FLOUROQUINOLONE, MACROLIDE AND MISCELLANOUES PPT.pptx

SLIDES FOR FLUOROQUINOLONE ,MACROLIDES , AND OTHER MISCELLANEOUS DRUGS.
ALONG WITH NURSING INSTRUCTION.
SLIDES ARE FOR TEACHING NURSING STUDENTS

1. Fluoroquinolone Dr. Durga verma

2. B actericidal broad-spectrum antibiotics Includes ,norfloxacin, ciprofloxacin, levofloxacin, Moxifloxacin, G emifloxacin, most recently delafloxacin ( Baxdela ) E xcellent oral absorption ,Except NORFLOXACLIN

3. Mechanism of Action Destroy bacteria by altering their deoxyribonucleic acid ,by interfering with the bacterial enzymes DNA gyrase and topo - isomerase IV .

4. Kill susceptible strain of mostly gram-negative and some gram-positive organisms. concentrate themselves in human neutrophils, killing bacteria such as S. aureus , Serratia marcescens , and Mycobacterium fortuitum Bacterial resistance ,include Pseudomonas aeruginosa , S. aureus , Pneumococcus spp., Enterococcus spp., and the broad Enterobacteriaceae family that includes E. coli.

5. Indications wide variety of gram-negative and selected gram-positive bacteria, excreted primarily by the kidneys UNCHANGED Due to extensive gram-negative coverage, makes them suitable for treating complicated urinary tract infections. commonly used to treat respiratory, skin, GI, and bone and joint infections

6. USES Ciprofloxacin (Cipro) was the first quinolone Wide spread use Resistance seen in pseudomonas and streptococcus species Levofloxacin (Levaquin) and moxifloxacin ( Avelox ) more active than ciprofloxacin against gram-positive organisms such as Streptococcus pneumoniae , as well as Enterococcus and S. aureus Norfloxacin has limited oral absorption But its only available in oral forms use is limited to GU tract infections

7. Generic Name (Trade Name Antibacterial Spectrum Common Indications norfloxacin ( Noroxin ) Extensive gram- negative and selected gram- positive coverage Urinary tract infections, prostatitis, STIs ciprofloxacin (Cipro) Comparable to that of norfloxacin Anthrax (inhalational, postexposure); respiratory, skin, urinary tract, prostate, intraabdominal, GI, bone, and joint infections; typhoid fever; selected health care–associated pneumonias levofloxacin (Levaquin) Comparable to that of ciprofloxacin with better gram- positive coverage Respiratory and urinary tract infections; prophylaxis in various transrectal and transurethral prostate surgical procedures Quinolone common indication

8. Generic Name (Trade Name Antibacterial Spectrum Common Indications moxifloxacin ( Avelox ) Comparable to that of levofloxacin plus anaerobic coverage Respiratory and skin infections; CAP caused by PRSP; anaerobic infections gemifloxacin ( Factive ) Comparable to ciprofloxacin CAP, exacerbationofCOPD delafloxacin ( Baxdela ) Comparable to ciprofloxacin but has activity against MRSA Treatment of acute bacterial skin and skin structure infections.

9. Quinolones Adverse effect Body System Adverse Effects Central nervous Headache, dizziness, insomnia, depression, restlessness, convulsions, neuropathy Gastrointestinal Nausea, constipation, increased aspartate aminotransferase and alanine aminotransferase levels, flatulence, heartburn, vomiting, diarrhea , oral candidiasis, dysphagia Integumentary Rash, pruritus, urticaria, flushing Other Ruptured tendons and tendonitis (black box warning added in 2008), fever, chills, blurred vision, tinnitus, QT prolongation

10. Dosages Selected Quinolones Drug Pharmacological class Usual adult dosage range Indication Ciprofloxacin Fluororquinolone IV :200-400MG every 8-12hr, PO: 250-750MG every 12hr Broad gram- positive and gram- negative coverage for infection throughout the body Levofloxacin IV/PO- 250-750 MG Once daily. Various susceptible bacterial infection

11. Interaction Interactions with Metal Ions and Sucralfate- Concurrent use of oral quinolones with antacids, calcium, magnesium, iron, zinc preparations, or sucralfate causes a reduction in the oral absorption of the quinolone Take drugs at least 1 hour before or after taking quinolones Dairy products also reduce the absorption of quinolones

