ANTIBACTERIAL AGENTS Are prescribed to combat disease producing microorganisms ( pathogens) Used interchangeably with antimicrobial and antibiotic

ic Examples: Penicillins Cephalosporins Macrolides Tetracyclines Aminoglycosides Fluoroquinolones BACTERIOSTATIC Inhibit the growth of bacteria Tetracycline and sulphonamides BACTERICIDAL Kills bacteria Penicillins and cephalosporins BACTERIA Single cell organisms lacking a true nucleus and nuclear membrane Bacillus rod shape Cocci- spherical Gram positive-retain purple stain Gram negative-not stained MECHANISM OF ANTIBACTERIAL ACTION Inhibition of bacterial wall synthesis Alteration of membrane permeability Inhibition of protein synthesis Inhibition of the synthesis of bacterial RNA and DNA Interference with metabolism within the cell ACTION EFFECT DRUGS Inhibition of cell wall synthesis Bactericidal effect Enzyme breakdown of cell wall Inhibition of enzymes in synthesis of cell wall Bacteriostatic or bactericidal effect Membrane permeability increase Interferes with protein synthesis w/o affecting the normal cells Interferes with steps of metabolism within the cell Penicillin Cephalosporins Bacitracin Vancomycin Amphotericin B

Alteration in membrane permeability

Nystatin Polymyxin Colistin

Inhibition of protein synthesis

Aminoglycosides Tetracyclines Erythromycin lincomycin Sulfonamides Trimetoprim Isoniazid Nalidixic acid Rifampin

Interference with cellular metabolism

Pharmacokinetics Must penetrate bacterial cell wall and have an affinity to the binding sites on the bacterial cell Steady state of the antibacterial drug occurs after the fourth to fifth half lives Eliminated through the urine after the 7th half life Pharmacodynamics Attain bactericidal effect if within or above the minimum effective concentration (MEC) General adverse reaction to antibacterial drugs Allergy/hypersensitivity Superinfection Organ toxicity NARROW SPECTRUM ANTIBIOTICS Effective against one type of organism Penicillin and erythromycin against gram positive BROAD SPECTRUM Effective against narrow and broad spectrum antibiotic Used when offending organism is not identified Tetracyclines and cephalosporins Penicillins Natural antibacterial agent obtained from the mold genus Penicillium Miracle drug Pen G was the first to be administered orally and by injection Pen V-next type produced Food interferes with absorption Beta lactam antibiotics Beta lactamases- produced by bacteria and inactivates penicillin BASIC PENICILLINS Penicillin G procaine Penicillin G benzathine Penicillin G sodium Penicillin V potassium Broad spectrum penicillins Ampicillin ( Cloxapen) Amoxicillin ( Amoxil ) Bacampicillin ( Spectrobid) Amoxicillin-clavulanate (Augmentin) Ampicillin sulbactam (Unasyn) Penicillinase resistant penicillins (Antistaphylococcal penicillins ) Used to treat penicillinase producing S aureus Cloxacillin (Cloxapen) and dicloxacillin ( Dynapen)oral prep Nafcillin (Unipen) and oxacillin ( Prostaphin) IV and IM prep EXTENDED SPECTRUM PENICILLINS Antipseudomonal penicillins Useful against Klebsiella pneumoniae, enterobacter, acinetobacter Carbenicillin indanyl ( Geocillin) Mezlocillin sodium (Mezlin) Beta Lactamase Inhibitors Broad spectrum antibiotic ( amoxicillin) combined with a beta lactamase (enzyme inhibitor/clavulanic acid)= amoxicillin-clavulanic acid ( Augmentin) Examples : Oral use : amoxicillin-clavulanic acid ( Augmentin)

 Parenteral use: ampicillin sulbactam ( Unasyn),piperacillin-tazobactam (Zosyn) and ticarcillinclavulanic acid ( Timentin) Side effects and adverse reactions Hypersensitivity Superinfection Nausea Vomiting Diarrhea Generation Activity

Rash Anaphylactic reaction CEPHALOSPORINS First discovered in seawater-fungus called cephalosporium acremonium Effective against gram positive and gram negative bacteria Have a beta lactam structure Cause bacteria cell lysis Drugs

First

Second

Effective against gram positive ( streptococci, staphylococci) Gram negative ( E.Coli ,Klebsiella, Salmonella and Shigella) Broader spectrum against gram negative ( Haemophilus influenzae,Neisseria Gonorrhea, neisseria meningitidis) Effective against gram negative ( pseudomonas aeruginosa, Acinetobacter) Less effective boagainst gram positive bacteria Broader gram positive coverage than the third generation

Cephalexin (Keflex) Cefazolin sodium ( Ancef, kefzol)

Cefaclor ( ceclor) Cefuroxime ( Ceftin, Zinacef) Cefoxitin sodium ( Mefoxin) Ceftriaxone (Rocephin) Cefotaxime ( Claforan) Ceftazidime ( vantin ) Cefepime ( Maxipime)

Third

Fourth

Side effects and adverse reactions GI disturbances ( Nausea, vomiting, diarrhea) Increased bleeding Nephrotoxicity Drug interactions When taken with alcohol-flushing ,dizziness, headache, nausea and vomiting, muscular cramps When taken with uricocosuric drugs, decrease excretion CLIENT TEACHING Keep drugs out of reach of small children Use childproof containers Report signs of superinfection- mouth ulcers, discharge from genital or anal area Ingest buttermilk or yoghurt to prevent superinfection of instestinal flora Take complete course of medication even if infection have ceased Observe for hypersensitivity reaction