what are multiresistant organism to drugs

Mrsa, vre,esbl,cre

Aminoglycosides

bacterialcidal drug,poor oral absorption, no oral forms Except Neomycin, Very potent antibiotic with serious Toxicities

kills mostly gram- and some gram + bacteria

Aminoglycosides

Gentamicin, Neomycin

what are indications of Aminoglycosides

Poorly absorbed GI are usually given parenterally

Except Neomycin which is given orally to decontaminate the Gi tract before surgical procedures, Also used as an enemafor this purpose used to treat Hepatic encephalopathy

Aminoglycosides:Contradications

known drug allergy

Pregnacy category C and D

Can cross the placenta and cause fetal harm

through milk of the breast and should not be used if you are lactating

Aminoglycosides: Adverse Effects

Causes Serious Toxicities

Peak highest level drug levels for once daily regimens usually 30 mins to 1.5 hours after dose

Trough: lowest drug level will measure renl clearance of the drug and avoid Toxicity.Usually obtained one hour before next dose is scheduled depends on facility

quinolones drugs

CiproFloacin(cipro)

Levofloxacin(Levaquin)

Quinolones Also called Fluroquinolones

broad spectrum antibiotics, bacterialcidal, excellent oral oral absorption, Reduced by antacids,

Effective against gram negative organisms and some gram positive organisms

quinolones indications

Gram negative bacteria Psudomonas spp

Anthrax (ciproflaxicin) Helps take care the job

treats uti,resp,bone and joint,skin,sti

Adverse effects of quinolones

Cardiac Prolonged QT intervals

GI Nausea and Vomiting ,diarrhea, constipations

Cns headache dizziness, insomonia,depression

Adverse effects of Quinolones

Skin- pruritis,Urticaria

Ruptured Tendons, Tendonitis, fevers and chills

MIscellaneous Antibiotics

Clindamycin,(Cleocin)

Linezolid(Zyvox)

Metronidazole (Flagyl)

Vancomycin (Vancocin ,Vancoled)

Quinolones interactions

Antacids , Calcium, magnesium,iron,zinc preparations or sucrafate causes oral reduction

PAtient needs to take the interacting drug one hour before or one hour after taking quinolones

dairy products also reduce effect

enteral tube feeding can also reduce absorption

oral anticoagulants use with caution -decreased vitamin k absorption

Cindamycin (cleocin)

bacterialcidal/bacterial static

can cause cdiff

used for bone infections ,genitourinary infections

Linezolid (zyvox)

used to treat

Vre,vref, Hospital aquired, skin infections including MRsa

Also used for treatment for Healthcare associated pneumonia

Metroidazole(Flagyl)

Used for anaerobic organism

intrabdominal and gynecologic infections

Pregnacy category b not recommended for use during the first trimester of pregnancy

Also used as an antifungal and anti protozoa drug. Do not drink alcohol when taking flagyl

Nitrofurantoin (Macrodantin)

primarily used for uti ex(e coli) s aureus

use carefully if renal function is impaired

drug concentrates in urine

Quinupristin-Dalfopristin (synercid)

Used for bacteremia and infections caused by (Vre)

also skin to skin structures caused by s.pyogenes and s aureus

INCLUDING MRSA

Vancomycin(Vancocin)

Treatment of choice for MRSA and other gran- positive infections

oral vancomycin-is indicated for treatment of antibiotic -induced colitis (Cdiff)

Must monitor blood levels to ensure therapeutic levels and prevent Toxicity

What can you get from Vancomycin (VAncocin)

Redmans syndrome may occur, flushing or itching,of head neck and face,HIstamine release

anti histamines may be orderd to reduce thes effects

Should be infused over 60 mins

Rapid infusions may cause hypotension

nursing implications

before drug therapy asses drug allergies

hepatic,renal and cardiac functions,and other laboratory results

patient health history,including immune status,baseline labs

ekg,culture sensitivity

neuro and gi assessment

potential drug interactions

nursing implications

cultures before beginning antibiotic therapy

instruct on antibiotic therapy

signs and symptoms of superinfection

check meds prior to giving

asses each class for specific interaction

nursing implications

Monitor for therapeutic effects

improvement of signs and symptoms

return normal vital signs

negative culture and sensitivity

diasappearance of fever

client teaching

increase fluids to 3000ml a day unless contraindicated

report changes in hearing

report headache, vertigo

educate about signs and symptoms of superinfection

client teaching about quinolones

educate client about incidence of photosensitivity

stress importances of avoiding sun and tanning beds

instruct client to take calcium or magnesium supplements 1 hour before or after taking quinolones

instruct client to take antibiotic exactly how it is ordered

client teaching for Clindamycin

Do not use near eyes or near any abraded areas to avoid tissue to avoid tissue irritations

with vaginal forms do not engage in sexual intercourse for duration of therapy

full course of antibiotics must be taken

if it gets in eye rinse eye with alot of tap water

client teaching (vancomycin)

Instruct the client to report any changes in hearing such as ringing in the ears or a feeling of fullness in the ears

monitor therapeutic serum levels throughout therapy