12. Enteral tube feedings can also reduce the absorption of quinolones Probenecid can reduce the renal excretion of quinolones. Nitrofurantoin can antagonize the antibacterial activity of the quinolones, and oral anticoagulants are to be used with caution in patients receiving quinolones because of the antibiotic-induced alteration of the intestinal flora, which affects vitamin K synthesis

13. CIPROFLOXACIN the first of the broad-coverage, potent quinolones to become available available in oral tablets, injectable, ophthalmic , and otic formulations. excellent bioavailability, it can work orally as well as many intravenous antibiotics kill some anaerobic bacteria as well as atypical organisms such as Chlamydia , Mycoplasma , and Mycobacterium also a drug of choice for the treatment of anthrax (infection with Bacillus anthracis ).

14. Pharmacokinetics: CIPROFLOXACIN ROUTE Onset of action Peak plasma concentration Elimination half life Duration of action IV 30 min 1 hr 3-4.8hr Up to 12 hr PO variables 1hr- 2hr 3-4.8hr Up to 12 hr

15. Levofloxacin one of the most widely used quinolones broad spectrum it has the advantage of once-daily dosing oral form has excellent bioavailability available in both oral and injectable forms.

16. Pharmacokinetics:Levofloxacin ROUTE Onset of action Peak plasma concentration Elimination half life Duration of Action IV Variable 1-2hrs 6-8 hr Upto24hr PO Variable 2 hrs 6-8 hr Upto24hr

17. MRSA gram-negative pathogens. Delafloxacin

18. Quinolones in prepubescent children ot generally recommended , to affect cartilage development in fact these drugs are used commonly in children with cystic fibrosis

19. Macrolide Macrolides are a large group of antibiotics These antibiotics are primarily  bacteriostatic , meaning they inhibit the growth of bacteria, but they can become  bactericidal  at high enough concentrations against some susceptible bacteria .

20. MOA Macrolide antibiotics are bacteriostatic drugs that inhibit protein synthesis by binding reversibly to the 50S ribosomal subunits of susceptible microorganisms.

21. infections of the upper and lower respiratory tract, skin, and soft tissue caused by some strains of Streptococcus and Haemophilus; spirochetal infections such as syphilis and Lyme disease; gonorrhea along with Cephalosporins and Chlamydia, Mycoplasma, and Corynebacterium infections

22. I ndications Azithromycin and clarithromycin are approved for the prevention and treatment of Mycobacterium avium- intracellulare (MAC) complex infections. Clarithromycin use in combination for Helicobacter pylori infection

23. Contraindication allergy allergies to beta-lactam antibiotics.

24. ADVERSE EFFECT Body System Adverse effect Cardiovascular Palpitations, chest pain, QT prolongation Central nervous Headache, dizziness, vertigo Gastrointestinal Nausea,hepatotoxicity,heartburn,vomiting,diarrhea,flatulence , cholestatic jaundice, anorexia, abnormal taste Integumentary Rash, urticaria, phlebitis at intravenous site Other Hearing loss, tinnitus

25. Erythromycin absorption of oral erythromycin is enhanced if it is taken on an empty stomach, but because of the high incidence of stomach irritation associated with its use, many of these drugs are taken with a meal or snack strong inhibitor of cytochrome P450 enzymes.

26. Drug Pharmacological use Usual adult dosage form Indication Erythromycin(E- mycin , EryPed , Eryc , E.E.S., many others) Natural macrolide PO: 250–500 mg qid Infections of respiratory and GI tracts and skin caused by various gram-positive, gram- negative, and miscellaneous organisms

27. Azithromycin (Zithromax) Semisynthetic derivatives used for the treatment of both upper and lower respiratory tract and skin structure infections.

