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1. Antiinfectives
Key Points
N203
ATI (Unit 2)
Antiinfectives -

2. · Broad-spectrum vs. narrow-spectrum antibiotics
· Antimicrobials treat bacterial, viral, and fungal infections
· Culture and sensitivity specimens should be collected prior to
initiation of therapy.
· Adverse reactions include:
· Hypersensitivity & anaphylaxis · Superinfection
· Organ toxicity (ototoxic,
nephrotoxic) ·  warfarin activity
·  efficacy of oral contraceptives ·

3. Penicillins
N203
ATI (Unit 2)
Antiinfectives -

4. Expected Action:
· β-lactam – destroys bacteria by weakening cell wall
Therapeutic Uses:
· Med of choice for G+ cocci (Strep pneumoniae, S. viridans, S. pyogenes)
· Med of choice for
syphilis · First choice for meningitis
· Prophylaxis against bacterial endocarditis ·
· Extended spectrum against Pseudomonas, Proteus, Klebsiella
Adverse Effects:
· Anaphylaxis / Renal Impairment / Hyperkalemia (w  doses)
Contraindications:
· Allergies to Penicillin, Cephalosporin, or Imipenem / Kidney Dysfunction
Interactions:
· Aminoglycosides / η Oral Contraceptives
Education:
· Take orals ĉ H2O, ŝ food (some may be taken ĉ food)

5. Cephalosporins
N203
ATI (Unit 2)
Antiinfectives -

6. Expected Action:
· β-lactam – destroy bacteria by destroying cell wall
· Four generations, each is:η against G- and anaerobes –more resistant to
lactamase – more able to reach CSF
Therapeutic Uses:
· Broad spectrum with TI for postop infections, meningitis, pelvic infections
Adverse Effects:
· Anaphylaxis / Bleeding / Thrombophlebitis / Pain ĉ IM / cross allergies to
penicillins / AA-pseudomembranous colitis
Contraindications:
· Allergies to Penicillin / Kidney Dysfunction
· Caution with anticoagulants, antiplatelets, and thrombolytics
Interactions:
· EtOH intolerance (disulfiram reaction) / Probenecid  renal excretion
Education:
· Take ĉ food

7. Carbapenems
N203
ATI (Unit 2)
Antiinfectives -

8. Expected Action:
· β-lactam – destroy bacteria by destroying cell wall
Therapeutic Uses:
· Broad spectrum effective for serious infections such as pneumonia, peritonitis,
and UTIs. P. aeruginosa develops resistance (use combo) – [broadest
spectrum available]
Adverse Effects:
· Allergy / GI symptoms / Superinfection
Contraindications:
· Caution with renal impairment
Interactions:
·
Education:
·

9. Monobactams
N203
ATI (Unit 2)
Antiinfectives -

10. Expected Action:
· β-lactam – destroy bacteria by destroying cell wall
Therapeutic Uses:
· MRSA / Antibiotic-associated pseudomembranous colitis by C. difficile
Adverse Effects:
· Ototoxicity / Infusion Rxn (red man syndrome) / Thrombophlebitis
Contraindications/Precautions:
· Caution with renal impairment
· Infuse over 60 minutes
· Very low therapeutic index
Interactions:
·
Education:
·

11. Tetracyclines
N203
ATI (Unit 2)
Antiinfectives -

12. Expected Action:
· Bacteriostatic by preventing protein synthesis
Therapeutic Uses:
· Acne / rickettsia / Chlamydia / Helicobacter pylori / periodontal disease / typhus
fever / Rocky Mountain spotted fever / Lyme disease / UTI & VI
Adverse Effects:
· GI symptoms / tooth discoloration / hepatotoxicity / photosensitivity /
superinfection of bowel
Contraindications/Precautions:
· Renal disease (except doxycycline) / Use during pregnancy will stain deciduous
teeth but not permanent teeth
Interactions:
· Milk / Ca2+, Fe3+ supplements / Mg2+ laxatives / antacids (chelates to η)
· η of oral contraceptives
Education:
· Give with water on an empty stomach (except doxycycline & minocycline)

13. Bacteriostatic Inhibitors
(Macrolides / Ketolides)
N203
ATI (Unit 2)
Antiinfectives -

14. Expected Action:
· Bacteriostatic by inhibiting protein synthesis – Bactericidal at high doses
Therapeutic Uses:
· Use for pts with penicillin allergies / pertussis / diphtheria / Legionnaires’
· Chlamydia, Mycoplasma pneumoniae, Streptococcus pyogenes
Adverse Effects:
· GI discomfort / thrombophlebitis
Contraindications/Precautions:
· Pre-existing liver disease
Interactions:
· Toxic with: antihistamines, theophylline (asthma med), carbamazepine
(anticonvulsant), warfarin
Education:
· Administer on empty stomach with water – IV is rarely used

