Chapter 17

Anti-Infective Drugs

2

Treatment by Anti-Infectives

• Need to identify causative organism

• Determine sensitivity

• Culture and sensitivity– 24-48 hours

• Broad spectrum antibiotics

3

• Back in the Game Sports Medicine is a clinic dedicated to the treatment of physical injuries to the body. Caring for an injured body involves more than making the diagnosis; it's about understanding and treating the cause to prevent future injuries. The clinic addresses variety of injuries to the body whether it be from a car accident to over-use trauma. When injuries occur, it is no longer enough for people to "take it easy for awhile" or "work through it."

• PHYSICIAL THERAPYWe believe that the true goal of physical therapy involves restoration of function through neuromuscular re-education and specialized manual techniques. These techniques restore movement, balance and quality of life. At Back in the Game, we go a step further and instruct people how to keep their bodies stronger and healthier. We do this by teaching proper body mechanics and developing personalized exercises that will help prevent re-injury.

• At Back In The Game, it's all about you. You're the reason we're here. The entire visit is centered around giving you an experience uncommon in today's impersonal medical world. We recognize that you are a unique human being with specific needs which require talented people who truly care and we strive to deliver this care in a professional, yet comfortable environment. Dr. Lambert, a state licensed Chiropractic Physician, who has training in sports medicine, heads Back In The Game.

Edited by Dr. Ryan Lambert-Bellacov, chiropractor for Back in the Game in West Linn, OR

Resistance

• What is resistance?

• Misuse of antibiotics

• Nosocomial infections

• MRSA (Methicillin-Resistant Staphylococcus Aureus)

• VRE (Vancomycin-Resistant Enterococcus)

Edited by Dr. Ryan Lambert-Bellacov, chiropractor for Back in the Game in West Linn, OR

Strategies to Prevent Resistance

• Appropriate use of antibiotics

• Accurate diagnosis

• Targeted treatment of bacterial infections

• Preventive measures

Edited by Dr. Ryan Lambert-Bellacov, chiropractor for Back in the Game in West Linn, OR

Selection of Anti-Infective Drugs

• Status of hepatic and/or renal function

• Age of patient

• Pregnancy or lactation

• Likelihood of organisms developing resistance

• Know allergies

Edited by Dr. Ryan Lambert-Bellacov, chiropractor for Back in the Game in West Linn, OR

Adverse Reactions

• Hypersensitivity

• Anaphylaxis

• Direct toxicity

• Indirection toxicity

Edited by Dr. Ryan Lambert-Bellacov, chiropractor for Back in the Game in West Linn, OR

8

Aminoglycosides

• Gram-negative and gram-positive bacteria

• Toxicity• Peak and trough levels• Serious side effects• Contraindications• Interactions• Patient education

9

Cephalosporins

• Semisynthetic

• Broad-spectrum

• First, second, third, or fourth generation

• Side effects

• Contraindication or extreme caution

Copyright © 2007 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 10

Cephalosporins

• Interactions

• Patient education

11

Macrolides

• Used when there is allergy to penicillin

• Less toxicity

• Side effects

• Contraindications

• Interactions

• Patient education

Edited by Dr. Ryan Lambert-Bellacov, chiropractor for Back in the Game in West Linn, OR

12

Penicillins

• Produced from fungus

• Uses

• Semisynthetic penicillins

• Serious side effects

• Contraindications or extreme cautions

13

Penicillins

• Interactions

• Patient education

14

Quinolones

• When used

• Increased resistance

• Side effects

• Contraindications or caution

• Interactions

• Patient education

15

Tetracyclines

• Broad-spectrum

• When used

• Side effects

• Contraindications

• Interactions

• Patient education

Edited by Dr. Ryan Lambert-Bellacov, chiropractor for Back in the Game in West Linn, OR

16

Antifungals

• Amphotericin B

• Fluconazole

• Griseofulvin

• Nystatin

• Patient education

Edited by Dr. Ryan Lambert-Bellacov, chiropractor for Back in the Game in West Linn, OR

17

Antituberculosis Agents

• Treat asymptomatic infection

• Treat active clinical tuberculosis

• CDC recommendations

• Side effects

• Contraindications or caution

• Interactions

• Patient education

Edited by Dr. Ryan Lambert-Bellacov, chiropractor for Back in the Game in West Linn, OR

18

Other Anti-Infectives

• Clindamycin

• Metronidazole

• Vancomycin

Edited by Dr. Ryan Lambert-Bellacov, chiropractor for Back in the Game in West Linn, OR

19

Antivirals

• Acyclovir

• Amantadine

• Neuraminidase inhibitors

• Ribavirin

Edited by Dr. Ryan Lambert-Bellacov, chiropractor for Back in the Game in West Linn, OR

20

HIV/AIDS Treatment

• Incurable with current medications

• Suppression of viral load

• Restore and/or preserve immunologic function

• Improve quality of life

• Reduce HIV-related morbidity and mortality

Edited by Dr. Ryan Lambert-Bellacov, chiropractor for Back in the Game in West Linn, OR

21

HIV/AIDS Medications

• Anti-retroviral protease inhibitors

• Nucleoside reverse transcriptase inhibitors

• Non-nucleoside reverse transcriptase inhibitors

• Treatment of opportunistic infections

Edited by Dr. Ryan Lambert-Bellacov, chiropractor for Back in the Game in West Linn, OR

22

Sulfonamides

• Among oldest anti-infectives

• Increasing resistance

• Used in combination with other drugs

• Side effects

• Contraindications

• Interactions

• Patient education

Edited by Dr. Ryan Lambert-Bellacov, chiropractor for Back in the Game in West Linn, OR

23

Urinary Anti-Infectives

• Usually bacteriostatic instead of bactericidal

• Nitrofurantoin (Furadantin & Macrodantin)

• Side effects

• Contraindication or caution

24

Urinary Anti-Infectives

• Interactions

• Patient education

• Back in the Game Sports Medicine is a clinic dedicated to the treatment of physical injuries to the body. Caring for an injured body involves more than making the diagnosis; it's about understanding and treating the cause to prevent future injuries. The clinic addresses variety of injuries to the body whether it be from a car accident to over-use trauma. When injuries occur, it is no longer enough for people to "take it easy for awhile" or "work through it."

• PHYSICIAL THERAPYWe believe that the true goal of physical therapy involves restoration of function through neuromuscular re-education and specialized manual techniques. These techniques restore movement, balance and quality of life. At Back in the Game, we go a step further and instruct people how to keep their bodies stronger and healthier. We do this by teaching proper body mechanics and developing personalized exercises that will help prevent re-injury.

• At Back In The Game, it's all about you. You're the reason we're here. The entire visit is centered around giving you an experience uncommon in today's impersonal medical world. We recognize that you are a unique human being with specific needs which require talented people who truly care and we strive to deliver this care in a professional, yet comfortable environment. Dr. Lambert, a state licensed Chiropractic Physician, who has training in sports medicine, heads Back In The Game.