Antibiotics:  

Sulfonamides Aminoglycosides 
Penicillin  Quinolones 
Cephalosporins  Macrolides 
Tetracyclines 
 Medications used to treat bacterial infections  
 Ideally, before beginning antibiotic therapy, the suspected areas of infection
should be cultured to identify the causative organism and potential antibiotic
susceptibilities. 
 Empiric therapy:  
 treatment of an infection before specific culture information has been 
reported or obtained 
 Prophylactic therapy:  
 treatment with antibiotics to prevent an infection, as in intra-abdominal surgery 
 Mechanism of action 
 Bactericidal: kill bacteria  
 Bacteriostatic: inhibit growth of susceptible bacteria, rather than killing them
immediately; will eventually lead to bacterial death 
  
Antibiotics:Sulfonamides  
1. One of the first groups of antibiotics:: sulfadiazine,
sulfamethizole,sulfamethoxazole, sulfisoxazole 
2. Mechanism of Action  

Bacteriostatic action  
1. •Prevent synthesis of folic acid required for synthesis of purines and nucleic
acid  
2. •Does not affect human cells or certain bacteria—they can use preformed folic
acid  
3. Sulfonamides:sulfamethoxazole 

Therapeutic Uses 
1. Azo-Gantanol  

•Combined with phenazopyridine (an analgesic-anesthetic that affects the mucosa of the
urinary tract).  

•Used to treat urinary tract infections (UTIs) and to reduce the pain associated with
UTIs.  

2. Bactrim  
 
•Combined with trimethoprim.  
 
•Used to treat UTIs, Pneumocystis carinii pneumonia, ear infections, bronchitis,
gonorrhea, etc 
 3. Azo-Gantrisin  
 
•Combined with phenazopyridine  
 
•Used for UTIs  

4. Pediazole  
 
•Combined with erythromycin  
 
•Used to treat otitis media

5. Sulfonamides: Side Effects  

      
Body System                                 Effect  
Blood                                Hemolytic and aplastic anemia, thrombocytopenia  
Integumentary                   Photosensitivity, exfoliative dermatitis, Stevens- Johnson
syndrome, epidermal necrolysi 
GI                                       Nausea, vomiting, diarrhea, pancreatitis  
Other                                  Convulsions, crystalluria, toxic nephrosis, headache,
peripheral                                                              neuritis, urticaria  

Antibiotics: Penicillins  
 Natural penicillins    Aminopenicillins 
 Penicillinase-resistant  Extended-spectrum penicillins  
penicillins 
  
Natural penicillins : •penicillin G, penicillin V potassium  
Penicillinase-resistant penicillins: •cloxacillin, dicloxacillin, methicillin, nafcillin, oxacillin  
Aminopenicillins: •amoxicillin, ampicillin, bacampicillin  
Extended-spectrum penicillins : piperacillin, ticarcillin, carbenicillin, mezlocillin  
  
 First introduced in the 1940s  
 Bactericidal: inhibit cell wall synthesis  
 Kill a wide variety of bacteria  
 Also called “beta-lactams” 
 Bacteria produce enzymes capable of destroying penicillins.  
 These enzymes are known as beta-lactamases.  
 As a result, the medication is not effective.  
  
•Chemicals have been developed to inhibit these enzymes:  
1. •clavulanic acid                   •tazobactam                  •sulbactam 
2. •These chemicals bind with beta-lactamase and prevent the enzyme from
breaking Down the pecinillin 
  
Penicillin-beta-lactamase inhibitor combination drugs:  
•ampicillin + sulbactam = Unasyn                             •amoxicillin + clavulanic acid = Augmentin  
•ticarcillin + clavulanic acid = Timentin                      •piperacillin + tazobactam = Zosyn  
  

Penicillins: Mechanism of Action  

1. Penicillins enter the bacteria via the cell wall. Inside the cell, they bind to penicillin-
binding protein.  
1. Once bound, normal cell wall synthesis is disrupted.  
•Result: bacteria cells die from cell lysis.       •Penicillins do not kill other cells in the body 
  
Penicillins: Therapeutic Uses  
1. Prevention and treatment of infections caused by susceptible bacteria, such as:  
•gram-positive bacteria
•Streptococcus, Enterococcus, Staphylococcus species  
  
Penicillins: Adverse Effects  
•Allergic reactions occur in 0.7% – 8% of treatments  
•urticaria, pruritus, angioedema  
•10% of allergic reactions are life-threatening and  
•10% of these are fatal  

Penicillins: Common side effects:  

•nausea, vomiting, diarrhea, abdominal pain 
  
Antibiotics: Cephalosporins  
-Semisynthetic derivatives from a fungus  
•Structurally and pharmacologically related to penicillins  
•Bactericidal action: •Broad spectrum 
•Divided into groups according to their antimicrobial activity  
  