15. Aminoglycosides
(Medication List)
N203
ATI (Unit 2)
Antiinfectives -

16. · gentamicin · amikacin · kanamycin
· tobramycin sulfate · neomycin · paromomycin
· streptomycin

17. Aminoglycosides
N203
ATI (Unit 2)
Antiinfectives -

18. Expected Action:
· Kill bacteria by disrupting protein synthesis
Therapeutic Uses:
· Med of choice against aerobic G- bacilli (E. coli, K. pneumoniae, P. mirabilis, P.
aeruginosa)
· Oral paromomycin use for amebiasis and tapeworm
Adverse Effects:
· Ototoxicity ()/ nephrotoxicity / neuromuscular blockade / hypersensitivity
· Streptomycin: Neurologic disorders
Contraindications/Precautions:
· Renal impairment  reduced doses
Interactions:
· Ethacrynic acid (oto-tox) / amphotericin, cephalosporins, vanco (neph-tox) /
tubocurarine / penicillins ( AG)
Education:
·

19. Penicillins
(Medication List)
N203
ATI (Unit 2)
Antiinfectives -

20. · Penicillin G
· Augmentin (amoxicillin-clavulanate) - Broad spectrum
· Nafcillin -
· Carbenicillin -
Antistaphylococcal
Antipseudomonas
·

21. Cephalosporins
(Medication List)
N203
ATI (Unit 2)
Antiinfectives -

22. 1º
· Cephalexin (Keflex) · Cephapirin (Cefadyl)
2º
· Cefaclor (Ceclor) · Cefotetan (Cefotan)
3º
· Cefatriaxone (Rocephin) · Cefotaxime (Claforan)
4º
· Cefepime (Maxipime)

23. Carbapenems
(Medication List)
N203
ATI (Unit 2)
Antiinfectives -

24. · Imipenem (Primaxin) ·
· Meropenem (Merrem IV) ·
· ·
·

25. Monobactams
(Medication List)
N203
ATI (Unit 2)
Antiinfectives -

26. · Vancomycin (Vancocin) ·
· Aztreonam (Azactam) ·
· Fosfomycin (Monurol) ·
·

27. Tetracyclines
(Medication List)
N203
ATI (Unit 2)
Antiinfectives -

28. · Tetracycline hydrochloride (Sumycin) ·
· Doxycycline (Vibramycin) ·
· Minocycline ·
·

29. Macrolides / Ketolides
(Medication List)
N203
ATI (Unit 2)
Antiinfectives -

30. · Azithromycin (Zithromax) ·
· Clarithromycin (Biaxin) ·
· Dirithromycin ·
· Erythromycin ·
· Clindamycin (Cleocin) ·

31. Sulfonamides & Trimethoprim
(Medication List)
N203
ATI (Unit 2)
Antiinfectives -

32. · Sulfamethoxazole–Trimethoprim (TMP-SMZ, Bactrim)
· Cotrim
· Septra
· Sulfadiazine
· Sulfamethoxazole
· Sulfisoxazole

33. Sulfonadmides-Trimethoprim
N203
ATI (Unit 2)
Antiinfectives -

34. Expected Action:
· Bacteriostatic by inhibiting folate synthesis
Therapeutic Uses:
· Med of choice for UTI by E. coli and Pneumocystis carinii.
Adverse Effects:
· Hypersensitivity (sulfonamides, thiazide diuretics, tolbutamide, loop diuretics)
· Blood dyscrasias / crystalluria / kernicterus ( bilirubin) / photosensitivity
Contraindications/Precautions:
· Avoid in: folate deficiency / pregnancy / creatinine clearance < 15 mL/min
· Reduce dosages with renal dysfunction
Interactions:
· Warfarin / phenytoin / tolbutamide ( effects of these)
Education:
· Empty stomach with full glass of water

35. Urinary Tract Aseptics
N203
ATI (Unit 2)
Antiinfectives -

36. Expected Action: Damages DNA Prototype: Nitrofurantoin
· Static a@ doses, Cidal @ doses
Therapeutic Uses:
· Acute UTIs / Prophylaxis for recurrent lower UTI
Adverse Effects:
· GI / hypersensitivity / blood dyscrasias / peripheral neuropathy
Contraindications/Precautions:
· Renal dysfunction ĉ creatinine clearance < 40
Interactions:
·
Education:
· Urine will be brown