28. Drug Pharmacological class Usual adult dosage form Indication azithromycin (Zithromax) (B) Semisynthetic PO: 500 mg × 1 dose, then 250 mg daily × 4 days IV: 500 mg daily Comparable to those for erythromycin, but especially GU and respiratory tract infections, including MAC infections

29. C larithromycin (Biaxin) Drug Phamracological class Usual adult dosage form Indication Clarithromycin (Biaxin) (C) Semisynthetic macrolide PO: 500 mg twice daily Comparable to those for erythromycin, but especially GU and respiratory tract infections, including MAC infections

30. Clindamycin Introduction to Clindamycin (Cleocin) Type : Semisynthetic antibiotic Mechanism of Action : Inhibits bacterial protein synthesis Pharmacodynamics : Can be bacteriostatic or bactericidal, depending on concentration and bacteria Route of Administration : Oral, intravenous (IV), intramuscular (IM), topical

31. Mechanism of Action Clindamycin binds to the 50S ribosomal subunit of bacteria. Inhibits bacterial protein synthesis by interfering with the translocation step. Effective against a wide range of gram-positive bacteria and some anaerobes .

32. Indications Infections Treated by Clindamycin : Chronic bone infections (osteomyelitis) Genitourinary (GU) tract infections Intra-abdominal infections Anaerobic pneumonia Septicemia (caused by streptococci and staphylococci) Serious skin and soft-tissue infections

33. Spectrum of Activity Gram-Positive Bacteria : Effective against Staphylococci, Streptococci, and Pneumococci Anaerobic Bacteria : Effective against several anaerobic organisms Resistance : Ineffective against Enterobacteriaceae Resistance in some strains of gram-positive, gram-negative, and anaerobic organisms

34. Adverse Effects Common adverse effects: Nausea, vomiting, diarrhea Rash and urticaria Clostridioides difficile (C. difficile) colitis (a serious risk) Less common adverse effects: Hepatotoxicity Neutropenia and thrombocytopenia

35. Clinical Considerations Important Points : Monitor for signs of gastrointestinal distress and pseudomembranous colitis. Use cautiously in patients with hepatic impairment. Interaction with other drugs: Avoid concurrent use with drugs that may cause C. difficile infection .

36. Colistimethate Introduction to Colistimethate (Coly- Mycin ) Type : Polypeptide antibiotic Common Name : Colistin Mechanism of Action : Penetrates and disrupts the bacterial membrane of susceptible gram-negative bacteria Routes of Administration : Intravenous (IV), Intramuscular (IM), Inhalational

37. Mechanism of Action Bactericidal Activity : Acts as a cationic detergent. Binds to the lipopolysaccharides (LPS) and phospholipids in the outer membrane of gram-negative bacteria. Disrupts bacterial cell membrane integrity, leading to cell death. Effectiveness : Primarily used against multi-drug resistant (MDR) gram-negative bacteria, including Carbapenem-resistant Enterobacteriaceae (CRE).

38. Indications for Use Clinical Uses : Treatment of infections caused by MDR gram-negative bacteria. Often used as a last-resort option for infections resistant to other antibiotics. Common infections treated: pneumonia, bloodstream infections, and urinary tract infections caused by CRE and Pseudomonas aeruginosa.

39. Adverse Effects Serious Adverse Effects : Nephrotoxicity : Renal failure; requires monitoring of renal function. Neurotoxicity : Paraesthesia, numbness, tingling, vertigo, dizziness, and impairment of speech. Respiratory Effects : Acute respiratory failure when administered by inhalation. Pregnancy Considerations : Crosses the placenta; use with caution in pregnant women due to potential toxicity to the fetus .

40. Drug name Route Onset of action Peak plasma concentration Elimination half life Duration of action Colistimethate IV Unknown 10 min 2-3 hr 8-12hr Daptomycin IV Unknown 30 min 8-9 hr UNKOWN Linezolid IV Variable 1-2 hr 5 hr 12 hr PO Variable Immediate 6-7 hr 8-12 hr Metronidazole PO Variable 1-2 hr 8 hr Unknown IV Variable 1 hr 8 hr Unknown

41. Drug name Route Onset of action Peak plasma concentration Elimination half life Duration of action Nitrofurantoin PO 2.5.4.5 hr 30 min 0.5-1 hr 5-8 hr Quinpristin / Dalfopristin IV 1-2 hr 3-4 hr 1-3 hr 8-12 hr Telvancin IV Variable 1 hr 8-9 hr Upto 24 hr Vancomycin IV Variable 1 hr 4-6 hr Up to 24 hr Longer in renal dysfunction

42. DAPTOMYCIN Class: Lipopeptide antibiotic. Mechanism of Action: Not completely understood. Binds to gram-positive bacterial cells in a  calcium-dependent  manner. Disrupts the  cell membrane potential .