Cephalosporins: First Generation  
•cefadroxil              •cephalexin                   •cephradine 
•cefazolin                •cephalothin                  •cephapirin 
1. Good gram-positive coverage  
2. Poor gram-negative coverage  
 
cefazolin (Ancef and Kefzol)                         IV and PO 
3. cephalexin (Keflex and Keftab)                    PO  
4. used for surgical prophylaxis, URIs, otitis media  
  
Cephalosporins: Second Generation  
•cefaclor                 • cefonicid                     •cefprozil                      • ceforanide  
•cefamandole          • cefmetazole                •cefoxitin                       • cefotetan       •cefuroxime  
1. Good gram-positive coverage  
2. Better gram-negative coverage than first generation  
3. Cefoxitin     (Mefoxin) and Cefuroxime (Kefurox and Ceftin)               IV and IM, PO  
4. Used prophylactically for Surgical prophylaxis: abdominal or colorectal surgeries 
5. Does not kill  
Cephalosporins: Third Generation  
•cefixime                 • ceftizoxime                 •cefpodoxime proxetil                • ceftriaxone  
•cefoperazone         • ceftazidime                 •cefotaxime                               • moxalactam  
1. Most potent group against gram- negative  
2. Less active against gram-positive  
3. cefixime (Suprax)  and ceftriaxone (Rocephin)          Tablet and suspension 
 
•Only oral third-generation agent  
 
•Best of available oral cephalosporins against gram-negative  
 
•IV and IM, long half-life, once-a-day dosing  
 
•Easily passes meninges and diffused into CSF to treat CNS infections  

4. ceftazidime (Ceptaz, Fortaz, Tazidime, Tazicef)  

 
•IV and IM 
 
•Excellent gram-negative coverage 
 
•Used for difficult-to-treat organisms such as Pseudomonas.  
 
•Eliminated renally instead of biliary route  

•Excellent spectrum of coverage  

  
  
Cephalosporins: Fourth Generation  
1. Cefepime (Maxipime)  
a. •Newest cephalosporin agents.  
b. •Broader spectrum of antibacterial activity than third generation, especially
against gram-positive bacteria 
2. Cephalosporins: Side Effects : Similar to penicillins 
3. Common side effects: nausea, vomiting, diarrhea, abdominal pain 

Antibiotics: Tetracyclines

•demeclocycline (Declomycin)               •oxytetracycline            •tetracycline 

•doxycycline (Doryx, Doxy-Caps, Vibramycin)                 •minocyclin 
1. Natural and semi-synthetic  
2. Obtained from cultures of Streptomyces  
3. Bacteriostatic—inhibit bacterial growth  
4. Inhibit protein synthesis  
5. Stop many essential functions of the bacteria  
6. Bind to Ca2+ and Mg2+ and Al3+ ions to form insoluble complexes  
7. Thus, dairy products, antacids, and iron 
8. salts reduce absorption of tetracyclines 
Tetracyclines: Therapeutic Uses  
•Wide spectrum:  
•gram-negative, gram-positive, protozoa, Mycoplasma, Rickettsia, Chlamydia, syphilis, Lyme
disease  
•Demeclocycline is also used to treat SIADH, and pleural and pericardial effusions  
Tetracyclines: Side Effects  
-Strong affinity for calcium  
•Discoloration of permanent teeth and tooth enamel in fetuses and children  
•May retard fetal skeletal development if taken during pregnancy 
-Can cause photosensitivity (the patient becomes overly sensitive to light). 

Tetracyclines: Side Effects  

Alteration in intestinal flora may result in:  
•Superinfection (overgrowth of nonsusceptible organisms such as Candida)  
•Diarrhea  
•Pseudomembranous colitis  
May also cause:  
•Vaginal moniliasi                     •Gastric upset 
•Enterocolitis                            •Maculopapular rash 
  
Antibiotics: Aminoglycosides  
•gentamicin (Garamycin)                 •kanamycin                   •neomycin              •streptomycin 
•tobramycin                        •amikacin (Amikin)      •netilmicin                      
•Natural and semi-synthetic 
•Produced from Streptomyces 
•Poor oral absorption; no PO forms 
•Very potent antibiotics with serious toxicities  
•Bactericidal  
•Kill mostly gram-negative; some gram-positive also  
•Used to kill gram-negative bacteria such as Pseudomonas, E. coli, Proteus, Klebsiella,
Serratia.  
•Often used in combination with other antibiotics for synergistic effect.  
  
1. Three most common (systemic effect):
a. Gentamicin,      b. Tobramycin              c. Amikacin  
2. Streptomycin is an aminoglycoside and damage on the 8th cranial nerve
(ototoxicity) is a common side effect of aminoglycosides. 
 
