitivity reactions
2. Superinfections: E.g. candidiasis
3. GI tract: nausea, vomiting & diarrhea,.
4. Blood disorders: anemia &
thrombocytopenia,
Precautions
Contraindicated in clients:
With a history of previous
hypersensitivity to penicillins.
Clients with severe renal insufficiency.
Nursing interventions
1. Question the client concerning history of drug allergies.
2. Observation: signs of hypersensitivity, respiratory
distress, N & V.
3. Management of allergic reactions
Mild:
diphenhydramine (phenergan)
Severe: (respiratory ):
epinephrine
4. Oral penicillin
Give on an empty stomach, one hour before or 1 to 2 hours
after meals,
Amoxicillin give with food.
Take with full glass of water, never with acidic fluids like
orange juice.
5. IM injections
deep into a large muscle mass.
Client Education
1. Take the medication around the clock
2. Finish taking the drugs as ordered, even if condition
improves.
3. Never share this medication because other individuals
4. Report white patches on oral mucosa, vaginal discharge
5. Ingest yoghurt if diarrhea develops to help replace
intestinal flora
6. Notify health professional if symptoms do not improve.
CEPHALOSPORINS
Introduction
The cephalosporins are closely related in
structure to penicillin.
They have a beta-lactam ring.
They are relatively stable in dilute acid
and are highly resistant to penicillinase.
Bactericidal
Broad spectrum
Resistant to beta-lactamases
Mechanism of action
Cephalosporins
inhibit the
peptidoglycan synthesis of bacterial
cell wall in a manner similar to that
of penicillin and are considered
bactericidal.
classification
1st
generation:
generation
generation
generation-eg cefditoren
First Generation
cephalosporins
Second Generation
Cephalosporins
Examples cefamandole, cefoxitin, cefaclor,
cefonicid, cefuroxime, cefotetan, cefprozil.
Action of this generation on G+ bacteria is
the same or a little bit less than that of the
first generation.
Their antimicrobial action on G- bacteria is
obviously increased
Some of them are effective against
anaerobes such as B.fragilis.
Second Generation
Cephalosporins
Third Generation
Cephalosporins
Third Generation
Cephalosporins
almost no nephrotoxicity.
Third Generation
Cephalosporins
Adverse reactions
Relatively few and low
The most common ones are Allergy
-hypersensitivity reactions (5%-10%)
Adverse reactions
Nephrotoxicity
The first-generation cephalosporins have
certain nephrotoxicity. (Renal damage, including
interstitial nephritis and even tubular necrosis )
The second-generation have slight
nephrotoxicity.
The third-generation have almost no
nephrotoxicity
Contraindication
Nursing implications
Check
Nursing intervention
Make
Nursing intervention
Observe
Aminoglycosides
Potent
used
& bactericidal
threatening infections.
Have
Aminoglycosides
Examples
include:
Amikacin
Gentamicin
Kanamycin
Neomycin
Streptomycin
Aminoglycosides
Indication
Aminoglycosides
Mechanism
of action
Aminoglycosides
Contraindication/
caution
Aminoglycosides
Adverse
effects
Ototoxicity.
Confusion, depression,
disorientation
Nephrotoxicity
GI effect, nausea, vomiting
Cardiac effect: palpitations,
Hypersensitivity reaction.
Aminoglycosides
Adverse
effects
Ototoxicity.
Confusion, depression,
disorientation
Nephrotoxicity
GI effect, nausea, vomiting
Cardiac effect: palpitations,
Hypersensitivity reaction.
Aminoglycosides
Nursing
Implication
Aminoglycosides
Nursing
Implication
Aminoglycosides
Nursing
Implication
Tetracyclines
Overview
include:
Tetracycline
Doxycycline
Tetracyclines
Mechanism
of action