Medication Review
Anti-Infective Drugs
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Medication Review
Anti-Infectant Drugs
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Definitions
Urinary Anti-Infectives
Antibiotics
Penicillins
Cephalosporins
Quinolones
Macrolides
Ketolide
Tetracyclines
Glycylcyclines
Antiparasitic Agents
Antitubercular Agents
Antiviral Agents
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Medication Review
Anti-Infectant Drugs
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Definitions
Bacteriostatic
 Allows the body's natural defense mechanisms to have time to destroy the
microorganisms by inhibiting bacterial growth
Bactericidal
 Kills the microorganisms
Therapeutic Classes
Antibacterials

Unlike antibiotics, antibacterials are not synthesized from microorganisms.

Usually bacteriostatic, but some are considered bactericidal
Side Effects
 Photosensitivity - protect from the sun

Allergy
Antibacterial sulfonamides (Sulfa Agents)
Sulfacetamide (Sulamyd®) - Legend Drug
Sulfamethoxazole (Gantanol®) - Legend Drug
Other antibacterials
Acetic Acid (VoSol®) - Legend Drug
Povidone - Iodine (Betadine®, Medicated douches) - OTC Product
Hexachlorophen (pHisoHex®) - OTC Product
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Urinary Anti-Infectives

Concentrated in the urine and are used for urinary tract infections (UTI's)
Examples:
Nirofurantoin (Macrodantin, Macrobid®) - Legend Drug- take with food, drink plenty of
fluid
Norfloxacin (Noroxin®) - Legend Drug - take on empty stomach and drink plenty of
fluids
Note: Pyridium (Phenazopyridine) - Legend Drug - is often given with urinary
anti-infectives for urinary pain, may discolor urine and should have auxiliary label
"May Discolor Urine Red".
Antibiotics

Synthesized by microorganisms - grown

Can be bacteriostatic or bactericidal
Patient Information
 Most are taken on an empty stomach (one hour before or two hours after a
meal) to ensure proper absorption

Should be taken for the full course of therapy

Certain liquid antibiotics (procaine penicillin G for injection Bicillin L-A) need
refrigeration and certain powders need to be reconstituted. Once
reconstituted, some of these products should have 10 – 14 day expirations.
Mechanism of action

Prevents bacteria from growing
Examples:
Pencillins, Cephalosporins - Legend Drug
Penicillins
Side Effects
 Allergy

Nausea/vomiting/diarrhea
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Examples:
Penicillin (Pen-VK®) - Legend Drug
Amoxicillin (Amoxil®) - Legend Drug
Ampicillin (Amcill®) - Legend Drug
Cloxacillin (Tegopen®) - Legend Drug
Dicloxacillin (Dynapen®) - Legend Drug
Nafcillin (Nafcil®) - Legend Drug
Piperacillin (Pipracil®) - Legend Drug
Ticarcillin (Ticar®) - Legend Drug
Cephalosporins
Side Effects
 Allergy

Nausea/vomiting/diarrhea
First generation cephalosporins are moderate spectrum agents. They are effective
alternatives for treating staphylococcal and streptococcal infections and; therefore, are
alternatives for skin and soft-tissue infections, as well as for streptococcal pharyngitis.
Examples First Generation:
Cephalexin (Keflex®) - Legend Drug
Cefadroxil (Duricef®) - Legend Drug
Cefazolin (Ancef®) - Legend Drug
The second generation cephalosporins have a greater gram-negative spectrum while
retaining some activity against gram-positive bacteria. They are also more resistant to
beta-lactamase. They are useful agents for treating upper and lower respiratory tract
infections, sinusitis and otitis media.
Examples Second Generation:
Cefaclor (Ceclor®) - Legend Drug
Cefoxitin (Mefoxin®) - Legend Drug
Cefprozil (Cefzil®) - Legend Drug
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Cefuroxime (Ceftin®) - Legend Drug
Cefotetan (Cefotan®) - Legend Drug
Cefmetazole (Zefazone®) - Legend Drug
Third generation cephalosporins have a broad spectrum of activity and further
increased activity against gram-negative organisms.
Examples Third Generation:
Cefdinir (Omnicef®) - Legend Drug
Cefixime (Suprax®) - Legend Drug
Cefpodoxime (Vantin®) - Legend Drug
Ceftriaxone (Rocephin® -) Legend Drug
Cefotaxime (Claforan®) - Legend Drug
Ceftibuten (Cedax®) - Legend Drug
Ceftazidime (Fortaz®, Ceptaz®) - Legend Drug
Fourth generation cephalosporins are extended spectrum agents with similar activity
against gram-positive organisms as first generation cephalosporins. They also have a
greater resistance to beta-lactamases than the third generation cephalosporins. Many
can cross blood brain barrier and are effective in meningitis.
Examples Fourth Generation:
Cefepime (Maxiprime®) - Legend Drug
Quinolones