•Cause serious toxicities:  
1. Nephrotoxicity (renal failure)  
2. Ototoxicity (auditory impairment and vestibular [eighth cranial nerve])  
3. Must monitor drug levels to prevent toxicities  

Aminoglycosides: Side Effects  

1. Ototoxicity and nephrotoxicit are the most significant 
2. Headache        
•Paresthesia    •Neuromuscular blockade          •Dizziness 
•Vertigo            •Skin rash                     •Fever 
  
Antibiotics: Quinolones  
       •ciprofloxacin (Cipro)          •enoxacin (Penetrex)                 •lomefloxacin (Maxaquin) 
•norfloxacin (Noroxin)         •ofloxacin (Floxin) 

Quinolones: Mechanism of Action  

•Bactericidal  
•Effective against gram- negative organisms and some gram-positive organisms 
•Alter DNA of bacteria, causing death  
•Do not affect human DNA  
•Excellent oral absorption  
•Absorption reduced by antacids  
•First oral antibiotics effective against gram-negative bacteria  

Quinolones: Therapeutic Uses  

•Lower respiratory tract infections               •Bone and joint infections 
•Infectious diarrhea                                    •Urinary tract infections 
•Skin infections                                          •Sexually transmitted diseases  

Quinolones: Side Effects  

        Body System                     Effects  
CNS                       headache, dizziness, fatigue, depression, restlessness  
GI                           nausea, vomiting, diarrhea, constipation, thrush, increased
liver function studies 
Integumentary         rash, pruritus,urticaria, flushing, photosensitivity (with
lomefloxacin)  
Other                      fever, chills, blurred vision, tinnitus  
  
Antibiotics: Macrolides 
•erythromycin                     •azithromycin (Zithromax)                      •clarithromycin (Biaxin) 
•dirithromycin                     •troleandomycin 
 bactericidal action

Macrolides: Therapeutic Uses  

Strep infections       •Streptococcus pyogenes (group A beta-hemolytic streptococci)  
 Mild to moderate URI           •Haemophilus influenzae  
 Spirochetal infections          •Syphilis and Lyme disease  

Macrolides: Side Effects  

 GI effects, primarily with erythromycin: nausea, vomiting, diarrhea, hepatotoxicity,
flatulence, jaundice, anorexia  
 Newer agents, azithromycin and clarithromycin: fewer side effects, longer duration of
action, better efficacy, better tissue penetration 

Antibiotics: Nursing Implications  

•Before beginning therapy, assess drug allergies; hepatic, liver, and cardiac function; and other lab
studies.  
•Be sure to obtain thorough patient health history, including immune status.  
•Assess for conditions that may be contraindications to antibiotic use, or that may indicate cautious
use.  
•Assess for potential drug interactions.  
•It is ESSENTIAL to obtain cultures from appropriate sites BEFORE beginning antibiotic therapy. 
•Patients should be instructed to take antibiotics exactly as prescribed and for the length of time
prescribed; should not stop taking the medication early when they feel better. 
•Assess for signs and symptoms of superinfection: fever, perineal itching, cough, lethargy, or any
unusual discharge.  
•For safety reasons, check the name of the medication carefully since there are many agents that sound
alike or have similar spellings. 
•Each class of antibiotics has specific side effects and drug interactions that must be carefully assessed
and monitored. 
•The most common side effects of antibiotics are nausea, vomiting, and diarrhea.  
•All oral antibiotics are absorbed better if taken with at least 6 to 8 ounces of water.  
Antibiotics: Nursing Implications Sulfonamides  
•Should be taken with at least 2400 mL of fluid per day, unless contraindicated.  
•Due to photosensitivity, avoid sunlight and tanning beds.  
•These agents reduce the effectiveness of oral contraceptives.  
Antibiotics: Nursing Implications Penicillins  
•Any patient taking a penicillin should be carefully monitored for an allergic reaction for at least 30
minutes after its administration. 
•The effectiveness of oral penicillins is decreased when taken with caffeine, citrus fruit, cola beverages,
fruit juices, or tomato juice.  
Antibiotics: Nursing Implications Cephalosporins  
•Orally administered forms should be given with food to decrease GI upset, even though this will delay
absorption.  
•Some of these agents may cause an Antabuse-like reaction when taken with alcohol.  
  
Antibiotics: Nursing Implications Tetracyclines  
•Milk products, iron preparations, antacids, and other dairy products should be avoided because of the
chelation and drug-binding that occurs. 
•All medications should be taken with  6 to 8 ounces of fluid, preferably water.  
•Due to photosensitivity, avoid sunlight and tanning beds.  
  
Antibiotics: Nursing Implications Aminoglycosides  
•Monitor peak and trough blood levels of these agents to prevent nephrotoxicity and ototoxicity.  
•Symptoms of ototoxicity include dizziness, tinnitus, and hearing loss.  
•Symptoms of nephrotoxicity include urinary casts, proteinuria, and increased BUN and serum
creatinine levels. 
  
Antibiotics: Nursing Implications Quinolones  
•Should be taken with at least 3 L of fluid per day, unless otherwise specified  
  
Antibiotics: Nursing Implications Macrolides  
•These agents are highly protein- bound and will cause severe interactions with other protein-bound
drugs. 
•The absorption of oral erythromycin is enhanced when taken on an empty stomach, but because of the
high incidence of GI upset, many agents are taken after a meal or snack. 
  
Antibiotics: Nursing Implications  
1. Monitor for therapeutic effects:  
•Disappearance of fever, lethargy, drainage, and redness