Antibiotics

·         Drugs derived wholly or partially from certain microorganisms and are used to treat bacterial or fungal infections. They are ineffective against viruses.

·          Antibiotics either kill microorganisms or stop them from reproducing, allowing elimination by the body's natural defense.

o    Aminoglycosides: Inhibit protein synthesis by binding to a portion of the bacterial ribosome. Most of them are bacteriocidal (i.e., cause bacterial cell death).

o    Bacitracin: Inhibits cell wall production by blocking the step in the process (recycling of the membrane lipid carrier) which is needed to add on new cell wall subunits.

o    Beta-lactam antibiotics: A name for the group of antibiotics which contain a specific chemical structure (i.e., a beta-lactam ring). This includes penicillins, cephalosporins, carbapenems and monobactams.

o    Cephalosporins: Similar to penicillins in their mode of action but they treat a broader range of bacterial infections. They have structural similarities to penicillins and many people with allergies to penicillins also have allergic reactions to cephalosporins.

o    Chloramphenicol: Inhibits protein synthesis by binding to a subunit of bacterial ribosomes (50S).

o    Glycopeptides (e.g., vancomycin):  Interferes with cell wall development by blocking the attachment of new cell wall subunits (muramyl pentapeptides).

o    Macrolides (e.g., erythromycin) and Lincosamides (e.g., clindamycin): Inhibit protein synthesis by binding to a subunit of the bacterial ribosome (50S).

o    Penicillins:  Inhibits formation of the bacterial cell wall by blocking cross-linking of the cell wall structure. The cell wall is a needed protective casing for the bacterial cell.

o    Quinolones: Blocks DNA synthesis by inhibiting one of the enzymes (DNA gyrase)

o    Tetracyclines: Inhibit protein synthesis by binding to the subunit of the bacterial ribosome (30S subunit).

o    Trimethoprim and Sulfonamides: Blocks cell metabolism by inhibiting enzymes which are needed in the biosynthesis of folic acid which is a necessary cell compound.

Aminoglycosides
·           ·	·           ·         Amikacin        ·         Gentamicin ·         Kanamycin ·         Neomycin ·         Netilmicin ·         Streptomycin ·         Tobramycin		Infections caused by gram-negative bacteria, such as Escherichia coli and Klebsiella	Hearing loss ·         Dizziness         Kidney         damage
Carbapenems
	Ertapenem        Imipenem/  cilastatin		Gangrene, sepsis,  pneumonia, abdominal and urinary infections, and (except for ertapenem)Pseudomonas infections	Seizures         Confusion
Cephalosporins, 1st generation
	·              Cefadroxil ·               Cefazolin Cephalexin		Skin and soft tissue   infections	Gastrointesti-nal upset and diarrhea        Nausea        Allergic reactions
Cephalosporins, 2nd generation
	·         Cefaclor ·         Cefamandole ·         Cephalexin ·         Cefoxitin ·         Cefprozil      Cefuroxime		Some respiratory and abdominal infections	Gastrointesti -al upset and diarrhea       Nausea        Allergic reactions
Cephalosporins, 3rd generation
	·         Cefixime ·         Cefdinir ·         Cefditoren ·         Cefoperazone ·         Cefotaxime ·         Cefpodoxime ·         Ceftazidime ·         Ceftibuten ·         Ceftizoxime         Ceftriaxone	Broad coverage of many bacteria for people with mild-to-moderate infections (oral) and serious illness (by injection		Gastrointesti -al upset and diarrhea       Nausea        Allergic  reactions

Cephalosporins, 4th generation
	Cefepime	Serious infections, particularly in people with a weakened immune system	Gastrointesti -al upset and diarrhea        Nausea        Allergic  reactions
Macrolides
	·         Azithromycin ·         Clarithromycin ·         Dirithromycin ·         Erythromycin Troleandomy- cin	Streptococcal infections, syphilis, respiratory infections, myoplasmal infections, Lyme disease	·         Nausea, vomiting, and diarrhea (especially at higher doses) Jaundice
Monobactam
	Aztreonam	Infections caused by gram-negative bacteia	Allergic reactions
Penicillins
	·         Amoxicillin ·         Ampicillin ·         Carbenicillin ·         Cloxacillin ·         Dicloxacillin ·         Nafcillin ·         Oxacillin ·         Penicillin G ·         Penicillin V ·         Piperacillin Ticarcillin	Wide range of infections; penicillin used for streptococcal infections, syphilis, and Lyme disease	·         Nausea, vomiting, and diarrhea ·         Allergy with serious anaphylactic reactions         Brain and kidney damage (rare)
Polypeptides
	·         Bacitracin ·         Colistin         Polymyxin B	Ear, eye, skin, or bladder infections; usually applied directly to the skin or eye; rarely given by injection	Kidney and nerve damage (when given by injection)
Quinolones
	·         Ciprofloxacin ·         Enoxacin ·         Gatifloxacin ·         Levofloxacin ·         Lomefloxacin ·         Moxifloxacin ·         Norfloxacin ·         Ofloxacin Trovafloxacin	Urinary tract infections, bacterial prostatitis, bacterial diarrhea, gonorrhea	·         Nausea (rare) ·         Nervousness, tremors, seizures        Inflammation or rupture of tendons
Sulfonamides
	·         Mafenide ·         Sulfacetamide ·         Sulfamethizole ·         Sulfasalazine ·         Sulfisoxazole         Trimethoprim- sulfamethoxazole	Urinary tract infections (except sulfasalazine, sulfacetamide, and mafenide); mafenide is used topically for burns	·         Nausea, vomiting, and diarrhea ·         Allergy (including skin rashes)
Tetracyclines
	·         Demeclocycline ·         Doxycycline ·         Minocycline ·         Oxytetracycline        Tetracycline	Syphilis, chlamydial infections, Lyme disease, mycoplasmal infections, rickettsial infections	·         Gastrointestinal upset ·         Sensitivity to sunlight ·         Staining of teeth         Potential toxicity to mother and fetus during pregnancy

General Nursing Considerations:

ü  Instruct patient that antibiotics are for bacterial infections and are not effective in treating viral infections.

ü  Emphasize importance of asking questions about antibiotic prescription.

ü  Use the correct method to instill medications.

ü  Monitor laboratory values.

ü  Intruct the patient to complete the prescribed medication regimen as ordered, regardless of whether the patient feels relief quickly or not.

ü  Teach instructions to avoid such foods or supplements within several hours of taking the antibiotic dose for some antibiotics are less effective when taken with supplements or foods that are high in minerals such as iron or calcium.

ü  Provide patient teachings:

o    Specific antibiotic should not be taken if a previous allergic reaction has been experienced.

o    Take at evenly spaced intervals around the clock to maintain blood levels.

o    Do not take the medication after the expiration date.

o    Do not expose the drug to light, heat, or humidity.

o    Do not breast feed while taking Macrolide antibiotic.

o    Women on birth control pills need to use another form of birth control.

o    Most oral agents are taken on empty stomach as food decreases absorption.

o    Take oral agents with full glass of water to ensure drug is dissolving in the stomach.

o    Do not take left-over medications from previousi infection or those prescribed for another person.

ü  Provide teachings regarding potential side effects and their management, including the manifestations that necessitate stopping the drug, and notifying physician.