Have many drug interactions - antacids decrease the absorption and should be
given 2 to 4 hours apart.

Cimetidine (Tagamet®) - OTC Drug - increases the effect

Caffeine clearing from the body is reduced

Theophylline levels are increased
Side Effects
 GI upset

Headache
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Examples:
Ciprofloxacin (Cipro®) - Legend Drug
Ofloxacin (Floxin®) - Legend Drug
Norfloxacin (Noroxin®) - Legend Drug
Levofloxacin (Levaquin®) - Legend Drug
Cinoxacin (Cinobac®) - Legend Drug
Nalidixic Acid (NegGram®) - Legend Drug
Moxifloxacin (Avelox®) - Legend Drug considered a drug of last resort when all other
antibiotics have failed.[
Lomefloxacin( Maxaquin®) - Legend Drug
Gemifloxacin mesylate (Factive®) - Legend Drug
Macrolides
Side Effects
 GI upset

Diarrhea
Examples:
Erythromycin (EES®, Eryc®) - Legend Drug
Azithromycin (Zithromax®) - Legend Drug
Clarithromycin (Biaxin®) - Legend Drug
Dirithromycin (Dynabac®) - Legend Drug
Ketolide
Side Effects

Diarrhea

Nausea

Abdominal pain

Vomiting
Example
Telithromycin (Ketek®) - Legend Drug
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Tetracyclines
Side Effects
 Photosensitivity
CAUTION: Binds to Ca products (dairy products), binds to aluminum and
magnesium. Use protection in sunlight.
Examples:
Tetracycline (Achromycin®, Sumycin®) - Legend Drug
Doxycycline (Vibra-Tabs®) - Legend Drug
Minocycline (Minocin®) - Legend Drug
Demeclocycline (Declomycin®) - Legend Drug
Glycylcyclines
Glycylcyclines are a new class of antibiotics derived from tetracycline. These
tetracycline analogues are specifically designed to overcome tetracycline resistance
bacteria.
Side Effects
 GI upset

Diarrhea
Example
Tigecycline (Tygacil ®) - Legend Drug
Aminoglycosides - Used in Hospitals
Side Effects
 Kidney damage

Ototoxicity
Examples:
Gentamicin (Garamycin®) - Legend Drug
Tobramycin (Nebcin®) - Legend Drug
Amikacin (Amikin®) - Legend Drug
Neomycin (Mycifradin Sulfate®) - Legend Drug
Streptomycin - Legend Drug
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Miscellaneous:
Vancomycin (Vancocin®) - Legend Drug - Used in serious or severe infections not
treatable with other antimicrobials
Clindamycin (Cleocin®) - Legend Drug - Use: anaerobes - serious respiratory
infection, GI infection
Sulfamethoxazole and Trimethoprim (Bactrim®, Septra®, Cotrim®, SMZ-TMP®) –
Legend Drugs
Imipenem and Cilastatin (Primaxin®) - Legend Drugs - For I.V. use
Chloramphenicol - Legend Drug
Bacitracin - Legend Drug
Metronidazole (Flagyl®) - Legend Drug
Antifungals
Use

To treat topical and systemic fungal infections
Patient Information
 Many of these need to be protected from light and heat.

