Group of antibiotics for treatment of susceptible pathogens

1. Introduction to Clinical PharmacologyChapter 07-Antibacterial Drugs That Disrupt the Bacterial Cell Wall

2. Introduction to Penicillins • Group of antibiotics for treatment of susceptible pathogens • Actions: Cell wall synthesis; DNA or RNA synthesis; protein synthesis • **Four groups: Natural penicillins; penicillinase-resistant penicillins; aminopenicillins; extended-spectrum penicillins

3. Identifying the Appropriate Penicillin: Sensitivity and Resistance • Receive culture and sensitivity report • Select antibiotic to which the micro-organism is sensitive • To minimize risk of bacteriostatic activity, ensure adequate blood level of penicillin in the body

4. Uses • Used against infectious diseases • Used as initial therapy for any suspected staphylococcal infection • Prescribed as a prophylaxis • Potential secondary bacterial infection • Potential infection in high-risk patients • On a continuing basis to those with rheumatic fever or chronic ear infections

5. Resistance to Drugs • Drug resistance becomes an issue when • Antibiotics are regularly used by a patient • A group of people live in close proximity • Bacteria: Naturally resistant or acquired resistance to drug, such as MRSA • Emergence of a new resistance associated with bacteria that have both a natural and an acquired resistance ability

6. Adverse Reactions • Gastrointestinal reactions • Glossitis • Stomatitis • Gastritis • n/v/d, abdominal pain • Hypersensitivity reactions • Anaphylactic shock • Cross-sensitivity/cross-allergenicity • Superinfections • Pseudomembranous colitis • Candidiasis • C. diff

7. Contraindications and Precautions • Contraindicated in patients with history of hypersensitivity to penicillin or the cephalosporins • *Use cautiously in patients with renal disease, asthma, bleeding disorders, gastrointestinal disease, pregnancy or lactation, history of allergies • Reason for caution:Any indication of sensitivity

8. Interactions

9. Introduction to Cephalosporins • Effective in the treatment of all strains of bacteria affected by penicillins and some strains resistant to penicillins • Classification: Divided into first, second, third and fourth-generation drugs • Uses: Treat urinary tract; skin infections; hospital acquired pneumonias

10. Cephalosporins: Actions • Exert bactericidal effect: • Have a beta-lactam ring • Targets the bacterial cell wall, making it defective and unstable

11. Cephalosporins: Uses • *Used to treat infections caused by bacteria: • Respiratory • Ear • Bone/joint • Genitourinary tract infections • Culture and sensitivity tests: Help determine best antibiotic to control an infection • *Used throughout perioperative period-to prevent infection in patients having surgery on a contaminated or potentially contaminated area

12. *Cephalosporins: Adverse Reactions • Gastrointestinal reactions: • Nausea; vomiting; diarrhea (pseudomembranous colitis)* • Other body system reactions: • Headache; dizziness; malaise; heartburn; fever; nephrotoxicity;anaphylaxis; aplastic anemia (anemia d/t deficient RBC production); toxic epidermal necrolysis,SJS • Administration route reactions: • Intramuscularly and Intravenously • Thrombophlebitis*

13. Cephalosporins: Contraindications and Precautions • Contraindicated in patients: • Allergic to cephalosporins or penicillins • Used cautiously in patients with: • Renal disease; hepatic impairment; bleeding disorder; pregnancy; known penicillin allergy

14. Cephalosporins: Interactions

15. Cephalosporins: Interactions (cont’d) • Nursing alert: • Disulfiram-like reaction: If alcohol consumed within 72 hours • Symptoms: Flushing; throbbing; respiratory problems; vomiting; sweating; chest pain; hypotension • Severe reaction: Arrhythmias and unconsciousness

16. Carbapenems: Action and Uses • Inhibit synthesis of the bacterial cell wall and cause the death of susceptible cells • Meropenem: Used for intra-abdominal infections; bacterial meningitis • Imipenem-cilastatin: Used to treat serious infections; endocarditis; septicemia • Ertapenem: Used to treat serious infections; bacterial community-aquired pneumonia

17. Carbapenems: Adverse Reactions • Common adverse reactions: • Nausea • Vomiting • Diarrhea • Rash • Abscess, tissue sloughing, or phlebitis at the injection site • **Nephrotoxicity and ototoxicity (IV) with vancomycin administration

18. Carbapenems: Contraindications, Precautions, and Interactions • Contraindicated in patients: Who are allergic to cephalosporins and penicillins; with renal failure; children younger than 3 years; pregnant/lactating women • **Used cautiously in patients: With CNS disorders; seizure disorders; renal or hepatic failure • Excretion of carbapenems: Inhibited with probenecid

19. Nursing Process: Assessment • Preadministration assessment: • Obtain general health history before first dose • Check for need of cultures and sensitivity tests

