This document provides an overview of common antibiotics, anti-infectives, and antivirals that a new nurse needs to know including examples of each type of drug. It describes potential adverse effects and important considerations for monitoring patients and administering each drug such as taking certain drugs with or without food, monitoring lab values, and potential interactions with other medications. The document covers classes of drugs like aminoglycosides, cephalosporins, macrolides, penicillins, quinolones, sulfonamides, tetracyclines, vancomycin, antihelminthics, antimalarials, antiprotozoals, antivirals for influenza and hepatitis, and antiretro

1. ANTIBIOTICS/ANTI-INFECTIVES
ANTIBIOTICS WHAT I NEED TO KNOW AS A BRAND NEW NURSE
Aminoglycosides
Common examples:
Gentamicin (Garamycin)
Tobramycin (Nebcin)
Neomycin
*Irreversible Ototoxicity, Nephrotoxicity
*Baseline hearing test recommended.
*Peak and trough levels indicated.
*Monitor BUN and creatinine levels.
*Increase fluids 1500-2000 ml/day.
*Adverse effects include GI complaints, rash, fever, pain or swelling at the injection site, dizziness,
tinnitus, suprainfections and anaphylaxis.
Cephalosporins
Common examples:
1st
Generation
Cefazolin (Ancef, Kefzol)
Cephalexin (Keflex)
2nd
Generation
Cefaclor (Ceclor)
Cefoxitin (Mefoxin)
Cefprozil (Cefzil)
3rd
Generation
Cefatoxamine ( Claforan)
Ceftriaxone (Rocephin)
4th
Generation
Cefepime (Maxipime)
*10-15% incidence of Cross-sensitivity to Penicillins, however, may be a good alternative when
Penicillins not tolerated.
*Contraindicated for patients who have had an anaphylactic allergic reaction to penicillin.
*4 Generations – generally the higher the generation the better the Gram (-) coverage.
*1st
and 2nd
generations Do Not cross the blood/brain barrier – ineffective for neurological infections.
*Adverse reactions commonly include skin rashes, GI complaints. More rarely seen: suprainfections,
pseudomembraneous enterocolitis and anaphylaxis.
*Specific adverse reactions: Bleeding tendencies (monitor PT), IM injection pain (consider
administration with Xylocaine), thrombophlebitis (administer over 60 minutes).
*Over 50% are administered parenterally, refrigerate oral suspensions.
*Monitor use in renal patients.
Macrolides
Common examples:
Azithromycin (Zithromax)
Clarithromycin (Biaxin)
Erythromycin (Erythrocin)
*Good alternative for patients allergic to Penicillin.
*Administer on an empty stomach, destroyed by gastric acids and acidic fruit juice.
*Contraindicated with known liver disease, increased liver function tests with prolonged use.
*Adverse effects include GI complaints, suprainfections, hepatotoxicity, dysrhythmias, ototoxicity,
pseudomembranous colitis, and anaphylaxis.

2. Penicilllins
Common examples:
Penicillin G
Penicillin V (Pen VK)
Nafcillin, Oxacillin
Ampicillin (Principen)
Amoxicillin (Amoxil,
Trimox)
Ampicillin/Sulbactam
(Unasyn)
Amoxicillin/Clavulanate
(Augmentin)
Ticarcillin (Ticar)
Peperacillin/Tazobactam
(Zosyn)
*10-15% incidence of Cross-sensitivity to Cephalosporins.
*Give separately from Aminoglycosides, may inactivate.
*Adverse reactions range from mild rash, N/V, to severe anaphylaxis.
*Monitor use in renal patients
*Oral absorption limited by the presence of food, empty stomach preferred, administer with H20, not
acidic juices.
Quinolones
(Fluoroquinolones)
Common examples:
Ciprofloxacin (Cipro, Septra)
Gatifloxacin (Tequin, Zymar)
Levofloxacin (Levaquin)
Moxifloxacin (Avelox)
*Antacids interfere with absorption
*Monitor BUN and creatinine levels.
*Monitor I&O
*Adverse effects include: GI complaints, dizziness, headache, sleep disturbances, supraAinfections,
phototoxicity, cardiotoxicity, and tendon/joint toxicity (associated with small risk of tendon rupture).
*Contraindicated in pregnancy and patients < 18 years of age, except with Anthrax exposure.
Sulfonamides
Common examples:
Trimethoprim/Sulfamethoxazole
(Bactrim, Septra)
Sulfisoxazole (Gantrisin)
Sulfisoxasole/Erythromycin
(Pediazole)
Silver Sulfadiazine (Silvadene)
**Topical form
*Increase fluids to 2000-3000 ml/day
Adverse effects include GI complaints, skin rashes, suprainfections, crystalluria, renal damage,
phototoxicity, hyperkalemia, blood dyscarsias, Stevens-Johnson syndrome, anaphylaxis.

