Introduction

Antibiotics cure disease by killing or injuring bacteria. The first antibiotic was penicillin, discovered accidentally from a mold culture. Today, over 100 different antibiotics are available to cure minor, as well as life threatening infections.

T!"#$ %& A'TI(I%TI)$

A*I'%+,!)%$I-#$

A)TI%' . /$#
0ill the bacteria cell #ffective against aerobic gram negative infections -estroy urease producing bacteria to prevent absorption of ammonia in hepatic encephalopathy

)ommon medications
Amikacin sulfate 1Amikin2 +entamicin sulfate 1+aramycin2 0anamycin sulfate 10antre32 $treptomycin sulfate Tobramycin sulfate

Administration consideration
"referred routes4 I5, I*, intrathecal or intraventricular injections %ral route4 poorly absorbed effective pre surgery of bowel

)ontraindications
Allergy to aminoglycosides "ree3isting renal disease 6eceiving renal to3ic agents 7 amphotericin ( 1&ungi8one2, vancomycin 15ancocin2, loop diuretics 7 &urosemide 1,asi32 *yasthenia gravis "regnancy . lactation

$ignificant -rug interactions

Inactivated with high concentrations of penicillin -o not mi3 other medications in the same I5 9ith oral anticoagulant 7 bleeding may increase aminoglycosides decrease synthesis of vitamin 0 in the intestinal tract

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A)TI%' . /$#
$tructurally . chemically related to the penicillins Increased activity against gram negative organisms and anaerobes; less activity against gram positive microorganisms 1first gen2

/$#$
$T-s /TI, skin . tissue infections, ,yme disease 6espiratory infections 7 pharyngitis (one infection 7 cefa8olin #ndocarditis prophyla3is prior to surgery for clients with h3 of 6: #3creted in urine e3cept ceftria3one 16ocephin2, cefopera8one 1)efobid2

)ommon medications
)ephale3in )efaclor )efpro8il )efi3ime )efipime

Administration considerations
9ell absorbed in the +IT absorption delayed with food but amount absorbed not affected Absorption in the +IT, not delayed with cefadro3il . cefpro3il -o not readily enter the )$& e3cept for cefuro3ime, <rd gen readily enters the )$& )rosses the placenta 6enal impairment e3tends half life

 $eparate oral administration of antacids, histamine := blockers, iron supplements and foods fortified with iron by = hours before or after the administration of cephalosporins I* injection very painful 7 preferred route 7 I5 -rug administration for at least 10 days 7

)ontraindications
Allergy to penicillins /se e3treme precaution if the creatinine clearance is less than >0 ml? min :epatoto3icity "regnancy . lactation

$ignificant drug interactions

"robenecid 7 prolongs and increases half life of cephalosporins ,oop diuretics, aminoglycosides 7 risk for nephroto3icity #thanol, alcohol plus cephalosporins 7 cause disulfiram like reaction @ weakness, pulsating headache, and abdominal cramps Antacids 7 interferes absorption :istamine := antagonists 7 decrease plasma concentration of cephalosporins

&,%/6%A/I'%,%'#$

A)TI%' . /$#
'ewest class of broad spectrum bactericidal antibodies /sed against gram negative and selected gram positivie organisms used in various bacterial infections

)ommon medications
)iproflo3acin #no3acin +atiflo3acin ,evoflo3acin ,emoflo3acin *o3iflo3acin 'orflo3acin %flo3acin

)ontraindications
Allergy 6enal dysfunction

$ignificant drug interactions

%ral antacids, iron, 8inc preparations, sucralfate reduce absorption "robenecid , cimetidine7 prolongs half life (eta agonists effect of theophylline may be increased +lucocorticosteroids may increase risk for rupture of tendon )affeine elimination with ciproflo3acin, eno3acin, norflo3acin is decreased

 /se of ciproflo3acin with phenytoin 1-ilantin2 may lower levels of phenytoin -igo3in levels may increase with eno3acin 'itrofurantoin may reduce the efficacy of norflo3acin /se of '$AI-$ with levoflo3acin increases )'$ stimulation including sei8ures ,evoflo3acin may also increase or decrease blood glucose in conjunction with oral antidiabetic agents

 $ignificant cardiovascular side effects with sparflo3acin 1Bagam2, mo3iflo3acin 1Avelo32 Increased risk of bleeding may occur with oral anticoagulants

$ignificant food interactions

,imit alkaline foods that can alter p: of stomach and absorption Alkaline foods 7 dairy products, vegetables and legumes

*A)6%,I-#$ A',I')%$A*I-#$

A)TI%' . /$#
(acteriostatic 7 inhibiting the growth of bacteria )an be bactericidal in high doses with some bacteria Is highly protein bound /sed in upper and lower respiratory infections, skin . soft tissue infections, $T-s, bone infection, +/T infections, intra abdominal infections, pneumonia

)ommon medications
A8ithromycin )larithromycin -irithromycin #rythromycin )lindamycin ,incomycin

Administration considerations
#rythromycin is bitter taste 7 give with juice or applesauce )lindamycin and lincomycin with at least C ounces of fluid or on an empty stomach )lindamycin should not be given via I5 push Bithroma3 7 longer half life with less freDuent dosing, shorter term of therapy and has fewer or less intense +I side effects

)ontraindications
:ypersensitivity /se caution with liver or renal dysfunction, +I disorders, elderly and pregnant or lactating women ,incosamides are also contraindicated in ulcerative colitis?enteritis and children less 1 year of age

$ignificant drug interactions

)lindamycin . lincomycin4 many drugs may be antagonists 7 muscle rela3ant, chloramphenicol, erythromycin, theophylline, antihistamines, penicillins and oral anticoagulants *acrolides increased effects of these drugs carbama8epine 1Tegretol2, cyclosporine 1$andimmune2, warfarin and theophylline

*%'%(A)TA*$

A)TI%' . /$#
(actericidal against gram negative rods :ave similar activity as beta lactam antibiotic such as penicillin and cephalosporins (road spectrum antibiotics

)ommon medications
A8treonam Imipenem *eropenem Auinupristin vancomycin

Administration considerations
+iven I* or I5

)ontraindications
:ypersensitivity to a8treonam, penicillin or cephalosporins

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A)TI%' A'- /$#

(actericidal effect (road spectrum antibiotics

)ommon medications
Amo3icillin Ampicillin (acampicillin 'afcillin "enicillin + )lo3acillin )arbenicillin %3acillin

Administration considerations
%ral dose 7 < E times the parenteral dose 7 because of the hepatic first pass effect, instability of penicillin in the acid environment of the stomach I5 route for systemic infections Avoid I* 7 causes irritability of tissues I5 e3travasation can cause necrosis

$ignificant drug interactions

,oop and thia8ide diuretice may e3acerbate hypokalemia and rash "otassium sparing diuretics may contribute to hyperkalemia -ecreased efficacy of oral contraceptives "rebenecid delays e3cretion and increases serum levels Avoid co adm with tetracycline 7interferes with effectiveness of penicillin

 Atenolol level may be decreased Allopurinol increases risk for rash *e8locillin and piperacillin 7 alter elimination of lithium 'afcillin may cause lowered levels of cyclosporine Aspirin, phenylbuta8one 1ibuprofen like2 sulfonamides, furosemide,indomethacin, thia8ides 7 prolong half life of "en +

 "enicillins such as penicillin and amo3icillin

 )ephalosporins such as cephale3in 10efle32

 *ethicillin resistant $taphylococcus aureus 1*6$A2 causes infections that are resistant to several common antibiotics. )enters for -isease )ontrol and "revention