43. Indications: Complicated skin and soft-tissue infections caused by gram-positive bacteria. Effective against  Methicillin-Resistant Staphylococcus aureus (MRSA)  and  Vancomycin-Resistant Enterococci (VRE) . Treats  vancomycin-intermediate  or  vancomycin-resistant strains of MRSA . Not used for pneumonia  because it is inactivated by  lung surfactant . Contraindications: Known drug allergy to daptomycin.

44. Dosage Form: Injectable form  only. Adverse Reactions: Common : Headache, dizziness, rash, gastrointestinal discomfort, elevated liver enzyme levels, local injection site reactions. Serious : Hypotension or hypertension, renal failure, dyspnoea, fungal infection. Monitoring Required : Monitor  Creatine Phosphokinase (CPK) levels  as daptomycin may increase these levels, indicating potential muscle damage. Theoretical risk  of increased  myopathy  when used with  HMG-CoA reductase inhibitors (statins) .

45. Indications: Vancomycin-Resistant Enterococcus faecium (VRE)  infections. Health care-associated pneumonia  (previously known as nosocomial pneumonia). Complicated skin and skin structure infections  (including MRSA). Gram-positive infections  in infants and children. Community-associated pneumonia . Uncomplicated skin and skin structure infections . Contraindications: Known  hypersensitivity  to linezolid.

46. Linezolid Class: Oxazolidinone  antibiotic. Mechanism of Action: Inhibits  bacterial protein synthesis . Dosage Forms: Available in  oral  and  injectable  forms. Excellent oral absorption  allows continuation of oral therapy at home. Adverse Effects: Common : Headache, nausea, diarrhea , vomiting. Serious : Decreased platelet count (thrombocytopenia).

47. Drug Interactions: Vasopressor Effects : Can potentially enhance the prohypertensive effects of vasopressive drugs (e.g., dopamine). Serotonin Syndrome : Risk when used with serotonergic drugs like SSRIs. Careful monitoring is required if SSRIs cannot be stopped. Tyramine-Containing Foods : Foods like aged cheese, wine, soy sauce, smoked meats or fish, and sauerkraut can interact with linezolid to cause  hypertensive crises . Patients should avoid these foods during therapy.

48. METRONIDAZOLE Class : Nitroimidazole Mechanism of Action : DNA Synthesis Inhibition : Metronidazole is an antimicrobial drug that works by  interfering with microbial DNA synthesis . It is reduced inside the microbial cell to its active form, which then interacts with DNA, leading to the  breakage of DNA strands  and  inhibition of nucleic acid synthesis . This mechanism is similar to that of quinolones.

49. Indications : Anaerobic Infections : Used for intraabdominal and gynecologic infections caused by anaerobes, including: Peptostreptococcus spp. Eubacterium spp. Bacteroides spp. Clostridium spp.

50. Protozoal Infections : Effective against: Amebiasis Trichomoniasis Dosage : Oral : Adult dosage for anaerobic infections: 500 mg to 750 mg every 8 hours. Adult dosage for protozoal infections varies. Intravenous : Adult dosage: 500 mg to 750 mg every 8 hours .

51. Pregnancy Category : B (not recommended during the first trimester) Adverse Effects : Common : Dizziness, headache, gastrointestinal discomfort, nasal congestion. Serious : Reversible neutropenia, thrombocytopenia. Drug Interactions : Increased Toxicity : Lithium Benzodiazepines

52. Cyclosporine Calcium channel blockers Antidepressants (e.g., venlafaxine) Warfarin Reduced Effects : Phenytoin Phenobarbital Alcohol : Causes acute intolerance due to acetaldehyde accumulation. Avoid alcohol for 24 hours before and at least 36 hours after the last dose.

53. Newer Drug : Secnidazole ( Solosec ) : A newer drug similar to metronidazole, used as a single 2 g dose for bacterial vaginosis.

