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Antibiotic Notes and Classification 2012.docx

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McGill University
NUR1 420
Balbinder S.Deo

Antibiotic Notes Broad Spectrum and Narrow Spectrum  Once a culture and sensitivity is complete, a narrow-spectrum/bacteria specific drug can be used. Antagonism: combination of 2 antibiotics that actually decrease the drug’s efficacy.  Multiple drugs therapy has potential to promote resistance. Superinfections: occurs when micro-organisms that are normally present in the body are destroyed.  this flora serves purpose such as producing antibacterial substances and competing with pathogenic organisms for space and nutrients.  Symptoms of superinfections include diarrhea, bladder pain, painful urination and abnormal vaginal discharge.  Broad spectrum antibiotics are more likely to cause superinfections. Antibacterial Agents Penicillins  Discovered in 1941  Became a miracle drug preventing thousands of deaths.  Indicated in the treatment of: pneumonia, meningitis, skin bone and joint infections, stomach infections, blood and heart valve infections, gas gangrene, tetanus, anthrax, cicle cell anemia in infants.  Works by disrupting call walls, causing them to break down. Human cells do not have cell wall thus action specific to bacteria.  Some bacteria develop resistance by secreting an enzyme called beta lactamase or penicillinase.  This strain of bacteria has gently grown, limiting the effectiveness of penicillins.  “Oxacillin” and cloxacillin work against penicillase producing bacteria. Examples of commonly used Penicillins: 1. Penicillin G – Narrow spectrum 2. Cloxacillin- Narrow spectrum, penicillase resistant 3. Amoxicillin and Amoxicillin- Clavulamate (Clavulin)- Broad spectrum 4. Piperacillin Tazobactam (Tazocin)- Extended spectrum. Efective against even more microbes (pseudomonas, enterobactera, klebsiella and bacteroides). Nursing Care Penicillin’s  Up to 4% chance of allergic reaction with penicillin.  Avoid cephalosporin’s if patient has severe reaction to penicillin due to cross- sensitization.  May alter sodium and potassium levels so watch carefully  Patients with impaired renal function may require smaller doses as majority of penicillin is secreted through the kidneys.  Watch for bleeding with patient on anticoagulant therapy and penicillin (extended spectrum penicillin’s) as they may interfere with platelet aggravation.  Patients may develop antibiotic-associated psudomembranous colitis (AAPMC). The organism clostridium difficile secretes a toxin that causes severe inflammation of the bowel leading to necrosis.  Antidiarrheals should not be given, antibiotics discontinued and fluid and electrolytes replaced. Cephalosporin Largest class of antibiotics organized in four generations Isolated shortly after penicillin’s found Also contains a beta-lactum ring that attack the penicillin binding protein to inhibit cell wall synthesis. Generally the treatment of choice against gram negative infections. First generation:  Example: cefazolin (Ancef) and cephalexin (Keflex)  Contain beta-lactum ring  Beta-lactamase bacteria will be resistant to this generation.  Fairly narrow range Second Generation:  More potent, more resistant to beta-lactamase and has a broad spectrum.  Example: Cef
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