20. Nursing Process: Assessment (cont’d) • Ongoing assessment: • Evaluate response to therapy • If infection worsens then notify primary health care provider • Check for signs and symptoms of infection

21. Nursing Process: Planning • The expected outcome includes an optimal response to therapy: • Management of adverse drug reactions • Understanding of and compliance with the prescribed treatment regimen

22. Nursing Process: Implementation • Promoting an optimal response to therapy: • *Oral administration: shake oral suspensions; cufuroxime and cefpodoxime absorption is increased when given with food • Administer around the clock • Administer orally at least one hour before or two hours after meals • If patient experiences GI upset: Administer with food

23. Nursing Process: Implementation • Promoting an optimal response to therapy (cont’d): • Parenteral administration: • *Read the manufacturer’s instructions –keep powder refrigerated • Methods of infusing cephalosporin: Direct; intermittent; or continuous IV infusion

24. Nursing Process: Implementation • Promoting an optimal response to therapy (cont’d): • Nursing alert: • Inspect the needle insertion site for signs of extravasation or infiltration • Inspect several times a day for signs of redness - phlebitis or thrombophlebitis

25. Nursing Process: Implementation • Promoting an optimal response to therapy (cont’d): • Chronic care alert: • People with phenylketonuria need to be aware that the oral suspension cefprozil contains phenylalanine • Interferes with urine test results - diabetic patients

26. Nursing Process: Implementation • Monitoring and managing patient needs: • Impaired skin integrity: • Inspect skin every 4 hours for redness, rash, or lesions; report; emollients, or antipyretic creams may be prescribed; avoid harsh soaps and perfumed lotions; avoid rubbing the area; warn about wearing rough or irritating clothing

27. Nursing Process: Implementation • Monitoring and managing patient needs • Impaired comfort: • Increased fever; take vital signs every 4 hours; administer an antipyretic drug or change drug or dosage as prescribed • Impaired urinary elimination: • Nephrotoxicity may occur; measure and record the fluid intake and output; Report changes

28. Nursing Process: Implementation • Monitoring and managing patient needs (cont’d): • Impaired urinary elimination: Gerontologic alert: • **Nephrotoxic effects / renal impairment: Monitor blood creatinine levels • Diarrhea: Check the patient’s stools and reports any presence of blood and mucus immediately

29. Nursing Process: Implementation • Educating the patient and family: • Review dosage regimen with the patient and family • Advise to complete full therapy and adhere to timing • Explain to shake and keep oral suspensions refrigerated • Advise to avoid alcohol and take with food if GI upset

30. Nursing Process: Evaluation • Therapeutic effect achieved • Urine output at least 500mL daily; diarrhea - not experienced • Patient and family demonstrate understanding of drug regimen • Patient verbalizes importance of compliance with prescribed therapeutic regimen • Skin - free of inflammation, irritation or ulcerations

31. Preadministration Assessment • Obtain general health history • Record vital signs • Obtain description of signs and symptoms • Assess infected area • Note patient’s general appearance • Obtain culture and sensitivity test results

32. Ongoing Assessment • Evaluate patient daily • Pt. usually feel better-record on chart

33. Nursing Diagnoses • Impaired Skin Integrity • Risk for Ineffective Respiratory Function • Diarrhea • Impaired Oral Mucous Membrane • Impaired Comfort • Increased Fever

34. Planning • Expected outcomes of the patient • Depends on reason for administration of penicillin • Optimal response to drug therapy • Management of common adverse reactions • Understanding of and compliance with prescribed drug regimen

35. Implementation: Promoting Optimal Response to Therapy • Ensure proper administration • Allow time for culture and sensitivity test • Maintain adequate blood levels of drug • Give oral penicillins on empty stomach • Take care when preparing and administering various forms of penicillin • Shake vial thoroughly prior to withdrawing drug

36. Implementation: Diarrhea • Inspect stools, and report abnormalities • Save sample of stool and test for occult blood • *Observe for and report symptoms of a bacterial or fungal superinfection • Severe symptoms: Provide additional treatment

37. Implementation: Impaired Oral Mucous Membranes • Inspect patient’s mouth daily; report signs of impaired mucous membranes • Provide frequent mouth care • Use soft bristled toothbrush • Recommend nonirritating soft diet • Monitor dietary intake • Severe symptoms: Administer antipyretic or antifungal drug

38. Educating the Patient and Family • Ensure patient has thorough understanding of drug, treatment, and adverse reactions • Describe drug regimen; stress importance of continued and uninterrupted therapy • Provide patients with appropriate teaching plan

39. Evaluation • Therapeutic drug effect achieved • Infection is controlled • Adverse reactions: Identified; reported; managed successfully • Patient and family: Understood drug regimen