54. Nitrofurans ( Macrodantin ) Mechanism of Action : Nitrofurantoin works by  interfering with bacterial enzymes  involved in  carbohydrate metabolism  and by  disrupting bacterial cell wall formation . This dual mechanism makes it effective against a range of bacteria causing urinary tract infections (UTIs). Indications : Primarily indicated for  urinary tract infections (UTIs)  caused by susceptible bacteria, including:

55. Escherichia coli  (E. coli) Staphylococcus aureus  (S. aureus) Klebsiella spp. Enterobacter spp. Formulation : Oral : Available only in oral formulations such as capsules and tablets. Dosage : Adult dosage for uncomplicated UTIs is typically  50 to 100 mg  every 6 hours. The dose may need to be  reduced for older adults  or those with  impaired renal function .

56. Contraindications : Known drug allergy . Significant renal impairment : Nitrofurantoin is contraindicated in patients with a creatinine clearance below 60 mL/min because it needs to concentrate in the urine to be effective. Adverse Effects : Common : Gastrointestinal (GI) discomfort, dizziness, headache. Severe : Skin reactions (ranging from mild to severe), blood dyscrasias (e.g., hemolytic anemia ), electrocardiogram (ECG) changes,  irreversible peripheral neuropathy , and  hepatotoxicity  (though rare, it can be fatal).

57. Drug Interactions : Probenecid : Reduces renal excretion of nitrofurantoin, potentially increasing toxicity. Antacids : Can reduce the extent of GI absorption of nitrofurantoin, thereby reducing its efficacy. Special Considerations : Dose Adjustment : Necessary for older adult patients or those with decreased renal function to avoid accumulation and potential toxicity. Hepatotoxicity : Although rare, liver toxicity associated with nitrofurantoin can be severe and sometimes fatal.

58. Alternative Drug for UTIs : Fosfomycin ( Monurol ) : Approved for uncomplicated urinary tract infections. It is given as a  single-dose regimen and maintains  high concentrations in the urine for up to 48 hours , making it a convenient alternative to multi-dose therapies like nitrofurantoin.

59. Telavancin ( Vibativ ) and Newer Lipoglycopeptides Mechanism of Action : Telavancin inhibits cell wall synthesis, similar to vancomycin. It also disrupts bacterial membrane potential and increases membrane permeability.

60. Indications : Complicated skin and skin structure infections ( cSSSI ) Hospital-acquired and ventilator-associated bacterial pneumonia (HABP/VABP)  caused by  Methicillin-Resistant Staphylococcus aureus  (MRSA) and other susceptible gram-positive organisms. most common adverse effects include renal toxicity, infusion- related reactions, and QT prolongation

61. VANCOMYCIN Vancomycin is a bactericidal antibiotic glycopeptide class. MOA- It destroys bacteria by binding to the bacterial cell wall, producing antibiotic of choice for the treatment of MRSA infection and infections caused by many other gram-positive bacteria. oral formulation is poorly absorbed ORAL R x -Indication - treatment of antibiotic- induced colitis (C. difficile) and for the treatment of staphylococcal enterocolitis . parenteral form is indicated for the treatment of bone and joint infections and bacterial bloodstream infections caused by Staphylococcus spp

62. C ontraindication-Hypersensitivity preexisting renal dysfunction or hearing loss adult patients and neonates Adverse effect- ototoxicity (hearing loss) and nephrotoxicity (kidney damage) R ed man syndrome ( characterized by flushing and/or itching of the head, face, neck, and upper trunk area , most commonly seen when the drug is infused too rapidly

63. General Nursing Assessment for Antibiotic Administration Assessment for Hypersensitivity and Allergic Reactions : Evaluate the patient for any known allergies to antibiotics or other medications. Look for symptoms ranging from mild skin reactions (rash, pruritus, hives) to severe reactions (laryngeal edema , bronchospasm, hypotension, and possible cardiac arrest).

64. Baseline Physical Assessment : Document the patient's  age, weight , and  vital signs  (temperature, blood pressure, pulse, and respiratory rate). Perform a  complete physical examination  with emphasis on potential adverse effects based on the specific antibiotic prescribed.