Most need to be taken with meals to help with stomach upset.
Side Effects
 Kidney damage with systemic antifungals
Examples:
Amphotericin B (Fungizone®) - Legend Drug - must protect from light.
Ketoconazole (Nizoral®) - Legend Drug
Miconazole (Monistat®) - Legend Drug
Fluconazole (Diflucan®) - Legend Drug
Nystatin (Mycostatin®) - Legend Drug
Clotrimazole (Lotrimin®, Mycelex®, Gyne-Lotrimin®) - OTC Drug/Legend Drugs
Griseofulvin (Fulvicin P/G®) - Legend Drug
Intraconozole (Sporanox®) - Legend Drug
Terbinafine (Lamisal®) – cream: OTC Drug/ tablets: Legend Drug
Voriconazole (VFEND) - Legend Drug - is generally used to treat serious, invasive
fungal infections.
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Antiparasitic Agents
Use

To treat parasitic infections (parasites are organisms which need a host to
complete their life cycle)
Patient Information
 Many of these agents can cause stomach upset, so they need to be taken
with food.
Antihelminthics - Worm Infections
Side Effects
 Stomach upset nausea/diarrhea
Examples:
Mebendazole (Vermox®) - Legend Drug - Used to treat worms, whipworms,
pinworms, roundworms, hookworms
Pyrantel Pamoate (Antiminth®) - Legend Drug - Used to treat roundworms, pinworms
Albendazole (Albenza®) - Legend Drug - tapeworms
Piperazine (Vermizine®) - Legend Drug - pinworms, roundworms
Praziquantel (Biltricide®) - Legend Drug - effective against flatworms
Ivermectin (Stromectol ®) - Legend Drug - broad-spectrum antiparasitic agent (treat
worms)
Amebicides - Amoeba Infections
Side effects - same as Antibuse
 Avoid alcohol due to a vomiting reaction
Examples:
Metronidazole (Flagyl®) - Legend Drug
Chloroquine (Aralen®) - Legend Drug - indication; treatment of extraintestinal
amebiasis.
Antitubercular Agents
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Use

To treat tuberculosis

Combination therapy with several agents is usually required to avoid
resistance

Purified protein derivative is an agent used to detect tubercular infections
Examples:
Rifampin (Rifadin®) - Legend Drug - side effect: red urine
Isoniazid (INH®) Legend Drug - side effect: liver damage
Ethambutol (Myambutol®) - Legend Drug - side effect: optic neuritis
Pyrazinamide - Legend Drug- side effect: liver damage, gout
Antiviral Agents
Use

To treat viral infections
Antivirals for treatment influenza
Amantadine (Symmetrel®) - Legend Drug
Rimantadine (Flumadine®) - Legend Drug
Zanamivir (Relenza®) - Legend Drug
Oseltamivir (Tamiflu®) - Legend Drug
Side Effects
 Nausea

CNC effects
Antivirals for the Herpes Virus
Acyclovir (Zovirax®) - Legend Drug
Famciclovir (Famvif®) - Legend Drug
Valacyclovir (Valtrex®) - Legend Drug

Side effects include nausea/vomiting
Antivirals used for HIV and AIDS
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Protease inhibitors
Side Effects:

Nausea/vomiting

Muscle weakness
Examples:
Indinavir (Crixivan®) - Legend Drug
Nelfinavir (Viracept®) - Legend Drug
Ritonavir (Norvir®) - Legend Drug
Saquinavir (Invirase®) - Legend Drug
Non-nucleoside reverse transcriptase inhibitors
Nevirapine (Viramune®) - Legend Drug
Delavirdine (Rescriptor®) - Legend Drug
Reverse transcriptase inhibitors:
Side Effects:

Nausea/diarrhea

Anemia

Headache

Insomnia

Fatigue

Peripheral neuropathy
Examples:
Zidovudine (AZT®, Retrovir®) - Legend Drug
Didanosine (Videx®) - Legend Drug
Lamivudine (Epivir®) - Legend Drug
Stavudine (Zerit®) - Legend Drug
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