3. Tetracyclines
Common examples:
Doxycycline (Vibramycin)
Tetracycline (Sumycin)
*Take on an empty stomach to maximize absorption, although may not be tolerated unless
administered with food.
*Strong affinity for Calcium, do not administer with antacids or dairy products.
*Contraindicated during pregnancy, lactation and children < 8 years (May cause permanent staining
of teeth and/or delayed bone growth).
*Photosensitivity and GI disturbances common.
Adverse reactions include multiple GI complaints, skin rashes, suprainfections, phototoxicity,
hepatotoxicity, anaphylaxis.
Vancomycin *Ototoxicity, Nephrotoxicity
*Baseline hearing test recommended.
*Peak and trough levels indicated.
*Monitor BUN and creatinine levels.
*Infuse over at least 60 minutes on an infusion pump and monitor BP and HR during administration
due to risk of hypotension.
*Adverse reactions include GI disturbance, skin rashes, fever and chills, confusion, seizures,
ototoxicity, nephrotoxicity and Red Man Syndrome (a syndrome of flushing, hypotension and
tachycardia).
Anti-Infectives WHAT I NEED TO KNOW AS A BRAND NEW NURSE
Antihelminthics
Common examples:
Mebendazole (Vermox)
Pyrantel (Antiminth, Pinworm
caplets, Pin-X)
*Treat entire family and close personal contacts to prevent reinfestation
*Teach good personal hygiene, handwashing, frequent laundering of clothes and bed linens
*Adverse effects are rare, may experience GI complaints as the worms die, look for S&S of intestinal
blaockage.
Not recommended during pregnancy or for patients < 2 years.
Antimalarials
Common examples:
Hydroxychloroquine
(Plaquenil)
*Easier to prevent the disease of malaria than to treat it. Persons traveling to infested areas should take
prophylactic antimalarials prior to travel.
*Adverse effects include GI complaints, headache, agitation, photophobia, agranulocytosis, EKG
changes.
*Baseline CBC and EKG indicated with long-term therapy.

4. Antiprotozoals
(nonmalarial)
Common examples:
Metronidazole (Flagyl)
*May cause dark or reddish brown discoloration of urine
*Cautious use with known hepatic disease
*Adverse effects include GI complaints, headache, dizziness, thrombophlebitis, bone marrow
suppression.
Antivirals - (Non-HIV)
Common examples:
Acyclovir (Zovirax)
Valacyclovir (Valtrex)
-----------------------------------------
Influenza
Common examples:
Oseltamivir (Tamiflu)
Zanamivir (Relenza)
Prophylaxis
Amantadine (Symmetrel)
Rimantidine (Flumadine)
-----------------------------------------
Hepatitis
Common examples:
Antivirals
Ribavirin (Copegus, Virazole,
Rebetol, Ribasphere)
Adefovir dipivoxil (Hepsera)
Entecavir (Baraclude)
Lamivudine (Epivir HBV)
Inteferons
Peginterferon alfa-2a (Pegasys)
*For IV routes: Monitor I&O and encourage fluids, monitor BUN and creatinine.
*Adverse effects vary with drug.
---------------------------------------------------------------------------------------------------------------------------
*Prophylactic medications should be started within 48 hours after exposure.
*Screen for history of substance abuse and/or suicide, may exacerbate preexisting mental disease.
---------------------------------------------------------------------------------------------------------------------------
*Adverse effects include GI complaints, fatigue, and hepatotoxicity.
*Monitor ALT, AST and blood counts.
*Adverse effects include fatigue, headache, malaise, anorexia, diarrhea, suprainfections,
thrombocytopenia, suicidal thoughts
*Flulike symptoms likely after IV administration.
*Increase fluids to 2500ml or more/day and monitor I&O.

5. Antiretrovirals
Common examples:
-----------------------------------------
Integrase Inhibitors
Raltegravir (Isentress)
-----------------------------------------
CCR5 Inhibitors
Maraviroc (Selzentry)
-----------------------------------------
Fusion Inhibitors
Enfuvirtide (Fuzeon)
Protease Inhibitors
Saquinavir mesylate (Invirase)
-----------------------------------------
Nucleoside/Necleotide Reverse
Transcriptase Inhibitors
(NRTIs)
Zidovudine or AZT (Retrovir)
-----------------------------------------
Non-Nucleoside Reverse
Transcriptase Inhibitors
(NNRTIs)
Efavirenz (Sustiva)
Delavidrine (Rescriptor)
*Monitor CD4+ Tcell counts and HIV RNA viral load.
---------------------------------------------------------------------------
*Administer in combination therapy only.
*Adverse effects include headache and GI complaints.
---------------------------------------------------------------------------
*Administer in combination therapy only.
*Adverse effects include abdominal pain, cough, dizziness, pyrexia, rash, upper respiratory infections,
hepatotoxicity and increased risk of myocardial infaction.
*Use caution when administering to patients with known cardiac disease.
*Monitor ALT and AST.
---------------------------------------------------------------------------
*Subq injection, site reactions occur in nearly all patients.
*Adverse effects include fatigue, GI complaints, neutropenia, thrombocytopenia, and nephrotoxicity.
*Resistance develops rapidly, always administer in combination therapy with at least one NRTI.
*St John's Wort contraindicated, greatly reduces efficacy.
*Adverse effects include GI complaints specifically severe diarrhea, anemia, leucopenia,
lymphadenopathy, hemorrhagic colitis, and pancreatitis.
---------------------------------------------------------------------------
*Adverse effects include rash, malaise, GI complaints, bone marrow suppression, neutropenia,
anemia, neurotoxicity.
---------------------------------------------------------------------------
**Adverse effects include rash, GI complaints, parasthesia, hepatotoxicity, Stevens-Johnson
syndrome.
*Monitor ALT and AST.