37. Antimycobacterial
N203
ATI (Unit 2)
Antiinfectives -

38. Expected Action:
Prototypes: isoniazid (INH), streptomycin, ethambutol,
pyrazinamide
· Prevents synthesis of mycolic acid
Therapeutic Uses:
· Active and latent tuberculosis
Adverse Effects:
· Peripheral neuropathy (administer 50-200 mg of vitamin B6 daily)
· Hepatotoxicity
Contraindications/Precautions:
· Liver disease
Interactions:
· Phenytoin (accumulates)
· INH with EtOH, rifampin, pyrazinamide  hepatotoxicity
Education:
· Empty stomach but ĉ food if needed

39. Anti-Hansen’s Disease
N203
ATI (Unit 2)
Antiinfectives -

40. Expected Action: Prototype: Dapsone Others: Clofazimine, Rifampin
· Prevents synthesis of folate which inhibits M. leprae.
Therapeutic Uses:
· Used in combination therapy to treat leprosy
Adverse Effects:
· Rifampin: Discoloration of body fluids / Hepatotoxicity
· GI discomfort
Contraindications/Precautions:
· Use caution with liver dysfunction
Interactions:
· Rifampin η ĉ warfarin / OC / protease inhibitors / NNRTIs (HIV)
Education:
·

41. Antiviral
N203
ATI (Unit 2)
Antiinfectives -

42. Expected Action:
Prototype: Acyclovir
Others: ganciclovir, interferon, ribavirin, amantadine
· Prevents reproduction of viral DNA
Therapeutic Uses:
·
Adverse Effects:
· Acyclovir: Phlebitis, nephrotoxicity, nausea & headache
· Ganciclovir: Granulocytopenia / thrombocytopenia / reproductive toxicity /
teratogenic
Contraindications/Precautions:
· Pregnancy /  neutrophil count (<500/cc)
Interactions:
·
Nursing Info: · Acyclovir: Never give IV bolus, Infuse over 1 hour min.
·

43. Fluoroquinolones
(Medication List)
N203
ATI (Unit 2)
Antiinfectives -

44. Expected Action: Prototype: Ciprofloxacin
· Bactericidal by inhibition of enzyme needed for DNA
Therapeutic Uses:
· Broad spectrum / prevention of inhaled anthrax
Adverse Effects:
· GI discomfort / Achilles tendon rupture / superinfection
Contraindications/Precautions:
· Avoid use in children <18 d/t risk for tendon rupture
Interactions:
· Cations ( Cipro absorption) / Theophylline & warfarin ( med plasma levels)
Education:
· Infuse slowly over 60 minutes

45. Antiprotozoals
N203
ATI (Unit 2)
Antiinfectives -

46. Expected
Action:
Proto: Amphotericin
Others: flucytosine, miconazole, nystatin, griseofulvin, ketoconazole
·  permeability  leakage of intracellular cations (static or cidal)
Therapeutic Uses:
· Systemic or cutaneous fungal infections
Adverse Effects:
· Amphotericin: Infusion rxn (1-3 hrs) / thrombophlebitis / nephrotoxicity /
hypokalemia / marrow suppression
· Ketoconazole: Hepatotoxicity / Sex hormone effects
Contraindications/Precautions: Renal dysfunction
Interactions:
· Aminoglycosides (streptomycin, cyclosporine) – additive nephrotoxicity
· Flucytosine – antifungal effects are potentiated with amphotericin
Education: Highly toxic, infuse slowly (2-4 hr)
· Renal damage limited by infusing 1 L NS on day of amphotericin infusion

47. Antiprotozoals
N203
ATI (Unit 2)
Antiinfectives -

48. Expected Action: Proto: metronidazole (Flagyl)
· Broad spectrum with anaerobic activity
Therapeutic Uses:
· Protozoal infections / Bacterial infections against obligate anaerobes
· Prophylaxis for surgical procedures at high risk for anaerobic infections (vaginal,
abdominal, colorectal)
· H. pylori with tetracycline and bismuth salicylate
Adverse Effects:
· GI discomfort / metallic taste / darkening of urine / CNS symptoms
Contraindications/Precautions:
· Caution with renal dysfunction / avoid during 1st trimester of pregnancy
Interactions:
· Disulfiram-like reaction ĉ EtOH
· Warfarin – Flagyl inhibits inactivation of warfarin
Education:
·