Chapter 9 Antibiotics Summary: Page 95

The goal of antibiotic therapy is to reduce the population of invading bacteria to a size that the
human immune response can deal with.
Bacteria can be classified as gram-positive (frequently found in respiratory infections) or gramnegative (frequently found in GI and GU infections). They can also be classified as anaerobic (not
needing oxygen) or aerobic (dependent on oxygen).
Culture and sensitivity testing ensures that the correct antibiotic is chosen for each infection, a
practice that may help to decrease the number of emerging resistant-strain
bacteria.
Aminoglycosides inhibit protein synthesis in susceptible strains of gram-negative bacteria.
These drugs are reserved for use in serious infections because of potentially serious adverse
effects. Monitor for ototoxicity, renal toxicity, GI disturbances, bone marrow
depression, and superinfections
Carbapenems are used to treat serious infections caused by a wide range of bacteria.
Monitor for GI effects, serious diarrhea, dizziness, and Superinfections
Cephalosporins are a large group of antibiotics, similar to penicillin, that are effective against a wide
range of bacteria.
Monitor for GI upsets and diarrhea, pseudomembranous colitis, headache, dizziness, and
superinfections.
Fluoroquinolones inhibit the action of DNA enzymes in susceptible gram-negative bacteria. They are
used to treat a wide range of infections.
Monitor the patient for headache, dizziness, GI upsets, and bone marrow depression, and caution
the patient about the risk of photosensitivity reactions.
The penicillins are one of the oldest classes of antibiotics, and many resistant strains have
developed. The penicillinase- resistant antibiotics were created to combat bacteria
that produce an enzyme to destroy the penicillin. Penicillins are used to treat a broad spectrum of
infections, including respiratory tract infections and UTIs.
Monitor the patient on penicillin for nausea, vomiting, diarrhea, superinfections, and the possibility
of hypersensitivity reactions.
Sulfonamides are older drugs; many strains have developed resistance to the sulfonamides, so they
are no longer widely used.
Monitor the patient for CNS toxicity, nausea, vomiting, diarrhea, liver injury, renal toxicity, and bone
marrow depression
Tetracyclines inhibit protein synthesis and prevent bacteria from multiplying.
Tetracyclines can cause damage to developing teeth and bones and should not be used with
pregnant women or children
The mycobacteria have an outer coat of mycolic acid that protects them from many disinfectants and
allows them to survive for long periods in the environment. These slow-growing bacteria may need to
be treated for several years before they can be eradicated. They cause tuberculosis and leprosy.
Antituberculosis drugs are used in combination to increase effectiveness and decrease the
emergence of resistant strains. These drugs are divided into first-line
and second-line drugs. Adverse effects include rashes, an orange tint to body fluids, and GI reactions.
Dapsone is the only antibiotic now used to treat leprosy. Thalidomide recently was reintroduced to
treat an unusual reaction many patients develop after being on dapsone.

 Ketolides block protein synthesis in susceptible bacteria, leading to cell death. Telithromycin is the
only ketolide currently available. It is used to treat communityacquired pneumonia. Monitor the patient
for nausea, vomiting, diarrhea, and CNS effects, including dizziness and headache
.
Lincosamides are similar to macrolides but are more toxic. They are used to treat severe
infections. Monitor the patient for pseudomembranous colitis, bone marrow
depression, pain, and CNS effects.
Macrolides are in a class of older antibiotics that can be bactericidal or bacteriostatic. They are used
to treat URIs and UTIs, and are often used when patients are allergic to
penicillin. Monitor the patient for nausea, vomiting, diarrhea, dizziness, and other CNS effects.
The monobactam antibiotic aztreonam is effective against only gram-negative enterobacteria; it is
safely used when patients are allergic to penicillin or
cephalosporins. Monitor the patient taking aztreonam for GI problems, liver toxicity, and pain at the
injection site.
Summary: Antibiotics work by disrupting protein or enzyme systems within a bacterium, causing cell
death (bactericidal) or preventing multiplication (bacteriostatic).
The proteins or enzyme systems affected by antibiotics are more likely to be found or used in
bacteria than in human cells.
The primary therapeutic use of each antibiotic is determined by the bacterial species that are
sensitive to that drug, the clinical condition of the patient receiving the
drug, and the benefit-to-risk ratio for the patient
The longer an antibiotic has been available, the more likely it is that mutant bacterial strains resistant
to the mechanisms of antibiotic activity will have developed.
The most common adverse effects of antibiotic therapy involve the GI tract (nausea, vomiting,
diarrhea, anorexia, abdominal pain) and superinfections (invasion of the body
by normally occurring microorganisms that are usually kept in check by the normal flora).
To prevent or contain the growing threat of drug-resistant
strains of bacteria, it is very important to use antibiotics cautiously, to complete the full course of an
antibiotic prescription, and to avoid saving antibiotics for self-medication in
the future. A patient and family teaching program should address these issues, as well as the proper
dosing procedure for the drug (even if the patient feels better) and the importance of keeping a record
of any reactions to antibiotics