Macrolides

Tx of  respiratory tract infections, H. pylori, skin, PID, skin, bacterial STD's, MRSA
Take on empty stomach

• Prototype drug: Azithromycin (Zithromax) - "Z-pack"
• monitor for hepatotoxicity and ototoxicity
• assess liver enzymes on a regular basis

• Other Drugs: Erythromycin, Clarithromycin, Clindamycin, Vancomycin
• monitor for renal and hepatic function
• monitor for signs of colitis (diarrhea, abdominal cramping)
• monitor for ototoxicity

• Vancomycin: monitor for red man syndrome, nephrotoxicity (creatinine and Urine output); peak and through levels; infuse slowly - may cause IV site pain.

• Erythromycin: drug of choice when penicillin is not an option due to hypersensitivity

Antimicrobial Therapy

Sensitivity and resistance:

• Any medication allergy should be reported to the healthcare provider.
• Fluids should be encouraged with antibiotic therapy.
• To obtain the most accurate culture, culture should be obtained before antibiotic therapy begins.
• The entire course of the medication should be taken to ensure eradication of the infection and decreased resistance, even if the client’s symptoms has normalized. Resistance occurs when microbes become de-sensitized to an antimicrobial. 
• Multiantibiotic therapy delays development of resistance.
• When microbe is resistant to an antibiotic, antibiotic therapy must be changed. Bacteria mutate if they are in contact with antibiotics for extended periods.
• May decrease effectiveness of oral contraceptives
• Monitor for superinfections (fungal, C.difficile, vaginitis)
• Monitor for organ toxicity ( kidney and liver) (BUN and Creatinine level)
• Monitor for allergy/hypersensitivity
• High peak levels may indicate that the medication is above the toxic level.
• Medication levels must be maintained above the Minimum Effective Concentration throughout therapy to ensure that bacterial resistance does not occur.

Cephalosporins

Derived from fungus
Interferes w/ cell wall synthesis
Similar to PCN but resistant to beta-lactamase enzyme
Potential cross-allergy in those w/ PCN allergies. The nurse should administer the medication and carefully observe for allergic reaction.

• Prototype: Cefaclor, Cefazolin
• Interaction w/ alcohol, probenicid (treats gout) (decreases excretion of ceph; raises level of drug)
• Interaction w/ erythromycin will produce a decrease in the action of the Cefaclor.
• Side effects: GI (anorexia, nausea, vomiting), headache, dizziness, itching, rash, increased blood clotting time, nephrotoxicity
• Monitor renal and hepatic function, vital signs, urine output; monitor for superinfections

Penicillin

Derived from mold
Prevents cell from forming cell wall

• Prototype: amoxicillin, penicillin G, ampicillin
• no acidic fruits and juices
• Penicillin combined w/ beta-lactamase inhibitors: Augmentin, Zosyn, Timentin
• amplifies antimicrobial effect

Common drug allergy/hypersensitivity, drug-resistance issue, generally safe in pregnancy

General Antimicrobial guidelines:

• Any medication allergy should be reported to the healthcare provider.
• Fluids should be encouraged with antibiotic therapy.
• To obtain the most accurate culture, culture should be obtained before antibiotic therapy begins.
• The entire course of the medication should be taken to ensure eradication of the infection and decreased resistance, even if the client’s symptoms has normalized.