65. Laboratory and Diagnostic Studies : Liver Function : Assess AST (aspartate aminotransferase) and ALT (alanine aminotransferase) levels. Renal Function : Monitor urinalysis, BUN (blood urea nitrogen), and serum creatinine levels. Cardiac Function : Perform ECG, echocardiography, ultrasonography, and/or assess cardiac enzyme levels if required.

66. Infection Assessment : Obtain culture and sensitivity reports of infected tissue or blood to ensure appropriate antibiotic therapy. Blood Count Levels : Evaluate WBC count, hemoglobin level, hematocrit , RBC count, platelet count, and clotting values .

67. Neurologic and Gastrointestinal Assessment : Assess baseline  neurologic status  (e.g., sensorium, motor function, level of consciousness) due to the risk of CNS adverse effects. Evaluate  abdominal and gastrointestinal (GI) function  for bowel patterns, sounds, and potential GI side effects such as nausea, vomiting, diarrhea , and pseudomembranous colitis.

68. Medication and Cultural Assessment : Obtain a  complete list of the patient's medications , including over-the-counter drugs, herbals, and dietary supplements to check for potential drug interactions. Perform a  cultural assessment  to understand the patient's use of alternative healing practices or potential differences in drug metabolism among different racial and ethnic groups.

69. Assessment for Superinfection : Monitor for signs of superinfection, such as fungal infections, which may present with fever, lethargy, perineal itching, and other symptoms. Assessment of Immune System and Overall Condition : Evaluate the patient's immune status, especially in immunocompromised individuals (e.g., cancer, autoimmune disorders, AIDS, or chronic illnesses) who are at higher risk for infections.

70. Monitoring for Antibiotic Resistance : Consider the possibility of resistance to certain antibiotics, especially in pediatric patients, large healthcare institutions, and long-term care settings.

71. Specific Assessments for Different Antibiotic Classes

72. Aminoglycosides : Assess for  hypersensitivity  and preexisting   neurologic  and  renal function  conditions. Monitor for  ototoxicity  and  nephrotoxicity . Perform baseline hearing tests and renal function studies (BUN, serum, and urine creatinine). Consider dosage adjustments for patients with  renal impairment . Ensure adequate  hydration  and avoid concurrent use with other nephrotoxic drugs.

73. Quinolones : Evaluate for preexisting   CNS conditions  (e.g., seizure disorders) and  neuropathy  risks. Monitor for potential  cardiac arrhythmias  and assess for concurrent use of antidysrhythmics . Check for drug interactions with  antacids, iron, zinc preparations, sucralfate , and  oral anticoagulants .

74. Clindamycin : Assess for  GI disorders  (e.g., ulcerative colitis) due to the risk of pseudomembranous colitis. Monitor for  neuromuscular blocking drugs  in patients undergoing surgery or in intensive care to prevent excessive blockade and respiratory paralysis.

75. Linezolid : Check for concurrent use of  serotonergic drugs  (SSRIs) due to the risk of  serotonin syndrome . Assess for  intake of tyramine-containing foods  (e.g., aged cheese, wine) due to the risk of elevated blood pressure.

76. Metronidazole : Assess for allergies to the drug and other nitroimidazole derivatives. Inquire about  alcohol intake  to avoid acute alcohol intolerance. Check for drug interactions with  benzodiazepines, calcium channel blockers, antidepressants,  and  warfarin .

77. Nitrofurantoin : Assess for  drug allergies  and monitor  renal  and  liver function  due to risks of hepatotoxicity and nephrotoxicity. Evaluate for  sensory or motor problems  due to the risk of peripheral neuropathy. Quinupristin / Dalfopristin : Assess for  muscle pain or arthralgia  due to possible drug-induced side effects.

78. Vancomycin : Assess for concurrent use of  nephrotoxic or ototoxic drugs . Monitor for  "red man syndrome"  and adjust infusion rates accordingly. Check  trough levels  to optimize dosing and prevent toxicity.

79. Daptomycin : Monitor  vital signs  and  blood pressure  prior to and during infusion, especially in complicated skin and soft tissue infections. Dalbavancin ( Dalvance ) and Oritavancin ( Orbactiv ) : Assess medication order and dosing carefully due to  long half-life  and weekly dosing schedules. Monitor for  hypersensitivity, infusion reactions,  and  cardiac  concerns with anticoagulants.