Antibacterials

Question 1

What are the classifications of Antimicrobial medications??

Answer 1

1. Susceptibility –> START broad first and then go NARROW!!! if broad doesn’t work, then move to narrow
   A) Broad-Spectrum antibiotics –> works on variety of bacteria
   B) Narrow-spectrum antibiotics –> works on few (specific) types of bacteria
2. Identify MOA of each meds
   A) Bactericidal –> lethal to micro-organism. Antibiotic will KILL the bacterial cell!!!!!
   - Can be upsetting for stomach & make ur body system not well since it’s killing. usually antibiotics would be recommended to be companied w/ food or milk.
   B) Bacteriostatic –> slows growth, immune system destroys the bacteria (not the antibiotics). Antibiotic STOPS the GROWTH of bacteria!!!!

3) Selecting an Antibiotic
- Identify causative agent
- Sensitivity of infecting organism to antimicrobial
- Other factors: location, age, allergies, immune status of patient

Question 2

What are the Identification of Causative Agent??

Answer 2

Lab testing of body fluids (blood, urine, sputum & wound drainage)
- Gram stain –> examination of body fluid under microscope to identify
- Culture –> application of body fluid to culture medium, colonies grow
- Obtain specimens for culture PRIOR to starting antimicrobials. ALWAYS collect the culture before you start the antibiotics (even if it’s within 10-15 mins before), BUT, if you CAN’T get it due to whatever reason, then you’re NOT going to DELAY treatment!!
- Collect specimens carefully to prevent contamination

Question 3

What is the Sensitivity of a micro-organism to an antimicrobial?

Answer 3

Test sensitivity of organisms to various antimicrobials to determine if selected antimicrobial is appropriate. (sensitivity lets you know if the antibiotic will work against the microorganism)
1. Disk diffusion test
2. Serial dilution
- Minimum inhibitory concentration
- Minimum bactericidal concentration
3. Gradient diffusion

Question 4

What are the Factors of Host??

Answer 4

1. Immune system
   - Immunocompromised persons need bactericidal antibiotics because immune system is unstable to defeat micro-organism
2. Site of infection
   - CSF (cerebrospinal fluid) infections are difficult for antimicrobials to reach bc you have the blood brain barrier preventing the antibacterials from getting to the brain
   - Endocarditis (thrombus concealed/covered up so it’s difficult for defenses to kill the infection)
   - Purulent abscesses (pocket of pus) due to poor blood supply
   - Implanted objects (pacemakers, prosthetic joints, grafts, valves, mesh) –> weakened immune responds, so if those gets infected, the body response system is not as effective handling that
3. Age – older adults may develop toxicity due to reduced metabolism & excretion
4. Pregnancy
   - Antimicrobials can harm fetus by crossing over placenta
   
   • Sulfonamides can produce a severe neurological disorder in newborns.
   • Gentamicin causes hearing loss in infants
   • Tetracyclines cause discoloration of developing teeth. Toxicity more likely during pregnancy
     - Many antimicrobials are present in breast milk, risk of danger to infants
5. Presence of a previous allergic reaction – frequent cross-sensitivity between penicillins and cephalosporins

Question 5

What are the 5 combination therapy of additive or potentiating?

Answer 5

1. treatment of severe infections
2. treat infections of multiple micro-organisms
3. Prevent bacterial resistance
4. Decreases toxicity risk by reducing dose of each meds
5. Produces more effective treatment

Question 6

What are the 5 combination therapy of adverse effects?

Answer 6

1. Increased resistance to antimicrobials
2. Increased cost of therapy
3. More adverse/toxic reactions
4. Antagonistic (opposite) effects btwn. two or more might result in decreased effectiveness
5. Increased risk of superinfection (secondary infection on top of initial infection)

Question 7

Who should be given Prophylaxis (treatments/actions taken to prevent disease)?

Answer 7

Prevention of infections for patients:
- Having GI, cardia, PV, orthopedic, or gynecologic surgeries
- Sexual exposure to prevent STIs (or STDs)
- Before dental or other procedure in patients w/ prosthetic heart valves (increased risk of bacterial endocarditis)
- Recurring UTIs

Question 8

What are 6 preventative measures?

Answer 8

1. HAND hygiene
2. Invasive procedures (urinary catheter, IV catheter)
3. Immunizations up-to-date
4. Instruct patients to take FULL COURSE of antimicrobials to prevent resistance and recurrence
5. Prevent transmission of resistant micro-organism (PPE)
6. Evaluate effectiveness of treatment (post treatment cultures, monitor for clinical improvement)

Question 9

What are the 11 additional information common to most antibacterials?

Answer 9

1. Review allergies!!
2. Review labs (kidney & liver dysfunction can alter absorbtion and excretion)
3. Review pregnancy status
4. Instruct patients to take ENTIREEE course of treatment, EVEN if feeling better
5. Follow recommendations for oral and food/drink
6. Peak (an HOUR after the dose) and Trough (30 mins before giving the dose) use for dosing and therapeutic levels
   - If peak is high = lower dose
   - If trough is low = increase dose
   - You’d draw random at anytime
7. Follow recommendations for IV administration (dilution, rate, monitor site for: swelling & inflammation, and make sure it’s not infiltrating)
8. Instruct patients to monitor for signs/symptoms of complications (suprainfections, allergic reactions, etc)
   - supra infections means the antibiotic is doing an EXCELLENT job & in that, it killed way too much of good flora!!
9. Instruct women of childbearing age to use alternative forms of birth control (if taking hormonal birth control)
10. If taking to treat sexually transmitted infection, restrain from intercourse until therapy completed, symptoms resolved, and partners treated
11. Evaluate effectiveness of therapy by monitoring symptoms, WBC’s repeat cultures (if ordered), et cetera
    - Normal range : 5-10,000
    - Infection 15-20,000

Question 10

What’s the weight based formula??

Answer 10

(mg/kg) x (kg) = x

1 kg = 2.2 lbs!!!!

Question 11

What should you actually do before administering antibiotics????? What happens if you can’t?

Answer 11

Collect CULTURE before you start ANY antibiotics!!!!! But if you can’t, you are NOT going to delay treatment!!

Question 12

When you give Vancomycin for the first time/dose or when you administer it too fast, what complication would you see in your patient? What are the symptoms??

Answer 12

Red Man syndrome!!!
Symptoms: Flushing of face, neck, pruritis (itching), hypotension, dizziness

Question 13

What is an example of Spontaneous Tendon Rupture? Why are the symptoms like?

Answer 13

Fluoroquinolones

Symptoms: pain, swelling, redness at tendon sites (Achilles site common)